Causes and Symptoms
Learning to speak correctly is of great importance to all people. It involves the brain-coordinated use of the mouth, jaws, lips, and tongue, as well as of the vocal cords, lungs, and diaphragm. On average, children learn to talk during their second year by imitating the speech of those persons, mostly family members, with whom frequent and close contact is maintained. Hence, it is important that young children hear correct speech.
The development of speech is viewed as occurring in several distinct stages. First, babies make involuntary noises in response to physical stimuli. Then, they begin to enjoy making these noises at about two months of age. Next, about nine months after birth, they start to imitate the sounds and inflections of the speech of others around them. Beginning at twelve to eighteen months of age, children start to vocalize in a meaningful way, and in due time, they learn to speak.
In many cases, however, a child is quickly found to have some difficulties with the use of speech or with its development to levels viewed as appropriate within expected time spans. Such children suffer from speech disorders including
stuttering,
lisping, and lack of speech comprehension. They should receive appropriate professional help as soon as possible. Others are born with physical problems, such as cleft palate, which make appropriate speech impossible without medical intervention. Smaller numbers of people develop speech disorders later in life for various reasons, including accidents that damage the brain or the mechanical organs of speech, as well as the physical and mental ravages of advanced age.
Speech disorders fall into three main categories: problems associated with speech production, difficulties of articulation, and dysfunction in the ability to utilize language. These disorders have been known since antiquity and although they are frequently hereditary, the genetic cause is often unclear. In fact, there is often a psychogenic aspect to their origin as well.
Another broad means of categorizing speech disorders is by dividing them into causative organic and nonorganic groups. The term “organic speech disorder” is used to indicate
birth defects or later injuries to the brain or the structures, muscles, and connective tissues that are required to produce speech. The disorders for which no such origin can be clearly identified with existing techniques fall into the nonorganic group. Usually, they are attributed solely to psychogenic factors. It is probable, however, that they have subtle organic causes that are beyond present methods of identification.
Speech disorders may be associated with articulation, voice, fluency, language, and dementia. The cures for all these types of speech disorders vary; they include the interactive participation of teachers in school systems and the attention of speech professionals such as speech-language pathologists, audiologists, surgeons, psychiatrists, and physical therapists. Each case must be analyzed carefully and then treated individually. Even so, varied success is obtained from patient to patient, regardless of the disorder, the nature of the therapeutic procedures utilized, and the therapists who are involved.
Articulation disorders are attributable to the inappropriate sequential movement of the jaw, tongue, and related speech structures. Minor, nonpathological differences result in regional differences (accents) in the spoken language within a country. Pathological problems that cause speech that cannot be understood are most often organic in nature. Examples include
cleft palate and neurologic dysfunction. Voice disorders include inappropriate pitch, sound quality (for example, hoarseness), lack of audibility, or inappropriate loudness. Fluency disorders are most often identified with stuttering, speech rate problems, and speech rhythm problems. The best-known language disorders are the aphasias, which are characterized by poor language comprehension and childhood language impairment (often resulting from developmental problems). Dementia can impair speech at any age, but it is most common in the elderly, for whom memory, language, and
cognitive ability may be greatly impaired.
Treatment and Therapy
Many viewpoints exist concerning the treatment of speech disorders. All agree, however, that interaction between family, patient, teachers, and various clinicians is essential. Disorders of articulation are quite common and range from mild problems (for example, a lisp) to those that are so extreme that the speech of afflicted individuals becomes unintelligible. Many of the most severe of these speech disorders arise from the organic impairment of motor control in the speech musculature, which may be attributable to stroke, cleft palate, or even the loss of lips or other speech system components.
Frequently, efforts at remediating such problems must include surgical and dental treatment. After any necessary corrective surgery and/or dentistry, many treatment regimens focus on behavior modification. Affected individuals receive instruction regarding the physical basis of their problems and are then trained to overcome them as effectively as possible.
In many cases, the use of psychological and psychiatric counseling is considered to be of great value. Some experts suggest, however, that the main effect of such therapy is to enable afflicted individuals to live comfortably with the imperfections in articulation that remain after all treatments are tried.
Voice disorders occur when the phonatory mechanism is dysfunctional. They range from the consequences of laryngeal, oral, or respiratory disease to the misuse of the phonatory system, which may reflect psychological state. Such functional disorders, if left untreated for too long, may lead to organic damage. In the case of pitch abnormalities, causative factors may include psychological tension, an undersized larynx, misformed vocal cords, and hearing problems, either individually or in various combinations.
