What are the various speech and language disorders?

Speech Language Pathologists work with clients across the age span to diagnose and/or treat a variety of disorders. Diagnosis and treatment vary from pediatrics to adults. This article specifically addresses more common pediatric speech and language disorders. Speech refers to how we say sounds and words. As children are learning to speak, they can have difficulty producing sounds/words correctly, producing sounds/words consistently, producing words/sentences fluently, and/or producing speech with an appropriate tone/pitch/volume. The difficulties can be indicative of the following speech disorders which will be further discussed: a) speech sound disorder, b) Childhood Apraxia of Speech, c) fluency disorder, d) voice disorder, and e) resonance disorder. A functional speech sound disorder is characterized by difficulty producing certain sounds or patterns in words (American Speech Hearing Association, 2020b). More commonly these speech sound disorders are referred to as an articulation disorder or a phonological disorder. An articulation disorder is distinguished by an errored production. Examples include a substitution of a sound (e.g. “shun” for “sun”), omission of a sound (e.g. “un” for “sun”), distortion of a sound (e.g. lisp “s” in sun), and addition of a sound (e.g. “stun” for “sun”). A phonological disorder is distinguished by a predictable, rule-based error (e.g. child who delete final consonants in words (e.g ‘ha’ for “hat”, ‘ba’ for “bat”, ‘ta’ for “tap”; child who produces back “k,g” sounds in the front of their mouth (e.g. “tob” for “cob”, “otay‘’ for “okay”, ‘do’ for “go”). It is possible for a child to present with both articulation errors and phonological errors. Some articulation and phonological errors are considered typical depending on the child’s age as sounds develop overtime. If interested, research “speech sound acquisition” to find out specific information regarding sound development. Childhood Apraxia of Speech (CAS) is a motor planning disorder characterized by difficulty producing sounds and words correctly and consistently. Children with CAS can present with inconsistent errors (e.g. saying the same word different every time). Additionally, children with CAS may express difficulty putting sounds and syllables together correctly (Cedars-Sinai, 2020). This disorder is neurological in nature and can present with varying signs/symptoms. A fluency disorder is characterized by disruptions in speech. There are two types of fluency disorders: stuttering and cluttering. Stuttering, the most common fluency disorder, occurs when the flow of speech is broken by repetitions (he-he-hello), prolongations (hhhhello), or abnormal pauses (Stuttering Foundation, 2020). Some stuttering-like productions are typical in toddlers and preschoolers as they are learning language. An SLP is able to distinguish “typical” disfluencies versus non-typical disfluencies. Cluttering occurs when a child presents with disfluencies as well as a rapid or irregular rate of speech. A voice disorder is characterized by an abnormal tone, pitch, quality and/or volume when speaking. There are a variety of voice disorders that can be diagnosed in children. A team typically consisting of an SLP and an Ear Nose Throat (ENT) physician will work together to diagnosis a voice disorder. Similarly, an SLP and ENT typically collaborate on the diagnosis of a resonance disorder, which is characterized by too much or too little nasal and/or oral sounds in speech (American Speech Language Hearing Association. 2020a). Some sounds are considered “nasal” sounds, meaning air flows through the nose. Other sounds are considered “oral” sounds, meaning air flows through the mouth. A child can present with a) hypernasality, b) hypernasality, c) cul-de-sac resonance, or d) mixed resonance. A child who presents with hypernasality will have increased nasal emissions on oral sounds while a child who presents with hyponasality will have decreased nasal emissions on nasal sounds. Cul-de-sac resonance occurs when sound resonates but is “trapped” and cannot exit because of an obstruction (American Speech Language Hearing Association. 2020a). Mixed resonance can also occur, meaning a child can present with different variations of resonance. Language refers to words and how we use them. As children are learning language, they can have difficulty with using words/phrases/sentences to communicate, understanding words/concepts, and/or following the “rules” of language and interacting appropriately. The difficulties can be indicative of the following language disorders which will be further discussed: a) Expressive Language disorder, b) Mixed Expressive-Receptive Language disorder, and c) Social Communication disorder. An expressive language disorder is characterized by difficulty expressing thoughts/ideas/needs by using words or correct sentences. Some children may express difficulty using simple words, while others may not use correct word order or correct grammatical morphemes (e.g. “jump” when referring to past tense “jumped”). Additionally, children with expressive language disorders may overgeneralize words or use incorrect pronouns. There are many signs that could possibly indicate an expressive language disorder in children, which will be covered by a speech-language evaluation. A mixed expressive/receptive language disorder involves difficulties in both expressive and receptive language. A receptive language disorder is characterized by difficulty understanding what is being said. Some children may express difficulty following directions, pointing to pictures and/or answering questions. Understanding language is needed for a child to use language, thus if a child has a receptive language disorder, they often have an expressive language disorder as well. A social communication disorder is characterized by difficulty using language to interact with others. Children with a social communication disorder can express difficulty in turn taking, using and maintaining eye contact, using manners, making friends, using greetings and/or tailoring conversation to another’s interest. Many children who present with a social communication disorder respond well to explicit teaching of rules of communication, such as how to initiate conversation, how to ask questions, and how to read non-verbal body cues. It is important to note that all these disorders can co-occur, so it is possible for a child to present with an articulation disorder, a phonological disorder, and a mixed expressive-receptive language disorder. Additionally, this list does not include all pediatric speech and language disorders. Some other disorders not mentioned include dysarthria, orofacial myofunction disorders, selective mutism, and dyslexia. If any speech/language concerns arise with your child, consider seeking an evaluation from a Speech Language Pathologist. At Carolina Pediatric Therapy, we have many speech language therapists who are eager to meet you and assist in your child’s speech/language development. References American Speech Language Hearing Association. (2020a). Resonance Disorders. https://www.asha.org/Practice-Portal/Clinical-Topics/Resonance-Disorders/ American Speech Language Hearing Association. (2020b). Speech Sound Disorders. https://www.asha.org/Practice-Portal/Clinical-Topics/Resonance-Disorders/ Cedars-Sinai. (2020). Childhood Apraxia of Speech. https://www.cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/c/childhood-apraxia-of-speech.html Stuttering Foundation. (2020). Frequently Asked Questions. https://www.stutteringhelp.org/faq