Potential Causes

Potential causes of speech and language disorders include:

Speech motor control abnormalities, such as timing or sensory and motor coordination

Brain damage, resulting from: 

• • Genetics (inherited abnormalities)
  • Traumatic injury to the part of the brain affecting speech 
  • Disease or conditions, such as a stroke, dementia, Parkinson’s, brain tumors

Nervous system disorder, affecting muscles in mouth, jaw, lips, tongue or voice box

Nerve damage in voice box, affecting vocal folds 

Emotional trauma or stress

Signs or Symptoms

Children ages 2-5 often go through periods when they may stutter or exhibit other signs of a speech disorder. Mostly a part of learning to speak, this improves on its own. However, a child should have a comprehensive evaluation if speech problems:

• • Last more than six months
  • Co-occur with stuttering or other speech disorders
  • Occur with muscle tightening or visibly struggling to speak
  • Become more frequent or continue as the child grows older
  • Affect ability to effectively communicate at school, at work or in social interactions
  • Cause anxiety or emotional problems, such as fear or avoidance of situations where speaking is required
  • Begin as an adult

Some individuals with speech disorders are aware of their thoughts, but unable to articulate them. This and other frustrations and capacity limitations can lead to:

• • Problems with social skills and communicating with others
  • Being anxious about speaking
  • Not speaking or avoiding situations that require speaking
  • Loss of social, school or work participation and success
  • Being bullied or teased
  • Low self-esteem or depression

The broad category of speech and language disorders include these common speech disorders: 

Speech Sound Disorders 

Difficulties with perception, motor production or making speech sounds (phonemes) or speech sound sequences in language 

Fluency Disorders/Stuttering

(Also called stammering or childhood-onset fluency disorder) Interruptions or disfluencies in the flow of speech, such as an uncommon rate, rhythm or repetition of sounds, syllables, words or phrases 

Social Pragmatic Language Disorder

Difficulties with language skills used to communicate thoughts, ideas and feelings, leading to misinterpreting others’ communications and responding inappropriately, both verbally and non-verbally

Auditory Processing Disorder (APD)

APD affects one’s ability to understand speech (especially in noisy environments), follow directions or distinguish between similar sounds. With no known definite cause, APD may be linked to ear infections, premature birth or head trauma.

Other conditions are motor speech disorders, such as:  

Dysarthria: Muscles of the mouth, face or respiratory system becoming weak or having difficulty moving

Childhood apraxia of speech (CAS): Caused by damage to the parts of the brain related to speaking

Not covered here, but related are:

Hearing loss can also contribute to receptive and expressive language delays, speech and language impairments.

Voice disorders: Abnormal production or absence of vocal quality, pitch, volume, resonance or duration—inappropriate for the person’s age and sex 

Early diagnosis and intervention are key to achieving positive outcomes in speech therapy. If the condition is not identified and managed early, a child is at risk for listening and learning problems at home and school. 

Risks associated with stuttering include:

• • Males, much more likely than females to stutter
  • Children with developmental delays or other speech problems 
  • Stuttering in other family members
  • Stress in the family, high parental expectations or other types of pressure, worsening existing stuttering

Risks for other speech disorders, including stuttering:

• • Aging
  • Allergies
  • Smoking or alcohol use
  • Voice misuse, overuse or screaming
  • Throat dehydration or improper throat clearing over time
  • Neurological disorders
  • Psychological stress
  • Physical illness, such as colds or upper respiratory infections, gastroesophageal reflux disease (GERD), throat cancer or thyroid problems
  • Scarring from neck surgery or from trauma to the front of the neck

A multidisciplinary team of medical doctor, audiologist and speech-language pathologist (SLP) can conduct thorough examinations to assess voice, language, motor, swallowing and hearing problems. A medical exam and hearing test may rule out other medical or hearing problems. 

