Types of Speech Impediments

A speech impediment, also called a speech disorder, can make it hard for a person to produce sounds and words, which can make their speech difficult to understand. It often appears during early childhood when a person is developing their language skills. Although many children initially struggle with certain sounds and words, most will be able to speak clearly by the age of five. However, some speech disorders are persistent, affecting approximately 5% of children aged three to 17 in the United States.

There are various types of speech impediments, including:

• Disfluency
• Articulation errors
• Ankyloglossia
• Dysarthria
• Apraxia

This article delves into the causes, symptoms, and treatment options for different types of speech disorders.

Disfluency

Disfluency is a type of speech impediment characterized by disrupted speech flow. Stuttering is the most common form of disfluency, but others exist as well.

Symptoms and Characteristics of Disfluencies

Disfluencies are characterized by various symptoms, such as:

• 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 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 to these disfluencies, a person may exhibit the following symptoms while speaking:

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

Causes of Disfluencies

People with disfluencies often have neurological differences in brain areas that control language processing and speech coordination. These differences can 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 Errors

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

Articulation disorders are characterized by:

• 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, specifically 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

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, making 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, which 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
• Jaw pain

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

Dysarthria is a condition where people slur their words because they cannot control the muscles 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

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

Apraxia is characterized by:

• 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 illnesses that affect the parts of the brain involved in speech.

Treating Speech Disorders

If you have a speech impediment, or suspect your child might have one, it can be helpful to consult your healthcare provider. Your doctor can refer you to a speech-language pathologist, who can evaluate speech, diagnose speech