speech and language disorders classification

The Classification of Speech and Language Disorders

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• Hedwig Amorosa  

Part of the book series: Neuropsychology and Cognition ((NPCO,volume 13))

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Speech and language disorders in children interfere with other aspects of development and daily life. Different professions are usually involved in the diagnosis and management of these disorders. In this paper an attempt is made to describe how speech and language disorders are seen in current classifications of various professional backgrounds Similarities, differences and problems in classification will be discussed and a descriptive system will be proposed. Necessary research will be recommended that would allow a classification based on facts rather than on concepts.

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Basics of Developmental Disorders of Speech and Language

Diagnosis and differential diagnosis of developmental disorders of speech and language.

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Amorosa, H. (1998). The Classification of Speech and Language Disorders. In: Rispens, J., van Yperen, T.A., Yule, W. (eds) Perspectives on the Classification of Specific Developmental Disorders. Neuropsychology and Cognition, vol 13. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-2581-1_8

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Hui Zhang , Yuanyuan Zhang , Hao Zhang; The Handbook of Language and Speech Disorders. J. Acoust. Soc. Am. 1 April 2022; 151 (4): 2647–2648. https://doi.org/10.1121/10.0010238

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Language/speech disorders refer to the difficulties in production and comprehension at various linguistic levels. About 5% of the population suffer from language/speech disorders, which lead to subsequent social problems and mental pain if untreated. Recent years have witnessed an increasing amount of multidisciplinary research on language/speech disorders. The research, however, is scattered across a variety of journal categories, ranging from medicine, linguistics, psychology, social science, etc. The Handbook of Language and Speech Disorders presents a timely and comprehensive review of the latest linguistic, neurological, psychological, and social findings in language/speech disorders. It talks about the language/speech disorders in relation to cognitive, psychological, and physiological diseases. Moreover, it mentions theoretical linguistic and psychological models that influence assessment and treatment. The second edition of this volume, compared to the first one ( Buckingham and Benson, 2011 ; Damico et al. , 2010 ; Gunhan et al. , 2011 ; Hartman, 2011 ), reflects the recent developments by updating materials and switching focus to topics that are receiving increasing attention in recent years (e.g., hearing impairment, literacy, and genetic syndrome).

The volume consists of four parts. Part I discusses the fundamental issues for labeling, assessing, and treating disorders in general. Parts II and III focus on language and speech disorders, respectively. Part IV talks about the problems of language use caused by cognitive and intellectual deficits.

Part I ranges from Chaps. 1 to 8. The first chapter, by Damico, Müller, and Ball, discusses the influence of sociocultural factors on the diagnosis of language disorders and the impact of the diagnosis on treatment and society. In the second chapter, Babatsouli brings up the diversity considerations in clinical practices. Chapter 3, by Morris and Velde, reviews hearing loss and the benefits and problems with the use of cochlear implants. Chapter 4, by Hustad and Borrie, focuses on intelligibility impairment concerning the measurement of intelligibility and the identification of individuals with disorders. Stojanovik in Chap. 5 discusses how the study of genetic syndromes sheds light on the association of language skills and other general cognitive and communicative skills. Brinton, Fujiki, and Fujiki in Chap. 6 provide constructive principles that speech pathologists and therapists ought to follow in clinical practice.

Part II, from Chaps. 7 to 14, discusses eight types of language disorders concerning the latest progress and challenges. In Chap. 7, Prelock reviews Autism Spectrum Disorders. In Chap. 8 about language delay, Fletcher shows that the huge individual differences in the development of vocabulary and grammar pose challenges to identify a language delay. In Chap. 9, Gillam, Holbrook, and Kamhi discuss developmental language disorders (DLD), mainly focusing on the diagnosis, classification, causes, and intervention. Chapter 10, by Cummings, talks about how the theory of mind sheds light on the assessment of pragmatic impairment. Brennan in Chap. 11 discusses learning disabilities manifested in language, such as dyslexia, dysgraphia, dyscalculia, and non-verbal learning disabilities. Chapter 12, by Damico, Damico, and Nelson, focuses on literacy and literacy impairment, concerning how the conceptualization influences research and service delivery. Snow, Leitão, and Kippin in Chap. 13 explain how early-life psychosocial adversity hinders the development of language abilities. Code in Chap. 14 introduces aphasia, its features, and treatment.

Part III, from Chaps. 15 to 22 centers on the assessment and treatment of disorders with speech sounds. Chapter 15 by Rvachew talks about speech disorders in children. The topic of Chap. 16 is dysarthria reviewed by Hertrich, Ackermann, and Ziegler. Jacks and Haley in Chap. 17 review apraxia of speech. Drager, Finke, and Serpentine in Chap. 18 introduces augmentative and alternative communication as an aid for people with communicative challenges. Chapter 19, by Tetnowski, Scott, and Rutland, focuses on stuttering. Chapter 20 by Morris and Harmon talks about voice disorders. Chapter 21, by Sell, Pereira, Wren, and Russell, centers on patients who have innate cleft-related problems but receive timely surgical treatment. Chapter 22, by Bressmann, centers on the speech-production problems caused by head and neck cancer.

Part IV, with the four remaining chapters, talks about the cognitive and intellectual disorders that could incur language problems. Westby and Watson in Chap. 23 discuss language impairment associated with attention deficit hyperactivity disorder. Chapter 24, by Blake, centers on the communication disorders associated with right hemisphere brain damage. Lê and Mozeiko in Chap. 25 review traumatic brain injury and the subsequent cognitive and communicative disorders. Chapter 26, by Müller and Mok, focuses on dementia.

This book provides a comprehensive account of language/speech disorders with the latest findings in multiple disciplines, such as speech-language pathology, experimental psychology, linguistics, neuropsychologists, and neurology. In addition, the second volume keeps the audience updated with the latest progress and future research directions [e.g., Lee and Sim (2020) and Borrie et al. (2020) ]. For example, this book repeatedly mentions the revisions made in the manuals of clinical practice, the implications of the latest research findings, and the future research in urgent need to support assessment and treatment.

This book, however, is not without limitations. First, most of the research mentioned in this volume were conducted in Western languages, though diversity was emphasized in Chap. 2. The possible reason is that the research in other language families is scarce ( Lin et al. , 2018) . Future research in different languages will reveal important differences or universal patterns across cultures and ethnic groups. In addition, the language problems caused by other psychological problems, such as bipolar disorder and depression, are not documented in this book. In fact, there have been studies suggesting that patients with these psychological problems also struggle with language use ( Lin et al. , 2018 ).

Despite the limitations, this book provides comprehensive information for researchers and clinical practitioners in the field of language/speech disorders and thus is recommended to readers of the Journal of the Acoustical Society of America .