Other individuals in the child’s life can help get a clearer picture of the disorder. A teacher can indicate academic difficulties, a psychologist can evaluate cognitive functioning and parent can fill in the medical history. They can indicate when the disorder first appeared, how it affects relationships with friends or schoolwork, and what treatments were tried in the past. 

The evaluation may also include observing the individual speaking or reading aloud in different settings or request recorded samples of a child’s speech during play, telling stories or playing games—or ask a child to label pictures or items in their environment. This helps differentiate what is developmentally appropriate from a possible long-term condition.

For receptive and expressive language disorders

Receptive language includes understanding words and expressive language means understanding how to use words.

• • For a child ages 2-5, SLPs complete a play-based expressive and receptive language evaluation. 
  • For older children, SLPs complete a more structured assessment of the young person’s ability to follow verbal instructions and to read and understand sentences and paragraphs during engaging activities. 

For Auditory Processing Disorder (APD)

Children with APD may exhibit a variety of listening and related complaints, such as difficulty understanding speech in noisy environments, following directions and discriminating among similar-sounding speech sounds. In school, children with APD may have difficulty with spelling, reading and understanding verbal instructions.

Diagnosis must be made by an audiologist, who administers tests in a sound-treated room. Most tests require a child to be at least age 7 or 8. 

For Childhood Apraxia of Speech (CAS) 

It is  important to identify specific symptoms of apraxia—a relatively rare speech disorder—because it is treated differently. Depend on the child’s age, ability to cooperate and severity of the speech problem, an audiologist and SLP can conduct hearing tests and other exams including:

Oral-motor Assessment to observe for structural, facial or mouth problems, as in how your child moves lips, tongue and jaw 

Speech Evaluation to observe the child for:

• • How sounds, words and sentences are used during various activities
  • Difficulty and accuracy in speaking words or syllables
  • Coordination and smoothness of movement in speech
  • Melody and rhythm of speech

With treatment by a licensed speech-language pathologist (SLP), many children and adults can improve their speech or adapt to alternative communication methods. They help individuals:

• • Learn the correct way to make a sound, including when and how to move their mouth and tongue
  • Practice exercises to improve speech, including saying certain sounds
  • Learn to tell when a sound is correct or wrong
  • Practice using sounds in longer sentences. 

Depending on the type of speech disorder, other medical or mental healthcare might be necessary. 

Children can benefit from both individual and group therapy:

Individual therapy allows for more time to practice speech during each session. 

Group therapy allows for peer engagement and learning. 

Treating Receptive and Expressive Language Disorders

Treatment includes developing the child’s receptive vocabulary (understanding words) or expressive language (understanding how to use words). Treatment helps a child expand vocabulary and sentence complexity to clearly express wants, needs and ideas. 

Essential to therapy is educating parents about the disorder and how to reinforce language strategies daily, including use of alternative communication forms (picture systems or computer devices). This may include involving teachers and others to work with the child to identify an augmentative and alternative means of communication (AAC), including gestures, picture boards or computer devices to facilitate communication.

Treating speech sound disorders

Speech sound disorders include articulation disorders, phonological disorders and dysarthria—with some characteristics that can get confused with childhood apraxia of speech (CAS). A child who has trouble learning how to make specific sounds, but doesn’t have trouble planning or coordinating the movements to speak, may have the more common articulation or phonological disorder. 

Articulation approaches target and correct sound deviations when the child’s errors are assumed to be motor based.

Phonological/language-based approaches target a group of sounds with similar error patterns. Treatment helps the child internalize and generalize phonological rules to other sounds within the pattern.

Both treatment approaches typically involve the following steps:

Establishment—stabilizing target sounds

Generalization—facilitating carry-over of target sounds at increasingly challenging levels (syllables, words, phrases/sentences, conversational speaking)

Maintenance—stabilizing and making target sounds more automatic, while encouraging self-monitoring of speech and self-correction of errors

Treating Stuttering

After being evaluated, a SPL can help determine the best method—or combination of methods—to treat children and adults. Treatment may not eliminate all stuttering, but it can teach skills that:

• • Improve speech fluency
  • Help develop effective communication
  • Help support full participation in school, work and social activities

Examples of effective treatment approaches:

Speech therapy can teach individuals to notice when they stutter. While speech may be slow and deliberate at first, over time, speakers can assume a more natural speech pattern.

