Speech Problems



  • Communication is the exchange of ideas between two or more individuals.
  • Language is a systematic means of communication that relies on a socially agreed on set of symbols and rules for combining those symbols. Language includes comprehension, expression, and social-pragmatic rules (e.g., eye contact and turn-taking).
  • Speech is produced through vocal and articulatory movements using neuromotor control of respiration, phonation (vocalization), and articulation to shape airflow and vocal sounds into strings of speech sounds (phonemes) to form words and word combinations.
  • Articulation refers to the use of oral and pharyngeal structures (lips, tongue, palate, teeth) to shape vocal sounds and airflow into recognizable speech.
  • Hearing is the process of transferring sound from the environment to the brain via the outer, middle, and inner ear systems.
  • Speech disorders have three general points of origin: (i) neurologic, (ii) structural, or (iii) functional. Functional disorders are those that are unrelated to neurologic or structural disorders. More than one of these causes may be present in the same child.
  • Speech disorders can be classified and are described as follows:
    • Articulation or phonologic disorders
      • Disrupt the way a child says one or more speech sounds
      • Simplifications of complex adult speech are often normal very early in speech development but should be evaluated if these changes linger, are atypical, or interfere with socialization.
    • Fluency disorders
      • Disrupt the easy flow of speech production and include the conditions of stuttering and cluttering.
      • Examples of stuttering include repetitions of sounds, syllables, words, or phrases, pauses, blocks, or hesitations.
      • Easy repetitions are common in children ages 2 to 4 years and typically resolve quickly. Persistence, visible struggle, or avoidance of talking warrant referral.
    • Motor speech disorders
      • Disrupt timing, coordination, or the execution of the motor plan for speech
      • Divided into two major categories: (i) dysarthrias, which are most often related to neuromotor weakness or paralysis, and (ii) apraxia, a motor planning disorder in the absence of neuromotor weakness or paralysis
    • Voice disorders
      • Heard as atypical laryngeal quality such as hoarseness (dysphonia) or completely absent voice (aphonia)
    • Resonance disorders
      • Describe speech quality usually described as nasality
      • Hypernasality (excessively nasal quality) is associated with velopharyngeal dysfunction and is atypical.
      • Hyponasality (inadequate nasality) is common in young children in association with acute upper respiratory infection or adenoid hypertrophy.
  • Language disorders may occur in receptive, expressive, pragmatic, or some combination of these domains. Language disorders may occur in conjunction with other developmental, sensory, neurologic, or structural concerns but may also be isolated as an area of delay (see “Speech Delay” and “Autism” chapters).


  • The American Speech-Language Hearing Association states that communication disorders occur in 1 of every 8 people in the population.
    • Newborn screening identifies hearing loss or deafness in 1 to 5 per 1,000 newborns, with higher rates in neonatal intensive care.
  • Speech sound disorders including articulation, phonologic, and developmental apraxia of speech are considered the most prevalent communication problem diagnosed in 15% of preschoolers and 4–6% of school-aged children.
    • Fluency disorders affect 11% of children by age 4 years.
    • Boys are 3 times more likely to persist in stuttering beyond age 4 years.
  • Cerebral palsy affects 1 in 500 children born each year and may include mild to severe motor speech disorders and risk of other communication disorders.
  • Voice disorders such as chronic hoarseness are reported in 6–23% of children.

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