Disorders of voice quality likewise have many physical sources, including larynx and vocal cord abnormalities, and ones of psychogenic origin. The disorders associated with loudness range from overly loud voices caused by workplace noise or hearing loss to extremely soft ones that are generally psychogenic. Treatment of all such disorders begins with the disqualification of treatable organic problems. In the case of psychogenic disorders, psychiatric counseling can be extremely helpful. Psychological and medical treatments must be followed, however, by very thorough interaction with speech-language pathologists if optimum results are to be obtained.
Disorders of fluency most often involve stuttering, also called dysfluency, which features spasmodic hesitation and the prolongation or repetition of sounds. In addition,
stuttering is often accompanied by
tics and other uncontrolled body movements. The basis for the problem is unclear, and different experts point to learned behavior, psychogenic origins, or organic roots. There is no cure for dysfluency, but it (and the accompanying nonspeech problems) can be greatly diminished. Treatment usually involves both psychiatric counseling and behavior and/or speech modification by speech-language pathologists as well as by other related speech professionals. Such therapy varies widely from individual to individual and with the age of the patient.
Language disorders are characterized by the diminished ability to use or to understand spoken language. In children, these disorders are often identified as language delay or development aphasias. They are most often thought to be attributable to developmental disabilities,
hearing loss, or
autism. When lost hearing is not the main problem, the treatments for such language problems often involve behavior modification techniques. In all cases in which hearing loss is an important component, its correction is the first effort; such efforts may work wonders. When hearing problems cannot be remediated entirely, however, the overall treatment will be much less successful because hearing the speech of others is so important to speech development.
True aphasia is very often viewed as speech impairment; it occurs in adults as a result of stroke, accidents that produce severe head trauma, or dementia. It is desirable to begin treatment of afflicted persons as soon as possible after aphasia is observed. Some rapid and spontaneous healing of lost language ability occurs, and this healing can be maximized by the efforts of speech-language pathologists. The continued treatment of aphasias is very important and usually follows careful evaluation of its causes. It is often possible to make progressive, long-term advances in healing aphasias. Complete recovery is rare, however, and the use of sign language or personal computers for interpersonal communication may be necessary.
Perspective and Prospects
For many years, it was thought that speech disorders were caused only by insoluble psychological problems in the very young or by severe head, facial, and brain trauma later in life. It is now clear that they have other causes, ranging from hearing loss to dementia. Furthermore, it is currently understood that speech problems of every type can attack anyone—young children, adolescents, and adults of all ages.
These problems often have disastrous psychological and economic effects on the afflicted person. Young children may be traumatized if speech disorders are not treated early; in severe cases, they may later be unable to enter the workforce in meaningful positions or to receive anything above the most rudimentary education. This is unfortunate because many such problems of childhood, adolescence, and even young adulthood can be almost completely solved by careful medical examination, followed quickly by appropriate corrective action.
There is also help available for older people who develop speech problems because of aging, dementia, or harmful workplace conditions. In all cases, once a sound treatment plan is developed, it is essential that the afflicted person follow it rigorously. Miracles should not be expected; rather, sustained interaction between the treatment team—especially the patient and a speech-language pathologist—must be undertaken. Furthermore, the psychological support of the patient’s family and friends has been recognized as a crucial factor in many successful treatment plans.
In the case of the young child, the diagnosis of speech problems by schoolteachers can be another important means to treatment. Once a problem is observed, the child’s family can be advised concerning
special education available through the school system or local programs. Teachers should be cautioned, however, against attempts to treat the child in question unless they have adequate training. The job of unspecialized teachers should be diagnosis and the recommendation of an appropriate treatment group. When speech disorder therapy results in less-than-adequate treatment of extremely serious problems, the use of sign language, special typewriters, and computer-assisted communication, as well as psychotherapy, should be considered.
Overall, the treatment of speech problems has improved, and its sensible application can enable patients to enter into or return to the workforce at levels commensurate with their abilities, can prevent them from becoming maladjusted, and can enrich society as a whole. Dealing with such problems in the young is particularly important because it may help to prevent neuroses and psychoses from developing. It is hoped that ongoing research will continue to increase the avenues available for the prevention and cure of speech disorders, to identify additional methods for treating them, and to result in their eradication.
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