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Targeted Word Lists for Speech Therapy Practice

The speech therapy word lists are perfect for anyone who needs practice with speech and language concepts . For any type of practice...

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This page has words for anyone to practice articulation, apraxia, language, phonology, or stuttering principles . They will help children and adults be successful meeting their goals. 

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Each list of articulation sounds contains words with the target sound in the beginning, middle, and end position, including blends when applicable, as well as words that...

• are common and functional (words we use all day...everyday)
• are mostly 1 syllable (multi-syllabic words are more difficult)
• have a phonemic context that don't interfere with production of the target sound (most words)

If "R" is the problem sound using the word "Rope" makes saying the "R" sound harder because the "O" sound is considered a round vowel.

A round vowel is one where you round your lips to say it. Go ahead...try it by saying "O" as in "boat". You rounded your lips didn't you? I thought you might.

Children who have difficulty with the "R" sound tend to say the "W" sound...they say "Wabbit" instead of "Rabbit".

The "W" sound is considered a rounded sound too. Try saying the "W" sound without rounding your lips...you can't because that is how the sound is made.

So by pairing the "R" sound with the "O" sound like in the word "Rope", this makes the word extra difficult for a child who has a problem saying the "R" sound because the "O" that follows the "R" will naturally make them want to round there lips.

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Hard Words to Say with a Lisp: How to Work Around Your Speech Disability

Saying hard words is never easy, but it can be especially difficult when you have a speech disability. A lisp is a common speech disability that can make it difficult to pronounce certain sounds. If you have a lisp, don’t worry! There are plenty of ways to work around your speech disability and still communicate effectively with others. In this blog post, we will discuss some strategies that you can use to overcome your lisp and say hard words with ease!

What is a lisp, and how do you know if you have one?

Common causes of lisps, hard words to say with a lisp, how to correct a lisp, when is the best time to seek help for a lisp, how speech therapy can help correct a lisp.

What is a lisp? A l isp is a speech disorder that can make it difficult to say certain words. This disorder can make it difficult to produce the /s/ and /z/ sounds. A lisp is a very common sort of speech impediment.

It does not matter if you find the English language difficult or the Spanish language is harder. But the way you pronounce a difficult word, whether it’s from a native or foreign language, is what involves a lisp. If you are not sure if you have a lisp, there are a few ways that you can check. One way is to say the word “seesaw”. You will most likely say “seesaw” as “seesaow” if you have a lisp. Another way to check is to say the word “lizard”. If you have a lisp, you will most likely say “lizard” as “lidger”. If you think you may have a lisp, it is important to speak with your doctor.

Common causes of this functional speech disorder can include:

• Neurological problems:  Some people may develop a lisp due to a neurological problem, such as a stroke.
• Mouth and teeth problems:  Some people may develop a lisp if they have problems with their mouth or teeth, such as a misaligned jaw. Or they may either have a tongue tie or tongue thrust. Tongue-tie is a condition where the tongue is firmly connected to the floor of the mouth and movement is restricted. Tongue thrust is when the tongue protrudes between the front teeth.
• Speech disorders:  Some people may develop a lisp if they have another speech disorder or learn to pronounce sounds incorrectly.

What Are the Types of Lisps?

There are four professional categories of lisps , as the Speech-Language Pathology Graduate Programs outlines.

A  frontal lisp  is the most common and occurs when individuals push their tongues too far forward.

A  lateral lisp  happens if air moves over the sides of the tongue when speaking, resulting in a slurred sound.

People with  palatal lisps  touch their tongue to the roof of their mouth while saying certain sounds.

Dental lisps  are easily confused with frontal lisps, but these occur with the wrong mouth position; the individual pushes their tongue against the teeth — not through them.

If you have a lisp, it can be difficult to say certain words. Some of the hardest words to say with a lisp include “th” sounds (as in “think”), “s” sounds (as in “see”), and “z” sounds (as in “zoo”). Many people think that a lisp is usually only found in kids before the age of five. By the time they attend school, many would think they wouldn’t have lisp anymore and go on with their everyday lives. But honestly, it can still be present in adults who did not take this speech impediment seriously and did not seek help. If you have difficulty in pronouncing the word with s, z, and th, please consider that you have a lisp.

Here are some hard words to say with a lisp:

• narcissistic
• sixth sense
• statistician
• specificities
• Mississippi

This is just a shortlist of problematic word lisp, and there sure are plenty more speech sound errors that you may find as you continue reading words.

If you have a lisp , there are a few things that you can do to help correct it.

Practice on your own.

One thing is to practice saying the words that are difficult for you. Another thing is to make sure that you are using the right muscles when you speak. You can do this by practicing your speech in front of a mirror.

Seek out a Speech pathologist

They 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 a few months to a few years to get rid of a lisp. If a child is older when working with a speech-language pathologist, it may take longer.

Frenotomy or frenulopasty

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, they might require a surgery called frenuloplasty.

Other strategies

Another strategy is to mime the words that you are trying to say. This can help you get the pronunciation correct. You can also try speaking more slowly and enunciating each word clearly.

If you are having difficulty pronouncing certain words, it is best to seek help as soon as possible. The earlier you seek help, the easier it will be to correct the lisp. If you wait too long, the speech muscles may become harder to retrain.

If you have a lisp, speech therapy can help correct it. Speech therapists will evaluate your lisp and give you exercises to help improve your pronunciation. It may take time and effort, but you can overcome your lisp with patience and practice.

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, 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.

Lisps are just one type of speech impediment. There are still others who have difficulty saying short or long words with R, L, D, K, and many more. Now that you know some of the mispronounced words that you need to work on, you can either practice on your own or find professional help to help you pronounce words correctly.

References:

https://www.colgate.com/en-us/oral-health/developmental-disabilities/what-is-a-lisp-and-what-causes-it

https://www.wordnik.com/lists/lispers-nemeses

https://www.webmd.com/children/what-is-a-lisp#091e9c5e8217eb1b-1-4

https://www.wikihow.com/Talk-with-a-Lisp

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Types of Speech Impediments

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

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Articulation Errors

Ankyloglossia, treating speech disorders.

A speech impediment, also known as a speech disorder , is a condition that can affect a person’s ability to form sounds and words, making their speech difficult to understand.

Speech disorders generally become evident in early childhood, as children start speaking and learning language. While many children initially have trouble with certain sounds and words, most are able to speak easily by the time they are five years old. However, some speech disorders persist. Approximately 5% of children aged three to 17 in the United States experience speech disorders.

There are many different types of speech impediments, including:

• Articulation errors

This article explores the causes, symptoms, and treatment of the different types of speech disorders.

Speech impediments that break the flow of speech are known as disfluencies. Stuttering is the most common form of disfluency, however there are other types as well.

Symptoms and Characteristics of Disfluencies

These are some of the characteristics of disfluencies:

• Repeating certain phrases, words, or sounds after the age of 4 (For example: “O…orange,” “I like…like orange juice,” “I want…I want orange juice”)
• Adding in extra sounds or words into sentences (For example: “We…uh…went to buy…um…orange juice”)
• Elongating words (For example: Saying “orange joooose” instead of "orange juice")
• Replacing words (For example: “What…Where is the orange juice?”)
• Hesitating while speaking (For example: A long pause while thinking)
• Pausing mid-speech (For example: Stopping abruptly mid-speech, due to lack of airflow, causing no sounds to come out, leading to a tense pause)

In addition, someone with disfluencies may also experience the following symptoms while speaking:

• Vocal tension and strain
• Head jerking
• Eye blinking
• Lip trembling

Causes of Disfluencies

People with disfluencies tend to have neurological differences in areas of the brain that control language processing and coordinate speech, which may be caused by:

• Genetic factors
• Trauma or infection to the brain
• Environmental stressors that cause anxiety or emotional distress
• Neurodevelopmental conditions like attention-deficit hyperactivity disorder (ADHD)

Articulation disorders occur when a person has trouble placing their tongue in the correct position to form certain speech sounds. Lisping is the most common type of articulation disorder.

Symptoms and Characteristics of Articulation Errors

These are some of the characteristics of articulation disorders:

• Substituting one sound for another . People typically have trouble with ‘r’ and ‘l’ sounds. (For example: Being unable to say “rabbit” and saying “wabbit” instead)
• Lisping , which refers specifically to difficulty with ‘s’ and ‘z’ sounds. (For example: Saying “thugar” instead of “sugar” or producing a whistling sound while trying to pronounce these letters)
• Omitting sounds (For example: Saying “coo” instead of “school”)
• Adding sounds (For example: Saying “pinanio” instead of “piano”)
• Making other speech errors that can make it difficult to decipher what the person is saying. For instance, only family members may be able to understand what they’re trying to say.

Causes of Articulation Errors

Articulation errors may be caused by:

• Genetic factors, as it can run in families
• Hearing loss , as mishearing sounds can affect the person’s ability to reproduce the sound
• Changes in the bones or muscles that are needed for speech, including a cleft palate (a hole in the roof of the mouth) and tooth problems
• Damage to the nerves or parts of the brain that coordinate speech, caused by conditions such as cerebral palsy , for instance

Ankyloglossia, also known as tongue-tie, is a condition where the person’s tongue is attached to the bottom of their mouth. This can restrict the tongue’s movement and make it hard for the person to move their tongue.

Symptoms and Characteristics of Ankyloglossia

Ankyloglossia is characterized by difficulty pronouncing ‘d,’ ‘n,’ ‘s,’ ‘t,’ ‘th,’ and ‘z’ sounds that require the person’s tongue to touch the roof of their mouth or their upper teeth, as their tongue may not be able to reach there.

Apart from speech impediments, people with ankyloglossia may also experience other symptoms as a result of their tongue-tie. These symptoms include:

• Difficulty breastfeeding in newborns
• Trouble swallowing
• Limited ability to move the tongue from side to side or stick it out
• Difficulty with activities like playing wind instruments, licking ice cream, or kissing
• Mouth breathing

Causes of Ankyloglossia

Ankyloglossia is a congenital condition, which means it is present from birth. A tissue known as the lingual frenulum attaches the tongue to the base of the mouth. People with ankyloglossia have a shorter lingual frenulum, or it is attached further along their tongue than most people’s.

Dysarthria is a condition where people slur their words because they cannot control the muscles that are required for speech, due to brain, nerve, or organ damage.

Symptoms and Characteristics of Dysarthria

Dysarthria is characterized by:

• Slurred, choppy, or robotic speech
• Rapid, slow, or soft speech
• Breathy, hoarse, or nasal voice

Additionally, someone with dysarthria may also have other symptoms such as difficulty swallowing and inability to move their tongue, lips, or jaw easily.

Causes of Dysarthria

Dysarthria is caused by paralysis or weakness of the speech muscles. The causes of the weakness can vary depending on the type of dysarthria the person has:

• Central dysarthria is caused by brain damage. It may be the result of neuromuscular diseases, such as cerebral palsy, Huntington’s disease, multiple sclerosis, muscular dystrophy, Huntington’s disease, Parkinson’s disease, or Lou Gehrig’s disease. Central dysarthria may also be caused by injuries or illnesses that damage the brain, such as dementia, stroke, brain tumor, or traumatic brain injury .
• Peripheral dysarthria is caused by damage to the organs involved in speech. It may be caused by congenital structural problems, trauma to the mouth or face, or surgery to the tongue, mouth, head, neck, or voice box.

Apraxia, also known as dyspraxia, verbal apraxia, or apraxia of speech, is a neurological condition that can cause a person to have trouble moving the muscles they need to create sounds or words. The person’s brain knows what they want to say, but is unable to plan and sequence the words accordingly.

Symptoms and Characteristics of Apraxia

These are some of the characteristics of apraxia:

• Distorting sounds: The person may have trouble pronouncing certain sounds, particularly vowels, because they may be unable to move their tongue or jaw in the manner required to produce the right sound. Longer or more complex words may be especially harder to manage.
• Being inconsistent in their speech: For instance, the person may be able to pronounce a word correctly once, but may not be able to repeat it. Or, they may pronounce it correctly today and differently on another day.
• Grasping for words: The person may appear to be searching for the right word or sound, or attempt the pronunciation several times before getting it right.
• Making errors with the rhythm or tone of speech: The person may struggle with using tone and inflection to communicate meaning. For instance, they may not stress any of the words in a sentence, have trouble going from one syllable in a word to another, or pause at an inappropriate part of a sentence.

Causes of Apraxia

Apraxia occurs when nerve pathways in the brain are interrupted, which can make it difficult for the brain to send messages to the organs involved in speaking. The causes of these neurological disturbances can vary depending on the type of apraxia the person has:

• Childhood apraxia of speech (CAS): This condition is present from birth and is often hereditary. A person may be more likely to have it if a biological relative has a learning disability or communication disorder.
• Acquired apraxia of speech (AOS): This condition can occur in adults, due to brain damage as a result of a tumor, head injury , stroke, or other illness that affects the parts of the brain involved in speech.

If you have a speech impediment, or suspect your child might have one, it can be helpful to visit your healthcare provider. Your primary care physician can refer you to a speech-language pathologist, who can evaluate speech, diagnose speech disorders, and recommend treatment options.

The diagnostic process may involve a physical examination as well as psychological, neurological, or hearing tests, in order to confirm the diagnosis and rule out other causes.

Treatment for speech disorders often involves speech therapy, which can help you learn how to move your muscles and position your tongue correctly in order to create specific sounds. It can be quite effective in improving your speech.

Children often grow out of milder speech disorders; however, special education and speech therapy can help with more serious ones.

For ankyloglossia, or tongue-tie, a minor surgery known as a frenectomy can help detach the tongue from the bottom of the mouth.

A Word From Verywell

A speech impediment can make it difficult to pronounce certain sounds, speak clearly, or communicate fluently. 

Living with a speech disorder can be frustrating because people may cut you off while you’re speaking, try to finish your sentences, or treat you differently. It can be helpful to talk to your healthcare providers about how to cope with these situations.

You may also benefit from joining a support group, where you can connect with others living with speech disorders.

National Library of Medicine. Speech disorders . Medline Plus.

Centers for Disease Control and Prevention. Language and speech disorders .

Cincinnati Children's Hospital. Stuttering .

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, and language .

Cleveland Clinic. Speech impediment .

Lee H, Sim H, Lee E, Choi D. Disfluency characteristics of children with attention-deficit/hyperactivity disorder symptoms . J Commun Disord . 2017;65:54-64. doi:10.1016/j.jcomdis.2016.12.001

Nemours Foundation. Speech problems .

Penn Medicine. Speech and language disorders .

Cleveland Clinic. Tongue-tie .

University of Rochester Medical Center. Ankyloglossia .

Cleveland Clinic. Dysarthria .

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

Cleveland Clinic. Childhood apraxia of speech .

Stanford Children’s Hospital. Speech sound disorders in children .

Abbastabar H, Alizadeh A, Darparesh M, Mohseni S, Roozbeh N. Spatial distribution and the prevalence of speech disorders in the provinces of Iran . J Med Life . 2015;8(Spec Iss 2):99-104.

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

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Home / Blog

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 assessment tool methods for speech impaired children: a systematic literature review on the state-of-the-art in Speech impairment analysis

Gowri prasood usha.

School of Electronics Engineering, Vellore Institute of Technology, Chennai, 600127 India

John Sahaya Rani Alex

Associated data.

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Speech is a powerful, natural mode of communication that facilitates effective interactions in human societies. However, when fluency or flow of speech is affected or interrupted, it leads to speech impairment. There are several types of speech impairment depending on the speech pattern and range from mild to severe. Childhood apraxia of speech (CAS) is the most common speech disorder in children, with 1 out of 12 children diagnosed globally. Significant advancements in speech assessment tools have been reported to assist speech-language pathologists diagnosis speech impairment. In recent years, speech assessment tools have also gained popularity among pediatricians and teachers who work with preschoolers. Automatic speech tools can be more accurate for detecting speech sound disorders (SSD) than human-based speech assessment methods. This systematic literature review covers 88 studies, including more than 500 children, infants, toddlers, and a few adolescents, (both male and female) (age = 0–17) representing speech impairment from more than 10 countries. It discusses the state-of-the-art speech assessment methods, including tools, techniques, and protocols for speech-impaired children. Additionally, this review summarizes notable outcomes in detecting speech impairments using said assessment methods and discusses various limitations such as universality, reliability, and validity. Finally, we consider the challenges and future directions for speech impairment assessment tool research.

