What is a Functional Speech-Language Disoder?

Functional speech-language disorders often have no known cause and don’t always indicate abnormalities with your child’s hearing, muscles, or perception. These disorders usually show up in childhood and can consist of abnormalities in muscle usage or linguistic aspects, affecting the rhythm, pitch, and intonation of speech. People who are affected by functional speech disorders may speak with an unusual quality, making sounds that are hoarse, raspy, breathy, strained, or weak. 

Functional speech-language disorders can lead to social anxiety and avoidance behaviors as well as contribute to low self esteem due to social stigmatization and occupational discrimination.

Our Speech-Language Pathologists can assess your child to determine whether they are experiencing an articulation disorder, another type of speech-language issue, or sensory issues like hearing impairment. Early treatment can help your child overcome any speech difficulties and learn to speak comfortably and effectively.

Articulation

With articulation disorder, children may have trouble coordinating their flow of speech and struggle with the placement of their tongue, lips, palate, teeth, and jaw. This usually shows up in four ways:

Substitution: Consistently using one sound in place of another. For example, they may use the w sound instead of r, use an s or f sound instead of th, or use a t instead of ck.

Omission: Completely leaving out certain sounds or shortening words. Examples include saying ool instead of pool or school, saying cu instead of cup, or saying at for hat.

Distortion: Using an atypical sound in place of certain speech sounds. This would look like a nasally produced p that sounds more like an m or an s that sounds fuzzy. Lisps are a common form of distortion.

Addition: Adding syllables or sounds to words. Examples include saying puhlay instead of play, or saying dogah instead of dog.

SLPs can help your child re-learn how to make certain speech sounds, control muscles involved in speech production, recognize which sounds need adjustment, and practice sound formation in different words.

Articulation milestones:*

• By age 3, a child should be able to pronounce all vowels and the p, b, m, h, and w sounds.
• At age 4, the sounds d, t, k, g, f, n, ng, and y should appear.
• At about 6, you should see proper use of the sounds s, z, l, v, and sh.
• By age 7, children have mastered j, ch, and th sounds
• And by age 8, use of r and zh is acquired.

*These speech markers are based on English speaking children with no regional accents. The use of multiple languages and influence of regional dialects may alter the formation of certain speech sounds. In those cases, there is no need for concern or therapy.

Phonology

While articulation disorders affect the pronunciation of one sound and tend to be motor based, phonological disorders refer to the misapplying of patterns of sounds and an incomplete understanding of the rules around the meaning of sounds. It’s normal for young children to use these phonological short cuts when learning adult speech but, if your child continues to mispronounce words longer than their peers, it can indicate a phonological issue. Phonology disorders can show up in a variety of ways.

Fronting: Replacing sounds made with the back of the tongue for those made with the front of the tongue. For example, saying tar instead of car or date instead of gate. The process of fronting usually
disappears before age 4.

Stopping: When a child is unable to produce hissing or sounds that create a stream of air such as the s, sh, ch, th, j, z, or f they may use a stop consonant in it’s place. Stop consonants are p, b, t, d, k, and g. Stopping results in children saying pun instead of sun or saying top instead of shop. This process is usually eliminated between the ages of 3 and 5.

Final Consonant Deletion: Completely dropping the last syllable of multi-syllabic words or the last consonant of one syllable words. This may look like a child saying wa for water, or bie instead of bike. Final consonant deletion usually disappears by age 3.

Cluster Reduction: Leaving out one consonant in words that contain 2 or more consonants together. Your child may drop the s in spill resulting in pill, or the r in tree to produce tee. This process is usually gone by age 4.

With phonological disorder, children may be able to produce individual sounds correctly but struggle when trying to put sounds together. Your child may be able to make the C sound on its own but, when your child tries to say a word that starts with C, they may use a T sound instead.

SLPs can improve your child’s intelligibility by helping them recognize the sounds that need adjustment, understand the differences in meaning between similar sounds, teaching your child how to make certain speech sounds, and practicing proper formation of words.

Fluency

Fluency disorders affect the flow and cadence of speech. People experiencing fluency issues may take frequent pauses while talking, repeat sounds, stretch sounds out, or have an unusual rhythm of speech. While everyone experiences trouble with fluency at times, people with the disorder are affected on a regular basis which causes a disruption in their life. The two most common types are:

Stuttering: Categorized by frequent repetitions of sounds and syllables or the stretching out of consonants. 

Cluttering: Categorized by rapid rate of speech, shoving together of words, skipping over syllables, and/or omission of word endings.

Fluency disorders can co-occur in people who also experience auditory processing disorder, ADHD, Tourette syndrome, are on the autism spectrum, or have learning disabilities.

Treatment for fluency disorders by SLPs can result in increased effectiveness of communication, increased self-confidence, and improved social engagement.

What is a Cognitive Language Disorder?

Sometimes speech-language issues have a physical or motor origin, but other times, they’re caused by a disconnect in the brain. People who experience cognitive related language issues may have difficulty following conversation, remembering information, following directions, and/or putting their thoughts into words. This can affect their ability to manage daily tasks. Cognitive Language Disorders can show up in childhood as a developmental delay, or later in life due to neurological disease or trauma.

Aphasia

Aphasia is a condition that affects your ability to communicate thoughts and understand language. Adults who experience brain injuries due to stroke, Alzheimer’s disease, tumors, or physical trauma may have difficulties with the language parts of their brains. People who experience aphasia may struggle to recall words they want to say, mix words up, use the wrong word, and struggle recognizing an object by its name. By improving language skills and/or finding alternative ways to communicate, our Speech-Language Pathologists (or SLPs) can help people experiencing aphasia participate more fully in life.  

