SPEECH AND LANGUAGE DISABILITY
The following are brief definitions of several of the more prominent speech disorders:
APRAXIA OF SPEECH
Apraxia of speech is the acquired form of motor speech disorder caused by brain injury, stroke or dementia.
DEVELOPMENTAL VERBAL DYSPRAXIA
Developmental verbal dyspraxia refers specifically to a motor speech disorder. This is a neurological disorder. Individuals with developmental verbal apraxia encounter difficulty saying sounds, syllables, and words. The difficulties are not due to weakness of muscles, but rather on coordination between the brain and the specific parts of the body. Apraxia of speech is the acquired form of this disorder caused by brain injury, stroke or dementia.
Interventions are more effective when they occur individually at first, and between three and five times per week. With improvements, children with apraxia may be transitioned into group therapy settings. Therapeutic exercises must focus on planning, sequencing, and coordinating the muscle movements involved in speech production. Children with developmental verbal dyspraxia must practice the strategies and techniques that they learn in order to improve. In addition to practice, feedback can be helpful to improve apraxia of speech. Tactile feedback (touch), visual feedback (watching self in mirror), and verbal feedback are all important additions. Biofeedback has also been cited as a possible therapy. Functional training involves placing the individual in more speech situations, while providing him/her with a speech model, such as the SLP. Because the cause is neurological, however, some patients do not progress. In these cases, AAC may be more appropriate.
Dysarthria is a motor speech disorder that results from a neurological injury. Some stem from central damage, while other stem from peripheral nerve damage. Difficulties may be encountered in respiratory problems, vocal fold function, or velopharyngeal closure, for example.
OROFACIAL MYOFUNCTIONAL DISORDERS
Orofacial myofunctional disorders refers to problems encountered when the tongue thrusts forward inappropriately during speech. While this is typical in infants, most children outgrow this. Children that continue to exaggerate the tongue movement may incorrectly produce speech sounds, such as /s/, /z/, /ʃ/, /tʃ/, and /dʒ/. For example, the word, "some," might be pronounced as "thumb".
The treatment of OMD will be based upon the professional's evaluation. Each child will present a unique oral posture that must be corrected. Thus, the individual interventions will vary. Some examples include:
ü increasing awareness of muscles around the mouth
ü increasing awareness of oral postures
ü improving muscle strength and coordination
ü improving speech sound productions
ü improving swallowing patterns
SPEECH SOUND DISORDER
Speech sound disorders may be of two varieties: articulation (the production of sounds) or phonological processes (sound patterns). An articulation disorder may take the form of substitution, omission, addition, or distortion of normal speech sounds. Phonological process disorders may involve more systematic difficulties with the production of particular types of sounds, such as those made in the back of the mouth, like "k" and "g".
Naturally, abnormalities in speech mechanisms would need to be ruled out by a medical professional. Therapies for articulation problems must be individualized to fit the individual case. The placement approach—instructing the individual on the location in which the tongue should be and how to blow air correctly—could be helpful in difficulties with certain speech sounds. Another individual might benefit more from developing auditory discrimination skills, since he/she has not learned to identify error sounds in his/her speech. Generalization of these learned speech techniques will need to be generalized to everyday situations. Phonological process treatment, on the other hand, can involve making syntactical errors, such as omissions in words. In cases such as these, explicit teaching of the linguistic rules may be sufficient.
Some cases of speech sound disorders, for example, may involve difficulties articulating speech sounds. Educating a child on the appropriate ways to produce a speech sound and encouraging the child to practice this articulation over time may produce natural speech, Speech sound disorder. Likewise, stuttering does not have a single, known cause, but has been shown to be effectively reduced or eliminated by fluency shaping (based on behavioral principles) and stuttering modification techniques.
Stuttering is a disruption in the fluency of an individual's speech, which begins in childhood and may persist over a lifetime. Stuttering is a form of disfluency; disfluency becomes a problem insofar as it impedes successful communication between two parties. Disfluencies may be due to unwanted repetitions of sounds, or extension of speech sounds, syllables, or words. Disfluencies also incorporate unintentional pauses in speech, in which the individual is unable to produce speech sounds.
