1. STUTTERING
What is stuttering?
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.
In most cases, stuttering has an impact on at least some daily activities. The specific activities that a person finds challenging to perform vary across individuals. 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.
What are signs and symptoms of stuttering?
Stuttered speech often includes repetitions of words or parts of words, as well as prolongationsof speech sounds. These disfluencies occur more often in persons who stutter than they do in the general population. Some people who stutter appear very tense or "out of breath" when talking. Speech may become completely stopped or blocked . Blocked is when the mouth is positioned to say a sound, sometimes for several seconds, with little or no sound forthcoming. After some effort, the person may complete the word. Interjections such as "um" or "like" can occur, as well, particularly when they contain repeated ("u- um- um") or prolonged ("uuuum") speech sounds or when they are used intentionally to delay the initiation of a word the speaker expects to "get stuck on."
Some examples of stuttering include:
" W- W- W- Where are you going?" (Part-word repetition: The person is having difficulty moving from the "w" in "where" to the remaining sounds in the word. On the fourth attempt, he successfully completes the word.)" SSSS ave me a seat." (Sound prolongation: The person is having difficulty moving from the "s" in "save" to the remaining sounds in the word. He continues to say the "s" sound until he is able to complete the word.)
"I'll meet you - um um you know like - around six o'clock." (A series of interjections: The person expects to have difficulty smoothly joining the word "you" with the word "around." In response to the anticipated difficulty, he produces several interjections until he is able to say the word "around" smoothly.)
How is stuttering diagnosed?
Identifying stuttering in an individual's speech would seem like an easy task. Disfluencies often "stand out" and disrupt a person's communication. Listeners can usually detect when a person is stuttering. At the same time, however, stuttering can affect more than just a person's observable speech. Some characteristics of stuttered speech are not as easy for listeners to detect. As a result, diagnosing stuttering requires the skills of a certified speech-language pathologist (SLP).
During an evaluation, an SLP will note the number and types of speech disfluencies a person produces in various situations. The SLP will also assess the ways in which the person reacts to and copes with disfluencies. The SLP may also gather information about factors such as teasing that may make the problem worse. A variety of other assessments (e.g., speech rate, language skills) may be completed as well, depending upon the person's age and history. Information about the person is then analyzed to determine whether a fluency disorder exists. If so, the extent to which it affects the ability to perform and participate in daily activities is determined.
For young children, it is important to predict whether the stuttering is likely to continue. An evaluation consists of a series of tests, observations, and interviews designed to estimate the child's risk for continuing to stutter. Although there is some disagreement among SLPs about which risk factors are most important to consider, factors that are noted by many specialists include the following:
a family history of stutteringFor young children, it is important to predict whether the stuttering is likely to continue. An evaluation consists of a series of tests, observations, and interviews designed to estimate the child's risk for continuing to stutter. Although there is some disagreement among SLPs about which risk factors are most important to consider, factors that are noted by many specialists include the following:
stuttering that has continued for 6 months or longer
presence of other speech or language disorders
strong fears or concerns about stuttering on the part of the child or the family
No single factor can be used to predict whether a child will continue to stutter. The combination of these factors can help SLPs determine whether treatment is indicated.
For older children and adults, the question of whether stuttering is likely to continue is somewhat less important, because the stuttering has continued at least long enough for it to become a problem in the person's daily life. For these individuals, an evaluation consists of tests, observations, and interviews that are designed to assess the overall severity of the disorder. In addition, the impact the disorder has on the person's ability to communicate and participate appropriately in daily activities is evaluated.
For older children and adults, the question of whether stuttering is likely to continue is somewhat less important, because the stuttering has continued at least long enough for it to become a problem in the person's daily life. For these individuals, an evaluation consists of tests, observations, and interviews that are designed to assess the overall severity of the disorder. In addition, the impact the disorder has on the person's ability to communicate and participate appropriately in daily activities is evaluated.
What treatments are available for stuttering?
