Childhood Speech and Language Disorders
During the first five years of children's lives most will pass through the same stages while learning to talk, but the rate at which they progress from stage to stage will vary.
Cooing and babbling heralds the one-word phase, the one-word stage graduates to the two-word level, two becomes three.
At the same time, children learn and refine the grammar rules and perfect their pronunciation.
They learn how to manipulate the language in a wide range of social situations - they learn how to say what to whom ….just right…. to get their needs met and their ideas expressed.
Most five year olds should talk like little adults!
Some children however experience difficulties learning their language.
A child may have trouble saying speech sounds, or he may have trouble understanding what you’re saying to him.
A child may not string words together to form grammatically correct sentences. She may not be able to tell you exactly what happened during her day at school. She may have trouble answering questions or getting the main idea when she is read a story. He may have difficulty remembering directions.
A child may stutter, or a child may have a very raspy voice.
A child may fall on the autism disorder spectrum and have difficulty not only with expressing himself but with socializing and using language effectively when playing with his friends.
Speech disorders, language disorders, apraxia, phonological disorder, auditory processing disorder, stuttering, lisping, speech delays …… are some of the disorders that can impede the ability to communicate easily and effectively.
A child may have a speech disorder only, she may have a language disorder only or she may have both.
Childhood speech disorders may be caused by abnormalities with the structures that are involved in producing speech (lips, tongue, back of the mouth, palate), neurological abnormalities, developmental delays, injury, disease, genetic conditions, hearing impairment, and for unknown reasons.
Language disorders can be further divided into two subcategories, receptive language disorders and expressive language disorders. A child with a receptive language disorder has difficulty understanding. A child with an expressive language disorder has difficulty expressing himself.
Childhood language disorders can be caused by developmental delays, neurological impairments, illness and disease, injury, genetic conditions, hearing impairment and unknown reasons.
Speech Disorders
Speech Sound Disorders
A child who has difficulty producing speech sounds, or who does not produce speech sounds clearly has a speech sound disorder, which is also called an articulation disorder.
Sounds may be substituted, omitted, added or altered.
If there is a pattern to the mis-articulated sounds, then it is called a phonological disorder.
Some phonological disorder speech patterns might be: final consonant deletion where final sounds of words are omitted. A child may say ca for cat, mi for milk, I wa da boo for I want that book. Cluster reduction is when clusters of consonants such as str-, bl- pl- are reduced or simplified; a child may say peaz for please, ting for sting, top for stop. The phonological process of stopping is when phonemes (speech sounds) that have a continuous flow of air, like the f, v, s, z, sh, th, are produced with a speech sound that has no air flow; a child may say pery punny for very funny, tide dape for five shapes, dode doed for those shoes. Yet another process is fronting. This occurs when the k, g phonemes, which are produced at the back of the mouth, are produced in the front of the mouth. A child may say tat for cat, and tiss for kiss.
A child with childhood apraxia of speech (sometimes referred to as dyspraxia) typically does not have a muscle or structural impairment but a motor planning problem.
Muscle movement for speech is intact. The speech message from the brain is not relayed properly to the speech muscles and so the child has difficulty coordinating the movement for speech sounds even though he knows what he wants to say. She will have difficulty saying speech sounds and blending them together to produce words. Words with more than one syllable generally are more difficult as are longer phrases and sentences.
A child with orofacial myofunction disorder also called tongue thrust carries or holds her tongue in a more forward position than is normal when in a resting position, when speaking and/or swallowing. The tongue thrusts forward up against the front teeth or protrudes beyond the front teeth. Speech may or may not be affected. The s and z phonemes (speech sounds) may be produced as a th. A child may say thun for sun, thoo for zoo, Thally for Sally. The sh and zh (as in measure), ch and j sounds may also be affected, as well as the t, d and n phonemes.
If you are concerned about your child's speech development or suspect that she has a speech disorder, a certified speech language pathologist will be able to determine if indeed there is an articulation disorder, the degree of the disorder, and suggest an intervention plan.
Stuttering
A child who stutters has non-fluent speech which can interfere with her ability to communicate.
We all have some normal disfluencies when talking: we say uh, or pause momentarily, or repeat a phrase.
However disfluencies that occur more often or are more severe than normal can hinder normal discourse.
A child with disfluencies may have repetitions of sounds, words and phrases. She may say p-p-p-p-pass the salt, or I I I I I want the salt, or I want I want the the the salt.
She may prolong the beginnings of words or she may prolong vowels within words. She may say ssssssalt, mmmmmmman haaaaaaaaat.
She may pause and hesitate more frequently than is normal; she may interject more uh's and um's than are normal.
A child may avoid saying "difficult" words as well. The frequency and severity of these features varies within a child's speech and from child to child.
If you are worried that your child may be more disfluent than normal, a certified speech language pathologist will be able to assess and diagnose the severity of the stuttering and provide recommendations for a treatment plan.
Voice
The vocal quality of a child with a voice disorder will not sound normal. We all have different and distinct voices, but when the vocal quality is atypical, usually there is a voice disorder.
The vocal cords, made up of two muscles shaped like a /\ (with the apex facing forward) sit in the larynx (the voice box). When air passes through the vocal cords from the lungs, they vibrate (open and close) very quickly, which creates sound - your voice!
If the vocal cords do not close completely, the features of the voice change. It may sound breathy, hoarse or harsh. There may be some difficulty with changing the pitch (speaking in a high or low voice) and volume (speaking loudly).
Nodules, polyps, lesions, paralysis (where one or both of the cords cannot vibrate) or weakness can be caused by injury, vocal abuse (shouting, talking too much, clearing your throat), pathology or disease. These affect the condition and movement of the vocal cords, consequently affecting the quality of the voice.
If you wonder about your child's voice, that it may be too hoarse, harsh or breathy, consult a certified speech language pathologist who will be able to confirm the existence of a voice disorder, refer you to the appropriate medical specialist, and based on medical diagnosis recommend a treatment plan.
Language Disorders
Receptive Language Disorder
A child with a receptive language disorder has difficulty understanding what is said to him.
He may be unable to answer simple questions or follow simple directions, or he may have difficulty following a story.
An older child may be unable to answer who, what, where and why questions. He may have difficulty following more complex directions. He may not remember what was said or read to him.
Generally a child with a receptive language delay/disorder will also have difficulties with expressive language.
Langue processing disorders as well as (central) auditory processing disorders is a type of receptive language disorder.
Expressive Language Disorder
A child with an expressive language disorder has difficulty expressing himself. It may exist on its own or it may be combined with a receptive language disorder.
A child may not be combining two words at two years of age, he may have difficulties with pronouns, he may not use the correct verb tenses, or he may have difficulty describing an object or an event. He may confuse words.
An expressive language disorder may be seen early in a child's development or at a later stage.
It can be a difficult task to decide whether your child has a speech disorder, a language disorder, or is delayed in learning to speak.
If you have doubts about your child’s progress in acquiring language or are suspicious of a delay or a disorder, seek the advice of a certified speech language pathologist who will be able to assess the presence of a disorder, the severity, and make recommendations for your child.