HUI ZHANG Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China

YUANYUAN ZHANG School of Foreign Languages, East China University of Science and Technology, 130 Meilong Road, Shanghai 200237, China

HAO ZHANG School of Foreign Languages, Shan Dong University, 5 Hongjialou Road, Jinan, Shandong 250100, China

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What Are Language Disorders?

Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

LightFieldStudios / Getty Images

Children come to the world almost pre-programmed to learn the language of their environment. But while it appears automatic for a child to learn to read, speak, and understand communication around them—the pace at which these skills are learned vary among children. In some cases, children may not meet certain developmental milestones .

A language disorder occurs when a child is unable to compose their thoughts , ideas, and messages using language. This is known as an expressive language disorder. When a child faces difficulty in understanding what is communicated via language, this is called a receptive language disorder.

Sometimes, a child may live with a mix of expressive and receptive language disorders. A lack of understanding or poor expression of language does not always indicate a language disorder, however. This could simply be the result of a speech delay.

Read on to learn about the types, characteristics, causes, and trusted treatment methods to manage language disorders in children .

Types of Language Disorders in Children 

With language , there are specific achievements expected when children mark a certain age. At 15 months, it is likely that a child can recognize between five to ten people when they are named by parents or caregivers. At 18 months, it is expected that a child can respond to simple directives like ‘let’s go outside’ without challenges. This is an already receptive child.

If at 18 months, a child is unable to pronounce ‘mama’ and ‘dada’, or if at 24 months, this child does not have at least 25 words in their vocabulary—this could signal an expressive language disorder.

Receptive Language Disorder

When a child struggles to understand the messages communicated to, or around them, this can be explained as a receptive disorder. Children with receptive challenges will usually display these difficulties before the age of four.  

Receptive difficulties may be observed where a child does not properly understand oral communication directed at, or around them.

In such cases, the child struggles to understand the spoken conversations or instructions directed around them. Likewise, written words may be difficult to process. Simple gestures to come, go, or sit still may also prove challenging to comprehend.

Expressive Language Disorders

Expressive language disorders occur when a child is unable to use language to communicate their thoughts or feelings.

In this sense, oral communication is just one of the affected areas. A child may also consider written communications difficult to express.

Children with expressive disorders will find it difficult to name objects, tell stories, or make gestures to communicate a point. This disorder can cause challenges with asking or answering questions, and may lead to improper grammar usage when communicating.

Symptoms of Language Disorders

Language disorders are a common observation in children. Up to 1 out of 20 children exhibit at least one symptom of a language disorder as they grow. The symptoms of receptive disorders include:

• Difficulty understanding words that are spoken
• Challenges with following spoken directions
• Experiencing strain with organizing thoughts

Expressive language disorders are identified through the following traits in children:

• Struggling to piece words into a sentence
• Adopting simple and short words when speaking 
• Arranging spoken words in a skewed manner
• Difficulty finding correct words when speaking
• Resorting to placeholders like ‘er’ when speaking
• Skipping over important words when communicating
• Using tenses improperly 
• Repeating phrases or questions when answering

Causes of Language Disorders

With a language disorder, the child does not develop the normal skills necessary for speech and language. The factors responsible for language disorders are unknown, this explains why they are often termed developmental disorders .  

Disabilities or Brain Injury

Despite the uncertainty around the causes of these disorders, certain factors have strong links to these conditions. In particular, other developmental disorders like autism and hearing loss commonly co-occur with language disorders. Likewise, a child with learning disabilities may also live with language disorders.

Aphasia is another condition linked with language disorders. This condition develops from damage to the portion of the brain responsible for language. Aphasia may be caused by a stroke, blows to the head, and brain infections.  The injury may increase the chances of developing a language disorder.  

Diagnosis of Language Disorders

To determine if a child has a language disorder, the first step is to receive an expert’s assessment of their condition.

A speech-language pathologist or a neuropsychologist may administer standardized tests. These are to review the child’s levels of language reception and expression.

The Link Between Deafness and Language Problems

In making their assessment, the health expert will conduct a hearing test to discover if the child suffers from hearing loss. This is because deafness is one of the most common causes of language problems.  

Treatment of Language Disorders

Language disorders can have far-reaching effects on the life of a child. These disorders can lead to poor social interactions, or a dependence on others as an adult. Challenges with reception and expression can also lead to reading challenges, or problems with learning .

To manage this condition, parents/guardians should exercise patience and care when dealing with children managing language disorders. While it can be challenging, children already experience frustration when dealing with others and expressing themselves. Caregivers can provide a place of comfort for children who have learning challenges.

For expert guidance, a speech-language pathologist can work with children and their guardians to improve communication and expression.

Because language disorders can be emotionally taxing, parents and children with these disorders can try therapy . This will help in navigating the emotional and behavioral issues caused by language impairments.

NCBI. Speech and Language Disorders in Children: Implications for the Social Security Administration's Supplemental Security Income Program .

MedlinePlus. Language Disorders in Children .

Ritvo A, Volkmar F, Lionello-Denolf K et al. Receptive Language Disorders . Encyclopedia of Autism Spectrum Disorders . 2013:2521-2526. doi:10.1007/978-1-4419-1698-3_1695

Reindal L, Nærland T, Weidle B, Lydersen S, Andreassen O, Sund A. Structural and Pragmatic Language Impairments in Children Evaluated for Autism Spectrum Disorder (ASD) .  J Autism Dev Disord . 2021. doi:10.1007/s10803-020-04853-1

National Institute on Deafness and Other Communication Disorders. Aphasia .

Centers for Disease Control and Prevention. Language and Speech Disorders in Children .

By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

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A Psycholinguistic Framework for Diagnosis and Treatment Planning of Developmental Speech Disorders

Hayo terband.

a Utrecht Institute of Linguistics-OTS, Utrecht University, Utrecht, The Netherlands

Ben Maassen

b Centre for Language and Cognition (CLCG) and University Medical Centre, University of Groningen, Groningen, The Netherlands

c Department of Communication Sciences and Disorders, Temple University, Philadelphia, Pennsylvania, USA

Differential diagnosis and treatment planning of developmental speech disorders (DSD) remains a major challenge in paediatric speech-language pathology. Different classification systems exist, in which subtypes are differentiated based on their theoretical cause and in which the definitions generally refer to speech production processes. Accordingly, various intervention methods have been developed aiming at different parts of the speech production process. Diagnostic classification in these systems, however, is primarily based on a description of behavioural speech symptoms rather than on underlying deficits.

In this paper, we present a process-oriented approach to diagnosis and treatment planning of DSD. Our framework comprises two general diagnostic categories: developmental delay and developmental disorder. Within these categories, treatment goals/targets and treatment methods are formulated at the level of processes and rules/representations.

