General Child Neurology
Breath-holding spells
Nov. 25, 2024
Worddefinition
At vero eos et accusamus et iusto odio dignissimos ducimus qui blanditiis praesentium voluptatum deleniti atque corrupti quos dolores et quas.
Disorders of articulation …
- Updated 07.01.2024
- Released 06.25.2004
- Expires For CME 07.01.2027
Disorders of articulation
Introduction
Overview
Disorders of articulation generally refers to common childhood speech problems. These disorders are now more commonly referred to as speech sound disorders. They are generally treated by speech-language pathologists. Awareness of disorders of articulation aids physicians in effective identification and referrals. This article reviews these common disorders, includes an understanding of current genetic underpinnings, touches on nondevelopmental and degenerative causes of articulation difficulties, and provides an overview of the current intervention debate.
Key points
|
• Disorders of articulation are common in early childhood and are generally resolved by adolescence, although associated language and reading difficulties may persist. | |
|
• Disorders of articulation manifest in the form of incorrect pronunciation, particularly of consonants. | |
|
• Some genetic syndromes and neurodevelopmental disabilities are associated with disorders of articulation. There are also anatomic and neurologic causes of nondevelopmental articulation disorders. Other common causes of articulation disorders in adults are degenerative diseases that affect oral motor muscles. | |
|
• Treatment varies and determining evidenced-based practices is an active area of research. |
Historical note and terminology
Demosthenes, the Greek orator, had difficulties with articulation in his youth and pioneered speech therapy by placing pebbles underneath his tongue to elevate it. Aristotle recognized that articulation, the organized combination of consonants and vowels, is required for human speech. In 1848, Bouillaud listed the components required for spoken language as the instruments, such as the tongue, which provide “articulatory power,” and the “cerebral organ,” which coordinates speech.
The functional outcome of disorders of articulation is impaired intelligibility; however, a number of disorders can result in speech being difficult to understand. Dysarthria refers to acquired or congenital neurologic motor speech impairment characterized by slow, weak, uncoordinated movements of the speech musculature and can affect many areas required for speech production including articulation, but also respiration, phonation, and prosody (16). The term “phonological disorder” is sometimes used interchangeably with “disorders of articulation;” however, the American Speech-Language-Hearing Association distinguishes phonological disorder as the characteristic confusion of certain patterns of sounds, as opposed to the inability to produce certain sounds. Articulation disorder emphasizes that speech is a motor activity. Phonological disorder emphasizes that speech requires knowledge of language patterns (06).
Childhood apraxia of speech is controversial and is defined by the American Speech-Language-Hearing Association’s position statement as “a neurologic childhood (pediatric) speech sound disorder in which precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits.” A survey of speech-language pathologists revealed little agreement on its diagnostic criteria despite its frequent diagnosis and treatment (20). The term speech sound disorders as defined by the International Expert Panel on Multilingual Children’s Speech includes “any combination of difficulties with perception, articulation/motor production or phonological representation of speech segments (consonants and vowels), phonotactics (syllable and word shapes), and prosody (lexical and grammatical tones, rhythm, stress, and intonation) that may impact speech intelligibility and acceptability” (International Expert Panel on Multilingual Children’s Speech). Therefore, speech sound disorders can refer to difficulty with articulation, phonology, motor speech, or childhood apraxia of speech (34).
Clinical manifestations
Presentation and course
Disorders of articulation manifest with impaired intelligibility in the form of incorrect pronunciation, particularly of consonants. As language skills advance, preschool children make known developmental errors of speech that are not considered disorders of articulation. Hustad and colleagues state, “General rules of thumb for intelligibility of multiword utterances, based on data for the lowest performing typical children, are as follows: (a) By 4 years, children should be at least 50% intelligible to an unfamiliar listener; (b) by 5 years, children should be at least 75% intelligible to an unfamiliar listener; and (c) by just over 7 years, children should be 90% intelligible to an unfamiliar listener” (23). Therefore, disorders of articulation are typically not identified until early school age with the persistence of immature articulation patterns. Children with the presence of atypical articulation patterns are often identified earlier. The most problematic consonants are the later acquired “r” and “s,” and easier to pronounce consonants are typically substituted, such as “w” for “r.” Substitutions tend to be consistent. Difficulty being understood can result in social, emotional, or academic challenges.
