Speech and Language Disorders

Articulation Disorder/ Phonological Disorder:

When speech sounds are made incorrectly due to incorrect placement or movement of the lips, tongue, velum, and/or pharynx. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand what is said. For instance, many children make the “t” sound for a “k” sound, e.g., “tup” for “cup”) or they may leave sounds out of words, such as “nana” for “banana.”

Fluency Disorder (Stuttering/Stammering and Cluttering):

In stuttering the flow of speech is disrupted. Stuttered speech often includes repetitions of words or parts of words, as well as prolongations of speech sounds and silent blocks. Eg. W-W-W Where are you going? , Mom Mom Mom Mom come here. , I …….. want the ball. Cluttering is characterized primarily by a rapid rate of speech, which makes speech difficult to understand.

Dysarthria:

In dysarthria speech intelligibility, audibility and naturalness are affected because of weakness or paralysis or a lack of coordination of the motor-speech system. Symptoms of dysarthria include:

  • Slurred speech (sounding as if drunk)
  • Speaking softly or barely able to whisper
  • Slow rate of speech
  • Limited tongue, lip, and jaw movement
  • Breathiness
  • Drooling or poor control of saliva

Dysarthria is often caused by strokes, Parkinson's disease, ALS, head or neck injuries (surgical /accident) or cerebral palsy.

Apraxia:

Apraxia of speech (AOS) is a neurogenic communication disorder affecting the motor programming system for speech production. Individuals with AOS demonstrate difficulty in speech production, specifically with sequencing and forming sounds.

Delayed / Deficient Language in children:

The first few years of a child's life are very important for language development.
The important speech, language and communication milestones are enlisted below.

Birth – 3 Months:

  • Startles to loud sounds.
  • Quiets or smiles when spoken to.
  • Seems to recognize your voice and quiets if crying.
  • Increases or decreases sucking behavior in response to sound.
  • Makes pleasure sounds (cooing, gooing)
  • Cries differently for different needs.
  • Smiles when sees you.

4 – 6 Months

  • Moves eyes in direction of sounds.
  • Responds to changes in tone of your voice.
  • Notices toys that make sounds
  • Pays attention to music.
  • Babbling sounds more speech-like with many different sounds, including, p, b, and m.
  • Vocalizes excitement and displeasure.
  • Makes gurgling sounds when left alone and when playing with you.

7 Months – 12 Months

  • Enjoys games like peek-a-boo and pat-a-cake.
  • Turns and looks in direction of sounds.
  • Listens when spoken to.
  • Recognizes words for common items like “cup”, “shoe,” “juice.”
  • Begins to responds to requests (“Come here,” “Want more?”).
  • Babbling has both long and short groups of sounds such as “tataupup bibibibibi.”
  • Uses speech or non-crying sounds to get and keep attention.
  • Imitates different speech sounds.
  • Has 1 or 2 words.

12 Months

  • Responds to their name
  • Understands simple directions with gestures
  • Uses a variety of sounds
  • Plays social games like peek a boo

15 Months

  • Uses a variety of sounds and gestures to communicate
  • Uses some simple words to communicate
  • Plays with different toys
  • Understands simple directions

18 Months

  • Understands several body parts
  • Attempts to imitate words you say
  • Uses at least 10 – 20 words
  • Uses pretend play

24 Months

  • Uses at least 50 words
  • Recognizes pictures in books and listens to simple stories
  • Begins to combine two words
  • Uses many different sounds at the beginning of words.

2 to 3 Years

  • Speech is understood by familiar listeners most of the time.
  • Understands differences in meaning (go-stop, in-on, big-little, up-down)
  • Follows two requests (“Get the book and put it on the table.”)
  • Combines three or more words into sentences
  • Understands simple questions
  • Recognizes at least two colors
  • Understands descriptive concepts

3 to 4 Years

  • Uses sentences with 4 or more words.
  • Talks about activities at school or at friends’ homes.
  • People outside family usually understand child’s speech.
  • Identifies colors
  • Compares objects
  • Answers questions logically
  • Tells how objects are used

4 to 5 Years

  • Answers simple questions about a story
  • Voice sounds clear
  • Tells stories that stay on topic.
  • Communicates with other children and adults.
  • Says most sounds correctly
  • Can define some words
  • Uses prepositions
  • Answers why questions
  • Understands more complex directions
  • Compiled from www.asha.org, “How Does Your Child Hear and Talk?”

Conditions such as Autism, Mental Retardation, ADHD, Cerebral Palsy, Hearing loss interfere with normal speech and language development. Such children often show a gap between their chronological age and language age (expressive language and receptive language). A speech language pathologist plays a key role in bridging this gap and enabling these children to participate in the world around them to the best of their capacity.

Acquired Language Disorders in adults

Acquired language and communication difficulties/disorders in adults occur due to brain damage caused by trauma to the brain.

Trauma to the brain can be caused by conditions like:

  • Intra cranial surgery for tumour removal
  • Cerebrovascular disruption such as a stroke
  • Traumatic Brain Injury (TBI) following a motor vehicle incident or fall
  • Infectious diseases such as encephalitis or meningitis
  • Other neurological disorders such as Multiple Sclerosis (MS), Parkinson’s Disease (PD), Amyotrophic Lateral Sclerosis (ALS), Huntington’s Disease (HD).

The communication disorder is manifested by significant decline in cognitive functioning, including changes in neuropsychological functions (such as language, memory, attention, executive functions, etc.), deterioration in personality, impulse control, judgment; modulation of mood or awareness of deficits.

The most common acquired neurological communication disorders are aphasia and dementia.

Aphasia is a communication disorder resulting from brain damage usually following a stroke. In aphasia a person losses the ability to either comprehend or express thoughts using language (spoken or written). These language impairments involve difficulties in the recall of words, difficulty formulating  sentences to express oneself and difficulty in comprehension of speech or printed word or even sign language.

Dementia is characterized by a progressive decline in cognitive functions (such as orientation to time, place and persons, memory, attention, executive functions, visual-spatial skills and reasoning), linguistic functions and behavioral functions.

Voice Disorders

A voice disorder occurs when the vocal folds do not vibrate effectively. Vocal folds are affected by excessive voice use, voice abuse or misuse (yelling), excessive throat clearing and gastro-esophageal reflux (excessive stomach acid backing into the larynx). The above conditions cause vocal pathologies like mmmmmmuscle tension dysphonia, vocal fold nodules, vocal fold polyps, contact ulcers, Reinke’s edema and vocal fold cysts.

Other vocal pathologies include vocal fold paralysis, spasmodic dysphonia, puberphonia and aphonia.

A voice disorder manifest itself as hoarseness of voice, breathiness in voice, harshness of voice, pitch fluctuations, monotone, feeble voice, vocal fatigue.

Voice therapy focuses on improving voice quality and helping the patient regain his/her original voice through vocal strengthening exercises and reduction of vocally abusive behaviors.