A process-oriented approach to diagnosis and treatment planning holds important advantages, offering direct leads for treatment aimed at the underlying impairment, tailored to the specific needs of the individual and adjusted to the developmental trajectory.

Introduction

Speech constitutes the primary channel of human social interaction; yet speaking can be considered the most complex skill humans perform. Although most children acquire speech relatively automatically and with little difficulty, some children struggle with the acquisition of speech production skills and require sustained and intensive treatment [ 1 ]. Children with speech disorders are at increased risk of social-emotional and behavioural problems [ 2 , 3 ], as well as of delayed development of language, literacy, and other academic skills [ 4 ]. These issues may limit employment and occupational opportunities in adulthood [ 5 , 6 ]. Accurate diagnostic methods and effective intervention programmes are thus of crucial importance to limit the short- and long-term impact of developmental speech disorders (DSD) on the individual.

Unfortunately, differential diagnosis and treatment planning of paediatric speech disorders remains problematic. Existing systems of diagnostic classification comprise a set of theoretically grounded categories (definitions) that are associated with a symptom complex and start from the assumption that the categories can be differentiated by a diagnostic marker. A number of different systems for the classification of paediatric speech disorders have been proposed throughout the years [for an overview, see 7 ], in which subtypes are differentiated based on their distal or proximal cause. The predominant systems at the moment are Shriberg's Speech Disorders Classification System (SDCS) [ 8 , 9 ] and Dodd's Model of Differential Diagnosis (MDD) [ 10 , 11 ]. The SDCS is a classification based on the presumed aetiological background of the speech impairment and consists in its most recent form of three main categories divided into eight subcategories:

• Speech delay (SD; distal causes)
• Otitis media
• Psychosocial
• Motor speech disorders (MSD; proximal causes)
• Apraxia (childhood apraxia of speech; CAS)
• Dysarthria (developmental dysarthria; DD)
• Not otherwise specified (MSD-NOS)
• Residual speech errors

The basic idea behind the SDCS is that there are identifiable causes and that there are one-to-one relationships to specific speech symptoms [ 9 ]. A fundamental problem of the SDCS is that the classification system is inconsistent in specifying the levels of explanation across categories. In principle, the categorisation is based on the presumed aetiological background [ 8 , 9 ], but the two subcategories of residual speech errors are purely symptomatic descriptions at the behavioural level. Additionally and more importantly, the other subcategories of SD and MSD represent factors on different levels of explanation, i.e., genetic, otological, neurological, and psychological. Multiple factors and multiple levels could be involved in a single case, and their exact role and weight in causing the speech symptoms remains unclear. Moreover, the clinical characterisations of the diagnostic categories consist of a terminology that refers to speech production processes, but how the aetiology is related to the processing deficit is not specified. Thus, the SDCS can be characterised as a hybrid classification system that has the ambition to encompass all speech sound disorders. In its current state, however, the complexity of this system due to the different levels of causation involved, and the underspecification of the relation between levels, form serious obstacles to clinical use.

The MDD [ 10 , 11 ] is based on Stackhouse and Wells' [ 12 ] Psycholinguistic Framework, a modular psycholinguistic model of speech production and development. The categorisation consists of (sub)groups that are based on the psycholinguistic level of the presumed core deficit, the processing level that would be affected:

• Phonological disorder (PD; phonemic level)
• Phonological delay
• Inconsistent
• Phonetic articulation disorder (PAD; phonetic level)
• Developmental apraxia of speech (DAS; motor level; planning and programming)

In contrast to the SDCS, the MDD thus revolves around the proximal cause of the different disorders (the processing level) and it does not make claims about their possible more distal causes (neurobiology or aetiology). Although this system is consistent in terms of definitions and level of description (the psycholinguistic level of processing), this is only the case for the main categories, whereas subcategories of PD are defined based on symptomatology.

Apart from these specific issues, both classification systems suffer the same problem in that the relation between different levels of causation, in particular the psycholinguistic and the behavioural level, remains underspecified. Diagnostic markers that are both specific and sensitive have not yet been identified for all categories that are differentiated (e.g., PD, CAS/DAS, and MSD-NOS). Regardless of the theoretical basis, the definitions of the disorders in these systems refer to speech production processes. A variety of intervention methods for helping children with DSD have been developed, aiming at different parts of the speech production process, such as lemma selection, sequencing speech sounds and syllables, and planning/programming and execution of articulatory movements. Clear criteria for determining which treatment is the most suitable for an individual child, however, are lacking. Thus, whereas the definitions of the different disorders tend to refer to (hypothesised) underlying deficits or causes, the clinical procedures for differential diagnosis are not aimed at these definitions [see also, e.g., 13 , 14 , 15 , 16 , 17 , where similar conclusions were presented with respect to the taxonomy of adult dysarthria]. The current diagnostic instruments consist of tests that measure knowledge and complex skills, such as sentence formulation, vocabulary, picture and colour naming, and phoneme inventory. Classification comprises the assignment of a diagnostic category based on a behavioural description and symptomatology. This classification procedure does not provide sufficient direct information about the underlying processes and does not allow specification of the gradual involvement of different speech production processes.

At the genetic level, a variety of abnormalities have been linked with developmental speech and language disorders (e.g., mutation of FOXP2 [ 18 , 19 ], mutation of GRIN2A [ 20 ], and microdeletion of BCL11A [ 21 ]). Although the progress in this area is promising, the associated symptomatology is highly heterogeneous and often encompasses speech and non-speech motor functions, expressive and receptive language functions, and cognitive functions such as short-term memory and sequencing more in general [ 18 , 22 , 23 , 24 , 25 , 26 ]. Direct links between genotype and phenotype have yet to be established [ 25 , 26 ]. Also at the neurobiological level, few specific underlying deficits have been established for speech disorders other than perhaps those affecting peripheral sensory and motor systems. The link between particular neurobiological findings (e.g., atypical development of the left corticobulbar tract [ 27 ] and a thinner corpus callosum [ 28 ]) and cognitive and sensorimotor processes and behavioural performance remains to be explicated. Furthermore, in typical clinical settings, such information about the underlying genetic or neurobiological pathology is rarely available. Thus, although research on the genetic and neurobiological underpinnings of DSD may hold promise for our understanding and, in the long term, for clinical purposes, at present such research does not provide insights or specific suggestions to speech-language pathologists for diagnosis or for treatment planning for speech therapy [ 29 ]. In contrast, a focus on the underlying psycholinguistic processes has clear implications for diagnosis and treatment, as we outline further below.

