Communication Disorders in Children/Adolescents
Speech Therapy Center, LLC, provides speech language therapy for the following communication disorders in children and adolescents in the following areas: Please click on the names below to view a full description.
Articulation is the way we produce speech sounds. Many children make speech errors, so it is important to consider the age range during which children develop each sound when determining if sound substitutions are age-appropriate. An Articulation Disorder involves difficulties producing sounds. Sounds may be substituted, omitted, added or deleted in an articulation disorder. For example, a child who says “tup” for “cup” is substituting the sound “t” for the sound “k.” An articulation disorder can make it difficult for a child to be understood by others and can impact social interactions, school participation and academics (i.e. reading, writing, phonological awareness skills). The child’s speech could be unclear, slushy or sound mumbled. The child may have an articulation disorder if these sound errors continue past the expected age of mastery.
Phonological Processes are patterns of sound errors which children use to simplify speech as they are learning to talk. These processes are considered normal unless they continue beyond the age when most children have stopped using them. If the phonological process persists past when it is expected to be extinguished, the child may have a Phonological Processing Disorder. Speech therapy for phonological processes will often target a class of sounds (i.e. the “k” sound and the “g” sound simultaneously) while still moving through the hierarchy until mastery is achieved.
Apraxia of Speech/Motor Speech Disorder
Apraxia of speech is a motor-speech programming disorder resulting in difficulty executing and/or coordinating (sequencing) the oral- motor movement necessary to produce and combine speech sounds (phonemes) to form syllables, words, phrases and sentences on voluntary (rather than only reflexive) control. Many children are able to hear words, and are able to understand what they mean, but they cannot change what they hear into the fine-motor skill of combining consonants and vowels to form words. This difficulty in combining consonants and vowels into words upon direct imitation is called apraxia of speech. Many children do have “pop-outs” which are real words and phrases they are able to say or have said in the past, but are either never heard again, or cannot be imitated when asked to do so. Here at the STC, we provide a systematic program that helps apraxic children be able to combine simple to complex consonants and vowels into functional vocabulary. Parents, family and teachers are trained to script best words approximations towards functional vocabulary and language development. This is done through drill, conversation, and play, with cues, prompts and support. Oral-motor weakness or dysarthria may co-exist but must not be a primary concern.
Early Signs and Symptoms
– Limited or little babbling as an infant (void of many consonants). First words may not appear at all, pointing and “grunting” may be all that is heard.
– The child is able to open and close mouth, lick lips, protrude, react and lateralize tongue while eating, but may not be able to when directed to do so.
– First word approximations occurring beyond age 18 months, without developing into understandable simple vocabulary words by age two.
– Continuous grunting and pointing beyond age two.
– Lack a significant consonant repertoire: child may only use /b, m, p, t, d, h/
– All phonemes (consonants and vowels) may be imitated well in isolation, but any attempts to combine phonemes are unsuccessful.
– Prosody is unusual, there is equal stress and sometimes monotone quality.
– Speech may change or disintegrate with many repetitions.
– Words may be simplified by deleting consonants or vowels, and/or replacing difficult phonemes (consonants and vowels) with easier ones.
– Single words may be articulated well, but attempts at further sentence length become unintelligible.
– Receptive language (comprehension) appears to be better than attempts at expressive language (verbal output).
– One syllable or word is favored and used to convey all or many words beyond age two.
– The child speaks mostly in vowels.
– Verbal perseveration: getting “stuck” on a previously uttered word, or bringing oral motor elements from a previous word into the next word uttered.
– Oral groping may occurring when attempting oral motor movements or consonant/vowel production.
– Struggle behavior may occur when attempting to imitate or speak (with dysfluency or stuttering).
– Deletions or replacements of consonants, vowels or syllables may occur at the end of a word, phrase or connected word levels.
– Vowel distortions or replacements occur which are not due to oral motor weakness.
– The ability to blurt out clear whole words, phrases or sentences may occur though there is difficulty imitating these same words “on command” or upon imitation.
– Difficulty with maintaining clarity with extended word length or complexity.
– Phonological processes are employed to simplify motor speech output.
– Late talking with above characteristics or errors may be present.
– Other fine motor challenges may be present.
– Echolalic utterances (the automatic repetition of words, phrases or sentences often without comprehension) might be perfectly articulated but novel attempts at words or combinations might be more effortful.
Information courtesy of the Kaufman Children’s Center.
Oral Motor Disorders
Oral-motor skills involve the movements of the lips, jaw, tongue and cheeks. These muscles are important for eating, drinking and speech.
Evaluation of oral motor skills should include assessment of jaw stability and strength, as well as coordination, strength and range of motion of the lips and tongue. If a child presents with reduced oral motor skills that are negatively affecting his/her function, treatment would be recommended. An example would be if a child is unable to elevate his/her tongue. This would make production of /l/ difficult, and therefore cause an articulation error. Treatment to facilitate the needed tongue movement would allow the child to acquire speech sounds appropriately.