Introduction

Speaking difficulties, whether in producing sound or in other aspects of articulation, are collectively known as speech impairment. Speaking difficulties encompass several types of disorders and can range from mild to severe. Language Speech Impairment (LSI) [ 86 ] is a form of speech impairment that occurs without any evident underlying mental or physical disorder or direct neurological damage. More specifically, a language disorder describes an impairment in comprehension and spoken, written, and other symbol systems [ 26 ]. Speech sound disorders (SSD) are categorised into articulation, fluency, and voice disorders.

Previous studies have shown that childhood apraxia of speech is one of the most common disorders among children, with 1 out of 12 children globally affected by this condition [ 86 ]. Existing literature indicates that SSD prevalence in children is comparable in monolingual and multilingual communities [ 47 ]. Children with SSD present with low speech lucidity and have retarded speech sound acquisition [ 34 ]. Therefore, helpful speech evaluation tools must be developed to help speech-language pathologists (SLP) detect speech deficits in children as early possible to begin appropriate intervention. To better understand the current scenario and provide a foundation on which subsequent studies can be built on, this paper systematically reviews literature for voice assessment tool methods for children with speech impairments.

Earlier studies have dedicated little attention to understanding the morbid impacts of infectious diseases and epidemics in developing countries. There are several risks associated with these epidemics, such as the possibility of neurocognitive impairments in the children who survive the epidemic [ 17 ]. Therefore, SLPs must be culturally and linguistically competent to deliver effective patient service and not only cater to a specific demographic [ 28 ]. Traditional articulation treatment methods aim to rectify solitary speech sounds instead of phonological interventions that address speech sound systems [ 16 ]. Hence, the most desirable speech assessment tool methods are those that use the latter approach.

Adopting measures that reduce the need for further treatment will positively impact the children and their families, as well as the treatment systems itself [ 60 ]. During preschool, family members often misunderstand children with SSD since they are unintelligible [ 23 ]. The delay in their literacy competencies is often severe and present with concomitant language disorders [ 16 ]. Additionally, poor social relations among children with SSD might negatively impact their self-image [ 10 , 12 ]. Despite such consequences, there is little evidence about the treatments SLPs employ when treating children with SSD [ 16 ]. Efficient and effective treatment methods must therefore be developed and promoted.

According to recent studies, the prevalence of speech and language impairments in children is rising [ 67 , 68 ]. Speech therapy is the most common therapeutic intervention for SSD, but it is also one of the most expensive and challenging treatments available other than surgery. A speech-language evaluation normally costs between $200 to $300, and a half-hour therapy session may cost between $50 to $100 although the actual cost of speech therapy can vary depending on various factors [ 31 ]. In addition, it takes numerous sessions to observe a noticeable improvement in the children. According to research, intensive intervention is more successful and efficient for kids with SSD [ 43 ]. In other words, one might require multiple sessions each week. The research published in the literature thus indicates a likely increase in the number of children with SSD in the future, considering the costs of intervention and frequency, which are the limiting factors. A suitable, efficient, and cost-effective treatment should be available for these children to lower the rate of child SSD and help them navigate the condition.

Children presenting with cleft palate lip are likely to develop speech difficulties that will require speech and language therapy [ 13 ]. According to Cummins et al. (2015), speech is a sensitive output system due to the complexity of speech production; hence, slight physiological and cognitive changes potentially can produce noticeable acoustic changes [ 20 ]. Brookes and Bowley (2014) describe tongue-tie as a congenital state characterised by a short lingual frenulum that could restrict the tongue’s movement and influence its function [ 14 ]. Studies have shown that tongue-tie is a common disorder with a documented 3–4% incidence among infants [ 9 ]. Therefore, a universal criterion for diagnosing children’s language impairments is necessary to reduce present variations.

Fundamental elements of communicative competence encompass a framework that describes reasonably intelligible pronunciation [ 22 ]. Perceptual measures, which form a part of the comprehensive speech evaluation, are concerned with assessing the speaker’s intelligibility [ 10 ], while a systematic speech pathology assessment tool uses articulation to predict the overall intelligibility score [ 12 ]. Intervention outcomes associated with speech impairments, such as increased sentence length, improved articulatory function, and use of grammatical markers, form the traditional focus of studies assessing speech-language therapies’ effectiveness [ 21 ]. This paper aims to conduct a systematic literature review of the speech assessment tools for impaired speech children. Here, we review the speech impairment detection tools to establish current trends and findings in the educational relevant domain.

The current review presents the research and studies involved in speech assessment methods for children and adolescents with different speech impairments from 2010 to 2022. We present the methodology adopted in this study and literature review results in Sections 2 and 3 , respectively. Section  4 presents the discussion, while Section 5 mentions future directions and challenges. Finally, we conclude the study in Section 6 .

In this review, we aim to address the following research questions:

• What are the different types of assessment methods being used?
• For what disordered language or disordered speech and the range of delay or disorder investigated?
• Accuracy of analysis: How do these methods perform, and their efficiency/precision?
• Is there room for improvement in these methods for the early detection of speech and language disorders?

Though these research questions are interrelated and discussed throughout the article, the speech assessment methods and purpose have been discussed mainly in Sections 3 and 4 . Accuracy analysis of the methods is covered in Section 3 and especially in Table ​ Table3 3 on pages 9 and 10, but the efficiency of the method concerning the studies reported has been explained in Section 4 . Finally, the challenges associated with existing methods and the ways to improve them are explored in Section 5 .

Comparison of speech assessment tools

Literature selection criteria

The authors searched for primary and secondary peer-reviewed articles that met the quality assessment criteria in this systematic literature review. Various digital databases were queried using keyword search to select the study’s most appropriate and relevant papers. The criteria for exclusion and inclusion were met in the document studies that were analysed. Therefore, this paper’s research design is a systematic approach that adheres to an outlined study protocol.

The research question was to establish whether methods can detect SSD using different techniques to develop practical speech assessment tools. The reliance on a well-defined methodology ensured that research bias is eliminated to result in fair and objective outcomes. The authors designed, reviewed, and revised the study protocol for the present review. Here, we analysed each peer-reviewed article twice to ascertain that the extracted data complied with the review protocol. The search strategy, criteria for integration and exclusion, and quality assessment process are described in detail in the following sections. We followed the PRISMA protocol to perform the systematic literature review to achieve higher transparency and reliability.

Search strategy

We established the existing studies in speech assessment tools for speech-impaired children by querying online databases such as Medline, ScienceDirect, CINAHL, EMBASE, IEEE Xplore, PsychInfo, Web of Search, SpringerLink, Scopus, First Search, ERIC, ACM Digital Library, Linguistics and Language Behaviour Abstracts, and DARE for articles that contained the keywords speech, speech impairments, speech assessment tools, speech impaired children, speech analysis and SSD in the title, abstract. Additionally, the authors queried Scopus and Web of Science to locate other published articles in little-known online libraries. The rationale behind the search strategy was to find significant peer-reviewed articles with full-text and conference proceedings related to the field of “Speech Impairment” and “Speech Assessment Tools”. The keywords used during the search strategy were expected to yield most of the papers containing speech assessment tools. Google Scholar and Google search engines were also utilised to ensure no relevant article was omitted from the study. The author conducted the entire search process, and the process was finalised on 11th May 2022.

Inclusion and exclusion criteria

The researcher developed a pilot version of the selection criteria that targeted all relevant primary studies and finalised it after revising the review protocol. The authors’ institutional affiliation and names were irrelevant when deciding on the inclusion and exclusion criteria. Exclusion criteria were as follows: Studies that did not include speech assessment tools and those that did not have robust speech assessment mechanisms for speech-impaired children; papers that failed incorporate the speech assessment tool’s interrater reliability were not considered for the study; overlapping studies from various journals and online databases; and peer-reviewed studies published before 2010.

In the end, only 92 items that were written in English from 2010 onwards about speech assessment tools, protocols and methods for speech-impaired children were selected for a systematic analysis. Only original articles were included in the review. Additionally, these studies include interrater reliability of the speech assessment tools between 2010 and 2022. A significant proportion of the 92 articles selected for review had different authors, while a small number authoring more than one paper was found. Fig. ​ Fig.1 1 below shows the scientometric mapping of the type of research conducted by authors in the review articles.

Scientometric mapping of the categories of peer-reviewed papers included in the systematic review

Figure ​ Figure2 2 shows the year-wise category of the papers selected from 2010 to 2022. The full-text paper’s quality is assessed based on the sampling method, the study’s sample size, and whether the survey is cohort or research-based.

Number of papers included in the review published year-wise from 2010 to 2022

Speech impairment analysis methods

Tools, techniques, and protocols.

The planning and coordination of speech arises from complex neurological interactions occurring in certain brain regions while fold vibrations in the larynx generate signals that make speech audible [ 71 ]. According to Strand et al., Paediatric SSD results from various aetiologies and impairs speech production on several levels, including linguistic/phonological and motor speech [ 79 ]. Establishing the degree of contribution of motor speech impairment in the child’s SSD is one of the principal difficulties during differential diagnosis [ 23 ]. Hence, it is necessary to develop a speech assessment tool that will eliminate these existing challenges. In the subsequent sections, we describe and compare the leading speech assessment methods currently employed by paediatricians, clinics, and therapists.

Dynamic Evaluation of Motor Speech Skill (DEMSS)

DMESS tool is designed to help in differential detection of SSD among both young children and older children. It is challenging to isolate deficits in plan and program transitions between the volitional speech articulation positions of SSD children, partly because of the interactive speech and language processes. DMESS is a recent speech assessment tool designed to counter the abovementioned issue [ 79 ]. Strand et al., relied on expert opinions and current literature to conclude that there is consensus among researchers about CAS [ 79 ]. CAS is in the recurrent construction of words or syllables through erroneous vowels and consonants; extended and disorderly co-articulatory shifts linked syllables and sounds; and ill-suited prosody achievement phrasal or lexical string [ 79 ]. Clinical assessment of children with SSD typically involves issuing oral structural-functional tests [ 66 ].

According to Strand et al., as a motor speech examination, the DEMSS systematically varies the length, vowel content, prosodic content, and phonetic complexity within sampled utterances [ 79 ]. DEMSS test is designed to test young children’s speech movements and little ones with severe speech impairment. It does not act as a phonologic proficiency or articulation test which evaluates overall segments in a language. It is designed for children incapable of producing syllables, sounds, or words.

The DEMSS is concerned with earlier developing consonant sounds matched with an array of vowels in numerous evolving syllable shapes [ 59 ]. The DEMSS comprises nine subtests consisting of 66 utterances, as shown in this Table ​ Table1. 1 . The 66 pronunciations contain 171 judgmental items that make four sets of sub-scores [ 79 ]. The severity of the childhood apraxia of speech is determined based on the child’s overall score after taking the test.

Dynamic Evaluation of Motor Speech Skills (DEMSS) Content Coverage

The DEMSS is the most influential speech assessment tool among children with impaired speech. It incorporates the dynamic assessment for judgments about severity and prognosis. The medical practitioner administering the DEMSS test instructs the child to fixate their eyes on the instructor’s face as much as possible while uttering a series of words. Considering the child’s first imitation, the pediatrician might use various levels of cuing to elicit more imitative attempts before compiling the final score. Evidence shows that the DEMSS tool is one of the most suitable speech assessment tools since it indicates the SSD severity. Since the tool utilises a dynamic assessment, the pediatrician incorporates cues and other techniques, such as simultaneous production or slowed rate, to elicit several scoring attempts. The prosody and vowel accuracy scoring are done when the child first attempts an utterance. Overall articulatory accuracy is not scored based on the initial effort but on subsequent trials [ 79 ]. Table ​ Table2 2 illustrates the basic rules clinicians follow when scoring the child within the four sub-scores: vowel accuracy, consistency, overall articulatory accuracy, and prosodic accuracy (lexical stress accuracy), with poor performance symbolised by higher scores [ 79 ].

DMESS Scoring

Motor Speech Examination

MSE, often used to establish the presence or absence of speech motor programming and planning in adults, can also be adapted to diagnose SSD in young children [ 79 ] MSE enables a pediatrician to detect speech construction across utterances that differ in phonetic complexity and length using organised stimuli systematically to vary programming demands. Previous studies have shown that only the Verbal Motor Production for children, among the six documented assessment tools for diagnosing SSD, passed the validity test, although none of the tests recorded reliability [ 79 ]. Therefore, there is a need to develop an MSE tool that provides proof of validity and reliability.

According to Strand et al., providing evidence of reliability is critical to developing speech assessment examinations. Validity in MSE tools can be described as the extent to which the study measures the elements it seeks to evaluate [ 79 ]. Several approaches can document the validity of a given test used in SSD diagnosis. Therefore, the validity and reliability measures of a particular speech assessment tool are critical in determining the overall acceptance of its outcomes.

The most frequently used validity measures methods are the gold standard (acknowledged valid measure) and contrasting correlations and groups between the examinations under investigation [ 79 ]. Another technique used to measure the validity evidence of an MSE test is cluster analysis. Cluster analysis is commonly used to evaluate constructs that identify homogeneous subcategories within broader clusters, including civic language disorders, autism spectrum disorders, and SSDs [ 32 ]. Moreover, they are used to detect non-speech and co-occurring speech characteristics in childhood apraxia of speech [ 79 ]. The test validity is evident if the results of the examination mirror those conducted using different diagnostic tools.

Automatic speech analysis tools

Children with difficulties producing intelligible speech are categorised as having paediatric SSD [ 75 ]. Speech impairment can occur during speech production’s motor planning, linguistic, or motor execution phases [ 77 ]. Technological advancements in automatic speech analysis have reinforced the idea that artificial intelligence can use for speech assessment and intervention for children with SSD [ 3 , 53 ]. Clients and parents have shown interest in the cost-friendly alternative measure since the existing speech assessment and intervention techniques are costly for children who need intensive and long-term speech therapy, placing multiple barriers in the way of effective service delivery. Computer-driven approaches incorporating online gaming are the long-term solution to removing the aforementioned barriers [ 81 ]. Tabby Talks is one of the automated tools for assessing childhood apraxia of speech. Devices are composed of clinician interface, mobile application, and speech processing engine and identify grouping errors, articulation errors, and prosodic errors [ 73 ]. Tabby Talks tool offers the capability to reduce the enormous amount of speech therapists’ work and the time and finance for families.

The earliest forms of automatic speech analysis and recognition (ASA) tools developed in the 1960s and 70s could process isolated sounds from minute to medium pre-defined lexicon [ 44 ]. Linear predictive coding (LPC) was developed to account for variations arising from vocal tract differences. Technological advancements in the 1980s based on statistical probability modelling that a specific set of language symbols matched the incoming utterance signal enhanced the ASA tools.

The predominant technology utilised by most speech recognition systems is the Hidden Markov Models (HMMs), which are designed to undertake temporal pattern recognition [ 44 ]. According to McKechnie et al. (2018), In the 1990s, new pattern recognition innovations led to discriminatory training and kernel-based techniques that functioned as classifiers, such as Support Vector Machines (SVMs). Fig. ​ Fig.3 3 below shows the theme component processes model encompassed in new ASA systems [ 44 ]. Therefore, the superior technological advancements in ASA tools enable the system to sift through speech variations from different speaker.

Model of contemporary ASA speech recognition system

While ASR systems have vastly improved in recent years, children’s ASR remains are not as well-known as adult ASR. Children’s HMM-ASR systems, like deep neural network ASR systems, require much data to train and are extremely reliant on the data they use. Clinical speech data (particularly for children’s speech) is far more challenging than average speech data, and physicians cannot be expected to collect enough data for such systems. More research is needed to develop clinical evaluation systems with minimal training data. The limitation of databases that contain large languages is another element that hinders system development and performance accuracy. The speech acoustic model is the second component that impacts performance accuracy and is based on the speaker mode. The model can either rely on the speaker, be independent of the speaker, or speaker adaptive. The ASA tools system also has two other principal components that influencing its accuracy [ 44 ]. The type of speech (isolated words or continuous speech) and the lexicon’s size impact the feature extraction process, the first component of the ASA tools with improved performance measured through long vocabularies. Therefore, the feature extraction and speech acoustic model affect the performance accuracy of the ASA tools. Notwithstanding the significant improvements in ASA tools, computational modelling systems still experience challenges [ 78 ]. Specifically, young children undergoing developmental growth stages while committing speech errors present even more challenges for ASA tools designed to assess children’s speech [ 44 ]. Therefore, the ASA tools need to consider the impact of impaired speech assessment and children intervention.

