Unclear Speech & Speech Sound Disorder

What is Articulation?

In speech, Articulation is the process of moving the tongue, jaws, lips and other organs of speech (articulators) to form speech units.

The articulation of speech sounds, the consonants, vowels and other speech units, demands incredibly minute coordination of the tongue, lips, mandible ( lower jaw) and velum ( soft palate – back part of the roof of the mouth that extends into the throat). The movements of these structures must occur in synchrony with the respiratory and phonatory systems.

Certain speech sounds require the rounding of lips some need lip closure. The mandible (lower jaw) must be lowered to help create a larger mouth cavity for some vowels than the others. The velum and the pharyngeal (throat) walls must perform timely movements. The tongue which is the most agile articulator continuously has to assume different shapes and postures as we speak various combinations of vowels and consonants.

What is an Speech Sound disorder?

An Speech Sound disorder is characterized by deviant speech production in the presence of some anatomical, motor or sensory impairment. That means if a child has unclear speech due to some physical motor apparent reason he is showing an articulation disorder.

The most common problem of the 5 – 10 % of all children who are estimated to have a communication disorder is some type of difficulty that affetcs their speech sound system. Some of these Speech Sound disorder are related to hearing impairment, or cleft palate or other neural developmental disorders and there are also some disorders which have no physical basis. They may be a part of a broader linguistic difficulty and there can be children who have already mastered speech sounds, but may acquire articulation disorders due to stroke, head injury or other neurological disorder.

Such difficulties can vary widely in severity, from speech that is very intelligible  to a tiny lisp in which a /th/ sound preceeds or follows the /s/ sound as in ‘sthoup’ or ‘yeths’.

There are 4 ways of this articulations:

1. Omission of sounds (‘oup’ for soup)
2. Substitution of sounds ( ‘thoup’ for ‘soup’)
3. Distortion of sounds – substitution of a non-standard sound for a standard one ( a slushy unvoiced /l/ for /s/)
4. Addition of sounds (‘isoup’ for ‘soup’,  /bilu/ for blue)

What are the causes of Speech Sound disorder?

Learning to produce different speech sounds is a mammoth task for a child.. From neural pathways to respiratory function, there are many processes involved in the articulating (pronouncing) a phoneme. It is difficult for the mentally impaired children to do this learning. Hearing losses ( even temporary ones) may hold back children from perceiving the required information to articulate clearly. Neurological distress, like in cerebral palsy, may lead to deficits in the motor control that make the mastery of complicated speech utterances. Emotional problems, isolation and also the lack of a caring parent can also interfere with the learning process.

Factors that cause articulation disorders can be summed as under

1. Structural factors

   1. Organic deviations of the tongue and other oral structures.
   2. Short Frenum, also called Tongue Tie ( Ankyloglossia) – causes misarticulations of all speech sounds which require movement of the tongue against the palate. E.g – /s/, /l/, /r/ etc
   3. Malocclusion – abnormal bite of the teeth.  2 types seen – underbite or overbite. Misarticulations of /f/, /v/, /s/,/z/ etc
   4. Missing or jumbled teeth – Most common issue is the absent front incisors before the permanent teeth emerge. These deviances cause lisps or errors of the /s/, /z/ sounds.
   5. Cleft lip/palate- depending on the type and severity, misarticulations vary
   6. Tongue thrusting – It’s an orofacial muscular imbalance in which the tongue protrudes through the incisors while swallowing, speaking and when the tongue is at rest. Difficulties with sibilant sounds /s/, /z/ are seen.

2. Audition

   1. Hearing impairment- Children with either permanent or temporary hearing loss have difficulty perceiving speech from their surroundings.
   2. Chronic infections of the ear like otitis media result in temporary hearing loss which is shown to hamper with the clarity of speech.
   3. Auditory perceptual difficulties. Children with auditory deficiencies do not perceive the errors they produce while speaking, hence they are not able to correct their speech.
   4. Poor Auditory Discrimination –Children with poor auditory discrimination have difficulties in recognizing the essential differences between the speech sounds.
   5. Poor Auditory memory – Reduced auditory memory also prolongs the process of mastery of the different speech sounds and interferes with correct speech sound production.

3. Parental and Family Influences

   1. Parental Dialect – The production of consonants might be related to imitation of a parental dialect.
   2. Age – Children born to young parents might be neglected and unwanted. This emotional stress might mount up to interference with the speech sound production. On the other hand, old parents might place unnecessary demands on the child for high standard of speech pronunciation which also indirectly influence the way a child picks up language and speech.
   3. Parental models – Poor articulation by parents sets wrong models for the child to imitate. A parent with pronunciation errors in his speech gives wrong standards to the child.
   4. Home conditions – Speech development is not fostered by a critical, demanding environment or by one which promotes overdependence

4. Developmental History

   1. Physical development – Almost any factor that delays physical development also might retard speech. Youngsters with sluggish tongues and palates have histories of slow physical development.
   2. Intelligence-There seems to be a correlation between low IQ scores and poor articulation skills of children. Children with Down syndrome have motor deficits that affect speech production.
   3. Illnesses – Certain severe illnesses lower the vitality of a child so much that he has no energy to learn the complex speech skills. Prolonged illness may result in parental attitudes of over concern and overprotection.
   4. Play – Children might imitate improper pronunciation styles from the children they play with.
   5. Emotional Problems – In some children, misarticulations may stem from emotional immaturity and aggressive behaviours.

Hearing-Speaking: Are they related?

Hearing-Speaking, We usually get a question of

-How hearing problem from birth plays a critical role in speech and language development, communication and learning?

-When the child cannot hear why cannot he/she speak?