While the effectiveness is debated, most treatment programs for stuttering are behavioral. In such cases, the individual learns skills that improve oral communication abilities, such as controlling and monitoring the rate of speech. SLPs may also help these individuals to speak more slowly and to manage the physical tension involved in the communication process. Fluency may be developed by selecting a slow rate of speech, and making use of short phrases and sentences. With success, the speed may be increased until a natural rate of smooth speech is achieved. Additionally, punishment for incorrect speech production should be eliminated, and a permissive speaking environment encouraged. Electronic fluency devices, which alter the auditory input and provide modified auditory feedback to the individual, have shown mixed results in research reviews.
Because stuttering is such a common phenomenon, and because it is not entirely understood, various opposing schools of thought emerge to describe its etiology. The Breakdown theories maintain that stuttering is the result of a weakening or breakdown in physical systems that are necessary for smooth speech production. Cerebral dominance theories (in the stutterer, no cerebral hemisphere takes the neurological lead) and theories of perseveration (neurological "skipping record" of sorts) are both Breakdown theories. Auditory Monitoring theories suggest that stutters hear themselves differently from how other people hear them. Since speakers adjust their communication based upon the auditory feedback they hear (their own speech), this creates conflict between the input and the output process. Psychoneurotic theories posit repressed needs as the source of stuttering. Lastly, Learning theories are straightforward—children learn to stutter. It should be clear that each etiological position would suggest a different intervention, leading to controversy with the field.
Voice disorders range from aphonia (loss of phonation) to dysphonia, which may be phonatory and/or resonance disorders. Phonatory characteristics could include breathiness, hoarseness, harshness, intermittency, pitch, etc. Resonance characteristics refer to overuse or underuse of the resonance chambers resulting in hypernasality or hyponasality. Several examples of voice problems are vocal cord nodules or polyps, vocal cord paralysis, paradoxical vocal fold movement, and spasmodic dysphonia. Vocal cord nodules and polyps are different phenomena, but both may be caused by vocal abuse, and both may take the form of growths, bumps, or swelling on the vocal cords. Vocal fold paralysis is the inability to move one or both of the vocal cords, which results in difficulties with voice and perhaps swallowing. Paradoxical vocal fold movement occurs when the vocal cords close when they should actually be open. Spasmodic dysphonia is caused by strained vocal cord movement, which results in awkward voice problems, such as jerkiness or quavering.
If nodules or polyps are present, and are large, surgery may be the appropriate choice for removal. Surgery is not recommended for children, however. Other medical treatment may suffice for slighter problems, such as those induced by gastroesophageal reflux disease, allergies, or thyroid problems. Outside of medical and surgical interventions, professional behavioral interventions can be useful in teaching good vocal habits and minimizing abuse of vocal cords. This voice therapy may instruct in attention to pitch, loudness, and breathing exercises. Additionally, the individual may be instructed on the optimal position to produce the maximum vocal quality. Bilateral paralysis is another disorder that may require medical or surgical interventions to return vocal cords to normalcy; unilateral paralysis may be treated medically or behaviorally.
Paradoxical vocal fold movement (PVFM) is also treated medically and behaviorally. Behavioral interventions will focus on voice exercises, relaxation strategies, and techniques that can be used to support breath. More generally, however, PVFM interventions focus on helping an individual to understand what triggers the episode, and how to deal with it when it does occur.
A language disorder is an impairment in the ability to understand and/or use words in context, both verbally and nonverbally. Some characteristics of language disorders include improper use of words and their meanings, inability to express ideas, inappropriate grammatical patterns, reduced vocabulary and inability to follow directions. One or a combination of these characteristics may occur in children who are affected by language learning disabilities or developmental language delay. Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate.
SPECIFIC LANGUAGE IMPAIRMENT
Interventions for specific language impairment will be based upon the individual difficulties in which the impairment manifests. For example, if the child is incapable of separating individual morphemes, or units of sound, in speech, then the interventions may take the form of rhyming, or of tapping on each syllable. If comprehension is the trouble, the intervention may focus on developing metacognitive strategies to evaluate his/her knowledge while reading, and after reading is complete. It is important that whatever intervention is employed, it must be generalized to the general education classroom.
Selective mutism is a disorder that manifests as a child that does not speak in at least one social setting, despite being able to speak in other situations. Selective mutism is normally discovered when the child first starts school.
Behavioral treatment plans can be effective in bringing about the desired communication across settings. Stimulus fading involves a gradual desensitization, in which the individual is placed in a comfortable situation and the environment is gradually modified to increase the stress levels without creating a large change in stress level. Shaping relies on behavioral modification techniques, in which successive attempts to produce speech is reinforced. Self-modeling techniques may also be helpful; for example, self-modeling video tapes, in which the child watches a video of him/herself performing the desired action, can be useful.