The major tool for clinical assessment of speech-language disorders, one of the most common juvenile disabilities, is auditory perceptual analysis (APA). APA outcomes, however, are subject to intra- and inter-rater variability. Manual or hand transcription-based speech problem diagnostic approaches have various drawbacks. To address these constraints, there is a growing interest in creating automated approaches for identifying speech abnormalities in children that quantify speech patterns. Landmark (LM) analysis is a method of identifying auditory events that occur as a result of sufficiently accurate articulatory motions [ 61 ] and it is suggested that LMs be used to detect speech disorders in youngsters automatically. This study offered a series of novel knowledge-based features that were not previously proposed, in addition to the LM-based features that have been proposed in previous studies. To test the usefulness of the innovative features in differentiating speech disorder patients from regular speakers, a comprehensive investigation and comparison of several linear and nonlinear machine learning classification approaches based on raw characteristics and proposed features are done.

The lest speech assessment tool

Language is the medium used to exchange the abovementioned elements between people of different races, colours, and religions [ 84 ] and is defined as the sound produced by the human voice, which the ear receives and interprets by the brain [ 57 ]. The LEST scale was developed to address universal and direct language development assessment in neuro-developmental follow-up clinics. The LEST tool was used for two groups of children; the first group for 0–3 years and the second group for 3–6 years. Each category encompasses items concerning expressive and receptive language development. Therefore, the LEST is one of the various speech assessment tools clinicians use in children with SSD for diagnosis and intervention.

Battery of Western Speech and Language Assessment Tool

Motor aphasia was first diagnosed by the French neurologist Paul Broca in the 1860s. The condition is associated with patients who can comprehend what is said but have difficulties exhibiting speech fluency, leading to communication breakdown. The Battery of Western Speech and Language Assessment Tools was developed to detect this speech impairment condition [ 17 ].

CHOCSLAT – Chinese Healthcare-Oriented Computerised Speech & Language Assessment Tools

The CHOCSLAT relies on technology to identify speech impairments in children. This tool aims to provide a technical advance in helping children who may have speech impairment or language delay. The computer records the utterances for processing and analysis. The C-LARSP (Chinese Language Assessment, Remediation, and Screening Procedure) is used in the grammar assessment section and concentrates on the grammatical classification and meanings of children’s statements.

The grammatical structures are classified by age group (“stage”) and several grammatical levels (clause, phrase, and word prefix/suffix), allowing for evaluation of children’s grammar at seven different age stages, ranging from 1 year to 4 years and 6 months (labelled “4; 6”) and above. The marking scheme incorporates semantic and syntactic features and result in a score ranging from 0 to 5 depending on the child’s response. The Phonology Assessment of Chinese (Mandarin) is used in the phonology test, and consists of 44 prompts, each of which targets a one- or two-character Chinese word. Percent Consonant Correct (PCC), present & absent consonants, and mistake patterns are three characteristics of pronunciation that are measured and analysed (mispronunciations that follow specific patterns). The average accuracy of all sample sentences is used to calculate the total accuracy. With N = 106 sentences, the most recent prototype iteration attained an average accuracy of 0.87. Several challenges were encountered while developing the tool, like using pinyin instead of the International Phonetic Alphabet (IPA) for the transcription, even though pinyin lacks accuracy and specificity compared to IPA. The tool was developed in close collaboration between Chinese experts in applied linguistics, computer scientists, and speech pathologists [ 83 ].

The Clinical Evaluation of Language Fundamentals (CELF) is a comprehensive speech impairment assessment tool to evaluate a child’s speech and language skills competency in various contexts. The aim is to identify the present speech and language disorders, their category, and the necessary intervention to treat the condition [ 57 ]. For children aged 5 to 21, the CELF-4 is considered a standard gold assessment for detecting language problems or delays. CELF-4 acts as a bridge to between the speech pathologist and children, assist in determining why a child may require classroom language adaptations, improvements, or curriculum changes. Its ability to administer subtests in various ways allows for faster testing while delivering extraordinarily reliable and accurate findings. After administering the CELF-4 battery, six indices can be calculated: the core language index and five other language indices. CELF-4 is relevant and is an exciting alternative for children due to its cultural inclusiveness and visual stimuli. The CELF-4 was created to reflect the clinical decision-making process, which begins with a diagnosis and determining the severity of a language disorder, then moves on to identifying relative strengths and weaknesses, making recommendations for accommodations and intervention, and evaluating the effectiveness of the intervention.

PLS-5 English

This tool was developed to assess and analyse language developmental milestones in children to identify the presence or absence of SSDs [ 76 ]. The screening test tool is designed for the children to screen their broad spectrum of language and speech skills from 0 to 7 age. Also, it helps to identify the language disorder within 6 speech and language areas in just 5 to 10 min. PLS-5 contains 2 standardized scales; one is to determine how a child communicates with others (Expressive Communication), and the second is to evaluate a child’s language comprehension. The PLS-5 has a good to excellent test-retest reliability (r = 0.86–0.95). The auditory comprehension and expressive communication scores had an internal consistency of r > 0.80 and r > 0.9, respectively. Test content (comprehensive/skills elicited are diagnostic indicators of whether a child is developing language typically or has a language disorder), response processes (effectively elicited), the internal structure (highly homogeneous within and across scales), and evidence-based relationships with the prior version of the test (r = 0.80 for both subscales) and other tests that measure the same constructs are all used to support the validity of the PLS-5 (moderate to high correlations ranging from 0.70 to 0.82 with the Clinical Evaluation of Language Fundamentals Preschool 2). The PLS-5 produces norm-referenced test results, such as Standard Scores (Mean = 100, SD = 15).

The Goldman-Fristoe Test of Articulation is a tool used to evaluate the articulation of consonant sounds in children to reveal the disorder’s severity if present [ 4 ]. The Goldman Fristoe Articulation test is open to children over the age of 2 and under 22. The GFTA-3 is a widely used standardised speech test that assesses children’s pronunciation using clinically relevant utterances. Using the GFTA-3 assessment framework, clinicians tracked the quality of each child’s phoneme pronunciation; each kid was positioned in a sound booth with a double-walled sound barrier, and a student clinician administered the GFTA-3.

“Sounds in Words” and “Sounds in Sentences” are the two sections of the GFTA-3. For the sounds in words subtest, picture stimuli and target words elicited the production of 23 consonant sounds and 15 consonant clusters, whereas the storey retell task elicited connected speech for the sentence’s subset. Scoring and interpretation depend on omissions, addition (phonetic transcription), and raw score (count number of incorrect responses). The raw score will be converted into standard, percentiles, and age equivalents. The scores are then used to compare individual results to gender-specific norms.

The norms were determined using a national sample of 1,500 examinees by age and gender. Test-retest and internal consistency is used to verify the tool’s reliability. Evidence-based test content, response processes, the performance of a speech sound disorder group, and its relationship with the GFTA-2 are used to support the tool’s validity. The GFTA-3 is appropriate to test those with suspected word production disorder. The GFTA-3 identifies the presence or absence of distinct speech sounds within the client’s repertoire but is not without its disadvantages. The sentence length requirement may be too high, and some graphics may be obscure to some young children. An additional limitation is that it only for children who have trouble pronouncing consonants (b,c,d, etc.) and will not help identify whether a child has articulation issues or problems with vowels.

The Bayley Scale of Infant and Toddler Development (Bayley) evaluates the developmental speech milestones of children aged 1 to 42 months. This tool’s primary aim is to detect any speech disorders in the child to develop the necessary intervention strategies [ 76 ]. The third edition (Bayley-III) is a simple, straightforward, method used to measure cognitive and motor skills and its results are exceedingly reliable. It is delivered with the help of a caregiver or parent, allowing for more input from the child’s natural surroundings. Furthermore, all assessment parameters are based on the child’s age, allowing for more precise developmental assessments. It is a comprehensive solution for assessing the entire kid, including adaptive behaviour, cognitive, language, social-emotional, and motor abilities. The Bayley-III produces composite and subscale scores for fine and gross motor development and composite and subscale scores for cognition and motor ability. For composite scales, raw scores are converted to norm-referenced standard scores (mean = 100, SD = 15), and for motor subscales, scaled scores (mean = 10, SD = 3).

The Differential Ability Scales assessment (DAS-II) assesses children’s cognitive competencies. The device identifies mental and cognitive disorders in children aged 2 to 18 [ 65 ]. The DAS-II is a standardised cognitive assessment tool increasingly being utilised with children with autism spectrum disorders. It is also commonly used to assess students’ cognitive capacity and aid in school planning. The DAS-II has a low item floor and an enlarged ceiling, allowing for adaptive testing in preschoolers or toddlers with potential deficits (especially in language). Furthermore, the DAS and DAS-II have been used to diagnose learning problems by determining processing style and doing an ability-achievement discrepancy analysis, both of which allow for more targeted intervention planning. Despite the popularity of the DAS and DAS-II as cognitive assessments for children with learning impairments or autism, their application in groups of children with hearing loss has not been independently validated.

The test assesses receptive and expressive language skills, nonverbal reasoning, and spatial abilities. The DAS-II has good test-retest reliability (> 0.73 across all index and composite scores), great internal consistency (intercorrelations of 0.84 between the index and composite scores), and good convergent validity when compared to the Weschler series tests and the Mullen Scales of Early Learning. The Nonverbal Reasoning Cluster (r = 0.65) and the Spatial Ability Cluster (r = 0.67) of the DAS have moderate associations with the WISC-III Performance IQ in students with learning difficulties. Table ​ Table3 3 illustrate the comparison of speech analysis tools with accuracy and other significant information.

In both developed and developing countries, smartphones and tablets have become increasingly accessible to children, forming a part of their daily lives. Approximately 88% and 79% of Australian households with children aged 15 and below living in major cities and rural areas, respectively, have fast and stable internet connections [ 44 ]. The statistics also show that 94%, 85%, and 62% of households access the internet via desktop or laptop computers, mobile or smartphone, or tablet, respectively. Although computer and mobile-based speech analysis techniques are not commonly used in children with SSD, they possess capabilities to access easily accessible, affordable, and objective speech assessment tools and interventions [ 46 ]. The development of such computer and mobile-based tools will likely enhance the efficiency of medical practitioners who deal with children with SSD and reduce their caseloads while also increasing accessibility and practice intensity due to reduced barriers resulting from the elimination of the face-to-face SLP [ 27 ].

Despite recognizing that early detection and treatment of communication disorders is critical for school readiness and has been shown to significantly improve communication, literacy, and mental health outcomes for young children, nearly 40% of children with speech and language disorders do not receive appropriate intervention because their impairment goes undetected. The predominant tool for clinical assessment of aberrant speech is auditory perceptual analysis (APA); however, APA outcomes are subject to intra- and inter-rater variability. Another consideration is that some children may be hesitant to participate in lengthy testing sessions, and even if they do, transcription of big data sets of audio recordings is time-consuming and needs therapists with a high level of skill. Because of the constraints of manual or hand transcription-based diagnostic evaluation approaches, there is a growing demand for automated methods to quantify kid speech patterns rapidly and reliably, allowing them to be diagnosed whether they have impaired speech [ 80 ].

Moreover, such approaches are likely to improve the child’s motivation to participate in and study exercises since they perceive them appealing, including audio prompts, reinforcers, or animation, encompass speech recording, playback responses, live manipulation of gameplay and stimuli, and prerecorded models. Nonetheless, the ASA tools that utilise diagnostic or therapeutic software are supposed to match reliability standards applied to human raters for them to be viable [ 44 ]. According to McKechnie et al. (2018), the Commonly accepted percentage agreement criteria for perceptual judgments of speech between two human raters or outcome reliability across two separate assessments of the same behavior range from 75 to 85%. Despite the extensive work on ASR, little work has been reported on developing speech therapy tools with ASR capabilities for use in paediatric speech sound disorders such as CAS. Although automated system is working with 80% accuracy, further work is needed to train automated systems with larger samples of speech to increase accuracy for assessment and therapeutic feedback. Therefore, ASA tools should meet the 80% threshold of reliability to be considered viable for speech assessment in children with SSD.

Protocols are the norms and procedures for assessing speech and language using instruments. Technical specifications for data acquisition, voice and speech tasks, analysis methods, and results for instrumental evaluation of voice/speech production are all included in the protocols. Even though these types of assessments are performed regularly at many research and clinical facilities in the United States, a lack of standardised procedures/protocols currently limits the extent to which the results can be used to facilitate comparisons across clinics and research studies to improve the evidence base for the management of voice disorders. The recommended protocols aim to produce a core set of well-defined measures that can be universally interpreted and compared using instrumental approaches. These recommendations are not intended to preclude the use of additional measures or protocols that individual clinics/clinicians or researchers believe are useful in evaluating vocal function.

MSAP – Madison Speech Assessment Protocol The Madison Speech Assessment Protocol (MSAP) was developed to cater to the need to diagnose speech and language disorders in the United States. The protocol employs 17 speech-related and eight motor and language activities and tasks in a 25-measure battery with a 2-hour run time in various clinical, educational, and research programs [ 75 ].

Connected Speech Transcription Protocol (CoST-P)

A clinically feasible protocol is connected speech transcription for children suffering from Apraxia. This development protocol’s main reason is to assist children aged 6–13 in describing their connected speech. The connected speech can be evaluated to pick up the independent and relational analyses [ 8 ].

Trivandrum Development Screening Chart (TDSC)

The TDSC (0–6 y) is a 51-item screening test created from existing developmental tools and has been validated for children up to the age of six. The TDSC is a straightforward, reliable, and valid screening tool for identifying children with developmental delays in the community. The Child Development Centre, SAT Hospital and Medical College, Trivandrum, conceived and developed it. The ranges for each test item were derived from the Bayley Scales of Infant Development standards (Baroda norms). The sensitivity and specificity of a TDSC chart with one item delay were 84.62% and 90.8%, respectively [ 69 ].

Ages and stages questionnaire test

The Ages & Stages Questionnaires are a developmental screening tool that measures developmental progress in children aged one month to five and a half years. The ages and stages questionnaire was designed to help health professionals and teachers who handle young children identify speech deficits in their patients. The tool relies on parents’ information about their children to detect speech deficits and other critical milestone delays [ 87 ]. Its popularity is due to its parent-centred approach and intrinsic ease of use, which has made it the most extensively used developmental screener in the world. Evidence demonstrates that the earlier a child’s development is examined, the more likely they are to fulfil their full potential. Arabic, Chinese, English, French, Spanish, and Vietnamese tests are accessible. It also takes parents 10–15 minutes to complete, and professionals 2–3 minutes to grade and highlight a child’s strengths and issues. The ASQ exam is used by programmes all over the country because it is highly valid, dependable, and accurate, as well as being cost-effective, easy to score in minutes, and well researched and tested with a varied sample of children. ASQ is a fun and engaging method to collaborate with parents and make the most of their expert knowledge.

The caterpillar novel reading passage

The existing approaches, methods, and materials of speech assessment used by clinicians are affected by limitations in validity and reliability [ 37 ]. The importance of motor speech evaluation is that it enables the diagnosis of speech impairment and further reveals the disorder’s severity [ 38 ]. The assessments’ outcomes are critical in identifying the salient elements of speech production targeted for intervention to enhance communication effectively [ 61 ]. Therefore, motor speech assessment tools are critical since they reveal the degree of speech impairment among children with SSD.

Contextual speech is the most significant speech assessment activity [ 61 ]. Reading the passage provides clinicians with valuable information compared to scores assigned through syllable and word repetition exercises. The passage is designed to present a controlled and repeatable activity in speaking, gauge the speech production system and conduct a differential diagnosis. The evidence shows that pediatricians can diagnose speech and language disorders in children by reading a passage.

The My Grandfather was the most famous speech assessment passage joined by Van Riper in 1963 [ 61 ]. The passage is ill-suited to examine speech motor skills to differentiate the severity and type of motor speech disorder [ 61 ]. The author of the passage, Van Riper, concurred with the fact mentioned above when he described the tool as useful for a quick survey of the student’s (client’s) ability to produce correct speech sounds [ 61 ]. The seminal work of Darley et al. in 1969 is seen as the historical root of the usage of the “My Grandfather” passage in speech and motor assessment on the perceptual traits of dysarthria. Therefore, Van Riper created the “My Grandfather” passage to assess speech and sound recognition among children.

“The Caterpillar” reading novel passage was developed to systematically enhance the “My Grandfather” passage by incorporating activities that evaluate deficits within and across speech subsystems [ 61 ]. To observe the variations between connected and isolated speech performance, embedding the word and syllable repetition activities into the passage is recommended as a best practice for evaluating motor speech disorders. Additionally, the reading passage offers a chance to perceive the motor speech’s performance on exercises that cannot be evaluated in isolation, such as prosodic modulation. Therefore, researchers have an opportunity to assess various speakers’ speech performance through the use of a reading passage as a speech assessment tool.

