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Speech Impediment Guide: Definition, Causes, and Resources

December 8, 2020 

Tables of Contents

What Is a Speech Impediment?

Types of speech disorders, speech impediment causes, how to fix a speech impediment, making a difference in speech disorders.

Communication is a cornerstone of human relationships. When an individual struggles to verbalize information, thoughts, and feelings, it can cause major barriers in personal, learning, and business interactions.

Speech impediments, or speech disorders, can lead to feelings of insecurity and frustration. They can also cause worry for family members and friends who don’t know how to help their loved ones express themselves.

Fortunately, there are a number of ways that speech disorders can be treated, and in many cases, cured. Health professionals in fields including speech-language pathology and audiology can work with patients to overcome communication disorders, and individuals and families can learn techniques to help.

Commonly referred to as a speech disorder, a speech impediment is a condition that impacts an individual’s ability to speak fluently, correctly, or with clear resonance or tone. Individuals with speech disorders have problems creating understandable sounds or forming words, leading to communication difficulties.

Some 7.7% of U.S. children — or 1 in 12 youths between the ages of 3 and 17 — have speech, voice, language, or swallowing disorders, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). About 70 million people worldwide, including some 3 million Americans, experience stuttering difficulties, according to the Stuttering Foundation.

Common signs of a speech disorder

There are several symptoms and indicators that can point to a speech disorder.

• Unintelligible speech — A speech disorder may be present when others have difficulty understanding a person’s verbalizations.
• Omitted sounds — This symptom can include the omission of part of a word, such as saying “bo” instead of “boat,” and may include omission of consonants or syllables.
• Added sounds — This can involve adding extra sounds in a word, such as “buhlack” instead of “black,” or repeating sounds like “b-b-b-ball.”
• Substituted sounds — When sounds are substituted or distorted, such as saying “wabbit” instead of “rabbit,” it may indicate a speech disorder.
• Use of gestures — When individuals use gestures to communicate instead of words, a speech impediment may be the cause.
• Inappropriate pitch — This symptom is characterized by speaking with a strange pitch or volume.

In children, signs might also include a lack of babbling or making limited sounds. Symptoms may also include the incorrect use of specific sounds in words, according to the American Speech-Language-Hearing Association (ASHA). This may include the sounds p, m, b, w, and h among children aged 1-2, and k, f, g, d, n, and t for children aged 2-3.

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Categories of Speech Impediments

Speech impediments can range from speech sound disorders (articulation and phonological disorders) to voice disorders. Speech sound disorders may be organic — resulting from a motor or sensory cause — or may be functional with no known cause. Voice disorders deal with physical problems that limit speech. The main categories of speech impediments include the following:

Fluency disorders occur when a patient has trouble with speech timing or rhythms. This can lead to hesitations, repetitions, or prolonged sounds. Fluency disorders include stuttering (repetition of sounds) or   (rapid or irregular rate of speech).

Resonance disorders are related to voice quality that is impacted by the shape of the nose, throat, and/or mouth. Examples of resonance disorders include hyponasality and cul-de-sac resonance.

Articulation disorders occur when a patient has difficulty producing speech sounds. These disorders may stem from physical or anatomical limitations such as muscular, neuromuscular, or skeletal support. Examples of articulation speech impairments include sound omissions, substitutions, and distortions.

Phonological disorders result in the misuse of certain speech sounds to form words. Conditions include fronting, stopping, and the omission of final consonants.

Voice disorders are the result of problems in the larynx that harm the quality or use of an individual’s voice. This can impact pitch, resonance, and loudness.

Impact of Speech Disorders

Some speech disorders have little impact on socialization and daily activities, but other conditions can make some tasks difficult for individuals. Following are a few of the impacts of speech impediments.

• Poor communication — Children may be unable to participate in certain learning activities, such as answering questions or reading out loud, due to communication difficulties. Adults may avoid work or social activities such as giving speeches or attending parties.
• Mental health and confidence — Speech disorders may cause children or adults to feel different from peers, leading to a lack of self-confidence and, potentially, self-isolation.

Resources on Speech Disorders

The following resources may help those who are seeking more information about speech impediments.

Health Information : Information and statistics on common voice and speech disorders from the NIDCD

Speech Disorders : Information on childhood speech disorders from Cincinnati Children’s Hospital Medical Center

Speech, Language, and Swallowing : Resources about speech and language development from the ASHA

Children and adults can suffer from a variety of speech impairments that may have mild to severe impacts on their ability to communicate. The following 10 conditions are examples of specific types of speech disorders and voice disorders.

1. Stuttering

This condition is one of the most common speech disorders. Stuttering is the repetition of syllables or words, interruptions in speech, or prolonged use of a sound.

This organic speech disorder is a result of damage to the neural pathways that connect the brain to speech-producing muscles. This results in a person knowing what they want to say, but being unable to speak the words.

This consists of the lost ability to speak, understand, or write languages. It is common in stroke, brain tumor, or traumatic brain injury patients.

4. Dysarthria

This condition is an organic speech sound disorder that involves difficulty expressing certain noises. This may involve slurring, or poor pronunciation, and rhythm differences related to nerve or brain disorders.

The condition of lisping is the replacing of sounds in words, including “th” for “s.” Lisping is a functional speech impediment.

6. Hyponasality

This condition is a resonance disorder related to limited sound coming through the nose, causing a “stopped up” quality to speech.

7. Cul-de-sac resonance

This speech disorder is the result of blockage in the mouth, throat, or nose that results in quiet or muffled speech.

8. Orofacial myofunctional disorders

These conditions involve abnormal patterns of mouth and face movement. Conditions include tongue thrusting (fronting), where individuals push out their tongue while eating or talking.

9. Spasmodic Dysphonia

This condition is a voice disorder in which spasms in the vocal cords produce speech that is hoarse, strained, or jittery.

10. Other voice disorders

These conditions can include having a voice that sounds breathy, hoarse, or scratchy. Some disorders deal with vocal folds closing when they should open (paradoxical vocal fold movement) or the presence of polyps or nodules in the vocal folds.

Speech Disorders vs. Language Disorders

Speech disorders deal with difficulty in creating sounds due to articulation, fluency, phonology, and voice problems. These problems are typically related to physical, motor, sensory, neurological, or mental health issues.

Language disorders, on the other hand, occur when individuals have difficulty communicating the meaning of what they want to express. Common in children, these disorders may result in low vocabulary and difficulty saying complex sentences. Such a disorder may reflect difficulty in comprehending school lessons or adopting new words, or it may be related to a learning disability such as dyslexia. Language disorders can also involve receptive language difficulties, where individuals have trouble understanding the messages that others are trying to convey.  

Resources on Types of Speech Disorders

The following resources may provide additional information on the types of speech impediments.

Common Speech Disorders: A guide to the most common speech impediments from GreatSpeech

Speech impairment in adults: Descriptions of common adult speech issues from MedlinePlus

Stuttering Facts: Information on stuttering indications and causes from the Stuttering Foundation

Speech disorders may be caused by a variety of factors related to physical features, neurological ailments, or mental health conditions. In children, they may be related to developmental issues or unknown causes and may go away naturally over time.

Physical and neurological issues. Speech impediment causes related to physical characteristics may include:

• Brain damage
• Nervous system damage
• Respiratory system damage
• Hearing difficulties
• Cancerous or noncancerous growths
• Muscle and bone problems such as dental issues or cleft palate

Mental health issues. Some speech disorders are related to clinical conditions such as:

• Autism spectrum disorder
• Down syndrome or other genetic syndromes
• Cerebral palsy or other neurological disorders
• Multiple sclerosis

Some speech impairments may also have to do with family history, such as when parents or siblings have experienced language or speech difficulties. Other causes may include premature birth, pregnancy complications, or delivery difficulties. Voice overuse and chronic coughs can also cause speech issues.

The most common way that speech disorders are treated involves seeking professional help. If patients and families feel that symptoms warrant therapy, health professionals can help determine how to fix a speech impediment. Early treatment is best to curb speech disorders, but impairments can also be treated later in life.

Professionals in the speech therapy field include speech-language pathologists (SLPs) . These practitioners assess, diagnose, and treat communication disorders including speech, language, social, cognitive, and swallowing disorders in both adults and children. They may have an SLP assistant to help with diagnostic and therapy activities.

Speech-language pathologists may also share a practice with audiologists and audiology assistants. Audiologists help identify and treat hearing, balance, and other auditory disorders.

How Are Speech Disorders Diagnosed?

Typically, a pediatrician, social worker, teacher, or other concerned party will recognize the symptoms of a speech disorder in children. These individuals, who frequently deal with speech and language conditions and are more familiar with symptoms, will recommend that parents have their child evaluated. Adults who struggle with speech problems may seek direct guidance from a physician or speech evaluation specialist.

When evaluating a patient for a potential speech impediment, a physician will:

• Conduct hearing and vision tests
• Evaluate patient records
• Observe patient symptoms

A speech-language pathologist will conduct an initial screening that might include:

• An evaluation of speech sounds in words and sentences
• An evaluation of oral motor function
• An orofacial examination
• An assessment of language comprehension

The initial screening might result in no action if speech symptoms are determined to be developmentally appropriate. If a disorder is suspected, the initial screening might result in a referral for a comprehensive speech sound assessment, comprehensive language assessment, audiology evaluation, or other medical services.

Initial assessments and more in-depth screenings might occur in a private speech therapy practice, rehabilitation center, school, childcare program, or early intervention center. For older adults, skilled nursing centers and nursing homes may assess patients for speech, hearing, and language disorders.

How Are Speech Impediments Treated?

Once an evaluation determines precisely what type of speech sound disorder is present, patients can begin treatment. Speech-language pathologists use a combination of therapy, exercise, and assistive devices to treat speech disorders.

Speech therapy might focus on motor production (articulation) or linguistic (phonological or language-based) elements of speech, according to ASHA. There are various types of speech therapy available to patients.

Contextual Utilization  — This therapeutic approach teaches methods for producing sounds consistently in different syllable-based contexts, such as phonemic or phonetic contexts. These methods are helpful for patients who produce sounds inconsistently.

Phonological Contrast — This approach focuses on improving speech through emphasis of phonemic contrasts that serve to differentiate words. Examples might include minimal opposition words (pot vs. spot) or maximal oppositions (mall vs. call). These therapy methods can help patients who use phonological error patterns.

Distinctive Feature — In this category of therapy, SLPs focus on elements that are missing in speech, such as articulation or nasality. This helps patients who substitute sounds by teaching them to distinguish target sounds from substituted sounds.

Core Vocabulary — This therapeutic approach involves practicing whole words that are commonly used in a specific patient’s communications. It is effective for patients with inconsistent sound production.

Metaphon — In this type of therapy, patients are taught to identify phonological language structures. The technique focuses on contrasting sound elements, such as loud vs. quiet, and helps patients with unintelligible speech issues.

Oral-Motor — This approach uses non-speech exercises to supplement sound therapies. This helps patients gain oral-motor strength and control to improve articulation.

Other methods professionals may use to help fix speech impediments include relaxation, breathing, muscle strengthening, and voice exercises. They may also recommend assistive devices, which may include:

• Radio transmission systems
• Personal amplifiers
• Picture boards
• Touch screens
• Text displays
• Speech-generating devices
• Hearing aids
• Cochlear implants

Resources for Professionals on How to Fix a Speech Impediment

The following resources provide information for speech therapists and other health professionals.