The fundamental diagnostic problem is that different levels of causation in interaction underlie the speech disorder, and that at none of these levels in isolation, specific and sensitive diagnostic markers for diagnostic classification can be found. Due to the interactions between levels, there is a large overlap of symptomatology between categories and a large heterogeneity within categories. According to the 2004 model of Bishop and Snowling [ 30 ], four levels of causation, or four levels of aggregation, can be distinguished that are involved in developmental disorders. The first, aetiological level concerns the genetic constitution of the individual and environmental factors, which together determine the unfolding of the neurological architecture at the second, neurobiological level. The brain does not develop according to an exact predetermined blueprint, but is continuously adapting to biological and behavioural (environmental) circumstances. An example would be the communicative activity level of an infant. More active infants tend to elicit more communicative responses from the carer than do more passive infants. The third level is the cognitive and sensorimotor, or psycholinguistic, level describing the processes that underlie the fourth, behavioural level.

As we have argued before, core impairments at different levels of speech development and in different parts of the speech production chain cannot be clearly distinguished from each other at the behavioural symptom level alone, but they need an understanding of the complex interactions between causation levels [ 31 , 32 , 33 , 34 ]. Many examples have shown that different disorders may show similar symptoms [ 17 , 35 ], but computer simulations have also exemplified that a specific underlying deficit can produce symptoms on (apparently) different levels or domains [ 36 ]. Thus, behavioural symptoms are often multi-interpretable at the cognitive and neurobiological level. For example, specific phoneme substitution errors (behavioural) can often be analysed in phonological terms as feature substitutions or in speech-motor terms as articulatory simplifications or as sequencing errors (all three cognitive). Likewise, specific deficits at the neurobiological or cognitive level, if they can be determined at all, can result in a variety of behavioural symptoms. Thus, diagnostic classification requires assessments at different levels of causation and some description of the interaction between levels.

A good example of this basic challenge is the history of the dispute on the core definitions of CAS/DAS. The comprehensive 2007 ASHA Technical Report [ 37 ] noted that “[w]hereas some of the definitions of CAS reviewed by the Committee view the core problem as one of planning and programming (cognitive level) the spatiotemporal properties of movement sequences (behavioural level) underlying speech sound production, others propose that the deficit extends to representational-level (cognitive) segmental and/or suprasegmental units in both input processing and production” (p. 4). The ASHA Technical Report has had the effect of enhancing consensus on its definition of CAS as a “core impairment in planning and/or programming spatiotemporal parameters of movement sequences” (pp. 3–4) and, currently, researchers seem to have agreed on this description of processes or proximal causes underlying CAS. Thus, the report clearly makes a choice here at the cognitive and sensorimotor level. The basic problem is how to develop test procedures such that processing and representational deficits can be distinguished. Note that all test procedures make use of behavioural measures, not only assessment of symptoms, but also cognitive tests. The latter are based on behavioural assessments under strict experimental and test administration procedures; also functional brain imaging tests make use of presenting the subject with a task to elicit behaviour such that brain activity can be interpreted.

The high variability and broad spectrum of symptoms in DSD form a major challenge for clinical management and research. Effective differential diagnosis therefore requires a theoretically grounded process-oriented approach focusing on clearly defined underlying deficits (whether cause or processes) rather than classification based on symptoms. Instead of searching for homogeneous groupings of overt speech symptoms and subsequently trying to identify a common cause (whether proximal or distal) one should start with what can be clearly defined. Although the symptomatology and aetiology are not completely clear, there is a solid theoretical basis that allows us to precisely describe specific core problems in terms of psycholinguistic processes [ 33 , 34 ]. To identify underlying deficits, one must thus start with a model of the cognitive and sensorimotor operations involved, from which specific hypotheses of speech symptoms are derived [ 33 , 34 ] [see also 12 , 38 ]. A focus on processes instead of cause (aetiology) has the advantage that it provides direct information for treatment. In this paper, we present a theoretically based framework for process-oriented diagnosis and treatment planning of DSD.

An Integrated Psycholinguistic Model of Speech Processing

The starting point of our framework is an integrated model of the cognitive and sensorimotor functions involved in speech production and perception (Fig. ​ (Fig.1). 1 ). A variety of models of speech processing have been presented over the years [e.g., 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. Each model has its own specific approach, scope and theoretical basis and the scientific discussion on which model gives the best account of all the different speech phenomena traditionally revolves around the differences between models. Whereas the scientific endeavour tends to focus on what we do not know, what we do know is far more important for clinical practice. From this perspective, it can be noted that the different models show important similarities and overlap [see also, e.g., 31 , 33 , 34 , 38 , 47 ].

Adult model of speech processing [ 33 , 34 ] (adapted from Levelt [ 39 , 51 ], Van der Merwe [ 40 , 50 ], and Guenther [ 45 , 53 ]), displaying the sensorimotor and memory functions involved in speech production and perception.

Similar to any model of complex motor performance, all models of speech processing first and foremost adopt a cascade-style hierarchy of control in which the output of one process forms the input of the next processing level [e.g., 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 48 , 49 , 50 , 51 , 52 ]. Leaving out all the details of dispute and differences in scope between models, speech production is preceded by a language process of sentence formulation, in which lemmata are retrieved from the lexicon and inflected and sequenced in a grammatical phrase to match intended concepts, and stored in a short-term memory buffer ( grammatical encoding ) [e.g., 39 , 51 ]. Speech production models then start with the word forms (lexemes) retrieved from the lexicon, which forms the input for phonological encoding , in which the sensorimotor targets that constitute the speech sounds or syllables are selected and sequenced in a phonological phrase of linguistic/symbolic units, and stored in a short-term memory buffer [e.g., 39 , 40 , 41 , 49 , 50 , 51 ].

The next stage, motor planning , comprises the selection and sequencing of the articulatory movement goals that would produce these targets [e.g., 40 , 41 , 42 , 48 , 50 ], and the adaptation of these goals to the phonetic environment (e.g., coarticulation) [ 40 , 50 ]. During the subsequent stage, motor programming , the motor plans are then implemented in muscle-specific motor programmes [e.g., 40 , 43 , 45 , 48 , 50 , 53 ], taking into account articulatory context, sensory information, and (meta)linguistic requirements (e.g., speech rate, prosody, and prominence) [ 40 , 50 ]. Finally, the constructed neural signals that constitute the motor programmes are sent to the peripheral systems and executed, resulting in the actual movements of the articulators ( motor execution ) [e.g., 40 , 43 , 45 , 48 , 50 , 53 ].

