speech impairment is not a disability

Understanding Speech Impairments: Are They Considered a Disability?

Ever wondered if speech impairment qualifies as a disability? You’re not alone. Many people question whether difficulties with speech fall under the umbrella of disability.

Speech impairment can range from stuttering to complete inability to communicate verbally. It’s a complex issue, with social, psychological, and physical aspects.

In this article, we’ll delve into the nitty-gritty of speech impairment. We’ll explore its classification as a disability , the impact it has on individuals’ lives, and the resources available for those affected. Stay tuned to gain a deeper understanding of this multifaceted topic.

Speech Impairment: An Overview

Speech impairment, in essence, is a broad term that encompasses various conditions . These range from stuttering problems through to a complete inability to communicate verbally – making the condition a topic of much discussion and study. It’s not just about the physical difficulties of producing sounds or forming words. The impact of speech impairment goes far beyond that.

For you to understand its complexity, it’s crucial to dig deeper into its various forms. You might wonder, what exactly falls under the category of speech impairment? Let’s look at some of the primary types:

• Stuttering: This condition affects the flow of speech. Someone who stutters may repeat words or sounds, or find it hard to start sentences.
• Apraxia: This involves difficulty with motor planning to produce speech. Despite having a clear understanding of what they wish to say, a person with apraxia struggles to convert these thoughts into spoken words.
• Dysarthria: This is where the muscles responsible for speech are weak, resulting in slow or slurred speech.

To classify speech impairment as a disability, it’s essential to understand how it affects an individual’s life. It’s not just about being unable to communicate effectively . Speech impairment can affect a person’s social interactions, their ability to learn and work, and their overall mental well-being. Having speech impairment can indeed pose significant hurdles in navigating life.

For those affected, there are resources available. Various types of therapies aim to enhance communication skills, while assistive devices may be used to facilitate communication. Tech advancements have also stepped in to provide alternative ways to express thoughts and ideas. More details on these resources will be covered in the next section.

We’ve covered the basics, but there’s more to learn about speech impairment. In the following sections, we’ll delve deeper into its classification as a disability, weighing the advantages and disadvantages that come with this categorization. Stay tuned to get a well-rounded understanding of this complex issue.

Understanding Disability: Definitions and Criteria

So, what exactly is a disability? In layman’s terms, you could consider disability as a physical or mental condition that limits a person’s movements, senses, or activities. However, to truly grasp the idea of disability and its implications, it’s crucial to understand the legal and medical perspectives.

Legally defined , disability refers to a physical or mental impairment that significantly restricts one or more major life activities — such as seeing, hearing, speaking, walking, or learning. This definition comes directly from the Americans with Disabilities Act (ADA), aimed at protecting individuals with disabilities from discrimination.

Emphasizing mental health, medical professionals often describe disability in the context of one’s capacity to execute tasks and participate in society. The World Health Organization (WHO) states that disabilities result from the interaction between people with a health condition and their environment.

Understanding these definitions and criteria are vital as they determine access to various benefits and protections . People who meet these conditions could be eligible for certain types of assistance, including accommodations at school or work, health care services, tax credits, and disability benefits.

Let’s deep dive into the concept of speech impairment being considered as a disability. But before that, let’s have a quick glance at a comparison table:

However, just because someone has a speech impairment doesn’t automatically qualify them as ‘disabled’. Various factors come into play – severity, impact on daily life, and more. Let’s head into the next section and explore this in detail.

Is Speech Impairment Considered a Disability?

You’ve learned that disability can be seen through two lenses: the legal definition, as outlined by the Americans with Disabilities Act (ADA) , and the medical perspective, which considers the limitations placed on one’s ability to perform tasks and engage with society. With these definitions in mind, let’s delve further into whether speech impairment is, in fact, classified as a disability.

Your understanding of speech impairments is key here. These are conditions that inhibit a person’s ability to communicate effectively. They can manifest as stutters, lisps, voice disorders, or language difficulties. But does this equate to a disability?

Under the ADA, speech impairments are labeled as communication disorders. They are classified as disabilities when they significantly limit one or more of a person’s life activities. Bear in mind, severity and the impact on daily functioning are vital factors that aid in making this determination.

For instance, take the case of a severe stutter that prevents a person from communicating effectively in social settings or at the workplace. This scenario could meet the criteria for a disability as it puts a major restriction on their ability to interact and express themselves. However, it’s not a one-size-fits-all situation.

Even at this point, it’s important to remember that each case of speech impairment is unique, and its classification as a disability will depend on each specific situation. You’d have noticed the complexities of how impairments are considered as disabilities; how societal, individual, and institutional factors all intertwine. This diversity is the heart of understanding disabilities. It’s best to keep this in mind as you continue this journey of discovery, while we segue into more discussions on specific types of speech impairments next.

The Impact of Speech Impairment on Daily Life

Navigating through the particulars of daily life with a speech impairment can be challenging. It’s essential to understand how speech impairments can affect your daily activities .

Optimal communication skills are a key aspect of normal functioning in society. Those with speech impairments often find social interaction, professional tasks, and even simple day-to-day tasks challenging. While it might be difficult for those without speech impairments to sympathize with these struggles, it’s an unfortunate reality for many.

Consider basic tasks like ordering food at a restaurant. Without proper speech ability, this basic task becomes a stressful event. This can lead to feelings of frustration, anxiety, and even social withdrawal. Let’s also look at higher-stakes situations like a job interview or work presentation. When speech clarity and fluidity are crucial, a speech impairment can significantly diminish an individual’s ability to perform successfully.

These daily life examples are not comprehensive; they are just a glimpse into the world of someone with a speech impairment. It’s essential to remember that every person’s struggle with speech impairment is unique. The extent of the impact on daily life will depend on multiple factors like the severity of the impairment, individual resilience, and the level of support available. These variables help determine whether a person’s speech impairment is severe enough to be categorized as a disability.

There’s a broad spectrum of speech impairments; their impact ranges from a minor inconvenience that can be managed with adequate support, to a severe limitation requiring comprehensive intervention. Various resources and therapeutic interventions are available to support those with speech impairments. Therapies such as speech and language therapy or using assistive devices can significantly improve an individual’s communication abilities.

Let’s now delve into some specific types of speech impairments, their particular challenges, and possible ways to manage them.

Available Resources and Support for Individuals with Speech Impairment

Figuring out where to turn for help with speech impairments might seem overwhelming yet there’s a wealth of resources available . We’ll run through some of the most effective therapeutic interventions, educational support centers, and digital tools that can make living with a speech impairment more manageable.

Therapeutic Interventions

Professional speech and language therapy is a common strategy for handling speech impairments. Therapists work in numerous environments:

• Rehabilitation centers

They’ll offer tailor-made programs to fit your specific needs. With regular sessions, you’ll see improvements in pronunciation, fluency, and general speech clarity.

Educational Support

For children experiencing speech impairments, schools often offer a range of inclusive services:

• Individualized Education Programs (IEPs)
• Speech therapy sessions during the school day
• Special education services

These resources aim to ensure that young people with speech impairments don’t fall behind in academic and social settings.

Digital Tools

In the modern world, digital innovation plays a significant role in helping individuals manage speech impairments. Various mobile apps focus on different areas of speech development:

• Pronunciation
• Vocabulary building
• Sentence construction
• Fluency exercises

These tools are accessible and convenient to use on the go or comfortably from your home, adding a practical method to target your speech impairment.

In this digitized world, remember that support for managing your speech impairment is only a few clicks away. Dive into these resources, find what works best for you, and don’t let incapacities prevent you from effectively expressing yourself. Instead, arm yourself with the tools and interventions that’ll help you develop your speech skills and break down communication barriers.

You’ve seen the profound impact speech impairments can have on daily life. Yet, it’s important to remember that these challenges can be managed with the right resources and support. Therapeutic interventions, educational programs, and digital tools are available to help individuals navigate through their speech impairments. Don’t let a speech impairment hold you back. It’s a hurdle, not a full stop. With resilience and the right support, you can improve your speech, engage in social interactions, and excel in your professional tasks. Remember, it’s not about the impairment itself, but how you choose to manage it. So, is speech impairment a disability? It can be. But with the right approach, it doesn’t have to disable your ability to communicate effectively. Explore these resources, embrace the support, and let your voice be heard.

Understanding speech impairments involves recognizing their classification as disabilities and the implications for educational support. According to ASHA , speech impairments include difficulties with articulation, fluency, and voice, which can affect communication and learning. Understood.org emphasizes that early intervention and speech therapy are critical for improving outcomes for students with speech impairments.

What is the impact of speech impairments on daily life?

Speech impairments can make social interaction, professional tasks, and everyday activities challenging. The magnitude of impact can depend on the severity of the impairment, the individual’s resilience, and the level of support available.

What are some specific types of speech impairments?

The article discusses various types of speech impairments and their unique challenges. It does not detail each type but implies they include a wide range from pronunciation issues to fluency complications.

What services are available to support individuals with speech impairments?

Individuals with speech impairments can benefit from therapeutic interventions such as speech and language therapy. Educational support centers and individualized education programs are also available. Digital tools and mobile apps contribute significantly to speech development.

Can digital tools aid individuals with speech impairments?

Yes, digital tools, such as mobile apps, can assist in improving pronunciation, vocabulary building, sentence construction, and fluency exercises. These tools provide accessible and interactive aid, therefore, highly recommended.

What message does the article convey to individuals with speech impairments?

The article encourages individuals with speech impairments not to allow their limitations to prevent effective expression. It encourages the exploration and utilization of available resources to manage and improve their conditions.

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What to Know About Speech Impairment

A speech impairment affects people who have problems speaking in a regular tone of voice or tempo. Speech impairments make it hard for people to communicate properly, and they can happen in both children and adults. ‌

These disorders can cause frustration and embarrassment to the person suffering from them.

What is Speech Impairment?

People who have speech impairments have a hard time pronouncing different speech sounds. They might distort the sounds of some words and leave other sounds out completely.

There are three general categories of speech impairment:

• Fluency disorder. This type can be described as continuity, smoothness, rate, and effort in speech production.
• Voice disorder. A voice disorder means you have an atypical tone of voice. It could be an unusual pitch, quality, resonance, or volume.
• Articulation disorder. If you have an articulation disorder, you might distort certain sounds. You could also fully omit sounds.

Stuttering , or stammering, is a common fluency disorder that affects about 3 million Americans. It usually affects young children who are just learning to speak, but it can continue on into adulthood.

Speech and language impairments are two words that are often used interchangeably, but they are two very different types of problems.

Speech means talking. It uses the jaw muscles, tongue, lips, and vocal chords. Language is a set of words and symbols made to communicate a message. Language and speech disorders can affect you separately, or both can happen at the same time.

Types of Speech Impairments

Speech impairments can begin in childhood and carry on through your adult years. Others can happen due to trauma, or after a medical event like a stroke.

The types of speech impairments are:

• Childhood apraxia of speech. This can happen to children when it’s time for them to start talking. The brain’s signals don’t communicate with the mouth, so the child can’t move their lips and tongue in the way they’re mean to.
• Dysarthria. This type of speech impairment happens when the muscles you use to talk are too weak, and can’t form words properly.
• Orofacial myofunctional disorders (OMD). OMDs are characterized by an abnormal pattern of facial muscle use. OMD interferes with how the facial muscles, including the tongue, are used. People who suffer from OMD might also struggle to breathe through their nose.
• Speech sound disorders. It’s normal for children to struggle to pronounce certain sounds as they learn to talk. But after ages four or five, constant mispronunciation might signal a problem. It can continue into adulthood, or some people get it after a stroke.
• Stuttering. Stuttering can mean repeating words or sounds like “uh” and “um” (disfluencies) involuntarily. Stuttering can be intensified by strong emotions or stress.
• Voice. A voice disorder can mean you “lost” your voice because you stressed it too much. It can also mean a chronic cough or paralysis of the vocal cords, among others.

Health Issues That Affect Speech Impairment

Other than childhood speech impairments, there are a range of reasons you could get one in your adult years. They can happen due to a traumatic event, illness, or surgery.

Dysarthria , aphasia, and voice disturbances can happen in adulthood, and are usually due to these medical events.

Aphasia. Aphasia is the loss of ability to understand words, spoken or written. There are many types of aphasia . It can happen after a stroke or if a tumor reaches the part of the brain where language is processed.