Prognosis and complications
Evidence from natural history studies demonstrate that speech-only problems may be less persistent than language problems, with reports of 78% of articulation errors resolving (07). Additionally, residual or persistent speech errors were estimated to occur in only 1% to 2% of older children and adults (19). However, a 28-year follow-up of adults with a history of preschool phonological disorders showed residual articulation errors and poorer language performance than typically developing controls, though favorable emotional adjustment (18). The strongest predictor of ongoing speech impairment is poor early phonological skills (05). Likewise, at time points from preschool to adulthood, people with articulation disorders show deficits in phonology and phonological awareness, albeit increasingly subtle with age (45). Concomitant reading and spelling deficits were only noted in those children who had language problems in addition to articulation disorders in preschool (31). In fact, in one group of 125 children aged 3 to 6 years with articulation disorders, no relationship between early reading and writing scores and severity of the articulation disorder was found once comorbid language impairments were taken into account (50). However, children with dyslexia generally have more difficulty with speech production tasks, suggesting there is an association between dyslexia and underlying phonological awareness (58).
Clinical vignette
MM was an ex-premature (30-week) 3-year-old boy with minor neuromotor abnormalities resulting in hypotonia, a receptive and expressive language delay, and articulatory problems. His 10-word vocabulary was unintelligible due to consonant omissions and vowel distortions. His struggles to communicate were frustrating for both him and his family.
Speech-language therapy incorporated sign language and pictures. MM worked on pronouncing his name and the word “potty” as preschool readiness skills. He learned to say “ear hurts,” with frequent ear infections. While he continued to add new sounds to his phonemic repertoire, he used alternative ways to communicate and learn more words and became more willing to participate in school and activities. His family’s frustration decreased as did his own as he was able to use effective alternative ways to express his needs.
Biological basis
Etiology and pathogenesis
The term “articulation” implies moving surfaces from opposing positions into positions that come into contact. Articulators, such as the lips, teeth, tongue, palate, and jaw shape and direct the flow of air from the larynx into speech sounds. However, difficulties with speech intelligibility often localize poorly because speech production can be affected by lack of accurate feedback (hearing impairment), deficits in cognition, breath support, phonation, and articulation. Production of speech sounds can be disrupted at multiple levels: cerebral cortex, basal ganglia, cranial nerves (V, VII, IX-X, and XII), peripheral nerves, neuromuscular junction, and the structural apparatus of the lips, palate, tongue, velopharynx, and vocal folds. The cerebellum has also been implicated in speech motor control as well as processing and planning (51).
Disorders of articulation in children are usually idiopathic, though there is probably a genetic component given hereditability patterns. It is well documented that genetic factors contribute to susceptibility to speech and language impairments. Speech and language deficits are heritable and show strong familial aggregation (02; 09; 12; 32). Speech sound disorders have been linked to the 15q14 locus (53) and FOXP2 deletions on chromosome 7 (28; 54). However, these regions have also been implicated in more global language disabilities and other neurodevelopmental disorders.
Motor difficulties in cerebral palsy can cause articulation difficulties that persist into adulthood. Naive listeners evaluated speech as only about 50% intelligible in a series of adults reading both single words and prose (44). Minor neuromotor abnormalities, associated with many developmental disabilities, may manifest with low oral tone and contribute to articulatory difficulties in such neurodevelopmental disabilities as ADHD, learning disorders, and epilepsy. In a small case-control study, children with epilepsy without intellectual disability or cerebral palsy had more articulation difficulties than typically developing children (48). In addition, cognitive impairment may also contribute to articulation problems, probably due to mislearning of speech sounds. Down syndrome affects speech production via intellectual disability, macroglossia, and hypotonia (27).
Other syndromes that affect the motor anatomy necessary for speech can result in disorders of articulation. For example, Moebius syndrome involves congenital paralysis of bilateral facial and abducens nerves and can result in speech sound difficulties. Cleft palate may affect speech through anatomic changes as well as other coexisting factors such as cognitive immaturity, coexisting language disorder, middle ear effusion, and conductive hearing loss (39). Congenital or acquired malformations of the temporomandibular joint can also be a contributing factor to speech sound difficulties (03).