During speaking, these stages form an ongoing process that is monitored continuously at several levels. This self-monitoring is based on both internal and external feedback (Fig. ​ (Fig.1). 1 ). Internal feedback is used during motor planning to avoid, for example, that erroneously planned speech movements are executed [e.g., 39 , 51 , 54 ]. External feedback comprises both fast somatosensory and slow auditory monitoring and provides current information about the state and position of the articulatory organs (such as position, movement direction, and speed) as input for motor programming [e.g., 40 , 43 , 44 , 45 , 50 , 53 ]. External feedback is further used to monitor the produced speech on the motor programming, phonological, and higher linguistic levels [e.g., 26 , 27 , 38 , 41 ] and can be used for ongoing adaptation of articulation and error correction [e.g., 43 , 44 , 45 , 53 ].

The adult speech production system is very robust. The different processes and representations are highly overlearned and the system is highly redundant. In case of acquired deafness, for example, speakers continue to be intelligible despite the fact that auditory self-monitoring is completely disabled. The situation is different, however, during speech acquisition in infants and children. The different cognitive and sensorimotor functions are not pre-specified in the infant brain, but they develop gradually into the adult system [ 55 , 56 , 57 ]. The different functions and representations develop simultaneously and influence each other during development [e.g., 36 , 58 ].

However, also in the adult speech production and perception system, the different parts of the processing chain are not fully independent. The mutual dependence between processes mainly expresses itself in the case of disruptions. In the adult model, two types of interaction can be distinguished: direct and indirect. With direct interaction, we mean that processes are dependent on input received from other processes. Degraded input from one specific impaired process can lead to problems at the subsequent processing level (which may itself be intact). For example, difficulties in phonological encoding may affect speech motor control processes and thus cause (sensori)motor symptoms [e.g., 49 ]. Indirect interaction refers to adaptive and compensatory mechanisms. If some part of the system suffers an impairment, the system will try to adapt to the deviant circumstances and/or compensate for the impediments. One simple way in which the system can adapt is by slowing down the speech rate. A slow speech rate is a general characteristic of MSD irrespective of the underlying deficit. In many cases, it does not constitute a primary symptom but rather acts as a compensatory mechanism to make the control task easier [ 17 , 59 ]. A clear example of adaptation and compensation mechanisms on a functional-cognitive level can be seen in people with anatomical deformities of the articulatory organs, such as glossectomy [ 60 , 61 , 62 , 63 , 64 , 65 ] or dental occlusions and prostheses [ 66 , 67 , 68 , 69 ].

In the case of an impairment in one of the processes or representations in children, the interaction between the different parts of the system gets an extra dimension. A specific underlying impairment on one level or domain also affects the development on adjacent levels or domains [ 14 , 36 , 70 , 71 , 72 ]. Due to this developmental interaction, the potential influence of primary deficits on adjacent processing levels and of adaptive and compensatory mechanisms is even stronger. A primary impairment at the acoustic-perceptual level can, for example, cause the phonological representations to be incorrect or underspecified. This could in turn lead to a deviant and incomplete phonological system, primarily because it had to learn from degraded input. Similar observations have been described in children with a cleft palate, who often develop specific articulation patterns to compensate for their deficit [ 73 , 74 , 75 ]. These compensatory articulation patterns may persist after the cleft has been surgically repaired, causing problems in the development of the children's phonological system [e.g., 73 , 74 , 76 ]. Another example is the correlational evidence that suggests that poor motor control in CAS is associated with poor development of the lexicon, the phonological system, and auditory processing [ 77 , 78 ].

As a result of these interdependencies between the different levels of speech development and different parts of the speech production chain, overlap of symptoms in paediatric speech sound disorder is the rule rather than the exception, which has frustrated attempts to find single diagnostic markers for differential diagnosis. This interdependent nature of the developing speech processing system means that the idea of finding single diagnostic markers is fundamentally problematic and that attempts to do so are unlikely to be fruitful. As Bishop [ 55 ] argued in the context of specific language impairment already more than 20 years ago, the neuropsychological principle of double dissociation in the study of acquired disorders in adults does not apply to developmental disorders. Developmental disorders are characterised by associations between functions rather than dissociation. Differential diagnosis and treatment planning therefore require a different approach than classification based on overt speech symptoms only. Along this line, Maassen [ 25 ] presented a multi-level, multi-factorial description of the underlying deficit of CAS.

Process-Oriented Diagnosis and Treatment Planning

The multi-factorial nature of developmental disorders means that effective diagnosis and treatment planning require a dynamic, process-oriented approach aimed at describing the development of underlying processing deficits to characterise disorders [ 31 , 32 , 36 ]. Based on the integrated model of speech processing presented above (Fig. ​ (Fig.1), 1 ), we propose a framework for process-oriented diagnosis and treatment planning of DSD (Table ​ (Table1). 1 ). Two essential elements of our framework are that it comprises general diagnostic categories within which specific treatment goals/targets are formulated at the level of processes and representations.

The processes and rules/representations of the speech production chain that form the possible treatment goals/targets, accompanied by examples of assessments and possible specific task comparisons based on these assessments that address these (note that these are not exhaustive)

General Diagnostic Categories

The framework that we propose distinguishes two general diagnostic categories labelled developmental delay and developmental disorder . The division between these categories is based on fundamental differences in the general characterisation of delayed versus deviant speech development [ 79 , 80 , 81 , 82 ]. These differences are informative for both the treatment goals/targets and the choice of the treatment method (the design of the treatment programme; the choice and planning of exercises and activities). In the case of developmental delay, development follows the typical pattern, but is delayed. The speech difficulties that the child experiences are not unusual and are also commonly experienced by children with typical development, but they are unusual for the age. Development can also be delayed in the case of developmental disorder; however, essential for the latter category is that development does not follow the typical pattern. Speech difficulties occur that are not usual during any stage in typical development. The different characteristics of the developmental trajectories demand a fundamentally different approach in terms of treatment and thus importantly serve to direct the choice of the treatment goals/targets and methods.

Treatment Goals/Targets at the Level of Processes and Representations

The goal of the speech acquisition process is to form the different components of the speech production chain as they exist and function in the adult system (Fig. ​ (Fig.1). 1 ). What we propose with the current framework is that when problems are encountered during speech acquisition, the goals/targets for treatment are defined in terms of these same components. In other words, the possible treatment goals/targets correspond to the processes and rules/representations that are presented in the speech production model in Figure ​ Figure1. 1 . Leaving the language processes aside, the framework differentiates four processing processes and three monitoring processes. The framework further contains a set of phonological rules and two representations that are used by the different processes. A short overview of the different components of the framework that form the possible goals/targets for treatment is presented in Table ​ Table1 1 [ 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 ].