Medical issues that can cause aphasia:

• Head trauma
• Transient ischemic attack (TIA)
• Brain tumor
• Alzheimer’s disease

Dysarthria. Dysarthria is usually caused by a nerve problem. The person suffering from it loses the ability to make certain sounds or might have poor pronunciation. It can also affect your ability to control the tongue, larynx, lips, and vocal chords.

Medical issues that can cause dysarthria:

• Facial trauma
• Diseases that affect your nervous system
• Side effects of certain medication
• Alcoholic intoxication
• Dentures that don’t fit properly
• Transient ischemic attack (TIA) ‌

Voice disturbances. Traumatic events or extreme stress placed on the vocal cords can cause you to “lose” your voice or have a vocal disturbance. Disease can also affect the way your voice sounds.

Cancerous or noncancerous growths or nodules on the vocal cords can make your voice sound different.

Understanding Speech Impairments

Having a speech impairment can be a very frustrating and embarrassing experience for the person experiencing it. It’s important to be patient and understanding when communicating.

Try the following tips to improve communication and foster an accepting environment with someone who has a speech impairment:

• Speak slowly and use hand gestures
• Keep a pen and paper handy in case it’s needed to communicate
• Maintain a calm environment free of stimulating sounds
• Use simple phrases when you speak
• Use your normal tone of voice

Consulting with a mental health care provider can help with feelings of anger and depression that can accompany speech impairments.

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The 13 disability categories under IDEA

How do kids qualify for special education? Learn about the 13 disability categories and other important details about Individualized Education Programs (IEPs).

By Julie Rawe

Expert reviewed by Rayma Griffin, MA, MEd

Updated April 9, 2024

What are the 13 disability categories in special education ? And why do they matter?

To qualify for services, kids need to have a disability that impacts their schooling. The Individuals with Disabilities Education Act (IDEA) groups disabilities into 13 categories. But this doesn’t mean the law only covers 13 disabilities . Some of the categories cover a wide range of challenges.

IDEA disability categories

To get an Individualized Education Program (IEP), kids need to meet the requirements for at least one category. Keep reading to learn about the 13 disability categories and why all of them require finding that the disability “adversely affects” a child’s education.

1. Specific learning disability (SLD)

This category covers a wide range of learning challenges. These include differences that make it hard to read, write, listen, speak, reason, or do math. Here are some common examples of specific learning disabilities (SLD):

Dyscalculia

Written expression disorder (you may also hear this referred to as dysgraphia)

This is by far the most common category in special education. The numbers vary a bit from year to year. But students with learning disabilities tend to make up about a third of all students who have IEPs. In the 2020–21 school year, around 35 percent of students who had IEPs qualified under this category.

2. Speech or language impairment

This is the second most common category in special education. A lot of kids have IEPs for speech impediments. Common examples include lisping and stuttering.

Language disorders can be covered in this category too. Or they can be covered in the learning disability category. These disorders make it hard for kids to understand words or express themselves.

3. Other health impairment

This is another commonly used category. It covers a wide range of conditions that may limit a child’s strength, energy, or alertness. One example is ADHD . Many kids who qualify for an IEP under this category have attention deficits.

Other examples in this category include epilepsy, sickle cell anemia, and Tourette syndrome.

4. Autism spectrum disorder (ASD)

ASD is a common developmental disability. It affects social and communication skills. It can also impact behavior.

5. Intellectual disability

This category covers below-average intellectual ability. Kids with Down syndrome often qualify for special education under this category.

6. Emotional disturbance

This category covers mental health issues. Examples include anxiety disorder, bipolar disorder, and oppositional defiant disorder. (Some emotional or conduct disorders may also be covered under “other health impairment.”)

7. Developmental delay

This category can be used for young kids who are late in meeting developmental milestones like walking and talking.

Different states have different rules about this category. It’s also the only category in IDEA that has an age limit. It can’t be used after age 9.

8. Multiple disabilities

Many kids have more than one disability, such as ADHD and autism. But this category is only used when the combination of disabilities requires a highly specialized approach, such as intellectual disability and blindness. 

9. Hearing impairment, including deafness

This category includes a range of hearing issues that can be permanent or that can change over time. (This category does not include auditory processing disorder , which is considered a learning disability.)

10. Orthopedic impairment

This category covers issues with bones, joints, and muscles. One example is cerebral palsy.

11. Visual impairment, including blindness

This category covers a range of vision problems, including partial sight and blindness. But if eyewear can correct a vision problem, then a child wouldn’t qualify for special education under this category.

12. Traumatic brain injury

This category covers brain injuries that happen at some point after a child is born. These can be caused by things like being shaken as a baby or hitting your head in an accident.

13. Deaf-blindness

This category covers kids with severe hearing and vision loss. Their communication challenges are so unique that programs for just the deaf or blind can’t meet their needs.

What “adversely affects” means

Kids need to have a disability to qualify for special education. But IDEA says schools must also find that the disability “adversely affects” a child’s performance in school. This means it has to have a negative impact on how the student is doing in school.

Learn how schools decide if a child is eligible for special education .

Primary disability category

When kids have more than one disability, it’s a good idea to include all of them in the IEP. This can help get the right services and supports in place.

But the IEP will likely need to list a primary disability category. This is mainly for data-tracking reasons and will not limit the amount or type of services a child receives.

Variations in some states

Depending on where you live, your state may have more than 13 disability categories. For example, some states may split hearing impairment and deafness into two categories.

In most states, a child’s disability category is listed in their IEP. Iowa is the only state that doesn’t do this. (But it still keeps track of disability categories and reports this data to the federal government.)

To learn more about the categories in your state, contact a Parent Training and Information Center . They’re free and there’s at least one in every state.

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Can I get Disability Benefits for a Speech Disorder?

Can i get disability benefits if i am suffering from the effects of a speech disorder.

Author Attorney Lloyd Bemis:

One of the main ways we express our thoughts, feelings and ideas to one another is through speech. A speech disorder can prevent a person from communicating effectively and impact their employment and personal life. If you have a speech disorder you may qualify for Social Security disability benefits.

If you are experiencing loss of speech and it has prevented you from working full-time, you may be eligible for Social Security Disability Income.

Speech disorders can affect a person at any age and occur when a person is unable to produce sounds correctly or has problems with their voice..

Symptoms of speech disorders include:

•    Difficulty pronouncing words correctly
•   Struggling to say the correct word or sound
•   Repeating or distorting sounds
•   Adding sounds or syllables to words
•   Rearranging syllables
•   Speaking with a hoarse or raspy voice
•   Speaking very softly

These or a combination of these symptoms can cause you to miss work and jeopardize your ability to maintain employment.

The American Speech-Language-Hearing Association estimates that approximately 5% -10% of Americans may have a communication disorder and more than 3 million Americans stutter.

There are many types of speech impairments that can impact a person’s ability to speak..

•    Dysarthria. Muscle weakness in the face and throat caused by injury to the brain results in slurred speech, speaking very softly, mumbling, speaking too slowly or too quickly.
•    Spasmodic dysphonia. Involuntary movements of the vocal cords cause hoarseness in the voice.
•    Apraxia. Brain damage impairs a person’s motor skills and affects their ability to form sounds and words, even when the individual knows what they want to say.
•    Stuttering. A disorder that interrupts the flow of speech, involuntarily repeating words or sounds.
•    Dysprosody. A neurological disorder characterized by changes in volume, rhythm, cadence and intonation of words.
•    Aphasia. A language disorder caused by a stroke or brain damage that affects speech, listening, reading and writing.
•    Muteness. Inability to speak caused by damage to the brain or speech muscles, or the result of emotional or psychological trauma.

Contact a Social Security disability attorney at 512-454-4000 for a free consultation and see if you can get disability benefits while suffering from a speech disorder. If you have been denied disability don’t give up!

Treatment for a speech impairment depends on the severity of the disorder and its underlying cause(s)..

Typically, treatment involves exercises that focus on building familiarity with words and sounds as well as physical exercises to strengthen the muscles used in speaking. Medication may also be prescribed to alleviate any anxiety or stress a patient may be experiencing. Demonstrating that you are following your doctor’s treatment plan is an important part of qualifying for disability benefits.

Speech Impairments and Qualifying for Social Security Disability Benefits

If your speech impairment is so severe it prevents you from working and interferes with your daily tasks, you may be eligible for ssdi benefits..

Basically, there are two ways to qualify: 1) you must meet the requirements of an impairment listing in Social Security’s Blue Book; or 2) you must be unable to perform any job safely because of your speech impairment.

Social Security lists loss of speech as an impairment under Section 2.09.

To qualify for SSDI under this listing you must be unable to produce any speech that can be “heard, understood, or sustained.” This means that if you use esophageal speech speech (a method of speaking which is used by individuals whose larynx has been removed) or electronic devices such as an electrolarynx (a battery-operated machine that produces sound to create a voice) to articulate and you can speak well enough to be understood by others, you probably won’t meet the criteria of this listing. You do not need to provide a specific cause for your speech impairment, but you do need to provide evidence that you are not able to communicate effectively with others.

Social Security will only use the Section 2.09 Loss of speech listing to evaluate your impairment if your speech impairment is related to the physical structures of speech; that is, the larynx, tongue or pharynx.

If another medical condition such as a stroke, traumatic brain injury or cerebral palsy is responsible for your speech impairment, your disability will be evaluated under that Blue Book listing. Likewise, if your speech impairment is caused by a mental disorder, it will be evaluated under that impairment.

In order to qualify, you will need to provide documentation to Social Security proving the severity of your speech impairment and its impact on your employment and finances.

With your application you should submit:

•    Statements from doctors confirming loss of speech (for at least 12 months)
•   Results of diagnostic tests performed by speech pathologists
•   Treatment procedures and responses to treatment
•   Medical invoices associated with diagnosis, treatment and rehabilitation

If your disability doesn’t match a Social Security impairment listing criteria, but still impacts your work life severely, Social Security will perform a Residual Functional Capacity (RFC) assessment to determine how your speech impairment affects your job performance.

Speech disorders create barriers to communication, making it difficult to talk on the phone, interact with customers or coworkers, and respond to directions from supervisors. Social Security will evaluate your ability to speak, hear, feel and adapt to your environment, as well as your ability to understand instructions, complete tasks in a timely manner, and handle stress at work. The RFC may conclude that you cannot work in any job that requires proper speech, such as teaching, sales, or phone work. If you are no longer able to perform the tasks of your previous job, Social Security will consider other jobs you can do. If you are 55 or older with limited education and job skills, Social Security may find there is no other work you can perform and approve Social Security Disability benefits.

Additionally, if an applicant has multiple medical conditions, Social Security must consider how those health issues, combined together, limit an applicant’s ability to hold a job and perform necessary daily tasks.

Applicants often have more than one illness or injury that prevents them from working full time. By itself one disorder may not meet the requirements of an impairment as stated in Social Security’s Blue Book; however, if you have another impairment; for example, high blood pressure, you may still be eligible for SSDI.

In order to qualify for Social Security Disability, you will need to satisfy a few specific requirements in two categories as determined by the Social Security Administration.

The first category is the work requirements which has two tests..

•    The Duration of Work test.    Whether you have worked long enough to be covered under SSDI.
•    The Current Work Test.    Whether you worked recently enough for the work to actually count toward coverage.

The second category is the Medical Eligibility Requirement.

•    Are you working?    Your disability must be “total”.
•    Is your medical condition severe?    Your disability must be “severe” enough to interfere with your ability to perform basic work-related activities, such as walking, sitting, and remembering.
•    Is your medical condition on the List of Impairments?   The SSA has a “List of Impairments” that automatically qualify as “severe” disabilities. If your disease is not listed this does not mean you cannot get disability, it means you must prove you cannot maintain employment due to your limitations.
•    Can you do the work you did before?    SSDI rules look at whether your medical condition prevents you from doing the work you did prior to developing the condition.
•    Can you do any other type of work?    If you cannot do your prior work, an evaluation is made as to whether you can perform any other kind of work.

More details can be found on our Qualifying for Disability page.

Disability benefits are an important source of income for those who are unable to work. If you are not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.

