Pediatric Speech Language Disorders – Details from Diagnosis to Prognosis

Has your child been diagnosed with a speech language disorder or do you suspect that your child may have a speech or language problem? If so, you may find our detailed speech language disorders section helpful. We outline the causes, signs / symptoms, diagnosis, treatment and prognosis for pediatric speech and language disorders.

Some of these disorders are complex and many disorders are confused for others, so if you need further explanation, you can talk to a speech language pathologist at 484-367-7131.

Let me try to explain this as simply as possible. An Articulation Disorder is a problem with the production of speech sounds due to incorrect placement, timing, pressure, speed and/or coordination of articulators. That is a fancy word for lips, tongue, teeth, jaw and velum. This issue can lead to additions, deletions, distortions, or substitutions of sounds. Children who have articulation disorders may be difficult to understand. It is important to note that there is a developmental hierarchy to speech development. A sound substitution at 2 years old may be developmentally appropriate but the same error at 4-5 years old would need remediation.

Click here for details on the Causes, Diagnosis, Signs / Symptoms, Treatment and Prognosis for Articulation Disorder.

Before I explain phonological disorders, we need to clear up the confusion between phonological disorders and articulation disorders. Both of these conditions are speech disorders that result in speech sound errors. However, an articulation disorder occurs at the phonetic level (the individual speech sounds that are specific to a language), while a phonological disorder is based on errors at the cognitive or linguistic level (the pattern of sounds in a language).

A child with an articulation disorder knows where each sound is supposed to be placed in a word, but he or she has trouble making the sounds correctly with the articulators (lips, tongue, teeth, jaw, and velum). On the other hand, a child with a phonological disorder can produce the sounds correctly, but the sounds are used in the wrong places in words (fire becomes pire) or omitted completely (book becomes boo-). Both disorders adversely affect speech intelligibility (how well the listener understands the child), and a child can have both disorders at the same time.

There are a variety of patterns of errors, called phonological processes, such as fronting, backing, stopping, and gliding (see below for more details). Some of these processes are normal at young ages but should be outgrown by a certain age, while other processes are only heard in the speech of a child with a phonological disorder.

It is important to note that young children who are learning to talk make many speech mistakes. This is not necessarily a cause for concern. You should have your child evaluated by a speech-language pathologist (SLP) only if your child does not produce any sounds or seems to make more errors than his or her same-aged peers. If you are concerned, talk to your pediatrician or consult an SLP.

Click here for details on the Causes, Diagnosis, Signs / Symptoms, Treatment and Prognosis for Phonological Disorder.

Stuttering is a fluency disorder. Stuttering is sometimes referred to as stammering or disfluent speech. In short, stuttering is any interruption in the flow of speech. It’s quite common for children between ages 2 and 5. In fact, about 5% of children will develop stuttering during their childhood. It’s part of the process of learning how to speak. For most children, stuttering issues get better on their own, however for some kids, less than 1%, stuttering will continue and perhaps get worse after age five. Stuttering is twice as common in boys than girls and 3 to 4 times more likely to persist into adulthood for boys. Stuttering should be treated because it can affect a child’s academics and social interactions. It often causes emotional problems such as anxiety, fear or avoidance which can limit the potential of a child.

Click here for details on the Causes, Diagnosis, Signs / Symptoms, Treatment and Prognosis for stuttering Disorder.

Like stuttering, cluttering is a fluency disorder, though cluttering is much less common. Cluttering is often confused for stuttering, but the disorders are not the same. (See “Stuttering” for more information). To clarify the difference between the two disorders, a person who stutters typically knows what he or she wants to say, but cannot seem to form the words correctly and smoothly with the articulators. On the other hand, a person who clutters cannot efficiently organize the words in his or her mind to produce fluent speech. Thus, stuttering is considered to be a speech disorder (errors in the mechanical process of making sounds), while cluttering is considered to be a language disorder (errors in producing the thoughts that the speaker wants to share). Both disorders are treated by a speech-language pathologist (SLP).