Electronic devices are available to enhance fluency. Delayed auditory feedback requires an individual to slow speech, or it sounds distorted through the machine. Another method mimics speech so it sounds as if speaking is in unison with another person. Some devices are worn during the day.

Cognitive Behavioral Therapy (CBT) can help individuals learn to identify and change ways of thinking that might make stuttering worse. It can also help resolve stress, anxiety or self-esteem problems related to stuttering.

Parent-child interaction. Parental involvement in practicing techniques at home is a key part of helping a child cope with stuttering.

Treating Auditory Processing Disorder (APD) 

There’s no known cure for APD, but different strategies help with listening and developing the auditory pathway over time, especially when started young. Some children seem to grow out of APD, while others retain some degree of deficit into adulthood. As they grow older, children with APD can learn to take responsibility for their own listening success or failure and participate in active listening and problem-solving techniques.

Treatment plans address areas of difficulty and improve access to auditorily presented information by focusing on three primary areas: 

Changing the Learning or Communication Environment:

Physical accommodations to improve the listening and speaking environment by reducing background noise, sound and sight distractions or poor classroom acoustics

Use of assistive electronic listening devices, such as a remote microphone system that emphasizes a speaker’s voice over background noise (some schools offer these programs)

Providing suggestions to teachers to improve delivery of information, such as slowing down speech, speaking clearly and deliberately or seating the child where they can see and hear them better

Recruiting higher-order skills that strengthen listeners’ central resources (language, problem-solving, memory, attention, other cognitive skills). Includes different types of therapy to help manage non-listening symptoms, such as:

• • • Speech-language therapy for language deficits
    • Mental health counseling to help with depression or anxiety
    • Art or music therapy to build self-esteem
    • Occupational therapy to help with sensory issues or auditory timing

Remediation of auditory deficit through treatment activities, including computer-assisted programs, one-on-one therapy with an SLP and CBT therapist and home-based programs.  

Treating Childhood Apraxia of Speech (CAS) 

Children with CAS have difficulty planning movements for speech and need significant time and practice to say words and phrases during therapy and at home. No single speech therapy approach is more effective than others, but general principles for treating CAS include:

Speech drills. The child repeats words or phrases many times during a therapy session.

Sound and movement exercises. The child listens carefully to the SLPs spoken cues and watches them form the target word or phrase with their mouth. SLPs may touch the child’s face when makings certain sounds or syllables, as in the SLP using her hands to help the child round his lips to say “oo.”

Speaking practice of syllables, words or phrases, rather than isolated sounds, during speech therapy. Children practice making the movements from one sound to another.

Vowel practice in different types of syllables. For example, saying “hi,” “mine” and “bite” or “out,” “down” and “house”

Paced learning for severe CAS, practicing with a small set of words at first and gradually increasing the number of practice words as the child improves.

Speech disorders do not have to hinder successful communication, education and careers. People of all ages can learn to use ways of communicating besides talking—what’s called augmentative and alternative communication (AAC)—if they have trouble with speech or language skills. Others may use AAC only for a short time, such as when they can’t talk after surgery. Some people use AAC throughout their life. 

It is important to use alternative communication methods early, to help a child become less frustrated when trying to communicate. Use of an AAC device acts less as a substitute for verbal language than as a compensatory strategy. It may also help a child develop language skills such as vocabulary and the ability to put words together in sentences.

Augmentative means to add to someone’s speech

Alternative means to be used instead of speech. Alternative methods can include sign language or natural gestures, such as pointing or pretending to eat or drink

An AAC system includes a range of tools and devices to help in communication. As speech improves, these strategies and devices may no longer be necessary.

