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Overcoming Speech Impediment: Symptoms to Treatment

There are many causes and solutions for impaired speech

• Types and Symptoms
• Speech Therapy
• Building Confidence

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

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

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

FG Trade / Getty Images

Types and Symptoms of Speech Impediment

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

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

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

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

Can Symptoms Worsen?

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

Symptoms of dysarthria can include:

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

Symptoms of aphasia may involve:

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

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

Causes of Speech Impediment

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

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

Speech Impairment in Children

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

Common causes of childhood speech impediments include:

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

Do Childhood Speech Disorders Persist?

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

Speech Impairment in Adulthood

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

Common causes of adult speech impairment include:

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

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

Do Speech Disorders Resolve on Their Own?

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

Steps to Treating Speech Impediment 

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

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

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

Diagnostic testing may include:

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

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

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

Therapy to Address Speech Impediment

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

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

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

Exercises during speech therapy may include:

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

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

Building Confidence With Speech Problems 

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

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

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

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

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

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

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

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

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

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

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

By Heidi Moawad, MD Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.  

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Types of Speech Impediments

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

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Articulation Errors

Ankyloglossia, treating speech disorders.

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

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

There are many different types of speech impediments, including:

• Articulation errors

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

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

Symptoms and Characteristics of Disfluencies

These are some of the characteristics of disfluencies:

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

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

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

Causes of Disfluencies

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

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

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

Symptoms and Characteristics of Articulation Errors

These are some of the characteristics of articulation disorders:

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

Causes of Articulation Errors

Articulation errors may be caused by:

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

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

Symptoms and Characteristics of Ankyloglossia

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

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

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

Causes of Ankyloglossia

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

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

Symptoms and Characteristics of Dysarthria

Dysarthria is characterized by:

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

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

Causes of Dysarthria

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

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

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

Symptoms and Characteristics of Apraxia

These are some of the characteristics of apraxia:

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

Causes of Apraxia

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

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

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

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

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

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

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

A Word From Verywell

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

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

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

National Library of Medicine. Speech disorders . Medline Plus.

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

Cincinnati Children's Hospital. Stuttering .

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

Cleveland Clinic. Speech impediment .

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

Nemours Foundation. Speech problems .

Penn Medicine. Speech and language disorders .

Cleveland Clinic. Tongue-tie .

University of Rochester Medical Center. Ankyloglossia .

Cleveland Clinic. Dysarthria .

National Institute on Deafness and Other Communication Disorders. Apraxia of speech .

Cleveland Clinic. Childhood apraxia of speech .

Stanford Children’s Hospital. Speech sound disorders in children .

Abbastabar H, Alizadeh A, Darparesh M, Mohseni S, Roozbeh N. Spatial distribution and the prevalence of speech disorders in the provinces of Iran . J Med Life . 2015;8(Spec Iss 2):99-104.

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

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Home / Blog

Speech Impediment Guide: Definition, Causes, and Resources

December 8, 2020 

Tables of Contents

What Is a Speech Impediment?

Types of speech disorders, speech impediment causes, how to fix a speech impediment, making a difference in speech disorders.

Communication is a cornerstone of human relationships. When an individual struggles to verbalize information, thoughts, and feelings, it can cause major barriers in personal, learning, and business interactions.

Speech impediments, or speech disorders, can lead to feelings of insecurity and frustration. They can also cause worry for family members and friends who don’t know how to help their loved ones express themselves.

Fortunately, there are a number of ways that speech disorders can be treated, and in many cases, cured. Health professionals in fields including speech-language pathology and audiology can work with patients to overcome communication disorders, and individuals and families can learn techniques to help.

Commonly referred to as a speech disorder, a speech impediment is a condition that impacts an individual’s ability to speak fluently, correctly, or with clear resonance or tone. Individuals with speech disorders have problems creating understandable sounds or forming words, leading to communication difficulties.

Some 7.7% of U.S. children — or 1 in 12 youths between the ages of 3 and 17 — have speech, voice, language, or swallowing disorders, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). About 70 million people worldwide, including some 3 million Americans, experience stuttering difficulties, according to the Stuttering Foundation.

Common signs of a speech disorder

There are several symptoms and indicators that can point to a speech disorder.

• Unintelligible speech — A speech disorder may be present when others have difficulty understanding a person’s verbalizations.
• Omitted sounds — This symptom can include the omission of part of a word, such as saying “bo” instead of “boat,” and may include omission of consonants or syllables.
• Added sounds — This can involve adding extra sounds in a word, such as “buhlack” instead of “black,” or repeating sounds like “b-b-b-ball.”
• Substituted sounds — When sounds are substituted or distorted, such as saying “wabbit” instead of “rabbit,” it may indicate a speech disorder.
• Use of gestures — When individuals use gestures to communicate instead of words, a speech impediment may be the cause.
• Inappropriate pitch — This symptom is characterized by speaking with a strange pitch or volume.

In children, signs might also include a lack of babbling or making limited sounds. Symptoms may also include the incorrect use of specific sounds in words, according to the American Speech-Language-Hearing Association (ASHA). This may include the sounds p, m, b, w, and h among children aged 1-2, and k, f, g, d, n, and t for children aged 2-3.

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Categories of Speech Impediments

Speech impediments can range from speech sound disorders (articulation and phonological disorders) to voice disorders. Speech sound disorders may be organic — resulting from a motor or sensory cause — or may be functional with no known cause. Voice disorders deal with physical problems that limit speech. The main categories of speech impediments include the following:

Fluency disorders occur when a patient has trouble with speech timing or rhythms. This can lead to hesitations, repetitions, or prolonged sounds. Fluency disorders include stuttering (repetition of sounds) or   (rapid or irregular rate of speech).

Resonance disorders are related to voice quality that is impacted by the shape of the nose, throat, and/or mouth. Examples of resonance disorders include hyponasality and cul-de-sac resonance.

Articulation disorders occur when a patient has difficulty producing speech sounds. These disorders may stem from physical or anatomical limitations such as muscular, neuromuscular, or skeletal support. Examples of articulation speech impairments include sound omissions, substitutions, and distortions.

Phonological disorders result in the misuse of certain speech sounds to form words. Conditions include fronting, stopping, and the omission of final consonants.

Voice disorders are the result of problems in the larynx that harm the quality or use of an individual’s voice. This can impact pitch, resonance, and loudness.

Impact of Speech Disorders

Some speech disorders have little impact on socialization and daily activities, but other conditions can make some tasks difficult for individuals. Following are a few of the impacts of speech impediments.

• Poor communication — Children may be unable to participate in certain learning activities, such as answering questions or reading out loud, due to communication difficulties. Adults may avoid work or social activities such as giving speeches or attending parties.
• Mental health and confidence — Speech disorders may cause children or adults to feel different from peers, leading to a lack of self-confidence and, potentially, self-isolation.

Resources on Speech Disorders

The following resources may help those who are seeking more information about speech impediments.

Health Information : Information and statistics on common voice and speech disorders from the NIDCD

Speech Disorders : Information on childhood speech disorders from Cincinnati Children’s Hospital Medical Center

Speech, Language, and Swallowing : Resources about speech and language development from the ASHA

Children and adults can suffer from a variety of speech impairments that may have mild to severe impacts on their ability to communicate. The following 10 conditions are examples of specific types of speech disorders and voice disorders.

1. Stuttering

This condition is one of the most common speech disorders. Stuttering is the repetition of syllables or words, interruptions in speech, or prolonged use of a sound.

This organic speech disorder is a result of damage to the neural pathways that connect the brain to speech-producing muscles. This results in a person knowing what they want to say, but being unable to speak the words.

This consists of the lost ability to speak, understand, or write languages. It is common in stroke, brain tumor, or traumatic brain injury patients.

4. Dysarthria

This condition is an organic speech sound disorder that involves difficulty expressing certain noises. This may involve slurring, or poor pronunciation, and rhythm differences related to nerve or brain disorders.

The condition of lisping is the replacing of sounds in words, including “th” for “s.” Lisping is a functional speech impediment.

6. Hyponasality

This condition is a resonance disorder related to limited sound coming through the nose, causing a “stopped up” quality to speech.

7. Cul-de-sac resonance

This speech disorder is the result of blockage in the mouth, throat, or nose that results in quiet or muffled speech.

8. Orofacial myofunctional disorders

These conditions involve abnormal patterns of mouth and face movement. Conditions include tongue thrusting (fronting), where individuals push out their tongue while eating or talking.

9. Spasmodic Dysphonia

This condition is a voice disorder in which spasms in the vocal cords produce speech that is hoarse, strained, or jittery.