Developmental Language Disorder

Developmental Language Disorder is usually noticed when a child is a late talker and having trouble keeping up with their peers in language development. Usually the cause is unknown and is not related to intelligence or speech ability, but can exist alongside other conditions such as autism and Down’s syndrome. Language Disorders affect a person’s ability to express themselves and/or understand things that are spoken to them. This can interfere with learning by affecting their speaking, writing, reading, and listening abilities.

With an expressive language disorder, there is no problem with pronunciation or speech capabilities. Rather, people struggle to organize their thoughts into words. Children experiencing it may use words incorrectly, use limited vocabulary compared to their peers, struggle to form sentences, and have trouble reading and writing.

Receptive language disorders have to do with understanding what others say. Children who experience this disorder have trouble processing the meaning of spoken and written language. They may not understand what people are saying to them and struggle to follow directions or connect with others.

Some children may show signs of only one of these disorders, while others experience both. Developmental Language Disorders can be frustrating for the child experiencing them and they may act out or avoid interactions altogether. Our Speech-Language Pathologists can diagnose these disorders and help children fill in the gaps of grammar and word usage while developing social communication skills.

If you are concerned your child is behind their peers in speech and language abilities, check the American Speech-Language-Hearing Association’s chart of speech milestones by age to determine if you should talk to your doctor:

https://www.asha.org/public/speech/development/chart/

What are Motor Speech Disorders?

It takes the coordinated effort of about 100 muscles in your lips, tongue, throat, chest, and neck to produce speech. Many of the same muscles are responsible for swallowing food and drink. If these muscles are weak or not communicating with the brain properly, people may experience difficulty making speech sounds or struggle to eat and drink.

Impairments to these muscles can be caused by developmental disabilities or by damage and illnesses that affect the nervous system such as stroke, Parkinson’s disease, multiple sclerosis, ALS, cerebral palsy, or Alzheimer’s. The effect these disorders have on the muscles involved with speech can be mitigated by Speech-Language Pathologists.

Apraxia

Apraxia is a condition that can affect both children and adults. Apraxia happens when the brain and muscles don’t communicate properly. Though there is no muscle weakness, people experiencing apraxia struggle with moving their muscles to produce speech. With apraxia, people may not always say words the same way every time, may change or distort sounds, struggle with longer words, or have difficulty with fine motor skills. Our SLPs can help improve coordination of muscles to produce desired sounds using visual, listening, and touch cues.

Dysarthria

Dysarthria is a speech disorder characterized by muscle weakness. The tongue, larynx, and surrounding muscles can become paralyzed or weakened by damage to or disorders of the brain and nervous system.  People who experience dysarthria can struggle to form and pronounce words. Someone with dysarthria may have slurred speech, talk either too fast or too slow, or have trouble moving their tongue, lips, and jaw. The quality of their voice may sound robotic, hoarse, breathy, or nasally.

Our SLPs test speech and language abilities through a series of movement and language tasks. The SLP will watch how the muscles in your mouth, lips, and tongue move when speaking as well as check your breathing ability. They can teach techniques to speak more clearly, improve articulation, strengthen muscles, and provide supplemental ways of communicating. They will also determine if any additional support is needed with understanding language.

Dysphagia

Dysphagia refers to difficulty swallowing food or drink. Problems can arise with sucking, chewing, and moving food or liquid into the throat. People who experience dysphasia may feel the urge to cough while swallowing, feel as if food is sticking in their neck/chest, or have pain when swallowing. People with dysphasia may also experience recurring reflux, frequent lung infections from food entering the airway, or poor nutrition due to avoidance of food.

Our SLPs can give exercises to strengthen the muscles used for swallowing as well as teach posturing techniques to minimize unpleasant sensations and keep food moving along. They will also help identify problem foods and give tips on changing the consistency of foods that aggravate swallowing difficulties.

What is a Resonance Disorder?

The vocal tract consists of our nasal cavity, oral cavity, throat, and vocal cords. This is the area where speech sounds are made. When we talk about resonance we’re referring to the tone and quality of sound vibrations produced from our vocal folds as they pass through our vocal tract. In other words, vibrations resonate through our oral and nasal cavities to produce the vowel and consonant sounds we’re familiar with.

During normal resonance, the soft palate and the walls of the throat come together to form a seal that separates the oral and nasal cavities. This mechanism, dubbed the velopharyngeal valve, directs airflow to the oral cavity during speech. When this valve has structural irregularities or otherwise doesn’t function as a tight seal, it can cause a resonance disorder. A cleft palate is a common structural cause of this disorder.

Our Speech-Language Pathologists can help identify what may be causing a resonance issue and work with you to mitigate the impact of this disorder by building effective communication skills.

Hypernasality

A condition called hypernasality happens when excessive sound comes from the nose. Someone experiencing hypernasality may sound high-pitched or like they’re speaking through their nose. As air escapes through the nose, pressure cannot build up in the mouth and the pronunciation of consonants can become weak. A child may replace consonants with abnormal speech sounds such as using the sound uh in place of g.

Hyponasality

A condition known as hyponasality occurs when there is not enough sound coming through the nose. This can be due to a blockage in the nasal cavity or throat. Common causes include enlarged tonsils, enlarged adenoids, or obstruction in the nose. Someone experiencing hyponasality may sound “stopped up” or congested. A child may mispronounce nasal consonants making m sound like b or the letter n sound like d.