Orofacial Myofunctional Disorders (Tongue Thrust)
Tongue thrust is a specific category of an Oral Myofunctional Disorder. Tongue thrust refers to the improper placement and function of the tongue during swallowing. Too much pressure against the teeth may result in a malocclusion or misalignment of the teeth. This disorder can negatively affect dentition and dental occlusion. Myofunctional therapy is used to correct the improper function of the tongue and facial muscles used at rest, for chewing and swallowing. Myofunctional therapy helps correct thumb or finger sucking habits, incorrect tongue resting posture, tongue thrust swallowing patterns, open mouth rest posture and mouth breathing. It helps guide teeth into a more desirable relationship during a child’s early development (before the age of 12).
Receptive Language Delay/Disorder
Receptive language involves the comprehension of spoken language. Children with a receptive language disorder have trouble understanding and processing what is said to them. They may have difficulty following directions, may often ask the speaker to repeat themselves, or may appear to be not listening. For a child with this diagnosis, spoken words may sound like a foreign language; the child can hear the words being said, but doesn’t understand what they mean.
Receptive Language Disorders are a broad category and often overlap with other diagnoses. These diagnoses are often used by many people in different ways. Other names for a receptive language disorder may include:
– Auditory Processing Disorder
– Auditory-Linguistic Processing Disorder
– Central Auditory Processing Disorders (CAPD);
– Comprehension Deficit;
– “Delayed language”
Receptive language disorders often coexist with expressive language disorders.
Early Signs and Symptoms
-Echoalia (repeating back words or phrases either immediately or at a later time)
– Inability to follow directions (Following of routine, repetitive directions may be ok)
– Inappropriate, off-target responses to “wh” questions
– Re-auditorization (repeating back a question first then responding to it)
– Difficulty responding appropriately to: yes/no questions, either/or questions, who/what/where questions, when/why/how questions
– Does not attend to spoken language
– May appear to have poor listening skills
– Jargon (sounds like “unintelligible speech”)
– Using “memorized” phrases and sentences
– May need additional time to process information
– Has difficulty presenting information orally
Information courtesy of the Kaufman Children’s Center.
Expressive Language Delay/Disorder
Children with expressive language disorders have difficulty expressing themselves using speech. The signs and symptoms vary drastically from child to child. The child does not have problems with the pronunciation of words, such as occurs in phonological disorder, or apraxia of speech. The child does have problems putting sentences together coherently, using proper grammar, recalling the appropriate word to use, or other similar problems. A child with an expressive language disorder is not able to communicate thoughts, needs or wants at the same level or with the same complexity as his or her peers. The child often has a smaller vocabulary than his or her peers.
Children with expressive language disorders may have the same ability to understand speech as their peers, and have the same level of intelligence. Therefore, a child with this disorder may understand words that he or she cannot use in sentences. The child may understand complex spoken sentences and be able to carry out intricate instruction, although he or she cannot form complex sentences.
Early Signs & Symptoms
There are many different ways in which expressive language disorder can manifest itself. Children with this disorder may have one or more of the following indicators:
- Labeling words
- Describing objects or events
Using age-appropriate vocabulary
Expressing word meanings and definitions
Using semantic categories such as: classifying words into categories,associations,
synonyms, antonyms, multiple meaning words
Labeling or retrieving (recalling) the names of objects or events
- Using complete sentences or a variety of sentences
- Sequencing words, thoughts or events or relating events in an organized manner
- Using aspects of grammar such as: verbs, pronouns, prepositions, conjunctions
- Formulating “Wh” questions
Central Auditory Processing Disorder
Auditory processing is how your brain processes the speech sounds your ear is hearing. When a child has a Central Auditory Processing Disorder, many areas of function can be affected. It may be hard to understand what is said, therefore the child will have difficulty following auditory directions. It also frequently negatively affects a child’s acquisition of phonics for reading and spelling skills. Diagnosis of an Auditory Processing Disorder is done through a combination of audiological and speech/language evaluations, and treatment is usually completed by the Speech Language Pathologist.
Social Pragmatic Language Disorders may also be known as semantic/pragmatic language disorder, non-verbal learning disability (NLD).
Early Signs and Symptoms
– Excessive questioning.
– Lack of eye contact.
– Aggressive language.
– Excessive talk about specific subjects in too much detail.
– Only talking about him/herself.
– Uninterested in other children.
– Unable to engage in conversational exchange.
– Literal/concrete understanding of language.
– Difficulty with abstract language: figurative language, idioms, expressions.
– Verbal problem-solving: why when, how do you know?;
– Double meanings;
– Difficulty initiating and maintaining conversations
– Difficulty staying on topics of conversation
– Unable to take the listener’s perspective.
– Unable to read/interpret body language, facial expressions.
– Unable to express feelings.