A number of reviews on speech assessment are available in the literature, of which those with a detailed discussion on the methods for the assessment are less.

A review published in 2012 summarised the findings on speech production issues in people with Down syndrome (DS) to enhance therapeutic services and guide future research in the field [ 36 ]. In their work, the authors selected one speech impairment disorder. Another review article was published in 2013 that aids in determining the interventions for preschool children according to the circumstances utilising a practice-based model of interventions to select the intervention subgroups [ 1 ]. Though the paper included studies from January 1980 to November 2011, it focused only on the interventions.

In 2014, a literature review was published to analyse the elements contributing to the debate over describing and diagnosing CAS and examine a therapeutically relevant body of knowledge on CAS diagnosis [ 7 ]. Thework entirely focused on CAS over the 10 years. Broome et al. conducted a systematic review in 2017 intending to provide a summary and assessment of speech examinations used in children with autism spectrum disorders (ASD). Later, a narrative review was reported to determine the essential components of an evidence-based paediatric speech assessment, combined with the systematic review findings, giving clinical and research guidelines for best practice [ 15 ].The review was published with the research articles published between 1990 and 2014, assessing children’s speech only with ASD.

Another review published in 2018 by Wren et al. aimed to assess the evidence for therapies for SSD in preschool children and categorised them under a classification of interventions for SSD [ 90 ] The intervention studies published up to 2012 were selected for the work. In 2018, a systematic search and review of the published studies on the use of automated speech analysis (ASA) tools for analysing and modifying speech of typically the developing children learning a foreign language as well as children with speech sound disorders were conducted to determine the types, attributes, and purposes of ASA tools being used. The performance of the therapeutic tools and their comparison with the human judgement was also included [ 44 ]. The research articles published between January 2007 and December 2016 were selected for the study.

Low et al. reported a systematic review in 2020 on voice for automated assessments across a more extensive range of psychiatric diseases [ 42 ]. According to the authors, speech processing technology could aid mental health assessments, but several barriers exist, including the need for extensive transdiagnostic and longitudinal investigations. The work concentrated on analysing psychiatric disorders and collected studies from the past 10 years that employ speech to identify the presence or severity of mental disorders. In 2021, another review was published to summarise and evaluate oral sensory problems in children and adolescents with ASD [ 18 ]. A systematic search was reported in the work with the published articles from January 2000 to December 2018, concentrating entirely on ASD. Additionally, the review suggests that oral stimulation employing speech-sensory technologies may be necessary.

The present systematic literature review aimed to identify, categorize, and compare the effective speech assessment methods for analysing multiple speech disorders in children, instead of choosing only a particular disorder or speech analysis tool as observed in the existing reviews. A statistical analysis of the reported speech impairment assessment methods, protocols and case studies from the last 12 years has been included. We have also covered the state-of-the-art solutions with the level of accuracy of each tool and their contribution to the research in the field of interest.

Application of speech assessment tools for speech impairment analysis

Cas disorder.

Different research groups have reported adopting multiple tools for the analysis of CAS. Table ​ Table4 4 shows the studies reported in the last decade using corresponding tools utilised.

Studies Reported on Childhood Apraxia of Speech Disorder

Strand et al. used DMESS to analyse speech and prosody’s motor function for children aged 3–6 years and seven months to diagnose childhood apraxia [ 79 ]. The child performed the stimuli in two ways during this protocol’s application: an initial attempt and after the examiner’s demonstration. The proof of construct validity and reliability presented as intra-judges’ 89%, inter-judges 91%, and test-retest 89%. However, positive and negative risk ratios, sensitivity, and specificity measurements showed that CAS was not over-diagnosed by DEMSS, though children with CAS were not detected in a few cases.

In 2013, Preston et al. conducted a study on ultrasound imaging assessment and treatment on CAS [ 66 ]. The research explored the efficacy of a treatment program for children with severe speech sound errors associated with childhood speech apraxia involving ultrasound biofeedback. Diagnostic ultrasound imaging has, for many decades, been a popular instrument in medical practice, and it offers a healthy and productive way to visualize internal structures of the body. Children are cured of altering their gestures by using real-time ultrasound images to provide visual feedback. A multiple baseline experiment in 18 sessions was conducted in the study by six children between 9 and 15 years of age during therapies centered on developing lingual sound sequences. Even though this study achieved about 80% accuracy, cost, access and training with this technology might limit the implementation of this tool in clinics.

CoST-P utilised CAS in the case study on 12 children aged 6–13 years [ 8 ]. The participants’ related speech parameters were selected to obtain independent and relational analyses. The usage of CoST-P to represent CAS speech characteristics was related to associated speech features. Children with CAS had their connected speech transcribed using the CoST-P. With appropriate reliability and fidelity scores, the CoST-P can be employed in researching children’s connected speech transcription of 50 utterances and takes between 5 and 7 h per child (including orthography, target output, and actual production). Because of the time burden, the current CoST-P is used infrequently in speech-language pathology practice. Even though the tool is an adequate resource for speech-language pathologists and clinical researchers, its usage is challenging.

Terband et al. conducted a study in 2019 to assess CAS by using objective measurement techniques for 3- to 6-year-old ones [ 82 ]. The analysis has made considerable progress regarding the clinical criteria for diagnosing childhood speech apraxia (commonly described as a speech motor planning or programming disorder) in recent years. For participant selection purposes, three segmental and supra-segmental speech features, i.e., error inconsistency, lengthened and interrupted co-articulation, and improper prosody has gained broad acceptance. Few researchers have also attempted to assess the validity of these features empirically. The fact that none of these features operationalized is a fundamental challenge for analytical analysis.

In 2015, Shahin et al. did a study explaining the pipeline to detect speech processing CAS-related common errors [ 69 ] automatically. It is used for children within the age group of 4–16 years. The device achieves an accuracy of pronunciation tests of 88.2% on phoneme and 80.7% on utterance stages, with a classification of lexical stress of 83.3%. Murray et al., in 2015, did a study to establish a variety of objective measures to distinguish CAS from other speech disorders, i.e., multivariate discriminant function analysis [ 53 ]. It involves syllable segregation, matched lexical stress, proper phonemes percentages from a polysyllabic image-name task, and precise articulatory repetition. It reported that the discriminant functional analysis model had achieved 91% accuracy by expert diagnoses. Twenty-eight children met two sets of CASs diagnostic criteria; 4 other children met the CAS criteria’ comorbidity. The researcher used the combination of the best-expected expert diagnoses for Multivariate Discriminating Feature Research.

Abdou et al., to identify the possible presence of CAS in Arabic-speaking children, developed a test battery, thus allowing the planning of appropriate therapy programs [ 3 ]. Seventy monolingual Arabic-speaking Egyptian children, including ten children with suspected CAS, 20 children with phonological disorders, and 40 typically developing children, were given the built-up test battery for CAS. The study concluded that the built-in test battery for CAS diagnosis is a reliable, valid, sensitive instrument that can be used to detect and differentiate between the presence of CAS in Arabic-speaking children and phonological disorders.

SSD and SLD

SSDs and SLDs are mostly seen in children. In some cases, their cause remains yet to be discovered or detected earlier. With the help of verbal tests, screening tests, instruments, and scales and with some tools and techniques, these disorders can be assessed and help clinicians and pathologies in the process of identifying the diseases. Table ​ Table5 5 lists the different styles and methods that can be used, not only for better assessment but also for therapy necessity among children with speech and language disorders.

Studies that Investigated Speech Sound Disorders and Speech-Language Disorders

In 2010, Shriberg et al., to identify diagnostic markers for eight subtypes of SSDs of unknown origin, developed MSAP [ 75 ]. Unlike other existing tools, the tool is not intended only to identify speech Apraxia but also for SSDs. In addition to its presentation, the protocol was also used to study different age groups and was designed to include a description of a classification system for motor speech disorders. Due to the significant prevalence of SSDs in public, Shriberg et al. did another investigation with MSAP to investigate the prevalence and phenotype of CAS in patients with lactose intolerance, albeit much information is absent from the literature. The results showed a high prevalence of the disorder in the investigated sample. Eight of the 33 respondents (24%) reported meeting the current CAS diagnostic criteria. Ataxic or hyperkinetic dysarthria criteria were seemed to be completed by two participants, 1 of whom was among the 8 with CAS. Group results for the remaining 24 respondents were consistent with a classification category called Motor Speech Disorder-Not Specified Otherwise. Here, both the evidence of validity and liability were nil.

In 2012, Carter et al. provided an approach to advancing children’s speech and language evaluation methods, using the morbid results of extreme falciparum malaria research as a guideline [ 17 ]. They chose children exposed to severe malaria to test tools for children with language disabilities. Other causes of language impairment may have features that are not readily available through this adaptation process, such as the impact of social communication on language assessment. The final battery- ‘speech-language assessment tool’ consisted of seven assessments: (1a) receptive language (original estimate changed to an adaptation of the Grammar Reception Test), (2b) syntax (new score system adapted from the Renfrew Action Picture Test), (3) lexical semantics (minor changes to the original), (4) higher-level language (significant changes to reduce the number of different items and increase the number of questions per item), 5) test of word-finding and language-specific test (a new assessment based on the Test of Word Finding), 6) Pragmatics profile of everyday communication skills in children, 7) Peabody picture vocabulary Test.

Nelson et al. conducted a study for using transcription in assessing speech disorders in children [ 54 ]. This research analyzed transcription, facilitators, transcription use issues, and detailed transcription discrepancies with different clients’ groups. Transcription charts (81%), self-practice (68%), and blogs were the three most frequently identified strategies/resources (42%). The use of two vowel notation systems, diminished transcription abilities, problems with service delivery, sampling/recording problems, and transcription to communicate were transcription challenges. This study reported that when recording children’s speech with childhood speech apraxia and craniofacial impairment, participants use detailed transcription more often than transcription to record children’s addresses with SSD of unknown origin.

Mehta et al., in 2015, presented an update on ongoing work using a miniature accelerometer on the neck surface below the larynx to collect a large set of outpatient data on patients with hyper-functional voice disorders (before and after treatment) and matched-control subjects [ 48 ]. Three types of analysis approach were employed to identify the best set of differentiating measures between hyper-functional and standard vocal behavior patterns: (1) ambulatory voice measurements, including vocal dose and voice quality correlates; (2) aerodynamically metric measures, which are based on glottal airflow estimates derived from the specified accelerometer signal and; (3) classification of other physiological signal recordings based on machine learning and pattern-recognition approaches, which were successfully used in analyzing long-term recordings.

In 2010, Mullen and schooling focused on the data collected from prekindergarten NOMS (National Outcomes Measurement System) and K-12 NOMS in school settings [ 52 ]. The primary objective was to serve as a data source for speech-language pathologists who were called upon to provide empirical evidence of the functional results of their clinical services to children and adult patients with different speech-language pathologies. The 2 NOMS components had reported studying more than 2,000 preschool students and 14,000 K-12 students by SLPs working in school settings. In 2013, McLeod et al. conducted a study to describe the speech of preschool children identified by parents/teachers as having difficulty “talking and making speech sounds” and to compare the speech characteristics of those who did not have access to SLP services [ 46 ]. The method of the study includes Stage 1: assessed documented parent/teacher concern about the speech skills of 1,097 children in the year 4- to 5- attending early childhood centers, Stage 2a: 143 children identified with problems, and Stage 2b: parents have returned questionnaires about service access for 109 children.

Towey et al. conducted a study in developing a diagnostic profiling tool for healthcare professionals to identify the potential problems of Chinese-speaking children with speech and language development [ 83 ]. The instrument aimed to provide a technical breakthrough to help kids with speech impairment or language delay. The case study was carried out in different stages, from 1 to 4 years. However, the exactness and specificity offered by the IPA are lacking. Due to data availability limitations, text output from the speech-to-text API is not always an accurate transcription.

The caterpillar passage study conducted by Patel et al. in 2013 describes the passage as an assessment tool or protocol to provide specific tasks aimed at informing the assessment of motor speech disorders with a contemporary, easy-to-read, contextual speech sample [ 61 ]. To demonstrate its usefulness in examining motor speech performance, twenty-two participants, 15, were recorded reading the passage “The Caterpillar” with DYS or AOS and 7 healthy controls (HC). Performance analysis across a subset of segmental and prosodic variables showed that “The Caterpillar” passage showed promise to extract individual impairment profiles that could increase current evaluation protocols and inform motor speech disorder therapy planning.

Hasson et al. conducted a DAPPLE study (Dynamic Assessment of Pre-schoolers’ Proficiency in Learning English) in 2013 [ 29 ]. To examine the ability of children to learn vocabulary, sentence structure, and phonology, the evaluation used a test-teach-test format evaluation, which takes less than 60 min to perform, given to 26 bilingual children: 12 currently on a caseload of speech and language therapy, and 14 children matched by age and socioeconomic status who never referred to speech therapy and language therapy. Qualitative analysis of individual children’s performance on the DAPPLE suggested that it can discriminate against core language deficits from the difference due to a bilingual language learning context.

In 2013, Newbold et al. compared a range of commonly used procedures for perceptual phonological and phonetic analysis of developmental speech difficulties to identify the best ways to measure speech changes in children with severe and persistent language difficulties (SPSD) [ 55 ]. Speech output measures included the percentage of whole words correct (PWC), correct consonant percentage (PCC), total word proximity proportion (PWP), analysis of phonological patterns (process), and phonetic inventory analysis. The study was conducted on 4 SPSD children, registered at 4 years of age and again at 6 years of age, who perform naming and repetition duties.

Eadie et al. conducted a study to assess the prevalence of idiopathic sound speech, the co-morbidity with language and pre-literacy difficulties of language sound disorders, and the factors contributing to the speech outcome for 4 years [ 24 ]. 1494 participants completed 4-year voice, language, and pre-literacy evaluations from an Australian longitudinal cohort. In four areas: child and family, reported parental speech, cognitive-linguistic, and motor abilities, the logistical regression examined SSD predictors. Early 4-year SSD detection should focus on family variables and 2-year language and motor skills measurement.

Morgan et al. conducted a study in 2018 to (i) test for the hypothesis that neurostructural difference in autism spectrum disorder (ASD) and CAS compared to typically developed (TD) is demonstrated by morphometric MRI measurements (ASD vs. TD and CAS vs. TD), (ii) investigating early possible diseasing-specific patterns of the two clinical groups (ASD vs. CAS) for the brain, and (iii) evaluating the machine-learning predictive strength of ASD, CAS, and TD [ 50 ]. T1-weighted brain MRI scans of 68 children (age range: 34–74 months) were analysed and divided into three cohorts: (1) 26 ASD children (mean age ± standard deviation: 56 ± 11 months); (2) 24 CAS children (57 ± 10 months); and (3) 18 TD children (55 ± 13 months). In the ML analysis, the differences between ASD and TD children in brain characteristics were significant, while only some CAS classification trends were detected compared with TD peers.

The aim of the study conducted by Zarifian et al. was to adapt the articulation assessment, subtest the articulation, phonology diagnostic assessment, and determine its reliability and validity for Persian-speaking children [ 91 ]. The Persian version of the articulation assessment (PAA) was administered to 387 children between the ages of 36 and 72 months, with M(SD): 53.7 (± 10.1) per month following the adaptation process. The study included test-retest reproducibility, score-rescore consistency, and validity evaluation through content, convergent, and discriminative validity to establish the instrument’s psychometric properties. The mean scores for articulation disorders were significantly lower than those for normal children in the Persian Articulation Assessment, showing discriminative validity (t = 7.245, df = 34, P < 0.001). The study concluded that it is suggested in the Persian version of Articulation Assessment as a reliable and valid tool for assessing articulation skills in Persian-speaking children.

In 2019, Jesus et al. experimented on the efficacy of a modern tablet-based approach to phonological intervention and compared it to a conventional tabletop approach targeted at children with speech sound problems based on phonology (SSD) [ 34 ]. Twenty-two children with phonological SSD were randomly allocated to 1 out of 2 assessments, tabletop, phone, and evaluation based upon similar activities (11 children in each group), with delivery being the only difference. The same speech-language pathologist treated all children over two blocks of 6 weekly sessions for 12 intervention sessions. The findings provide new evidence concerning using digital materials in children with SSD to improve speech.

