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Overcoming Speech Impediment: Symptoms to Treatment
There are many causes and solutions for impaired speech
- Types and Symptoms
- Speech Therapy
- Building Confidence
Speech impediments are conditions that can cause a variety of symptoms, such as an inability to understand language or speak with a stable sense of tone, speed, or fluidity. There are many different types of speech impediments, and they can begin during childhood or develop during adulthood.
Common causes include physical trauma, neurological disorders, or anxiety. If you or your child is experiencing signs of a speech impediment, you need to know that these conditions can be diagnosed and treated with professional speech therapy.
This article will discuss what you can do if you are concerned about a speech impediment and what you can expect during your diagnostic process and therapy.
FG Trade / Getty Images
Types and Symptoms of Speech Impediment
People can have speech problems due to developmental conditions that begin to show symptoms during early childhood or as a result of conditions that may occur during adulthood.
The main classifications of speech impairment are aphasia (difficulty understanding or producing the correct words or phrases) or dysarthria (difficulty enunciating words).
Often, speech problems can be part of neurological or neurodevelopmental disorders that also cause other symptoms, such as multiple sclerosis (MS) or autism spectrum disorder .
There are several different symptoms of speech impediments, and you may experience one or more.
Can Symptoms Worsen?
Most speech disorders cause persistent symptoms and can temporarily get worse when you are tired, anxious, or sick.
Symptoms of dysarthria can include:
- Slurred speech
- Slow speech
- Choppy speech
- Hesitant speech
- Inability to control the volume of your speech
- Shaking or tremulous speech pattern
- Inability to pronounce certain sounds
Symptoms of aphasia may involve:
- Speech apraxia (difficulty coordinating speech)
- Difficulty understanding the meaning of what other people are saying
- Inability to use the correct words
- Inability to repeat words or phases
- Speech that has an irregular rhythm
You can have one or more of these speech patterns as part of your speech impediment, and their combination and frequency will help determine the type and cause of your speech problem.
Causes of Speech Impediment
The conditions that cause speech impediments can include developmental problems that are present from birth, neurological diseases such as Parkinson’s disease , or sudden neurological events, such as a stroke .
Some people can also experience temporary speech impairment due to anxiety, intoxication, medication side effects, postictal state (the time immediately after a seizure), or a change of consciousness.
Speech Impairment in Children
Children can have speech disorders associated with neurodevelopmental problems, which can interfere with speech development. Some childhood neurological or neurodevelopmental disorders may cause a regression (backsliding) of speech skills.
Common causes of childhood speech impediments include:
- Autism spectrum disorder : A neurodevelopmental disorder that affects social and interactive development
- Cerebral palsy : A congenital (from birth) disorder that affects learning and control of physical movement
- Hearing loss : Can affect the way children hear and imitate speech
- Rett syndrome : A genetic neurodevelopmental condition that causes regression of physical and social skills beginning during the early school-age years.
- Adrenoleukodystrophy : A genetic disorder that causes a decline in motor and cognitive skills beginning during early childhood
- Childhood metabolic disorders : A group of conditions that affects the way children break down nutrients, often resulting in toxic damage to organs
- Brain tumor : A growth that may damage areas of the brain, including those that control speech or language
- Encephalitis : Brain inflammation or infection that may affect the way regions in the brain function
- Hydrocephalus : Excess fluid within the skull, which may develop after brain surgery and can cause brain damage
Do Childhood Speech Disorders Persist?
Speech disorders during childhood can have persistent effects throughout life. Therapy can often help improve speech skills.
Speech Impairment in Adulthood
Adult speech disorders develop due to conditions that damage the speech areas of the brain.
Common causes of adult speech impairment include:
- Head trauma
- Nerve injury
- Throat tumor
- Stroke
- Parkinson’s disease
- Essential tremor
- Brain tumor
- Brain infection
Additionally, people may develop changes in speech with advancing age, even without a specific neurological cause. This can happen due to presbyphonia , which is a change in the volume and control of speech due to declining hormone levels and reduced elasticity and movement of the vocal cords.
Do Speech Disorders Resolve on Their Own?
Children and adults who have persistent speech disorders are unlikely to experience spontaneous improvement without therapy and should seek professional attention.
Steps to Treating Speech Impediment
If you or your child has a speech impediment, your healthcare providers will work to diagnose the type of speech impediment as well as the underlying condition that caused it. Defining the cause and type of speech impediment will help determine your prognosis and treatment plan.
Sometimes the cause is known before symptoms begin, as is the case with trauma or MS. Impaired speech may first be a symptom of a condition, such as a stroke that causes aphasia as the primary symptom.
The diagnosis will include a comprehensive medical history, physical examination, and a thorough evaluation of speech and language. Diagnostic testing is directed by the medical history and clinical evaluation.
Diagnostic testing may include:
- Brain imaging , such as brain computerized tomography (CT) or magnetic residence imaging (MRI), if there’s concern about a disease process in the brain
- Swallowing evaluation if there’s concern about dysfunction of the muscles in the throat
- Electromyography (EMG) and nerve conduction studies (aka nerve conduction velocity, or NCV) if there’s concern about nerve and muscle damage
- Blood tests, which can help in diagnosing inflammatory disorders or infections
Your diagnostic tests will help pinpoint the cause of your speech problem. Your treatment will include specific therapy to help improve your speech, as well as medication or other interventions to treat the underlying disorder.