If additional confounding speech problems exist, an SLP may work with the student to identify what factors are complicating speech production and what factors might be increasing the mute behaviors. Additionally, he/she might work with the individual to become more comfortable with social situations, and with the qualities of their own voice. If voice training is required, they might offer this as well.
Aphasia refers to a family of language disorders that usually stem from injury, lesion, or atrophy to the left side of the brain that result in reception, perception, and recall of language; in addition, language formation and expressive capacities may be inhibited.
LANGUAGE-BASED LEARNING DISABILITIES
Language-based learning disabilities, which refer to difficulties with reading, spelling, and/or writing that are evidenced in a significant lag behind the individual's same-age peers. Most children with these disabilities are at least of average intelligence, ruling out intellectual impairments as the causal factor.
Speech is one of the main ways in which we communicate with those around us. It develops naturally, along with other signs of normal growth and development. Disorders of speech and language are common in preschool age children.
Disfluencies are disorders in which a person repeats a sound, word, or phrase. Stuttering may be the most serious disfluency. It may be caused by:
- Genetic abnormalities
- Emotional stress
- Any trauma to brain or infection
Articulation and phonological disorders may occur in other family members. Other causes include:
- Problems or changes in the structure or shape of the muscles and bones used to make speech sounds. These changes may include cleft palate and tooth problems.
- Damage to parts of the brain or the nerves (such as from cerebral palsy) that control how the muscles work together to create speech.
- Hearing loss.
Voice disorders are caused by problems when air passes from the lungs, through the vocal cords, and then through the throat, nose, mouth, and lips. A voice disorder may be due to:
- Acid from the stomach moving upward (GERD)
- Cancer of the throat
- Cleft palate or other problems with the palate
- Conditions that damage the nerves that supply the muscles of the vocal cords
- Laryngeal webs or clefts (a birth defect in which a thin layer of tissue is between the vocal cords)
- Noncancerous growths (polyps, nodules, cysts, granulomas, papillomas, or ulcers) on the vocal cords
- Overuse of the vocal cords from screaming, constantly clearing the throat, or singing
- Hearing loss
Stuttering is the most common type of disfluency.
Symptoms of disfluency can include:
- Repetition of sounds, words, or parts of words or phrases after age 4 (I want...I want my doll. I...I see you.)
- Putting in (interjecting) extra sounds or words (We went to the...uh...store.)
- Making words longer (I am Boooobbby Jones.)
- Pausing during a sentence or words, often with the lips together
- Tension in the voice or sounds
- Frustration with attempts to communicate
- Head jerking while talking
- Eye blinking while talking
- Embarrassment with speech
The child is not able to produce speech sounds clearly, such as saying "coo" instead of "school."
Certain sounds (like "r", "l", or "s") may be consistently distorted or changed (such as making the 's' sound with a whistle).
Errors may make it hard for people to understand the person (only family members may be able to understand a child).
The child does not use some or all of the speech sounds to form words as expected for their age.
The last or first sound of words (most often consonants) may be left out or changed.
The child may have no problem pronouncing the same sound in other words (a child may say "boo" for "book" and "pi" for "pig", but may have no problem saying "key" or "go").
Other speech problems include:
- Hoarseness or raspiness to the voice
- Voice may break in or out
- Pitch of the voice may change suddenly
- Voice may be too loud or too soft
- Person may run out of air during a sentence
- Speech may sound odd because too much air is escaping through the hose (hypernasality) or too little air is coming out through the nose (hyponasality)
EXAMS AND TESTS
Your health care provider will ask about your child's developmental and family history. The provider will do some neurological screening and check for:
- Fluency of speech
- Any emotional stress
- Any underlying condition
- Effect of speech disorder on daily life
Hearing loss is a risk factor for speech disorders. At-risk infants should be referred to an audiologist for a hearing test. Hearing and speech therapy can then be started, if necessary.
As young children begin to speak, some disfluency is common, and most of the time, it goes away without treatment. If you place too much attention on the disfluency, a stuttering pattern may develop.
Helping children learn language
Parents and caregivers are the most important teachers during a child’s early years. Children learn language by listening to others speak and by practicing. Even young babies notice when others repeat and respond to the noises and sounds they make. Children’s language and brain skills get stronger if they hear many different words. Parents can help their child learn in many different ways, such as
- Responding to the first sounds, gurgles, and gestures a baby makes.