Email us at: [email protected].

~~~~~~~~~~~~~~~~~~~~~~~

Try these links for further reading on this subject:

When Should I apply for Social Security Disability? It helps to have a supportive doctor when you file for disability What Information will I need to apply for SSDI?

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We offer each of our prospective clients a free no obligation one hour phone or office consultation to see if we can help you and if you are comfortable with us. We know how difficult a time like this can be and how hard the decisions are. If we can be of assistance to you and help you find a solution to your issue we will even if that means referring you to another attorney.

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Overcoming Speech Impediment: Symptoms to Treatment

There are many causes and solutions for impaired speech

• Types and Symptoms
• Speech Therapy
• Building Confidence

Speech impediments are conditions that can cause a variety of symptoms, such as an inability to understand language or speak with a stable sense of tone, speed, or fluidity. There are many different types of speech impediments, and they can begin during childhood or develop during adulthood.

Common causes include physical trauma, neurological disorders, or anxiety. If you or your child is experiencing signs of a speech impediment, you need to know that these conditions can be diagnosed and treated with professional speech therapy.

This article will discuss what you can do if you are concerned about a speech impediment and what you can expect during your diagnostic process and therapy.

FG Trade / Getty Images

Types and Symptoms of Speech Impediment

People can have speech problems due to developmental conditions that begin to show symptoms during early childhood or as a result of conditions that may occur during adulthood. 

The main classifications of speech impairment are aphasia (difficulty understanding or producing the correct words or phrases) or dysarthria (difficulty enunciating words).

Often, speech problems can be part of neurological or neurodevelopmental disorders that also cause other symptoms, such as multiple sclerosis (MS) or autism spectrum disorder .

There are several different symptoms of speech impediments, and you may experience one or more.

Can Symptoms Worsen?

Most speech disorders cause persistent symptoms and can temporarily get worse when you are tired, anxious, or sick.

Symptoms of dysarthria can include:

• Slurred speech
• Slow speech
• Choppy speech
• Hesitant speech
• Inability to control the volume of your speech
• Shaking or tremulous speech pattern
• Inability to pronounce certain sounds

Symptoms of aphasia may involve:

• Speech apraxia (difficulty coordinating speech)
• Difficulty understanding the meaning of what other people are saying
• Inability to use the correct words
• Inability to repeat words or phases
• Speech that has an irregular rhythm

You can have one or more of these speech patterns as part of your speech impediment, and their combination and frequency will help determine the type and cause of your speech problem.

Causes of Speech Impediment

The conditions that cause speech impediments can include developmental problems that are present from birth, neurological diseases such as Parkinson’s disease , or sudden neurological events, such as a stroke .

Some people can also experience temporary speech impairment due to anxiety, intoxication, medication side effects, postictal state (the time immediately after a seizure), or a change of consciousness.

Speech Impairment in Children

Children can have speech disorders associated with neurodevelopmental problems, which can interfere with speech development. Some childhood neurological or neurodevelopmental disorders may cause a regression (backsliding) of speech skills.

Common causes of childhood speech impediments include:

• Autism spectrum disorder : A neurodevelopmental disorder that affects social and interactive development
• Cerebral palsy :  A congenital (from birth) disorder that affects learning and control of physical movement
• Hearing loss : Can affect the way children hear and imitate speech
• Rett syndrome : A genetic neurodevelopmental condition that causes regression of physical and social skills beginning during the early school-age years.
• Adrenoleukodystrophy : A genetic disorder that causes a decline in motor and cognitive skills beginning during early childhood
• Childhood metabolic disorders : A group of conditions that affects the way children break down nutrients, often resulting in toxic damage to organs
• Brain tumor : A growth that may damage areas of the brain, including those that control speech or language
• Encephalitis : Brain inflammation or infection that may affect the way regions in the brain function
• Hydrocephalus : Excess fluid within the skull, which may develop after brain surgery and can cause brain damage

Do Childhood Speech Disorders Persist?

Speech disorders during childhood can have persistent effects throughout life. Therapy can often help improve speech skills.

Speech Impairment in Adulthood

Adult speech disorders develop due to conditions that damage the speech areas of the brain.

Common causes of adult speech impairment include:

• Head trauma 
• Nerve injury
• Throat tumor
• Stroke 
• Parkinson’s disease 
• Essential tremor
• Brain tumor
• Brain infection

Additionally, people may develop changes in speech with advancing age, even without a specific neurological cause. This can happen due to presbyphonia , which is a change in the volume and control of speech due to declining hormone levels and reduced elasticity and movement of the vocal cords.

Do Speech Disorders Resolve on Their Own?

Children and adults who have persistent speech disorders are unlikely to experience spontaneous improvement without therapy and should seek professional attention.

Steps to Treating Speech Impediment 

If you or your child has a speech impediment, your healthcare providers will work to diagnose the type of speech impediment as well as the underlying condition that caused it. Defining the cause and type of speech impediment will help determine your prognosis and treatment plan.

Sometimes the cause is known before symptoms begin, as is the case with trauma or MS. Impaired speech may first be a symptom of a condition, such as a stroke that causes aphasia as the primary symptom.

The diagnosis will include a comprehensive medical history, physical examination, and a thorough evaluation of speech and language. Diagnostic testing is directed by the medical history and clinical evaluation.

Diagnostic testing may include:

• Brain imaging , such as brain computerized tomography (CT) or magnetic residence imaging (MRI), if there’s concern about a disease process in the brain
• Swallowing evaluation if there’s concern about dysfunction of the muscles in the throat
• Electromyography (EMG) and nerve conduction studies (aka nerve conduction velocity, or NCV) if there’s concern about nerve and muscle damage
• Blood tests, which can help in diagnosing inflammatory disorders or infections

Your diagnostic tests will help pinpoint the cause of your speech problem. Your treatment will include specific therapy to help improve your speech, as well as medication or other interventions to treat the underlying disorder.

For example, if you are diagnosed with MS, you would likely receive disease-modifying therapy to help prevent MS progression. And if you are diagnosed with a brain tumor, you may need surgery, chemotherapy, or radiation to treat the tumor.

Therapy to Address Speech Impediment

Therapy for speech impairment is interactive and directed by a specialist who is experienced in treating speech problems . Sometimes, children receive speech therapy as part of a specialized learning program at school.

The duration and frequency of your speech therapy program depend on the underlying cause of your impediment, your improvement, and approval from your health insurance.

If you or your child has a serious speech problem, you may qualify for speech therapy. Working with your therapist can help you build confidence, particularly as you begin to see improvement.

Exercises during speech therapy may include:

• Pronouncing individual sounds, such as la la la or da da da
• Practicing pronunciation of words that you have trouble pronouncing
• Adjusting the rate or volume of your speech
• Mouth exercises
• Practicing language skills by naming objects or repeating what the therapist is saying

These therapies are meant to help achieve more fluent and understandable speech as well as an increased comfort level with speech and language.

Building Confidence With Speech Problems 

Some types of speech impairment might not qualify for therapy. If you have speech difficulties due to anxiety or a social phobia or if you don’t have access to therapy, you might benefit from activities that can help you practice your speech. 

You might consider one or more of the following for you or your child:

• Joining a local theater group
• Volunteering in a school or community activity that involves interaction with the public
• Signing up for a class that requires a significant amount of class participation
• Joining a support group for people who have problems with speech

Activities that you do on your own to improve your confidence with speaking can be most beneficial when you are in a non-judgmental and safe space.

Many different types of speech problems can affect children and adults. Some of these are congenital (present from birth), while others are acquired due to health conditions, medication side effects, substances, or mood and anxiety disorders. Because there are so many different types of speech problems, seeking a medical diagnosis so you can get the right therapy for your specific disorder is crucial.

Centers for Disease Control and Prevention. Language and speech disorders in children .

Han C, Tang J, Tang B, et al. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: a systematic review and meta-analysis . Medicine (Baltimore). 2024;103(2):e36880. doi:10.1097/MD.0000000000036880

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, language .

Mackey J, McCulloch H, Scheiner G, et al. Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience . Brain Impair. 2023;24(2):168-184. doi:10.1017/BrImp.2023.9

Allison KM, Doherty KM. Relation of speech-language profile and communication modality to participation of children with cerebral palsy . Am J Speech Lang Pathol . 2024:1-11. doi:10.1044/2023_AJSLP-23-00267

Saccente-Kennedy B, Gillies F, Desjardins M, et al. A systematic review of speech-language pathology interventions for presbyphonia using the rehabilitation treatment specification system . J Voice. 2024:S0892-1997(23)00396-X. doi:10.1016/j.jvoice.2023.12.010

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

What is a speech impairment?

A speech impairment refers to an impaired ability to produce speech sounds and may range from mild to severe. It may include an articulation disorder, characterized by omissions or distortions of speech sounds; a fluency disorder, characterized by atypical flow, rhythm, and/or repetitions of sounds; or a voice disorder, characterized by abnormal pitch, volume, resonance, vocal quality, or duration.

The American Speech-Language Hearing Association (ASHA) has published its official definitions in Definitions of Communication Disorders and Variations .

Additional information is available from Speech and Language Impairments  hosted by the Center for Parent Information and Resources.

Childhood Speech Disorders and Disability Benefits

Technically Qualifying for Social Security

All children are eligible for Supplemental Security Income, or SSI benefits. SSI is only awarded to families with a severe financial need. This means that if you or your spouse earns a decent wage, you will not be eligible for disability benefits. The larger your family, the higher your monthly income limit will be.

For example, if you’re a single parent and you have one child, you cannot earn more than $38,000 before taxes in 2018 and still qualify for SSI. If you are a two-parent household of five, you could earn a little over $55,000 and still qualify. You can view a chart on the SSA’s website to determine how much your unique family could make while still qualifying.

Unfortunately, most children are denied SSI benefits due to household income limits. The good news is once your child turns 18, your income will no longer against your child, even if he or she still lives at home.

Medically Qualifying With a Speech Impairment

All conditions that qualify for disability benefits can be found in the Blue Book , the SSA’s manual of qualification criteria. There is a separate version of the Blue Book for both children and adults. Children do not qualify for a speech disorder alone, so this means that if your child has no other diagnoses or disabilities, he or she will unfortunately not qualify for disability benefits due to an inability to speak.

If your child’s speech impairment is cause by another condition, he or she may be eligible. There are many qualifying conditions listed in the Blue Book, but some conditions that often qualify include:

Autism can be found in Section 112.10 of the Blue Book. Under this listing, your child will qualify if he or she has measurable difficulty in any form of communication (verbal, nonverbal, social interaction) and has severely limited interests or participates in repetitive patterns of behavior. Children with autism will also need to have medical evidence proving severe difficulty with one of the following areas of physical functioning:

• Understanding and remembering information
• Interacting with others (playing with children, following adults’ instructions)
• Concentrating and accomplishing tasks
• “Adapting oneself,” which means controlling emotions in a school setting

Down syndrome, on the other hand, will automatically medically qualify with a karyotype analysis. The only exception is if your child has Mosaic Down syndrome (2% of the Down syndrome population), which often has less severe health and intellectual complications will need a little more medical evidence.

Starting Your Application

Before applying, you should always review the Child Disability Starter Kit to get a list of all documents needed before officially applying. You’ll have to apply for SSI benefits in person at your local SSA office . Your child does not have to be present for the application process. To schedule an appointment to apply in person, call the SSA toll free at 1-800-772-1213.

Helpful Resources:

Household SSI Limits: https://www.ssa.gov/ssi/text-child-ussi.htm

Childhood Blue Book: https://www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm?PHPSESSID=2e1852cec574b204c1062189dbe882f2

Local SSA Office: https://www.disability-benefits-help.org/social-security-disability-locations

Child Disability Starter Kit: https://www.ssa.gov/disability/disability_starter_kits_child_eng.htm

Provided to ABC Pediatric Therapy Network, https://www.abcpediatrictherapy.com by:

Deanna Power

Director of Outreach

Disability Benefits Help

Developmental Checklist

Is your child meeting their developmental milestones? 

10 Most Common Speech-Language Disorders & Impediments

As you get to know more about the field of speech-language pathology you’ll increasingly realize why SLPs are required to earn at least a master’s degree . This stuff is serious – and there’s nothing easy about it.

In 2016 the National Institute on Deafness and Other Communication Disorders reported that 7.7% of American children have been diagnosed with a speech or swallowing disorder. That comes out to nearly one in 12 children, and gets even bigger if you factor in adults.

Whether rooted in psycho-speech behavioral issues, muscular disorders, or brain damage, nearly all the diagnoses SLPs make fall within just 10 common categories…

Types of Speech Disorders & Impediments

Apraxia of speech (aos).