Most treatment programs for people who stutter are "behavioral." They are designed to teach the person specific skills or behaviors that lead to improved oral communication. For instance, many SLPs teach people who stutter to control and/or monitor the rate at which they speak. In addition, people may learn to start saying words in a slightly slower and less physically tense manner. They may also learn to control or monitor their breathing. When learning to control speech rate, people often begin by practicing smooth, fluent speech at rates that are much slower than typical speech, using short phrases and sentences. Over time, people learn to produce smooth speech at faster rates, in longer sentences, and in more challenging situations until speech sounds both fluent and natural. "Follow-up" or "maintenance" sessions are often necessary after completion of formal intervention to prevent relapse.
What organizations have information about stuttering?
This list is not exhaustive and inclusion does not imply endorsement of the organization or the content of the Web site by ASHA.
National Stuttering AssociationSpeech samples from children who stutter
2. CLUTTERING
How do you know if you or someone else has a cluttering problem?
Like stuttering, cluttering is a fluency disorder, but the two disorders are not the same.
Cluttering involves excessive breaks in the normal flow of speech that seem to result from disorganized speech planning, talking too fast or in spurts, or simply being unsure of what one wants to say. By contrast, the person who stutters typically knows exactly what he or she wants to say but is temporarily unable to say it. To make matters even more confusing, since cluttering is not well known, many who clutter are described by themselves or others as "stuttering." Also, and equally confusing, cluttering often occurs along with stuttering.
The definition of cluttering adopted by the fluency disorders division of the American Speech-Language-Hearing Association is: Cluttering is a fluency disorder characterized by a rapid and/or irregular speaking rate, excessive disfluencies, and often other symptoms such as language or phonological errors and attention deficits. To identify cluttering, you must listen to nonstuttered speech of the speaker.
These fluency and rate deviations are the essential symptoms of cluttering. In addition, however, there are a number of symptoms suggested in the latter part of the above definition that may or may not be present but add support to the impression that a person is cluttering. Accordingly, the clinical picture of a typical cluttering problem would be enhanced if the person in question had any of the following:The definition of cluttering adopted by the fluency disorders division of the American Speech-Language-Hearing Association is: Cluttering is a fluency disorder characterized by a rapid and/or irregular speaking rate, excessive disfluencies, and often other symptoms such as language or phonological errors and attention deficits. To identify cluttering, you must listen to nonstuttered speech of the speaker.
- Confusing, disorganized language or conversational skills.
Until recently, most of what we knew of cluttering came from Europe. Except for one book in 1964, cluttering was essentially ignored in North America from the 1930s to the mid-1980s. Since that time, however, considerable research and attention is now being devoted to the problem.
How is cluttering diagnosed?
Before getting treatment, it is important that someone suspected of cluttering be diagnosed accurately. It is advisable to consult a speech-language pathologist to make the diagnosis. The assessment process is often quite extensive and may require two or more sessions. It may also require contributions or reports from other professionals, such as classroom teachers, special educators, psychologists, or (possibly) neuro-psychologists. The evaluation should obviously include consideration of the fluency problem, but also any co-existing oral-motor, language, pronunciation, learning, or social problems. If the suspected clutterer is in school, it may be a good idea to get a comprehensive academic achievement test (e.g., mathe-matics, writing, and reading) and even an intelligence test.The diagnosis should specify whether or not cluttering is present and also what other problems are present, such as stuttering, a language disorder, or a learning disability. It is important to note that if a stutterer also clutters, sometimes the cluttering will not be noticed until the stuttering diminishes, either on its own or from speech therapy.
How is cluttering treated?