For example, if you are diagnosed with MS, you would likely receive disease-modifying therapy to help prevent MS progression. And if you are diagnosed with a brain tumor, you may need surgery, chemotherapy, or radiation to treat the tumor.
Therapy to Address Speech Impediment
Therapy for speech impairment is interactive and directed by a specialist who is experienced in treating speech problems . Sometimes, children receive speech therapy as part of a specialized learning program at school.
The duration and frequency of your speech therapy program depend on the underlying cause of your impediment, your improvement, and approval from your health insurance.
If you or your child has a serious speech problem, you may qualify for speech therapy. Working with your therapist can help you build confidence, particularly as you begin to see improvement.
Exercises during speech therapy may include:
- Pronouncing individual sounds, such as la la la or da da da
- Practicing pronunciation of words that you have trouble pronouncing
- Adjusting the rate or volume of your speech
- Mouth exercises
- Practicing language skills by naming objects or repeating what the therapist is saying
These therapies are meant to help achieve more fluent and understandable speech as well as an increased comfort level with speech and language.
Building Confidence With Speech Problems
Some types of speech impairment might not qualify for therapy. If you have speech difficulties due to anxiety or a social phobia or if you don’t have access to therapy, you might benefit from activities that can help you practice your speech.
You might consider one or more of the following for you or your child:
- Joining a local theater group
- Volunteering in a school or community activity that involves interaction with the public
- Signing up for a class that requires a significant amount of class participation
- Joining a support group for people who have problems with speech
Activities that you do on your own to improve your confidence with speaking can be most beneficial when you are in a non-judgmental and safe space.
Many different types of speech problems can affect children and adults. Some of these are congenital (present from birth), while others are acquired due to health conditions, medication side effects, substances, or mood and anxiety disorders. Because there are so many different types of speech problems, seeking a medical diagnosis so you can get the right therapy for your specific disorder is crucial.
Centers for Disease Control and Prevention. Language and speech disorders in children .
Han C, Tang J, Tang B, et al. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: a systematic review and meta-analysis . Medicine (Baltimore). 2024;103(2):e36880. doi:10.1097/MD.0000000000036880
National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, language .
Mackey J, McCulloch H, Scheiner G, et al. Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience . Brain Impair. 2023;24(2):168-184. doi:10.1017/BrImp.2023.9
Allison KM, Doherty KM. Relation of speech-language profile and communication modality to participation of children with cerebral palsy . Am J Speech Lang Pathol . 2024:1-11. doi:10.1044/2023_AJSLP-23-00267
Saccente-Kennedy B, Gillies F, Desjardins M, et al. A systematic review of speech-language pathology interventions for presbyphonia using the rehabilitation treatment specification system . J Voice. 2024:S0892-1997(23)00396-X. doi:10.1016/j.jvoice.2023.12.010
By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.
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Speech Sound Disorder (Phonological Disorder) DSM-5 315.39 (F80.0)
DSM-5 Category: Communication Disorders
Introduction.
Speech is the verbal expression of one's cognitive content and process, and emotions. Clarity of speech is essential to social interaction, and educational and occupational functioning, as well as one's self confidence, self image, and sense of self efficacy. Impairment in speech can have a negative influence on all of these areas. Speech Sound Disorder (SSD), formerly known as Phonological Disorder in the DSM -IV, (Diagnostic and Statistical Manual of Mental Disorders, fourth Edition) is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), diagnosis assigned to individuals who have difficulties in productive speech which interferes with communication, and produces impairment in functioning, and distress. In Speech Sound Disorder, phonemes, or the basic units of speech, can be added, omitted, distorted or changed, or substituted in a manner which makes the speaker difficult to understand (American Speech Language Hearing Association, 2014). Addition of sounds is defined as including unneeded sounds in the pronunciation of the word. Omission involves deleting sounds or syllables, e,g, the word Doggie is pronounced as “oggie”. Distortions involve altering the correct sound of the word, which includes lisping. Substitution is using an incorrect sound to pronounce the word, e.g., cry is pronounced as “Cwy”. Acquisition of articulate speech is a developmental process which unfolds over almost a decade from birth. At age two, about 50% of a child's speech should be intelligible, and by age four, speech should be mostly understandable. At age eight, all words used by a child should be intelligible. Difficulties with speech production outside of these normal developmental parameters, in the absence of a sensory -motor deficit, neurological problem, or facial structural abnormality can indicate Speech Sound Disorder (American Psychiatric Association, 2013).
Symptoms of Speech Sound Disorder
According to the DSM-5, there are four criterion for Speech Sound Disorder:
- Persistent unintelligible speech consisting of phoneme addition, omission, distortion, or substitution, which interferes with verbal communication.
- There is interference with either social participation, academic performance, or occupational performance (or any combination thereof).
- The onset of symptoms is during childhood.
- The symptoms cannot be accounted for by another medical or neurological condition, including TBI (Traumatic Brain Injury) (American Psychiatric Association, 2013).