Apraxia of Speech (AOS) happens when the neural pathway between the brain and a person’s speech function (speech muscles) is lost or obscured. The person knows what they want to say – they can even write what they want to say on paper – however the brain is unable to send the correct messages so that speech muscles can articulate what they want to say, even though the speech muscles themselves work just fine. Many SLPs specialize in the treatment of Apraxia .

There are different levels of severity of AOS, ranging from mostly functional, to speech that is incoherent. And right now we know for certain it can be caused by brain damage, such as in an adult who has a stroke. This is called Acquired AOS.

However the scientific and medical community has been unable to detect brain damage – or even differences – in children who are born with this disorder, making the causes of Childhood AOS somewhat of a mystery. There is often a correlation present, with close family members suffering from learning or communication disorders, suggesting there may be a genetic link.

Mild cases might be harder to diagnose, especially in children where multiple unknown speech disorders may be present. Symptoms of mild forms of AOS are shared by a range of different speech disorders, and include mispronunciation of words and irregularities in tone, rhythm, or emphasis (prosody).

Stuttering – Stammering

Stuttering, also referred to as stammering, is so common that everyone knows what it sounds like and can easily recognize it. Everyone has probably had moments of stuttering at least once in their life. The National Institute on Deafness and Other Communication Disorders estimates that three million Americans stutter, and reports that of the up-to-10-percent of children who do stutter, three-quarters of them will outgrow it. It should not be confused with cluttering.

Most people don’t know that stuttering can also include non-verbal involuntary or semi-voluntary actions like blinking or abdominal tensing (tics). Speech language pathologists are trained to look for all the symptoms of stuttering , especially the non-verbal ones, and that is why an SLP is qualified to make a stuttering diagnosis.

The earliest this fluency disorder can become apparent is when a child is learning to talk. It may also surface later during childhood. Rarely if ever has it developed in adults, although many adults have kept a stutter from childhood.

Stuttering only becomes a problem when it has an impact on daily activities, or when it causes concern to parents or the child suffering from it. In some people, a stutter is triggered by certain events like talking on the phone. When people start to avoid specific activities so as not to trigger their stutter, this is a sure sign that the stutter has reached the level of a speech disorder.

The causes of stuttering are mostly a mystery. There is a correlation with family history indicating a genetic link. Another theory is that a stutter is a form of involuntary or semi-voluntary tic. Most studies of stuttering agree there are many factors involved.

Dysarthria is a symptom of nerve or muscle damage. It manifests itself as slurred speech, slowed speech, limited tongue, jaw, or lip movement, abnormal rhythm and pitch when speaking, changes in voice quality, difficulty articulating, labored speech, and other related symptoms.

It is caused by muscle damage, or nerve damage to the muscles involved in the process of speaking such as the diaphragm, lips, tongue, and vocal chords.

Because it is a symptom of nerve and/or muscle damage it can be caused by a wide range of phenomena that affect people of all ages. This can start during development in the womb or shortly after birth as a result of conditions like muscular dystrophy and cerebral palsy. In adults some of the most common causes of dysarthria are stroke, tumors, and MS.

A lay term, lisping can be recognized by anyone and is very common.

Speech language pathologists provide an extra level of expertise when treating patients with lisping disorders . They can make sure that a lisp is not being confused with another type of disorder such as apraxia, aphasia, impaired development of expressive language, or a speech impediment caused by hearing loss.

SLPs are also important in distinguishing between the five different types of lisps. Most laypersons can usually pick out the most common type, the interdental/dentalised lisp. This is when a speaker makes a “th” sound when trying to make the “s” sound. It is caused by the tongue reaching past or touching the front teeth.

Because lisps are functional speech disorders, SLPs can play a huge role in correcting these with results often being a complete elimination of the lisp. Treatment is particularly effective when implemented early, although adults can also benefit.

Experts recommend professional SLP intervention if a child has reached the age of four and still has an interdental/dentalised lisp. SLP intervention is recommended as soon as possible for all other types of lisps. Treatment includes pronunciation and annunciation coaching, re-teaching how a sound or word is supposed to be pronounced, practice in front of a mirror, and speech-muscle strengthening that can be as simple as drinking out of a straw.

Spasmodic Dysphonia

Spasmodic Dysphonia (SD) is a chronic long-term disorder that affects the voice. It is characterized by a spasming of the vocal chords when a person attempts to speak and results in a voice that can be described as shaky, hoarse, groaning, tight, or jittery. It can cause the emphasis of speech to vary considerably. Many SLPs specialize in the treatment of Spasmodic Dysphonia .

SLPs will most often encounter this disorder in adults, with the first symptoms usually occurring between the ages of 30 and 50. It can be caused by a range of things mostly related to aging, such as nervous system changes and muscle tone disorders.

It’s difficult to isolate vocal chord spasms as being responsible for a shaky or trembly voice, so diagnosing SD is a team effort for SLPs that also involves an ear, nose, and throat doctor (otolaryngologist) and a neurologist.

Have you ever heard people talking about how they are smart but also nervous in large groups of people, and then self-diagnose themselves as having Asperger’s? You might have heard a similar lay diagnosis for cluttering. This is an indication of how common this disorder is as well as how crucial SLPs are in making a proper cluttering diagnosis .

A fluency disorder, cluttering is characterized by a person’s speech being too rapid, too jerky, or both. To qualify as cluttering, the person’s speech must also have excessive amounts of “well,” “um,” “like,” “hmm,” or “so,” (speech disfluencies), an excessive exclusion or collapsing of syllables, or abnormal syllable stresses or rhythms.

The first symptoms of this disorder appear in childhood. Like other fluency disorders, SLPs can have a huge impact on improving or eliminating cluttering. Intervention is most effective early on in life, however adults can also benefit from working with an SLP.

Muteness – Selective Mutism

There are different kinds of mutism, and here we are talking about selective mutism. This used to be called elective mutism to emphasize its difference from disorders that caused mutism through damage to, or irregularities in, the speech process.

Selective mutism is when a person does not speak in some or most situations, however that person is physically capable of speaking. It most often occurs in children, and is commonly exemplified by a child speaking at home but not at school.

Selective mutism is related to psychology. It appears in children who are very shy, who have an anxiety disorder, or who are going through a period of social withdrawal or isolation. These psychological factors have their own origins and should be dealt with through counseling or another type of psychological intervention.

Diagnosing selective mutism involves a team of professionals including SLPs, pediatricians, psychologists, and psychiatrists. SLPs play an important role in this process because there are speech language disorders that can have the same effect as selective muteness – stuttering, aphasia, apraxia of speech, or dysarthria – and it’s important to eliminate these as possibilities.

And just because selective mutism is primarily a psychological phenomenon, that doesn’t mean SLPs can’t do anything. Quite the contrary.

The National Institute on Neurological Disorders and Stroke estimates that one million Americans have some form of aphasia.

Aphasia is a communication disorder caused by damage to the brain’s language capabilities. Aphasia differs from apraxia of speech and dysarthria in that it solely pertains to the brain’s speech and language center.

As such anyone can suffer from aphasia because brain damage can be caused by a number of factors. However SLPs are most likely to encounter aphasia in adults, especially those who have had a stroke. Other common causes of aphasia are brain tumors, traumatic brain injuries, and degenerative brain diseases.

In addition to neurologists, speech language pathologists have an important role in diagnosing aphasia. As an SLP you’ll assess factors such as a person’s reading and writing, functional communication, auditory comprehension, and verbal expression.

Speech Delay – Alalia

A speech delay, known to professionals as alalia, refers to the phenomenon when a child is not making normal attempts to verbally communicate. There can be a number of factors causing this to happen, and that’s why it’s critical for a speech language pathologist to be involved.

The are many potential reasons why a child would not be using age-appropriate communication. These can range anywhere from the child being a “late bloomer” – the child just takes a bit longer than average to speak – to the child having brain damage. It is the role of an SLP to go through a process of elimination, evaluating each possibility that could cause a speech delay, until an explanation is found.

Approaching a child with a speech delay starts by distinguishing among the two main categories an SLP will evaluate: speech and language.

Speech has a lot to do with the organs of speech – the tongue, mouth, and vocal chords – as well as the muscles and nerves that connect them with the brain. Disorders like apraxia of speech and dysarthria are two examples that affect the nerve connections and organs of speech. Other examples in this category could include a cleft palette or even hearing loss.

The other major category SLPs will evaluate is language. This relates more to the brain and can be affected by brain damage or developmental disorders like autism. There are many different types of brain damage that each manifest themselves differently, as well as developmental disorders, and the SLP will make evaluations for everything.

Issues Related to Autism

While the autism spectrum itself isn’t a speech disorder, it makes this list because the two go hand-in-hand more often than not.

The Centers for Disease Control and Prevention (CDC) reports that one out of every 68 children in our country have an autism spectrum disorder. And by definition, all children who have autism also have social communication problems.

Speech-language pathologists are often a critical voice on a team of professionals – also including pediatricians, occupational therapists, neurologists, developmental specialists, and physical therapists – who make an autism spectrum diagnosis .

In fact, the American Speech-Language Hearing Association reports that problems with communication are the first detectable signs of autism. That is why language disorders – specifically disordered verbal and nonverbal communication – are one of the primary diagnostic criteria for autism.

So what kinds of SLP disorders are you likely to encounter with someone on the autism spectrum?

A big one is apraxia of speech. A study that came out of Penn State in 2015 found that 64 percent of children who were diagnosed with autism also had childhood apraxia of speech.

This basic primer on the most common speech disorders offers little more than an interesting glimpse into the kind of issues that SLPs work with patients to resolve. But even knowing everything there is to know about communication science and speech disorders doesn’t tell the whole story of what this profession is all about. With every client in every therapy session, the goal is always to have the folks that come to you for help leave with a little more confidence than when they walked in the door that day. As a trusted SLP, you will build on those gains with every session, helping clients experience the joy and freedom that comes with the ability to express themselves freely. At the end of the day, this is what being an SLP is all about.

Ready to make a difference in speech pathology? Learn how to become a Speech-Language Pathologist today

• Emerson College - Master's in Speech-Language Pathology online - Prepare to become an SLP in as few as 20 months. No GRE required. Scholarships available.
• Arizona State University - Online - Online Bachelor of Science in Speech and Hearing Science - Designed to prepare graduates to work in behavioral health settings or transition to graduate programs in speech-language pathology and audiology.
• NYU Steinhardt - NYU Steinhardt's Master of Science in Communicative Sciences and Disorders online - ASHA-accredited. Bachelor's degree required. Graduate prepared to pursue licensure.
• Calvin University - Calvin University's Online Speech and Hearing Foundations Certificate - Helps You Gain a Strong Foundation for Your Speech-Language Pathology Career.

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Types of Speech Impediments

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Articulation Errors

Ankyloglossia, treating speech disorders.

A speech impediment, also known as a speech disorder , is a condition that can affect a person’s ability to form sounds and words, making their speech difficult to understand.

Speech disorders generally become evident in early childhood, as children start speaking and learning language. While many children initially have trouble with certain sounds and words, most are able to speak easily by the time they are five years old. However, some speech disorders persist. Approximately 5% of children aged three to 17 in the United States experience speech disorders.

There are many different types of speech impediments, including:

• Articulation errors

This article explores the causes, symptoms, and treatment of the different types of speech disorders.

Speech impediments that break the flow of speech are known as disfluencies. Stuttering is the most common form of disfluency, however there are other types as well.

Symptoms and Characteristics of Disfluencies

These are some of the characteristics of disfluencies:

• Repeating certain phrases, words, or sounds after the age of 4 (For example: “O…orange,” “I like…like orange juice,” “I want…I want orange juice”)
• Adding in extra sounds or words into sentences (For example: “We…uh…went to buy…um…orange juice”)
• Elongating words (For example: Saying “orange joooose” instead of "orange juice")
• Replacing words (For example: “What…Where is the orange juice?”)
• Hesitating while speaking (For example: A long pause while thinking)
• Pausing mid-speech (For example: Stopping abruptly mid-speech, due to lack of airflow, causing no sounds to come out, leading to a tense pause)

In addition, someone with disfluencies may also experience the following symptoms while speaking:

• Vocal tension and strain
• Head jerking
• Eye blinking
• Lip trembling

Causes of Disfluencies

People with disfluencies tend to have neurological differences in areas of the brain that control language processing and coordinate speech, which may be caused by:

• Genetic factors
• Trauma or infection to the brain
• Environmental stressors that cause anxiety or emotional distress
• Neurodevelopmental conditions like attention-deficit hyperactivity disorder (ADHD)