Assistive Devices: Information on hearing and speech aids from the NIDCD

Information for Audiologists: Publications, news, and practice aids for audiologists from ASHA

Information for Speech-Language Pathologists: Publications, news, and practice aids for SLPs from ASHA

Speech Disorder Tips for Families

For parents who are concerned that their child might have a speech disorder — or who want to prevent the development of a disorder — there are a number of activities that can help. The following are tasks that parents can engage in on a regular basis to develop literacy and speech skills.

• Introducing new vocabulary words
• Reading picture and story books with various sounds and patterns
• Talking to children about objects and events
• Answering children’s questions during routine activities
• Encouraging drawing and scribbling
• Pointing to words while reading books
• Pointing out words and sentences in objects and signs

Parents can take the following steps to make sure that potential speech impediments are identified early on.

• Discussing concerns with physicians
• Asking for hearing, vision, and speech screenings from doctors
• Requesting special education assessments from school officials
• Requesting a referral to a speech-language pathologist, audiologist, or other specialist

When a child is engaged in speech therapy, speech-language pathologists will typically establish collaborative relationships with families, sharing information and encouraging parents to participate in therapy decisions and practices.

SLPs will work with patients and their families to set goals for therapy outcomes. In addition to therapy sessions, they may develop activities and exercises for families to work on at home. It is important that caregivers are encouraging and patient with children during therapy.  

Resources for Parents on How to Fix a Speech Impediment

The following resources provide additional information on treatment options for speech disorders.

Speech, Language, and Swallowing Disorders Groups: Listing of self-help groups from ASHA

ProFind: Search tool for finding certified SLPs and audiologists from ASHA

Baby’s Hearing and Communication Development Checklist: Listing of milestones that children should meet by certain ages from the NIDCD

If identified during childhood, speech disorders can be corrected efficiently, giving children greater communication opportunities. If left untreated, speech impediments can cause a variety of problems in adulthood, and may be more difficult to diagnose and treat.

Parents, teachers, doctors, speech and language professionals, and other concerned parties all have unique responsibilities in recognizing and treating speech disorders. Through professional therapy, family engagement, positive encouragement and a strong support network, individuals with speech impediments can overcome their challenges and develop essential communication skills.

Additional Sources

American Speech-Language-Hearing Association, Speech Sound Disorders

Identify the Signs, Signs of Speech and Language Disorders

Intermountain Healthcare, Phonological Disorders

MedlinePlus, Speech disorders – children

National Institutes of Health, National Institutes on Deafness and Other Communication Disorders, “Quick Statistics About Voice, Speech, Language”

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Speech Impediment: Definition, Causes, Types and Treatment

02 may speech impediment: definition, causes, types and treatment.

One of life’s joys as a parent is watching your kids grow and change. You see them learn new things, meet new friends, and explore the world around them. But sometimes, you also witness them struggle – like when they have their first fight with a friend or don’t do as well as they wanted to on a test. And while it’s never easy to see your child suffer, one of the hardest things to watch is when your child has difficulty communicating. If your child has a speech impediment, you know that feeling all too well. It can be frustrating and heartbreaking to see your little one struggling to be understood. But take heart – you’re not alone. Many children have difficulties with speech, and with the right pediatric speech therapist in Chicago , your child can learn to overcome their impediment. This blog post will define a speech impediment, discuss some of the most common types and causes, and provide information on treatment options.

What is a speech impediment?

A speech impediment is a condition that affects a person’s ability to produce sound correctly. The term can refer to any difficulties that impede a person’s speech, from mild sound errors to severe problems with articulation. All individuals with speech impediments have difficulty producing certain sounds, depending on one sound. Some people may only have trouble with one sound, while others may have difficulty producing multiple sounds.

What causes speech impediments?

Some people are born with speech impediments, while others develop them later in life. There are many different causes of speech impediment, as you will see below.

1. Congenital defects Congenital defects are abnormalities that are present at birth. They can affect any part of the body, including the mouth and vocal cords. In some cases, congenital defects can cause problems with the tongue moving or the formation of teeth. Many different types of congenital defects can cause a speech impediment, including : Cleft lip and palate is a condition where there is an opening in the lip and/or roof of the mouth. This opening can cause problems with the way the mouth forms words, as well as with eating and drinking. Cleft lip and palate can also cause hearing problems. Vocal cord paralysis is a condition where the vocal cords are unable to move correctly. This can make it difficult to produce sound, as well as to breathe properly. Tongue-tie is a condition where the tongue is tethered to the floor of the mouth. This can make it difficult to move the tongue and can cause problems with eating, drinking, and speaking.

2. Neurological disorders Neurological disorders are conditions that affect the nervous system. These disorders can cause problems with the way the brain sends signals to the muscles, which can lead to difficulties with movement and speech. Some of the more common neurological disorders include: Cerebral palsy is a condition that affects movement and muscle coordination. It is caused by damage to the brain, usually before or during birth. Cerebral palsy can cause problems with the way a person walks, talks, and eats. Multiple sclerosis is a disease of the nervous system that causes the immune system to attack the nerves. This can lead to problems with muscle control and vision, hearing, and speech.

3. Hearing loss Hearing loss can be caused by many different things, including exposure to loud noise, certain medications, and aging. Hearing loss can make it difficult to understand what other people are saying, which can lead to problems with speech. There are many different types of hearing loss, and the severity can vary from person to person. Some people with hearing loss may only have trouble hearing certain sounds, while others may not be able to hear anything at all. Hearing loss can be temporary or permanent. Temporary hearing loss can be caused by things like earwax buildup or infection. Permanent hearing loss can be caused by things like damage to the inner ear or a genetic disorder.

4. Language disorders Language disorders are conditions that affect a person’s ability to understand or use language. These disorders can make it difficult to produce or comprehend speech. Some of the more common language disorders include dyslexia and aphasia.

5. Emotional disorders Emotional disorders are conditions that affect a person’s emotions or mood. These disorders can cause problems with speech due to anxiety or stress. Some of the more common emotional disorders include anxiety disorders and depression. lip

Types of speech disorder

There are many different types of speech disorders, and the symptoms can vary from person to person. Some of the more common types of speech disorders include:

1. Articulation disorder An articulation disorder is a problem with the way the mouth, teeth, or tongue move to make sounds. This can make it difficult to produce certain sounds correctly. People with articulation disorders may have trouble saying certain words correctly, or they may leave out parts of words when they speak.

2. Fluency disorder A fluency disorder is a problem with the flow of speech. People with fluency disorders may have trouble putting their thoughts into words, and they may stutter when they speak. Stuttering is a type of fluency disorder that is characterized by pauses, repetitions, or prolongations of sounds.

3. Resonance disorder A resonance disorder is a problem with the way sound resonates in the mouth and throat. This can make it difficult to produce certain sounds correctly. People with resonance disorders may have trouble producing vowel sounds, or they may speak with a nasal tone.

4. Voice disorder A voice disorder is a problem with the way the voice sounds. This can be caused by things like vocal cord damage or misuse of the voice. People with voice disorders may have trouble speaking loudly or speaking in a hoarse or breathy voice.

Treatment of speech impediments

There are many different treatments for speech disorders, and the best treatment will depend on the individual and the cause of the disorder. Some of the more common treatments include:

1. Speech therapy Speech therapy is a type of treatment that helps people with speech disorders improve their abilities. Speech therapists can help people with articulation disorders learn to produce sounds correctly, people with fluency disorders reduce their stuttering, and people with resonance disorders improve their vowel production.

2. Surgery Surgery can be used to correct some anatomical defects that cause speech disorders. For example, surgery can be used to correct cleft lip and palate, vocal cord paralysis, and tongue tie.

3. Medication Medication can be used to treat some neurological disorders that cause speech disorders. For example, medication can be used to treat conditions like cerebral palsy and multiple sclerosis.

4. Hearing aids Hearing aids can be used to treat hearing loss that causes speech disorders. Hearing aids amplify sound so that people with hearing loss can better understand what other people are saying.

5. Communication devices Communication devices can be used to help people with language disorders or severe speech disorders communicate. These devices can include things like picture boards and computer software that helps people generate speech.

6. Counseling Counseling can be used to treat emotional disorders that cause speech disorders. Counseling can help people manage their anxiety and stress and learn coping mechanisms to deal with their disorders.

7. Alternative treatments There are many different alternative treatments for speech disorders. Some of these treatments include acupuncture, aromatherapy, and massage therapy. It is important to speak with a doctor before starting any alternative treatment.

Speech disorders can cause a variety of problems for people, ranging from difficulty understanding what other people are saying to difficulty producing speech. There are many different causes of speech disorders, and the best treatment will depend on the individual and the cause of the disorder. Visit https://functionalspeechtherapy.com/ to learn more about pediatric speech disorders and treatment options.

Functional Speech Therapy Co., 960 Route 22, Unit 216 Fox River Grove Illinois 60021, (224) 219-1924

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What Is a Speech Sound Disorder?

Halfpoint Images / Getty Images

Speech sound disorders are a blanket description for a child’s difficulty in learning, articulating, or using the sounds/sound patterns of their language. These difficulties are usually clear when compared to the communication abilities of children within the same age group.

Speech developmental disorders may indicate challenges with motor speech. Here, a child experiences difficulty moving the muscles necessary for speech production. This child may also face reduced coordination when attempting to speak.

Speech sound disorders are recognized where speech patterns do not correspond with the movements/gestures made when speaking.  

Speech impairments are a common early childhood occurrence—an estimated 2% to 13% of children live with these difficulties. Children with these disorders may struggle with reading and writing. This can interfere with their expected academic performance. Speech sound disorders are often confused with language conditions such as specific language impairment (SLI).

This article will examine the distinguishing features of this disorder. It will also review factors responsible for speech challenges, and the different ways they can manifest. Lastly, we’ll cover different treatment methods that make managing this disorder possible.

Symptoms of Speech Sound Disorder

A speech sound disorder may manifest in different ways. This usually depends on the factors responsible for the challenge, or how extreme it is.

There are different patterns of error that may signal a speech sound disorder. These include:

• Removing a sound from a word
• Including a sound in a word
• Replacing hard to pronounce sounds with an unsuitable alternative
• Difficulty pronouncing the same sound in different words (e.g., "pig" and "kit")
• Repeating sounds or words
• Lengthening words
• Pauses while speaking
• Tension when producing sounds
• Head jerks during speech
• Blinking while speaking
• Shame while speaking
• Changes in voice pitch
• Running out of breath while speaking

It’s important to note that children develop at different rates. This can reflect in the ease and ability to produce sounds. But where children repeatedly make sounds or statements that are difficult to understand, this could indicate a speech disorder.

Diagnosis of Speech Sound Disorders

For a correct diagnosis, a speech-language pathologist can determine whether or not a child has a speech-sound disorder.

This determination may be made in line with the requirements of the DSM-5 diagnostic criteria . These guidelines require that:

• The child experience persistent difficulty with sound production (this affects communication and speech comprehension)
• Symptoms of the disorder appear early during the child’s development stages
• This disorder limits communication. It affects social interactions, academic achievements, and job performance.
• The disorder is not caused by other conditions like a congenital disorder or an acquired condition like hearing loss . Hereditary disorders are, however, exempted. 

