Speech or verbal communication through language is the primary way of communication or interaction among individuals in a society. By a certain point of time, most children have developed speech skills depending on their individual capability. While some children are quick in picking up how to communicate verbally, some children take time and this causes the parents to worry about their child’s slow development of speech. Problems in speech language development require thorough evaluation and treatment by speech professionals, which includes testing both speech and hearing.
The inability of an individual, especially children, to communicate verbally their needs and thoughts may be socially devastating, hampers interpersonal relationships and may lead to depression and social isolation.
Most Common Speech Disorders & Their Causes and Treatment
Stuttering is a very common speech disorder characterised by speech which has words, sounds and syllables being repeated ( li-li like this), prolonged (liiiikkkkeee this) and or abnormal pauses and stoppages of speech, disrupting the normal flow of conversation. Stuttering may be accompanied by rapid eye blinks or tremors of the lips.
Stuttering is also called stammering or speech disfluency and it affects people of all age groups. The symptoms of stuttering vary from person to person and it gets severe when the person is asked to address a group or make conversation and is less severe while singing or speaking in unison. Stuttering affects 4 times as many males than females and most children outgrow stuttering leaving 1 % or less adults who continue to stutter.
Forms of Stuttering: There are three forms of stuttering;
- Developmental stuttering is the most common form of stuttering that occurs in young children while they are still learning speech and language skills. Some scientists and clinicians believe that developmental stuttering occurs when children’s speech and language abilities are unable to meet the child’s verbal demands.
- Neurogenic Stuttering occurs due to signalling problems between the brain and the nerves, the brain has a problem coordinating the different components needed for speech. This occurs due to a heart stroke or brain injury.
- Psychogenic Stuttering occurs due to emotional trauma, low IQ, or problems in reasoning.
Causes of Stuttering: There are four broad causes of stuttering i.e. Genetics, delayed child development, neurophysiology and family dynamics. Children who have undergone mental and physical abuse are more likely to stutter than those who have not.
Stuttering is diagnosed and evaluated by a Speech Language Specialist who will look into the child’s case history, family history, analyse the stuttering behaviour and whether it lasted for more than six months.
Treatment for Stuttering: It is important to work out the best treatment option with a speech specialist to treat this common speech disorder. Health specialists recommend checkups after every three months to see if the patient’s stuttering has increased or decreased. Parents are encouraged to help their child develop fluent speech, by creating a relaxed environment at home and encouraging your child to speak. Be less demanding from your child to speak in a certain way and do not react negatively when he or she stutters; but be encouraging and correct them gently when they stutter and praise them for their fluency. Stuttering therapies are opted by teens and adults to learn ways to minimise stuttering and regulate breathing. It also helps teenagers to deal with stuttering associated with anxiety of speaking in public. Self-help groups provide a way for people who stutter to find resources and support as they face the challenges of stuttering. The U.S. Food and Drug Administration (FDA) have not approved any drug for the treatment of stuttering.
Childhood Apraxia of Speech
Apraxia of Speech is another common speech disorder or communication disorder in which a child has difficulty making accurate movements when speaking. Your child might not be able to move his lips or tongue to the right place to say the appropriate sounds. The speech muscles are not weak, but they do not perform normally because the brain has difficulty directing or coordinating the movements. This common speech disorder is also called verbal dyspraxia or developmental Apraxia.
Signs of Childhood Apraxia of speech includes, not saying same words the same way each time they say it, problems imitating what others say and can understand what others say better than they can talk. Patient suffering from this speech disorder also has to move the tongue and lips a number of times for sounds/speech to come out. He or she is hard to understand, especially by those unfamiliar to them and finds trouble in talking when nervous. The patient suffering childhood apraxia of speech may have trouble with motor skills, such as writing, drawing and experience difficulty in reading and singing.
Causes of Childhood Apraxia of Speech: CAS is a motor speech disorder and has a number of possible causes; however, in many cases, a cause cannot be determined. This motor speech disorder can be caused by brain injury, stroke or infections. CAS may also occur as a symptom of a genetic disorder, syndrome or metabolic condition.