Articulation disorders occur when a person has trouble placing their tongue in the correct position to form certain speech sounds. Lisping is the most common type of articulation disorder.

Symptoms and Characteristics of Articulation Errors

These are some of the characteristics of articulation disorders:

• Substituting one sound for another . People typically have trouble with ‘r’ and ‘l’ sounds. (For example: Being unable to say “rabbit” and saying “wabbit” instead)
• Lisping , which refers specifically to difficulty with ‘s’ and ‘z’ sounds. (For example: Saying “thugar” instead of “sugar” or producing a whistling sound while trying to pronounce these letters)
• Omitting sounds (For example: Saying “coo” instead of “school”)
• Adding sounds (For example: Saying “pinanio” instead of “piano”)
• Making other speech errors that can make it difficult to decipher what the person is saying. For instance, only family members may be able to understand what they’re trying to say.

Causes of Articulation Errors

Articulation errors may be caused by:

• Genetic factors, as it can run in families
• Hearing loss , as mishearing sounds can affect the person’s ability to reproduce the sound
• Changes in the bones or muscles that are needed for speech, including a cleft palate (a hole in the roof of the mouth) and tooth problems
• Damage to the nerves or parts of the brain that coordinate speech, caused by conditions such as cerebral palsy , for instance

Ankyloglossia, also known as tongue-tie, is a condition where the person’s tongue is attached to the bottom of their mouth. This can restrict the tongue’s movement and make it hard for the person to move their tongue.

Symptoms and Characteristics of Ankyloglossia

Ankyloglossia is characterized by difficulty pronouncing ‘d,’ ‘n,’ ‘s,’ ‘t,’ ‘th,’ and ‘z’ sounds that require the person’s tongue to touch the roof of their mouth or their upper teeth, as their tongue may not be able to reach there.

Apart from speech impediments, people with ankyloglossia may also experience other symptoms as a result of their tongue-tie. These symptoms include:

• Difficulty breastfeeding in newborns
• Trouble swallowing
• Limited ability to move the tongue from side to side or stick it out
• Difficulty with activities like playing wind instruments, licking ice cream, or kissing
• Mouth breathing

Causes of Ankyloglossia

Ankyloglossia is a congenital condition, which means it is present from birth. A tissue known as the lingual frenulum attaches the tongue to the base of the mouth. People with ankyloglossia have a shorter lingual frenulum, or it is attached further along their tongue than most people’s.

Dysarthria is a condition where people slur their words because they cannot control the muscles that are required for speech, due to brain, nerve, or organ damage.

Symptoms and Characteristics of Dysarthria

Dysarthria is characterized by:

• Slurred, choppy, or robotic speech
• Rapid, slow, or soft speech
• Breathy, hoarse, or nasal voice

Additionally, someone with dysarthria may also have other symptoms such as difficulty swallowing and inability to move their tongue, lips, or jaw easily.

Causes of Dysarthria

Dysarthria is caused by paralysis or weakness of the speech muscles. The causes of the weakness can vary depending on the type of dysarthria the person has:

• Central dysarthria is caused by brain damage. It may be the result of neuromuscular diseases, such as cerebral palsy, Huntington’s disease, multiple sclerosis, muscular dystrophy, Huntington’s disease, Parkinson’s disease, or Lou Gehrig’s disease. Central dysarthria may also be caused by injuries or illnesses that damage the brain, such as dementia, stroke, brain tumor, or traumatic brain injury .
• Peripheral dysarthria is caused by damage to the organs involved in speech. It may be caused by congenital structural problems, trauma to the mouth or face, or surgery to the tongue, mouth, head, neck, or voice box.

Apraxia, also known as dyspraxia, verbal apraxia, or apraxia of speech, is a neurological condition that can cause a person to have trouble moving the muscles they need to create sounds or words. The person’s brain knows what they want to say, but is unable to plan and sequence the words accordingly.

Symptoms and Characteristics of Apraxia

These are some of the characteristics of apraxia:

• Distorting sounds: The person may have trouble pronouncing certain sounds, particularly vowels, because they may be unable to move their tongue or jaw in the manner required to produce the right sound. Longer or more complex words may be especially harder to manage.
• Being inconsistent in their speech: For instance, the person may be able to pronounce a word correctly once, but may not be able to repeat it. Or, they may pronounce it correctly today and differently on another day.
• Grasping for words: The person may appear to be searching for the right word or sound, or attempt the pronunciation several times before getting it right.
• Making errors with the rhythm or tone of speech: The person may struggle with using tone and inflection to communicate meaning. For instance, they may not stress any of the words in a sentence, have trouble going from one syllable in a word to another, or pause at an inappropriate part of a sentence.

Causes of Apraxia

Apraxia occurs when nerve pathways in the brain are interrupted, which can make it difficult for the brain to send messages to the organs involved in speaking. The causes of these neurological disturbances can vary depending on the type of apraxia the person has:

• Childhood apraxia of speech (CAS): This condition is present from birth and is often hereditary. A person may be more likely to have it if a biological relative has a learning disability or communication disorder.
• Acquired apraxia of speech (AOS): This condition can occur in adults, due to brain damage as a result of a tumor, head injury , stroke, or other illness that affects the parts of the brain involved in speech.

If you have a speech impediment, or suspect your child might have one, it can be helpful to visit your healthcare provider. Your primary care physician can refer you to a speech-language pathologist, who can evaluate speech, diagnose speech disorders, and recommend treatment options.

The diagnostic process may involve a physical examination as well as psychological, neurological, or hearing tests, in order to confirm the diagnosis and rule out other causes.

Treatment for speech disorders often involves speech therapy, which can help you learn how to move your muscles and position your tongue correctly in order to create specific sounds. It can be quite effective in improving your speech.

Children often grow out of milder speech disorders; however, special education and speech therapy can help with more serious ones.

For ankyloglossia, or tongue-tie, a minor surgery known as a frenectomy can help detach the tongue from the bottom of the mouth.

A Word From Verywell

A speech impediment can make it difficult to pronounce certain sounds, speak clearly, or communicate fluently. 

Living with a speech disorder can be frustrating because people may cut you off while you’re speaking, try to finish your sentences, or treat you differently. It can be helpful to talk to your healthcare providers about how to cope with these situations.

You may also benefit from joining a support group, where you can connect with others living with speech disorders.

National Library of Medicine. Speech disorders . Medline Plus.

Centers for Disease Control and Prevention. Language and speech disorders .

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Lee H, Sim H, Lee E, Choi D. Disfluency characteristics of children with attention-deficit/hyperactivity disorder symptoms . J Commun Disord . 2017;65:54-64. doi:10.1016/j.jcomdis.2016.12.001

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• v.10(6); 2008

Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood

Patricia a. prelock.

Department of Communication Sciences, University of Vermont, Burlington, Vermont

Tiffany Hutchins

Frances p. glascoe.

Department of Pediatrics, Vanderbilt University, Nashville, Tennessee

Disclosure: Tiffany Hutchins, PhD, has disclosed no relevant financial relationships in addition to her employment.

Disclosure: Frances P. Glascoe, PhD, has disclosed no relevant financial relationships in addition to her employment.

Abstract and Introduction

Speech-language problems are the most common disability of childhood yet they are the least well detected, particularly in primary care settings. The goal of this article is to: (1) define the nature of speech-language problems, their causes, and consequences; (2) facilitate early recognition by healthcare providers via accurate screening and surveillance measures suitable for busy clinics; and (3) describe the referral and intervention process.

Introduction

Speech-language deficits are the most common of childhood disabilities and affect about 1 in 12 children or 5% to 8% of preschool children. [1] The consequences of untreated speech-language problems are significant and lead to behavioral challenges, mental health problems, reading difficulties, [2] and academic failure including in-grade retention and high school dropout. [3] Yet, such problems are ones that are least well detected in primary care, [4] even though intervention is available and plentiful.

Speech-language impairments embrace a wide range of conditions that have, at their core, challenges in effective communication. As the term implies, they include speech disorders which refer to impairment in the articulation of speech sounds, fluency, and voice as well as language disorders which refer to impairments in the use of the spoken (or signed or written) system and may involve the form of language (grammar and phonology), the content of language (semantics), and the function of language (pragmatics). [5] These may also be described more generally as communication disorders which are typically classified by their impact on a child's receptive skills (ie, the ability to understand what is said or to decode, integrate, and organize what is heard) and expressive skills (ie, the ability to articulate sounds, use appropriate rate and rhythm during speech, exhibit appropriate vocal tone and resonance, and use sounds, words, and sentences in meaningful contexts). There are common conditions in infants, toddlers, and preschoolers that are associated with receptive and expressive communication challenges as presented in Table 1 . [6 – 17]

Disorders in Young Children Commonly Associated With Receptive and Expressive Communication Problems

It is important to distinguish speech and language impairment from language delay and language difference. Language delay is characterized by the emergence of language that is relatively late albeit typical in its pattern of development. In contrast to an impairment or a delay, a language difference is associated with systematic variation in vocabulary, grammar, or sound structures. Such variation is “used by a group of individuals [and] reflects and is determined by shared regional, social, or cultural and ethnic factors” and is not considered a disorder. [18]

Unfortunately, non-native speakers of English, speakers of various dialects (whose language also varies within dialect), and bilingual or multilingual speakers are frequently classified as language delayed or disordered when, in fact, they are language different [18 , 19] –although problems of underidentification also occur. This is particularly important in an increasingly pluralistic society such as ours in which 1 of 4 people identify as other than white non-Hispanic, approximately 17% of the population is bilingual (mostly speaking Spanish and English), and where minorities represent more than 50% of the population in several cities and counties. [20]

The overidentification of culturally and linguistically diverse populations commonly occurs when a mismatch is observed and incorrectly interpreted between a language used in a particular community and that of the majority culture. This may be seen most clearly in the improper use of formal tests of speech and language to assess the competencies of speakers who are dissimilar to the sample upon which the test was normed and developed. [21] Similar errors also occur during informal evaluations of language and literacy as when the sound structure of the language influences the spelling or grammatical conventions used in written discourse. [22] With regard to bilingualism, it is commonly assumed that children's acquisition of 1 or both languages is delayed; however, the effects of bilingualism are more complex and differ with the age of the child, the nature of the linguistic input, and the manner and timing of language acquisition. What is clear is that equivalent proficiency in each language should not be expected or assumed as this has the potential to lead to misidentification of a speech and language impairment. (For more information on the effects of bilingualism on language learning, see http://asha.org/public/speech/development/BilingualChildren.htm and http://asha.org/public/speech/development/second.htm ) In the case of culturally and linguistically diverse individuals, decisions to intervene and bring language use in line with that of the majority culture or promote proficiency in the dominant language are not inappropriate; however, such decisions must be seen as separate from the language difference vs disorder question.

In your experience, which of the following is the most important barrier to the effective assessment of speech and language impairment in young children? (Select only 1 answer.)

• ○ Variability in the development of speech and language in young children
• ○ Lack of effective screening tools that discriminate children with and without speech and language impairment
• ○ Lack of accurate parent interview tools that identify clear concerns in speech and language development
• ○ Insufficient time with young children in the clinical setting to observe speech and language skills
• ○ Inadequate understanding of milestones for speech and language development

How confident are you that you are up-to-date in the diagnosis and management of speech and language impairment in young children? (Select only 1 answer.)

• ○ Not at all confident
• ○ Somewhat confident
• ○ Confident
• ○ Very confident

All of the following statements about young children with speech and language impairment are true except :

• ○ Young children tend to produce words with sounds that are consistent with the words they already know
• ○ Young children are able to communicate intent before speaking their first words
• ○ Disfluency is a common occurrence in a young child's early speech
• ○ Children usually begin to put 2 words together at 30 months

Answer: Children usually begin to put 2 words together at 30 months. Children usually begin to put 2 words together at 18 months.

Etiology, Neurobiology, and Prevalence of Speech-Language Impairments

The etiology of most cases of speech-language impairments is unknown but diverse causes are suspected. The range of causes or origins includes anatomical abnormalities, cognitive deficits, faulty learning, genetic differences, hearing impairments, neurologic impairments, or physiologic abnormalities. [6] As noted above, language differences as revealed in the communication output associated with diverse cultural, ethnic, regional or social dialects are not considered disorders. [5] Speech and language impairments may be acquired (ie, result from illness, injury or environmental factors) or congenital (ie, present at birth).

Children with speech and language impairment are an under-representation of the broader occurrence of communication disorders, [23] especially considering the co-occurrence of communication disorders with other disabilities (eg, learning disabilities). Approximately 8% to 12% of preschool populations exhibit language impairments. [6] Among children enrolled in early intervention programs, 46% have communication impairments while 26% have developmental delays in multiple areas, usually including language skills. [24] These findings indicate that the most common presentation of disability in preschoolers involves problems with language.