Causes of Speech Sound Disorders

There is no known cause of speech sound disorders. However, several risk factors may increase the odds of developing a speech challenge. These include:

• Gender : Male children are more likely to develop a speech sound disorder
• Family history : Children with family members living with speech disorders may acquire a similar challenge.
• Socioeconomics : Being raised in a low socioeconomic environment may contribute to the development of speech and literacy challenges.
• Pre- and post-natal challenges : Difficulties faced during pregnancy such as maternal infections and stressors may worsen the chances of speech disorders in a child. Likewise, delivery complications, premature birth, and low-birth-weight could lead to speech disorders.
• Disabilities : Down syndrome, autism , and other disabilities may be linked to speech-sound disorders.
• Physical challenges : Children with a cleft lip may experience speech sound difficulties.
• Brain damage : These disorders may also be caused by an infection or trauma to a child’s brain . This is seen in conditions like cerebral palsy where the muscles affecting speech are injured.

Types of Speech Sound Disorders

By the time a child turns three, at least half of what they say should be properly understood. By ages four and five, most sounds should be pronounced correctly—although, exceptions may arise when pronouncing “l”, “s”,”r”,”v”, and other similar sounds. By seven or eight, harder sounds should be properly pronounced. 

A child with a speech sound disorder will continue to struggle to pronounce words, even past the expected age. Difficulty with speech patterns may signal one of the following speech sound disorders:

This refers to interruptions while speaking. Stuttering is the most common form of disfluency. It is recognized for recurring breaks in the free flow of speech. After the age of four, a child with disfluency will still repeat words or phrases while speaking. This child may include extra words or sounds when communicating—they may also make words longer by stressing syllables.

This disorder may cause tension while speaking. Other times, head jerking or blinking may be observed with disfluency. 

Children with this disorder often feel frustrated when speaking, it may also cause embarrassment during interactions. 

Articulation Disorder

When a child is unable to properly produce sounds, this may be caused by inexact placement, speed, pressure, or movement from the lips, tongue, or throat.  

This usually signals an articulation disorder, where sounds like “r”, “l”, or “s” may be changed. In these cases, a child’s communication may be understood by only close family members.

Phonological Disorder

A phonological disorder is present where a child is unable to make the speech sounds expected of their age. Here, mistakes may be made when producing sounds. Other times, sounds like consonants may be omitted when speaking.  

Voice Disorder

Where a child is observed to have a raspy voice, this may be an early sign of a voice disorder. Other indicators include voice breaks, a change in pitch, or an excessively loud or soft voice.  

Children that run out of breath while speaking may also live with this disorder. Likewise, children may sound very nasally, or can appear to have inadequate air coming out of their nose if they have a voice disorder.

Childhood apraxia of speech occurs when a child lacks the proper motor skills for sound production. Children with this condition will find it difficult to plan and produce movements in the tongue, lips, jaw, and palate required for speech.  

Treatment of Speech Sound Disorder

Parents of children with speech sound disorders may feel at a loss for the next steps to take. To avoid further strain to the child, it’s important to avoid showing excessive concern.

Instead, listening patiently to their needs, letting them speak without completing their sentences, and showing usual love and care can go a long way.

For professional assistance, a speech-language pathologist can assist with improving a child’s communication. These pathologists will typically use oral motor exercises to enhance speech.

These oral exercises may also include nonspeech oral exercises such as blowing, oral massages and brushing, cheek puffing, whistleblowing, etc.

Nonspeech oral exercises help to strengthen weak mouth muscles, and can help with learning the common ways of communicating.

Parents and children with speech sound disorders may also join support groups for information and assistance with the condition.

A Word From Verywell

It can be frustrating to witness the challenges in communication. But while it's understandable to long for typical communication from a child—the differences caused by speech disorders can be managed with the right care and supervision. Speaking to a speech therapist, and showing love o children with speech disorders can be important first steps in overcoming these conditions.

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McLeod S, Harrison LJ, McAllister L, McCormack J. Speech sound disorders in a community study of preschool children . Am J Speech Lang Pathol . 2013;22(3):503-522. doi:10.1044/1058-0360(2012/11-0123)

Murphy CF, Pagan-Neves LO, Wertzner HF, Schochat E. Children with speech sound disorder: comparing a non-linguistic auditory approach with a phonological intervention approach to improve phonological skills . Front Psychol . 2015;6:64. Published 2015 Feb 4. doi:10.3389/fpsyg.2015.00064

Penn Medicine. Speech and Language Disorders-Symptoms and Causes .

PsychDB. Speech Sound Disorder (Phonological Disorder) .

Sices L, Taylor HG, Freebairn L, Hansen A, Lewis B. Relationship between speech-sound disorders and early literacy skills in preschool-age children: impact of comorbid language impairment . J Dev Behav Pediatr . 2007;28(6):438-447. doi:10.1097/DBP.0b013e31811ff8ca

American Speech-Language-Hearing Association. Speech Sound Disorders: Articulation and Phonology .

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Lee AS, Gibbon FE. Non-speech oral motor treatment for children with developmental speech sound disorders . Cochrane Database Syst Rev . 2015;2015(3):CD009383. Published 2015 Mar 25. doi:10.1002/14651858.CD009383.pub2

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What Is Apraxia of Speech?

A Challenging Language Disorder

Apraxia of speech is a language impairment that occurs due to brain damage. The underlying causes of apraxia of speech are usually different for children than for adults. Speech apraxia is difficult to cope with, and speech therapy can help improve communication.

Diagnosis of the underlying cause is crucial, both to help direct treatment for speech difficulties and to treat and prevent further neurological problems.

Illustration by Zoe Hansen for Verywell Health

Apraxia of Speech Symptoms 

Speech apraxia leads to significant difficulties in communicating. This condition usually causes persistent symptoms and typically doesn't change.

People with apraxia of speech are cognitively and physically able to produce words and sentences. Language comprehension should not be affected by apraxia of speech, and words are not slurred in apraxia of speech.

Features of apraxia of speech include the following:

• Distortion of sounds : The sounds of words and phrases are often wrong in speech apraxia. For example, the vowels or consonants might be drawn out for too long.
• Inconsistency in pronouncing words and sounds : The mispronunciation of words with speech apraxia is not necessarily consistent. For example, you could have difficulty with the first part of a word, and the next time you say that word, you might have difficulty with the middle or the end.
• Struggling for words : If you have apraxia of speech, you will work hard to say the words you want to say.
• Errors in speech : You might use the wrong words and phrases if you have apraxia of speech, despite knowing what you mean to say.

Other cognitive or physical problems can often occur with speech apraxia, depending on the underlying cause.

Apraxia vs. Other Speech and Language Disorders

Apraxia of speech is a type of language disorder. Aphasia is the most common language impairment, and dysarthria is a speech impairment caused by difficulty with motor speech function. Apraxia is distinct from these disorders, although they may share some similarities. Common speech disorders include:

• Receptive aphasia : Usually referred to as Wernicke’s aphasia, this type of language impairment is characterized by fluid speech that usually doesn’t make sense, often with word substitutions. Language comprehension is typically impaired with Wernicke’s aphasia.
• Impaired fluency : Often described as Broca’s aphasia , this is a language problem that causes people to have choppy speech without a normal rhythm. Usually, speech comprehension is not substantially affected by Broca’s aphasia.
• Conduction aphasia : In conduction aphasia, the problem is the ability to repeat a short sentence. Expression and comprehension of speech are spared.
• Dysarthria : This condition is characterized by slurred speech or difficulty making certain sounds. Usually, people with dysarthria without aphasia can understand language and may know which words they want to say but have difficulty pronouncing them.

Speech apraxia is caused by damage to regions in the brain that mediate communication between language regions in the brain and between the left and right hemispheres of the brain.

This can occur with developmental conditions, such as autism, or it may result from harm to the brain, such as from head trauma.

Conditions associated with apraxia of speech include:

• Autism spectrum disorder
• Cerebral palsy
• Head trauma
• Brain tumors
• Brain surgery

These conditions are not always associated with apraxia of speech. But they can sometimes cause damage or dysfunction to regions of the brain that allow communication between the right and left hemispheres—and then they could be associated with speech apraxia.

Speech apraxia is diagnosed based on a clinical evaluation, usually by a physician or a speech therapist . A detailed examination of speech and cognitive abilities is necessary to define apraxia of speech and to rule out other disorders that can cause similar speech and language patterns, such as dysarthria and aphasia.

Speech patterns noted in apraxia of speech include the following:

• Phonemic error frequency : This involves assessment of the frequency of mistakes while pronouncing words.
• Distortion error frequency : This is a count of how often sounds are altered during speech.
• Word syllable duration : This involves assessment of the extra time in saying a word, usually due to struggling.

The Apraxia of Speech Rating Scale (ASRS) is one of the ways that speech apraxia can be defined. Healthcare providers can use this scale to communicate with each other and follow the improvement of apraxia of speech with therapy. The ASRS includes 16 components, such as repetition of sounds or inaccurate sounds, that are rated on a scale from zero to four.

If you’ve been diagnosed with speech apraxia or any communication problem, healthcare providers will work to determine the underlying cause. Issues such as childhood neurodevelopmental problems, stroke, brain tumors, or damage from a head injury need to be identified and treated.

Diagnostic testing may include:

• Brain imaging tests : These tests can help identify common causes of apraxia of speech, such as a stroke or head trauma.
• Cognitive testing : These tests may be used as part of the assessment for autism, dementia, or psychiatric conditions, which may be related to speech challenges.
• Blood tests : Medical problems such as infections, electrolyte disturbances , or organ failure may cause communication difficulties.

In addition to diagnosing speech apraxia, your healthcare providers will also work to determine whether you have other neurological deficits that could be caused by the underlying issue causing your speech apraxia. These can include learning difficulties, behavioral problems, or body weakness.

Apraxia of speech is treated with speech therapy . This type of therapy will follow patterns of treatment that are well-established for improving speech and will also provide an individualized treatment plan.

Therapy may need to be ongoing, and the frequency and specific exercises used during your therapy can be adjusted as you improve. For example, if your speech improves substantially, you might be able to work with your speech therapist less frequently, or you may be able to do some speech exercises at home, as directed by your therapist.

It’s not possible to predict with absolute certainty whether a person will recover from apraxia of speech and how much they might improve. However, there are some diagnostic clues that can help in anticipating the extent of recovery. 

If you or a loved one has apraxia of speech, it can help to know that the ability to participate in speech therapy can lead to better outcomes. If your cognitive function is not affected or is only mildly impaired, this can help you take an active role in your therapy.

Research About Prognosis and Treatment

Stronger connectivity between certain areas of the right and left hemispheres of the brain is associated with better recovery.

For example, one research study showed that early connectivity of the inferior frontal gyrus (an area that processes speech and language) within two weeks after a stroke may be a strong predictor of recovery of apraxia of speech.  

And at six months, lower severity of speech apraxia was associated with stronger connectivity of the anterior insula (which supports subjective feelings) on the right and left hemispheres and the ventral premotor cortex (which is involved in grasping and manipulating objects) of the right and left hemispheres.

This type of connectivity can be identified with metabolic brain testing, which is time-consuming and often impractical. However, this research can help scientists learn about ways to improve treatment for people with apraxia of speech.

Living with a language impairment can be difficult. Communication challenges interfere with relationships and day-to-day life. This can require extra effort from family, friends, and everybody else who interacts with a person who has apraxia of speech.

Patience is essential to managing this communication difficulty. It is important to work with your speech therapist in order to identify ways to communicate as you work to recover. This can include using pictures, gestures, and other ways of expressing your needs.