Cluttering is characterized by a rapid or irregular speaking rate or excessive disfluencies (breaks) in the flow of speech that make the speaker difficult to understand. Erratic rhythm, poor grammar, and the use of unrelated words in a sentence are other symptoms. Essentially, the cluttered speaker has a difficult time expressing the thoughts that are produced as speech due to speech and language errors. The stutterer has a difficult time speaking based on speech errors alone.

Normally-fluent speakers can also exhibit cluttered speech when they become nervous. Have you ever wished you had stated something more clearly or by using a different set of words, perhaps when you had to speak in front of a large audience? Your nerves may have taken over and affected how clearly and concisely you spoke. If this has happened to you, you have experienced how cluttered speech sounds. However, there is not necessarily a “nervous” component to cluttering. Instead, the cluttered speaker cannot produce smooth language in speech regardless of his or her mood or emotions. To complicate things further, cluttering can also occur with stuttering, and writing can also be affected by cluttering.

Cluttering should be treated to limit the effects it has on a child’s academics and social interactions. Cluttering can also cause emotional problems such as anxiety, fear, or avoidance, which may negatively affect the child’s potential.

Click here for details on the Causes, Diagnosis, Signs / Symptoms, Treatment and Prognosis for cluttering Disorder.

Childhood apraxia of speech (CAS) is an oral motor speech disorder. Children with CAS find it difficult to produce the sounds that they want to make because they cannot correctly plan the movement of the muscles that control the articulators (lips, tongue, teeth, jaw, velum, pharynx). In other words, the brain of a child with CAS does not send the proper instructions to the muscles that adjust both the positioning of the jaw, lips and tongue and the speed and rhythm of speech. If the signals sent by the brain are not transmitted correctly or are disrupted, proper speech is difficult to achieve.

For example, a child with CAS might be incapable of articulating consonants. You may think of consonants as B, C, D, F, etc. In speech, consonants are sounds created by the articulators by either stopping the outgoing breath or by creating a narrow opening to create resistance against the energy of the air stream. Try it out. Say each of these consonants slowly (B, H, K, T) and notice how your tongue and mouth move for each letter compared to when you say (A, E, I, O, U). Vowel sounds require a lot less movement. Now imagine only being able to say “sentences” with vowel sounds only. It would be incomprehensible. It should be noted that many children with apraxia also have difficulty with vowels.

It is important to note that Children with CAS may have normal receptive language skills (understanding), despite their troubles with expressive language skills (talking).

Click here for details on the Causes, Diagnosis, Signs / Symptoms, Treatment and Prognosis for Childhood Apraxia of Speech.

The two basic parts of language are expressive and receptive skills. Expressive language includes the words in our vocabulary and how we put those words together to communicate by talking, writing, and gesturing. The speech-language pathologist (SLP) will examine various parts of the child’s expressive language skills, including the form, content, and use of language. As with most speech and language disorders, some expressive language errors are considered normal in younger but not older children. For example, it would be typical for a 3-year-old child to explain, “I runned.” This is a form error called overgeneralization, because the child has applied the add -ed for past tense rule to the verb run. However, an older child should know that the past tense form of run is ran, so an SLP would be concerned if a 6-year-old made the same error.

Your young child might not meet the first expressive language milestones of speaking his first word by 12 months, two-word sentences by 2 years, or three-word sentences by 3 years. An older child might struggle with adding new vocabulary words to his book report. These problems in learning and using new words describe errors in the content of the child’s language. Finally, the way we use language varies widely within and across cultures. Making eye contact while speaking is a common courtesy in the U.S. but may be considered rude in Japan. Children usually pick up on the subtle rules of our language, called pragmatics, but some children need coaching in how to use language rules while interacting with other people.

As you can see, if your child has been diagnosed with an expressive language disorder, it will be helpful for you to learn which of the many areas of language are impaired.

Click here for details on the Causes, Diagnosis, Signs / Symptoms, Treatment and Prognosis for Expressive Language Disorder.