10. Other voice disorders

These conditions can include having a voice that sounds breathy, hoarse, or scratchy. Some disorders deal with vocal folds closing when they should open (paradoxical vocal fold movement) or the presence of polyps or nodules in the vocal folds.

Speech Disorders vs. Language Disorders

Speech disorders deal with difficulty in creating sounds due to articulation, fluency, phonology, and voice problems. These problems are typically related to physical, motor, sensory, neurological, or mental health issues.

Language disorders, on the other hand, occur when individuals have difficulty communicating the meaning of what they want to express. Common in children, these disorders may result in low vocabulary and difficulty saying complex sentences. Such a disorder may reflect difficulty in comprehending school lessons or adopting new words, or it may be related to a learning disability such as dyslexia. Language disorders can also involve receptive language difficulties, where individuals have trouble understanding the messages that others are trying to convey.  

Resources on Types of Speech Disorders

The following resources may provide additional information on the types of speech impediments.

Common Speech Disorders: A guide to the most common speech impediments from GreatSpeech

Speech impairment in adults: Descriptions of common adult speech issues from MedlinePlus

Stuttering Facts: Information on stuttering indications and causes from the Stuttering Foundation

Speech disorders may be caused by a variety of factors related to physical features, neurological ailments, or mental health conditions. In children, they may be related to developmental issues or unknown causes and may go away naturally over time.

Physical and neurological issues. Speech impediment causes related to physical characteristics may include:

• Brain damage
• Nervous system damage
• Respiratory system damage
• Hearing difficulties
• Cancerous or noncancerous growths
• Muscle and bone problems such as dental issues or cleft palate

Mental health issues. Some speech disorders are related to clinical conditions such as:

• Autism spectrum disorder
• Down syndrome or other genetic syndromes
• Cerebral palsy or other neurological disorders
• Multiple sclerosis

Some speech impairments may also have to do with family history, such as when parents or siblings have experienced language or speech difficulties. Other causes may include premature birth, pregnancy complications, or delivery difficulties. Voice overuse and chronic coughs can also cause speech issues.

The most common way that speech disorders are treated involves seeking professional help. If patients and families feel that symptoms warrant therapy, health professionals can help determine how to fix a speech impediment. Early treatment is best to curb speech disorders, but impairments can also be treated later in life.

Professionals in the speech therapy field include speech-language pathologists (SLPs) . These practitioners assess, diagnose, and treat communication disorders including speech, language, social, cognitive, and swallowing disorders in both adults and children. They may have an SLP assistant to help with diagnostic and therapy activities.

Speech-language pathologists may also share a practice with audiologists and audiology assistants. Audiologists help identify and treat hearing, balance, and other auditory disorders.

How Are Speech Disorders Diagnosed?

Typically, a pediatrician, social worker, teacher, or other concerned party will recognize the symptoms of a speech disorder in children. These individuals, who frequently deal with speech and language conditions and are more familiar with symptoms, will recommend that parents have their child evaluated. Adults who struggle with speech problems may seek direct guidance from a physician or speech evaluation specialist.

When evaluating a patient for a potential speech impediment, a physician will:

• Conduct hearing and vision tests
• Evaluate patient records
• Observe patient symptoms

A speech-language pathologist will conduct an initial screening that might include:

• An evaluation of speech sounds in words and sentences
• An evaluation of oral motor function
• An orofacial examination
• An assessment of language comprehension

The initial screening might result in no action if speech symptoms are determined to be developmentally appropriate. If a disorder is suspected, the initial screening might result in a referral for a comprehensive speech sound assessment, comprehensive language assessment, audiology evaluation, or other medical services.

Initial assessments and more in-depth screenings might occur in a private speech therapy practice, rehabilitation center, school, childcare program, or early intervention center. For older adults, skilled nursing centers and nursing homes may assess patients for speech, hearing, and language disorders.

How Are Speech Impediments Treated?

Once an evaluation determines precisely what type of speech sound disorder is present, patients can begin treatment. Speech-language pathologists use a combination of therapy, exercise, and assistive devices to treat speech disorders.

Speech therapy might focus on motor production (articulation) or linguistic (phonological or language-based) elements of speech, according to ASHA. There are various types of speech therapy available to patients.

Contextual Utilization  — This therapeutic approach teaches methods for producing sounds consistently in different syllable-based contexts, such as phonemic or phonetic contexts. These methods are helpful for patients who produce sounds inconsistently.

Phonological Contrast — This approach focuses on improving speech through emphasis of phonemic contrasts that serve to differentiate words. Examples might include minimal opposition words (pot vs. spot) or maximal oppositions (mall vs. call). These therapy methods can help patients who use phonological error patterns.

Distinctive Feature — In this category of therapy, SLPs focus on elements that are missing in speech, such as articulation or nasality. This helps patients who substitute sounds by teaching them to distinguish target sounds from substituted sounds.

Core Vocabulary — This therapeutic approach involves practicing whole words that are commonly used in a specific patient’s communications. It is effective for patients with inconsistent sound production.

Metaphon — In this type of therapy, patients are taught to identify phonological language structures. The technique focuses on contrasting sound elements, such as loud vs. quiet, and helps patients with unintelligible speech issues.

Oral-Motor — This approach uses non-speech exercises to supplement sound therapies. This helps patients gain oral-motor strength and control to improve articulation.

Other methods professionals may use to help fix speech impediments include relaxation, breathing, muscle strengthening, and voice exercises. They may also recommend assistive devices, which may include:

• Radio transmission systems
• Personal amplifiers
• Picture boards
• Touch screens
• Text displays
• Speech-generating devices
• Hearing aids
• Cochlear implants

Resources for Professionals on How to Fix a Speech Impediment

The following resources provide information for speech therapists and other health professionals.

Assistive Devices: Information on hearing and speech aids from the NIDCD

Information for Audiologists: Publications, news, and practice aids for audiologists from ASHA

Information for Speech-Language Pathologists: Publications, news, and practice aids for SLPs from ASHA

Speech Disorder Tips for Families

For parents who are concerned that their child might have a speech disorder — or who want to prevent the development of a disorder — there are a number of activities that can help. The following are tasks that parents can engage in on a regular basis to develop literacy and speech skills.

• Introducing new vocabulary words
• Reading picture and story books with various sounds and patterns
• Talking to children about objects and events
• Answering children’s questions during routine activities
• Encouraging drawing and scribbling
• Pointing to words while reading books
• Pointing out words and sentences in objects and signs

Parents can take the following steps to make sure that potential speech impediments are identified early on.

• Discussing concerns with physicians
• Asking for hearing, vision, and speech screenings from doctors
• Requesting special education assessments from school officials
• Requesting a referral to a speech-language pathologist, audiologist, or other specialist

When a child is engaged in speech therapy, speech-language pathologists will typically establish collaborative relationships with families, sharing information and encouraging parents to participate in therapy decisions and practices.

SLPs will work with patients and their families to set goals for therapy outcomes. In addition to therapy sessions, they may develop activities and exercises for families to work on at home. It is important that caregivers are encouraging and patient with children during therapy.  

Resources for Parents on How to Fix a Speech Impediment

The following resources provide additional information on treatment options for speech disorders.

Speech, Language, and Swallowing Disorders Groups: Listing of self-help groups from ASHA

ProFind: Search tool for finding certified SLPs and audiologists from ASHA

Baby’s Hearing and Communication Development Checklist: Listing of milestones that children should meet by certain ages from the NIDCD

If identified during childhood, speech disorders can be corrected efficiently, giving children greater communication opportunities. If left untreated, speech impediments can cause a variety of problems in adulthood, and may be more difficult to diagnose and treat.

Parents, teachers, doctors, speech and language professionals, and other concerned parties all have unique responsibilities in recognizing and treating speech disorders. Through professional therapy, family engagement, positive encouragement and a strong support network, individuals with speech impediments can overcome their challenges and develop essential communication skills.

Additional Sources

American Speech-Language-Hearing Association, Speech Sound Disorders

Identify the Signs, Signs of Speech and Language Disorders

Intermountain Healthcare, Phonological Disorders

MedlinePlus, Speech disorders – children

National Institutes of Health, National Institutes on Deafness and Other Communication Disorders, “Quick Statistics About Voice, Speech, Language”

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Common Speech Impediments: Causes, Symptoms, Treatment, And Support

Speech impediments include a variety of both language and speech disorders, some of which can be addressed through  online speech therapy  with speech-language pathologists. They can arise because of heredity and genetics, developmental delays, or even damage to Broca’s area—the part of the brain that’s involved in language skills and speech skills. They may also be linked to other conditions like autism spectrum disorder, cerebral palsy, dyslexia, or even hearing loss. It depends on the type and the cause, but most speech impediments and speech impairments can be treated through speech therapy.