Treatment of Childhood Apraxia of Speech: Treatment of a person suffering from CAS requires help from a Speech Language Professional. Therapy 3-5 times a week will help the child speak better. The goal is to make the child say words more clearly; the child needs to plan his or her muscle movement at the right time, in the right way, to say the words. Remember that muscle exercises are not necessary as their muscles are not weak, and working on how to move muscles to say the words is what is needed here. The child must regularly practice speaking and they may use “touch” cues, like putting their finger on their lips when saying the “b” sound to remind them to close her lips. Alternatively, visual cues may be used, like watching themselves in a mirror while speaking. Children having extreme difficulty in speaking should be taught to use sign language or picture boards or computers that can talk. CAS treatment takes time and parents must be supportive of their children. Avoiding negative reactions when the child makes a mistake and constant appreciation of fluency in speech should be exercised to help the child remained motivated and for the treatment to be effective.
In this speech disorder, the patient has errors in speech sounds by mispronouncing; substituting or leaving out a sound. At certain ages, it is normal for making sound related mistakes, however, if they continue making such sound errors then it is an articulation disorder and it may negatively affect the child intelligibility. Children intelligible to others at the age of three or older may have articulation disorder.
Causes of Articulation Disorder: Articulation problems can be caused by physical circumstances, such as a cleft palate, hearing loss, neurological disorders, dental problems, vocal abuse or misuse, hypotonia, oral-motor skills, or difficulty with placement of articulators.
Treatment for Articulation Disorder: Intervention and therapy by a speech-language pathologist is generally recommended for treating articulation disorder. The speech therapist will assist your child to produce correct articulator (tongue, lips, teeth) placement and voicing to generate the sound and to correct this speech disorder. Constant speech practice and general encouragement from parents and teachers will help the patient gain confidence and combat the stress and anxiety attached with this speech disorder.
Dysarthria is a motor speech disorder in which the muscles used for speaking are weakened and there is difficulty experienced in controlling them, characterized by slurring and dragging of words and often making it very difficult to pronounce words. Dysarthria that has progressed to a total loss of speech is known as anarthria. Dysarthria does not include speech disorders from structural abnormalities, such as cleft palate; and must not be confused with Apraxia of speech.
Causes of Dysarthria: Toxic, metabolic, degenerative diseases, traumatic brain injury and strokes are some of the causes of this speech disorder, Dysarthria. These result in lesions to the key areas of the brain involved in planning motor operations in the skeletal muscles leading to Dysarthria.
Treatment of Dysarthria: Dysarthria can be treated by speech specialists using variety of techniques, such as exercises to strengthen muscles and tongue. Learning to speak slowly, pausing before words; and using devices such as amplifiers to make your voice louder; using facial expressions or hand gestures to get your point across; and always talking face to face rather than telephone conversations come under the treatment of Dysarthria.
Classification of Language Disorders
Language disorders can be classified in three different ways:
- Expressive Language Disorder (ELD).
- Receptive Language Disorder (RLD).
- Expressive-Receptive Language Disorder (ERLD).
Expressive Language Disorder or ELD is a communication disorder in which children do not have a problem producing sounds and words, but find it difficult to retrieve the correct word or sound at the given time. There can be problems with vocabulary, producing complex sentences, and remembering words. Expressive language disorder can be further classified into two groups: Developmental Expressive Language Disorder and Acquired Expressive Language Disorder.
Developmental expressive language disorder currently has no known cause. Acquired expressive language disorder is caused by specific damage to the brain by a traumatic brain injury stroke or seizures.
Students with a Receptive Language Disorder have problems understanding oral or written language or in listening. They may have difficulties processing and retaining auditory information, and find it difficult to follow instructions and directions. They have short memory span and find it difficult to understand what is said in group discussions. They find it difficult to answer questions, because they rarely understand the questions being asked. They find it difficult to cut out the background noises and concentrate on the task at hand. Because of the inability to understand questions in RLD, they are not able to initiate or hold conversations and lead socially isolated and lonely lives. There may be pragmatic difficulties, such as poor understanding of sentences and situations, poor use of tone, facial gesture and body language, and the inability to maintain eye contact.
Receptive-Expressive Language Disorder is a communication disorder in which a child finds it difficult to express oneself in the spoken word and is unable to understand what the other is saying to him or her. The child experiences symptoms of both expressive language disorder and receptive language disorder. He or she does not have a problem in pronouncing words; however, they face difficulty in forming proper coherent sentences, using correct grammar and other speech related problems. The child is unable to follow simple instructions and directions and retain auditory information. They face problems in answering questions because they cannot easily comprehend what they are being asked and hence shy away from making conversations. Their responses are mostly inappropriate and out of context. Most of the times, it is seen that such children are labelled as stubborn or difficult to deal with, but the reality is that they sincerely find human interaction confusing and taxing. People suffering from this disorder find it difficult in making friends or even sustaining healthy peer relationships.
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