Speech Disorders

There are a variety of speech delays and disorders that we at Clear Speech and Language can help remediate. If your child needs professional help for their speech sounds, voice, or fluency/stuttering, our therapists have years of experience to help him or her be better communicators.

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Articulation and Phonological Disorders

What are speech sound disorders?

Most children make some mistakes as they learn to say new words. A speech sound disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should produce the sound correctly. Speech sound disorders include problems with articulation (producing sounds) and phonological processes (sound patterns).

What are some signs of an articulation disorder?

An articulation disorder involves problems making sounds. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand you.

Young children often make speech errors. For instance, many young children produce a “w” sound for an “r” sound (e.g., “wabbit” for “rabbit”) or may leave sounds out of words, such as “nana” for “banana.” The child may have an articulation disorder if these errors continue past the expected age.

What are some signs of a phonological disorder?

A phonological process disorder involves patterns of sound errors. For example, substituting all sounds made in the back of the mouth like “k” and “g” for those in the front of the mouth like “t” and “d” (e.g., saying “tup” for “cup” or “das” for “gas”).

Another rule of speech is that some words start with two consonants, such as broken or spoon. When children don’t follow this rule and say only one of the sounds (“boken” for broken or “poon” for spoon), it is more difficult for the listener to understand the child. While it is common for young children learning speech to leave one of the sounds out of the word, it is not expected as a child gets older. If a child continues to demonstrate such cluster reduction, he or she may have a phonological process disorder.

What treatments are available for people with speech sound disorders?

SLPs provide treatment to improve articulation of individual sounds or reduce errors in production of sound patterns.

Articulation treatment may involve demonstrating how to produce the sound correctly, learning to recognize which sounds are correct and incorrect, and practicing sounds in different words. Phonological process treatment may involve teaching the rules of speech to individuals to help them say words correctly.

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Childhood Apraxia of Speech

What is childhood apraxia of speech?

Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.

What are some signs or symptoms of childhood apraxia of speech?

Not all children with CAS are the same. All of the signs and symptoms listed below may not be present in every child. It is important to have your child evaluated by a speech-language pathologist (SLP) who has knowledge of CAS to rule out other causes of speech problems. General things to look for include the following:

A Very Young Child

• Does not coo or babble as an infant
• First words are late, and they may be missing sounds
• Only a few different consonant and vowel sounds
• Problems combining sounds; may show long pauses between sounds
• Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
• May have problems eating

An Older Child

• Makes inconsistent sound errors that are not the result of immaturity
• Can understand language much better than he or she can talk
• Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
• May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
• Has more difficulty saying longer words or phrases clearly than shorter ones
• Appears to have more difficulty when he or she is anxious
• Is hard to understand, especially for an unfamiliar listener
• Sounds choppy, monotonous, or stresses the wrong syllable or word

Potential Other Problems

• Delayed language development
• Other expressive language problems like word order confusions and word recall
• Difficulties with fine motor movement/coordination
• Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like toothbrushing or crunchy foods, may not be able to identify an object in their mouth through touch)
• Children with CAS or other speech problems may have problems when learning to read, spell, and write

What treatments are available for children with apraxia of speech?

Research shows the children with CAS have more success when they receive frequent (3-5 times per week) and intensive treatment. Children seen alone for treatment tend to do better than children seen in groups. As the child improves, they may need treatment less often, and group therapy may be a better alternative.

The focus of intervention for CAS is on improving the planning, sequencing, and coordination of muscle movements for speech production. Isolated exercises designed to “strengthen” the oral muscles will not help with speech. CAS is a disorder of speech coordination, not strength.

To improve speech, the child must practice speech. However, getting feedback from a number of senses, such as tactile “touch” cues and visual cues (e.g., watching him/herself in the mirror) as well as auditory feedback, is often helpful. With this multi-sensory feedback, the child can more readily repeat syllables, words, sentences and longer utterances to improve muscle coordination and sequencing for speech.

Some clients may be taught to use sign language or an augmentative and alternative communication system  (e.g., a portable computer that writes and/or produces speech) if the apraxia makes speaking very difficult. Once speech production is improved, the need for these systems may lessen, but they can be used to support speech or move the child more quickly to higher levels of language complexity.

Practice at home is very important. Families will often be given assignments to help the child progress and allow the child to use new strategies outside of the treatment room, and to assure optimal progress in therapy.

One of the most important things for the family to remember is that treatment of apraxia of speech takes time and commitment. Children with CAS need a supportive environment that helps them feel successful with communication. For children who also receive other services, such as physical or occupational therapy, families and professionals need to schedule services in a way that does not make the child too tired and unable to make the best use of therapy time.

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Dysarthria

What is dysarthria?

Dysarthria is a motor speech disorder. It results from impaired movement of the muscles used for speech production, including the lips, tongue, vocal folds, and/or diaphragm. The type and severity of dysarthria depend on which area of the nervous system is affected.

What are some signs or symptoms of dysarthria?

A person with dysarthria may demonstrate the following speech characteristics:

• “Slurred,” “choppy,” or “mumbled” speech that may be difficult to understand
• Slow rate of speech
• Rapid rate of speech with a “mumbling” quality
• Limited tongue, lip, and jaw movement
• Abnormal pitch and rhythm when speaking
• Changes in voice quality, such as hoarse or breathy voice or speech that sounds “nasal” or “stuffy”

What treatment is available for people with dysarthria?