Therapy for clutterers generally addresses the contributing problems first before focusing directly on fluency. Ordinarily, one of the first goals of therapy is to reduce the speaking rate, although this may not be easy for the clutterer to achieve. Some clutterers respond well to "timing" their speech to a delayed auditory feedback (DAF) device; some do not. Another technique that has been found helpful with younger clutterers is to use the analogy of a speedo-meter wherein rapid speech is above the "speed limit" and "speeding tickets" are given for exceeding the "limit." Often the clutterer must be taught to pause deliberately. If the person is unaware of where to pause, it may be useful to write some unintelligible sentences (from a tape recording) that he or she has actually said, first without spaces between words and then with normal spacing. Seeing the difference can often assist in learning to find appropriate pause locations.Pronunciation (articulation) and language problems are often reduced if the clutterer can achieve a slower rate. Sometimes, however, these problems need to be addressed directly. One technique involves practice first in using short, highly structured utterances (e.g., "Hi. My name is John. I live at 148 Third Street. I work at the drug store on Main Street.") and then progressing to more normal language (e.g., "Hi. I’m John. I live on Third Street, three blocks from the drug store where I work on Main Street.") It may also be helpful for clutterers to learn to exaggerate stressed syllables in longer words while being sure to include all the un-stressed syllables (e.g., "par·tic´·u·lar," "con·di´·tion·al," or "gen·er·o´·si·ty"). Some clutterers benefit from planning both the content (the "what") of a message as well as the delivery (the "how"). For example, the "what" can be taught as formulating a telegram (e.g., "Car won’t start. I pump accelerator. Carburetor gets flooded."). The "how" then focuses on filling in the appropriate small words (e.g., "My car often won’t start after it sits for a few minutes. I pump the accelerator a few times before trying again. Often, the carburetor gets flooded.")
As noted, many clutterers also stutter. And often the cluttering is covered up or masked by the stuttering. In some of these individuals, the cluttering emerges as the individual gets control of the stuttering or begins to stutter less. Yet, whether or not the clutterer also stutters (or previously stuttered), any therapy techniques that focus attention on fluency targets such as easy onset of the voice, more prolonged syllables, or correct breathing can also help the person to manage many of the cluttering symptoms. The important thing is that the clutterer learn to pay attention to—or monitor—his or her speech and do anything that makes it easier to remember to do so. Some adults who clutter are better able to monitor if they listen daily to a tape with a short sample of their disorganized cluttered speech and, immediately following, a sample of their clear, monitored speech. Some clutterers even find it helpful to listen to and compare these "wrong" and "right" speech samples several times a day.
3. DYSPROSODY
What is dysprosody?
Dysprosody is known as the rarest neurological speech disorder. It is also known as psuedo-foreign dialect syndrome, where one or more prosodic functions are either absent completely or compromised. People diagnosed with this particular problem have difficulties in pitch and timing control.
Causes of Dysprosody
Dysprosody is usually caused due to neurological damage like brain trauma, severe head injury, stroke, brain vascular damage or brain tumors. To get a clear understandings on causes of dysporosody, from 1907 to 1978, 25 cases of dysprosody have been diagnosed. It was found that 6 out of 25 cases were caused due to a head trauma , whereas remaining developed due to a cerebrovascular accident.
Dysprosody is usually caused due to neurological damage like brain trauma, severe head injury, stroke, brain vascular damage or brain tumors. To get a clear understandings on causes of dysporosody, from 1907 to 1978, 25 cases of dysprosody have been diagnosed. It was found that 6 out of 25 cases were caused due to a head trauma , whereas remaining developed due to a cerebrovascular accident.
Symptoms of Dysprosody
The symptoms of dysprosody is the alterations in intensity of timing to speak a sentence, cadency intonation of words etc.
The symptoms of dysprosody is the alterations in intensity of timing to speak a sentence, cadency intonation of words etc.
Types of Dysprosody
There are two different types of dysprosody. One is linguastic and other one is emotional.
There are two different types of dysprosody. One is linguastic and other one is emotional.
Linguastic dysprosody
Linguastic dysprosody is the one that specifies the adverse of a person’s speech. This is a disorder, which alters one’s vocal identification and effects on one’s verbal communication.
Linguastic dysprosody is the one that specifies the adverse of a person’s speech. This is a disorder, which alters one’s vocal identification and effects on one’s verbal communication.
Emotional dysprosody
Emotional dysprosody is the one that deals wth one’s emotions thorugh his/her speech and also the ability to understand the emotions in others’ speech.
Emotional dysprosody is the one that deals wth one’s emotions thorugh his/her speech and also the ability to understand the emotions in others’ speech.
Treatments of Dysprosody
The most useful treatment of dysprosody is speech therapy. This therapy include various exercises like repeating phrases by using prosodic contours like intonation, pitch and timing. After a patient completes this drill effectively, she or he can start with more advanced exercises of speech therapy.
