Speech and language impairment are basic categorizations of communication involving hearing, speech, language, and fluency. Speech-Language disorders can occur with other learning disorders that affect reading and writing. The descriptions below are not intended to be used for self diagnosis. An evaluation must be performed to determine if your child has a speech-language disorder, you must have an evaluation.
Studies show that children with ADD are at risk for articulation disorders, which affect their ability to produce letter sounds appropriate for their age. Beyond that, they also commonly have differences in fluency and vocal quality when speaking. One study even detected ADD through these speech differences. Compared to peers with learning disabilities alone, children with ADD showed increased volume and variability in pitch when talking, along with particular patterns such as increased number of vocal pauses.
There are various treatment approaches used for apraxia. How effective they are can vary from person to person. For the best results, apraxia treatment must be developed to meet a given individual’s needs.
Therapy for childhood apraxia of speech aims to improve speech coordination. Most children with apraxia of speech benefit from meeting one on one with a speech-language pathologist three to five times a week. They may also need to work with their parents or guardians to practice the skills they are developing.
An articulation disorder involves problems making sounds. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand you.
Young children often make speech errors. For instance, many young children sound like they are making a “w” sound for an “r” sound (e.g., “wabbit” for “rabbit”) or may leave sounds out of words, such as “nana” for “banana.” The child may have an articulation disorder if these errors continue past the expected age.
A phonological process disorder involves patterns of sound errors. For example, substituting all sounds made in the back of the mouth like “k” and “g” for those in the front of the mouth like “t” and “d” (e.g., saying “tup” for “cup” or “das” for “gas”).
Another rule of speech is that some words start with two consonants, such as broken or spoon. When children don’t follow this rule and say only one of the sounds (“boken” for broken or “poon” for spoon), it is more difficult for the listener to understand the child. While it is common for young children learning speech to leave one of the sounds out of the word, it is not expected as a child gets older. If a child continues to demonstrate such cluster reduction, he or she may have a phonological process disorder.
Information taken from ASHA.org.
Children with APD may exhibit a variety of listening and related complaints. For example, they may have difficulty understanding speech in noisy environments, following directions, and discriminating (or telling the difference between) similar-sounding speech sounds. Sometimes they may behave as if a hearing loss is present, often asking for repetition or clarification. In school, children with APD may have difficulty with spelling, reading, and understanding information presented verbally in the classroom. Often their performance in classes that don’t rely heavily on listening is much better, and they typically are able to complete a task independently once they know what is expected of them. However, it is critical to understand that these same types of symptoms may be apparent in children who do not exhibit APD. Therefore, we should always keep in mind that not all language and learning problems are due to APD, and all cases of APD do not lead to language and learning problems. APD cannot be diagnosed from a symptoms checklist. No matter how many symptoms of APD a child may have, only careful and accurate diagnostics can determine the underlying cause.
A multidisciplinary team approach is critical to fully assess and understand the cluster of problems exhibited by children with APD. Thus, a teacher or educational diagnostician may shed light on academic difficulties; a psychologist may evaluate cognitive functioning in a variety of different areas; a speech-language pathologist may investigate written and oral language, speech, and related capabilities; and so forth. Some of these professionals may actually use test tools that incorporate the terms “auditory processing” or “auditory perception” in their evaluation, and may even suggest that a child exhibits an “auditory processing disorder.” Yet it is important to know that, however valuable the information from the multidisciplinary team is in understanding the child’s overall areas of strength and weakness, none of the test tools used by these professionals are diagnostic tools for APD, and the actual diagnosis of APD must be made by an audiologist.
To diagnose APD, the audiologist will administer a series of tests in a sound-treated room. These tests require listeners to attend to a variety of signals and to respond to them via repetition, pushing a button, or in some other way. Other tests that measure the auditory system’s physiologic responses to sound may also be administered. Most of the tests of APD require that a child be at least 7 or 8 years of age because the variability in brain function is so marked in younger children that test interpretation may not be possible.
Once a diagnosis of APD is made, the nature of the disorder is determined. There are many types of auditory processing deficits and, because each child is an individual, APD may manifest itself in a variety of ways. Therefore, it is necessary to determine the type of auditory deficit a given child exhibits so that individualized management and treatment activities may be recommended that address his or her specific areas of difficulty.
It is important to understand that there is not one, sure-fire, cure-all method of treating APD. Notwithstanding anecdotal reports of “miracle cures” available in popular literature or on the internet, treatment of APD must be highly individualized and deficit-specific. No matter how successful a particular therapy approach may have been for another child, it does not mean that it will be effective for your child. Therefore, the key to appropriate treatment is accurate and careful diagnosis by an audiologist.