Hypothesis Testing

In this framework, a diagnosis comprises the assessment of the two aspects described in the previous paragraphs: (1) the developmental trajectory as a whole, characterised by the developmental profile of processes, and (2) deducing the underlying processing deficit(s) and, from there, identifying treatment targets. Identifying the developmental profile reveals whether specific processes lag behind, which forms the basis for specifying treatment targets. A delayed but balanced profile indicates developmental delay, whereas an unbalanced profile indicates a deviant development [ 82 ]. In addition, it needs to be determined whether specific deficits underlie the unbalanced profile, which is especially important for the choice of treatment method.

Thus, development could be delayed or deviant in different ways. Processes and rules/representations can be less accurate, less automated, or slower. Additionally, speech development could start typically until the onset of the speech difficulties, for example, due to increased demands. The assessment and characterisation of the developmental trajectory require standardised and norm-referenced speech tasks, as well as language and oral motor tasks [ 115 , see also 116 ]. 1 To a large extent, these instruments are available (albeit not for all languages). Identifying the processes involved requires an experimental research methodology that has become available only recently, and still needs to be further developed and refined and subsequently implemented in clinical instruments. In essence, the approach follows the principal ideas of Stackhouse and Wells [ 12 , 121 ], later advocated by Baker et al. [ 38 ], and is very similar in spirit to the Psycholinguistic Assessments of Language Processing in Aphasia (PALPA) [ 122 ]. The approach comprises a reiterative process of hypothesis testing by means of objective measurements of speech output in systematically varied tasks under systematically varied conditions. Different speaking tasks and speaking conditions put different demands on different components of the speech production model (Table ​ (Table1). 1 ). In the right combination, this enables a demonstration of the processes involved. Based on a specific test result, a hypothesis about the speech impairment is formulated or adjusted, which is then evaluated by means of a subsequent test or condition. Eventually, after a number of steps, this leads to a profile characterising which processes and rules/representations of the speech production chain are involved. Ultimately, a specific diagnosis is established by deducing the underlying deficit(s) based on this profile, in combination with the characterisation of the impairment. A concrete treatment plan can then be drafted to target (or circumvent) the impairment, taking into account other relevant aspects such as age, severity, and individual characteristics and personal interests.

First steps in such profiling of speech production and perception characteristics based on an extensive assessment battery have been successfully made in research applications for diagnostic group assignment for some time [ 123 , 124 , 125 ]. Similarly, model-based approaches comprising detailed comparisons of different tasks and/or conditions to specify the underlying speech processing difficulties involved in children with speech impairment are being used successfully in experimental studies [ 108 , 110 , 126 , 127 ]. A particularly nice example is the recent study by Geronikou and Rees [ 127 ], who used a battery of speech production and perception tasks to specify - for each child individually - the underlying speech processing difficulties in four 4.5- to 5.5-year-old children with a PD with very similar speech error patterns. The speech output tasks included picture naming, word repetition, and non-word repetition, while the perception tasks included non-word discrimination and mispronunciation detection. All children showed similar problems in the speech production tasks, but the results showed specific differences in the performance on the perception tasks for these specific target sounds. Two of the children had difficulties in the mispronunciation detection task but not in non-word discrimination, leading the authors to infer that for these children the problem resided in the phonological representations of the target sounds. The other 2 children had no difficulty with either mispronunciation detection or non-word discrimination, suggesting that the target sounds were well specified in the phonological representations but not in the motor representations (phonemic mappings in the terminology of the present paper). As the authors concluded, this makes a fundamental difference for intervention [ 127 ].

The example above, as well as the PALPA [ 122 ], can be characterised as a neuropsychological approach, comprising the administration of a test battery and deducing from the profile which underlying process(es) is/are disrupted. Such a comprehensive speech profile is the first step towards a process-oriented diagnosis in which underlying deficits are identified. The next step is to directly manipulate speech processes, for instance, by speeding up, masking noise, auditory perturbation, distorting kinaesthetic feedback, or short learning tasks (brief diagnostic therapies). Rather than having to interpret a particular speech profile, which relies on a matched comparison group, in these varying conditions the subject is his or her own control. The required experimental methods are available and are being further developed and fine-tuned in research studies. Slowly but certainly, they are becoming available for use in clinical practice.

Conclusions

In this paper, we presented a model of speech processing that can serve as a framework for a process-oriented approach to diagnosis and treatment planning of DSD. This process-oriented approach holds important advantages, in that it offers direct leads for treatment aimed at the specific underlying impairment and adjusted during the course of the speech disorder. Although the diagnostic procedure will be more time-consuming than the current procedures, a more targeted treatment tailored to the specific needs of the individual promises to be more effective and efficient. Moreover, we believe that current and future technological advances in diagnostic instrumentation, such as automated test administration and automated processing and analyses of test performance, will partly eliminate these drawbacks.

Possibly more problematic is that this process-oriented approach requires a different way of thinking by clinical practitioners [ 12 , 33 , 34 , 38 , 40 , 50 , 121 ]. Speech therapists are generally trained to focus on speech output skills, to think and work according to a framework of diagnostic classification based on behavioural symptoms only and plan treatment according to the corresponding protocol. A change to a practice of hypothesis testing in a psycholinguistic framework requires a different education and training to provide speech therapists with the theoretical background and the clinical skills to utilise and interpret a process-oriented instrument for diagnostics and treatment planning [ 31 , 32 , 33 ]. The step from a behavioural to a process-oriented diagnostic and treatment planning means, in the words of Baker et al. [ 38 ], “reframing the ways in which we understand children's communication problems” (p. 700) [see also 33 , 34 , 40 , 50 , 121 ].

Statement of Ethics

The authors have no ethical conflicts to disclose.

Disclosure Statement

The authors have no conflicts of interest to disclose.

Acknowledgements

This work was supported by the Netherlands Organization for Scientific Research (NWO-VENI grant 275-89-016 awarded to H.T.), and the National Institutes of Health (National Institute of Deafness and Other Communication Disorders grant K01-DC010216 awarded to E.M.).

What are language disorders?

Language disorders and speech disorders are used to describe when a person has a specific difficulty with communication or other areas related to communication, like oral motor functions. These disorders have a varied symptomology, from the inability to understand speech to the inability to talk, and the symptoms can appear from childhood into adulthood.

Causes of language disorders

There are many different causes of learning disorders, so it is impossible to pinpoint just one. It is possible to differentiate between the causes depending on the chain of events that lead to the language problem, some of which are organic, which refers to any damage to the organs that play a fundamental role in language. We can break down organic causes into the following groups:

Hereditary causes: When the language disorder is inherited from one or both of the parents Congenital causes: When the language disorder is caused by the use of prescription drugs or complications during pregnancy. Perinatal causes : Language disorders that originate during birth Postnatal causes: Language disorders that appear after pregnancy, like disorders due to premature birth. Aside from the organic causes, there are also functional causes of language disorders, which are due to the pathological function of the organs that are used in language. Endocrine causes mainly affect the child’s psychomotor development . Environmental causes are also a large factor that influences language, as the child surroundings may affect his or her linguistic abilities. Finally, psychosomatic causes have been known to play an important role in the development of some language disorders. Our thoughts are powerful, and they can even lead us to create speech disorders. Likewise, speech disorders can also affect how we think. Both things can make it more difficult to develop good communication skills.