The most useful treatment of dysprosody is speech therapy. This therapy include various exercises like repeating phrases by using prosodic contours like intonation, pitch and timing. After a patient completes this drill effectively, she or he can start with more advanced exercises of speech therapy.
4. SPEECH SOUND DISORDERS
What causes speech sound disorders?
Many speech sound disorders occur without a known cause. A child may not learn how to produce sounds correctly or may not learn the rules of speech sounds on his or her own. These children may have a problem with speech development, which does not always mean that they will simply outgrow it by themselves. Many children do develop speech sounds over time but those who do not often need the services of an SLP to learn correct speech sounds.
Some speech sound errors can result from physical problems, such as:
developmental disorders (e.g.,autism)genetic syndromes (e.g., Down syndrome)
hearing loss
illness
neurological disorders (e.g., cerebral palsy)
Children who experience frequent ear infections when they were young are at risk for speech sound disorders if the ear infections were accompanied by hearing loss.
Speaking with an accent and/or dialect is not a speech sound disorder.
How common are speech sound disorders?
In young children learning to speak, speech sound errors are quite common. In fact, very few children develop speech without producing errors early on. By the age of 8, children should be able to produce all sounds in English correctly.
5. VOICE DISORDERS
What are Voice Disorders?
Voice disorders can have both serious psychological and physical complications. The ability to exercise, enjoy a family outing or participate in any physical activity is restricted. Impairment may result from trauma, polyps/nodules, benign and cancerous tumors, vocal cord paralysis, multiple sclerosis, thyroid problems and vocal cord swelling.
Common in the elderly, voice disorders are being seen in increasing numbers as people live well into their 80's.
Patients usually have a variety of complaints including breathlessness, fatigue and dizziness. In some cases, life-threatening situations can occur due to the inability of the affected vocal cord to open and close properly, allowing food to become lodged in the trachea, the main airway to the lungs.
Voice disorders from overuse and misuse are common in a variety of professions including professional singers, actors, radio/television personalities, politicians, salespeople, teachers and public speakers. A voice disorder may directly impact on an individual's ability to hold steady employment and /or limit everyday physical activities seriously.
6. DYSARTHRIA
What is dysarthria?
Dysarthria is a motor speech disorder . The muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all after a stroke or other brain injury. The type and severity of dysarthria depend on which area of the nervous system is affected.
A person with dysarthria may experience any of the following symptoms, depending on the extent and location of damage to the nervous system:
"Slurred" speechSpeaking softly or barely able to whisper
Slow rate of speech
Rapid rate of speech with a "mumbling" quality
Limited tongue, lip, and jaw movement
Abnormal intonation (rhythm) when speaking
Changes in vocal quality ("nasal" speech or sounding "stuffy")
Hoarseness
Breathiness
Drooling or poor control of saliva
Chewing and swallowing difficulty
A speech-language pathologist (SLP) can evaluate a person with speech difficulties and determine the nature and severity of the problem. The SLP will look at movement of the lips, tongue, and face, as well as breath support for speech, voice quality, and more.
Another motor speech disorder is apraxia. An important role of the SLP is to determine whether the person's speech problems are due to dysarthria, apraxia, or both.
Treatment depends on the cause, type, and severity of the symptoms. An SLP works with the individual to improve communication abilities.
Possible Goals of Treatment
Slowing the rate of speechImproving the breath support so the person can speak more loudly
Strengthening muscles
Increasing mouth, tongue, and lip movement
Improving articulation so that speech is more clear
Teaching caregivers and family members strategies to better communicate with the person with dysarthria
It is important for both the person with dysarthria and the people he or she communicates with to work together to improve interactions. Here are some tips for both speaker and listener.
Tips for the Person With Dysarthria
Introduce your topic with a single word or short phrase before beginning to speak in more complete sentencesCheck with the listeners to make sure that they understand you
Speak slowly and loudly; pause frequently
Try to limit conversations when you feel tired, when your speech will be harder to understand
If you become frustrated, try to use other methods, such as pointing or gesturing, to get your message across, or take a rest and try again later
Tips for the Listener
Reduce distractions and background noise
Pay attention to the speaker
Watch the person as he or she talks
Let the speaker know when you have difficulty understanding him or her
Repeat only the part of the message that you understood so that the speaker does not have to repeat the entire message
If you still don't understand the message, ask yes/no questions or have the speaker write his or her message to you.