Apraxia of speech is a type of language impairment that is caused by damage to the brain, either during fetal development, childhood, or adulthood. This condition can occur along with other neurological deficits that are associated with damage to the brain.

There are many different causes, and a diagnosis of the cause is essential for a comprehensive treatment of speech apraxia, as well as any associated physical and cognitive deficits. Speech therapy is the treatment for the speech impairment seen in this condition.

National Institute on Deafness and Other Communication Disorders. Apraxia of speech .

Vogindroukas I, Stankova M, Chelas EN, Proedrou A. Language and speech characteristics in autism . Neuropsychiatr Dis Treat . 2022;18:2367-2377. doi:10.2147/NDT.S331987

Haley KL, Jacks A. Three-dimensional speech profiles in stroke aphasia and apraxia of speech . Am J Speech Lang Pathol. 2023:1-10. doi:10.1044/2022_AJSLP-22-00170

Hybbinette H, Östberg P, Schalling E, et al. Longitudinal changes in functional connectivity in speech motor networks in apraxia of speech after stroke . Front Neurol. 2022;13:1013652. doi:10.3389/fneur.2022.1013652

Duffy JR, Martin PR, Clark HM, et al. The apraxia of speech rating scale: reliability, validity, and utility . Am J Speech Lang Pathol. 2023;32(2):469-491. doi:10.1044/2022_AJSLP-22-00148

Zhao J, Li Y, Zhang X, et al. Alteration of network connectivity in stroke patients with apraxia of speech after tDCS: a randomized controlled study . Front Neurol. 2022;13:969786. doi:10.3389/fneur.2022.969786

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

• Patient Care & Health Information
• Diseases & Conditions
• Childhood apraxia of speech

Childhood apraxia of speech (CAS) is a rare speech disorder. Children with this disorder have trouble controlling their lips, jaws and tongues when speaking.

In CAS , the brain has trouble planning for speech movement. The brain isn't able to properly direct the movements needed for speech. The speech muscles aren't weak, but the muscles don't form words the right way.

To speak correctly, the brain has to make plans that tell the speech muscles how to move the lips, jaw and tongue. The movements usually result in accurate sounds and words spoken at the proper speed and rhythm. CAS affects this process.

CAS is often treated with speech therapy. During speech therapy, a speech-language pathologist teaches the child to practice the correct way to say words, syllables and phrases.

Children with childhood apraxia of speech (CAS) may have a variety of speech symptoms. Symptoms vary depending on a child's age and the severity of the speech problems.

CAS can result in:

• Babbling less or making fewer vocal sounds than is typical between the ages of 7 to 12 months.
• Speaking first words late, typically after ages 12 to 18 months old.
• Using a limited number of consonants and vowels.
• Often leaving out sounds when speaking.
• Using speech that is hard to understand.

These symptoms are usually noticed between ages 18 months and 2 years. Symptoms at this age may indicate suspected CAS . Suspected CAS means a child may potentially have this speech disorder. The child's speech development should be watched to determine if therapy should begin.

Children usually produce more speech between ages 2 and 4. Signs that may indicate CAS include:

• Vowel and consonant distortions.
• Pauses between syllables or words.
• Voicing errors, such as "pie" sounding like "bye."

Many children with CAS have trouble getting their jaws, lips and tongues to the correct positions to make a sound. They also may have a hard time moving smoothly to the next sound.

Many children with CAS also have language problems, such as reduced vocabulary or trouble with word order.

Some symptoms may be unique to children with CAS , which helps to make a diagnosis. However, some symptoms of CAS are also symptoms of other types of speech or language disorders. It's hard to diagnose CAS if a child has only symptoms that are found both in CAS and in other disorders.

Some characteristics, sometimes called markers, help distinguish CAS from other types of speech disorders. Those associated with CAS include:

• Trouble moving smoothly from one sound, syllable or word to another.
• Groping movements with the jaw, lips or tongue to try to make the correct movement for speech sounds.
• Vowel distortions, such as trying to use the correct vowel but saying it incorrectly.
• Using the wrong stress in a word, such as pronouncing "banana" as "BUH-nan-uh" instead of "buh-NAN-uh."
• Using equal emphasis on all syllables, such as saying "BUH-NAN-UH."
• Separation of syllables, such as putting a pause or gap between syllables.
• Inconsistency, such as making different errors when trying to say the same word a second time.
• Having a hard time imitating simple words.
• Voicing errors, such as saying "down" instead of "town."

Other speech disorders sometimes confused with CAS

Some speech sound disorders often get confused with CAS because some of the symptoms may overlap. These speech sound disorders include articulation disorders, phonological disorders and dysarthria.

A child with an articulation or phonological disorder has trouble learning how to make and use specific sounds. Unlike in CAS , the child doesn't have trouble planning or coordinating the movements to speak. Articulation and phonological disorders are more common than CAS .

Articulation or phonological speech errors may include:

• Substituting sounds. The child might say "fum" instead of "thumb," "wabbit" instead of "rabbit" or "tup" instead of "cup."
• Leaving out final consonants. A child with CAS might say "duh" instead of "duck" or "uh" instead of "up."
• Stopping the airstream. The child might say "tun" instead of "sun" or "doo" instead of "zoo."
• Simplifying sound combinations. The child might say "ting" instead of "string" or "fog" instead of "frog."

Dysarthria is a speech disorder that occurs because the speech muscles are weak. Making speech sounds is hard because the speech muscles can't move as far, as quickly or as strongly as they do during typical speech. People with dysarthria may also have a hoarse, soft or even strained voice. Or they may have slurred or slow speech.

Dysarthria is often easier to identify than CAS . However, when dysarthria is caused by damage to areas of the brain that affect coordination, it can be hard to determine the differences between CAS and dysarthria.

Childhood apraxia of speech (CAS) has a number of possible causes. But often a cause can't be determined. There usually isn't an observable problem in the brain of a child with CAS .

However, CAS can be the result of brain conditions or injury. These may include a stroke, infections or traumatic brain injury.

CAS also may occur as a symptom of a genetic disorder, syndrome or metabolic condition.

CAS is sometimes referred to as developmental apraxia. But children with CAS don't make typical developmental sound errors and they don't grow out of CAS . This is unlike children with delayed speech or developmental disorders who typically follow patterns in speech and sounds development but at a slower pace than usual.

Risk factors

Changes in the FOXP2 gene appear to increase the risk of childhood apraxia of speech (CAS) and other speech and language disorders. The FOXP2 gene may be involved in how certain nerves and pathways in the brain develop. Researchers continue to study how changes in the FOXP2 gene may affect motor coordination and speech and language processing in the brain. Other genes also may impact motor speech development.

Complications

Many children with childhood apraxia of speech (CAS) have other problems that affect their ability to communicate. These problems aren't due to CAS , but they may be seen along with CAS .

Symptoms or problems that are often present along with CAS include:

• Delayed language. This may include trouble understanding speech, reduced vocabulary, or not using correct grammar when putting words together in a phrase or sentence.
• Delays in intellectual and motor development and problems with reading, spelling and writing.
• Trouble with gross and fine motor movement skills or coordination.
• Trouble using communication in social interactions.

Diagnosing and treating childhood apraxia of speech at an early stage may reduce the risk of long-term persistence of the problem. If your child experiences speech problems, have a speech-language pathologist evaluate your child as soon as you notice any speech problems.

Childhood apraxia of speech care at Mayo Clinic

• Jankovic J, et al., eds. Dysarthria and apraxia of speech. In: Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed April 6, 2023.
• Carter J, et al. Etiology of speech and language disorders in children. https://www.uptodate.com/contents/search. Accessed April 6, 2023.
• Childhood apraxia of speech. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/childhood-apraxia-of-speech/. Accessed April 6, 2023.
• Apraxia of speech. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/pages/apraxia.aspx. Accessed April 6, 2023.
• Ng WL, et al. Predicting treatment of outcomes in rapid syllable transition treatment: An individual participant data meta-analysis. Journal of Speech, Language and Hearing Research. 2022; doi:10.1044/2022_JSLHR-21-00617.
• Speech sound disorders. American Speech-Language-Hearing Association. http://www.asha.org/public/speech/disorders/SpeechSoundDisorders/. Accessed April 6, 2023.
• Iuzzini-Seigel J. Prologue to the forum: Care of the whole child — Key considerations when working with children with childhood apraxia of speech. Language, Speech and Hearing Services in Schools. 2022; doi:10.1044/2022_LSHSS-22-00119.
• Namasivayam AK, et al. Speech sound disorders in children: An articulatory phonology perspective. 2020; doi:10.3389/fpsyg.2019.02998.
• Strand EA. Dynamic temporal and tactile cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech-Language Pathology. 2020; doi:10.1044/2019_AJSLP-19-0005.
• Ami TR. Allscripts EPSi. Mayo Clinic. March 13, 2023.
• Kliegman RM, et al. Language development and communication disorders. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed April 6, 2023.
• Adam MP, et al., eds. FOXP2-related speech and language disorder. In: GeneReviews. University of Washington, Seattle; 1993-2023. https://www.ncbi.nlm.nih.gov/books/NBK1116. Accessed April 6, 2023.
• How is CAS diagnosed? Childhood Apraxia of Speech Association of North America. https://www.apraxia-kids.org/apraxia_kids_library/how-is-cas-diagnosed/. Accessed April 13, 2023.
• Chenausky KV, et al. The importance of deep speech phenotyping for neurodevelopmental and genetic disorders: A conceptual review. Journal of Neurodevelopmental Disorders. 2022; doi:10.1186/s11689-022-09443-z.
• Strand EA. Dynamic temporal and tactile cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech Language Pathology. 2020; doi:10.1044/2019_AJSLP-19-0005.
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Speech Sound Disorders in Children

What are speech sound disorders in children?

It’s normal for young children learning language skills to have some trouble saying words the right way. That’s part of the learning process. Their speech skills develop over time. They master certain sounds and words at each age. By age 8, most children have learned how to master all word sounds.

But some children have speech sound disorders. This means they have trouble saying certain sounds and words past the expected age. This can make it hard to understand what a child is trying to say.  

Speech sound problems include articulation disorder and phonological process disorder.

Articulation disorder is a problem with making certain sounds, such as “sh.”

Phonological process disorder is a pattern of sound mistakes. This includes not pronouncing certain letters.

What causes speech sound disorders in a child?

Often, a speech sound disorder has no known cause. But some speech sound errors may be caused by:

Injury to the brain

Thinking or development disability

Problems with hearing or hearing loss, such as past ear infections

Physical problems that affect speech, such cleft palate or cleft lip

Disorders affecting the nerves involved in speech

Which children are at risk for speech sound disorders?

The cause often is not known, but children at risk for a speech sound disorder include those with:

Developmental disorders such as autism

Genetic disorders such as Down syndrome

Hearing loss

Nervous system disorders such as cerebral palsy

Illnesses such as frequent ear infections

Physical problems such as a cleft lip or palate

Too much thumb-sucking or pacifier use

Low education level of the parent

Lack of support for learning in the home

What are the symptoms of speech sound disorders in a child?