In fact, hearing impairment can independently affect speech by impairing auditory feedback, which can hinder correct learning and reproduction of speech sounds. In children with profound hearing loss, one option is cochlear implants. The minimum age for implantation recommended by the United States FDA is 12 months, with language exposure through sign language until implantation. Supporting the idea that early implantation allows for added phonologic development, one study of 11 young cochlear implant recipients demonstrated progress with consonant acquisition though they were still delayed compared to typically developing peers (17). It also appears that the children with cochlear implants followed both typical and atypical patterns of articulation development. Another study that followed 32 children implanted before 30 months of age for 4 years reported that length of cochlear implant use could be used as a proxy for chronological age when predicting articulation development (52).
Epidemiology
Speech disorders are common in childhood, but prevalence declines by adolescence. The National Center for Health Statistics estimates a 1% prevalence of speech disorders among all ages in the United States. Up to 8.4% of 6 to 11 year olds were reported to have speech problems, compared to 4.2% in 12 to 17 year olds. Among almost 40,000 children, 5.7% aged 6 to 18 years had speech problems affecting articulation and voice, including stuttering.
A study of over 12,000 Australian children up to 14 years of age showed a 1.7% prevalence of speech disorders. Peak prevalence in boys was 7.4% at 5 years of age, whereas in girls, it was 1.8% at 3 to 4 years of age. Even after excluding children with developmental delay, children with speech disorders were more likely to have additional health problems. Socioeconomic status did not affect the likelihood of an articulation disorder (26).
In a systematic review of epidemiologic studies, prevalence ranged from 2.3% to 24.6% for speech sound disorders and 4.56% to 19% for combined speech and language disorders (29). A community study of Australian children demonstrated that a significant number of preschool age children with speech sound disorders did not have contact with speech language pathologists; therefore, these prevalence rates may be underestimates (35).
Differential diagnosis
Children typically learn to pronounce consonants in an orderly sequence. It is important to determine whether the child’s pronunciation is delayed compared to peers and normal samples, as certain sounds are mastered later even in typical development (47).
Table 1. Speech Milestones in Young Children
Consonant Production and Intelligibility
|
Age in years |
Consonant sound Production correct in > 50% |
Percent intelligibility |
|
< 2 years |
p--(3) | |
|
2 years |
k--(4) |
50% intelligible |
|
3 years |
f--(4) | |
|
4 years |
ch--(7) |
100% intelligible |
|
5 years |
th--(7-8) | |
|
6 years |
zh--(> 8) |
Once a difficulty with articulation is identified, it is important to consider other reasons a child is difficult to understand, and one should look for any underlying causes and rule out acquired disorders before concluding there is an idiopathic articulation disorder. Hearing impairment can lead to mislearning certain speech sounds and should be evaluated. Children with expressive language disorders may present as difficult to understand due to problems in language structure, although these conditions can coexist. Stuttering affects fluency rather than articulation. Variations in pronunciation attributable to dialect do not constitute phonological disorders. Acquired epileptic aphasia (Landau-Kleffner syndrome) causes acute onset speech-language problems and seizures. Atopy, particularly allergic rhinitis, may also affect articulation, possibly via transient hearing loss (01).
Acquired disorders of articulation, or dysarthrias, involve paralysis, weakness, or incoordination of speech musculature that interferes with speech and can also occur during development (57). Dysarthrias are generally classified as flaccid, spastic, hypokinetic, hyperkinetic, ataxic, and mixed. Causes include acquired brain injuries, such as stroke, traumatic brain injury, or tumor, as well as neurodegenerative disorders affecting the motor system such as Parkinson disease and amyotrophic lateral sclerosis (38; 16). Isolated dysarthria or posterior fossa syndrome following surgical resection of posterior fossa tumors is not uncommon (37). Finally, chemoradiation can also affect articulation of patients with head and neck cancer (25). Dysarthrias usually share imprecise consonants, monotone quality, lack of variation in loudness, and harsh voice (14; 15), however, they also have distinctive features. For instance, ataxic dysarthria, found in cerebellar disorders, involves excess and equal stresses (the “scanning speech” described by Charcot), irregular articulatory breakdown, and distorted vowels.
Nonfluent or transcortical aphasias can cause difficulties with intelligibility. These can coexist with dysarthrias, particularly in strokes (41). Paraphasic speech involves sound substitutions that are less predictable than in dysarthrias, in which the same sounds tend to be consistently misarticulated or omitted.