Language disorders symptoms

There are various symptoms that can predict a possible language disorder, depending on the type of disorder and the affected area. We can, however, classify the general language disorders by discerning different symptoms.

• Symptoms of an expressive development disorder : You’ll see symptoms like an extremely limited vocabulary, difficulty memorizing words, or creating long sentences.
• Symptoms of an expressive-receptive mixed language disorder : You will see the same symptoms as the disorder above, combined with possible problems associated with reception, like understanding words or phrases. Following is a video of a teenager with a mixed language disorder explaining the experience of living with it.

• Symptoms of a phonological language disorder : You will notice certain mistakes when pronouncing words, reproducing sounds, and/or using sounds.

One of the more apparent speech disorder is stuttering, where the person will have an alteration in the fluidity and organization of words.

Even though the language is a complex process and speech disorders can have a number of different symptoms, we can identify certain signs that would indicate a possible speech disorder. We can differentiate the following in child speech disorders:

• Expressive language : This problem might become apparent when the child has a very limited vocabulary compared to others of his or her age. They may have a hard time learning new words, and they may confuse verb tenses. Look out for using general words (this, that, etc.), rather than the precise word. They may not talk very much, and they say things that don’t make sense, even though they’re able to pronounce the words well. The child might use a limited structure in their sentences and repeat the same sentences when they speak.
• Receptive language : Some common signs of an expressive language disorder in children are seeming disinterested when other people talk, trouble following directions or a hard time understanding what is being said.

Types and classification of language disorders

1. language disorders- dysarthrias.

An affection that makes speech difficult due to muscle problems that inhibit speaking.

2. Language disorders- Dyslalia:

A type of language disorder that is classified by the alteration, omission, or substation of certain phonemes for other, incorrect ones.

There are different types of dyslalias:

• Physiological dyslalia : The child’s organs aren’t mature enough to articulate certain words. It is completely normal and no need for worry, as long as it doesn’t last for too long.
• Audiogenic dyslalia : As the name suggests, this speech problem is caused by a defect in the child’s hiring which prevents them from properly being able to imitate sounds. Functional: This occurs when physiological dyslalia happens over a prolonged period of time.
• Functional dyslalia : It may appear after prolonged physiological dyslalia when the organs have already matured. It is related to a defect in the articulation of the message.
• Organic dyslalia : This type of dyslalia is also called diglossia, and is related to defects in the organs that are used in speech.

3. Language disorders- Diglossia:

Diglossia is a type of language disorder classified by the following characteristics:

• Labial diglossia:  Caused by an alteration of the shape or strength of the lips. Some of the more well-known cases are cleft lip and frenulum.
• Mandibular (jaw) diglossia:  Caused by an alteration in one or both jaws.
• Dental diglossia:  Caused by an alteration in the shape or position of the teeth.
• Lingual diglossia:  Caused by alterations of the tongue. Without the perfect synchronization of the tongue, speech is impaired. Some of the most common disorders that can cause this kind of diglossia is ankyloglossia (small frenulum), macroglossia (large tongue), or unilateral or bilateral paralysis.
• Nasal diglossia:  Caused by alterations that prevent air from properly reaching the lungs.
• Palatal diglossia:  Caused by alterations to the palate (roof of the mouth).

4. Language disorders-Dysphemia

Dysphemia is defined as an alteration to the tongue and is characterized by spams and tics caused by poor coordination in the brain’s motor skills. An example of dysphemia is stuttering, which we mentioned earlier.

5.  Language disorders- Aphasia:

This type of language disorder doesn’t generally occur in children, as it is the consequence of a brain injury, where certain parts of the brain related to language are affected.

• Broca’s Aphasia:  Broca’s aphasia is the caused by a lesion in the frontal lobe where the Broca’s area is located. It is characterized by an extreme difficulty articulating ideas and speaking in short phrases. This aphasia most affects the patient’s expression (which is why it is also called expressive aphasia). However, the patient usually has little to no problems with comprehension.

• Wernicke’s Aphasia:  Wernicke’s aphasia is caused by damage to the left temporal lobe, next to the auditory cortex. This disorder is also known as  receptive aphasia because it is characterized by fluid speech that makes little sense. Those who suffer from this disorder also have problems with comprehension.

• Conduction (associative) aphasia:  This disorder is caused by damage to the arcuate fasciculus and/or other connections between the temporal and frontal lobes. This disorder is characterized relatively fluid (paraphasic) speech, good comprehension, but trouble reproducing speech. Patients with conduction aphasia have a hard time reading out loud, especially if the words or sentences are long.
• Transcortical sensory aphasia (TSA):  Characterized by damage to specific parts of the temporal and parietal lobes, and causes problems with the comprehension of single words, but the ability to reproduce sounds and words is relatively intact.
• Transcortical motor aphasia (TMoA):  Also known as commissural dysphasia, TMoA is caused by damage to the anterior superior frontal lobe. It is characterized by spontaneous speech but doesn’t generally affect the ability to name objects.
• Anomic aphasia:  Caused by damage to parts of the temporal and parietal lobes, and causes problems producing single words on their own.
• Global aphasia:  Global aphasia is the most serious aphasia, and affects important language functions. It affects both receptive brain functions and is caused by a lesion in the perisylvian cortex.

6. Language disorders- Dyslexia:

Dyslexia is common enough that we’ll provide it its own section . Dyslexia is characterized by a learning disorder that affects a child’s reading and writing skills. While professionals still aren’t sure exactly why some people suffer from dyslexia, it is believed that it is caused by problems with the child’s neurodevelopment. This disorder can affect both adults and children, but there are programs available to help assess and improve the symptoms of dyslexia, like CogniFit’s   neurocognitive assessments for dyslexia , brain games to help treat dyslexia , and programs for schools .

CogniFit innovative online dyslexia test is a scientific resource that allows you to carry out a complete cognitive screening. Find out cognitive weaknesses and strengths, and evaluate the risk index of dyslexia with excellent reliability. This test is aimed at children over 7 years old, young people and adults.

How to diagnose language disorders

In order to properly diagnose a language disorder, it’s important to follow certain guidelines and tests. Identifying a language or speech disorder in a child is especially important, as it may help the child either improve or learn to cope with their language disorder.