Your child’s symptoms depend on what type of speech sound disorder your child has. He or she may have trouble forming some word sounds correctly past a certain age. This is called articulation disorder. Your child may drop, add, distort, or swap word sounds. Keep in mind that some sound changes may be part of an accent. They are not speech errors. Signs of this problem can include:

Leaving off sounds from words (example: saying “coo” instead of “school”)

Adding sounds to words (example: saying “puhlay” instead of “play”)

Distorting sounds in words (example: saying “thith” instead of “this”)

Swapping sounds in words (example: saying “wadio” instead of “radio”)

If your child often makes certain word speech mistakes, he or she may have phonological process disorder. The mistakes may be common in young children learning speech skills. But when they last past a certain age, it may be a disorder. Signs of this problem are:

Saying only 1 syllable in a word (example: “bay” instead of “baby”)

Simplifying a word by repeating 2 syllables (example: “baba” instead of “bottle”)

Leaving out a consonant sound (example: “at” or “ba” instead of “bat”)

Changing certain consonant sounds (example: “tat” instead of “cat”)

How are speech sound disorders diagnosed in a child?

First, your child’s healthcare provider will check his or her hearing. This is to make sure that your child isn’t simply hearing words and sounds incorrectly.

If your child’s healthcare provider rules out hearing loss, you may want to talk with a speech-language pathologist. This is a speech expert who evaluates and treats children who are having problems with speech-language and communication.                       

By watching and listening to your child speak, a speech-language pathologist can determine whether your child has a speech sound disorder. The pathologist will evaluate your child’s speech and language skills. He or she will keep in mind accents and dialect. He or she can also find out if a physical problem in the mouth is affecting your child’s ability to speak. Finding the problem and getting help early are important to treat speech sound disorders.

How are speech sound disorders treated in a child?

The speech-language pathologist can put together a therapy plan to help your child with his or her disorder. These healthcare providers work with children to help them:

Notice and fix sounds that they are making wrong

Learn how to correctly form their problem sound

Practice saying certain words and making certain sounds

The pathologist can also give you activities and strategies to help your child practice at home. If your child has a physical problem in the mouth, the pathologist can refer your child to an ear, nose, throat healthcare provider or orthodontist if needed.

Spotting a speech sound disorder early can help your child overcome any speech problems. He or she can learn how to speak well and comfortably.

How can I help my child live with a speech sound disorder?

You can do things to take care of your child with a speech sound disorder:

Keep all appointments with your child’s healthcare provider.

Talk with your healthcare provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include experts such as speech-language pathologists and counselors. Your child’s care team will depend on your child’s needs and the severity of the speech sound disorder.

Tell others of your child’s disorder. Work with your child’s healthcare provider and schools to develop a treatment plan.

Reach out for support from local community services. Being in touch with other parents who have a child with a speech sound disorder may be helpful.

When should I call my child’s healthcare provider?

Call your child’s healthcare provider if your child has:

Symptoms that don’t get better, or get worse

New symptoms

Key points about speech sound disorders in children

A speech sound disorder means a child has trouble saying certain sounds and words past the expected age.

A child with an articulation disorder has problems making certain sounds the right way.

A child with phonological process disorder regularly makes certain word speech mistakes.

The cause of this problem is often unknown.

A speech-language pathologist can help diagnose and treat a speech sound disorder.

Tips to help you get the most from a visit to your child’s healthcare provider:

Know the reason for the visit and what you want to happen.

Before your visit, write down questions you want answered.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

Ask if your child’s condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if your child does not take the medicine or have the test or procedure.

If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Fluency Disorder

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• Communication Disorders in Children

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Common Speech Impediments: Causes, Symptoms, Treatment, And Support

Speech impediments include a variety of both language and speech disorders, some of which can be addressed through  online speech therapy  with speech-language pathologists. They can arise because of heredity and genetics, developmental delays, or even damage to Broca’s area—the part of the brain that’s involved in language skills and speech skills. They may also be linked to other conditions like autism spectrum disorder, cerebral palsy, dyslexia, or even hearing loss. It depends on the type and the cause, but most speech impediments and speech impairments can be treated through speech therapy.

That said, recognizing when a speech impediment may be present can help you get yourself or your child the treatment and support they may need for improved academic and/or social functioning and self-confidence.

Common symptoms of a speech impediment

There are many different types of speech impediments a person can have, so the symptoms can vary. However, it’s important to understand what symptoms may indicate a speech disorder so that you can seek treatment if necessary. 

Symptoms of a speech disorder

• Elongating words
• Quiet or muffled speech
• Blinking frequently
• Distorted sounds while talking
• Frequent changes in pitch
• Poor voice quality
• Visible frustration when trying to communicate
• Overall difficulty communicating and expressing thoughts and ideas
• Inability to repeat words
• Inability to pronounce words the same way twice
• A phobia of speaking in public
• Speaking slowly and carefully
• Speech delay
• Frequent pauses when talking
• Limited vocabulary over several years, delayed language development

Some speech and language disorders are consistent with underlying mental health conditions such as autism. You can visit licensed health professionals or speech therapists to receive an accurate diagnosis and find out how to treat a speech impediment or language disorder, and its underlying cause, if applicable.

Categories of a speech disorder

Speech impediments or communication disorders can take many forms, from speech sound disorders to voice-related disorders. While speech sound disorders mostly result from sensory or motor causes, voice-related disorders deal with physical problems regarding speech. Read on for a list of some of the most common categories of speech impediments.

Voice disorders

Voice disorders  primarily arise due to issues regarding the health and structure of the larynx or the voice box. They can impact pitch, resonance, volume, and voice quality. Symptoms of a voice disorder may include having a hoarse, quivering, strained, choppy, or weak and whispery voice, which can make it difficult to produce speech sounds.

The root cause of these disorders can be either organic, like alterations to respiratory, laryngeal, or vocal tract mechanisms, or functional, like improper use of the voice. Some risk factors that may contribute to vocal health challenges include allergies, psychological stress, age, excessive alcohol or drug use, screaming, scarring from neck surgery, or even gastroesophageal reflux disease (GERD). Examples of voice disorders include laryngitis, vocal cord paralysis/weakness, polyps or nodes present on the vocal cords, leukoplakia, or muscle tension dysphonia.

Fluency disorders

A person may be diagnosed with a fluency disorder if they have trouble with speech timing and rhythm which makes it difficult to create a normal speech pattern. These disorders are characterized by interruptions in the typical flow of speaking, including abnormal repetitions, hesitation, and prolongations. Their cause is unknown, but it may be genetic. Symptoms can also be exacerbated by stress and anxiety. Stuttering is the most common example of fluency disorders. 

Symptoms of a fluency disorder may include dragging out syllables, speaking breathlessly, repetition of words, speaking slowly, and being tense while speaking. Secondary symptoms may include fidgeting, mumbling, saying “um” or “uh” often, not using certain problematic words, rearranging words in sentences, and anxiety around speaking. Treatment options vary depending on the specific disorder. With stuttering, for example, slowing down, practicing, using speech monitors, attending speech therapy, and receiving cognitive behavioral therapy (CBT) are all potential treatment options.

Articulation disorders and phonological disorders

Articulation and phonological disorders are two types of speech disorders classified as speech sound disorders that may impact communication. An articulation disorder includes speech that commonly exhibits errors such as substitution, omission, distortion, and/or addition (SODA). Although the actual causes of articulation disorders aren’t well understood, contributing factors may include brain injuries, a cleft palate/cleft lip, or nerve damage. Phonological disorders typically involve producing sounds correctly but using them in the wrong place and are more predictable than articulation errors. There may also be a genetic factor that contributes to both disorders and other families may be impacted as well. A licensed speech-language pathologist (SLP) can determine if an individual may have an articulation disorder or a phonological disorder. Ongoing speech therapy is typically the recommended treatment method.

Speech impediments versus language impairments

A speech impediment is typically characterized by difficulty creating sound due to factors like fluency disorders or other voice problems. These disorders may arise from underlying mental health issues, neurological problems, or physical factors or conditions impacting speech muscles.

Language impairments, on the other hand, are more about difficulty processing, reading, and writing and can be connected to an issue processing receptive language. They’re common in children, especially when they first start school. Language impairments relate to meaning, whereas speech impediments relate to sound. It’s also very common for a language impairment disorder to present alongside a learning disability like dyslexia.

An example of speech disorder: Apraxia

Apraxia of speech is a speech sound disorder that affects the pathways of the brain. It’s characterized by a person having difficulty expressing their thoughts accurately and consistently. It involves the brain being able to form the words and knowing exactly what to say, but the person then being unable to properly execute the required speech movements to deliver accurate sounds. In mild cases, a person will only have small limitations in their ability to form speech sounds. In severe cases, alternate communication methods may need to be used.

An SLP is the type of provider who can diagnose apraxia. To diagnose speech disorders, including both childhood apraxia (sometimes called verbal apraxia) and acquired apraxia, they may ask the individual to perform simple speech tasks like repeating a particular word several times or repeating a list of words that increase in length. Apraxia generally needs to be monitored by both parents and an SLP over time for an accurate diagnosis to be possible.

There are various treatment options for apraxia, the most common being one-on-one meetings with a speech pathologist. They’ll likely help you or your child build helpful strategies and skills to help strengthen problem areas and communicate more clearly. Some other treatment methods include improving speech intelligibility or using alternate forms of communication, like electronic speech or manual signs and gestures.

An example of communication disorder: Aphasia

The National Institute on Deafness and Other Communication Disorders describes aphasia as a communication disorder that results in a person’s inability to speak, write, and/or understand language. Like other communication disorders, it may occur because of damage to the portions of the brain that are involved in language, which is common in those who have experienced a stroke. It may also come on gradually in those who have a tumor or a progressive neurological disease like Alzheimer’s. Symptoms may include saying or writing sentences that don’t make sense, a reduction in a person’s ability to understand a conversation, and substituting certain sounds and words for others.

Brain injuries in patients with Aphasia

Since this disorder is usually caused by damage to parts of the brain, it will typically first be recognized in an MRI or CT scan that can confirm the presence of a brain injury. The extent and type of aphasia can generally only be determined by observing the affected part of the brain and determining how extensively it has been damaged, which is often done with the help of an SLP.

Treatment options for aphasia can be restorative (aimed at restoring impaired function) or compensatory (aimed at compensating for deficits).

An example of nervous system disorder: Dysarthria 

Dysarthria is usually caused by brain damage or facial paralysis that affects the muscles of the jaw, tongue, or throat, which may result in deficits in a person’s speech. It may also be caused by other conditions like Lou Gehrig’s disease, Parkinson’s, or a stroke. It’s considered a nervous system disorder, subclassified as a motor speech disorder. It’s commonly seen in those who already have other speech disorders, such as aphasia or apraxia. Symptoms of dysarthria include slurred speech, speaking too slowly, speaking too quickly, speaking very softly, being unable to move one’s lips or jaw, and having monotonous speech.

Exercises to counter muscle weakness

Dysarthria can be diagnosed by an expert in speech-language pathology through an exam and tests like MRI, CT, electromyography, or the Denver articulation screening examination. Treatment depends upon the severity and rate of progression of the disorder. Some potential examples include tactics like slowing down while talking, doing exercises to help strengthen jaw muscles, moving the lips and tongue more, and learning strategies for speaking more loudly. Hand gestures and speech machines may also help. 

