Speech & Language Impairments NICHCY Disability Fact Sheet #11 January 2011 A Day in the Life Pearl one on one, using the same • Articulation | speech impair- of an SLP storybook. Pearl has a speech ments where the child pro- disorder, too, but hers is called duces sounds incorrectly (e.g., Christina is a speech-language dysarthria. It causes Pearl’s lisp, difficulty articulating pathologist. She works with speech to be slurred, very soft, certain sounds, such as “l” or children and adults who have breathy, and slow. Here, the “r”); impairments in their speech, cause is weak muscles of the tongue, lips, palate, and jaw. So • Fluency | speech impairments voice, or language skills. These where a child’s flow of speech impairments can take many that’s what Christina and Pearl work on—strengthening the is disrupted by sounds, forms, as her schedule today syllables, and words that are shows. muscles used to form sounds, words, and sentences, and repeated, prolonged, or First comes Robbie. He’s a improving Pearl’s articulation. avoided and where there may cutie pie in the first grade and be silent blocks or inappropri- has recently been diagnosed with One more student to see—4th ate inhalation, exhalation, or childhood apraxia of speech—or grader Mario, who has a stutter. phonation patterns; CAS. CAS is a speech disorder She’s helping Mario learn to slow down his speech and control his • Voice | speech impairments marked by choppy speech. where the child’s voice has an Robbie also talks in a monotone, breathing as he talks. Christina already sees improvement in his abnormal quality to its pitch, making odd pauses as he tries to resonance, or loudness; and form words. Sometimes she can fluency. see him struggle. It’s not that the Tomorrow she’ll go to a muscles of his tongue, lips, and different school, and meet with jaw are weak. The difficulty lies different students. But for today, in the brain and how it commu- her day is...Robbie, Pearl, and nicates to the muscles involved Mario. in producing speech. The is the muscles need to move in precise National Dissemination Center ways for speech to be intelligible. Definition for Children with Disabilities. And that’s what she and Robbie There are many kinds of are working on. NICHCY speech and language disorders 1825 Connecticut Avenue N.W. that can affect children. In this Next, Christina goes down the Washington, DC 20009 fact sheet, we’ll talk about four hall and meets with Pearl in her 1.800.695.0285 (Voice / TTY) major areas in which these third grade classroom. While the 202.884.8200 (Voice / TTY) impairments occur. These are the other students are reading in [email protected] areas of: small groups, she works with http://nichcy.org Disability Fact Sheet #11 (FS11) • Language | language impair- ments where the child has Definition of “Speech or Language Impairment” problems expressing needs, under IDEA ideas, or information, and/or in understanding what others The Individuals with Disabilities Education Act, or IDEA, defines say.1 the term “speech or language impairment” as follows: These areas are reflected in “(11) Speech or language impairment means a communica- how “speech or language impair- tion disorder, such as stuttering, impaired articulation, a ment” is defined by the nation’s language impairment, or a voice impairment, that adversely special education law, the Indi- affects a child’s educational performance.” viduals with Disabilities Educa- tion Act (IDEA’s definition is [34 CFR §300.8(c)(11] given in the box to the right). IDEA is the law that makes early intervention services available to Having the child’s hearing the two is most reliably done by infants and toddlers with dis- checked is a critical first step. The a certified speech-language abilities, and special education child may not have a speech or pathologist such as Christina, the available to school-aged children language impairment at all but, SLP in our opening story. with disabilities. rather, a hearing impairment that is interfering with his or her Characteristics of Speech or Development of Speech development of language. Language Impairments and Language Skills It’s important to realize that a The characteristics of speech in Childhood language delay isn’t the same thing as a speech or language or language impairments will vary depending upon the type of Speech and language skills impairment. Language delay is a impairment involved. There may develop in childhood according very common developmental also be a combination of several to fairly well-defined milestones problem—in fact, the most problems. (see the box below). Parents and common, affecting 5-10% of children in preschool.2 With other caregivers may become When a child has an articula- language delay, children’s lan- concerned if a child’s language tion disorder, he or she has guage is developing