If you think that your child or someone you know might have a language disorder, talk to teachers and school staff to find out what information and resources are available to you. They might suggest that you see a professional speech therapist, or that you should wait to see if the child grows out of it.

Language disorders: How to help at home

As you saw above, language and speech disorders don’t only affect one part of speech, and as such, there isn’t only one way to help your child improve their speech problems.

• Find out if the child has a language or speech disorder, or if they just have trouble communicating. Do what you can to have your child communicate in different ways: listen to music, sing, and listen to them.
• Reading is also helpful and can be interactive. Talk about what you’ve read, the pictures, what’s happening in the story, what they think will happen, etc.
• Understanding the problem is also a good start to helping your child. If you’re not sure, see a specialist to help you better understand what’s going on.

Questions? Leave me a message below 😉

This article was originally written in Spanish by Mario de Vicente

Alejandra is a clinical and health psychologist. She is a child specialist with a diploma in evaluation and intervention in autism. She has worked in different schools with young children and private practice for over 6 years. She is interested in early childhood intervention, emotional intelligence, and attachment styles. As a brain and human behavior enthusiast, she is more than happy to answer your questions and share her experience.

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Screening for speech and language delay and disorders in children 5 years or younger

Evidence report and systematic review for the US preventive services task force

Feltner, C. , Wallace, I. F. , Nowell, S. W., Orr, C. J., Raffa, B., Middleton, J. C., Vaughan, J., Baker, C., Chou, R. , & Kahwati, L. (2024). Screening for speech and language delay and disorders in children 5 years or younger: Evidence report and systematic review for the US preventive services task force . JAMA , 331 (4), 335-351. https://doi.org/10.1001/jama.2023.24647

IMPORTANCE: Children with speech and language difficulties are at risk for learning and behavioral problems.

OBJECTIVE: To review the evidence on screening for speech and language delay or disorders in children 5 years or younger to inform the US Preventive Services Task Force.

DATA SOURCES: PubMed/MEDLINE, Cochrane Library, PsycInfo, ERIC, Linguistic and Language Behavior Abstracts (ProQuest), and trial registries through January 17, 2023; surveillance through November 24, 2023.

STUDY SELECTION: English-language studies of screening test accuracy, trials or cohort studies comparing screening vs no screening; randomized clinical trials (RCTs) of interventions.

DATA EXTRACTION AND SYNTHESIS: Dual review of abstracts, full-text articles, study quality, and data extraction; results were narratively summarized.

MAIN OUTCOMES AND MEASURES: Screening test accuracy, speech and language outcomes, school performance, function, quality of life, and harms.

RESULTS: Thirty-eight studies in 41 articles were included (N = 9006). No study evaluated the direct benefits of screening vs no screening. Twenty-one studies (n = 7489) assessed the accuracy of 23 different screening tools that varied with regard to whether they were designed to be completed by parents vs trained examiners, and to screen for global (any) language problems vs specific skills (eg, expressive language). Three studies assessing parent-reported tools for expressive language skills found consistently high sensitivity (range, 88%-93%) and specificity (range, 88%-85%). The accuracy of other screening tools varied widely. Seventeen RCTs (n = 1517) evaluated interventions for speech and language delay or disorders, although none enrolled children identified by routine screening in primary care. Two RCTs evaluating relatively intensive parental group training interventions (11 sessions) found benefit for different measures of expressive language skills, and 1 evaluating a less intensive intervention (6 sessions) found no difference between groups for any outcome. Two RCTs (n = 76) evaluating the Lidcombe Program of Early Stuttering Intervention delivered by speech-language pathologists featuring parent training found a 2.3% to 3.0% lower proportion of syllables stuttered at 9 months compared with the control group when delivered in clinic and via telehealth, respectively. Evidence on other interventions was limited. No RCTs reported on the harms of interventions.

CONCLUSIONS AND RELEVANCE: No studies directly assessed the benefits and harms of screening. Some parent-reported screening tools for expressive language skills had reasonable accuracy for detecting expressive language delay. Group parent training programs for speech delay that provided at least 11 parental training sessions improved expressive language skills, and a stuttering intervention delivered by speech-language pathologists reduced stuttering frequency.

10.1001/jama.2023.24647

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Leila Kahwati

Recent publications, respiratory syncytial virus knowledge, attitudes, and perceptions among adults in the united states, adult, adolescent, and caregiver preferences for attributes of topical treatments for mild-to-moderate atopic dermatitis, exploring factors associated with trichuris trichiura infection in school children in a high-transmission setting in kenya., effects of mtbi with loss of consciousness on neurobehavioral symptoms, depression, and insomnia in former collegiate and nfl football athletes.

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May 16, 2024

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Neuroplasticity study shows how singing rehabilitates speech production in post-stroke aphasia

by University of Helsinki

Cerebrovascular accidents, or strokes, are the most common cause of aphasia, a speech disorder of cerebral origin. People with aphasia have a reduced ability to understand or produce speech or written language. An estimated 40% of people who have had a stroke have aphasia. As many as half of them experience aphasia symptoms even a year after the original attack.

Researchers at the University of Helsinki previously found that sung music helps in the language recovery of patients affected by strokes. Now, the researchers have uncovered the reason for the rehabilitative effect of singing. The recently completed study was published in eNeuro .

According to the findings, singing repairs the structural language network of the brain. The language network processes language and speech in our brain. In patients with aphasia, the network has been damaged.

"For the first time, our findings demonstrate that the rehabilitation of patients with aphasia through singing is based on neuroplasticity changes, that is, the plasticity of the brain," says University Researcher Aleksi Sihvonen from the University of Helsinki.

Singing improves language network pathways

The language network encompasses the cortical regions of the brain involved in the processing of language and speech, as well as the white matter tracts that convey information between the different end points of the cortex.

According to the study results, singing increased the volume of gray matter in the language regions of the left frontal lobe and improved tract connectivity especially in the language network of the left hemisphere, but also in the right hemisphere.

"These positive changes were associated with patients' improved speech production ," Sihvonen says.

A total of 54 aphasia patients participated in the study, of whom 28 underwent MRI scans at the beginning and end of the study. The researchers investigated the rehabilitative effect of singing with the help of choir singing, music therapy and singing exercises at home.

Singing is a cost-effective treatment

Aphasia has a wide-ranging effect on the functional capacity and quality of life of affected individuals and easily leads to social isolation.

According to Sihvonen, singing can be seen as a cost-effective addition to conventional forms of rehabilitation, or as rehabilitation for mild speech disorders in cases where access to other types of rehabilitation is limited.

"Patients can also sing with their family members , and singing can be organized in health care units as a group-based, cost-efficient rehabilitation ," Sihvonen says.

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