Seek treatment if you’re having difficulty with verbal communication

It is important to treat speech disorders; the consequences of an untreated speech or language impediment can vary widely depending on the type, symptoms, and severity, as well as the age and life situation of the individual. In general, it’s usually helpful to seek professional advice on treating speech disorders as soon as you notice or suspect an impediment present in yours or your child’s speech. Especially for moderate to severe cases, some potential effects of leaving these common speech disorders untreated can include:

• Poor academic performance/dropping out of school
• Decrease in quality of life
• Social anxiety and an inability to connect with people
• Damaged relationships
• Social isolation
• Hospitalization

Support options and resources

Meeting with an SLP is usually the recommended first step for someone who believes they or their child may have a speech impediment. If you have a teenager with dyslexia, there are  resources for dyslexic teens  that can give supportive information about the condition. Healthcare providers may also provide helpful insights and ask about your family members’ history when it comes to speech and language-related issues as they can be hereditary.

Therapeutic support for speech impediments

While these professionals can help with the physical aspects of a variety of speech and language impediments, you or your child may also benefit from emotional support in relation to the mental health effects of having an impediment. A therapist may be able to provide this type of guidance. If your child is experiencing a speech impediment, a counselor may be able to work with them to process their feelings of frustration and learn healthy coping mechanisms for stress. They can help you manage the same feelings if you receive a speech or language impediment diagnosis, or may be able to support you in your journey of parenting a child with a speech or language impediment diagnosis.

In addition to support at home, teenagers with a diagnosed speech impairment or impediment can receive special education services at school. The Centers for Disease Control notes that under the Individuals with Disabilities Act (IDEA) and Section 504, schools must provide support and accommodations for students with speech disorders. For some children, support groups can provide outlets for social connections and advice for coping. 

Accessible healthcare options online

Meeting with a therapist in person is an option if there are providers in your area. That said, many people find it less intimidating or more comfortable to meet with a therapist virtually. For example, a teen who is experiencing a speech or language impediment may feel better interacting with a counselor through the online chat feature that virtual therapy platforms like TeenCounseling provide. It may allow them to express themselves more clearly than they could face-to-face or over the phone. Parents who need support in caring for a child with a speech or language impediment may find the availability and convenience of meeting with a therapist through an online therapy service like BetterHelp to be most beneficial. Research suggests that online and in-person therapy offer similar benefits for a variety of conditions, so you can choose the format that’s best for you.

Counselor reviews

See below for reviews of TeenCounseling therapists written by parents who sought help for their children through this service. 

“Kathleen has been good for my daughter to talk to. I am thankful for her to give my daughter someone else's perspective other than her parents. Thank you.”

“I love Ms. Jones. She doesn’t over-talk or judge you. She gives really good advice and if you're confused she knows how to break it down or explain whatever it is so you can understand. If you need to talk about anything, she’s always an open ear and responds quickly. Not only does she give you points from others' perspectives but she steps into yours so she can understand why certain things are the way they are. In my first session, I was nervous and I think she could tell. She’ll crack a joke every now and then to make me feel more comfortable. She’s just such a bundle of joy and a good counselor to have.”

Speech and language impediments can vary widely in terms of types, causes, symptoms, and severity. These are diagnosed by professionals in the field of speech and language pathology or by a medical doctor. A therapist can provide emotional support for those who are having difficulty coping with their own or their child’s diagnosis or other related challenges. 

What are the 3 speech impediments?

Speech impediments can manifest in a variety of ways. Three of the most common are listed below: 

• Voice disorders affect the tone, pitch, quality, and volume of a person’s voice. A person with a voice disorder may have difficulty speaking or being heard clearly by others. Voice disorders can be either functional or organic. Functional disorders occur due to improper use of the parts of the throat that produce speech, such as overuse of the voice leading to vocal fatigue. Organic voice disorders result from physical anatomical changes, such as nodules on the vocal cords. 
• Fluency disorders affect the rate, rhythm, and cadence of speech. Those with fluency disorders may speak in a disjointed, choppy, or prolonged fashion, making them difficult for others to understand clearly. While many types of fluency disorders exist, stuttering is likely the best-known. Speech often requires precise timing to convey a message accurately, which fluency disorders can disrupt. 
• Speech sound disorders are a broad category of disorders that interferes with a person’s ability to produce sounds and words correctly. Speech sound disorders can present very differently from person to person. Sometimes word sounds are omitted or added where not appropriate, and sometimes word sounds are distorted or substituted completely. A typical example of a speech sound disorder is the substitution of “r” for “w” in words like “rabbit” (becoming “wabbit”). Many children experience that substitution, but it does not become a disorder until the child does not outgrow it. 

Other types of disorders can cause problems with expressive communication or tongue-tie those experiencing them, such as developmental language disorder. Language disorders also cause concerns related to expressive communication, but the concerns are due to a lack of understanding of one or more components of language, not an inability to produce or use word sounds. 

What do you call a speech impediment?

Speech impediments are typically referred to as speech disorders . Speech refers to the ability to form speech sounds using the vocal cords, mouth, lips, and tongue. Speech also requires that a rhythm and cadence be maintained. Speech disorders indicate a problem producing intelligible speech; word sounds may be omitted or misplaced, the rhythm of the speech may be difficult to follow, or a person’s voice might be strangely pitched or too soft to hear clearly. 

It is important not to confuse speech disorders with language disorders . Language disorders arise due to difficulty understanding what words mean, how word sounds fit together, or how to use spoken language to communicate. Language problems may affect how a person speaks, but the root cause of the concern is linked to their understanding of language, not their ability to produce intelligible speech. 

How do I know if I have a speech impediment?

If you’re experiencing a sudden onset of impaired speech with no apparent cause, seek medical attention immediately. Strokes, traumatic brain injuries, and other serious medical conditions can cause sudden changes in speaking ability. Gradual changes in speaking ability may also indicate an underlying medical problem. If you’re concerned that your speaking ability has been gradually deteriorating, consider making an appointment with a healthcare provider in the near future. 

Most people with a speech disorder are diagnosed in childhood. Parents often identify speech-related concerns in early childhood based on their child’s speech patterns. The child’s pediatrician may also refer the child to a speech-language pathologist, a professional specializing in evaluating and treating speech disorders. If problems persist until the child is in school, teachers and other school officials might initiate a referral for an evaluation if they believe speech concerns are present. Children often receive speech and language therapy that resolves or improves their speech problems. 

Speech disorders also appear in adulthood, often due to injury or illness. It is also possible, although rare, for speech problems to be misdiagnosed or missed outright during a person’s childhood. In that case, the speech disorder may have been present since childhood and symptoms persisted into adulthood.

If you’re finding it difficult to communicate verbally with others, have an easily identifiable speech problem (like stuttering), or receive feedback that others have trouble understanding you, consider making an appointment with your doctor for an evaluation and referral to the appropriate healthcare providers. 

What are 5 causes of speech impairment?

Speech and language disorders can result from conditions that interfere with the development of perceptual, structural, motor, cognitive, or socioemotional functions. The cause of many speech disorders is unknown, but research has indicated several underlying factors that may be responsible: 

• Pre-existing genetic conditions, like Down’s syndrome or Fragile X syndrome. Evidence suggests that genes may play a role even if genetic abnormalities do not result in a diagnosable genetic condition. 
• Physical abnormalities, such as damage or improper development of the respiratory system, facial muscles, or cranial nerves. 
• Hearing problems, which can delay a child’s acquisition of speech. 
• Neurodevelopmental disorders, such as autism spectrum disorder, may interfere with speech development. There is also evidence to suggest that those with attention-deficit hyperactivity disorder may have a more challenging time acquiring speech skills. 
• Neurological conditions such as cerebral palsy. 

Mental health concerns can also cause problems communicating with others. For example, an underlying anxiety disorder may lead to selective mutism , wherein a child speaks only under certain circumstances. 

Is speech impediment a disability?

A speech-language disorder is considered a “ communication disability ” under the Americans with Disabilities Act (ADA). The ADA requires government and businesses to establish “effective communication” with people who have communication disabilities. Effective communication can be established in several ways. For those with a speech disorder, accommodation may be as simple as ensuring the person can get hold of writing materials if they need to express themselves quickly. In some cases, organizations may use a transliterator, or person trained to recognize unclear speech and repeat it clearly. 

Because speech disorders are known to lead to academic struggles in K-12 and higher education settings, they are categorized as a disability under the Individuals with Disabilities Education Improvement Act (IDEIA) . The IDEIA sets guidelines for all schools in the United States, public or not public, guaranteeing each child a right to accommodations and interventions for their speech disorder. 

Can I fix my speech impediment?

Whether or not a speech disorder can be completely eliminated depends heavily on individual factors. The cause of the disorder, its severity, and the type of speech dysfunction all play a role in determining whether a particular disorder can be completely resolved. While it is not possible to guarantee that a speech disorder can be “cured,” nearly all disorders are treatable, and improvement is likely possible. 

Can you treat a speech impediment?

Yes, many speech disorders are highly treatable. Most people receive treatment as children when most speech disorders become apparent. For children, speech-language pathologists will identify the specific speech disorder, search for an underlying cause, and design an intervention that targets that child’s speech problem. For example, a child who struggles with articulation errors and producing word sounds consistently may benefit from a contextual utilization approach . Contextual utilization leverages the fact that one sound is easier or more difficult to pronounce depending on which other sounds surround it. 

Speech disorders that emerge in adulthood may be more challenging to treat due to underlying factors, such as brain injury. Suppose an adult experiences a traumatic brain injury that affects their speaking ability. In that case, a speech-language pathologist may help them find alternative communication methods, such as using a computer. They may also help them directly restore some of their speaking ability by leading them through exercises that improve nerve function and muscle control.  

Is a speech impediment mental?

Speech disorders can be caused by various factors, many of which have nothing to do with the brain. However, there is a relationship between psychiatric mental health concerns and difficulty with spoken communication . Although researchers are still unsure of the exact cause, studies have identified a significant link between speech disorders and mental health disorders like schizophrenia, bipolar disorder, and major depression. 

Neurodevelopmental disorders, such as autism spectrum disorder and attention-deficit hyperactivity disorder, are also associated with an increased risk of developing a speech disorder. Although the link between neurodevelopmental disorders and speech disorders is not fully understood, evidence suggests that treating the speech disorder is still possible. 

Finally, speech disorders can also be caused by illness or injury in the brain, such as cancer, an infection, or traumatic brain injury. Although these are not considered mental or developmental disorders, they may affect brain function and mental acuity. Speaking is a complex process, and there are many ways it can be affected. 

Is autism a speech impediment?

Autism spectrum disorder is not a speech disorder, but it is heavily associated with communication problems. Those on the autism spectrum often use repetitive or rigid language and may not follow communication norms. They may repeat phrases continuously, use a modified tone of voice, or introduce information that has little to do with the conversation at hand. 

Those on the autism spectrum are often able to form word sounds properly. The communication deficits of autism spectrum disorder are more closely related to language disorders than speech disorders. Speech disorders are associated with difficulty producing or using word sounds correctly, whereas language disorders are associated with a lack of understanding of one or more language components.

Autism spectrum disorder is also characterized by difficulties using pragmatic communication, or communication that is appropriate to a specific social situation. Although not a disorder of speech, a limited ability to recognize the socioemotional content of speech can significantly impact interpersonal communication and social interactions. 

• Navigating Depression In Teens And Young People Medically reviewed by Elizabeth Erban , LMFT, IMH-E
• ADHD Signs In Women, Men, And Children Medically reviewed by Julie Dodson , MA, LCSW
• Relationships and Relations

10 Most Common Speech-Language Disorders & Impediments

As you get to know more about the field of speech-language pathology you’ll increasingly realize why SLPs are required to earn at least a master’s degree . This stuff is serious – and there’s nothing easy about it.

