Speech Problems

Descriptive text is not available for this imageBASICS

DESCRIPTION

  • Communication is the exchange of ideas between two or more individuals.
  • Language is a systematic means of communication that relies on a socially agreed on set of symbols and rules for combining those symbols. Language includes comprehension, expression, and social-pragmatic rules (e.g., eye contact and turn-taking).
  • Speech is produced through vocal and articulatory movements using neuromotor control of respiration, phonation (vocalization), and articulation to shape airflow and vocal sounds into strings of speech sounds (phonemes) to form words and word combinations.
  • Articulation refers to the use of oral and pharyngeal structures (lips, tongue, palate, teeth) to shape vocal sounds and airflow into recognizable speech.
  • Hearing is the process of transferring sound from the environment to the brain via the outer, middle, and inner ear systems.
  • Speech disorders have three general points of origin: (i) neurologic, (ii) structural, or (iii) functional. Functional disorders are those with no obvious cause and unrelated to neurologic or structural disorders. More than one of these causes may be present in the same child.
  • Speech disorders can be classified and are described as follows:
    • Articulation or phonologic disorders
      • Disrupt the way a child says one or more speech sounds; these include sound distortions.
      • Simplifications of complex adult speech are often normal in very early speech development. An example is the reduction of a two-consonant combination (“spel” said as “pell”). If these simplifications linger, are atypical, or interfere with socialization the child should be referred for evaluation.
    • Fluency disorders (see “Stuttering” chapter)
      • Disrupt the easy flow of speech production and include the conditions of stuttering and cluttering
      • Examples of stuttering include repetitions of sounds, syllables, words, or phrases; pauses; blocks; or hesitations.
      • Easy repetitions are common in children ages 2 to 4 years and typically resolve quickly. Persistence, visible struggle, or avoidance of talking warrants referral.
    • Motor speech disorders
      • Disrupt timing, coordination, or the execution of the motor plan for speech
      • Divided into two major categories: (i) dysarthrias, which are most often related to neuromotor weakness or paralysis, and (ii) apraxia, a motor planning disorder in the absence of neuromotor weakness or paralysis
    • Voice disorders
      • Heard as atypical laryngeal quality such as hoarseness (dysphonia), breathiness (excess airflow), or completely absent voice (aphonia)
    • Resonance disorders
      • Speech quality is described as nasal.
      • Hypernasality (excessively nasal quality) is associated with dysfunction of the velopharyngeal mechanism that controls airflow and sound transfer to the nasal cavity. Hypernasality is atypical and warrants referral.
      • Hyponasality (inadequate nasality) is common in young children in association with acute upper respiratory infection or adenoid hypertrophy.
  • Language disorders may occur in receptive, expressive, pragmatic, or some combination of these domains. Language disorders may occur in conjunction with other developmental, sensory, neurologic, or structural concerns but may also be isolated as an area of delay (see “Speech Delay” and “Autism” chapters).

EPIDEMIOLOGY

  • One of every 12 children (ages 3 to 17) has a speech, voice, language, or swallowing disorder, with higher observed prevalence at younger ages (11% in ages 3 to 6 years, 9% in ages 7 to 10 years).
    • Prevalence among boys (9.6%) is greater than girls (5.7%) and is higher among Black children (9.6%).
    • Communication disorders are undertreated with approximately 55% of children with speech, voice, language, or swallowing disorders receiving intervention services. Disparities are evident in intervention with approximately 46% of Hispanic and Black children with identified disorders receiving services.
  • Speech sound disorders including articulation, phonologic, and developmental apraxia of speech are considered the most prevalent communication problem diagnosed in 10–15% of preschoolers and 4–6% of school-aged children.
  • Fluency disorders affect 11% of children aged 4 years.

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