Treatment of APD generally focuses on three primary areas: changing the learning or communication environment, recruiting higher-order skills to help compensate for the disorder, and remediation of the auditory deficit itself. The primary purpose of environmental modifications is to improve access to auditorily presented information. Suggestions may include use of electronic devices that assist listening, teacher-oriented suggestions to improve delivery of information, and other methods of altering the learning environment so that the child with APD can focus his or her attention on the message.
Compensatory strategies usually consist of suggestions for assisting listeners in strengthening central resources (language, problem-solving, memory, attention, other cognitive skills) so that they can be used to help overcome the auditory disorder. In addition, many compensatory strategy approaches teach children with APD to take responsibility for their own listening success or failure and to be an active participant in daily listening activities through a variety of active listening and problem-solving techniques.
Finally, direct treatment of APD seeks to remediate the disorder, itself. There exist a wide variety of treatment activities to address specific auditory deficits. Some may be computer- assisted, others may include one-on-one training with a therapist. Sometimes home-based programs are appropriate whereas others may require children to attend therapy sessions in school or at a local clinic. Once again, it should be emphasized that there is no one treatment approach that is appropriate for all children with APD. The type, frequency, and intensity of therapy, like all aspects of APD intervention, should be highly individualized and programmed for the specific type of auditory disorder that is present.
The degree to which an individual child’s auditory deficits will improve with therapy cannot be determined in advance. Whereas some children with APD experience complete amelioration of their difficulties or seem to “grow out of” their disorders, others may exhibit some residual degree of deficit forever. However, with appropriate intervention, all children with APD can learn to become active participants in their own listening, learning, and communication success rather than hapless (and helpless) victims of an insidious impairment. Thus, when the journey is navigated carefully, accurately, and appropriately, there can be light at the end of the tunnel for the millions of children afflicted with APD.
- APD is an auditory disorder that is not the result of higher-order, more global deficit such as autism, mental retardation, attention deficits, or similar impairments.
- Not all learning, language, and communication deficits are due to APD.
- No matter how many symptoms of APD a child has, only careful and accurate diagnosis can determine if APD is, indeed, present.
- Although a multidisciplinary team approach is important in fully understanding the cluster of problems associated with APD, the diagnosis of APD can only be made by an audiologist.
- Treatment of APD is highly individualized. There is no one treatment approach that is appropriate for all children with APD.
Information from the American Speech-Language-Hearing Association
Psychologists and psychiatrists sometimes use the term “pervasive developmental disorders” and “autism spectrum disorders” (ASD) interchangeably. As such, PDD-NOS became the diagnosis applied to children or adults who are on the autism spectrum but do not fully meet the criteria for another ASD such as autistic disorder (sometimes called “classic” autism) or Asperger Syndrome.
Like all forms of autism, PDD-NOS can occur in conjunction with a wide spectrum of intellectual ability. Its defining features are significant challenges in social and language development.
Some developmental health professionals refer to PDD-NOS as “subthreshold autism.” In other words, it’s the diagnosis they use for someone who has some but not all characteristics of autism or who has relatively mild symptoms. For instance, a person may have significant autism symptoms in one core area such as social deficits, but mild or no symptoms in another core area such as restricted, repetitive behaviors.
As a diagnosis, PDD-NOS remains relatively new, dating back only 15 years or so. As a result, some physicians and educators may not be familiar with the term or may use it incorrectly.
The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) spells out the criteria for a diagnosis of PDD-NOS. Unfortunately, this description consists of a single paragraph, which mainly asserts what it is not:
“This category should be used when there is severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behavior, interests, and activities, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder. For example, this category includes “atypical autism” – presentations that do not meet the criteria for Autistic Disorder because of late age at onset, atypical symptomatology, or subthreshold symptomatology, or all of these.”
More helpful, perhaps, are studies suggesting that persons with PDD-NOS can be placed in one of three very different subgroups:
- A high-functioning group (around 25 percent) whose symptoms largely overlap with that of Asperger syndrome, but who differ in terms of having a lag in language development and mild cognitive impairment. (Asperger syndrome does not generally involve speech delay or cognitive impairment).
- A second group (around 25 percent) whose symptoms more closely resemble those of autistic disorder, but do not fully meet all its diagnostic signs and symptoms.
- A third group (around 50 percent) who meet all the diagnostic criteria for autistic disorder, but whose stereotypical and repetitive behaviors are noticeably mild.
- As these findings suggest, individuals with PDD-NOS vary widely in their strengths and challenges.