That said, recognizing when a speech impediment may be present can help you get yourself or your child the treatment and support they may need for improved academic and/or social functioning and self-confidence.

Common symptoms of a speech impediment

There are many different types of speech impediments a person can have, so the symptoms can vary. That said, those listed below are common symptoms that could be initial indicators that you or your child may be experiencing speech problems or challenges:

• Elongating words
• Quiet or muffled speech
• Blinking frequently
• Distorted sounds while talking
• Frequent changes in pitch
• Poor voice quality
• Visible frustration when trying to communicate
• Overall difficulty communicating and expressing thoughts and ideas
• Inability to repeat words
• Inability to pronounce words the same way twice
• A phobia of speaking in public
• Speaking slowly and carefully
• Speech delay
• Frequent pauses when talking
• Limited vocabulary over several years, delayed language development

Some speech and language disorders are consistent with underlying mental health conditions such as autism. You can visit licensed health professionals or speech therapists to receive an accurate diagnosis and find out how to treat a speech impediment or language disorder, and its underlying cause, if applicable.

Key categories of speech impediments

Speech impediments or communication disorders can take many forms, from speech sound disorders to voice-related disorders. While speech sound disorders mostly result from sensory or motor causes, voice-related disorders deal with physical problems regarding speech. Read on for a list of some of the most common categories of speech impediments.

Voice disorders

Voice disorders  primarily arise due to issues regarding the health and structure of the larynx or the voice box. They can impact pitch, resonance, volume, and voice quality. Symptoms of a voice disorder may include having a hoarse, quivering, strained, choppy, or weak and whispery voice, which can make it difficult to produce speech sounds.

The root cause of these disorders can be either organic, like alterations to respiratory, laryngeal, or vocal tract mechanisms, or functional, like improper use of the voice. Some risk factors that may contribute to vocal health challenges include allergies, psychological stress, age, excessive alcohol or drug use, screaming, scarring from neck surgery, or even gastroesophageal reflux disease (GERD). Examples of voice disorders include laryngitis, vocal cord paralysis/weakness, polyps or nodes present on the vocal cords, leukoplakia, or muscle tension dysphonia.

Fluency disorders

A person may be diagnosed with a fluency disorder if they have trouble with speech timing and rhythm which makes it difficult to create a normal speech pattern. These disorders are characterized by interruptions in the typical flow of speaking, including abnormal repetitions, hesitation, and prolongations. Their cause is unknown, but it may be genetic. Symptoms can also be exacerbated by stress and anxiety. Stuttering is the most common example of fluency disorders. 

Symptoms of a fluency disorder may include dragging out syllables, speaking breathlessly, repetition of words, speaking slowly, and being tense while speaking. Secondary symptoms may include fidgeting, mumbling, saying “um” or “uh” often, not using certain problematic words, rearranging words in sentences, and anxiety around speaking. Treatment options vary depending on the specific disorder. With stuttering, for example, slowing down, practicing, using speech monitors, attending speech therapy, and receiving cognitive behavioral therapy (CBT) are all potential treatment options.

Articulation disorders and phonological disorders

Articulation and phonological disorders are two types of speech disorders classified as speech sound disorders that may impact communication. An articulation disorder includes speech that commonly exhibits errors such as substitution, omission, distortion, and/or addition (SODA). Although the actual causes of articulation disorders aren’t well understood, contributing factors may include brain injuries, a cleft palate/cleft lip, or nerve damage. Phonological disorders typically involve producing sounds correctly but using them in the wrong place and are more predictable than articulation errors. There may also be a genetic factor that contributes to both disorders and other families may be impacted as well. A licensed speech-language pathologist (SLP) can determine if an individual may have an articulation disorder or a phonological disorder. Ongoing speech therapy is typically the recommended treatment method.

Speech impediments versus language impairments

A speech impediment is typically characterized by difficulty creating sound due to factors like fluency disorders or other voice problems. These disorders may arise from underlying mental health issues, neurological problems, or physical factors or conditions impacting speech muscles.

Language impairments, on the other hand, are more about difficulty processing, reading, and writing and can be connected to an issue processing receptive language. They’re common in children, especially when they first start school. Language impairments relate to meaning, whereas speech impediments relate to sound. It’s also very common for a language impairment disorder to present alongside a learning disability like dyslexia.

Examples of speech impediments

Below is a brief overview of a few of the most common speech disorders and speech impediments, along with symptoms and potential treatment options.

Apraxia  of speech is a speech sound disorder that affects the pathways of the brain. It’s characterized by a person having difficulty expressing their thoughts accurately and consistently. It involves the brain being able to form the words and knowing exactly what to say, but the person then being unable to properly execute the required speech movements to deliver accurate sounds. In mild cases, a person will only have small limitations in their ability to form speech sounds. In severe cases, alternate communication methods may need to be used.

An SLP is the type of provider who can diagnose apraxia. To diagnose speech disorders, including both childhood apraxia (sometimes called verbal apraxia) and acquired apraxia, they may ask the individual to perform simple speech tasks like repeating a particular word several times or repeating a list of words that increase in length. Apraxia generally needs to be monitored by both parents and an SLP over time for an accurate diagnosis to be possible.

There are various treatment options for apraxia, the most common being one-on-one meetings with a speech pathologist. They’ll likely help you or your child build helpful strategies and skills to help strengthen problem areas and communicate more clearly. Some other treatment methods include improving speech intelligibility or using alternate forms of communication, like electronic speech or manual signs and gestures.

The National Institute on Deafness and Other Communication Disorders describes aphasia as a communication disorder that results in a person’s inability to speak, write, and/or understand language. Like other communication disorders, it may occur because of damage to the portions of the brain that are involved in language, which is common in those who have experienced a stroke. It may also come on gradually in those who have a tumor or a progressive neurological disease like Alzheimer’s. Symptoms may include saying or writing sentences that don’t make sense, a reduction in a person’s ability to understand a conversation, and substituting certain sounds and words for others.

Since this disorder is usually caused by damage to parts of the brain, it will typically first be recognized in an MRI or CT scan that can confirm the presence of a brain injury. The extent and type of aphasia can generally only be determined by observing the affected part of the brain and determining how extensively it has been damaged, which is often done with the help of an SLP.

Treatment options for aphasia can be restorative (aimed at restoring impaired function) or compensatory (aimed at compensating for deficits).

Dysarthria 

Dysarthria is usually caused by brain damage or facial paralysis that affects the muscles of the jaw, tongue, or throat, which may result in deficits in a person’s speech. It may also be caused by other conditions like Lou Gehrig’s disease, Parkinson’s, or a stroke. It’s considered a nervous system disorder, subclassified as a motor speech disorder. It’s commonly seen in those who already have other speech disorders, such as aphasia or apraxia. Symptoms of dysarthria include slurred speech, speaking too slowly, speaking too quickly, speaking very softly, being unable to move one’s lips or jaw, and having monotonous speech.

Dysarthria can be diagnosed by an expert in speech-language pathology through an exam and tests like MRI, CT, electromyography, or the Denver articulation screening examination. Treatment depends upon the severity and rate of progression of the disorder. Some potential examples include tactics like slowing down while talking, doing exercises to help strengthen jaw muscles, moving the lips and tongue more, and learning strategies for speaking more loudly. Hand gestures and speech machines may also help. 

The importance of treatment

It is important to treat speech disorders; the consequences of an untreated speech or language impediment can vary widely depending on the type, symptoms, and severity, as well as the age and life situation of the individual. In general, it’s usually helpful to seek professional advice on treating speech disorders as soon as you notice or suspect an impediment present in yours or your child’s speech. Especially for moderate to severe cases, some potential effects of leaving these common speech disorders untreated can include:

• Poor academic performance/dropping out of school
• Decrease in quality of life
• Social anxiety and an inability to connect with people
• Damaged relationships
• Social isolation
• Hospitalization

Seeking professional support

Meeting with an SLP is usually the recommended first step for someone who believes they or their child may have a speech impediment. If you have a teenager with dyslexia, there are  resources for dyslexic teens  that can give supportive information about the condition. Healthcare providers may also provide helpful insights and ask about your family members’ history when it comes to speech and language-related issues as they can be hereditary. While these professionals can help with the physical aspects of a variety of speech and language impediments, you or your child may also benefit from emotional support in relation to the mental health effects of having an impediment. A therapist may be able to provide this type of guidance. If your child is experiencing a speech impediment, a counselor may be able to work with them to process their feelings of frustration and learn healthy coping mechanisms for stress. They can help you manage the same feelings if you receive a speech or language impediment diagnosis, or may be able to support you in your journey of parenting a child with a speech or language impediment diagnosis.