Treatment depends on the cause, type, and severity of the symptoms. An SLP works with the individual to improve communication abilities. Some possible goals of treatment include:

• Slowing the rate of speech
• Improving the breath support so the person can speak more loudly
• Strengthening muscles
• Increasing tongue and lip movement
• Improving speech sound production so that speech is more clear
• Teaching caregivers, family members, and teachers strategies to better communicate with the person with dysarthria
• In severe cases, learning to use alternative means of communication (http://www.asha.org/public/speech/disorders/AAC/) (e.g., simple gestures, alphabet boards, or electronic or computer-based equipment)

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Stuttering

What is stuttering?

Stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts a lifetime. The disorder is characterized by disruptions in the production of speech sounds, also called “disfluencies.” Most people produce brief disfluencies from time to time. For instance, some words are repeated and others are preceded by “um” or “uh.” Disfluencies are not necessarily a problem; however, they can impede communication when a person produces too many of them.

In most cases, stuttering has an impact on at least some daily activities. The specific activities that a person finds challenging to perform vary across individuals. For some people, communication difficulties only happen during specific activities, for example, talking on the telephone or talking before large groups. For most others, however, communication difficulties occur across a number of activities at home, school, or work. Some people may limit their participation in certain activities. Such “participation restrictions” often occur because the person is concerned about how others might react to disfluent speech. Other people may try to hide their disfluent speech from others by rearranging the words in their sentence, pretending to forget what they wanted to say, or declining to speak. Some individuals may find that they are excluded from participating in certain activities because of stuttering. Clearly, the impact of stuttering on daily life can be affected by how the person and others react to the disorder.

What are signs and symptoms of stuttering?

Stuttered speech often includes repetitions of words or parts of words, as well as prolongations of speech sounds. These disfluencies occur more often in persons who stutter than they do in the general population. Some people who stutter appear very tense or “out of breath” when talking. Speech may become completely stopped or blocked. Blocked is when the mouth is positioned to say a sound, sometimes for several seconds, with little or no sound forthcoming. After some effort, the person may complete the word. Interjections such as “um” or “like” can occur, as well, particularly when they contain repeated (“u- um- um”) or prolonged (“uuuum”) speech sounds or when they are used intentionally to delay the initiation of a word the speaker expects to “get stuck on.”

Some examples of stuttering include:

• “W- W- W- Wait for me.” (Part-word repetition)
• “SSSS ave some for me.” (Sound prolongation)
• “I’ll meet you – um um like – around six o’clock.” (A series of interjections)

What treatments are available for stuttering?

The majority of treatment programs available to people who stutter are “behavioral.” They are designed to teach the individual specific skills or behaviors that lead to improved oral communication. For instance, many SLPs teach people who stutter to control and/or monitor the rate at which they speak. In addition, people may learn to start saying words in a slightly slower and less physically tense manner. They may also learn to control or monitor their breathing. When learning to control speech rate, people often begin by practicing smooth, fluent speech at rates that are much slower than typical speech, using short phrases and sentences. Over time, people learn to produce more fluent and natural speech at faster rates, in longer sentences, and in more challenging situations. “Follow-up” or “maintenance” sessions are often necessary after completion of formal intervention to prevent relapse.

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Voice Disorders

What is voice 

and how does sound emit from our mouths? It starts with air from our lungs being pushed through our larynx (or voice box). The larynx contains two cords that are called vocal cords and they need to vibrate to produce sound. Sometimes, due to a variety of reasons, the vocal cords are damaged and a patient will suffer a voice disorder. Specialists at Clear Speech and Language provide treatment and options for voice disorders.

Many people have colds and temporary voice issues such as hoarseness or they may lose their voice. These minor situations typically resolve with rest and home remedies of hot tea with honey and lemon. There are more serious forms of voice disorders. They generally fall into four main types of voice disorders:

Vocal Cord Paralysis

This happens when one or both of the vocal cords in the larynx stop vibrating during speech. If both stop vibrating, it may impact a person’s eating. This condition can be caused from a head or neck injury, tumor, surgery or possibly a stroke. This condition needs to be treated medically and a specialist at Clear Speech and Language can suggest behaviors to help the patient cope after it is diagnosed.

Vocal Cord Nodules & Polyps

These nodules and polyps are typically non-cancerous. They are caused from overuse such as yelling and singing. The vocal cord becomes soft and swells. If it develops into a blister type of sore, it is a polyp and if it becomes hardened like a growth, it is a nodule. After diagnosis by the physician, a speech language pathologist will help the patient identify abusive vocal behaviors that cause it and suggest alternatives. They will also work with the patient to come up with communication mechanisms while the cords are healing.

Spasmodic Dysphonia

This condition is typically long term where the voice will change to a quivery, jerky sound with little or no warning and then go back to normal. The condition starts out with minimal changes and then progresses. The highly trained specialists at Clear Speech and Language can help the patient determine what triggers this nervous system condition and how to work around them.

Paradoxical Vocal Fold Movement (PVFM)

Sometimes the vocal cords or folds will spontaneously close at inappropriate times causing issues with breathing. This condition is one of the most difficult voice disorders to treat due to similar symptoms to asthma and other wheezing conditions.

If you have any of the following symptoms, the specialists at Clear Speech and Language can help evaluate if you need further testing and an appointment with a physician:

• Hoarseness
• A feeling something is lodged in the throat
• Voice changes that do not improve after 2-3 weeks of being ill
• Voice problems (changes in pitch or volume or a rough voice) that come and go

If you have suffered any of the above symptoms or if you need more information, call one of the trained and qualified speech therapists at Clear Speech and Language.