Diagnostic workup
A complete history including neonatal feeding difficulties should be obtained. Dysphagia, choking, swallowing difficulties, and gag, including saliva management, should be assessed as these two conditions frequently co-occur. Audiologic evaluation is advised, particularly in young children. Structural defects such as cleft palate or dental malocclusion should be noted. It is important to identify cognitive impairment and dysmorphisms suggestive of genetic syndromes and to look for any additional neurologic signs that would suggest a broader disability. Spasticity, dystonia, or flaccidity should be noted. Cerebellar signs, such as gait ataxia or dysdiadochokinesia, may aid in localization. If there are concerns, swallow study, often performed by occupational or speech therapists, may be considered. Consider magnetic resonance imaging of the brain and spine in cerebral palsy, where underlying etiology may be defined.
Referral to a speech-language pathologist is the most effective way to define disorders or articulation. Tests include the Assessment of Intelligibility of Speech, the Assessment of Phonological Processing, the Goldman-Fristoe Test of Articulation-Third Edition, and the Khan Lewis Phonologic Analysis-Third Edition. The Oral Speech Mechanism Screening Examination-Third Edition identifies anatomical or functional problems. Many full language batteries also include an articulation screening component. Other techniques include multisyllabic word lists, tongue twisters, Pig Latin tasks, and nonsense word repetition. Currently, there is no specific pediatric dysarthria scale (22); however, the Verbal Motor Production Assessment for Children does attempt to determine if articulation difficulties are related to more general neuromotor abnormality. Analysis of a language sample is also informative. Language may be observed informally or during an interview. In addition to specific sound articulation testing, it is important to measure intelligibility of single words and continuous speech in order to determine the functional severity of an articulation disorder (33).
Management
Speech therapy is the major treatment modality for articulation disorders. A variety of approaches are used. It is important to identify the type of speech sound disorder in order to identify appropriate therapy techniques (articulation vs. phonologic approach). A small intervention study of 14 children with phonologically based speech sound disorders found that although both groups improved in articulation, only the group with phonological intervention showed improvement in intelligibility (33). One major difference in the main therapies is whether to focus directly on speech or to shape speech while focusing on language (55). Some therapies emphasize starting with isolated phonemes of difficulty and building to connected language. Other therapies encourage children to master more complex sounds through language acquisition and then less complex ones fall into place (21). Additional literature has encouraged generalization through the teaching of nonwords rather than real words (13). New work piloting visual biofeedback has been promising in some populations (11). A systematic review of screening and treatment for speech and language delays found that most treatment studies demonstrated improvement, with characteristics of effective studies, including higher intensity of treatment, more severely affected children, and individualized treatment (04). However, a Cochrane review found no randomized controlled trails or group studies for efficacy of speech therapy for children with dysarthria under 3 years of age (43). In children with cleft palate, speech pathology intervention is indicated alongside cleft palate repair to support intelligibility at their earliest stages of development. One study of 51 children aged 3 or 5 with repaired cleft palate suggested that such children are able to approximate typically developing children by 5 years (08). Another study of 180 children with clef palate repair between ages 3 to 7 found that age at the time of palatal repair was significantly associated with compensatory misarticulations, which further supports earlier intervention (46).
A sizable number of clinicians report using non-speech oral motor therapy or exercises of the oral musculature that do not include speech production, attempting to influence speech despite the fact that data for their efficacy are controversial at best (10; 40). An updated Cochrane review confirmed previous conclusions that there is no strong evidence that suggests that nonspeech oral motor therapy is an effective single or adjunctive treatment for developmental phonological disorders. The three studies they found evaluating efficacy of nonspeech oral motor therapy were small in scale and had a number of serious methodological limitations (30).
There is a gap in the literature regarding efficacy of speech therapy for articulation disorders related to cerebral palsy (49). However, a study of 77 children with cerebral palsy suggested that speech characteristics identified at 2 years of age could predict communication and speech performance at 5 years (42). There is noted impairment at multiple levels of speech production in children with cerebral palsy (36). Therefore, early speech pathology intervention may be recommended based on individual assessment.
More severe cases may require augmentative communication devices such as picture boards and voice output devices (60; 59).
“Velopharyngeal insufficiency treatment usually comprised speech therapy and surgical intervention. Although there is no surgical technique considered to be the gold standard” (56).
Special considerations
Anesthesia
There is no published literature specifically addressing anesthesia in patients with disorders of articulation. However, persons with abnormalities and neuromuscular disorders may present special challenges for anesthesiologists.