Information taken from AutismSpeaks.org
Broadly stated, (Central) Auditory Processing [(C)AP] refers to the efficiency and effectiveness by which the central nervous system (CNS) utilizes auditory information. Narrowly defined, (C)AP refers to the perceptual processing of auditory information in the CNS and the neurobiologic activity that underlies that processing and gives rise to electrophysiologic auditory potentials. (C)AP includes the auditory mechanisms that underlie the following abilities or skills: sound localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals (ASHA, 1996; Bellis, 2003; Chermak & Musiek, 1997). (Central) Auditory Processing Disorder [(C)APD] refers to difficulties in the perceptual processing of auditory information in the CNS as demonstrated by poor performance in one or more of the above skills. Although abilities such as phonological awareness, attention to and memory for auditory information, auditory synthesis, comprehension and interpretation of auditorily presented information, and similar skills may be reliant on or associated with intact central auditory function, they are considered higher order cognitive-communicative and/or language-related functions and, thus, are not included in the definition of (C)AP. Definitions of other key terms used in this report can be found in the Appendix. –
Information taken from asha.org
The development of communication skills begins in infancy, before the emergence of the first word. Any speech or language problem is likely to have a significant effect on the child’s social and academic skills and behavior. The earlier a child’s speech and language problems are identified and treated, the less likely it is that problems will persist or get worse. Early speech and language intervention can help children be more successful with reading, writing, schoolwork, and interpersonal relationships.
This information represents, on average, the age by which most monolingual speaking children will accomplish the listed milestones. Children typically do not master all items in a category until they reach the upper age in each age range. Just because your child has not accomplished one skill within an age range does not mean the child has a disorder. However, if you have answered no to the majority of items in an age range, seek the advice of an ASHA-certified speech-language pathologist or audiologist.
Information taken from asha.org
Autism is a developmental disability. Children with autism, also known as autism spectrum disorder or ASD, have social, communication and language problems. They also have restricted and repetitive patterns of behavior, interests, or activities, such as flipping objects, echolalia, or excessive smelling or touching of objects. Autism may be mild or severe. All children with autism don’t have the exact same problems. Children with autism may have the following social and communication skills and common behaviors:
Your child may have problems using social skills to connect with other people. He may seem to be in his own world. It may be hard for him to share a common focus with another person about the same object or event-known as joint attention; play with others and share toys; understand feelings;
make and keep friends.
Your child may have trouble with communication skills like understanding, talking with others, reading or writing. Sometimes, she might lose words or other skills that she’s used before. Your child may have problems understanding and using gestures, like pointing, waving, or showing objects to others; following directions; understanding and using words; having conversations; learning to read or write. Or she may read early but without understanding the meaning—called hyperlexia.
Your child also may repeat words just heard or words heard days or weeks earlier-called echolalia (pronounced ek-o-lay-le-a); talk with little expression or use a sing-song voice; use tantrums to tell you what he does or does not want.
A child with autism may have trouble changing from one activity to the next; flap hands, rock, spin or stare; get upset by certain sounds; like only a few foods; have limited and unusual interests-for example, talk about only one topic or keep staring at one toy.
How is autism diagnosed?
It is important to have your child evaluated by professionals who know about autism. Speech-language pathologists (SLPs), typically as part of a team, may diagnose autism. The team might include pediatricians, neurologists, occupational therapists, physical therapists, and developmental specialists, among others. SLPs play a key role because problems with social skills and communication are often the first symptoms of autism. SLPs should be consulted early in the evaluation process. There are a number of tests and observational checklists available to evaluate children with developmental problems. The most important information, however, comes from parents and caregivers who know the child best and can tell the SLP and others all about the child’s behavior.
Information taken from asha.org
A communication disorder in which there are difficulties with verbal and written expression. It is a specific language impairment characterized by an ability to use expressive spoken language that is markedly below the appropriate level for the mental age, but with a language comprehension that is within normal limits. There can be problems with vocabulary, producing complex sentences, and remembering words and there may or may not be abnormalities in articulation (speech).
Set of all mental abilities and processes related to knowledge: attention, memory & working memory, judgment & evaluation, reasoning & “computation”, problem solving & decision making, comprehension & production of language, etc. Cognition is by humans conscious and unconscious, concrete or abstract, as well as intuitive (like knowledge of a language) and conceptual (like a model of a language). Cognitive processes use existing knowledge and generate new knowledge.
Oral-motor skills involve the movements of the lips, jaw, tongue, and cheeks. These muscles are important for eating, drinking and speech. Examples of oral-motor activities including drinking from a straw, chewing, and blowing a toy horn. Children who struggle in this area may have problems tolerating different food textures, drinking from a cup, having their teeth brushed, and may overstuff their mouth with food.
Though there is a distinction between phonological awareness and phonemic awareness the two terms are often used interchangeably. For the most part both are used to refer to what is technically phonological awareness. The more common term used to encompass both skill sets is phonemic awareness. In most literature on reading you will see “phonemic awareness” used. Know when you see this term usually the writer is actually referring to “phonological awareness”. Phonological awareness provides the basis for phonics. Phonics, the understanding that sounds and print letters are connected, is the first step towards the act we call reading. When measuring a child’s phonological awareness look at his ability to apply several different skills. A child with strong phonological awareness should be able to recognize and use rhyme, break words into syllables, blend phonemes into syllables and words, identify the beginning and ending sounds in a syllable and see smaller words within larger words (ie. “cat” in “catalog”).