No- and low-tech AAC options include:

• • Gestures and facial expressions
  • Writing or drawing
  • Spelling words by pointing to letters
  • Pointing to photos, pictures or written words

High-tech options include:

• • Using an app on an iPad or tablet to communicate 
  • Using a computer with a “voice,” sometimes called a speech-generating device

Therapies for Coexisting Problems

• • In conjunction with speech therapy, cognitive-behavioral therapy (CBT) can help alleviate anxiety, depression, low self-esteem and other problems caused by speech disorders. 
  • Many children with speech and language disorders may have other development delays and need therapy to address their difficulties.
  • Children with fine and gross motor movement difficulties may need physical or occupational therapy.
  • If a child has another medical condition, then effective treatment for that condition may be important to improving the child’s speech.

Other recommended treatments depending on diagnosis

• • Rest, liquids and voice therapy. Vocal cords need regular rest and fluids. In voice therapy, SLPs can teach how to use the voice more efficiently, how to properly clear the throat and how much liquid to drink.
  • Allergy treatments, if an allergy is creating too much throat mucus 
  • Smoking cessation can help improve the voice

Medications

Several medications are available for treating voice disorders. Depending on the cause, medication can reduce inflammation, treat gastroesophageal reflux or prevent blood vessel regrowth. Medications can be taken orally, injected into the vocal cords or applied topically during surgery.

LIFESTYLE AND HOME REMEDIES

Parents and other caregivers can encourage and support their children to practice speech and language skills learned in speech therapy at home—and aid them in making progress.

For younger children, parents can help by:

• • Practice words and phrases in brief sessions (5 minutes, twice a day) 
  • Parents can create situations for their child to say words or phrases spontaneously. For example, the child can practice saying, “hi, mom,” each time the mother enters a room, making it easier for the child to say the practice phrase automatically.
  • Receptive language activities can include playing games like Simon Says or Red Light/Green Light, with modified rules, if necessary. 
  • Read aloud to promote a child’s expressive language skills. 
  • Read picture books together, labeling items in the story or asking the child to describe the pictures. 
  • Depending on skill level, children can retell the story, label pictures, predict what will happen next or create their own title for the story.

With older children, parents can: 

• • Read short stories, asking questions about the story’s purpose
  • Provide complex directions for a task, such as taking steps for completing and handing in homework. 
  • Help increase vocabulary and expressive language skills
  • Allow their child enough time to talk without interruptions, take the lead and talk about what they observe or do what interests them. 

Refrain from correcting something incorrect (“I goed to the beach”) and instead rephrase to offer a good example (“Yes, you went to the beach”).

COPING AND SUPPORT

It helps children, parents and adults who stutter to connect with others who stutter or who have children who stutter for encouragement, advice and coping tips.

There are also support groups available for parents of children with childhood apraxia of speech (CAS). 

Tips for parents of children with a speech disorder:

Listen attentively and maintain natural eye contact when the child speaks

Wait for the child to say a word or complete a sentence or thought

Set aside time to talk to the child without distraction, such as mealtimes

Speak slowly, in an unhurried way, to model this way of speaking

Encourage others in the family to be a good listener and to take turns talking

Additional tips include:

• Help create a relaxed, calm atmosphere at home to help the child feel comfortable speaking freely
• Try not to draw attention to the stuttering or speech impairments during daily interactions. Protect the child from pressured situations that create a sense of urgency, a need to rush or a need to speak in front of others
• Offer praise to the child for speaking clearly, rather than criticizing or drawing attention to a speech impairment. Correct speech in a gentle, positive way.
• Accept the child and avoid adding to feelings of insecurity and self-consciousness.

CONNECT TO CARE

References

American Speech-Language-Hearing Association (ASHA)

Emerson College on what speech pathologists do

Connected Speech Pathology

Healthline

Kids Health

Mayo Clinic

National Institute of Deafness and Other Communication Disorders (NIDCD)

National Stuttering Association

Sensational Kids 

The Stuttering Foundation

The 5 Rule Systems of Language by Heather Goff