Acknowledgements
Thanks to Mary Katherine Boyle, CCC-SLP, for her invaluable comments on this manuscript.
References
- 01
- Baker BM, Baker CD, Le HT. Vocal quality, articulation, and audiological characteristics of children and young adults with diagnosed allergies. Ann Otol Rhinol Laryngol 1982;91(3 Pt 1):277-80. PMID 7092048
- 02
- Barry JG, Yasin I, Bishop DVM. Heritable risk factors associated with language impairments. Genes Brain Behav 2007;6:66-76. PMID 17233642
- 03
- Bender ME, Lipin RB, Goudy SL. Development of the pediatric temporomandibular joint. Oral Maxillofac Surg Clin North Am 2018;30(1):1-9. PMID 29153232
- 04
- Berkman ND, Wallace I, Watson L, et al. Screening for speech and language delays and disorders in children age 5 years or younger: a systematic review for the U.S. preventive services task force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality, 2015.
- 05
- Bernhardt B, Major E. Speech, language, and literacy skills 3 years later: a follow-up study of early phonological and metaphonological intervention. Int J Lang Comm Dis 2005;40(1):1-27. PMID 15832523
- 06
- Bleile KM. Manual of articulation and phonological disorders infancy through adulthood. San Diego: Singular Publishing Group, 1995.
- 07
- Bralley RC, Stoudt RJ. A five year longitudinal study of developmental of articulation. Lang Speech Hear Serv Sch 1977;8:176-80.
- 08
- Chacon A, Parkin M, Broome K, Purcell A. Australian children with cleft palate achieve age-appropriate speech by 5 years of age. Int J Pediatr Otorhinolaryngol 2017;103:93-102. PMID 29224774
- 09
- Clark A, O'Hare A, Watson J, et al. Severe receptive language disorder in childhood—familial aspects and long-term outcomes: results from a Scottish study. Arch Dis Child 2007;92(7):614-9. PMID 17405857
- 10
- Clark HM. The role of strength training in speech sound disorders. Semin Speech Lang 2008;29(4):276-83. PMID 19058114
- 11
- Cleland J, Scobbie JM, Wrench AA. Using ultrasound visual biofeedback to treat persistent primary speech sound disorders. Clin Linguist Phon 2015;29(8-10):575-97. PMID 25751614
- 12
- Conti-Ramsden G, Falcaro M, Simkin Z, Pickles A. Familial loading in specific language impairment: patterns of differences across proband characteristics, gender and relative type. Genes Brain Behav 2007;6:216-28. PMID 16827920
- 13
- Cummings AE, Barlow JA. A comparison of word lexicality in the treatment of speech sound disorders. Clin Linguist Phon 2011;25(4):265-86. PMID 21158502
- 14
- Darley FL, Aronson AE, Brown JR. Differential diagnostic patterns of dysarthria. J Speech Hear Res 1969a;12(2):246-69. PMID 5808852
- 15
- Darley FL, Aronson AE, Brown JR. Clusters of deviant speech dimensions in the dysarthrias. J Speech Hear Res 1969b;12(3):462-96. PMID 5811846
- 16
- Enderby P. Disorders of communication: dysarthria. Handb Clin Neurol 2013;110:273-81. PMID 23312647
- 17
- Ertmer DJ, Kloiber DT, Jung J, Kirleis KC, Bradford D. Consonant production accuracy in young cochlea implant recipients: developmental sounds classes and word position effects. Am J Speech Lang Pathol 2012;21:342-53. PMID 22846882
- 18
- Felsenfeld S, Broen PA, McGue M. A 28-year follow-up of adults with a history of moderate phonological disorder: linguistic and personality results. J Speech Hear Res 1992;35(5):1114-25. PMID 1280310
- 19
- Flipsen P Jr, Emergence and prevalence of persistent and residual speech errors. Semin Speech Lang 2015;36(4):217-23. PMID 26458197
- 20
- Forrest K. Diagnostic criteria of developmental apraxia of speech used by clinical speech-language pathologists. Am J Speech Lang Pathol 2003;12(3):376-80. PMID 12971826
- 21
- Gierut JA. Treatment efficacy: functional phonological disorders in children. J Speech Lang Hear Res 1998;41(1):S85-100. PMID 9493748
- 22