A study was conducted to investigate, describe, and analyze the characteristics of speech, intelligibility, orofacial function, and co-existing neurodevelopmental symptoms persisting after six years of age in children with SSD of unknown origin [ 49 ]. They concluded that the children with persistent SSD are at risk of orofacial dysfunction, general motor problems, and other neurodevelopmental disorders, so co-occurring conditions should screen. The study included 61 children of unknown origin with SSD (6–17 years), referred for a speech and oral motor test. Parents completed context Scale Intelligibility (CIS) and a questionnaire containing heredity, health and neurodevelopment, and speech development.

In 2021, Chong et al. took a cross-sectional study in a tertiary center in Malaysia to explore the socio-demographics of children with speech delay [ 19 ]. The study was conducted at speech therapy clinics for children with speech delays less than 72 months old. Both speech and other developmental skills were assessed using the Developmental Quotient scores (DQ). There were 91 children in the study (67 boys and 24 girls), 54.9% of whom had a direct speech delay, and 45.1% had neurodevelopmental disorders. The average age was 39.9 months and 11.52 months. The average speech DQ was 54.76%, with a margin of error of 24.06%. Lower DQs in the speech was linked to lower DQs in other skills (p 0.01). There was no significant relationship between screen time for children and parents and DQs of speech and other skills (p > 0.05).

Speech Articulation Disorder, Cleft Palate Disorder, Tongue-tie, Childhood Dysarthria, Oral Motor Placement Disorder

Most articulation disorders are SSDs and come under motor speech disorders. Table ​ Table6 6 includes Speech Articulation Disorder, Cleft Palate Disorder, Tongue-tie, Childhood Dysarthria, Oral Motor Placement Disorder s tudies selected for the review published between 2010 and 2021 to address speech articulation disorder in children specifically.

Studies that Examined Speech Articulation Disorder, Cleft Palate Disorder, Tongue-tie, Childhood Dysarthria, Oral Motor Placement Disorder

In 2013, Khattab et al. conducted a study to assess oral impairment levels using standardised questionnaires [ 37 ]. Thirty-four Class-I Division-1 patients with malocclusion and moderate upper teeth crowding were randomly distributed into two groups. Seventeen patients in group A were treated with fixed lingual appliances (Stealth®, AO, Sheboygan, Wisc; mean age: 20.6 years; standard deviation [SD]: 2.9 years), whereas 17 patients in group B (mean age: 21.8 years; SD: 3.3 years) treated with conventional fixed labial appliances. Using fricative/s/sound spectrographic analysis, speech performance has been tested before, immediately after (T1), 1 month after, and 3 months after bracket placement.

Wang et al., in 2013, conducted a study on articulatory speech disorder assessment via speech therapy [ 88 ]. The research objective was to compare speech therapy’s efficacy with functional articulation disorders in two groups of children: those without speech Impairment disorder (SID). There were no major differences statistically between the two groups in age, gender, sibling order, parenting education, and pre-test number of pronunciation errors (P > 0.05). After speech therapy assessment (F = 70.393; P < 0.001) and interaction between pre/post-speech therapy assessment (F = 11.119; P = 0.002), the results showed significant changes. Speech therapy improved the articulation performance of children with functional articulation disorders, regardless of whether they have SID, but in children without SID, it results in significantly greater improvement. Thus, the assessment efficiency of speech therapy in young children with articulation disorders may be affected by SID.

In 2017, Afshan et al. introduced an automated approach to children’s speech clinical evaluations using limited data [ 4 ]. Graduate clinicians have assessed the Rhotic sound pronunciation by evaluating words in the GFTA-3 with the letter ‘r.‘ Due to their late acquisition in children; the rhotic sounds were explicitly selected. The remaining kids, used for evaluation, were aligned using the dynamic time to match the five template warping. The difference between both test child’s ‘r’ and model child’s ‘r’ was measured using the cosine distance. Multiple linear regression is shown on the differential scores to generate well-correlated forecasts with Human Clinical Assessments.

The risk of speech disorder is more for children born with cleft palate. Cleft lip or cleft palate are congenital disabilities that result in the incorrect formation of the fetal lip or mouth during pregnancy. Together, these congenital disabilities are usually known as “orofacial clefts.“ Speaking and feeding are difficult in such situations and surgical interventions are required to restore normal scar-free function. Language therapy helps to correct speech problems, if necessary. Zharkova, in 2013, conducted a study to describe ultrasound tongue imagery as a potential tool in cleft palate speakers for quantitative tongue function analysis [ 92 ]. The other three steps compare tongue curve sets to quantify tongue displacement dynamics, token-to-token variability in the tongue’s position, and the extent of separation between tongue curves for different sounds of speech.

Britton et al. conducted a study to develop national standards for speech results and care treatment processes for children with cleft palate ± lip [ 13 ]. In this large, multicenter, prospective cohort study, 12 cleft centres in Great Britain and Ireland collected speech recordings of 1,110 five-year-old with cleft palate who were involved (born 2001 to 2003). Results were compared against the evidence-based method, speech outcome requirements, and statistical analysis performed. The development of standards facilitated increased reporting of speech and treatment results. To Study whether Tele Practice (TP) intervention/assessment in SLP could efficiently improve the speech performance in children with cleft palate (CCP), Pamplona and Ysunza conducted a study in 2020 during COVID − 19 [ 58 ]. There was a significant CA severity improvement at the end of the TP period (p < 0.001). The researcher indicates that TP can be a safe and reliable tool for CA improvement. The COVID-19 pandemic would radically alter healthcare services delivery long-term, so studying and implementing alternative service delivery modes.

Ankyloglossia is a congenital condition in which an abnormally short, thickened, or tight lingual frenulum is born to a neonate, limiting the tongues mobility. In 2015, Ito et al. conducted a study to determine the efficacy of tongue-tie division (frenuloplasty/frenulotomy) in children with ankyloglossia for speech articulation disorder (tongue-tie) articulation test [ 33 ]. Articulation testing was performed in five children (3-8years) with speech problems with tongue-tie division. A speech therapist interviewed the patients and asked them to pronounce what the picture card showed. Substitution and deletion improved relatively early after the tongue-tie division and progressed to distortion, a form of articulation disorder that is less impaired. Thus, distortion required more time for improvement, and in some patients, it remained a lousy speaking habit.

In 2010, Liss et al. investigated automated analysis of speech envelope modulation spectra (EMS), which quantified speech rhythmicity within specified frequency bands and examined whether comparable results could be obtained [ 41 ]. EMS was conducted on sentences produced by 43 speakers with 1 of 4 types of dysarthria and healthy controls. EMS consisted of full-signal slow-rate (up to 10 Hz) amplitude modulations and 7-octave bands ranging from 125 to 8000 Hz in centre frequency. Discriminant function analysis (DFA) determined which sets of predictor variables between groups best discriminated against. For group membership, these variables achieved 84% 100% lassification precision. Dysarthria could be described in acoustic output by quantifiable temporal patterns. EMS shows promise as a clinical and research tool because the analysis is automated and requires no editing or linguistic assumptions.

Paediatric dysarthria is a sound disorder of motor speech that results from neuromuscular weakness, paralysis, or incoordination of the muscles needed for speech production. The child’s speech may be slurred or distorted, and speech may vary in intelligibility based on the extent of neurological weakness. There are some well-established therapy and tools for assessing and treating childhood dysarthria. Scholderle et al. conducted a study in 2020 to collect auditory-perceptual data from typically developing children between 3 and 9 years of age on established symptom categories of dysarthria to create age standards for assessing dysarthria [ 70 ]. We are used to analysing speech recordings of the Bogenhausen Dysarthria Scales’ auditory-perceptual criteria, a standardised German assessment tool for dysarthria in adults. The Bogenhausen Dysarthria Scales (scales and characteristics) cover clinically relevant speech dimensions and assess well-established categories of dysarthria symptoms. Several speech characteristics overlapped with established symptom categories of dysarthria in typically developing children. The results published in the study are a first step towards establishing auditory-perceptual standards for dysarthria in kindergarten and elementary school children.

Al-Qatab and M. Mustafa investigated the acoustic features and feature selection approaches utilised to improve dysarthric speech classification in ASR based on the severity of impairment in 2021 [ 5 ]. They used four acoustic features in their study: prosody, spectral, cepstral, and voice quality, as well as seven feature selection methods: Interaction Capping (ICAP), Conditional Information Feature Extraction (CIFE), Conditional Mutual Information Maximization (CMIM), Double Input Symmetrical Relevance (DISR), Joint Mutual Information (JMI), Conditional redundancy (Condred), and Relief. In addition to that, they used Support Vector Machine (SVM), Linear Discriminant Analysis (LDA), Artificial Neural Network (ANN), Classification and Regression Tree (CART), Naive Bayes (NB), and Random Forest (RF) as classification techniques in the experiment. They stated their experiment has several merits that add knowledge to the classification of dysarthric speech according to the level of severity like, the research has identified the features that can work in most of the classifiers, looked at the importance of feature selection in the classification of dysarthric speech and it looked at the best combination that gives the best classification accuracy in the classification. But their disadvantages were that they used a small database – Nemour and the other was that they did not adopt the state-of-the-art classifiers such as deep learning.

This study by Lehner et al. in 2021 covers the development of KommPaS, a web-based instrument for assessing communication impairment in dysarthria patients [ 40 ] KommPaS (Communication-related Factors in Speech Disorders) allows doctors to crowdsource laypeople to evaluate dysarthric speech samples for communication-related parameters such as intelligibility, naturalness, perceived listener effort, and efficiency (intelligible speech units per unit time). Significant problems about test efficiency, reliability, and validity would be addressed in addition to material influencing variables and the link between the four KommPaS characteristics.

Researchers used the Radboud Dysarthria Assessment in adults (over 18 years old) and the Radboud Dysarthria Assessment in children (5–18 years old) to assess dysarthria, which included observational tasks such as “conversation” and “reading,“ as well as speech-related maximum performance tasks such as “repetition rate,“ “phonation time,“ “fundamental frequency range,“ and “phonation volume” in 2021. Twenty-two people (15 children [5–17 years], seven adults [19–47 years], 14 men and eight females; mean age 19 years, SD 15 years 2 months) took part in the study. All subjects had dysarthria, defined by ataxic components in adults and similar uncontrollable movements in youngsters. Dysarthria in ataxia-telangiectasia is defined by uncontrolled, ataxic, and involuntary movements, which result in monotonous, unsteady, sluggish, hypernasal, and chanted speech, according to Veenhuis et al. They concluded by stating that the Radboud Dysarthria Assessment and the paediatric Radboud Dysarthria Assessment can be used to assess dysarthria in ataxia-telangiectasia.

In 2012, Kayikci et al. conducted a study to evaluate (1) whether Hawley retainers cause speech disturbance and (2) objective and subjective tests the duration of speech adaptation to Hawley retainers [ 35 ]. This study included 12 young people aged 11.11 to 18.03 years. Before and after the Hawley retainer application, speech sounds were assessed subjectively using an articulation test and objectively using acoustic analysis. After wearing Hawley retainers, patients showed statistically significant speech disturbances with consonants [ş] and [z]. Statistically significant changes were reported to the vowels. In 2018, Mugada et al. conducted a study to evaluate the quality of life for Head and neck cancer patients who received the therapy [ 51 ]. The study was conducted for 9 months. The EORTC QLQ-C30 Items (European Organization for Cancer Research and Treatment Quality of Life Questionnaire Core 30) were used, including the H&N-35 module, to evaluate QOL. The contrast of Specific socio-demographic and clinical features with EORTCC domains created between Questionnaire QLQ-C30 and the H&N35 QLQ EORTC. At p < 0.05, the significance level was taken.

Sharma and Singh, in 2016, conducted an observational study on squamous cell carcinoma of the pediatric head and neck, which is rare [ 74 ]. For assessing clinicopathological characteristics, treatment, and outcome of this emerging problem, obtained data on pediatric head and neck cancer in the younger age group (20 years of age) was used. Nine patients aged 20 years or younger were identified for analysis in this study during the said period. Various parameters were recorded and analyzed for the outcome, such as age, clinical features, clinical stage, and patients’ treatment. Further clinical studies need to be conducted to establish etiopathological characteristics and treatment guidelines in this issue.

In 2021, Bachmann et al. conducted a study to adapt the well-known Speech Handicap Index (SHI) to German, test its suitability for assessing the speech-related quality of life, and compare it to the German Voice-Handicap-Index (VHI) to aid in the treatment of oral cancer patients who experience post-treatment speech difficulties. Participants conducted a web-based survey with a 2 (experienced problem: speech/articulation-related vs. voice-related) x 2 (SHI vs. VHI) between-subject experimental design to distinguish between voice and intelligibility deficits and determine the discriminatory ability of the two instruments. They concluded that the German SHI is a more reliable and responsive measure of speech intelligibility and articulation-related quality of life than the VHI.

Cerebral Palsy, Autism Spectrum Speech Disorder, Hearing Loss, Phonology and Articulation, Friedreich Ataxia (FRDA), Aphasia, Epilepsy, Craniofacial Microsomia

Table ​ Table7 7 shows the papers included in the review used in studies investigating cerebral palsy, autism spectrum disorder, hearing loss, phonology and articulation, Friedreich ataxia (FRDA), Aphasia Epilepsy and Craniofacial Microsomia that cause speech impairment in children.

Studies that Investigated Cerebral Palsy and Autism Spectrum Disorder, Hearing Loss, Phonology and Articulation, Friedreich Ataxia (FRDA), Aphasia, Epilepsy, and Craniofacial Microsomia

A preliminary language classification system for cerebral paralysis children was suggested and tested in 2010 by Hustad et al. In the laboratory, 34 children with cerebral paralysis were assembled and collected their speaking and language assessment data (CP; 18 males, 16 female) with an average age of 54 months (SD = 1.8) [ 32 ]. The study provided preliminary support for classifying CP children’s speech and language skills into 4 initial profile groups. To validate the entire classification system, further research is necessary.

This study compared Down syndrome (DS) and TD infants between the ages of 5 and 7 months in a visual orientation test as well as an audiovisual speech processing task, which examined infants’ gazing patterns to communicative signals (i.e., face, eyes, mouth, and waving arm) by Pejovic et al. in 2021 [ 62 ]. The study found that DS infants’ early visual attention and audiovisual speech processing may be disrupted, with implications for their communication development, suggesting new options for early intervention in this clinical population. According to the findings, DS newborns orient their visual attention slower than TD infants. Both groups focused on the eyes rather than the mouth and the face rather than the waving arm. Furthermore, the findings of this research imply that DS children may require more time to detect/attend to communicative cues in face-to-face communication and that caregivers should emphasize face-to-face communication as a way of training attention to communicative cues from an early age.

The evolution of a scale would classify children’s speech performance for use in brain paralysis monitoring registers by Pennington et al. Its reliability across raters and over time analyzed [ 63 ]. Cerebral paralysis speech of 139 children (85 boys, 54 girls; mean age 6.03 years, SD 1.09) were classified from the observation and prior knowledge of the children from their language therapist and speech therapists, parents, and other health professionals. Another group of health professionals also rated children’s speech from the data in their medical notes. Instead, it asked to assess the scale’s simplicity to use, and the scale used Likert scales to describe the child’s speech production. More than 74% of raters reported the scale easy or relatively easy to use; 66% of parents and more than 70% of health care professionals judged the scale to describe children’s speech well or very well. The Viking Speech Scale was a reliable tool for describing the speech performance of children with cerebral paralysis by observing children or reviewing case notes.

Ertmer et al. investigated children with hearing loss to determine whether scores from a commonly used word-based articulation test are closely associated with speech intelligibility [ 25 ]. GFTA – II and 10 short sentences produced words from 44 children with hearing losses. Correlations between 7 word-based predictor variables and percentage-intelligible scores derived from the hearer judgment of stimulus phrases performed. However, regression analysis revealed that the variability in intelligibility scores accounted for no single variable or multivariable model predictor for over 25%.

In 2010, Florian Stelzle et al. conducted a study to introduce and validate a computer-based speech recognition system (ASR) for automatic speech evaluation after dental rehabilitation in edentulous patients with complete dentures [ 78 ]. 28 patients twice recorded reading a standardised text - with and without their complete dentures in situ—the speech quality measured by the percentage of the word accuracy (WA) by a polyphone-based ASR. The wearing of complete dentures, on the other hand, considerably increased the WA of the edentulous patients. The reconstitution of speech production quality is essential for dental rehabilitation and can be improved by complete dentures for edentulous patients. The ASR proved a helpful, practical, and easily applicable tool for an automatic speech evaluation in a standardised way.

