Speech is defined as the use of the voice to express ideas. Some infants are born with disabilities that interfere with normal speech development. Other children acquire speech disorders after birth.
Speech is not the same as language, though the two are often related. Language is any method of expression or communication, which may or may not be vocal. For example, a child may be unable to talk but still able to use sign language. There are many causes of speech disorders in children.
A child with a speech disorder may have a variety of symptoms, including but not limited to: altered pitch or tone of speechhoarse speechlimited speechnasal speechrapid speechslurred speechspeaking with a lispspeech only in certain situationsspeech problems related to language problemsspeech that is indistinct or hard to understandstutteringtotal inability to speak
Many factors can contribute to speech disorders in children. Language disorders in children can lead to problems with speaking, writing, and other forms of communication. Physical or birth defects may interfere with the mechanics of speaking. An example would be a cleft palate, which is an abnormal space in the roof of the mouth. This defect interferes with the ability to pronounce certain words. Many children with Down syndrome have trouble producing speech because of physical differences.
Nervous system conditions or damage may affect coordination or speech centers in the brain. Nervous system disorders can result in a wide variety of speech problems, depending on the area of the brain that is affected. For example, damage to a nerve called the hypoglossal nerve can result in clumsiness of the tongue and interfere with pronunciation. Cerebral palsy, a type of brain damage often present at birth, may affect speech and language.
Deafness or hearing impairment can interfere with the child's ability to learn to speak. Stuttering is a condition without a known cause that often goes away on its own. Selective mutism occurs when a child chooses or pretends not to talk in certain settings. This usually indicates an emotional or psychiatric disturbance in the child. It may be caused by child abuse. Other causes of speech problems are also possible. Sometimes, no cause can be found.
Most of the time, speech disorders in children cannot be prevented. Measures to avoid child abuse may prevent some speech disorders, such as selective mutism.
The parents or a teacher often notice the problem first. When the problem is brought to the attention of a healthcare professional, sometimes the cause is obvious from the history and physical examination. In other cases, further testing may be needed. For example, a formal hearing test may be done if hearing loss is suspected. One such test is called brain stem evoked-response audiometry, or BAER.
A formal test of language or a test of intelligence, also called an IQ test, may be advised if these are suspected causes. Examples of language tests include the Early Language Milestone Scale and the Clinical Linguistic Assessment Measurement test. A cranial CT scan may be ordered if nervous system damage is suspected. Psychological testing may be carried out if an emotional disturbance is suspected.
Children with speech difficulties may have trouble in school or with peers. Most long-term effects are related to the cause. For example, those who stutter often outgrow this condition and have no long-term effects. Some children with cerebral palsy may have severe mental retardation and movement problems and need around-the-clock care.
Speech disorders are not contagious and pose no risk to others.
Treatment is directed at the cause. Some examples include: cleft palate repair for children with cleft palatehearing aids for children with hearing impairmentsmedicines and counseling for psychiatric problemsremoval of child abuse victims from the abusive environmentsign language instruction for children with hearing impairments, as well as for children with delayed speech or languagespecial classes or learning environments for children with severe impairments
In addition to treatment of the underlying cause, speech therapy can be invaluable in training children to talk.
Surgery can be complicated by bleeding, infection, or reactions to anesthesia. Medicines used for psychiatric problems may cause allergic reactions, drowsiness, or stomach upset.
The child's quality of life is affected by the speech disorder and the success of treatment. Those with cerebral palsy or Down syndrome may need lifelong therapy and treatment. Those with a cleft palate may be cured by surgery and need no further treatment after recovery. Children who stutter may or may not benefit from treatment.
Any change in the child's speech or response to treatment can be reported to the healthcare professional.
Pediatric Rehabilitation, 1992, Molnar et al.
Rudolph's fundamentals of Pediatrics, 1998, Rudolph et al.