7. APRAXIA OF SPEECH
What is apraxia of speech?
Apraxia of speech, also known as verbal apraxia or dyspraxia, is a speech disorder in which a person has trouble saying what he or she wants to say correctly and consistently. It is not due to weakness or paralysis of the speech muscles (the muscles of the face, tongue, and lips). The severity of apraxia of speech can range from mild to severe.
What are the types and causes of apraxia?
There are two main types of speech apraxia: acquired apraxia of speech and developmental apraxia of speech. Acquired apraxia of speech can affect a person at any age, although it most typically occurs in adults. It is caused by damage to the parts of the brain that are involved in speaking, and involves the loss or impairment of existing speech abilities. The disorder may result from a stroke, head injury, tumor, or other illness affecting the brain. Acquired apraxia of speech may occur together with muscle weakness affecting speech production (dysarthria) or language difficulties caused by damage to the nervous system (aphasia).
Developmental apraxia of speech (DAS) occurs in children and is present from birth. It appears to affect more boys than girls. This speech disorder goes by several other names, including developmental verbal apraxia, developmental verbal dyspraxia, articulatory apraxia, and childhood apraxia of speech. DAS is different from what is known as a developmental delay of speech, in which a child follows the "typical" path of speech development but does so more slowly than normal.
The cause or causes of DAS are not yet known. Some scientists believe that DAS is a disorder related to a child's overall language development. Others believe it is a neurological disorder that affects the brain's ability to send the proper signals to move the muscles involved in speech. However, brain imaging and other studies have not found evidence of specific brain lesions or differences in brain structure in children with DAS. Children with DAS often have family members who have a history of communication disorders or learning disabilities. This observation and recent research findings suggest that genetic factors may play a role in the disorder.
What are the symptoms?
People with either form of apraxia of speech may have a number of different speech characteristics, or symptoms. One of the most notable symptoms is difficulty putting sounds and syllables together in the correct order to form words. Longer or more complex words are usually harder to say than shorter or simpler words. People with apraxia of speech also tend to make inconsistent mistakes when speaking. For example, they may say a difficult word correctly but then have trouble repeating it, or they may be able to say a particular sound one day and have trouble with the same sound the next day. People with apraxia of speech often appear to be groping for the right sound or word, and may try saying a word several times before they say it correctly. Another common characteristic of apraxia of speech is the incorrect use of "prosody" -- that is, the varying rhythms, stresses, and inflections of speech that are used to help express meaning.
Children with developmental apraxia of speech generally can understand language much better than they are able to use language to express themselves. Some children with the disorder may also have other problems. These can include other speech problems, such as dysarthria; language problems such as poor vocabulary, incorrect grammar, and difficulty in clearly organizing spoken information; problems with reading, writing, spelling, or math; coordination or "motor-skill" problems; and chewing and swallowing difficulties.
The severity of both acquired and developmental apraxia of speech varies from person to person. Apraxia can be so mild that a person has trouble with very few speech sounds or only has occasional problems pronouncing words with many syllables. In the most severe cases, a person may not be able to communicate effectively with speech, and may need the help of alternative or additional communication methods.
How is it treated?
In some cases, people with acquired apraxia of speech recover some or all of their speech abilities on their own. This is called spontaneous recovery. Children with developmental apraxia of speech will not outgrow the problem on their own. Speech-language therapy is often helpful for these children and for people with acquired apraxia who do not spontaneously recover all of their speech abilities.
Speech-language pathologists use different approaches to treat apraxia of speech, and no single approach has been proven to be the most effective. Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with apraxia. Each person responds differently to therapy, and some people will make more progress than others. People with apraxia of speech usually need frequent and intensive one-on-one therapy. Support and encouragement from family members and friends are also important.
In severe cases, people with acquired or developmental apraxia of speech may need to use other ways to express themselves. These might include formal or informal sign language, a language notebook with pictures or written words that the person can show to other people, or an electronic communication device such as a portable computer that writes and produces speech.