The DSM-5 notes that the onset of Speech Sound Disorder is in childhood. (American Psychiatric Association, 2013). Speech Sound Disorder responds well to speech therapy, with good resolution, however, some speech errors can persist into adulthood.
The DSM-5 does not indicate the prevalence of Speech Sound Disorder (American Psychiatric Association, 2013). Other sources indicate the prevalence of Speech Sound Disorder is 8%-9% in children (National Institute on Deafness and other Communication Disorders, 2010).
Risk Factors
The DSM-5 does not list specific risk factors for Speech Sound Disorder (American Psychiatric Association, 2013). Other sources indicate children who experience frequent ear infections may develop hearing impairment and be at risk for Speech Sound Disorder (American Speech Language Hearing Association, 2014).
Comorbidity
The DSM-5 does not indicate any specific comorbid disorders with Speech Sound Disorder
(American Psychiatric Association, 2013). Other sources indicate Language Impairment (LI) is also seen in children with Speech Sound Disorder (Lewis, Avrich, Freebairn,Hansen, Sucheston, Kuo, Taylor, Iyengar, & Steina, 2011). If Speech Sound Disorder is not corrected, and a lisp or other speech impediment persists into adulthood, it can be a contributing factor in social anxiety disorder. Some individuals will be very self-conscious of their lisp, overestimating how noticeable it is by others, or assigning an overly negative impression to it.
Treatment for Speech Sound Disorder
The DSM-5 does not specify treatment options for Speech Sound Disorder(American Psychiatric Association, 2013). Speech Sound Disorder can be diagnosed, evaluated, and treated by an SLP (Speech Language Pathologist) (American Speech Language Hearing Association, 2014). In some cases, supportive psychotherapy may be beneficial to prevent Speech Disorders from contributing to Social Anxiety, or problems with self confidence, particularly in adults who are self-conscious about residual speech errors.
Impact on Functioning
Speech Sound Disorder can impact educational, interpersonal, and occupational functioning.
(American Psychiatric Association, 2013). Peers may bully or ridicule children who lisp, or have other indicators of Speech Sound Disorder. Children with Speech Sound Disorder, as well as adults with residual speech errors may be perceived as less intelligent, or mature, as speech production is generally considered a marker of one's intellect and maturity. Speech Sound Disorder can impact learning and literacy. Studies have shown that 18% of children with Speech Sound Disorder will have difficulty reading in elementary school by about third or fourth grade (Lewis, et al, 2011). Adults with unresolved Speech disorders may restrict their participation in certain activities to prevent revealing their speech difficulty (Board of Regents of the University Of Oklahoma, 2011)
Differential Diagnosis
There are several diagnostic rule-outs for the clinician to consider in Speech Sound Disorder. In the DSM -5, it is noted that disorders such as hearing impairment can in turn produce speech impairment, which if in excess of what is typically expected for the degree of hearing loss, can be diagnosed separately as Speech Sound Disorder. There may be structural facial abnormalities such as a cleft palette which can produce difficulty with speech articulation. Dysarthria is a discrete speech disorder due to a neurological disorder, such as cerebral palsy. Following a TBI affecting Broca's area (Productive speech center of the cerebral cortex), there may be difficulties with speech production, articulation, and ability to retrieve words appropriate for the context (aphasia). This is not only a different etiology, but different qualitatively than Speech Sound Disorder. Selective Mutism involves limited speech production secondary to anxiety, There are also normal speech variations which are not considered a Speech Sound Disorder, such as accents. (American Psychiatric Association, 2013). Accents are regional differences in pronunciation due to the influence and filtering of one language through another, e.g, in northern Vermont, the “Au” sound in the word Aunt is pronounced with an “ awh” sound, whereas in New York State the same word is pronounced with an “eh” sound. The difference is due to English being filtered through French, which is an ancestral language in northern Vermont. The correct pronunciation is relative, depending on the region.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.
American Speech Language Hearing Association. (2014). Speech Sound Disorders: Articulation and Phonological Processes. American Speech Language Hearing Association. Retrieved March 17, 2014, from http://www.asha.org/public/speech/disorders/speechsounddisorders.htm
Board of Regents of the University Of Oklahoma. (2011). Common Development Speech and Language Disorders. The Department of Communication Sciences and Disorders. Retrieved March 22, 2014, from http://www.ah.ouhsc.edu/csd/leaps_disorders.asp
Lewis, B.A., Avrich, A.A., Freebairn,L.A., Hansen A.J., Sucheston, L.E., Kuo, I., Taylor, H.G., Iyengar, S.K., and Steina, C.M. (2011). Literacy Outcomes of Children With Early Childhood Speech Sound Disorders: Impact of Endophenotypes. Journal of Speech, Language and Hearing Residents. 54(6):1628–1643. doi: 10.1044/1092-4388(2011/10-0124)
National Institute on Deafness and other Communication Disorders (2010). Statistics on Voice, Speech, and Language. National Institute on Deafness and other Communication Disorders. Retrieved March 23, 2014, from https://www.nidcd.nih.gov/health/statistics/pages/vsl.aspx
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