Voice disorders

Alternative names 
Articulation deficiency; Speech disorders; Dysfluency

Definition
Speech disorders include several speech-related problems that result in impaired or ineffective oral communication. Also see speech impairment.

Causes, incidence, and risk factors
Speech is one of the primary ways we communicate with our environment. It is also an effective way to monitor normal growth and development as well as to identify potential problems.

Dysfluencies are rhythm disorders that are usually characterized by the repetition of a sound, word, or phrase. Stuttering is, perhaps, the most serious dysfluency.

Articulation deficiencies involve sounds made incorrectly or inappropriately.

Voice disorders involve abnormalities in the quality, pitch, and loudness of the sound.

There are many potential causes of speech impairment:

     
  • the most common is mental retardation  
  • hearing impairment  
  • ADD  
  • learning disabilities  
  • autism  
  • schizophrenia  
  • cerebral palsy  
  • cleft palate  
  • vocal cord injury  
  • disorders of the palate  
  • cri-du-chat syndrome  
  • Gilles de la Tourette syndrome

Delayed speech development is one of the common symptoms of developmentally delayed children. It occurs in 5-10% of all children. Boys are three to four times as likely to experience speech disorders as girls.

Symptoms
Dysfluency:

     
  • repetition of sounds, words, or phrases after age 4  
  • frustration with attempts to communicate  
  • head jerking while talking  
  • eye blinking while talking  
  • embarrassment with speech

Articulation Deficiency:

     
  • unintelligible speech by age 3  
  • the leaving out of consonants at the beginning of words by age 3  
  • the leaving out of consonants at the end of words by age 4  
  • persistent problems with articulation after age 7  
  • the leaving out of sounds where they should occur  
  • the distortion of sounds  
  • substituting an incorrect sound for a correct one

Voice disorders:

     
  • pitch deviations  
  • deviations in the loudness of the voice  
  • quality deviations

Signs and tests

     
  • Denver Articulation Screening Examination  
  • Early Language Milestone Scale  
  • Denver II  
  • Peabody Picture Test Revised

Treatment
The best treatment is prevention and early intervention by a speech pathologist. Speech training is an involved and time consuming endeavor that can have profound results with consistent treatment.

Expectations (prognosis)
The prognosis depends on the cause of the disorder. Usually, speech can be improved with speech therapy. Prognosis improves with early intervention.

Complications

     
  • psycho-social problems associated with ineffective communication

Calling your health care provider
Call your health care provider if your child’s speech is not reaching the standard landmarks, if you suspect your child is in a high risk group, or your child is showing other signs of a speech disorder.

Prevention
Since mental retardation and hearing loss are predisposing factors for speech disorders, at-risk infants should be referred to an audiologist for an audiology exam. Audiological and speech therapy can then be started if necessary.

Stuttering can best be prevented by parents withholding undue attention to dysfluency in their young child. As young children begin to speak, some dysfluency is common. They lack a large vocabulary and have difficulty expressing themselves. This results in broken or dysfluent speech. If parents place excessive attention on the dysfluency, a pattern may develop.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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