SPEECH Disorder. Speech is "an act of communication by articulating verbal expression."
Speech development follows a sequence of events from sucking, swallowing, and chewing (1-3 months) to babbling (3-15 months) and finally the acquisition of true speech (18-50 months).
Stabilization of articulation skills is attained at 50-80 months.
Sound production also follows a sequence from the simplest sounds to the more complex. Normal children may not be able to master the most difficult sounds until 7-8 years.
Intelligibility of speech usually increases at the rate of 25 percent per year. A one- year-old child has about 25 percent intelligibility of speech. At two years 50 percent, at age 3 years 75 percent and expect about 100 percent intelligibility at age 4 years. Delay in intelligibility is an indication for evaluation and possible intervention.
Speech delay is failure in the progression of verbal skills at expected rate or time. The causes of speech delay are: mental retardation, hearing loss, developmental language disorders, environmental deprivation and neglect and autistic spectrum disorders.
Children needing referral include those without meaningful words at 18 months of age, meaningful phrases by 2 years or those with unintelligible speech at age 3 years.
Neuromuscular (nerves and muscles) and structural features are factors that influence speech development.
Neuromuscular control on the coordination of respiration with movements of the articulators (lips, tongue, teeth, throat and vocal cords) is responsible for the production of speech.
Children with neurological disabilities like cerebral palsy may result in dysfunction of neuromuscular control, delaying speech development.
Structural features needed for the oral mechanism (lips, tongue, palate, roof of mouth, throat, and vocal cords) must be intact for speech production.
Structural defects like cleft lip and cleft palate, structural impairment of tongue or malocclusion of teeth will result in speech problem.
Articulatory defects consist in errors of substitution as in "thun" for "sun" and "wewow" for "yellow"; distortion errors as "bud" for "bird". Another error is omission of consonants at the end words like "cu" for "cup".
Normally, most vowels are acquired in infancy. Consonants are acquired over the next 2 years. Areas of concerns and are indications for evaluation are: articulations that are unintelligible after age three years; many substitutions after age five years; child who uses vowel sounds with few or no consonants: word endings are constantly dropped after age five years.
If hearing is normal in these children, majority of the articulation problems under 7 years can be handled at home by mother, in nursery school, or in the classroom. Everybody around the child is instructed to use clear, precise speech -- no baby talk in order to provide suitable models for the child to follow.
Most children will improve in a good speech environment. For articulatory defects after 7 years of age should be referred to a speech therapist.
"Tongue tie"
A short lingual frenulum (a connecting fold of mucous membrane under the tongue) is often blamed for delay in speech development. A very short lingual frenulum can sometimes interfere with the mobility of tongue, breastfeeding, and speech.
A true "tongue tie" is rarely found. If the child can articulate and say "ta-ta" or "dada" and can extend the tip of his tongue past the lips and can lick ice cream on a cone or lollipop, the speech problem is not due to "tongue-tie".
Only if the tongue is tightly bound to the lower central incisors (lower front teeth) surgical treatment may be indicated.
Stuttering
Stuttering (fluency problem disorders) are disruptions in the fluent production of speech that involve word or phrase repetitions, sound prolongation, or excessive pauses and hesitations. This is common in preschool children.
However, majority of stuttering do not persist beyond 5 or 6 years of age.
Persistence of stuttering beyond 6 years of age is found in children with positive family history of stuttering, those with anxiety provoking stress related to talking such as anxious parents who have labeled the child "stutterer", or an anxious child who anticipates speech difficulty.
The onset of stuttering occurs at 3 years of age. The prevalence is 2.5% among preschoolers and 1% in all age groups. The onset is sudden in 40 percent of children.
Treatment is aimed at the child's environment. The cooperation and participation of the family is important. Members of the family are advised to change home conditions that may provoke stuttering episodes.
Encourage the child to speak, giving him time to speak, encourage and maintain eye contact with him and be a good listener. Avoid comments such as "slow down", "start all over again", "stop and think before you try to talk", or suggestions to correct his speaking.
Provide a relaxed and easy speech model for the child to follow and reduce the need to speak to strangers, authority figures or to compete with siblings or others. If the problem of fluency have not improved in 3 months and the child develops struggle reactions such as facial tics and grimaces to avoid speaking or if the child is aware of his problem and is trying to modify them should be referred to a professional for treatment.
Voice disorders
Voice disorders are common in children. They are mostly hoarseness or partial loss of voice. Children usually abuse their voices like frequent screaming, yelling, singing and loud talking. Hoarseness is also found in children with allergy, those with chronic (long duration) respiratory infection or sometimes the presence of tiny nodules in the vocal cords.
Tell the child to stop yelling, or singing loudly. Treat the allergy and tell the child to alter voice pitch.
Voice dysfunction
Voice dysfunction is relatively uncommon. Nasal (pertaining to the nose) voice or nasality may be either hyper (increased) nasality or hypo (decreased) nasality of voice. Hyper-and hypo-nasality of voice are resonance disorders.
Hypernasality may be functional from inadequate function of the palate (structures at roof of the mouth that separate the mouth from the nose consisting of hard and soft palates) or the presence of structural defects such as cleft palate.
Functional hypernasality of voice is treated by teaching the child to use his soft palate in blowing exercises. Several periods devoted each day to blowing soap bubbles, horns, whistles, or playing instruments like harmonica, trumpet, flute or clarinet.
Hyponasality of voice maybe caused by an obstructed nasal airway (nasal polyps, colds, or excessively enlarged adenoids -- tonsils behind the nose). Treatment of the cause will make hyponasality disappear. If it persists for more than 2 months after treatment, the child should be referred to speech therapist. (PVI)