In 2016 the National Institute on Deafness and Other Communication Disorders reported that 7.7% of American children have been diagnosed with a speech or swallowing disorder. That comes out to nearly one in 12 children, and gets even bigger if you factor in adults.

Whether rooted in psycho-speech behavioral issues, muscular disorders, or brain damage, nearly all the diagnoses SLPs make fall within just 10 common categories…

Types of Speech Disorders & Impediments

Apraxia of speech (aos).

Apraxia of Speech (AOS) happens when the neural pathway between the brain and a person’s speech function (speech muscles) is lost or obscured. The person knows what they want to say – they can even write what they want to say on paper – however the brain is unable to send the correct messages so that speech muscles can articulate what they want to say, even though the speech muscles themselves work just fine. Many SLPs specialize in the treatment of Apraxia .

There are different levels of severity of AOS, ranging from mostly functional, to speech that is incoherent. And right now we know for certain it can be caused by brain damage, such as in an adult who has a stroke. This is called Acquired AOS.

However the scientific and medical community has been unable to detect brain damage – or even differences – in children who are born with this disorder, making the causes of Childhood AOS somewhat of a mystery. There is often a correlation present, with close family members suffering from learning or communication disorders, suggesting there may be a genetic link.

Mild cases might be harder to diagnose, especially in children where multiple unknown speech disorders may be present. Symptoms of mild forms of AOS are shared by a range of different speech disorders, and include mispronunciation of words and irregularities in tone, rhythm, or emphasis (prosody).

Stuttering – Stammering

Stuttering, also referred to as stammering, is so common that everyone knows what it sounds like and can easily recognize it. Everyone has probably had moments of stuttering at least once in their life. The National Institute on Deafness and Other Communication Disorders estimates that three million Americans stutter, and reports that of the up-to-10-percent of children who do stutter, three-quarters of them will outgrow it. It should not be confused with cluttering.

Most people don’t know that stuttering can also include non-verbal involuntary or semi-voluntary actions like blinking or abdominal tensing (tics). Speech language pathologists are trained to look for all the symptoms of stuttering , especially the non-verbal ones, and that is why an SLP is qualified to make a stuttering diagnosis.

The earliest this fluency disorder can become apparent is when a child is learning to talk. It may also surface later during childhood. Rarely if ever has it developed in adults, although many adults have kept a stutter from childhood.

Stuttering only becomes a problem when it has an impact on daily activities, or when it causes concern to parents or the child suffering from it. In some people, a stutter is triggered by certain events like talking on the phone. When people start to avoid specific activities so as not to trigger their stutter, this is a sure sign that the stutter has reached the level of a speech disorder.

The causes of stuttering are mostly a mystery. There is a correlation with family history indicating a genetic link. Another theory is that a stutter is a form of involuntary or semi-voluntary tic. Most studies of stuttering agree there are many factors involved.

Dysarthria is a symptom of nerve or muscle damage. It manifests itself as slurred speech, slowed speech, limited tongue, jaw, or lip movement, abnormal rhythm and pitch when speaking, changes in voice quality, difficulty articulating, labored speech, and other related symptoms.

It is caused by muscle damage, or nerve damage to the muscles involved in the process of speaking such as the diaphragm, lips, tongue, and vocal chords.

Because it is a symptom of nerve and/or muscle damage it can be caused by a wide range of phenomena that affect people of all ages. This can start during development in the womb or shortly after birth as a result of conditions like muscular dystrophy and cerebral palsy. In adults some of the most common causes of dysarthria are stroke, tumors, and MS.

A lay term, lisping can be recognized by anyone and is very common.

Speech language pathologists provide an extra level of expertise when treating patients with lisping disorders . They can make sure that a lisp is not being confused with another type of disorder such as apraxia, aphasia, impaired development of expressive language, or a speech impediment caused by hearing loss.

SLPs are also important in distinguishing between the five different types of lisps. Most laypersons can usually pick out the most common type, the interdental/dentalised lisp. This is when a speaker makes a “th” sound when trying to make the “s” sound. It is caused by the tongue reaching past or touching the front teeth.

Because lisps are functional speech disorders, SLPs can play a huge role in correcting these with results often being a complete elimination of the lisp. Treatment is particularly effective when implemented early, although adults can also benefit.

Experts recommend professional SLP intervention if a child has reached the age of four and still has an interdental/dentalised lisp. SLP intervention is recommended as soon as possible for all other types of lisps. Treatment includes pronunciation and annunciation coaching, re-teaching how a sound or word is supposed to be pronounced, practice in front of a mirror, and speech-muscle strengthening that can be as simple as drinking out of a straw.

Spasmodic Dysphonia

Spasmodic Dysphonia (SD) is a chronic long-term disorder that affects the voice. It is characterized by a spasming of the vocal chords when a person attempts to speak and results in a voice that can be described as shaky, hoarse, groaning, tight, or jittery. It can cause the emphasis of speech to vary considerably. Many SLPs specialize in the treatment of Spasmodic Dysphonia .

SLPs will most often encounter this disorder in adults, with the first symptoms usually occurring between the ages of 30 and 50. It can be caused by a range of things mostly related to aging, such as nervous system changes and muscle tone disorders.

It’s difficult to isolate vocal chord spasms as being responsible for a shaky or trembly voice, so diagnosing SD is a team effort for SLPs that also involves an ear, nose, and throat doctor (otolaryngologist) and a neurologist.

Have you ever heard people talking about how they are smart but also nervous in large groups of people, and then self-diagnose themselves as having Asperger’s? You might have heard a similar lay diagnosis for cluttering. This is an indication of how common this disorder is as well as how crucial SLPs are in making a proper cluttering diagnosis .

A fluency disorder, cluttering is characterized by a person’s speech being too rapid, too jerky, or both. To qualify as cluttering, the person’s speech must also have excessive amounts of “well,” “um,” “like,” “hmm,” or “so,” (speech disfluencies), an excessive exclusion or collapsing of syllables, or abnormal syllable stresses or rhythms.

The first symptoms of this disorder appear in childhood. Like other fluency disorders, SLPs can have a huge impact on improving or eliminating cluttering. Intervention is most effective early on in life, however adults can also benefit from working with an SLP.

Muteness – Selective Mutism

There are different kinds of mutism, and here we are talking about selective mutism. This used to be called elective mutism to emphasize its difference from disorders that caused mutism through damage to, or irregularities in, the speech process.

Selective mutism is when a person does not speak in some or most situations, however that person is physically capable of speaking. It most often occurs in children, and is commonly exemplified by a child speaking at home but not at school.

Selective mutism is related to psychology. It appears in children who are very shy, who have an anxiety disorder, or who are going through a period of social withdrawal or isolation. These psychological factors have their own origins and should be dealt with through counseling or another type of psychological intervention.

Diagnosing selective mutism involves a team of professionals including SLPs, pediatricians, psychologists, and psychiatrists. SLPs play an important role in this process because there are speech language disorders that can have the same effect as selective muteness – stuttering, aphasia, apraxia of speech, or dysarthria – and it’s important to eliminate these as possibilities.

And just because selective mutism is primarily a psychological phenomenon, that doesn’t mean SLPs can’t do anything. Quite the contrary.

The National Institute on Neurological Disorders and Stroke estimates that one million Americans have some form of aphasia.

Aphasia is a communication disorder caused by damage to the brain’s language capabilities. Aphasia differs from apraxia of speech and dysarthria in that it solely pertains to the brain’s speech and language center.

As such anyone can suffer from aphasia because brain damage can be caused by a number of factors. However SLPs are most likely to encounter aphasia in adults, especially those who have had a stroke. Other common causes of aphasia are brain tumors, traumatic brain injuries, and degenerative brain diseases.

In addition to neurologists, speech language pathologists have an important role in diagnosing aphasia. As an SLP you’ll assess factors such as a person’s reading and writing, functional communication, auditory comprehension, and verbal expression.

Speech Delay – Alalia

A speech delay, known to professionals as alalia, refers to the phenomenon when a child is not making normal attempts to verbally communicate. There can be a number of factors causing this to happen, and that’s why it’s critical for a speech language pathologist to be involved.

The are many potential reasons why a child would not be using age-appropriate communication. These can range anywhere from the child being a “late bloomer” – the child just takes a bit longer than average to speak – to the child having brain damage. It is the role of an SLP to go through a process of elimination, evaluating each possibility that could cause a speech delay, until an explanation is found.

Approaching a child with a speech delay starts by distinguishing among the two main categories an SLP will evaluate: speech and language.

Speech has a lot to do with the organs of speech – the tongue, mouth, and vocal chords – as well as the muscles and nerves that connect them with the brain. Disorders like apraxia of speech and dysarthria are two examples that affect the nerve connections and organs of speech. Other examples in this category could include a cleft palette or even hearing loss.

The other major category SLPs will evaluate is language. This relates more to the brain and can be affected by brain damage or developmental disorders like autism. There are many different types of brain damage that each manifest themselves differently, as well as developmental disorders, and the SLP will make evaluations for everything.

Issues Related to Autism

While the autism spectrum itself isn’t a speech disorder, it makes this list because the two go hand-in-hand more often than not.

The Centers for Disease Control and Prevention (CDC) reports that one out of every 68 children in our country have an autism spectrum disorder. And by definition, all children who have autism also have social communication problems.

Speech-language pathologists are often a critical voice on a team of professionals – also including pediatricians, occupational therapists, neurologists, developmental specialists, and physical therapists – who make an autism spectrum diagnosis .

In fact, the American Speech-Language Hearing Association reports that problems with communication are the first detectable signs of autism. That is why language disorders – specifically disordered verbal and nonverbal communication – are one of the primary diagnostic criteria for autism.

So what kinds of SLP disorders are you likely to encounter with someone on the autism spectrum?

A big one is apraxia of speech. A study that came out of Penn State in 2015 found that 64 percent of children who were diagnosed with autism also had childhood apraxia of speech.

This basic primer on the most common speech disorders offers little more than an interesting glimpse into the kind of issues that SLPs work with patients to resolve. But even knowing everything there is to know about communication science and speech disorders doesn’t tell the whole story of what this profession is all about. With every client in every therapy session, the goal is always to have the folks that come to you for help leave with a little more confidence than when they walked in the door that day. As a trusted SLP, you will build on those gains with every session, helping clients experience the joy and freedom that comes with the ability to express themselves freely. At the end of the day, this is what being an SLP is all about.

Ready to make a difference in speech pathology? Learn how to become a Speech-Language Pathologist today

• Emerson College - Master's in Speech-Language Pathology online - Prepare to become an SLP in as few as 20 months. No GRE required. Scholarships available.
• Arizona State University - Online - Online Bachelor of Science in Speech and Hearing Science - Designed to prepare graduates to work in behavioral health settings or transition to graduate programs in speech-language pathology and audiology.
• NYU Steinhardt - NYU Steinhardt's Master of Science in Communicative Sciences and Disorders online - ASHA-accredited. Bachelor's degree required. Graduate prepared to pursue licensure.
• Calvin University - Calvin University's Online Speech and Hearing Foundations Certificate - Helps You Gain a Strong Foundation for Your Speech-Language Pathology Career.

• Children's Health

What Is a Lisp?

A lisp is a speech impediment that specifically relates to making the sounds associated with the letters S and Z. Lisps usually develop during childhood and often go away on their own. But some persist and require treatment.

What Causes a Lisp?