Fulcher et al. conducted a study in 2012 to check whether a homogeneous cohort of early identified children (approximately 12 months) with all severities of hearing loss and no other concomitant diagnoses could not only significantly outperform a similarly homogeneous cohort of later identified children (> 12 months and < 5 years), but also achieve and maintain age-appropriate speech/language outcomes by 3, 4 and 5 years of age [ 27 ]. The children had attended the same program of oral auditory-verbal early intervention. Standardized speech/language assessments performed at 3, 4, and 5 years of age typically developing hearing children. The previous children identified have significantly outperformed the late children identified at all ages.93% of all early identified participants scored for speech within normal limits (WNL) by 3 years of age; 90% were WNL for vocabulary understanding, and 95% were WNL for speech production.

Hochmuth et al. carried out a case study on a new Spanish noise sentence test to develop, optimise, and evaluate [ 30 ]. The trial included a fundamental matrix of 10 names, verbs, numerals, names, and adjectives. This matrix is used for test lists of 10 sentences of the same syntactic structure, containing the entire language material. The speech material was the distribution of phonemes in Spanish. Independent measures to examine the training effects, comparability of test lists, open-set vs. closed-set test format, and listeners’ performance from various Spanish varieties were conducted and assessed. In total, 68 normal-hearing native Spanish-speaking listeners were selected. No significant differences indicate that the test applies to Spanish and Latin American listeners for listeners of different Spanish varieties.

A study was conducted by Phillips et al., in a group of children who are deaf or hard-of-hearing to test the concurrent validity of the Leiter International Success Scale-Revised (Leiter-R Brief IQ) and Differential Ability Scales-Second Edition (DAS-II Nonverbal Reasoning Index) [ 65 ]. The participants included 54 children between the ages of 3 and 6 with permanent bilateral hearing loss. The mean values in the two assessments did not vary significantly. Hearing loss severity is not linked to the nonverbal IQ of either the Leiter-R or the DAS-II. Almost a quarter of the assessed children had significant intra-individual differences.

In 2020, Ng et al. described the design and development of CUCHILD, a Cantonese corpus of child speech evaluation tool, on a large scale [ 56 ]. The corpus includes words from 1,986 children between the ages of 3 and 6 years. 130 words with 1 to 4 syllables in length had in the speech materials. Speakers cover children with speech disorders, TD, and those with other speech disorders. The aim is to provide corpus support for scientific, clinical, and technological research relating to child speech evaluation. The corpus’ design is described in detail, including word selection, recruitment of participants, data acquisition process, and data pre-processing.

A cardinal feature of FRDA is dysarthria, which often leads to severe impairments in daily functioning. However, its precise characteristics are only poorly understood to date. In 2013, Brendel et al. carried out a comprehensive evaluation of the severity of dysarthria and the profile of speech motor deficits in 20 patients with a genetic diagnosis of FRDA, based on a carefully selected battery of speech tasks and two commonly used Paraspeech studies, i.e., oral diadochokinesis and sustained vowel production [ 12 ]. Breathing, voice quality, voice instability, articulation, and tempo were identified as the most affected speech dimensions by perceptual ratings of the speech samples. The outcome indicated that FRDA pathology is differentially susceptible to speech production components and trunk/limb motor functions. Evidence has also emerged that part speech tasks do not permit an adequate scaling of FRDA speech deficits.

Functional neuroimaging studies and investigations have shown increased activation of the unaffected hemisphere in aphasia patients, which hypothetically reflects a maladaptive brain reorganisation strategy [ 72 ]. Seniow et al. investigated whether, when combined with speech/language therapy, repetitive magnetic transcription (rTMS) stimulation inhibiting the homologue in the right hemisphere in Broca improves the repair of the language. 40 aphasia patients were randomised to a 3-week aphasia rehabilitation protocol combined with real rTMS by using the Boston Diagnostic Aphasia baseline test. They reported that severe aphasic rTMS showed significantly more improvement than patients receiving repeated sham stimulation.

Petrillo et al. experimented in 2021 for the Italian version of the progressive aphasia severity scale (Italian PASS), which was built according to guidelines for cross-cultural adaptation of self-report measures to aid researchers and clinicians in the diagnosis and follow-up of a primary progressive aphasia (PPA) in Italian populations [ 64 ]. This tool would allow researchers to gather data on patients with PPA’s communicative functioning in everyday contexts, considering standardised tests employed in the clinical setting and the perspectives of their caregivers. Furthermore, it could be particularly beneficial for long-term disease monitoring to track its advancement, and it could be an ideal way to check the success of speech/language treatment in delaying disease progression.

Laganaro et al. released a screening version of a speech assessment protocol (MonPaGe-2.0. s) in 2021 as a response to the demand for objective screening tools for motor speech disorders. It is based on semi-automated acoustic and perceptual assessments of many speech characteristics in French (MSD) [ 39 ]. They tested the screening tool’s sensitivity and specificity and compared the results to external standard evaluation methods. Data from 80 patients with mild to moderate MSD and 62 healthy test controls were compared to normative data from 404 neurotypical speakers, with Deviance Scores calculated on seven speech dimensions (articulation, prosody, pneumophonatory control, voice, speech rate, diadochokinetic rate, intelligibility) using acoustic and perceptual measures. The MonPaGe, TotDevS, and an external MSD composite perceptual score provided by six experts had a good connection. The sensitivity and specificity of the MonPaGe screening technique for diagnosing the existence and severity of MSD have been demonstrated. They concluded that to distinguish MSD subtypes, more implementations are needed to complement the definition of compromised dimensions.

Rolandic epilepsy is associated with developmental language impairment. Literature does not show exactly which domains are affected. In 2013, Overvliet et al. studied performance among children with Rolandic epilepsy and healthy controls in the language domains [ 57 ]. That is a focal study compared to healthy controls of children with Rolandic epilepsy. A CELF language test was carried out on 25 children with Rolandic epilepsy (mean 136.6 months, SD 23.0) and 25 years with healthy inspections matched with age (Clinical Evaluation of Language Fundamentals, Dutch edition). The core language score was significantly lower in children with epilepsy than healthy controls.

Speltz et al., in 2018, assessed whether infant cases with craniofacial microsomia (CFM) show lower neurodevelopmental status than demographically comparable infants without a craniofacial diagnosis (‘controls’) and examined the neurodevelopmental outcomes of cases by facial phenotype and hearing status [ 76 ]. Observational study on 108 cases and 84 controls aged 12–24 months was carried out. The third edition of Bayley scales for children and Toddlers and the fifth edition of the preschool linguist scales have been evaluated by participants (PLS-5). With the Craniofacial Microsomy Phenotypic Assessment Tool, facial features are categorised. Among women and those with higher socioeconomic status, outcomes were better. Facial phenotype and hearing status among cases showed little to no association with results. Although learning problems in older children with CFM have been observed, no evidence of developmental or language delay has been reported among infants.

Challenges, limitations and future research possibilities

With an increasing number of children with speech impairment, improving and devising methods for early detection is paramount to preventing disease progression. The development of this field may help adults and children receive better assessment and treatments from clinical trials and hospitals. Therefore, several tool methods have been proposed to detect and predict this speech impairment; however, these techniques have fundamental limitations. This part discusses some of the challenges and future research directions to help more researchers address them.

One of the challenges against universal screening is that identifying and correctly diagnosing infants with speech impairment at 24 months of age, unless it is a cleft palate, is very difficult. There is still a pressing need to identify the appropriate mix of assessment tool modalities that would improve detection rates and reduce false-positive results. The development of such diagnostic tools can lead to a precise and conclusive diagnosis of speech impairment and the early detection of the condition. Two more challenges that need to be addressed include cost and dataset availability. Sustained efforts into developing a proper universal speech assessment tool will positively impact children’s self-esteem and self-confidence with SSD [ 89 ]. The challenges faced during the study included a lack of databases that are dedicated to assessment tools for speech-impaired children. The absence of comprehensive datasets is a major setback to future development, as most publicly available datasets contain missing values for numerous detection algorithms. Data analysis is also complicated due to a lack of sufficient data. Techniques for early detection of speech problems in children are too costly for families and society to handle. In terms of screening children at an early age, progress is being made in improving screening techniques that can be cost-friendly, eco-friendly, and reliably identify at-risk status. Given the large amount of positive results, more effort is needed to duplicate, expand, and individualise available therapies and screening and diagnostic tools.

Additionally, the available literature is contained in databases that require either subscription or specific institutional credentials to have access. This phenomenon is quite frustrating since scientists should have unlimited access to the available data to conduct their studies seamlessly [ 11 ]. The researcher must perform numerous searches in various databases to capture all the relevant peer-reviewed studies for inclusion in the systematic review. Moreover, several papers were contained in multiple databases, which drastically reduced the number of eligible articles for inclusion in the systematic review.

Furthermore, Due to the limitation of manual or hand transcription-based diagnostic evaluation approaches, there is a growing demand for automated methods to quantify child speech patterns and aid in the rapid and reliable diagnosis of speech impairment [ 80 ]. Automatic assessment models are promising tools for detecting speech impairment. Artificial intelligence approaches, such as deep learning, effectively model exceedingly complex data accurately. These models are more resilient and interpretable than other similar techniques, yet they are computational models that try to find the relationship between a collection of datasets and their results. These models rely on many hyperparameters, all of which must be fine-tuned. Datasets are also crucial to the effectiveness of deep learning models; they must be impartial to achieve the best outcomes. Features in the datasets must also be thoroughly studied and unrelated. Another significant problem is predicting speech impairment in newborns and infants between 0 and 24 months.

The number of children with SSD is expected to rise in the future, along with the cost of treatment and intervention. Various speech assessment tools have been developed to diagnose and treat SSD, such as “The Caterpillar” and “My Grandfather” automatic tools, DEMSS, and MSE. However, their success is limited due to varied cultural practices and orientations, and lack of universality due to limited validity and reliability. Detecting SSD accurately at the child’s preschool years ensures that the condition is eliminated and does not persist into adolescence. Future studies will have to incorporate studies dedicated to testing speech-impaired children’s speech assessment tools’ validity, reliability, and universality. It is essential to ensure that researchers develop a universally accepted speech assessment tool that transcends all cultural barriers to help speech-language pathologists. For example, future studies should include more research on developing a speech assessment tool ideal for multilingual and bilingual children. Furthermore, studies should consist of more than 150 peer-reviewed papers to improve reliability and validity. In total, there still exists a need to develop speech assessment tools independent of human judgment to help diagnose and intervene to aid in the early detection and intervention of SSD in children.

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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.

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What is stuttering?

Who stutters, how is speech normally produced, what are the causes and types of stuttering, how is stuttering diagnosed, how is stuttering treated, what research is being conducted on stuttering, where can i find additional information about stuttering.

Stuttering is a speech disorder characterized by repetition of sounds, syllables, or words; prolongation of sounds; and interruptions in speech known as blocks. An individual who stutters exactly knows what he or she would like to say but has trouble producing a normal flow of speech. These speech disruptions may be accompanied by struggle behaviors, such as rapid eye blinks or tremors of the lips. Stuttering can make it difficult to communicate with other people, which often affects a person’s quality of life and interpersonal relationships. Stuttering can also negatively influence job performance and opportunities, and treatment can come at a high financial cost.

Symptoms of stuttering can vary significantly throughout a person’s day. In general, speaking before a group or talking on the telephone may make a person’s stuttering more severe, while singing, reading, or speaking in unison may temporarily reduce stuttering.

Stuttering is sometimes referred to as stammering and by a broader term, disfluent speech .

Roughly 3 million Americans stutter. Stuttering affects people of all ages. It occurs most often in children between the ages of 2 and 6 as they are developing their language skills. Approximately 5 to 10 percent of all children will stutter for some period in their life, lasting from a few weeks to several years. Boys are 2 to 3 times as likely to stutter as girls and as they get older this gender difference increases; the number of boys who continue to stutter is three to four times larger than the number of girls. Most children outgrow stuttering. Approximately 75 percent of children recover from stuttering. For the remaining 25 percent who continue to stutter, stuttering can persist as a lifelong communication disorder.

We make speech sounds through a series of precisely coordinated muscle movements involving breathing, phonation (voice production), and articulation (movement of the throat, palate, tongue, and lips). Muscle movements are controlled by the brain and monitored through our senses of hearing and touch.

The precise mechanisms that cause stuttering are not understood. Stuttering is commonly grouped into two types termed developmental and neurogenic.

Developmental stuttering

Developmental stuttering occurs in young children while they are still learning speech and language skills. It is the most common form of stuttering. Some scientists and clinicians believe that developmental stuttering occurs when children’s speech and language abilities are unable to meet the child’s verbal demands. Most scientists and clinicians believe that developmental stuttering stems from complex interactions of multiple factors. Recent brain imaging studies have shown consistent differences in those who stutter compared to nonstuttering peers. Developmental stuttering may also run in families and research has shown that genetic factors contribute to this type of stuttering. Starting in 2010, researchers at the National Institute on Deafness and Other Communication Disorders (NIDCD) have identified four different genes in which mutations are associated with stuttering. More information on the genetics of stuttering can be found in the research section of this fact sheet.

Neurogenic stuttering

Neurogenic stuttering may occur after a stroke, head trauma, or other type of brain injury. With neurogenic stuttering, the brain has difficulty coordinating the different brain regions involved in speaking, resulting in problems in production of clear, fluent speech.

At one time, all stuttering was believed to be psychogenic, caused by emotional trauma, but today we know that psychogenic stuttering is rare.

Stuttering is usually diagnosed by a speech-language pathologist, a health professional who is trained to test and treat individuals with voice, speech, and language disorders. The speech-language pathologist will consider a variety of factors, including the child’s case history (such as when the stuttering was first noticed and under what circumstances), an analysis of the child’s stuttering behaviors, and an evaluation of the child’s speech and language abilities and the impact of stuttering on his or her life.

When evaluating a young child for stuttering, a speech-language pathologist will try to determine if the child is likely to continue his or her stuttering behavior or outgrow it. To determine this difference, the speech-language pathologist will consider such factors as the family’s history of stuttering, whether the child’s stuttering has lasted 6 months or longer, and whether the child exhibits other speech or language problems.

Although there is currently no cure for stuttering, there are a variety of treatments available. The nature of the treatment will differ, based upon a person’s age, communication goals, and other factors. If you or your child stutters, it is important to work with a speech-language pathologist to determine the best treatment options.

Therapy for children

For very young children, early treatment may prevent developmental stuttering from becoming a lifelong problem. Certain strategies can help children learn to improve their speech fluency while developing positive attitudes toward communication. Health professionals generally recommend that a child be evaluated if he or she has stuttered for 3 to 6 months, exhibits struggle behaviors associated with stuttering, or has a family history of stuttering or related communication disorders. Some researchers recommend that a child be evaluated every 3 months to determine if the stuttering is increasing or decreasing. Treatment often involves teaching parents about ways to support their child’s production of fluent speech. Parents may be encouraged to:

• Provide a relaxed home environment that allows many opportunities for the child to speak. This includes setting aside time to talk to one another, especially when the child is excited and has a lot to say.
• Listen attentively when the child speaks and focus on the content of the message, rather than responding to how it is said or interruptng the child.
• Speak in a slightly slowed and relaxed manner. This can help reduce time pressures the child may be experiencing.
• Listen attentively when the child speaks and wait for him or her to say the intended word. Don't try to complete the child’s sentences. Also, help the child learn that a person can communicate successfully even when stuttering occurs.
• Talk openly and honestly to the child about stuttering if he or she brings up the subject. Let the child know that it is okay for some disruptions to occur.

Stuttering therapy

Many of the current therapies for teens and adults who stutter focus on helping them learn ways to minimize stuttering when they speak, such as by speaking more slowly, regulating their breathing, or gradually progressing from single-syllable responses to longer words and more complex sentences. Most of these therapies also help address the anxiety a person who stutters may feel in certain speaking situations.

Drug therapy

The U.S. Food and Drug Administration has not approved any drug for the treatment of stuttering. However, some drugs that are approved to treat other health problems—such as epilepsy, anxiety, or depression—have been used to treat stuttering. These drugs often have side effects that make them difficult to use over a long period of time.

Electronic devices

Some people who stutter use electronic devices to help control fluency. For example, one type of device fits into the ear canal, much like a hearing aid, and digitally replays a slightly altered version of the wearer’s voice into the ear so that it sounds as if he or she is speaking in unison with another person. In some people, electronic devices may help improve fluency in a relatively short period of time. Additional research is needed to determine how long such effects may last and whether people are able to easily use and benefit from these devices in real-world situations. For these reasons, researchers are continuing to study the long-term effectiveness of these devices.

