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speech disorders in children

Alternative Names
speaking disorders in children, talking disorders in children

Speech is defined as the use of the voice to express ideas. It is the same as talking or speaking. Some children develop problems with speech.

What is going on in the body?
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 different causes of speech problems in children.

What are the signs and symptoms of the condition?
Many different types of speech problems may be seen in children, including:
  • stuttering
  • slurred speech
  • altered pitch or tone of speech
  • hoarse speech
  • total inability to speak
  • limited speech
  • speaking only in certain situations
  • rapid speech
  • speech that is indistinct or hard to understand
  • speaking with a lisp
  • nasal speech
  • speech problems related to language problems
Other types of speech problems are also possible.

What are the causes and risks of the condition?
There are many causes of speech problems:
  • Language disorders result in problems with speaking, writing, and other forms of communication.
  • Physical or birth defects 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. Another example would be paralysis of a vocal cord, which often causes a hoarse voice. Many children with Down syndrome have trouble producing speech.
  • Deafness or hearing impairment can interfere with the child's ability to learn to speak. In the case of complete deafness, language can often be learned if taught without sound. This is the basis for sign language. Children need to hear sounds in order to learn and imitate them.
  • Stuttering is a condition without a known cause that often goes away on its own.
  • Nervous system conditions or damage may affect speech centres in the brain or co-ordination. 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. Damage to an area of the brain called the cerebellum can affect co-ordination and make speech clumsy and difficult. Cerebral palsy, a type of brain damage often present at birth, may affect speech and/or language.
  • Elective 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. This disturbance may be due to child abuse or other problems.
Other causes of speech problems are also possible. Sometimes, no cause can be found.

What can be done to prevent the condition?
Prevention is often not possible. Providing a loving, supportive home can prevent cases due to child abuse.

How is the condition diagnosed?
The parents or a teacher often notice the problem first. Diagnosis of the cause starts with a history and physical examination. This may be all that is needed to make the diagnosis in some cases. In other cases, further testing may be needed.

Which tests are used depend on the suspected cause. 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 one 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 x-ray test called a CT scan of the head may be ordered if nervous system damage is suspected.

What are the long-term effects of the condition?
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.

What are the risks to others?
Speech disorders are not contagious. They pose no risk to others. Parents and family members of affected children may experience guilt or other negative emotions.

What are the treatments for the condition?
Treatment is directed at the cause. For example, children who:
  • have a cleft palate often have surgery to repair the defect
  • have trouble hearing may benefit from a hearing aid
  • are completely deaf can often learn sign language
  • are being abused can be taken out of the abusive environment, which often is enough to improve the speech problem
  • have psychiatric problems may benefit from medications and counselling
  • have more severe problems may need special classes or learning environments
In addition to treatment of the underlying cause, speech therapy can be invaluable in training children to talk.

What are the side effects of the treatments?
Any surgery carries a risk of bleeding and infection. Medications used for psychiatric problems may cause: What happens after treatment for the condition?
This is related to the cause of the problem and the success of treatment. Those with cerebral palsy or mental retardation 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.

How is the condition monitored?
Any change in the child's speech or response to treatment can be reported to the doctor. Other monitoring relates to the cause. For example, children with emotional problems often need frequent counselling and monitoring to help watch for problems in other areas.

Author: Adam Brochert, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

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