There are no known causes of lisps. Some people think that using a pacifier after a certain age may contribute to lisps. They believe prolonged pacifier use can strengthen the muscles of the tongue and lips, making lisps more likely. However, pacifier usage is not a factor in every child with a lisp. Additionally, each child who uses a pacifier doesn't get a lisp.

Other possible causes of lisps include:

• Tongue-tie — a condition where the tongue is tethered to the bottom of the mouth. This restricts its movement. Another name for a tongue-tie is ankyloglossia.
• Problems with jaw alignment.
• Simply having learned to say the sound incorrectly.

When Is Lisping a Concern?

Many young children have some kind of lisp as they learn to talk. It is one of the most common speech impediments. About 23% of speech-language pathologist clients have lisps. 

However, you may want to look into professional help if your child is still lisping after the age of 4 1/2. However, children as young as three years old can work on lisping with a speech-language pathologist.

Types of Lisps

There are four types of lisps:

• Frontal lisp. This lisp occurs when you push your tongue too far forward, making a "th" sound when trying to words with S or Z in them.
• Lateral lisp. Extra air slides over your tongue when making S and Z sounds, making it sound like there is excess saliva.
• Palatal lisp. You touch your tongue to the roof of your mouth when making S and Z sounds.
• Dental lisp. This lisp sounds like a frontal lisp. The difference is that instead of pushing the tongue through the teeth, it is pressing against the teeth.

Treatment for Lisps

Speech-language pathologists are specialists who can help children with lisps. They will evaluate what type of lisp your child has and then help them with it over a period of time. It can take anywhere from a few months to a few years to get rid of a lisp. If a child is older when they start working with a speech-language pathologist, it may take a longer time. 

Speech pathologists work with people who have lisps to help them recognize what their lisp sounds like and how to position their tongue in the correct place to make the sound. They do this by giving them exercises to do, like saying specific words or phrases with the sounds in them. Once your child has been working on their lisp for a while, your speech pathologist will engage them in conversation to challenge them to remember proper tongue placement.

If your child's lisp is from a tongue-tie, a doctor may recommend a simple in-office procedure called a frenotomy to reduce the tethering. They take a pair of scissors and snip the excess tissue holding the tongue down. If the tongue-tie is more severe, a surgery called a frenuloplasty may be required.

How to Find a Speech-Language Pathologist

Make sure that any speech-language pathologist you take your child to is licensed. In the US, each state has a different licensure process for speech-language therapists. They may also opt to get an additional certification from ASHA — the American Speech-Language-Hearing Association. Those who have this certification show they meet certain qualifications and follow ASHA's code of ethics. 

You should also make sure the speech-language therapist is child-friendly. You may be able to find this information on their website or by reading reviews online. In the session, you can also observe the interaction to make sure you are comfortable with how the therapist is treating your child.

After evaluation, the speech-language pathologist should be able to tell which type of lisp your child has. They should also be able to recommend exercises specific to that type of lisp to help your child. 

Other Types of Speech Impediments

Lisps are just one type of speech impediment. Other common speech impediments include:

• Lambdacism. Trouble saying the letter L. People with lambdacism often use the R sound as a substitute.
• Rhotacism. Difficulty with saying the letter R correctly.

The three most common speech impediments are sigmatism (lisping), lambdacism, and rhotacism. However, other people can also have trouble pronouncing the sounds associated with the letters K, G, T, D, and E. 

Home Remedies to Help Lisps

Whether or not your child sees a speech-language pathologist, there are things you can do at home to help your child's lisp, including:

• Treat allergies and sinus problems that may lead to lisping.
• Curb thumb sucking .
• Have your child drink through a straw to build strength.
• Encourage playtime with things like bubbles or horns.

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What Causes Aphonia (Loss of Voice)?

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Aphonia is the medical term for losing your voice. This happens when your speech is very hoarse, strained, or no louder than a whisper, making it difficult for you to vocalize. Several factors can cause aphonia, such as allergies, respiratory infections (like the flu or COVID-19), and functional problems with your vocal cords.

Aphonia is usually temporary, and the condition is common. Research suggests that at least one in 13 adults experiences losing their voice at least once in their lives. If you lose your voice, resting it, staying hydrated, and certain therapies can help it return.

What Does Aphonia Feel Like?

When you develop aphonia, it can become difficult to speak audibly or make your voice loud enough to be heard. Many people notice that their voice becomes raspy, hoarse, or breathy. If you try to speak when you have aphonia, speaking can cause fatigue and make the voice weak or labored. You may even try to avoid speaking at all.

Depending on what caused you to lose your voice, the onset of these symptoms can happen suddenly or gradually. Generally, you'll only lose your voice for a few days, but speech disorders can cause aphonia to become chronic. In these cases, it can take weeks or months to get your voice back.

What Causes You To Lose Your Voice?

Vocal sounds are produced as air from the lungs pushes through the larynx (voice box) in the throat, which contains vocal cords. These vocal cords are bands of tissue and muscle that vibrate and create sound. As sound moves out of the larynx, the passages of the throat and nose help make sound louder.

Several conditions and health factors can affect this process, which can cause you to lose your voice.

Also known as allergy-related laryngitis , allergies can cause your vocal cords to become inflamed, leading to symptoms like hoarseness, weak voice, and, ultimately, aphonia. Factors like pollen and dust can trigger allergies and cause additional symptoms such as sneezing, coughing , itchy throat, watery eyes, nasal congestion, headache, and fatigue.

Respiratory Infections

Infections that affect the upper respiratory system, such as the common cold , influenza (the flu), COVID-19, or pneumonia, can also lead to aphonia. When you experience these infections, your throat can become inflamed and cause you to lose your voice or feel hoarse. Respiratory infections can also cause other symptoms, such as headaches, a runny nose, coughing, sneezing, and fatigue.

Voice Misuse

Some people develop aphonia due to the strain of talking loudly, yelling, or screaming too much. Think of this as the type of voice loss you get from cheering at a game or singing loudly at a concert. The vocal cords develop fatigue, affecting your ability to vocalize properly.

People who work in environments that require you to overuse your vocal cords (such as teachers, professional speakers, or singers) may be more prone to aphonia.

Structural Issues

Structural problems with the vocal cords, which may often occur with abnormal growths or cancer, can also lead to aphonia. Potential causes include:

• Edema (swelling): Reinke’s edema is when a noncancerous growth develops in the larynx, affecting the voice. This is a rare condition that can occur if you smoke often or experience frequent secondhand smoke . As a result, the condition makes it difficult for you to control your pitch and can cause long-term hoarseness or aphonia.
• Nodules: Vocal cord nodules, cysts, and polyps are noncancerous growths that occur due to vocal misuse, excessive and loud talking, smoking, and allergies. In addition to losing your voice, nodules can make your voice hoarse and scratchy, cause a feeling of a lump in your throat, and lead to neck pain .  
• Aging: As you get older, your vocal cords naturally weaken and change structure. This can lead to aphonia, hoarseness, vocal fatigue, and a weak voice.
• Laryngeal cancer: Aphonia and voice hoarseness can also be early signs of laryngeal cancer, which causes cancer cells in your larynx. This condition is more common in people who use alcohol and tobacco. Alongside a loss of voice, this cancer can also cause painful swallowing, sore throat, ear pain, and swollen lymph nodes in the neck.

Neurological Problems

Problems with the parts of the brain or nerves that regulate vocal cords can cause a type of aphonia called neurogenic aphonia. Damage to your vagal nerves—found on either side of the neck—can lead to vocal cord paralysis, or the complete inability of the vocal cords to move.

Several conditions can affect these nerve pathways and affect the voice through loss of motor control and paralysis, such as:

• Multiple sclerosis
• Parkinson's disease
• Tremors (shaking)
• Muscle tension dysphonia (tight vocal cords)
• Paradoxical vocal fold motion (vocal cords close when they should be open)

Psychological Factors

Losing your voice can also be a purely psychological reaction. Stress , trauma, extreme fear, and severe anxiety can sometimes cause you to lose your voice, especially if you lose your voice when an underlying condition isn't the cause of your aphonia.

People with the following conditions and symptoms can be at a higher risk of developing psychogenic aphonia:

• Motor difficulty or uncontrolled movements (tics)
• Difficulty swallowing (dysphagia)
• Trouble walking
• Hallucinations
• Dementia or memory loss

When to Contact a Healthcare Provider

Losing your voice can affect your everyday activities and your overall quality of life. You should contact your healthcare provider if you:

• Notice your voice is raspy or hoarse
• Can't speak at all
• Aren't able to sing notes that you once were able to
• Have a sudden lower, deeper pitch to your voice
• Feel your voice is wavering or weak
• Experience a raw, scratchy, or sore throat
• Develop fatigue when speaking or have difficulty talking
• Are constantly clearing your throat

Your healthcare provider will refer you to an ear, nose, and throat (ENT) specialist to diagnose and treat aphonia. At your appointment, your ENT will ask about your medical history, perform a physical exam, and complete a laryngoscopy .

There are two options for a laryngoscopy: rigid and flexible. A rigid exam runs a tube that's attached to a tiny camera down your throat to assess inflammation and signs of nodules. A flexible exam involves accessing the larynx through the nose, which helps your provider observe your larynx while you talk, sing, or cough.

The treatment for aphonia depends on the underlying cause. If you lose your voice due to allergies, a temporary infection, or speaking too loudly, it's important to get rest, stay hydrated, and avoid using your voice when possible.

If an underlying health condition such as cancer or an autoimmune disorder causes your aphonia, your healthcare provider will treat the whole condition and offer other therapies if your aphonia doesn't improve. These therapies may include:

• Speech therapy : If your ENT suspects a neurological concern or function issue as the cause of your aphonia, they may refer you to a speech-language pathologist (SLP). An SLP will use vocal and breathing exercises that can improve the function of your vocal cords. They can also show you exercises to do at home to maintain your vocal health.
• Psychotherapy :  If your aphonia is due to psychological reasons, such as stress, anxiety, or trauma, your provider may refer you to a mental health specialist, such as a psychologist or therapist, for counseling and therapy. Your therapist may suggest talk therapy, such as cognitive-behavioral therapy, to help you identify and work through stressors.

How To Prevent Aphonia

You can do several things to lower your risk of losing your voice. Consider these preventative strategies:  

• Drink enough water throughout the day
• Avoid or quit smoking
• Consume a diet high in whole grains, fruits, and vegetables to maintain good vocal health
• Limit spicy foods and alcohol, which can trigger acid reflux and affect your throat
• Wash your hands frequently to limit the risk of respiratory infections
• Get enough sleep to protect your voice
• Try not to scream, yell, or talk and sing too loudly to avoid putting strain on your vocal cords
• Rest your voice, especially when you're sick

A Quick Review

Aphonia is the medical term for losing your voice. When you develop aphonia, you may experience difficulty speaking, hoarseness in your voice, and a sore throat, among other symptoms. Several underlying factors can cause you to lose your voice, such as straining your voice, contracting a respiratory infection, experiencing allergies, or living with a chronic health condition, such as cancer.

Most cases of acute (short-term) aphonia that occur with a respiratory infection, after straining your voice, or due to recent stress resolve with several days of rest and hydration. Psychotherapy and speech therapy may be indicated if you have a long-term case of aphonia.

Reach out to a healthcare provider if symptoms persist or if you have other risk factors or associated symptoms. Seek immediate medical attention if you have symptoms like shortness of breath, chest pain, difficulty swallowing, or drooling. This may indicate further testing and visualization through a laryngoscopy.

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