In addition to support at home, teenagers with a diagnosed speech impairment or impediment can receive special education services at school. The Centers for Disease Control notes that under the Individuals with Disabilities Act (IDEA) and Section 504, schools must provide support and accommodations for students with speech disorders. For some children, support groups can provide outlets for social connections and advice for coping. 

Meeting with a therapist in person is an option if there are providers in your area. That said, many people find it less intimidating or more comfortable to meet with a therapist virtually. For example, a teen who is experiencing a speech or language impediment may feel better interacting with a counselor through the online chat feature that virtual therapy platforms like TeenCounseling provide. It may allow them to express themselves more clearly than they could face-to-face or over the phone. Parents who need support in caring for a child with a speech or language impediment may find the availability and convenience of meeting with a therapist through an online therapy service like BetterHelp to be most beneficial. Research suggests that online and in-person therapy offer similar benefits for a variety of conditions, so you can choose the format that’s best for you.

Counselor reviews

See below for reviews of TeenCounseling therapists written by parents who sought help for their children through this service. 

“Kathleen has been good for my daughter to talk to. I am thankful for her to give my daughter someone else's perspective other than her parents. Thank you.”

“I love Ms. Jones. She doesn’t over-talk or judge you. She gives really good advice and if you're confused she knows how to break it down or explain whatever it is so you can understand. If you need to talk about anything, she’s always an open ear and responds quickly. Not only does she give you points from others' perspectives but she steps into yours so she can understand why certain things are the way they are. In my first session, I was nervous and I think she could tell. She’ll crack a joke every now and then to make me feel more comfortable. She’s just such a bundle of joy and a good counselor to have.”

Speech and language impediments can vary widely in terms of types, causes, symptoms, and severity. These are diagnosed by professionals in the field of speech and language pathology or by a medical doctor. A therapist can provide emotional support for those who are having difficulty coping with their own or their child’s diagnosis or other related challenges. 

What are the 3 speech impediments?

Speech impediments can manifest in a variety of ways. Three of the most common are listed below: 

• Voice disorders affect the tone, pitch, quality, and volume of a person’s voice. A person with a voice disorder may have difficulty speaking or being heard clearly by others. Voice disorders can be either functional or organic. Functional disorders occur due to improper use of the parts of the throat that produce speech, such as overuse of the voice leading to vocal fatigue. Organic voice disorders result from physical anatomical changes, such as nodules on the vocal cords. 
• Fluency disorders affect the rate, rhythm, and cadence of speech. Those with fluency disorders may speak in a disjointed, choppy, or prolonged fashion, making them difficult for others to understand clearly. While many types of fluency disorders exist, stuttering is likely the best-known. Speech often requires precise timing to convey a message accurately, which fluency disorders can disrupt. 
• Speech sound disorders are a broad category of disorders that interferes with a person’s ability to produce sounds and words correctly. Speech sound disorders can present very differently from person to person. Sometimes word sounds are omitted or added where not appropriate, and sometimes word sounds are distorted or substituted completely. A typical example of a speech sound disorder is the substitution of “r” for “w” in words like “rabbit” (becoming “wabbit”). Many children experience that substitution, but it does not become a disorder until the child does not outgrow it. 

Other types of disorders can cause problems with expressive communication or tongue-tie those experiencing them, such as developmental language disorder . Language disorders also cause concerns related to expressive communication, but the concerns are due to a lack of understanding of one or more components of language , not an inability to produce or use word sounds. 

What do you call a speech impediment?

Speech impediments are typically referred to as speech disorders . Speech refers to the ability to form speech sounds using the vocal cords, mouth, lips, and tongue. Speech also requires that a rhythm and cadence be maintained. Speech disorders indicate a problem producing intelligible speech; word sounds may be omitted or misplaced, the rhythm of the speech may be difficult to follow, or a person’s voice might be strangely pitched or too soft to hear clearly. 

It is important not to confuse speech disorders with language disorders . Language disorders arise due to difficulty understanding what words mean, how word sounds fit together, or how to use spoken language to communicate. Language problems may affect how a person speaks, but the root cause of the concern is linked to their understanding of language, not their ability to produce intelligible speech. 

How do I know if I have a speech impediment?

If you’re experiencing a sudden onset of impaired speech with no apparent cause, seek medical attention immediately. Strokes, traumatic brain injuries, and other serious medical conditions can cause sudden changes in speaking ability. Gradual changes in speaking ability may also indicate an underlying medical problem. If you’re concerned that your speaking ability has been gradually deteriorating, consider making an appointment with a healthcare provider in the near future. 

Most people with a speech disorder are diagnosed in childhood. Parents often identify speech-related concerns in early childhood based on their child’s speech patterns. The child’s pediatrician may also refer the child to a speech-language pathologist, a professional specializing in evaluating and treating speech disorders. If problems persist until the child is in school, teachers and other school officials might initiate a referral for an evaluation if they believe speech concerns are present. Children often receive speech and language therapy that resolves or improves their speech problems. 

Speech disorders also appear in adulthood, often due to injury or illness. It is also possible, although rare, for speech problems to be misdiagnosed or missed outright during a person’s childhood. In that case, the speech disorder may have been present since childhood and symptoms persisted into adulthood.

If you’re finding it difficult to communicate verbally with others, have an easily identifiable speech problem (like stuttering), or receive feedback that others have trouble understanding you, consider making an appointment with your doctor for an evaluation and referral to the appropriate healthcare providers. 

What are 5 causes of speech impairment?

Speech and language disorders can result from conditions that interfere with the development of perceptual, structural, motor, cognitive, or socioemotional functions. The cause of many speech disorders is unknown, but research has indicated several underlying factors that may be responsible: 

• Pre-existing genetic conditions, like Down’s syndrome or Fragile X syndrome. Evidence suggests that genes may play a role even if genetic abnormalities do not result in a diagnosable genetic condition. 
• Physical abnormalities, such as damage or improper development of the respiratory system, facial muscles, or cranial nerves. 
• Hearing problems, which can delay a child’s acquisition of speech. 
• Neurodevelopmental disorders, such as autism spectrum disorder, may interfere with speech development. There is also evidence to suggest that those with attention-deficit hyperactivity disorder may have a more challenging time acquiring speech skills. 
• Neurological conditions such as cerebral palsy. 

Mental health concerns can also cause problems communicating with others. For example, an underlying anxiety disorder may lead to selective mutism , wherein a child speaks only under certain circumstances. 

Is speech impediment a disability?

A speech-language disorder is considered a “ communication disability ” under the Americans with Disabilities Act (ADA). The ADA requires government and businesses to establish “effective communication” with people who have communication disabilities. Effective communication can be established in several ways. For those with a speech disorder, accommodation may be as simple as ensuring the person can get hold of writing materials if they need to express themselves quickly. In some cases, organizations may use a transliterator, or person trained to recognize unclear speech and repeat it clearly. 

Because speech disorders are known to lead to academic struggles in K-12 and higher education settings, they are categorized as a disability under the Individuals with Disabilities Education Improvement Act (IDEIA) . The IDEIA sets guidelines for all schools in the United States, public or not public, guaranteeing each child a right to accommodations and interventions for their speech disorder. 

Can I fix my speech impediment?

Whether or not a speech disorder can be completely eliminated depends heavily on individual factors. The cause of the disorder, its severity, and the type of speech dysfunction all play a role in determining whether a particular disorder can be completely resolved. While it is not possible to guarantee that a speech disorder can be “cured,” nearly all disorders are treatable, and improvement is likely possible. 

Can you treat a speech impediment?

Yes, many speech disorders are highly treatable. Most people receive treatment as children when most speech disorders become apparent. For children, speech-language pathologists will identify the specific speech disorder, search for an underlying cause, and design an intervention that targets that child’s speech problem. For example, a child who struggles with articulation errors and producing word sounds consistently may benefit from a contextual utilization approach . Contextual utilization leverages the fact that one sound is easier or more difficult to pronounce depending on which other sounds surround it. 

Speech disorders that emerge in adulthood may be more challenging to treat due to underlying factors, such as brain injury. Suppose an adult experiences a traumatic brain injury that affects their speaking ability. In that case, a speech-language pathologist may help them find alternative communication methods, such as using a computer. They may also help them directly restore some of their speaking ability by leading them through exercises that improve nerve function and muscle control.  