In a family with a child with a speech and language impairment, which of the following would be clinically appropriate?

• ○ Reassure the parents that the child is just a late talker and will catch up
• ○ Urge the parents to have their child undergo genetic testing
• ○ Discourage the child's parents and sibling(s) from talking for the child as this may be a primary cause of a speech and language impairment
• ○ Advise the parent to have the child's hearing tested

Answer: Advise the parent to have the child's hearing tested. This is appropriate because hearing would be the first condition to rule out as a potential cause of a speech and language delay.

Course and Prognosis

Speech-language impairment sometimes emerges during infancy with challenges in response to sound, atypical birth cries, or limited response to others and progresses through the toddler and preschool age with limited comprehension of spoken language and difficult interactions with peers and others as well as delays in producing first words and word combinations. Speech and language difficulties often persist in school age with difficulties following directions, attending and comprehending oral and written language, and problems producing narratives and using language appropriately in social contexts. Parents are often the first to notice difficulties as they encounter other children with more advanced speech-language skills and thus often wonder if their child is behind. [25] Although many parents raise concerns to primary care providers, many do not. In turn, primary care providers who do not use quality screening tools often dismiss parental concerns with panaceas such as, “He's a boy. Boys talk later.” Or, “Let's give this some time and see if it continues.” Yet, parental concerns about speech and language are associated with developmental disabilities [26] and, thus, careful screening with accurate tools is the requisite response. [27]

The use of a “wait and see” approach underscores the difficulty in distinguishing children who are language delayed from those who have a speech and language impairment. Although most children who have aspeech and language impairment have a history of language delay, only one quarter to one half of late-talkers are eventually diagnosed with a language disorder. [19] In advocating for a more aggressive response for late-talking children, some have argued for careful scrutiny of other risk factors that may guide decisions to refer and intervene. [19] Predictors of a true speech and language impairment that should be considered include poor receptive language skills, [28] limited expressive language skills (eg, small vocabulary, few verbs), and limited development in the sound structure of a language (eg, limited number of consonants, limited variety in babbling structure, vowel errors). [26] Additional predictors include nonspeech (eg, behavioral problems, few gestures, little imitation or symbolic play), environmental (eg, low socioeconomic status, parental use of a directive rather than sensitive and responsive interactional style), and hereditary factors (eg, family history). [26] As a general recommendation, professionals are urged to consider a larger number of risk factors with greater concern. [26]

Often speech-language impairments can be difficult to distinguish from what is considered typical variations in speech and language. For example, disfluencies in speech may be either normal or abnormal. In the nonstuttering child, the most common disfluencies include 1-unit word repetitions (eg, “I… I want that”), interjections (eg, “I saw a… um… picture”), and revisions (eg, “I don't know where… Mommy, help me find my doll”) and, when combined, comprise no more than 10% of words spoken. [29] In the stuttering child, the fluency disorder typically emerges between the ages of 2 and 5 years, is more common among males than females, and is characterized by more than 10% disfluencies in speech, multi-unit syllable (eg, “s-s-s-s-s-September”) and word (eg, “That's my-my-my ball”) repetitions, and may be accompanied by secondary behaviors such as eye-blinking, head-bobbing, or grimacing, as well as feelings of frustration or embarrassment surrounding the stuttering event. [29]

Identification of speech and language impairments is further complicated by the fact that they often masquerade as other diagnostic conditions. For example, children with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) may in fact have an underlying language disorder. Differential diagnosis is challenged by the diagnostic criteria shared between the 2 conditions. Specifically, the diagnostic criteria for ADHD share several characteristics with language disorders including difficulty listening when spoken to, following instructions, talking excessively, blurting out answers, interrupting, and waiting for turns in conversation. [30] Similarly, 50% of preschoolers presenting for psychiatric services were found in several studies to have undiagnosed language impairment. [31 , 32]

The diagnostic criteria for speech-language impairments are defined both by the Diagnostic and Statistical Manual of Mental Disorders , 4th edition (DSM-IV) [33 , 34] and by the Individuals with Disabilities Education Act (IDEA) through the US Department of Education. Table 2 specifies the criteria for communication disorders as described in the DSM-IV. As an example of eligibility criteria for speech-language impairment in response to IDEA guidelines, Vermont indicates that children must demonstrate significant deficits greater than 2 standard deviations below the mean in listening comprehension (eg, measures of auditory (language) processing or comprehension of connected speech including semantics, syntax, phonology, recalling information, following directions and pragmatics) and/or oral expression (eg, measures of oral discourse-syntax, semantics, phonology and pragmatics; voice; fluency; articulation) to qualify as speech or language impaired. [35]

Characteristics of Communication Disorders as Described in the DSM-IV [33 , 34]

Distinguishing children with speech-language deficits from those with other disabilities is often a challenging task as several disabilities share characteristics and have similar diagnostic criteria. For example, an intellectual disability is one in which a child's performance falls at or below 1.5 standard deviations from the mean on a test of intellectual ability with concurrent deficits in adaptive behavior. Children with intellectual disabilities, however, often have significant challenges in receptive and expressive communication as is typical of children with speech and language impairments. Children with learning disabilities have deficits in 1 or more basic skill areas including oral expression and listening comprehension, challenges characteristic of children with speech-language impairments. Children with pervasive developmental disorders/autism exhibit marked impairments in communication and social interaction and restricted and repetitive stereotyped patterns of behavior. Although social impairment is a defining feature of autism, communication impairments are similar to those with a speech-language impairment.

Which of the following is not true of speech-language impairment?

• ○ Early intervention is critical as speech-language impairments place children at risk for later academic difficulties
• ○ Most children with speech-language impairments have intellectual deficits
• ○ Communication disorders may manifest themselves at different stages of life
• ○ Children with learning disabilities are likely to have speech and language impairments

Answer: Most children with speech-language impairments have intellectual deficits. Although many children who have mental retardation have speech-language impairments, most children with specific speech-language impairments have nonverbal intelligence within normal limits.

Screening and Early Assessment of Speech-Language Disorders

The American Academy of Pediatrics recommends ongoing surveillance and periodic use of broad-band screening measures at all well-visits. Table 3 provides information on a number of tools that have high levels of accuracy in detecting speech-language problems and other disabilities. All included measures were standardized on national samples, proven to be reliable, and validated against a range of measures. When used, referral rates to early intervention programs rise to meet prevalence. [36] In the absence of accurate measures, most providers rely on informal milestone checklists. These lack criteria and are probably the leading reason why only about 1 in 4 children with disabilities of any kind are referred for needed assistance.

Accurate Developmental, Mental Health/Behavioral, and Academic Screens Suitable for Primary Care *

© 2007, Glascoe FP. PEDS: Developmental Milestones Professionals Manual. Nashville, Tennessee: Ellsworth & Vandermeer Press, Ltd. Permission is given to reproduce this table.

The first column in Table 3 provides publication information and the cost of purchasing a specimen set. The “Description” column provides information on alternative ways, if available, to administer measures (eg, waiting rooms). The “Accuracy” column shows the percentage of patients with and without problems identified correctly. The “Time Frame/Costs” column shows the costs of materials per visit along with the costs of professional time (using an average salary of $50 per hour) needed to administer and interpret each measure. Time/cost estimates do not include expenses associated with referring. For parent report tools, administration time reflects not only scoring of test results, but also the relationship between each test's reading level and the percentage of parents with less than a high school education (who may or may not be able to complete measures in waiting rooms due to literacy problems and will need interview administrations).

Even when screens are deployed, it is nevertheless helpful to complement these brief measures with clinical observation. The brevity of screens useful for primary care means that some skills may not be captured. For example, at any given age range, a brief screen may not present articulation items, measure ability to repeat a story, describe daily events, ask questions, or engage in conversation, etc. The value in routinely administering validated, accurate screening tools, however, is essential to improving currently problematic and extremely low rates of early detection on the part of primary healthcare providers.

Table 4 describes some major language developmental milestones in the prelinguistic (birth to 1 year) and linguistic period (1 year and beyond). [37 , 38] It is important to note that there are wide variations in the speed (and style) with which typically developing children acquire language skills.

Average Age and Range of Ages for Achievement for Important Language Developmental Milestones * [37 , 38]

Providers are reminded that these indicators are an aid to early detection but do not substitute for quality measurement. See Table 3 for a list of screening measures with proven accuracy.

Screening for Other Potential Contributors to Speech-Language Deficits

Another critical avenue for exploration into possible contributors to speech-language deficits is psychosocial risk. Parents who are depressed and/or have housing or food instability have children more likely to have language problems, perhaps because parents lack the energy and freedom from preoccupations to engage in the kinds of language-mediated social interactions known to support optimal child language development. Some parents are not aware of positive parenting practices that promote development, especially language skills (eg, talking with and reading to their child, creating opportunities for sustained dialogue, responding contingently to a child's initiations). Detecting and intervening when psychosocial risk factors, including abuse and neglect, are present has the potential to prevent language problems from developing. Screens for psychosocial risk factors including depression and parent-child interactions are widely available and include the Family Psychosocial Screen and the Brigance Parent-Child Interactions Scale . Both are included in PEDS: Developmental Milestones [39] as supplementary measures helpful for surveillance and offer evidence-based compliance with recommendations in early detection from the American Academy of Pediatrics. [40] , Many other screens, such as the Ages and Stages Questionnaire , include a background information questionnaire that captures common psychosocial risk factors. [41]

Screening Older Children

With school-age children, obtaining and reviewing group achievement test scores can help reveal undiagnosed language deficits. Such children typically have weaknesses in general information (eg, science, social studies knowledge), problems with reading comprehension, and sometimes also problems with math concepts. Table 3 also includes screens suitable for primary care professionals working with children aged 8 years and older.

For both preschoolers and school-age children, broad-band screens (or review of group achievement test results) should be deployed first and serve as a guide to the selection of narrow-band instruments. For example, attentional deficits can be due to a range of conditions such as language impairment, learning disabilities, and mental health problems such as depression. The optimal approach is to administer a broad developmental or academic screen along with a measure such as the Pediatric Symptom Checklist (which discriminates mental health from attentional difficulties). Only afterward and as suggested by the results of broad-band measures should a narrowly focused tool such as the Vanderbilt ADHD Diagnostic Rating Scale be administered. Making sure that other conditions are treated first or at least concomitantly with ADHD is essential.

Billing and Coding for Screening

Primary care providers can use the – 25 modifier to their preventive service code (to indicate that stand-alone services were offered and then use 96110 times the number of screens administered, eg, 96110 X 2. For insurers not accepting units, the distinct procedural service of each screen is best represented with the – 59 modifier appended to each additional unit of 96110.

In 2005, the Centers for Medicare and Medicaid Services published a total relative value unit (RVU) of 0.36 for 96110, which amounts to a Medicare payment of $13.64. None of this can guarantee that a valid claim will be accepted, so the American Academy of Pediatrics is willing to help with denied claims via their Coding Hotline: 800-433-9016, x4022, or at .gro.paa@eniltohgnidocpaa RVUs do not cover physician time, so making use of office staff and parent-report tools is essential.

Referrals and Other Interventions

Once suspicion exists that a child may have a speech-language impairment, referral to early intervention or to the public schools (depending on age) is the first step. These programs offer intervention by speech-language pathologists. If sufficient quantity is not available, referrals can also be made to private therapy services, which may be covered by the patients' insurance. If there appear to be underlying medical conditions, assessment by other disciplines, such as developmental-behavioral or neurodevelopmental pediatrics, is important.

For families with psychosocial risk factors, developmental promotion is essential as is careful monitoring of progress. If brief advice and information handouts are not effective and particularly if children have delays not sufficiently great as to qualify for services, then parent training, quality day care, Head Start, after-school tutoring, and private speech-language therapy should be recommended. Table 5 shows a list of professional development and referral resources. Table 6 provides a list of resources and information for parents.