To answer these questions we need to know something about the ear development. A child starts hearing to environmental sounds not only from the time he/she is born but also from 18 weeks of gestational age. Research says that fetus as young as 18-19 weeks hears mother’s heartbeat and other louder environmental sounds. Ultrasound studies show that a child can respond to mother’s voice even before birth. It is well documented that a child starts developing auditory skills from the day 1. The primitive startle reflexes to loud sounds is gradually developed into more and more advanced responses like localization, comprehension, understanding etc.

To read further about Hearing Loss and Unclear speech

What is Childhood apraxia of speech CAS?

Childhood apraxia of speech (CAS) is a motor speech disorder that affects a person’s ability to organise the movements of the muscles used in speech. CAS is a neurological disorder that affects the brain pathways involved in planning the sequence of movements involved in producing speech. The brain knows what it wants to say, but cannot properly plan and sequence the required speech sound movements. The person has difficulty making speech sounds voluntarily and stringing these sounds together in the correct order to make words.

Childhood apraxia of speech can continue into adult life. CAS is not caused by weakness or paralysis of the speech muscles (the muscles of the jaw, tongue, or lips). The difficulty seems to occur because of a breakdown in the program of movement sent from the brain to the muscles. This does not mean that the person has an intellectual impairment.

The severity of CAS varies from person to person. It can be so mild that it causes trouble with only a few speech sounds or with pronunciation of words that have many syllables. In the most severe cases, someone with CAS might not be able to communicate effectively by speaking, and may need the help of alternative communication methods.

Causes of Childhood Apraxia of Speech

CAS is a motor speech disorder. Something in the child’s brain does not allow messages to get to his mouth. Most of the time, the cause is unknown. It is possible that nothing would show up if you had tests done, like an MRI or CT scan of the child’s brain. This can be frustrating as you look for a reason for the child’s speech problems.

In some cases, the child may have brain damage that causes CAS. The child may have a genetic disorder or syndrome that causes brain damage. A stroke or brain injury can also cause CAS.

How is apraxia of speech diagnosed?

Currently, there is no validated list of diagnostic features differentiating CAS from other childhood speech sound disorders, including those due to phonological-level delay or neuromuscular disorder (dysarthria). However, three segmental and suprasegmental features consistent with a deficit in the planning and programming of movements for speech have gained some consensus among those investigating CAS:

• inconsistent errors on consonants and vowels in repeated productions of syllables or words,
• lengthened and disrupted coarticulatory transitions between sounds and syllables,
• inappropriate prosody, especially in the realization of lexical or phrasal stress.

Typical Articulation Development in Children

Children learn the different sounds of their language gradually over the first 8 years of life. They learn to combine words according to the rules or patterns they hear from adults in their environment. You might be surprised to know that children learn the sounds of their native language by nine months of age! But this doesn’t mean they must be producing these sounds correctly by nine months of age.  As they develop, their brain learns to organize the speech sounds they hear in the environment and produce them as and when their oral motor structures support them to produce more variety of speech sounds.

Treatments

Articulation Therapy: A Beginner’s Guide

Misarticulation or the lack of correct pronunciation of sounds can hinder good communication. Sounds are learnt developmentally and hence as the child grows, sounds would typically become clearer and more adult-like. However, at times, such clarity is not reached.

The sounds we produce use different positions of the tongue, lips, palate and other articulatory or speech sound structures.

Correct articulation, for many of us, is taken for granted and suspected to be quite simple. However, it requires precision of placement, good coordination and movement of articulators. Let’s understand the complexity of correct sound production through a simple exercise! Let’s say the sound /p/slowly. Now, the sound /n/. When saying each slowly, think about where your lips and tongue are positioned and what they are doing. Also, try to feel where the air from your throat is going while saying each sound. If noticed carefully – the sounds use different positions of the tongue and lips and the air moves through different airways in the mouth and nose!

Articulation Therapy: Four Go-To Materials

 

 

Articulation Therapy – The inability to pronounce sounds correctly in speech can be corrected through articulation therapy. It must be multisensorial as well as fun! There are several items that would make an articulation therapy effective yet interesting. My four go-to materials for articulation therapy are:

• Mirror
• Puppets
• Drawing board
• A word list

Speech therapy for Apraxia-Tips and strategies

Speech therapy for Apraxia-Tips and strategies, Childhood Apraxia of speech (CAS) is one of the Motor speech Disorder which affects a child’s ability to speak clearly. They have difficulty in planning to produce a speech sound and difficulty in sending neural signals to jaw, lips, and tongue to produce a required speech sound. In turn they find difficulty in learning a new speech sound or word. They have a better understanding of language and know what they want to express.

Different sounds teaching

1. The sounds P and B are bilabial plosives. 
2. The sounds /k/ and /g/ are velar stops.
3. The /w/ sound ( in well, week, one, etc.) is known as a glide or a semi-vowel. 
4. The articulation therapy for /ch/ and /j/ sounds involves teaching the correct placement of the articulators.
5. The sounds /m/ and /n/ are voiced nasals. 
6. The sounds /f/ and /v/ are labiodental fricatives. 
7.  The sounds T&d /t/ (as in tomato) and /d/ (as in dig) are lingua-alveolar plosives.
8. Difficulty in producing the “TH & DH” sounds is classified as a speech sound disorder.
9. Typically children learn to produce /s/ and /sh/ by 4 years of age and master it as they grow older.
10. Teaching R & L sounds

Please note that these are basic guidelines for articulation therapy. A child’s individual assessment results would guide a speech therapist for specific inputs which may include working on listening to sound and sound pairs or practicing specific sounds before the other (different from above) etc.

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