Is a speech impediment mental?

Speech disorders can be caused by various factors, many of which have nothing to do with the brain. However, there is a relationship between psychiatric mental health concerns and difficulty with spoken communication . Although researchers are still unsure of the exact cause, studies have identified a significant link between speech disorders and mental health disorders like schizophrenia, bipolar disorder, and major depression. 

Neurodevelopmental disorders, such as autism spectrum disorder and attention-deficit hyperactivity disorder, are also associated with an increased risk of developing a speech disorder. Although the link between neurodevelopmental disorders and speech disorders is not fully understood, evidence suggests that treating the speech disorder is still possible. 

Finally, speech disorders can also be caused by illness or injury in the brain, such as cancer, an infection, or traumatic brain injury. Although these are not considered mental or developmental disorders, they may affect brain function and mental acuity. Speaking is a complex process, and there are many ways it can be affected. 

Is autism a speech impediment?

Autism spectrum disorder is not a speech disorder, but it is heavily associated with communication problems. Those on the autism spectrum often use repetitive or rigid language and may not follow communication norms. They may repeat phrases continuously, use a modified tone of voice, or introduce information that has little to do with the conversation at hand. 

Those on the autism spectrum are often able to form word sounds properly. The communication deficits of autism spectrum disorder are more closely related to language disorders than speech disorders. Speech disorders are associated with difficulty producing or using word sounds correctly, whereas language disorders are associated with a lack of understanding of one or more language components.

Autism spectrum disorder is also characterized by difficulties using pragmatic communication , or communication that is appropriate to a specific social situation. Although not a disorder of speech, a limited ability to recognize the socioemotional content of speech can significantly impact interpersonal communication and social interactions. 

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How to improve your communication with someone with a speech impairment

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Claire Davies is a member of the Canadian Accessibility Network and collaborates with the International Society of Augmentative and Alternative Communication. She receives funding from the Government of Canada’s Accessibility Standards Canada, the Social Sciences and Humanities Research Council and Natural Sciences and Engineering Research Council.

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

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

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

Need for more acceptance

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

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

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

Tackling stigma

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

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

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

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

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

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

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

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

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Speaking clearly: Help for people with speech and language disorders

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Speaking and language abilities vary from person to person. Some people can quickly articulate exactly what they are thinking or feeling, while others struggle being understood or finding the right words.

These struggles could be due to a speech or language disorder if communication struggles cause ongoing communication challenges and frustrations. Speech and language disorders are common.

It's estimated that 5% to 10% of people in the U.S. have a communication disorder. By the first grade, about 5% of U.S. children have a noticeable speech disorder. About 3 million U.S. adults struggle with stuttering and about 1 million U.S. adults have aphasia. These conditions make reading, speaking, writing and comprehending difficult.

People with speech and language disorders can find hope in rehabilitation. Speech-language pathologists can evaluate and treat these disorders. This can lead to a happier, healthier and more expressive life.

Types of speech and language disorders

Speech and language disorders come in many forms, each with its own characteristics:.

• Aphasia People with aphasia have difficulty with reading, writing, speaking or understanding information they've heard. The intelligence of a person with aphasia is not affected.
• Dysarthria People with dysarthria demonstrate slurred or imprecise speech patterns that can affect the understanding of speech.
• Apraxia A person with this disorder has difficulty coordinating lip and tongue movements to produce understandable speech.
• Dysphagia This condition refers to swallowing difficulties, including food sticking in the throat, coughing or choking while eating or drinking, and other difficulties.
• Stuttering This speech disorder involves frequent and significant problems with normal fluency and flow of speech. People who stutter know what they want to say but have difficulty saying it.
• Articulation disorder People with this disorder have trouble learning how to make specific sounds. They may substitute sounds, such as saying "fum" instead of "thumb".
• Phonological disorder Phonological processes are patterns of errors children use to simplify language as they learn to speak. A phonological disorder may be present if these errors persist beyond the age when most other children stop using them. An example is saying "duh" instead of "duck."
• Voice Voice disorders include vocal cord paralysis, vocal abuse and vocal nodules, which could result in vocal hoarseness, changes in vocal volume and vocal fatigue.
• Cognitive communication impairment People with cognitive communication impairment have difficulty with concentration, memory, problem-solving, and completion of tasks for daily and medical needs.

Speech and language disorders are more common in children. It can take time to develop the ability to speak and communicate clearly. Some children struggle with finding the right word or getting their jaws, lips or tongues in the correct positions to make the right sounds.

In adults, speech and language disorders often are the result of a medical condition or injury. The most common of these conditions or injuries are a stroke, brain tumor, brain injury, cancer, Parkinson's disease, multiple sclerosis, Lou Gehrig's disease or other underlying health complications.

Treatment options

Speech and language disorders can be concerning, but speech-language pathologists can work with patients to evaluate and treat these conditions. Each treatment plan is specifically tailored to the patient.

Treatment plans can address difficulties with:

• Speech sounds, fluency or voice
• Understanding language
• Sharing thoughts, ideas and feelings
• Organizing thoughts, paying attention, remembering, planning or problem-solving
• Feeding and swallowing
• Vocabulary or improper grammar use

Treatment typically includes training to compensate for deficiencies; patient and family education; at-home exercises; or neurological rehabilitation to address impairments due to medical conditions, illnesses or injury.

Treatment options are extensive and not limited by age. Children and adults can experience the benefits of treatment.

If you or a loved one are struggling with speech and language issues, you are not alone. Millions of people experience similar daily challenges. Better yet, help is available.

Monica Marzinske is a speech-language pathologist  in New Prague , Minnesota.

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What is stuttering?

Who stutters, how is speech normally produced, what are the causes and types of stuttering, how is stuttering diagnosed, how is stuttering treated, what research is being conducted on stuttering, where can i find additional information about stuttering.

Stuttering is a speech disorder characterized by repetition of sounds, syllables, or words; prolongation of sounds; and interruptions in speech known as blocks. An individual who stutters exactly knows what he or she would like to say but has trouble producing a normal flow of speech. These speech disruptions may be accompanied by struggle behaviors, such as rapid eye blinks or tremors of the lips. Stuttering can make it difficult to communicate with other people, which often affects a person’s quality of life and interpersonal relationships. Stuttering can also negatively influence job performance and opportunities, and treatment can come at a high financial cost.

Symptoms of stuttering can vary significantly throughout a person’s day. In general, speaking before a group or talking on the telephone may make a person’s stuttering more severe, while singing, reading, or speaking in unison may temporarily reduce stuttering.

Stuttering is sometimes referred to as stammering and by a broader term, disfluent speech .

Roughly 3 million Americans stutter. Stuttering affects people of all ages. It occurs most often in children between the ages of 2 and 6 as they are developing their language skills. Approximately 5 to 10 percent of all children will stutter for some period in their life, lasting from a few weeks to several years. Boys are 2 to 3 times as likely to stutter as girls and as they get older this gender difference increases; the number of boys who continue to stutter is three to four times larger than the number of girls. Most children outgrow stuttering. Approximately 75 percent of children recover from stuttering. For the remaining 25 percent who continue to stutter, stuttering can persist as a lifelong communication disorder.

We make speech sounds through a series of precisely coordinated muscle movements involving breathing, phonation (voice production), and articulation (movement of the throat, palate, tongue, and lips). Muscle movements are controlled by the brain and monitored through our senses of hearing and touch.

The precise mechanisms that cause stuttering are not understood. Stuttering is commonly grouped into two types termed developmental and neurogenic.

Developmental stuttering

Developmental stuttering occurs in young children while they are still learning speech and language skills. It is the most common form of stuttering. Some scientists and clinicians believe that developmental stuttering occurs when children’s speech and language abilities are unable to meet the child’s verbal demands. Most scientists and clinicians believe that developmental stuttering stems from complex interactions of multiple factors. Recent brain imaging studies have shown consistent differences in those who stutter compared to nonstuttering peers. Developmental stuttering may also run in families and research has shown that genetic factors contribute to this type of stuttering. Starting in 2010, researchers at the National Institute on Deafness and Other Communication Disorders (NIDCD) have identified four different genes in which mutations are associated with stuttering. More information on the genetics of stuttering can be found in the research section of this fact sheet.

Neurogenic stuttering

Neurogenic stuttering may occur after a stroke, head trauma, or other type of brain injury. With neurogenic stuttering, the brain has difficulty coordinating the different brain regions involved in speaking, resulting in problems in production of clear, fluent speech.

At one time, all stuttering was believed to be psychogenic, caused by emotional trauma, but today we know that psychogenic stuttering is rare.