The two basic parts of language are expressive and receptive skills. Receptive language refers to the words and language concepts that we understand, such as the meaning of the smile (a noun) versus smiling (an action). Receptive language forms the foundation of language from which expressive language develops; that is, your child must first understand the meanings of words, phrases, and sentences in order to use them in spoken language. When the underlying receptive language skills are impaired, your child will show signs like not following simple directions (“Show me the apple.”) nor answering age-appropriate questions (“How old are you?”).

Language concepts, such as comparatives and superlatives (big, bigger, biggest), may be difficult for the child to learn. Although not as common, it is possible for a child to have greater expressive than receptive skills; in this case, the child’s language may sound age-appropriate when speaking, but upon deeper testing of his or her specific skills, the breakdown in understanding becomes apparent, such as not knowing specific prepositions (above, below, next to, inside) or not following multi-step directions (Put the ball in the cup then close the lid on the box). The speech-language pathologist (SLP) will examine your child’s language in parts in order to tease apart the specific areas of strengths and needs. Note that it is uncommon for a child to have a receptive-only disorder with normal expressive language skills; if this appears to be the case, it’s more likely that the child has learned to “get by” with the minimum amount of talking needed to blend in with peers. So, when receptive language is impaired, the child will likely receive a diagnosis of mixed receptive-expressive language disorder.

As you can see, if your child has been diagnosed with an expressive language disorder, it will be helpful for you to learn which of the many areas of language are impaired.

Click here for details on the Causes, Diagnosis, Signs / Symptoms, Treatment and Prognosis for Receptive Language Disorder.

When a child exhibits any of the following behaviors:  unintelligible speech due to weakness or difficulty with sequencing motor movements, excessive drooling, poor seal around the nipple, cup or spoon, loss of liquid when drinking, choking, gagging or coughing during feeding, inability to suck, excessive oral defensiveness, difficulty with transiting between simple to more advanced food textures, transitioning from tube feeding to oral feeding a speech-language pathologist may be consulted for a feeding/oral motor assessment.

Treatment Plan

The SLP evaluates the child’s ability to imitate and perform a variety of oral motor movements as well as observe the child’s ability to drink and eat a variety of food textures and liquids. The Speech Language Pathologist uses a variety of oral motor tools (bubbles, whistles, tongue depressors etc.) and feeding utensils (specific nipples, cut out cups, cups with straws etc.) based on the needs of the child.  Children benefit from visual feedback (such as mirrors and a model) and tactile cues.  The child will benefit from an oral motor regimen that the therapist develops based on the individual needs of the child.

Voice Disorders are characterized by the abnormal production and/or absence of vocal quality, pitch, loudness, resonance, and/or duration.  Early identification of pediatric voice disorders is advisable because these disorders may progress to lifelong communicative impairments if left untreated.  Vocal disturbances in children are surprisingly common. A child who presents with hoarseness should receive a thorough assessment from an ENT.  An ENT often refers children with voice disorders for speech therapy.

Treatment Plan

Voice therapy will target teaching healthy voice habits, educating the child about the vocal mechanism and practice techniques to learn how to use their voice effectively.

Central Auditory Processing disorder (CAPD) refers to how the central nervous system uses auditory information.  Children with this disorder often have difficulty attending, discriminating, and recognizing auditory information even though peripheral hearing is intact.  Their performance in school depends who how the information is relied (visual vs. auditory).  They often ask for repetition or clarification.  To diagnose APD, an audiologist administers a series of tests in a sound-treated room.

Treatment Plan

A Speech Language Pathologist provides direct treatment to address specific auditory deficits each treatment approach is highly individualized.

Pragmatic Disorders affect the use of language in social situations.  Children with difficulty in this area of communication often have difficulty establishing and/or maintaining eye contact, understanding personal space, using language for different purposes (greeting, informing, demanding, promising, requesting), adapting language depending on the needs of the listener, initiating/maintaining conversations, staying on conversational topic and interpreting non verbal cues such as facial expressions.  Children with pragmatic disorders often have difficulty with vocabulary development and syntax as well.

Treatment Plan

Children with pragmatic disorders benefit from joining social groups moderated by a SLP to work on improving social skills specifically maintaining appropriate personal space, establishing and maintaining eye contact, initiating and maintaining conversation, using language for a variety of purposes and listening to others.