Self-help groups

Many people find that they achieve their greatest success through a combination of self-study and therapy. Self-help groups provide a way for people who stutter to find resources and support as they face the challenges of stuttering.

Researchers around the world are exploring ways to improve the early identification and treatment of stuttering and to identify its causes. For example, scientists have been working to identify the possible genes responsible for stuttering that tend to run in families. NIDCD scientists have now identified variants in four such genes that account for some cases of stuttering in many populations around the world, including the United States and Europe. All of these genes encode proteins that direct traffic within cells, ensuring that various cell components get to their proper location within the cell. Such deficits in cellular trafficking are a newly recognized cause of many neurological disorders. Researchers are now studying how this defect in cellular trafficking leads to specific deficits in speech fluency.

Researchers are also working to help speech-language pathologists determine which children are most likely to outgrow their stuttering and which children are at risk for continuing to stutter into adulthood. In addition, researchers are examining ways to identify groups of individuals who exhibit similar stuttering patterns and behaviors that may be associated with a common cause.

Scientists are using brain imaging tools such as PET (positron emission tomography) and functional MRI (magnetic resonance imaging) scans to investigate brain activity in people who stutter. NIDCD-funded researchers are also using brain imaging to examine brain structure and functional changes that occur during childhood that differentiate children who continue to stutter from those who recover from stuttering. Brain imaging may be used in the future as a way to help treat people who stutter. Researchers are studying whether volunteer patients who stutter can learn to recognize, with the help of a computer program, specific speech patterns that are linked to stuttering and to avoid using those patterns when speaking.

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

Use the following keywords to help you find organizations that can answer questions and provide information on stuttering:

• Speech-language pathologists
• Physician/practitioner referrals

For more information, contact us at:

NIDCD Information Clearinghouse 1 Communication Avenue Bethesda, MD 20892-3456 Toll-free voice: (800) 241-1044 Toll-free TTY: (800) 241-1055 Email: [email protected]

NIH Pub. No. 97-4232 February 2016

* Note: PDF files require a viewer such as the free Adobe Reader .

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Rhotacism: A complete guide to this speech impediment

Remember when you were a child and spoke by making your “R’s” sound like “W’s” and everything thought it was cute? That’s known as rhotacism and some people live with it even as adults. What is rhotacism, what is it like in other languages, and what are its symptoms? What does it look like as a speech impediment and what are some examples? What are its causes? How does it affect the brain ? Is it curable and how can it be fixed? This article will answer all your doubts about rhotacism. 

What is rhotacism?

Rhotacism is a speech impediment that is defined by the lack of ability, or difficulty in, pronouncing the sound R . Some speech pathologists, those who work with speech impediments may call this impediment de-rhotacization because the sounds don’t become rhotic, rather they lose their rhotic quality. It could also be called a residual R error.

It’s not such an uncommon phenomenon and actually also happens with the letter L , a phenomenon known as lambdacism . Sometimes people mistake these speech impediments for a lisp, of which they are not. Within the 2000-2001 school year, more than 700,000 students within the American public school system were categorized as having either a language impediment or a speech impediment. Ironically, all three speech impediments contain the troubled letter within them.

The word rhotacism comes from the New Latin rhotacism meaning peculiar or excessive use of [r]. The Latin word came from Ancient Greek word rhōtakismós which means to incorrectly use “rho” which is the equivalent of the Greek R. For language nerds, here’s a really great explanation of how the word came into being.

How does rhotacism work in different languages?

Rhotacism is, in theory , more common among people whose native language has a trilled R. For example, in Spanish the “rr” is a trilled R. Other languages with a trilled R include Bulgarian, Hungarian, Arabic, Finnish, Romanian, Indonesian, Russian , Italian, and most Swedish speakers. Some people might mock Asians, specifically Chinese, for not being able to pronounce the English word “broccoli” correctly- rather pronouncing it “browccoli”. This isn’t due to a rhotacism, however. It’s actually due to the fact that Mandarin (Chinese) words can have an “r” sound in the beginning of a word, but not in the middle or end of a word. This leads them to have issues in their phonotactics and creates an inability to pronounce the English “R” in the middle of words.

The leader of Hezbollah, Hasan Nasrallah, is a Lebanese leader and is mocked for his rhotacism when he says, “ Amwīka ” and “ Iswā’īl ” for the Arabic Amrīka (America), and Isrā’īl (Israel). He is a native Arabic speaker- a language which has the trilled R. Notice how he puts a W sound in those two words where the R sound usually is.

Symptoms of rhotacism

• Some people try to hide their impediment by avoiding words with R ’s in them.
• An overall inability to say R sounds
• Using trilled R’s or guttural R’s (such as the French R) when trying to pronounce the regular English R.

Rhotacism as a speech impediment

Using a strict classification, only about 5%-10% of the human population speaks in a completely normal way. Everyone else suffers from some type of speech disorder or another. For children of any language, the R sounds are usually the hardest to master and often end up being the last ones a child learns. That’s why baby talk if you think about it, doesn’t really use explicit or strong R sounds. In English, rhotacism often comes off as a W sound which is why “Roger Rabbit” sounds like “Woger Wabbit”. R is often more difficult because a child has to learn the different combination of the /r/ sounds, not just the letter itself, unlike other letters. For example, when it comes before and after vowel sounds. The combination of a vowel with the /r/ sound is called a phenome and in English, there are eight combinations of these:

–        The prevocalic R , such as “rain”

–        The RL , such as “girl”

–        The IRE, such as “tire”

–        The AR, such as “car”

–        The EAR , “such as “beer”

–        The OR , such as “seashore”

–        The ER , such as “butter”

–        The AIR , such as “software”

A speech impediment is a speech disorder , not a language disorder . Speech disorders are problems in being able to produce the sounds of speech whereas language disorders are problems with understanding and/or being able to use words. Language disorders, unlike speech disorders, have nothing to do with speech production.

Often what happens is that the person speaking isn’t tensing their tongue enough, or not moving their tongue correctly (up and backward depending on the dialect) which makes the W or “uh” sound come out. It may also be that the person is moving their lips instead of their tongue.

Examples of rhotacism

• Barry Kripke from the TV show The Big Bang Theory has both rhotacism and lambdacism- meaning he has issues pronouncing both his R ’s and his L ’s.
• The most famous of rhotacism would be Elmer Fudd from Looney Tunes . He pronounces the word “rabbit” [ˈɹ̠ʷæbɪ̈t] as “wabbit” [ˈwæbɪ̈t]
• In Monty Python’s Life of Brian , the 1979 film’s character Pilate suffers from rhotacism. In the film, people mock him for his inability to be understood easily.

Here’s a video with a woman who suffers from rhotacism. She explains how difficult it can be to have the speech impediment.

Causes of rhotacism

For many people, the causes of rhotacism are relatively unknown-, especially in adults. However, scientists theorize that the biggest cause is that the person grew up in an environment where they heard R ’s in a weird way, the shape of their mouths are different than normal, or their tongues and lips never learned how to produce the letter. In children, this could happen because the parents or adults around think the way the child talks (using baby talk) is cute and the child never actually learns how to produce it.

For one internet forum user, it has to do with how they learned the language , “I speak various languages, I pronounce the “R” normal in Dutch, French, and Spanish, but I have a rhotacism when speaking English. It’s the way I learnt it.”

For other people, speech issues are a secondary condition to an already existing, serious condition. Physically, it would be a cleft lip or a cleft palate. Neurologically, it could be a condition such as cerebral palsy. It may also be a tongue tie . Almost everyone has a stretch of skin that runs along the bottom of their tongue. If that skin is too tight and reaches the tip of the tongue, it can make pronouncing (and learning how to pronounce) R ’s and L ’s difficult. If the tongue tie isn’t fixed early on, it can be incredibly difficult to fix and learn how to pronounce later.

How the brain affects rhotacism

The brain affects rhotacism only for those who suffer from it not due to a physical impediment (such as a cleft palate). For some, this could happen because the brain doesn’t have the phonemic awareness and never actually learned what the letter R is supposed to sound like. This is common with kids whose parents spoke to them in “baby talk” and encouraged the child’s baby talk, too. This kind of behavior only strengthens a child’s inner concept that / R / is pronounced like “w” or “uh”.

Another reason could be that the brain connections simply don’t allow the lips or mouth to move in the way they need to in order to pronounce the R . This inability has little to do with physical incapabilities and more to do with mental ones. Some people with rhotacism have an issue with their oral-motor skills which means that there isn’t sufficient communication in the parts of the brain responsible for speech production.

Treatment for rhotacism

Is rhotacism curable.

It can have negative social effects- especially among younger children, such as bullying, which lowers self-esteem and can have a lasting effect. However, if the impediment is caught early enough on and is treated rather quickly, there is a good overall prognosis meaning it’s curable.

        However, some people never end up being able to properly pronounce that R and they end up substituting other sounds, such as the velar approximant (like w sounds) , the uvular approximant (also known as the “French R ”), and the uvular trill ( like the trilled R in Spanish).

How to fix rhotacism

Rhotacism is fixed by speech therapy . Before anything else, there needs to be an assessment from a Speech Language Pathologist (SLP) who will help decide if the problem can be fixed. If a child is involved, the SLP would predict if the child can outgrow the problem or not. After the diagnosis, a speech therapist will work with the person who suffers from the speech impediment by possibly having weekly visits with some homework and practice instructions. Therapy happens in spouts- a period of a few weeks and a break. There is a follow-up to see if there has been an improvement in pronunciation. In the U.S., children who are in school and have a speech disorder are placed in a special education program. Most school districts provide these children with speech therapy during school hours.

Another option, often used alongside speech therapy, is using a speech therapy hand-held tool that helps isolate the sound being pronounced badly and gives an image of the proper tongue placement to enable better pronunciation.

One study tested a handheld tactical tool (known as Speech Buddies) and the traditional speech therapy methods. The study found that students who used the hand-held tool (alongside speech therapy) improved 33% faster than those who used only the traditional speech therapy methods.

Have you or someone you know ever struggled with rhotacism? Let us know what you think in the comments below!

• Category: Wellness
• Tag: language , Language Disorder

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Parent's Academy › Speech Therapy › Speech Therapy for Kids › Testing for Speech and Language Therapy

Testing for Speech and Language Therapy

Stacie bennett.

Speech-Language Pathologist , Trenton , New Jersey

Feb 5, 2022 What is the Test of Preschool Vocabulary? How, when and why should I get my child tested?

When getting a child evaluated for speech and language services, most parents want to know what sort of tests will their child be exposed to, when should they look into testing and how do you go about looking for an SLP ? This blog will go into detail about different batteries of tests that your child might be exposed to and will culminate in how and when testing should be completed. 

Test of Preschool Vocabulary (TOPV)

The Test of Preschool Vocabulary (TOPV) measures a child’s ability to recognize and use single words that represent all parts of speech and a variety of basic concepts, including things, events, and experiences. The words are presented in order of difficulty, progressing from familiar words and concepts to less familiar ones (wbspublish.com). 

The TOPV is divided into an expressive (what your child can produce verbally and written) vocabulary and receptive vocabulary (what words your child can understand). You would use the TOPV on children who are 2 years of age to 5 years and 11 months of age. This testing will help with:

• Identifying children with oral language disorders
• Diagnosing early semantic ability
• Comparing receptive and expressive vocabulary knowledge
• Monitoring language intervention progress
• Conducting research

Clinical Evaluation of Language Fundamentals (CELF)

There are several different versions of the CELF, depending on the age of your child. No matter what age bracket your child is in, the format of the testing is basically the same. Directions may change and the complexity of the subtests will adjust accordingly. As a speech pathologist, this is one of my favorite tests to administer because it truly looks at every aspect of a child’s language skills . The CELF includes a variety of subtests that provide in-depth assessment of a child’s language skills: Concepts and Following Directions, Word Structure, Expressive Vocabulary, Recalling Sentences, Sentence Structure, Basic Concepts, Recalling Sentences in Context, Word Classes and Phonological Awareness.

The CELF tests begin at preschool age and continue all the way into adulthood. The test will be administered to a child/adolescent if there are issues with formulating sentences , recalling verbal information, following multi-step directions or vocabulary.

Comprehension Assessment of Spoken Language (CASL)

The CASL looks at language processing skills and knowledge . It can be used on children as young as three and can be administered to adults up until the age of 21. What is really nice about this test is that it answers a variety of referral questions including eligibility for speech services, placement in special education, determining if a language delay or disorder is present, or measuring language abilities in English language learners.

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Goldman-Fristoe Test of Articulation (GFTA-3)

The GFTA is a test that looks at articulation skills or, in other words, how your child produces sounds , syllables, words, sentences and conversations. It can be used on a child as young as 2 and up until age 21.

The great thing about the GFTA is that it only takes between 15-20 minutes to complete so it’s perfect for young kids who may not have the attention span to sit for longer tests. The GFTA will, most likely, be included in your evaluation if your child is school aged and not speaking clearly.

Oral and Written Language Scales (OWLS)

The OWLS looks at how well your child can write language and formulate sentences verbally . Depending on your child’s ability level, it could take 40 minutes or 2 hours and can be given to children as young as 3, although I would not recommend it be given to children until they can formulate language and can start writing letters.

The OWLS will ask your child to complete a story based on a picture prompt that the speech pathologist will show him/her. Their story will be assessed to see if it has a logical flow, good vocabulary usage, punctuation/capitalization errors and age-appropriate grammar. Sentences will also be formulated based on vocabulary words given (definitions).

Peabody Picture Vocabulary Test (PPVT)

The Peabody Picture Vocabulary Test, revised edition (PPVT-R) “measures an individual’s receptive (hearing) vocabulary for Standard American English and provides, at the same time, a quick estimate of verbal ability or scholastic aptitude ” (Dunn and Dunn, 1981). The PPVT-R was designed for use with individuals aged 2½ to 40 years. The English language version of the PPVT-R consists of 175 vocabulary items of generally increasing difficulty. The child listens to a word uttered by the interviewer and then selects one of four pictures that best describes the word’s meaning.

The PPVT also has an expressive component where the child has to name a picture that is shown to them. These words also grow in complexity as the testing progresses.

Screening Test for Developmental Apraxia of Speech (STDAS)

The STDAS is an evaluation tool that is administered to determine if a child’s receptive language scores are higher than their expressive language . If a child can understand more than what they are expressing, that is a key sign that the child may have apraxia of speech . If this discrepancy is shown, a speech-language pathologist will complete further testing on your child to get a definitive diagnosis. Apraxia is an acquired oral motor speech disorder affecting an individual’s ability to translate conscious speech plans into motor plans, which results in limited and difficult speech ability. Basically, they can’t formulate the words that they are thinking in their heads. 

The STDAS takes about 15 minutes to complete and is acceptable to use on children 4-12 years of age. 

Test of Language Development (TOLD)

The TOLD is similar to the CELF. It’s a test that looks at a child’s ability to understand and formulate language . TOLD tests are also geared towards certain ages. For example, there is a TOLD-Primary, which looks at young children. There is also a version of the TOLD that can be used for students who are adolescents and young adults. 

The TOLD testing can take anywhere from 40 minutes to 2 hours. Testing lengths are really dependent on your child’s ability level and if there are any other cognitive or attention issues that may make testing more difficult. 

When To See A Speech-Language Pathologist

We at Speech Blubs have written several blogs about when to get help for your child’s speech. Instead of going to a lengthy discussion where I repeat the information that’s already been told, the biggest piece of advice I tell people who contact me about speech and language services is to go with your gut. You know your child the best. If you think there is a problem, get help. If a professional looks at him/her and tells you that they are “on target,” it will at least give you peace of mind. If they qualify for services, then they get the help that they need. 

Go with your gut. You know your child the best!

Why Speech Services?

A parent asked us why a child should be enrolled in therapy. There are several reasons why a child should receive services:

• Delayed speaking/communicating
• Speech is unclear or unintelligible to peers, family members and friends
• Child does not gesture or babble to communicate
• Limited eye contact or lacking social skills
• Poor written language skills
• Difficulty with processing information – it can be written or verbal
• Trouble with memory

If your child is exhibiting any of the above mentioned issues, I highly suggest getting a referral for speech services from your pediatrician. 

Most likely, there will be a waitlist to get into a speech therapist’s office. Please download the Speech Blubs app to work on speech and language skills. It’s great screen time that will allow your child to work on rhyming, vocabulary, articulation, social skills and oral motor activities. It doesn’t matter your child’s diagnosis – this app will assist in the refining and learning of speech!