Stuttering is usually diagnosed by a speech-language pathologist, a health professional who is trained to test and treat individuals with voice, speech, and language disorders. The speech-language pathologist will consider a variety of factors, including the child’s case history (such as when the stuttering was first noticed and under what circumstances), an analysis of the child’s stuttering behaviors, and an evaluation of the child’s speech and language abilities and the impact of stuttering on his or her life.

When evaluating a young child for stuttering, a speech-language pathologist will try to determine if the child is likely to continue his or her stuttering behavior or outgrow it. To determine this difference, the speech-language pathologist will consider such factors as the family’s history of stuttering, whether the child’s stuttering has lasted 6 months or longer, and whether the child exhibits other speech or language problems.

Although there is currently no cure for stuttering, there are a variety of treatments available. The nature of the treatment will differ, based upon a person’s age, communication goals, and other factors. If you or your child stutters, it is important to work with a speech-language pathologist to determine the best treatment options.

Therapy for children

For very young children, early treatment may prevent developmental stuttering from becoming a lifelong problem. Certain strategies can help children learn to improve their speech fluency while developing positive attitudes toward communication. Health professionals generally recommend that a child be evaluated if he or she has stuttered for 3 to 6 months, exhibits struggle behaviors associated with stuttering, or has a family history of stuttering or related communication disorders. Some researchers recommend that a child be evaluated every 3 months to determine if the stuttering is increasing or decreasing. Treatment often involves teaching parents about ways to support their child’s production of fluent speech. Parents may be encouraged to:

• Provide a relaxed home environment that allows many opportunities for the child to speak. This includes setting aside time to talk to one another, especially when the child is excited and has a lot to say.
• Listen attentively when the child speaks and focus on the content of the message, rather than responding to how it is said or interruptng the child.
• Speak in a slightly slowed and relaxed manner. This can help reduce time pressures the child may be experiencing.
• Listen attentively when the child speaks and wait for him or her to say the intended word. Don't try to complete the child’s sentences. Also, help the child learn that a person can communicate successfully even when stuttering occurs.
• Talk openly and honestly to the child about stuttering if he or she brings up the subject. Let the child know that it is okay for some disruptions to occur.

Stuttering therapy

Many of the current therapies for teens and adults who stutter focus on helping them learn ways to minimize stuttering when they speak, such as by speaking more slowly, regulating their breathing, or gradually progressing from single-syllable responses to longer words and more complex sentences. Most of these therapies also help address the anxiety a person who stutters may feel in certain speaking situations.

Drug therapy

The U.S. Food and Drug Administration has not approved any drug for the treatment of stuttering. However, some drugs that are approved to treat other health problems—such as epilepsy, anxiety, or depression—have been used to treat stuttering. These drugs often have side effects that make them difficult to use over a long period of time.

Electronic devices

Some people who stutter use electronic devices to help control fluency. For example, one type of device fits into the ear canal, much like a hearing aid, and digitally replays a slightly altered version of the wearer’s voice into the ear so that it sounds as if he or she is speaking in unison with another person. In some people, electronic devices may help improve fluency in a relatively short period of time. Additional research is needed to determine how long such effects may last and whether people are able to easily use and benefit from these devices in real-world situations. For these reasons, researchers are continuing to study the long-term effectiveness of these devices.

Self-help groups

Many people find that they achieve their greatest success through a combination of self-study and therapy. Self-help groups provide a way for people who stutter to find resources and support as they face the challenges of stuttering.

Researchers around the world are exploring ways to improve the early identification and treatment of stuttering and to identify its causes. For example, scientists have been working to identify the possible genes responsible for stuttering that tend to run in families. NIDCD scientists have now identified variants in four such genes that account for some cases of stuttering in many populations around the world, including the United States and Europe. All of these genes encode proteins that direct traffic within cells, ensuring that various cell components get to their proper location within the cell. Such deficits in cellular trafficking are a newly recognized cause of many neurological disorders. Researchers are now studying how this defect in cellular trafficking leads to specific deficits in speech fluency.

Researchers are also working to help speech-language pathologists determine which children are most likely to outgrow their stuttering and which children are at risk for continuing to stutter into adulthood. In addition, researchers are examining ways to identify groups of individuals who exhibit similar stuttering patterns and behaviors that may be associated with a common cause.

Scientists are using brain imaging tools such as PET (positron emission tomography) and functional MRI (magnetic resonance imaging) scans to investigate brain activity in people who stutter. NIDCD-funded researchers are also using brain imaging to examine brain structure and functional changes that occur during childhood that differentiate children who continue to stutter from those who recover from stuttering. Brain imaging may be used in the future as a way to help treat people who stutter. Researchers are studying whether volunteer patients who stutter can learn to recognize, with the help of a computer program, specific speech patterns that are linked to stuttering and to avoid using those patterns when speaking.

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

Use the following keywords to help you find organizations that can answer questions and provide information on stuttering:

• Speech-language pathologists
• Physician/practitioner referrals

For more information, contact us at:

NIDCD Information Clearinghouse 1 Communication Avenue Bethesda, MD 20892-3456 Toll-free voice: (800) 241-1044 Toll-free TTY: (800) 241-1055 Email: [email protected]

NIH Pub. No. 97-4232 February 2016

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• Diseases & Conditions

Stuttering is a speech condition that disrupts the normal flow of speech. Fluency means having an easy and smooth flow and rhythm when speaking. With stuttering, the interruptions in flow happen often and cause problems for the speaker. Other names for stuttering are stammering and childhood-onset fluency disorder.

People who stutter know what they want to say, but they have a hard time saying it. For example, they may repeat or stretch out a word, a syllable, or a consonant or vowel sound. Or they may pause during speech because they've reached a word or sound that's hard to get out.

Stuttering is common among young children as a usual part of learning to speak. Some young children may stutter when their speech and language abilities aren't developed enough to keep up with what they want to say. Most children outgrow this type of stuttering, called developmental stuttering.

But sometimes stuttering is a long-term condition that remains into adulthood. This type of stuttering can affect self-esteem and communicating with other people.

Children and adults who stutter may be helped by treatments such as speech therapy, electronic devices to improve speech fluency or a form of mental health therapy called cognitive behavioral therapy.

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Stuttering symptoms may include:

• Having a hard time starting a word, phrase or sentence.
• Stretching out a word or sounds within a word.
• Repeating a sound, syllable or word.
• Brief silence for certain syllables or words, or pausing before or within a word.
• Adding extra words such as "um" if expecting to have problems moving to the next word.
• A lot of tension, tightness or movement of the face or upper body when saying a word.
• Anxiety about talking.
• Not being able to communicate well with others.

These actions may happen when stuttering:

• Rapid eye blinks.
• Trembling of the lips or jaw.
• Unusual face movements, sometimes called facial tics.
• Head nodding.
• Tightening of fists.

Stuttering may be worse when the person is excited, tired or under stress, or when feeling self-conscious, hurried or pressured. Situations such as speaking in front of a group or talking on the phone can be especially hard for people who stutter.

But most people who stutter can speak without stuttering when they talk to themselves and when they sing or speak along with someone else.

When to see a doctor or speech-language pathologist

It's common for children between the ages of 2 and 5 years to go through periods when they may stutter. For most children, this is part of learning to speak, and it gets better on its own. But stuttering that continues may need treatment to improve speech fluency.

Call your healthcare professional for a referral to a specialist in speech and language called a speech-language pathologist. Or you can contact the speech-language pathologist directly for an appointment. Ask for help if stuttering:

• Lasts more than six months.
• Happens along with other speech or language problems.
• Happens more often or continues as the child grows older.
• Includes muscle tightening or physically struggling when trying to speak.
• Affects the ability to effectively communicate at school or work or in social situations.
• Causes anxiety or emotional problems, such as fear of or not taking part in situations that require speaking.
• Begins as an adult.

Researchers continue to study the underlying causes of developmental stuttering. A combination of factors may be involved.

Developmental stuttering

Stuttering that happens in children while they're learning to speak is called developmental stuttering. Possible causes of developmental stuttering include:

• Problems with speech motor control. Some evidence shows that problems in speech motor control, such as timing, sensory and motor coordination, may be involved.
• Genetics. Stuttering tends to run in families. It appears that stuttering can happen from changes in genes passed down from parents to children.

Stuttering that happens from other causes

Speech fluency can be disrupted from causes other than developmental stuttering.