- Repeating what the child says and adding to it.
- Talking about the things that a child sees.
- Asking questions and listening to the answers.
- Looking at or reading books.
- Telling stories.
- Singing songs and sharing rhymes.
This can happen both during playtime and during daily routines.
SPEECH THERAPY TECHNIQUES FOR CHILDREN
Activities to try with your child at home:
- Read to your child. Reading to your child is a wonderful way of developing their speech and language skills. If they’re old enough to read, let them read back to you. If they’re too young to read the words, let them explain what they see in the pictures. Have your child point to the pictures that you name for them, or have them name pictures you point to.
- Reduce screen time. Research shows that watching too much television can delay language development. The best way to teach your child proper speech is by modeling speech and language to them directly.
- Be attentive and patient. If your child has a speech disorder, it’s important to be patient. Don’t push them to get the words out. This may cause additional anxiety, which can make the problem worse. Say to your child, “Take your time, I’m listening.” Then give your undivided attention while they communicate with you.
- Play games with your child. Board games that include guessing objects, describing objects or asking questions are a wonderful way to expand language skills.
- Be a good speech model. Use simple but grammatically correct speech that’s easy for your child to imitate. Talk to them about what you’re doing. Label shapes, colors, clothing items and body parts.
SPEECH THERAPY TECHNIQUES FOR ADULTS
Adults with speech disorders can also benefit from at-home exercises. You can try:
- Tongue exercises. Stick your tongue out, hold for two seconds, then bring it back in. Repeat this process several times. You can also try this same exercise, but move your tongue to each corner of your mouth for two seconds. Finally, move your tongue up and down in the same fashion. These exercises help train your tongue to move in coordinated patterns.
- Smiling. Simply smiling in front of a mirror can help improve motor skills. Smile. Relax. Smile again. Repeat this process several times.
- Puckering your lips. Try puckering your lips, then relaxing. Repeat this several times. This can help you control the movement of your mouth.
- Reading out loud. If your speech disorder prevents you from moving your mouth and tongue properly, reading out loud can be excellent practice. Start out with a few small sentences and work your way up from there.
- Playing word games. Studies have shown that memory games, word searches and crossword puzzles can help maintain cognitive function and improve thinking skills.
Food plays an important role in development of human beings. Following food may be of help-
- Omega-3 fatty acids- Deficiency in proper intake of omega- 3 fatty acids may lead to speech development delay in children. It can also affect speech quality. Include fish like salmon, flaxseeds, walnuts, soybeans, tofu etc for ample supply of omega -3 fatty acids.
- Vitamin D- It is important for brain development in foetus. Hence during pregnancy consume more of fish, eggs, liver etc. Expose to early morning sunshine.
- Folic Acid- Foods rich in folic acid or Vitamin B9 helps in prevention of nerve defects. Include leafy dark green vegetables and food fortified with folic acids like breads, wheat flour in your diet.
- Vitamin E- This acts as antioxidants and kills free radicals which can damage our nerves resulting in speech problems. Include more fruits, vegetables, nuts, sunflower seeds, pumpkin seeds, etc in diet.
- Include food containing zinc, phosphorus, magnesiumin diet for better overall development of child. Include dairy foods, fish, rice, nuts, chocolates, spinach, tomatoes, ginger, cumin, cloves, eggs, beans, peas, yogurt etc.
- Avoid foods that cause allergies to you since allergic reactions are an important cause of hearing loss which can simultaneously contribute to speech disorders.
- Avoid food preservatives, canned foods, additives in artificial foods, glutamates, excess coffee and alcohol.
- Avoid smoking and alcohol during pregnancy
Few of the homoeopathic listed below are helpful to prevent blindness or to treat speech and language disability with favorable result, if taken according to the totality of symptoms. They are:
Spigelia is beneficial for a mild stutter at the beginning of a sentence, often followed by undisturbed speech.
Causticum is prescribed when emotional excitability causes stammering, twitching of the facial muscles, or problems in the vocal chords.
Lachesis is an effective homeopathic medicine when the patient stutters over specific letters or syllables.
Gelsemium is used to treat stuttering after severe viral infections when the patient complains of a heavy tongue and a lack of general coordination.
Staphysagria can aid in reducing social anxiety which often causes stammering i.e. the stammer only happens while interacting with strangers or authority figures.