Phonological Development is the process of learning to speak and is most closely associated with children. The physiological systems, which take part in this process, are the auditory and the vocal systems. The auditory system includes the ears, ear canal and brain. The vocal system includes the vocal chords, the throat, the mouth, teeth and tongue. The jaw is included in the vocal system due to the necessary jaw movements needed to create sounds, which make words.
Language Disorders, or language impairments, are disorders that involve the processing of linguistic information. Problems that may be experienced can involve grammar (syntax and/or morphology), semantics (meaning), or other aspects of language. These problems may be receptive (involving impaired language comprehension), expressive (involving language production), or a combination of both. Examples include specific language impairment and aphasia, among others. Language disorders can affect both spoken and written language, and can also affect sign language; typically, all forms of language will be impaired. Note that these are distinct from speech disorders, which involve difficulty with the act of speech production, but not with language.
Language Processing Disorder and Treatment refers to the way we use words to communicate their ideas and feelings, as well as how these types of communications are processed and understood. Simply put, it is how the brain creates and understands language. A Language processing disorder (“LPD”) is categorized when a person has difficulty understanding and making sense of what is heard. Those who have LPD usually have normal hearing abilities, however, their brains just do not process or interpret what they “hear” (the information) properly. LPD sometimes occurs in those who have speech and language difficulties, learning disabilities, attention deficit disorder, as well as developmental disabilities. Some students with LPD may have a difficult time hearing the differences between sounds in words, even if those sounds are very clear and loud. These problems are more obvious when the child is in a noisy environment such as a classroom.
Stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts throughout life. The disorder is characterized by disruptions in the production of speech sounds, also called “disfluencies.” Most people produce brief disfluencies from time to time. For instance, some words are repeated and others are preceded by “um” or “uh.” Disfluencies are not necessarily a problem; however, they can impede communication when a person produces too many of them. For some people, communication difficulties only happen during specific activities, for example, talking on the telephone or talking before large groups. For most others, however, communication difficulties occur across a number of activities at home, school, or work. Some people may limit their participation in certain activities. Such “participation restrictions” often occur because the person is concerned about how others might react to disfluent speech. Other people may try to hide their disfluent speech from others by rearranging the words in their sentence (circumlocution), pretending to forget what they wanted to say, or declining to speak. Other people may find that they are excluded from participating in certain activities because of stuttering. Clearly, the impact of stuttering on daily life can be affected by how the person and others react to the disorder.
Information taken from ASHA website.
When a child has receptive language disorder, he or she exhibits significant deficits in the level of development of comprehension of language. These deficits affect how the child functions socially or academically. Children with receptive language problems can have great difficulty understanding what is said to them. Most children with a receptive language disorder will also have an expressive language disorder (difficulty using language to express ideas).Children with a receptive language disorder can have difficulty with any of the following:
- Understanding what gestures mean
- Following directions
- Understanding questions
- Identifying objects and pictures
- Taking turns when talking with others
- Understanding the order of words in a sentence
- Understanding plurals and verb tenses
- Understanding age-appropriate vocabulary and knowledge about objects and sequence of events
- Knowledge of the goals or functions of language (e.g. to obtain a desired object, tell a story, ask questions, comment)
- Knowledge of how to use language to achieve goals (e.g. appropriately using language to get a desired object, )
- Carrying out cooperative conversations (e.g. perspective-taking and turn-taking)
An individual with pragmatic problems may: say inappropriate or unrelated things during conversations, tell stories in a disorganized way or have very little variety in language use. It is not unusual for children to have pragmatic problems in only a few situations. However, if problems in social language use occur often and seem inappropriate considering the child’s age, a pragmatic disorder may exist. Pragmatic disorders often coexist with other language problems such as vocabulary development or grammar. Pragmatic problems can lower social acceptance. Peers may avoid having conversations with an individual with a pragmatic disorder.
Tongue thrust (also called “reverse” or “immature” swallow) is the common name given to orofacial muscular imbalance, a human behavioral pattern in which the tongue protrudes through the anterior incisors during swallowing, speech and while the tongue is at rest. Nearly all young children exhibit a swallowing pattern involving tongue protrusion, but by the age of 6 most have automatically switched to a normal swallowing pattern. To correct tongue thrust, speech pathologists prescribe exercises designed to promote a normal swallowing pattern, as well as correct speech production. In the evaluation session the patient will be given swallowing and articulation inventory tests.