• Neurogenic stuttering. A stroke, traumatic brain injury or other brain disorders can cause speech that is slow or has pauses or repeated sounds.
• Emotional distress. Speech fluency can be disrupted during times of emotional distress. Speakers who usually do not stutter may experience problems with fluency when they are nervous or feel pressured. These situations also may cause speakers who stutter to have greater problems with fluency.
• Psychogenic stuttering. Speech difficulties that appear after an emotional trauma are uncommon and not the same as developmental stuttering.

Risk factors

Males are much more likely to stutter than females are. Things that raise the risk of stuttering include:

• Having a childhood developmental condition. Children who have developmental conditions, such as attention-deficit/hyperactivity disorder, autism or developmental delays, may be more likely to stutter. This is true for children with other speech problems too.
• Having relatives who stutter. Stuttering tends to run in families.
• Stress. Stress in the family and other types of stress or pressure can worsen existing stuttering.

Complications

Stuttering can lead to:

• Problems communicating with others.
• Not speaking or staying away from situations that require speaking.
• Not taking part in social, school or work activities and opportunities for success.
• Being bullied or teased.
• Low self-esteem.
• Stuttering. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/stuttering/. Accessed Feb. 2, 2024.
• Fluency disorders. American Speech-Language-Hearing Association. https://www.asha.org/practice-portal/clinical-topics/fluency-disorders/. Accessed Feb. 2, 2024.
• Childhood-onset fluency disorder (stuttering). In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed Feb. 2, 2024.
• Stuttering. National Institute on Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/stuttering. Accessed Feb. 2, 2024.
• Sander RW, et al. Stuttering: Understanding and treating a common disability. American Family Physician. 2019;100:556.
• Laiho A, et al. Stuttering interventions for children, adolescents and adults: A systematic review as part of the clinical guidelines. Journal of Communication Disorders. 2022; doi:10.1016/j.jcomdis.2022.106242.
• 6 tips for speaking with someone who stutters. The Stuttering Foundation. https://www.stutteringhelp.org/6-tips-speaking-someone-who-stutters-0. Accessed Feb. 2, 2024.
• 7 tips for talking with your child. The Stuttering Foundation. https://www.stutteringhelp.org/7-tips-talking-your-child-0. Accessed Feb. 2, 2024.
• Clark HM (expert opinion). Mayo Clinic. Feb. 11, 2024.

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Speech impairment in adults

Speech and language impairment may be any of several problems that make it difficult to communicate.

Considerations

The following are common speech and language disorders.

Aphasia is loss of the ability to understand or express spoken or written language. It commonly occurs after strokes or traumatic brain injuries. It can also occur in people with brain tumors or degenerative diseases that affect the language areas of the brain. This term does not apply to children who have never developed communication skills. There are many different types of aphasia.

In some cases of aphasia, the problem eventually corrects itself, but in others, it doesn't get better.

With dysarthria , the person has problems expressing certain sounds or words. They have poorly pronounced speech (such as slurring) and the rhythm or speed of speech is changed. Usually, a nerve or brain disorder has made it difficult to control the tongue, lips, larynx, or vocal cords, which make speech.

Dysarthria, which is difficulty pronouncing words, is sometimes confused with aphasia, which is difficulty producing language. They have different causes.

People with dysarthria may also have problems swallowing.

VOICE DISTURBANCES

Anything that changes the shape of the vocal cords or the way they work will cause a voice disturbance. Lump-like growths such as nodules, polyps, cysts, papillomas, granulomas, and cancers can be to blame. These changes cause the voice to sound different from the way it normally sounds.

Some of these disorders develop gradually, but anyone can develop a speech and language impairment suddenly, usually due to a stroke or trauma.

• Alzheimer disease
• Brain tumor (more common in aphasia than dysarthria)
• Head trauma
• Transient ischemic attack (TIA)
• Alcohol intoxication
• Diseases that affect nerves and muscles (neuromuscular diseases), such as amyotrophic lateral sclerosis (ALS or Lou Gehrig disease), cerebral palsy, myasthenia gravis, or multiple sclerosis (MS)
• Facial trauma
• Facial weakness, such as Bell's palsy or tongue weakness
• Head and neck cancer surgery
• Nervous system (neurological) disorders that affect the brain, such as Parkinson disease or Huntington disease (more common in dysarthria than aphasia)
• Poorly fitting dentures
• Side effects of medicines that act on the central nervous system, such as narcotics, phenytoin, or carbamazepine
• Growths or nodules on the vocal cords
• People who use their voice heavily (teachers, coaches, vocal performers) are more likely to develop voice disorders.

For dysarthria, ways to help improve communication include speaking slowly and using hand gestures. Family and friends need to provide plenty of time for those with the disorder to express themselves. Typing on an electronic device or using pen and paper can also help with communication.

For aphasia, family members may need to provide frequent orientation reminders, such as the day of the week. Disorientation and confusion often occur with aphasia.Using nonverbal ways of communicating may also help.

It's important to maintain a relaxed, calm environment and keep external stimuli to a minimum.

• Speak in a normal tone of voice (this condition is not a hearing or emotional problem).
• Use simple phrases to avoid misunderstandings.
• Don't assume that the person understands.
• Provide communication aids, if possible, depending on the person and condition.

Mental health counseling may help with depression or frustration that many people with speech impairment have.

When to Contact a Medical Professional

Contact the provider if:

• Impairment or loss of communication comes on suddenly
• There is any unexplained impairment of speech or written language

What to Expect at Your Office Visit

Unless the problems have developed after an emergency event, the provider will take a medical history and perform a physical exam. The medical history may require the assistance of family or friends.

The provider will likely ask about the speech impairment. Questions may include when the problem developed, whether there was an injury, and what medicines the person takes.

Diagnostic tests that may be performed include the following:

• Blood tests
• Cerebral angiography to check blood flow in the brain
• CT or MRI scan of the head to check for problems such as tumor
• Electroencephalogram (EEG) to measure electrical activity of the brain
• Electromyography ( EMG ) to check the health of the muscles and the nerves that control the muscles
• Lumbar puncture to check the cerebrospinal fluid that surrounds the brain and spinal cord
• Urine tests
• X-rays of the skull

If the tests find other medical problems, other specialist doctors will need to be consulted.

For help with the speech problem, a speech and language therapist or social worker will likely need to be consulted.

Alternative Names

Language impairment; Impairment of speech; Inability to speak; Aphasia; Dysarthria; Slurred speech; Dysphonia voice disorders

Kirshner HS. Dysarthria and apraxia of speech. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

Kirshner HS, Wilson SM. Aphasia and aphasic syndromes. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice.  8th ed. Philadelphia, PA: Elsevier; 2022:chap 13.

Rossi RP, Kortte JH, Palmer JB. Speech and language disorders. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation . 4th ed. Philadelphia, PA: Elsevier; 2019:chap 155.

Review Date 5/2/2022

Updated by: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Related MedlinePlus Health Topics

• Speech and Communication Disorders

April 1, 2024

Does My Child Have a Speech Delay?

It’s hard to know whether a toddler needs help with early speech. Here are some tips and guidelines

By Yolanda F. Holt

The Good Brigade/Getty Images

This piece is part of Scientific American's column The Science of Parenting. To learn more, go here .

My son Grayson was about two and a half years old when his preschool teacher called me. A child development specialist had visited his classroom and had some concerns about his development.

As a speech-language pathologist , I had been carefully monitoring my twins’ development since they were born, so I was surprised to receive the call. Even so, I was terrified that I had missed some critical issue in his development. I wondered: What if the specialist misdiagnosed my child? I couldn’t decide which scenario was worse: if I had missed something myself, or if my child was about to be misidentified. As those thoughts raced through my head, I asked to have the specialist call me immediately. I listened as she described Grayson’s typically developing motor and social/emotional abilities. Then she described his speech as mostly not intelligible.

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The specialist was telling me she thought my son had a developmental delay in his speech and language.

My experience is not unique. Every day in the U.S., some parent will field this sort of unsettling phone call about their child.

As a speech-language pathologist, I understand the duty to connect with parents to share professional concerns. As a parent, I understand how scary and confusing these calls can be. My son was two and a half! How many children that age engage in intelligible conversations with a stranger? Fortunately for all of us there are some benchmarks we can use to help us understand typical speech and language development and where our children’s skills fall.

Hearing : In the U.S. and other industrialized nations, audiologists test hospital-delivered newborns before the babies go home. While the child is sleeping, the audiologist places a small probe (sort of like an earbud) in the baby’s ear. The probe sends a signal into the ear. That signal causes organs in the ear to vibrate and send the signal back to the device. This hearing test is safe, short and causes no discomfort to a sleeping newborn. If they fail, a second test is completed with the audiologist sometime later. If additional testing reveals a hearing difficulty the child will receive early interventions. These can include family training, baby hearing aids or perhaps a cochlear implant. Parent counseling is also a part of this process. Speech and hearing professionals will work with the family to ensure the child never misses out on early language development because of a hearing difficulty.

