Causes

Speech is one of the main ways in which we communicate with those around us. It develops naturally, along with other signs of normal growth and development. Disfluencies are disorders in which a person repeats a sound, word, or phrase. Stuttering may be the most serious disfluency.

Articulation disorders may have no clear cause. They may also occur in other family members. Other causes include:

• Problems or changes in the structure or shape of the muscles and bones used to make speech sounds. These changes may include cleft palate and tooth problems.
• Damage to parts of the brain or the nerves (such as from cerebral palsy) that control how the muscles work together to create speech.
• Hearing loss.

Voice disorders are caused by problems when air passes from the lungs, through the vocal cords, and then through the throat, nose, mouth, and lips. A voice disorder may be due to:

• Acid from the stomach moving upward (GERD)
• Cancer of the throat
• Cleft palate or other problems with the palate
• Conditions that damage the nerves that supply the muscles of the vocal cords
• Laryngeal webs or clefts (a birth defect in which a thin layer of tissue is between the vocal cords)
• Noncancerous growths (polyps, nodules, cysts, granulomas, papillomas, or ulcers) on the vocal cords
• Overuse of the vocal cords from screaming, constantly clearing the throat, or singing
• Hearing loss

Symptoms

DISFLUENCY
Stuttering is the most common type of disfluency.
Symptoms of disfluency can include:

• Repetition of sounds, words, or parts of words or phrases after age 4 (I want...I want my doll. I...I see you.)
• Putting in (interjecting) extra sounds or words (We went to the...uh...store.)
• Making words longer (I am Boooobbby Jones.)
• Pausing during a sentence or words, often with the lips together
• Tension in the voice or sounds
• Frustration with attempts to communicate
• Head jerking while talking
• Eye blinking while talking
• Embarrassment with speech

ARTICULATION DISORDER

• Certain sounds (like "r", "l", or "s") may be consistently distorted or changed (such as making the 's' sound with a whistle)
• Errors may make it hard for people to understand the person (only family members may be able to understand a child)

PHONOLOGICAL DISORDER

• The last or first sound of words (most often consonants) may be left out or changed.
• The child may have no problem pronouncing the same sound in other words (a child may say "boo" for "book" and "pi" for "pig", but may have no problem saying "key" or "go").

VOICE DISORDERS

• Hoarseness or raspiness to the voice
• Voice may break in or out
• Pitch of the voice may change suddenly
• Voice may be too loud or too soft
• Person may run out of air during a sentence
• Speech may sound odd because too much air is escaping through the hose (hypernasality) or too little air is coming out through the nose (hyponasality)

Exams and Tests

The following are examples of screening and evaluation tools that can help identify and diagnose speech disorders:

• Denver Articulation Screening Examination
• Goldman-Fristoe Test of Articulation 3 (GFTA-3)
• Arizona Articulation and Phonology Scale 4th Revision (Arizona-4)

A hearing test may also be done to rule out hearing loss as a cause of the speech disorder.

Treatment

Children may outgrow milder forms of speech disorders.

Speech therapy may help with more severe symptoms or any speech problems that do not improve.

In therapy, the therapist may teach your child how to use their tongue to create certain sounds.

Outlook (Prognosis)

Outlook depends on the cause of the disorder. Speech can often be improved with speech therapy. Early treatment is likely to have better results.

Possible Complications

Speech disorders may lead to challenges with social interactions due to difficulty communicating.

When to Contact a Medical Professional

Call your health care provider if:

• Your child's speech is not developing according to normal milestones.
• You think your child is in a high-risk group.
• Your child is showing signs of a speech disorder.

Prevention

Hearing loss is a risk factor for speech disorders. At-risk infants should be referred to an audiologist for a hearing test. Hearing and speech therapy can then be started, if necessary.

As young children begin to speak, some disfluency is common, and most of the time, it goes away without treatment. If you place too much attention on the disfluency, a stuttering pattern may develop. If your child is stuttering, make sure to allow them to finish what they want to say, listen to what they are saying, and then respond in a calm and relaxed way. Avoid negative comments. If the stuttering continues, meet with a speech language pathologist for support.

Alternative Names

Articulation deficiency; Articulation disorder; Phonological disorder; Voice disorders; Vocal disorders; Disfluency; Communication disorder - speech disorder; Speech disorder - stuttering