- Huber-Okrainec J, Dennis M, Brettschneider J, Spiegler BJ. Neuromotor speech deficits in children and adults with spina bifida and hydrocephalus. Brain Lang 2002;80(3):592-602. PMID 11896659
- 23
- Hustad KC, Mahr TJ, Natzke P, Rathouz PJ. Speech development between 30 and 119 months in typical children I: intelligibility growth curves for single-word and multiword productions. J Speech Lang Hear Res 2021;64(10):3707-19. PMID 34491793
- 24
- International Expert Panel on Multilingual Children’s Speech. Multilingual children with speech sound disorders: Position paper. 2012
- 25
- Jacobi I, van Rossum MA, van der Molen L, Hilgers FJ, van den Brekel MW. Acoustic analysis of changes in articulation proficiency in patients with advanced head and neck cancer treated with chemoradiotherapy. Ann Otol Rhinol Laryngol 2013;122(12):754-62. PMID 24592578
- 26
- Keating D, Turrell G, Ozanne A. Childhood speech disorders: reported prevalence, comorbidity and socioeconomic profile. J Paediatr Child Health 2001;37(5):431-6. PMID 11885704
- 27
- Kent RD, Vorperian HK. Speech impairment in Down Syndrome: a review. J Speech Lang Hear Res 2013;56:178-210. PMID 23275397
- 28
- Lai CSL, Fisher SE, Hurst JA, Vargha-Khadem F, Monaco AP. A forkhead-domain gene is mutated in a severe speech and language disorder. Nature 2001;413(6855):519-23. PMID 11586359
- 29
- Law J, Boyle J, Harris F, Harkness A, Nye C. Prevalence and natural history of primary speech and language delay: findings from a systemic review of literature. Int J Lang Commun Disord 2000;35(2):165-88. PMID 10912250
- 30
- Lee AS, Gibbon FE. Non-speech oral motor treatment for children with developmental speech sound disorders. Cochrane Database Syst Rev 2015;(3):CD009383. PMID 25805060
- 31
- Lewis BA, Freebairn L. Residual effects of preschool phonology disorders in grade school, adolescence, and adulthood. J Speech Hear Res 1992;35(4):819-31. PMID 1405539
- 32
- Lewis BA, Freebairn LA, Hansen AJ, Miscimarra L, Iyengar SK, Taylor HG. Speech and language skills of parents of children with speech sound disorders. Am J Speech Lang Pathol 2007;16:108-18. PMID 17456889
- 33
- Lousada M, Jesus LM, Hall A, Joffe V. Intelligibility as a clinical outcome measure following intervention with children with phonologically based speech-sound disorders. Int J Lang Commun Disord 2014;49(5):584-601. PMID 24861159
- 34
- McLeod S, Harrison LJ, McAllister L, McCormack J. Speech sound disorders in a community study of preschool children. Am J Speech Lang Pathol 2013a;22(3):503-22. PMID 23813192
- 35
- McLeod S, Verdon S, Bowen C, International Expert Panel on Multilingual Children’s Speech. International aspirations for speech-language pathologists’ practice with multilingual children with speech sound disorders: development of a position paper. J Commun Disord 2013b;46(4):375-87. PMID 23731648
- 36
- Mei C, Reilly S, Bickerton M, et al. Speech in children with cerebral palsy. Dev Med Child Neurol 2020;62(12):1374-82. PMID 32588921
- 37
- Morgan AT, Liegeois F, Kiederkere C, et al. Role of cerebellum in fine speech control in childhood: persistent dysarthria after surgical treatment for posterior fossa tumour. Brain Lang 2011;117:69-76. PMID 21334735
- 38
- Morgan AT, Vogel AP. Intervention for dysarthria associated with acquired brain injury in children and adolescents (review). Cochrane Database Syst Rev 2008;(3):CD006279. PMID 18646143
- 39
- Morris H, Ozanne A. Phonetic, phonological, and language skills of children with a cleft palate. Cleft Palate Craniofac 2003;40(5):460-70. PMID 12943443
- 40
- Muttiah N, Georges K, Brachenbury T. Clinical and research perspectives on nonspeech oral motor treatments and evidence-based practice. Am J Speech Lang Pathol 2011;20:47-59. PMID 21173395
- 41