Professional Development and Referral Resources

Resources and Information for Parents

Components of a Diagnostic Evaluation of Speech-Language Impairment and the Nature of Interventions

Although screening tools for speech-language often identify those children who have speech-language impairments, a screening is not a diagnostic evaluation and only suggests a child requires a more comprehensive assessment. There are several goals in a diagnostic assessment, including verifying that a speech-language impairment exists, describing the strengths and challenges of the child's speech and language, evaluating the severity of the problem, ascertaining the etiology, determining recommendations for a treatment plan, and providing a prognosis. [6] Assessment requires obtaining a sample of communication skills across settings through a number of procedures. It is critical to collect information not only from standardized, formal tools but also to gather more authentic, real-life information to facilitate meaningful and accurate decisions. Typically, case history information, parent interviews, checklists from other providers, systematic observation, hearing screening, and examination of the speech mechanism is included. [6] Formal norm-referenced tests are used to assess articulation, phonology, grammatical understanding and production, and pragmatic language use. The collection of data from the authentic assessment tools and the formal measures provide a comprehensive picture of the speech-language needs of a young child with a communication impairment.

All of the following are true in the assessment of a young child with speech-language impairments except :

• ○ Obtaining information from multiple sources across settings is necessary to specify communication strengths and challenges
• ○ Speech-language pathologists (SLPs) make diagnoses of specific speech-language impairment, identify probable causes, determine severity, describe the likely prognosis, and provide recommendations
• ○ Clinical judgment is most appropriate for determining the severity of a child's speech-language impairment
• ○ During assessment, speech, language, hearing, and processing abilities should be probed

Answer: Clinical judgment is most appropriate for determining the severity of a child's speech-language impairment. Objective criteria are important to ensure consistency in the assessment of severity.

To determine the prognosis for a young child with a speech-language impairment, which of the following is true?

• ○ A clinician should avoid providing prognostic information, as questions like “Will my son outgrow his speech-language impairment?” cannot be answered
• ○ Trial therapy during an assessment period is an appropriate strategy to inform prognosis
• ○ Families and clinicians have little difficulty making decisions about whether or not a young child with early expressive language delay will benefit from therapy
• ○ Single evaluation measures can be used to determine the severity of a young child's speech-language impairment and the prognosis for successful outcomes

Answer: Trial therapy during an assessment period is an appropriate strategy to inform prognosis. Clinicians often probe a child's response to intervention strategies to determine responsiveness to treatment and to inform the development of the treatment plan.

Intervention Approaches and Outcomes

The complexity of impairments in speech and language requires a variety of intervention approaches that can address deficits in language form (syntax, phonology, morphology), language content (semantics), and language use (pragmatics) as well as speech and voice production. Further, intervention for young children may involve not just the speech-language pathologist but also care providers and peers.

The ultimate goal of intervention is to increase a child's success in using language to communicate his or her intent, respond to the intent of others, and participate in reciprocal interactions. The speech and language targets vary for each child depending on the context and aspects of communication affected. Targets may or may not follow a strict developmental approach. Sometimes a more functional approach is appropriate, supporting communication at the point of frustration and breakdown. [6] Intervention targets should consider the family's desired outcomes for their child's communication. Targets should be developmentally appropriate and meaningful to the child.

Several teaching methods are used to support the speech and language of children. Modeling is a typical intervention strategy that provides focused stimulation on the speech or language targets selected for an individual child. Cueing is another frequently used technique that includes direct and indirect verbal cues (eg, asking a child to imitate a sound, word, or utterance) or nonverbal cues (eg, giving a child a jar with a desired item that can't be opened without help). In addition, responding to a child's communication efforts through reinforcement or corrective feedback (eg, “Remember to say the ending sound /t/ so we know you mean the word ‘boat’”) is frequently used to facilitate effective communication. [6]

Case Studies

Bobby [pseudonym] is a 7-year-old boy whom you have seen in your office for a number of years. He comes to you today for his annual check-up. Bobby is enrolled in the second grade. His mother is concerned because Bobby's teachers have noted difficulties in his ability to learn to read. Specifically, Bobby's teachers say that he has difficulties with word recognition and reading comprehension. Bobby's mother indicates that this is consistent with her own observations that he seems to have trouble with understanding what is being said (eg, directions, questions) and storytelling. Moreover, she suspects that Bobby's vocabulary is less well developed compared with his peers. She also describes frequent errors in how he formulates sentences such as omitting possessives (eg, “Sam dog” instead of “Sam's dog”) and verbs (eg, “He cooking” instead of “He is cooking”) that she fears are atypical. Bobby's nonverbal IQ is in the typical range.

The difficulties described above are most consistent with a possible diagnosis of:

• ○ Autism spectrum disorder
• ○ Intellectual disability
• ○ Specific language impairment
• ○ Language delay

Answer: Specific language impairment.

Darius [pseudonym] is a 5-year-old African American boy whom you are meeting today for the first time. He and his mother have recently moved to your area and she has brought him to you because he seems to be developing a nasty cough. When talking with Darius, you notice that he is extremely difficult to understand. Darius is a speaker of African American English; however, even with young speakers of this dialect, you have never had such difficulty understanding and communicating effectively. You learn that he and his parents have just moved from an impoverished community in South Carolina where he attended an age-appropriate class in a school in which approximately 85% of his classmates were black, to a school district in your area that almost entirely comprises white administrators, staff, and students. His mother further reports that Darius's new teachers have expressed concerns about his language. They say he is hard to understand, has a limited vocabulary, cannot master letter-sound correspondences, and has trouble listening to and understanding others.

Which of the following additional patient characteristics obtained from the mother would increase your suspicion of a diagnosis of speech and language impairment? (Select all that apply.)

• ▪ Darius's mother reports that he has always talked differently compared with his parents, siblings, and peers
• ▪ Darius's scores on a test of articulation of standard English are in the 10th percentile
• ▪ Darius becomes frustrated when you ask him to repeat himself
• ▪ Even though they are consistent with the sound structure of African American English, errors in Darius's spelling are quite common (eg, he writes "nes" instead of “nest”)

Answer: Darius's mother reports that he has always talked differently compared with his parents, siblings, and peers.

Which of the following additional patient or parent characteristics would increase your suspicion that Darius is exhibiting a language difference as opposed to a speech and language impairment? (Select all that apply.)

• ▪ Not only do you find Darius difficult to understand, but his mother is equally difficult to understand; both seem to be using a variation of African American English dialect that, although not commonly heard in your area, is characteristic of their native community
• ▪ Darius's scores on a test of vocabulary standardized on a cross-section of North American native English speakers are in the 35th percentile
• ▪ Darius's mother has no trouble understanding him
• ▪ Darius's mother does not share these concerns and considers him competent in all aspects of his language development

Answer: Not only do you find Darius difficult to understand, but his mother is equally difficult to understand; both seem to be using a variation of African American English dialect that, although not commonly heard in your area, is characteristic of their native community. Darius's mother does not share these concerns and considers him competent in all aspects of his language development.

You have been Sam's [pseudonym] primary care physician since he was born. He is now 18 months old and comes to you for his annual flu shot. During this visit, his mother expresses concerns about his speech and language development. More specifically, she reports he is “not talking like other kids his age” and uses repeated vocalizations (eg, “eh eh eh eh” while pointing) to communicate. Very recently, Sam has begun to use some words which are often paired with a gesture (eg, “Daddy” while pointing or “up” while raising hands to be picked up). You notice during your visit that Sam is a social and attentive child. He looks at other people and follows their eye gaze to distal objects. He also seems to understand the speech that his mother directs to him and he can easily carry out 2-step commands (eg, “Pick up the cup and sit next to me, please”). Sam's mother is aware of no immediate or extended family members who have ever had a speech or language impairment. Sam has no history of ear infection, and a recent hearing screen indicated hearing in the normal range.

• ▪ Limited imitation
• ▪ Limited pretend play
• ▪ Limited facial expressiveness
• ▪ Excessive use of nonverbal communicative gestures (eg, reaching, pointing, looking)

Answer: Limited imitation. Limited pretend play.

What should the mother expect with time if her child does not have a speech and language impairment but is rather a late-talker? (Select all that apply.)

• ▪ The child will begin to engage in unusual repetitive behaviors
• ▪ The child will steadily albeit slowly add new words and begin to combine them into 2-word utterances
• ▪ Any new words that the child utters are likely to be distorted and difficult to understand
• ▪ The child may develop aggressive behaviors to cope with his inability to communicate effectively

Answer: The child will steadily albeit slowly add new words and begin to combine them into 2-word utterances.

Theresa [pseudonym] is a 3-year-old female whom you have seen in your office regularly since her birth. She comes to you today for her annual check-up. During her visit, you observe that Theresa is precocious in her language development. Indeed, her mother reports that she has always been a “great talker” and that she began to speak in well-formed utterances at age 18 months. During this visit, you notice a number of disfluencies in Theresa's speech. At one point, she repeats a word 3 times before getting the rest of the sentence out (ie, “I see… see… see a book with a clown”). Theresa's mother states that these kinds of disfluencies began about 1 month ago and, although she characterizes them as relatively infrequent, she has questions about whether this kind of speech is normal.

Which of the following additional patient characteristics obtained from your observation of Theresa would increase your suspicion of a diagnosis of a fluency disorder? (Select all that apply.)

• ▪ Theresa seems aware of and perturbed by her disfluencies
• ▪ Theresa sometimes jerks her head when hesitating to utter her next word
• ▪ Approximately 20% of Theresa's words appear to constitute disfluencies
• ▪ Theresa produces multi-unit syllable repetitions (eg, “t-t-t-time”)
• ▪ All of the above

Answer: All of the above.

Reader Comments on: Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood See reader comments on this article and provide your own.

Readers are encouraged to respond to the author at [email protected] or to George Lundberg, MD, Editor in Chief of The Medscape Journal of Medicine , for the editor's eyes only or for possible publication as an actual Letter in the Medscape Journal via email: ten.epacsdem@grebdnulg

Contributor Information

Patricia A. Prelock, Department of Communication Sciences, University of Vermont, Burlington, Vermont.

Tiffany Hutchins, Department of Communication Sciences, University of Vermont, Burlington, Vermont.

Frances P. Glascoe, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee.

How to improve your communication with someone with a speech impairment

Associate Professor of Mechanical and Materials Engineering, Building and Designing Assistive Technology Lab, Queen's University, Ontario

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October marked alternative and augmentative communication (AAC) awareness month. AAC includes all means of communication that a person may use besides talking . Low-tech methods include means of interaction like hand gestures, facial movements, or pointing, while more high-tech tools might include a speech generating device accessed through pointing or a joystick, eye-tracking, or even a brain-computer interface.

British physicist Stephen Hawking was long the most famous person associated with AAC, using an advanced computer system to generate sentences and speech. American actor Val Kilmer is another well-known person who has used AAC. Kilmer suffered irreparable damage to his voice due to throat cancer. However, in the latest installment of the Top Gun film franchise, artificial intelligence was used to “clone” the actor’s voice.

In 2006, 1.9 per cent of the Canadian population self-identified as having a speech disability . Unfortunately, this was the last time Statistics Canada identified speech disability within the Canadian census. That makes it difficult to gather more recent data of the number of people in Canada with impaired speech.

Need for more acceptance

Speech impairments can occur at a young age with disabilities such as cerebral palsy or autism spectrum disorder, but can also manifest later in life as a result of progressive disorders such as motor neuron disease, throat cancer, muscular dystrophy or strokes.

Increased acceptance of the use of AAC technologies in general society can enhance the quality of life for people with speech impairment by increasing autonomy, leading to more positive social interactions, better engagement in education and confidence in employment.

The Accessible Canada Act recognizes communication as a priority area, while the United Nations Convention on the Rights of Persons with Disabilities promotes the rights of autonomy, safety and social participation, and recognizes communication as a human right.

Tackling stigma

However, even if people have access to AAC technology, they can still face stigma and exclusion. Here are some things we can all do to be more inclusive of people with impaired speech:

Start with basic respect. Understand that cognition and lack of verbal speech are not correlated. Many people with speech impairments have no cognitive deficits at all and are just as intelligent as anyone else. They want others to be more patient and understanding of speech disabilities. In social situations, they might often be underestimated and treated as children even though they are capable and competent. Show them respect, even though they may sound different when they talk.

Pre-programmed sentences on a tablet or speech generating device do not suggest that the person is incapable of developing those ideas. They may have spent 20 minutes typing out those messages in an attempt to meet the fast-paced environment in which we all live.

Take time to listen. Individuals with speech impairment may need to type out phrases one letter at a time. Some may use a smartphone or iPad with a texting app, while others use an eye-tracking device or brain-computer interface to select letters using an on-screen keyboard. Be patient and wait for the person to speak.

As one occupational therapist noted , “[A problem] I often find some of my clients run into is not being given enough time to get their message written down. They’re composing it and the communication partner might not realize they need to give them a little extra time.” A conversation may require you to pause, ask a question and wait for an answer. Stop, think, be patient and understanding.

In addition, it’s important to realize that the use of some AAC technologies can be tiring. To use systems that rely on eye movements, for example, an individual must focus and is unable to use other means of communication such as emotional expression at the same time. Recognize that shorter conversations may be better. Perhaps try communicating by email or text. Let the person respond in their own time.

Be an advocate. People with speech impairments must always advocate for themselves. If you are planning a conference or hiring for a position, ask what accommodations might be beneficial rather than relying on the individual to request them. Provide advance notice of conversation topics or questions. Engage people with speech impairments in social events. If you see someone passing judgment, speak up.

Technology is improving, and maybe one day people with impaired speech will be able to communicate with the same ease as those without. But until then, being a friend to people with speech impairments means being patient and listening.

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What is a nonverbal learning disorder? Tim Walz’s son Gus’ condition, explained

Gus Walz stole the show Wednesday when his father, Minnesota Gov. Tim Walz, officially accepted the vice presidential nomination on the third night of the Democratic National Convention. 

The 17-year-old stood up during his father’s speech and said, “That’s my dad,” later adding, “I love you, Dad.”

The governor and his wife, Gwen Walz, revealed in a People interview that their son was diagnosed with nonverbal learning disability as a teenager.

A 2020 study estimated that as many as 2.9 million children and adolescents in North America have nonverbal learning disability, or NVLD, which affects a person’s spatial-visual skills.

The number of people who receive a diagnosis is likely much smaller than those living with the disability, said Santhosh Girirajan, the T. Ming Chu professor of biochemistry and molecular biology and professor of genomics at Penn State.

“These individuals are very intelligent and articulate well verbally, but they are typically clumsy with motor and spatial coordination,” he told NBC News. “It’s called a learning disorder because there are a lot of cues other than verbal cues that are necessary for us to keep information in our memory.”

People with NVLD often struggle with visual-spatial skills, such as reading a map, following directions, identifying mathematical patterns, remembering how to navigate spaces or fitting blocks together. Social situations can also be difficult. 

“Body language and some of the things we think about with day-to-day social norms, they may not be able to catch those,” Girirajan said. 

Unlike other learning disabilities such as dyslexia, signs of the disability typically don't become apparent until adolescence. 

Early in elementary school, learning is focused largely on memorization — learning words or performing straightforward mathematical equations, at which people with NVLD typically excel. Social skills are also more concrete, such as playing a game of tag at recess. 

“But as you get older, there’s a lot more subtlety, like sarcasm, that you have to understand in social interactions, that these kids might not understand,” said Laura Phillips, senior director and senior neuropsychologist of the Learning and Development Center at the Child Mind Institute, a nonprofit organization in New York.

In her own practice, she typically sees adolescents with NVLD, who usually have an average or above average IQ, when school demands more integrated knowledge and executive functioning, such as reading comprehension or integrating learning between subjects. They also usually seek help for something else, usually anxiety or depression, which are common among people with NVLD. 

Sometimes misdiagnosed as autism

Amy Margolis, director of the Environment, Brain, and Behavior Lab at Columbia University, is part of a group of researchers that is beginning to call the disability “developmental visual-spatial disorder” in an effort to better describe how it affects people who have it.

People with NVLD are “very much verbal,” Margolis said, contrary to what the name suggests.

The learning disability is sometimes misdiagnosed as autism spectrum disorder. Margolis led a 2019 study that found that although kids with autism spectrum disorder and NVLD often have overlapping traits, the underlying neurobiology — that is, what’s happening in their brains to cause these traits — is unique between the two conditions.

Margolis is trying to get NVLD recognized by the DSM-5, the handbook health care providers use to diagnose mental health conditions. Without such official recognition, people with NVLD can struggle to get the resources they need, such as special class placements or extra support in school.

“Without an officially recognized diagnosis, it’s hard for parents to understand how to seek information, and then communicate to other people what kinds of things might be challenging for their kid,” Phillips said, adding that widespread awareness is key to helping these families navigate NVLD.

Kaitlin Sullivan is a contributor for NBCNews.com who has worked with NBC News Investigations. She reports on health, science and the environment and is a graduate of the Craig Newmark Graduate School of Journalism at City University of New York.

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What's wrong with RFK Jr's voice? Spasmodic dysphonia explained

During  Robert F. Kennedy Jr.'s  now-suspended 2024 presidential race , many people noticed his raspy and often halting voice.

The son and nephew of slain political leaders has a rare disorder called spasmodic dysphonia — a spasm of the vocal muscles.

Kennedy is one of an estimated 50,000 people in North America with SD, as it is often referred to, a neurological condition that creates a vocal tremble in mostly middle-aged people that usually lasts for the rest of their lives.

There is no cure, but treatments can temporarily reduce symptoms.

Here's what to know about spasmodic dysphonia:

RFK Jr. and spasmodic dysphonia

Spasmodic dysphonia has recently been spotlighted due to Robert F. Kennedy Jr.’s presidential campaign. While the candidate has had the disorder for almost 30 years, his raspy, trembling voice has received more attention with a host of stump speeches, media appearances, and advertisements over his now-suspended presidential campaign.

In an  interview this spring  with the Los Angeles Times, Kennedy said his voice doesn’t tire or get worse as he speaks. It just sounds like he’s always on the verge of breaking down.

How is spasmodic dysphonia treated?

To date, no known cure for spasmodic dysphonia exists. However, several forms of treatment — including speech therapy, drugs and surgery — are available to alleviate or control the symptoms of the vocal spasms on a temporary or long-lasting basis.

Dr. Andrew Blitzer, a New Jersey ear, nose, and throat specialist,  developed  a now-common treatment for SD that involves injecting Botox into the throat muscles to control the vocal cords, the USA TODAY Network reported. Although it doesn't treat the neurological condition, it helps abate the symptoms for three to four months on average.

The problem has long been diagnosing the condition. Many of Dr. Blitzer's first patients had been seen by an average of 13 doctors and other medical personnel, from psychiatrists to speech pathologists, before they were diagnosed with SD. The situation has improved now that SD is taught more in medical schools and during ENT residencies. Still, many of Dr. Blitzer's patients come from across the U.S. and even overseas to have him treat them.

"You can make a big difference in people's lives by giving them their voice back," he said. "It's such a small procedure, but it makes a big difference."

Why did RFK Jr. drop out of the presidential race?

Robert F. Kennedy Jr.  says he will suspend his campaign in the 2024 presidential race and throw his support behind Republican nominee Donald Trump, USA TODAY reported.

In a virtual address on Friday, Kennedy clarified that he plans to remove his name from the ballot in about 10 battleground states, "where my presence would be a spoiler," a process he has already begun in states including Arizona and Pennsylvania.

Speculation  that Kennedy would drop out  began earlier this week after his running mate Nicole Shanahan said in an interview Tuesday the campaign had been  weighing a decision .

Trump earlier this week called Kennedy “a brilliant" and "very smart guy" — a far cry from April, when he called him “far more liberal than anyone running as a Democrat" and feared that Kennedy's independent candidacy might cost him votes in the general election.

Vice President Kamala Harris' campaign, in response to Kennedy's suspension, offered their ticket as an option to voters "tired of Donald Trump and looking for a new way forward."

“In order to deliver for working people and those who feel left behind, we need a leader who will fight for you, not just for themselves, and bring us together, not tear us apart," Campaign Chair Jen O’Malley Dillon said in a statement. "Vice President Harris wants to earn your support."

USA TODAY contributed to this report.

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Who is Gus Walz and what is a non-verbal learning disorder?

Midway through Minnesota Gov. Tim Walz's keynote address Wednesday night accepting the Democratic Party's nomination for vice president , he turned to his family and said: "Hope, Gus and Gwen, you are my entire world, and I love you."

His son Gus stood up, clapping with unrestrained emotion and pride, repeating "That's my dad!" The crowd at the Democratic National Convention erupted into applause and soon, social media erupted either because of the sheer emotion of the moment or because people wanted to express pride in having their own neurodivergent child or being neurodivergent themselves.

In a speech centered on gun control, reproductive rights, being a good neighbor and supporting one another despite what separates us , this extraordinary moment between father and son has ignited a conversation not often broached in political arenas.

Here's what to know.

What is Gus Walz's condition?

The vice presidential nominee's son, 17, has ADHD, an anxiety disorder and a non-verbal learning disorder, according to his parents.

The non-verbal learning disorder, which his dad calls his "secret power" is shared by millions of Americans. Despite the 3% to 4% of people (both children and adults) who have the condition, it's not nearly as understood as Gus's other diagnosis of attention deficit hyperactivity disorder.

According to the Journal of American Medical Association (JAMA) , it's estimated that upwards of 2 million children and adolescents in North America may have a non-verbal learning disorder. Here's what to know about this lesser known but not uncommon disability.

Despite its name, children with a non-verbal learning disorder can not only speak but exhibit strong verbal skills. Their challenges revolve around processing non-verbal or visual information, Marcia Eckerd, a licensed psychologist who specializes in autism spectrum disorder and anxiety, told Psychology Today .

It's the difference between having a conversation and absorbing details of that conversation.

OPINION: Gus Walz loves his dad, Tim. Anyone who doesn't see the beauty of this is weird.

How does the disorder present itself?

Children and adolescents with non-verbal learning disorders tend to struggle with at least one of the following areas:

• Visual and spatial awareness
• Comprehending the big picture
• Social communication
• Math concepts
• Executive functions

When it comes to a deficit in visual and spatial awareness, the best way to think about it is to imagine a child being told to draw a shape like a cube or an octagon. Children with a non-verbal learning disability may not accurately produce this shape from recall. It can also mean that children grapple with how they navigate the space around them. They might move with some degree of awkwardness.

Big picture deficits, or difficulty comprehending higher order thinking, may show itself as being unable to convey the main idea of a story. Students may not be able to discern the crucial points in a teacher's lecture and will, instead, write everything they say down.

Children with a non-verbal learning disability also may not pick up on facial expressions during a conversation. They may miss social patterns that other children automatically pick up on, and have trouble knowing what the appropriate behavior should be.

Math tends to be a strength among children with non-verbal learning disabilities up to a point. These children excel at rote learning, or memorization techniques based on repetition, but as these math concepts advance, similar to social communication, they may have trouble recognizing patterns.

Finally, problem solving is a cornerstone of executive functioning. Children with a non-verbal learning disability may not be able to break problems down into smaller pieces, or even conceive the steps necessary to accomplish a task.

What is ADHD?

Attention deficity hyperactivity disorder is marked by difficulty maintaining attention and being easily distracted, as well as having excessive energy and difficulty with self-control.

It has come to be an umbrella term for multiple degrees of the disability, with people who may have wide variances in symptoms, and who may be able to manage over time with treatment.

Wednesday's images from the DNC generated overflowing support

In the wake of the third night of the DNC, parents tweeted photos of their own children, stating "This is my Gus Walz." Others shared heartwarming photos of Tim and Gus Walz hugging on the national stage, praising the men for being open with their emotions.

Others saw themselves in Gus Walz. Many took to social media to share their own journeys of being accepted for their unique learning disabilities.

The images of Gus Walz also generated insensitivity

Conservative pundit Ann Coulter saw the display of emotions as an opportunity to deride the family. In a since deleted tweet, Coulter shared a gif of Gus Walz at the DNC and called it "weird," an obvious reference to Tim Walz popularizing the idea that MAGA people are "weird."

Closer to home, Jay Weber, a radio host for 1130 WISN-AM, tweeted, "If the Walzs [sic] represent today's American man, this country is screwed: 'Meet my son, Gus. He's a blubbering bitch boy. His mother and I are very proud'." The now-deleted tweet was screenshotted and shared by Milwaukee County Board Supervisor Shawn Rolland to hold Weber accountable.

Weber apologized for the tweet, stating that he didn't realize Gus Walz had a disability.