Listening : Between birth and 18 months, children listen to the sounds of the language(s) spoken around them and learn the rules to combine those sounds to make words. They learn where to add stress or pauses, or to get louder in case you weren’t listening. There are universal linguistic rules , including the general order of speech sound acquisition, word acquisition and sentence development that are relatively consistent across languages. If an infant does not respond to environmental sounds or the voice of the caregiver, or a 4–10-month-old baby does not coo, babble and make many different sounds, or a 12-month-old is not attempting to say words “mama, dada, bubu, uh-oh,” you should consider a hearing evaluation .

What’s interesting is that children in multilingual households (even children with developmental disorders) don’t mix up the rules for different languages. For example a child learning both Mandarin (a tone-based language where rises and falls in pitch change word meaning) and English (which has different rules to change word meaning) doesn’t apply the English rules to Mandarin. So the final pitch rise typically produced to indicate an English question—“Can I go?”—won’t be used to distinguish questions from statements in Mandarin.

Telling : Children learning multiple languages may demonstrate a longer learning period (they have more to learn) than monolingual language-learners. However, the quality and quantity of language output for typically developing mono- and multilingual children should be roughly equivalent. Parents who grew up in households where multiple languages were spoken may be familiar with this construct. If, however you are new to this experience you may find your multilingual child spends more time using one language over the other; or speaks to one caregiver exclusively in one language; or responds in English to questions posed in another language. All these behaviors are typical. Parents of mono- and multilingual children should reach out for help if their child (a) doesn’t respond in the expected manner in any language; (b) has trouble following simple instructions; or (c) does not name, tell, comment, request using from one to four words by the age of three.

Children learn to talk through practice, even if we sometimes don’t understand it. Based on what parents report to researchers , strangers typically understand about 25 percent of the words spoken by a one-year-old. For typically developing children speech intelligibility increases at a rate of around 25 percent each year so by age four most children should be understood by most people nearly 100 percent of the time. At two and a half, a child would be roughly 50 percent understandable to unfamiliar listeners.

Understanding : At two and a half, a child can understand between 100 to 500 words, but may only use 50 to 150 words . The child will arrange those words to communicate many ideas such as “all gone,” “dada go night-night” and other routine phrases. Over time and with practice the toddler’s receptive (listening) and expressive (telling) vocabulary increases exponentially. By age three vocabulary may grow to 1,000 words, and by age five the young pre-reader may have a vocabulary of around 10,000 words. Child speech and language development are roughly the same regardless of languages used, family income or family structure.

In our case Grayson’s speech was just below the developmental target for his age. As the specialist observed, he said lots of words; she just didn’t understand most of them. She made the responsible decision to call us and share her concerns. Although we were quite surprised, we listened to her concerns and discussed them as a family. We chose not to pursue early intervention. Instead, we continued to read and talk to Grayson and his twin every day. By age three, both twins were well above the developmental milestones expected for their age.

Our choice not to pursue therapy was based on several factors. As a speech pathologist, I had the training to provide support at home. As a result of frequent chronic ear infections, Grayson had ear tubes placed at 18 months. His ear infections could have negatively affected his language development, but still Grayson was not three months behind the milestones. Without this knowledge and the intervention we could provide at home, we would have accepted the referral.

In thinking about a child’s speech and language development, parents need to remember that hearing is foundational for both. Children develop language only by interacting with other people. For more information, the CDC provides a helpful checklist to assist parents in deciding when to ask their pediatrician for a speech and language referral. In general, if children are three months behind in one or more areas, a request for referral, to a speech language pathologist or child development specialist, is probably a good idea. Talk to your pediatrician. As parents we all want to provide the greatest opportunity for our children’s success. Creating a language-rich environment by talking with, reading with and listening to your child is one of the best ways to do that.

This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American .

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Here’s how voice assisted ai technology can give people a voice again.

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Dutch Whispp app user, Ruud, uses the app to speak clearly with friends.

Johns Hopkins defines stuttering as a voice speech disorder. Stuttering affects more than 80 million people worldwide, and in the United States, more than one million Americans stutter.

A voice disorder is a problem with pitch, volume, tone, and other qualities of your voice that occurs when vocal cords don't vibrate normally. There are several types of voice disorders classified as organic, which include structural and neurological (caused by a neurological disorder like Parkinson's or Alzheimer's), functional (muscle dysfunction), and psychogenic disorders.

A Dutch start-up has created an app designed to give a voice to people with voice disorders or speech disorders, such as stuttering.

Using artificial intelligence (AI), the Whispp app enables them to make understandable and relaxed phone and video calls.

"The app has a real-time assistive voice technology that converts voiceless/vocal cord-impaired speech or whispered speech (speech that does not have a clear pitch) into natural and voiced speech," said Joris Castermans, CEO of Whispp. "People who stutter severely, for example, can reduce their stuttering frequency by an average of 85% while whispering. Additionally, people who suffer from spasmodic dysphonia or recurrent respiratory papillomatosis speak much more relaxed and fluently when they whisper."

In an email interview, Castermans said the Whispp enables users to express themselves better and easier, enhancing their quality of life and allowing them to participate more fully in society.

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"Communication is a fundamental aspect of human existence that presents a daily challenge for people who suffer from a voice disability or stutter severely," said Castermans. "The inability to communicate can lead to social isolation and, in many cases, feelings of inadequacy and depression."

With their own AI models for Whispp, the AI is audio-to-audio based with no textual intermediate, so the company doesn't use language models.

"With this, Whisper converts non-voiced speech with a very low latency," said Castermans. "Whispp's AI converts every 20 milliseconds of audio into a real-time stream.

Whispp uses real-time, audio-to-audio-based assistive voice AI to create real-time speech conversion and accommodates a range of voice types — from whispers to rough esophageal speech. This allows the app to create a tailored solution for several voice conditions.

For example, Castermans says people who stutter severely speak fluently and are relaxed when they whisper. "This is because of a neurological change that occurs while they are speaking; aside from this, people who stutter severely didn't 'learn' to be anxious while whispering."

Castermans says that big tech and assistive speech tech companies predominantly focus on Automatic Speech Recognition, known as speech-to-text (STT), for non-standard speech. "This is very helpful for patients with reduced articulation (ALS, MS, stroke and Parkinson's Disease) who can use text-to-speech to synthesize their speech."

"The disadvantage of this approach, however, is the high latency of two to three seconds, which creates barriers to natural conversation," said Castermans. "As a result, current AI speech technology solutions do not provide an adequate solution for people with voice disorders who have lost their voice but still have good articulation."

The Whispp app is available on Android and IoS.

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What is wrong with RFK Jr.’s voice? The disorder behind Robert F. Kennedy Jr.’s speech impediment

R obert F. Kennedy has been campaigning as an independent candidate to become the next president of the United States. Now that he has constantly been in the public eye, his manner of speaking cannot help but get some attention. It seems that speech is difficult for him, and that his voice is constantly raspy .

This is not simply a result of overusing his voice box due to the rigors of giving rousing speeches. He has been diagnosed with a rare voice condition known as spasmodic dysphonia .

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What is spasmodic dysphonia? The disorder behind Robert F. Kennedy Jr.’s speech impediment

Spasmodic dysphonia is a neurological disorder that affects the muscles of the voice box or larynx, and leads to involuntary spasms or contractions of the vocal cords. The exact cause of this condition is not known, according to Dysphonia International .

These spasms disrupt the normal flow of air during speech, resulting in changes to the voice quality, such as breaks, pauses, or interruptions while talking. The voice may sound strained, shaky, or hoarse .

There are two main types of spasmodic dysphonia. Adductor spasmodic dysphonia causes the vocal cords to spasm and close together tightly , causing a strained or choked voice quality. Speech may be interrupted or difficult to initiate.

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The less common abductor spasmodic dysphonia on the other hand causes the vocal cords to spasm and open unexpectedly during speech , leading to a breathy or weak voice quality. Speaking may be broken off by involuntary breathy pauses.

Spasmodic dysphonia can vary in severity and may worsen over time . It can have a significant impact on communication and quality of life , as it can interfere with daily interactions, work, and social activities.

Though the exact cause of this condition is not fully understood, it is believed to involve a combination of genetic, neurological, and environmental factors .

Treatment options may include speech therapy, botulinum toxin injections to temporarily paralyze the affected muscles, and in some cases, surgery .