– Difficulty making inferences and understanding things that are implied, but not stated explicitly
– Not giving background information when speaking to an unfamiliar person
– Not understanding how to properly greet people, request information or gain attention
– Tendency to be overly literal and not understand riddles and sarcasm
Information courtesy of the Kaufman Children’s Center.
Fluency Disorders (Stuttering and Cluttering)
Stuttering is a disorder characterized by disruptions in the production of speech sounds, also called “disfluencies”. Stuttering is a communication disorder in which sounds, syllables, or words are repeated (li-li-like), prolonged (lllllike this),or speech may completely stop (blocking). Blocking is when the mouth is positioned to say a sound, sometimes for several seconds, with little or no sound coming out. After some attempts, the person may complete the word.Interjections such as “um” or “like” can occur, as well, particularly when they contain repeated (“u- um- um”) or prolonged (“uuuum”) speech sounds or when they are used intentionally to delay the initiation of a word the speaker expects to “get stuck on.” These disfluencies disrupt the normal flow of speech. There may also be secondary behaviors such as: rapid eye blinks, tremors of the lips, unusual facial and body movements associated with the effort to speak. Stuttering can make it difficult to communicate with other people, which often affects a person’s quality of life.
Cluttering (also called tachyphemia) is a communication disorder characterized by speech that is difficult for listeners to understand due to rapid speaking rate, erratic rhythm, poor syntax or grammar, and words unrelated to the sentence. Speech sounds like bursts that are filled with misarticulations and disfluencies. The person with cluttering may experience a short attention span, poor concentration, poorly organized thinking, inability to listen, and a lack of awareness that his or her speech is unintelligible.
Stuttering is a speech disorder and cluttering is language disorder. A stutterer knows what he or she wants to say, but can’t say it; in contrast, a clutterer can say what he or she is thinking, but his or her thinking becomes disorganized during speaking.
Stutterers are usually disfluent on initial sounds, when beginning to speak, and become more fluent towards the ends of utterances. In contrast, clutterers are most clear at the start of utterances, but their speaking rate increases and intelligibility decreases towards the end of utterances.
Stuttering is characterized by struggle behavior, such as overtense speech production muscles. Cluttering, in contrast, is effortless.
Cluttering is also characterized by slurred speech, especially dropped or distorted /r/ and /l/ sounds; and monotone speech that starts loud and trails off into a murmur.
Clutterers often also have reading and writing disorders, especially handwriting.
Speech Therapy Center, LLC, offers the following services:
- Comprehensive Speech and Language Evaluations
- Individual Therapy Sessions
- Parent Consultations
- Collaboration with schools, orthodontists and other professionals
- Resources for Families
Communication Disorders in Adults
Speech Therapy Center, LLC, provides speech language therapy for the following communication disorders in adults: Please click on the names below to view a full description.
Aphasia is a language disorder due to brain damage from a stroke or head injury that results in impairment in the comprehension and/or formulation of language.Damage to the left hemisphere of the brain, which controls the language area, affects a person’s ability to communicate, which includes speaking, understanding, reading, writing and gesturing.
Fluent aphasia consists of impairment in language comprehension and speaking fluently with little or no meaning. Words are often used incorrectly. The main characteristics are word retrieval, parahasias (unintended sounds or word selection), invented words and preservation. Individuals with aphasia may also have other problems, such as dysarthria, apraxia, or swallowing problems.
Non-Fluent aphasia is characterized by difficulties with output with relatively spared comprehension. It is characterized by reduced vocabulary, grammatical errors and impairments of articulation, rate and prosody (rhythm, stress, and intonation) resulting in labored and effortful production. Speech is hesitant and pauses occur while trying to find the right word to say.
Cognitive Communication Disorders
Cognitive Communication Impairment can occur as a result of right side damage to the brain. It may affect an individual’s attention and concentration, initiating or carrying on a conversation/task, problem solving, good judgement, memory, processing information in a timely manner, organization, sequencing and disorientation.
Apraxia is a motor speech disorder that affects the ability to plan or sequence voluntary muscle movements. There is a disruption in the brain’s transmission signals to the muscles. The person knows what to say but is unable to get the muscles of speech to produce the right sounds. Apraxia may cause people to mix up sounds in words, say the wrong sounds, say words/sounds differently every time they try to say them and struggle to say sounds. Often occurs with aphasia.
Dysarthria is a group of motor disorders resulting from muscle control of the speech mechanism due to damage of the nervous system. Oral communication problems due to paralysis, weakness or incoordination of the speech muscles.
In some cases Dysarthria can present as the following:
-Slurred, irregular or labored speech
-Imprecise constants and articulation
-Harsh, hoarseness or strained vocal quality
-Slow and effortful or rapid rate
-Breathiness, hoarseness, strained, harsh quality
-Choppy (breath phrasing)
Patients that present Dysarthria are those with ALS, Huntington Disease, Parkinson’s, Multiple Sclerosis, Muscular Dystrophy, stroke and Myasthenia Gravis.