in the seems noticeably behind (or difficulty making certain sounds. expected sequence, only at a different from) the language of These sounds may be left off, slower rate. In contrast, speech same-aged peers. This may added, changed, or distorted, and language disorder refers to motivate parents to investigate which makes it hard for people abnormal language develop- further and, eventually, to have to understand the child. the child evaluated by a profes- ment.3 Distinguishing between sional. Leaving out or changing certain sounds is common when young children are learning to More on the Milestones of Language Development talk, of course. A good example of this is saying “wabbit” for What are the milestones of typical speech-language development? “rabbit.” The incorrect articula- What level of communication skill does a typical 8-month-old tion isn’t necessarily a cause for baby have, or a 18-month-old, or a child who’s just celebrated his concern unless it continues past or her fourth birthday? the age where children are You’ll find these expertly described in How Does Your Child Hear and expected to produce such sounds 4 Talk?, a series of resource pages available online at the American correctly. (ASHA’s milestone Speech-Language-Hearing Association (ASHA): resource pages, mentioned above, are useful here.) http://www.asha.org/public/speech/development/chart.htm NICHCY: 1.800.695.0285 2 Speech-Language Impairments (FS11) Fluency refers to the flow of public schools in the 2005-2006 speech. A fluency disorder school year, more than 1.1 means that something is disrupt- million were served under the ing the rhythmic and forward category of speech or language flow of speech—usually, a stutter. impairment.11 As a result, the child’s speech contains an “abnormal number This estimate does not in- of repetitions, hesitations, clude children who have speech/ prolongations, or disturbances. language problems secondary to Tension may also be seen in the • improper use of words and other conditions such as deaf- face, neck, shoulders, or fists.”5 their meanings, ness, intellectual disability, autism, or cerebral palsy. Because Voice is the sound that’s • inability to express ideas, many disabilities do impact the produced when air from the individual’s ability to communi- • inappropriate grammatical lungs pushes through the voice cate, the actual incidence of patterns, box in the throat (also called the children with speech-language larnyx), making the vocal folds • reduced vocabulary, and impairment is undoubtedly within vibrate. From there, the much higher. sound generated travels up • inability to follow directions.10 through the spaces of the throat, Children may hear or see a Finding Help nose, and mouth, and emerges as word but not be able to under- our “voice.” A voice disorder Because all communication stand its meaning. They may involves problems with the disorders carry the potential to have trouble getting others to pitch, loudness, resonance, or isolate individuals from their understand what they are trying quality of the voice.6 The voice social and educational surround- to communicate. These symp- may be hoarse, raspy, or harsh. ings, it is essential to provide toms can easily be mistaken for For some, it may sound quite help and support as soon as a other disabilities such as autism nasal; others might seem as if problem is identified. While or learning disabilities, so it’s they are “stuffed up.” People many speech and language very important to ensure that the with voice problems often notice patterns can be called “baby child receives a thorough changes in pitch, loss of voice, talk” and are part of children’s evaluation by a certified speech- loss of endurance, and some- normal development, they can language pathologist. times a sharp or dull pain become problems if they are not associated with voice use.7 outgrown as expected. What Causes Speech and Language has to do with Language Disorders? Therefore, it’s important to meanings, rather than sounds.8 take action if you suspect that A language disorder refers to an Some causes of speech and your child has a speech or impaired ability to understand language disorders include language impairment (or other 9 and/or use words in context. A hearing loss, neurological disability or delay). The next two child may have an expressive disorders, brain injury, intellec- sections in this fact sheet will tell language disorder (difficulty in tual disabilities, drug abuse, you how to find this help. expressing ideas or needs), a physical impairments such as receptive language disorder cleft lip or palate, and vocal Help for (difficulty in understanding what abuse or misuse. Frequently, Babies and Toddlers others are saying), or a mixed however, the cause is unknown. language disorder (which in- Since we begin learning volves both).