The quest to be understood, communicate

It may be easy to take speech for granted, but its complexity requires coordination of the tongue, vocal cords, teeth, hard and soft palates, lungs, diaphragm and the brain to produce the sounds required to speak.

The American Speech-Language-Hearing Association estimates that between six and eight million people in the United States have some form of speech sound disorder. The National Institutes of Health defines a speech disorder as a condition in which a person has problems creating or forming the speech sounds needed to communicate with others. Most children will make some mistakes as they learn new words and sounds, but when they occur past a certain age, they become categorized as speech disorders. Each sound has a different range of ages at which the child should be able to articulate the sound properly.

According to the ASLHA, speech disorders can be divided into articulation/ phonological disorders, fluency disorders (disfluency) and voice disorders. An articulation disorder occurs when a person has trouble accurately producing phonemes (consonant and vowels sounds) in isolation or combining them to form words. According to the ASLHA, articulation disorders can be broken down into four categories:

• Substitution – using another sound in place of the right one

• Omission – leaving out sounds

• Addition – putting in an extra sound or letter where there shouldn’t be one

• Distortion – the sound is malformed or altered The ASLHA further states that articulation disorders can be caused by:

• Hearing loss

• Structural differences (cleft palate, ankyloglossia – “tongue tie”)

• Neurological disorders (dysarthria, dysprosody)

• Developmental delays

• Genetic syndromes (Down syndrome) The ASLHA describes the difference between articulation disorders and phonological disorders as the difference between being able to make the sounds (articulation) and being able to use the sound patterns appropriately to be understood.

Disfluency is an interruption in the flow or rhythm of speech with hesitations, repetitions or prolonging of sounds, syllables, words or phrases, the most common of which is stuttering. Stuttering, according to the NIH, is still not understood as to its cause, but speech language pathologist Ashley Carnahan, at CHRISTUS Schumpert Health, said there is effective treatment.

“Several treatments for stuttering include using a flexible rate of speech, an easy onset of voicing, and using proprioception,” Carnahan said. “Replacing stuttering with superfluency, transferring superfluency to structured situations, desensitizing the child to fluency disrupters and reducing fear and avoidance are additional treatments for disfluency.”

According to The National Institute on Deafness and Other Communication Disorders, approximately three million Americans stutter. It affects all ages but especially in children between the ages of two and five. They state that about five percent of all children will stutter for some period in their life. Its origins can be developmental in nature or due to brain injury, such as stroke or head trauma.

Carnahan said, “Articulation disorders, with appropriate treatment, can be remediated; however, stuttering cannot always be cured. A young child who begins to stutter may recover without any treatment. Others may require early intervention or therapy to prevent development of a serious problem. Those who stutter severely over a long period of time may only make moderate progress and some may never improve.”

Voice disorders occur when parts of the vocal mechanism are too damaged or weak to produce intelligible speech. The ASLHA lists causes such as colds, allergies, bronchitis, exposure to irritants or damage to vocal cords due to overuse, and trauma to the throat, all of which can result in voice loss. Voice disorders ASLHA describes as requiring more intensive treatment are:

• Vocal cord nodules and polyps

• Vocal cord paralysis – in which one or more vocal cords become “stuck” between open and closed, due to damage to the vagus nerve by

• Paradoxical vocal fold movement – episodes where the vocal cords close when they should open, such as when trying to breathe

• Spasmodic dysphonia – in which movement of the vocal cords is forced and strained, causing hoarseness, tightness, or a groaning or “quivering” voice.

If a speech disorder is suspected, ASLHA recommends evaluation by a speechlanguage pathologist. The SLP is trained to listen to and test people with speech problems in order to determine the specific problems, which exist and recommend the appropriate treatment.