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The author’s views are entirely his or her own and may not necessarily reflect the views of Blub Blub Inc. All content provided on this website is for informational purposes only and is not intended to be a substitute for independent professional medical judgement, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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Speech Impediment Test for Kids

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Apr 2, 2024

As a licensed practitioner working with children, I understand parents’ concerns about their kids’ speech development. If you’re worried your child might have a speech impediment, you’re not alone. Many parents find themselves in the same situation, questioning whether their child’s speech is developing typically or if there’s cause for concern. In this blog post, I’ll guide you through identifying potential speech impediments and what steps you can take to support your child’s speech development .

Table of Contents

What is a Speech Impediment?

A speech impediment, also known as a speech disorder , is a condition that affects an individual’s ability to produce sounds correctly or fluently, or to use spoken language effectively to communicate. Speech impediments can range from mild to severe and can impact a child’s ability to be understood by others.

Some common types of speech impediments in children include:

• Articulation disorders : Difficulty producing specific sounds or syllables correctly
• Fluency disorders : Interruptions in the flow of speech, such as stuttering or cluttering
• Voice disorders : Problems with pitch, volume, or quality of the voice
• Language disorders : Difficulty understanding or using spoken language effectively

According to the American Speech-Language-Hearing Association (ASHA), approximately 5% of children in the United States have noticeable speech disorders by first grade. Early identification and intervention can significantly affect a child’s speech development and overall communication skills.

Signs of a Potential Speech Impediment

As a parent, you are best positioned to observe your child’s speech development. While every child develops at their own pace, some signs may indicate a potential speech impediment. Keep an eye out for the following:

• Difficulty producing specific sounds consistently (e.g., substituting “w” for “r” or “t” for “k”)
• Omitting sounds or syllables in words (e.g., saying “ba” for “ball” or “poon” for “spoon”)
• Struggling to be understood by others, especially unfamiliar listeners
• Repeating sounds, words, or phrases (stuttering)
• Using a strained or hoarse voice consistently
• Limited vocabulary compared to peers of the same age
• Frustration or reluctance to communicate due to speech difficulties

If you notice any of these signs consistently in your child’s speech, it may be time to consider a speech impediment test or evaluation by a qualified speech-language pathologist (SLP) .

Goally’s Speech Impediment Test

If you’re looking for a quick and easy way to assess your child’s speech development, Goally offers a speech impediment test that can help identify potential areas of concern. While this test is not a substitute for a professional evaluation and cannot provide an official diagnosis , it can be a useful tool for parents who want to better understand their child’s speech abilities.

Keep in mind that if the test indicates a potential speech impediment, it’s essential to follow up with a licensed speech-language pathologist for a comprehensive evaluation and appropriate treatment plan.

Take this quiz to assess if your child might be experiencing a speech impediment, helping you to pinpoint areas where they could benefit from specialized support.

Does your child have difficulty pronouncing certain sounds or words clearly?

Do strangers or people outside the family often have trouble understanding what your child is saying?

Does your child avoid speaking in public or in front of classmates due to difficulty with speech?

Have you noticed your child repeating sounds or parts of words when speaking?

Does your child show signs of frustration or embarrassment when trying to communicate verbally?

Has a teacher or caregiver expressed concern about your child’s speech clarity or fluency?

Does your child’s speech seem less clear or less developed compared to peers of the same age?

Do you observe unusual patterns in your child’s speech, such as hesitations or prolonging sounds?

Does your child seem to struggle with breathing or vocal strain while speaking?

Have you been concerned about your child’s speech development for more than six months?

Restart quiz

Supporting Your Child’s Speech Development at Home

While professional intervention is crucial for children with speech impediments, you can support your child’s speech development at home in many ways. Here are some tips:

Remember, every child develops at their own pace, and speech development is no exception. By providing a supportive and language-rich environment at home, you can help your child build the foundation for effective communication skills.

When to Seek Professional Help

If you suspect your child may have a speech impediment, it’s essential to seek professional help sooner rather than later. Early intervention can significantly affect your child’s speech development and overall communication skills. According to a study published in Pediatrics, children who receive early speech therapy have better language outcomes than those who start therapy later.

Don’t hesitate to talk to your child’s pediatrician or contact a licensed speech-language pathologist if you have concerns about your child’s speech development. They can guide you through the process of a speech impediment test and provide the necessary support and resources for your child’s unique needs.

Goally | Apps that Teach Kids AAC & Core Words

Is your child facing challenges in expressing themselves or communicating effectively? Goally has one of the best language language learning apps for kids to support their journey in building essential communication skills!

The Word Lab and AAC Talker apps provide a simple, engaging platform for your child to learn core words and become a functional communicator right from the start. Customize the experience with a voice that suits them, and watch as their confidence grows in expressing their thoughts and needs!

As a parent, it’s natural to worry about your child’s development, including their speech. By understanding the signs of potential speech impediments and the importance of early intervention, you can take proactive steps to support your child’s speech development. Remember, a speech impediment test conducted by a qualified professional is the first step in identifying and addressing speech concerns. Your child can build the communication skills they need to thrive with the right support and resources.

• American Speech-Language-Hearing Association (ASHA) – A comprehensive overview of speech and language disorders in children.
• Centers for Disease Control and Prevention (CDC) – Information on language disorders and tips for encouraging language development.
• Understood.org – A guide to understanding speech impairments and strategies for supporting children with speech difficulties.

FAQs about Speech Impediment Test

Hennah is an experienced writer and researcher, helping children with autism, ADHD, and other neurodivergent conditions. As a blog contributor for Goally, she combines her deep understanding of neurodiversity with practical advice, offering valuable insights to parents and educators.

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How to tell if your child has a speech or language impairment

Speech Language Pathologist and Lecturer, Discipline of Speech Pathology, University of Sydney

Speech language pathologist & Lecturer, University of Sydney

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Elise Baker has received funding from the Australian Research Council, and the New South Wales Department of Education. She works for The University of Sydney. She is affiliated with Speech Pathology Australia.

Natalie Munro has received funding from NSW SPELD. She works for The University of Sydney. She is affiliated with Speech Pathology Australia.

University of Sydney provides funding as a member of The Conversation AU.

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Babies are born communicating. Their cries and coos speak volumes. However, much-anticipated first words do not appear until 12 months later. By 18 months, the average child says about 50 words. By the time a child is ready to start school, their vocabulary will be an estimated 2,300 to 4,700 words .

Speech and language development takes time. Speech gradually becomes easier to understand; language gradually becomes more sophisticated.

Problems arise when speech and language milestones are not met. Left untreated, children who start school with speech and language difficulties face an increased risk of reading and writing difficulties, more bullying, poorer peer relationships and less enjoyment of school. So, what should parents expect of children at different ages?

‘Normal’ speech and language development

During the early years a child learns language - that is, converting thoughts and emotions into words. A child also learns speech - that is, figuring out the mouth movements needed to make speech sounds in words and deciphering the rules for how those sounds combine to form words.

For instance, children learning English learn that you can start a word with three consonants, but that the first consonant must be s, the second consonant p, t or k and the third consonant l, r, w or j as in splash, street and square.

By 24 months, a child should have at least 50 words and should be putting two words together. These two-word utterances should form basic sentences to request actions (“mummy up”), request objects (“more milk”) and make comments (“big ball”).

The child should also understand a range of words and follow simple commands (“Where’s your nose?” “Where’s Amy’s tummy?”). Approximately 50% of a 24-month-old’s speech should be understood by an unfamiliar listener.

Speech errors such as substituting easy speech sounds for more difficult sounds (saying “wook” for “look”), omitting sounds in words (saying “poon” for “spoon”) and deleting entire syllables (saying “getti” for “spaghetti”) are typical of this age.

Between 24 and 36 months, a child’s speech and language ability should show rapid growth. By 36 months, 75% of what a child says should be understood by an unfamiliar listener.

By 48 months, a child should be talking in much longer, grammatically correct sentences. The child should be joining sentences using words such as “and” and “because”.

As many parents will be able to confirm, children can ask an average of 107 questions an hour including: what, where, who, whose, why and how? A four-year-old should be able to explain recent events. However, they may struggle with some elements, particularly those involving time. “When” questions can be difficult for a child to answer.

Familiar two- and three-step instructions (“wash your hands and dry them”) as well as less routine-bound instructions (“show me the monkey sitting under the chair”) should be understood. Speech should be 100% intelligible to an unfamiliar listener by 48 months.

Errors such as “poon” for “spoon” should have disappeared. Some speech sounds may still be difficult: particularly “r” and “th”, so that “rabbit” may still be pronounced as “wabbit” and “thumb” may be pronounced as “fum”.

If your two-year-old isn’t talking, or your four-year-old’s speech is difficult to understand, seek the advice of a speech pathologist. Do not wait until your child starts school to seek help. Children can have better outcomes if they receive help before they start school.

Vocabulary and long-term outcomes

The amount and types of words addressed to children in the home from a young age correlates with their growing vocabulary. In an interesting longitudinal study of 42 children and their families, two researchers observed children at home once a month for an hour for 2 ½ years.

When they analysed their data according to family socio-economic status (upper socio-economic status, middle/lower socio-economic status and welfare) they noticed that the average child from a family on welfare heard 616 words per hour, the average child from a middle/lower socio-economic status (working class) family heard 1,251 words per hour while the average child from an upper socio-economic status (professional) family heard 2153 words per hour . When they extrapolated their results over four years of experience, they found that:

the average child in a professional family would have accumulated experience with almost 45 million words

an average child in a welfare family would have accumulated experience with 13 million words.

Not surprisingly, the children who heard more words, had bigger vocabularies and better language abilities by school age. Vocabulary size is important because children who start school with larger vocabularies develop superior reading abilities .

Children should be seen and heard, and engaged in conversation from a young age. If you are concerned about your child’s speech or language development, seek the advice of a speech pathologist.

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Speech Impairment: Symptoms, Causes, and When to See Your Doctor

Speech impairment in adults is a symptom that causes difficulty in speaking or pronouncing words. This can be a temporary condition, or it can be a symptom of a severe medical condition. This guide will show you what to look for and when to see a doctor.

9 minute read

Last Updated September 20, 2021

Speech impairment in adults is any symptom that causes difficulty in speaking or pronouncing words. Speech impairments can include slurred, rapid, stuttered, hoarse, or slowed speech, and they can be caused by any number of factors. 

Some cases of impaired speech may be temporary, while others are caused by an underlying medical condition. When speech impairment is sudden, then it is a symptom of a serious problem , such as a heart attack or stroke, and requires immediate medical attention.

Symptoms of Speech impairment

Along with an inability to clearly communicate verbally, you can also experience other symptoms with speech impairment. 

♦ Weakened facial muscles ♦ Difficulty remembering words ♦ Deficits with expressive language ♦ Drooling ♦ Sudden contraction of vocal muscles

Causes of Speech Impairment

The different types of speech impairment have different causes, and you can develop speech impairment suddenly or gradually. 

♦ Aphasia: This is when you have difficulty thinking of words or pronouncing them, and the potential causes of this type include head trauma, brain tumors, and degenerative diseases such as Alzheimer’s disease. 

♦ Dysarthria: This is when you have trouble moving your lips, tongue, vocal folds, or diaphragm. This typically results from degenerative muscle conditions such as multiple sclerosis as well as stroke, head trauma, Bell’s palsy, Lyme disease, and excessive alcohol consumption.

♦ Vocal disorders: This affects your ability to speak and is caused by injuries to the area, throat cancer, polyps or nodules on the vocal cords, and consumption of drugs like antidepressants. 

♦ Spasmodic dysphonia: This involves involuntary movements of the vocal cords. The exact cause is unknown, but this impairment is linked to abnormal brain functioning. 

Diseases Associated with Speech Impairment

There can be temporary causes of speech impairment, but in most cases, there is an underlying condition impacting the speech region of the brain. Sudden speech impairment can be a sign of a serious medical condition that requires immediate medical attention.

♦  Stroke : Speech impairment and disorders are common after a stroke, but they can also be signs of an impending stroke. Slurred speech, along with facial muscle changes, can indicate a stroke and should not be ignored.

♦ Cardiovascular disease : Heart disease can cause structural changes in the brain as a result of reduced blood flow. Cognitive abilities and communication can be impacted as a result.

♦ Multiple sclerosis : This condition causes lesions that damaged parts of the brain, which can impair speech patterns.

♦ Infections : Viral and bacterial infections that reach the brain can cause damage to the areas that process language, causing temporary speech impairment. 

♦ Huntington’s Disease : This disease mostly affects movement, but the majority of patients with Huntington’s also report speech difficulties.

♦ Alzheimer’s disease : Speech impairment can develop as a result of plaques in the brain that are associated with Alzheimer’s disease. 

♦ Parkinson’s : Difficulty speaking and swallowing is common with Parkinson’s disease and gets worse as the disease progresses. 

♦ Cholesterol : High cholesterol can lead to the formation of plaques in the arteries, and without treatment, these increase your risk for stroke, which can cause speech impairment.

♦ Cancer : A tumor in your brain located near the speech center will cause speech impairments as well as changes in memory, seizures, and severe headaches.

♦ Head trauma : Injury, internal bleeding, or bruising to the brain, as a result of head trauma can impact speech. Depending on the severity and location of the trauma, speech impairment may be temporary or permanent.

Diagnosis of Speech Impairment

When speech impairment appears suddenly, seek immediate medical attention . When it develops more gradually, you need to see your doctor for testing, in case there is an underlying condition as the cause. 

You may experience speech impairment after using your voice too much or after an infection, but prolonged impairment requires attention and testing for diagnosis. Your doctor will start with a physical examination and discuss your medical history and symptoms. They will also talk with you to evaluate your speech during a discussion and to determine your level of comprehension and speaking ability. 

In addition to this, testing can be done to attempt to identify possible underlying causes. The most common tests include:

♦ Blood tests ♦ Electrical current tests ♦ MRI, CT, and x-Ray scans ♦ Urine tests

It may also be necessary for you to follow up with specialists such as a neurologist, speech pathologist, or otolaryngologist for more detailed testing and analysis.

Treatment for Speech impairment

The treatment will depend on the cause and severity of your speech impairment. In all cases of speech impairment, the underlying cause needs to be treated in order to restore speech. 

Exercises can be done to help strengthen vocal cords and improve articulation. You can also use assistive communication devices. Only in certain situations will surgery or any other invasive procedure be required. If the cause of your speech impairment is a stroke or heart disease, medications are prescribed as well as surgery. Your doctor will also recommend a heart-healthy lifestyle to follow.

In addition to any medical treatment plan given to you by your doctor, there are things you can try to help protect your voice, and prevent or limit the severity of a speech impairment. 

♦ Always wear protective headgear to prevent brain injuries. ♦ Quit or avoid smoking and second-hand smoke to reduce the risk of throat cancer. ♦ Limit consumption of alcohol. ♦ Get regular exercise to reduce the risk of stroke. ♦ Follow a balanced diet to protect against hypertension and high cholesterol.

Natural Treatment for Speech Impairment

Most of the causes of speech impairment will require medical treatment. However, there are certain conditions related to heart health that you can prevent naturally. Stroke and atherosclerosis are both related to high cholesterol and clogged arteries. 

By incorporating specific natural ingredients into your diet, you can promote overall heart health by reducing cholesterol levels. This will reduce your risk of heart-related conditions that can cause speech impairment. The top ingredients to try include:

♦ Berberine bark extract both lowers cholesterol and fights inflammation to protect against heart disease.  ♦ Chromium benefits the heart by reducing the risk of high cholesterol and arterial clogs . This significantly reduces the risk of stroke. ♦ Lion’s mane mushroom improves the good-to-bad ratio of cholesterol in your blood to protect against stroke. ♦ Niacin works to lower cholesterol and blood lipid levels to reduce the risk of heart attack and stroke. Studies have found that it works more effectively than cholesterol-lowering statins.  ♦ Pine bark extract helps lower bad cholesterol, which prevents clogged arteries and reduces the risk of stroke. This extract also reduces inflammation that can cause platelets to clump together, forming dangerous clots known to increase stroke risk.

When to See Your Doctor

The gradual development of speech impairment can be caused by a number of conditions or factors that can be effectively treated once identified. 

If you notice the sudden onset of any speech impairment, you need to seek immediate medical attention, as this is a common sign of a stroke. Without treatment, a stroke can cause permanent damage to your heart and brain and even death. 

While speech impairment may develop from a relatively harmless condition, the risk of stroke cannot be ignored, so be sure to seek help if impairment appears suddenly.

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