- Ogar JM, Dronkers NF, Brambati SM, Miller BL, Gorno-Tempini ML. Progressive nonfluent aphasia and its characteristic motor speech deficits. Alzheimer Dis Assoc Disord 2007;21(4):S23-30. PMID 18090419
- 42
- Pennington L, Dave M, Rudd J, Hidecker MJC, Caynes K, Pearce MS. Communication disorders in young children with cerebral palsy. Dev Med Child Neurol 2020;62(10):1161-9. PMID 32729634
- 43
- Pennington L, Parker NK, Kelly H, Miller N. Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database Syst Rev 2016;7:CD006937. PMID 27428115
- 44
- Platt LJ, Andrews G, Young M, Quinn PT. Dysarthria of adult cerebral palsy: I. Intelligibility and articulatory impairment. J Speech Hear Res 1980;23(1):28-40. PMID 7442182
- 45
- Preston JL, Hull M, Edwards ML. Preschool speech error patterns predict articulation and phonological awareness outcomes in children with histories of speech sound disorders. Am J Speech Lang Pathol 2013;22(2):173-84. PMID 23184137
- 46
- Rezaei P, Poorjavad M, Abdali H. Speech outcomes after palatal closure in 3-7-year-old children. Braz J Otorhinolaryngol 2020:S1808-8694(20)30152-X. PMID 33268307
- 47
- Sander E. When are speech sounds learned. J Speech Hear Disord 1972;37(1):55-63. PMID 5053945
- 48
- Selassie GR, Viggedal G, Olsson I, Jennische M. Speech, language, and cognition in preschool children with epilepsy. Dev Med Child Neurol 2008;50(6):432-8. PMID 18422681
- 49
- Sellars C, Hughes T, Langhorne P. Speech and language therapy for dysarthria due to non-progressive brain damage. Cochrane Database Syst Rev 2002;(4):CD002088. PMID 12519567
- 50
- Sices L, Taylor HG, Freebairn L, Hansen A, Lewis B. Relationship between speech-sound disorders and early literacy skills in preschool-age children: impact of comorbid language impairment. J Dev Behav Pediatr 2007;28(6):438-47. PMID 18091088
- 51
- Spencer KA, Slocomb DL. The neural basis of ataxic dysarthria. Cerebellum 2007;6(1):58-65. PMID 17366266
- 52
- Spencer LJ, Guo L. Consonant development in pediatric cochlear implant users who were implanted before 30 months of age. J Deaf Stud Deaf Educ 2013;18(1): 3-109. PMID 23143855
- 53
- Stein CM, Millard C, Kluge A, et al. Speech sound disorder influenced by a locus in 15q14 region. Behav Genet 2006;36(6):858-68. PMID 16786424
- 54
- Turner SJ, Hildebrand MS, Block S, et al. Small intragenic deletion in FOXP2 associated with childhood apraxia of speech and dysarthria. Am J Med Genet A 2013;161A(9):2321-6. PMID 23918746
- 55
- Tyler AA. What works: evidence-based intervention for children with speech sound disorders. Semin Speech Lang 2008;29(4):320-30. PMID 19058119
- 56
- Vale F, Paula AB, Travassos R, et al. Velopharyngeal insufficiency treatment in cleft palate patients: umbrella review. Biomimetics (Basel) 2022;7(3):118. PMID 36134922
- 57
- Velleman S. Childhood Apraxia of Speech Resource Guide. Clifton Park, NY: Delmar Learning, 2003.
- 58
- Vellutino FR, Fletcher JM, Snowling MJ, Scanlon DM. Specific reading disability (dyslexia): what have we learned in the past four decades. J Child Psychol Psychiatry 2004;45(1):2-40. PMID 14959801
- 59
- Yorkston KM, Beukelman DR, Duffy J, et al. Evidence-based practice guidelines for dysarthria: management of velopharyngeal function. J Med Speech Lang Pathol 2001;9(4):257-73.
- 60
- Yorkston KM, Beukelman DR, Strand EA, Bell KR. Management of motor speech disorders in children and adults. 2nd edition. Austin, TX: Pro-Ed, 1999.
Contributors
All contributors' financial relationships have been reviewed and mitigated to ensure that this and every other article is free from commercial bias.
Author
-
Amanda Haverfield MCD CCC-SLP
Ms. Haverfield of Children's Hospital New Orleans has no relevant financial relationships to disclose.
See Profile
Editor
-
Ann Tilton MD
Dr. Tilton has received honorariums from Allergan and Ipsen as an educator, advisor, and consultant.
See Profile
Former Authors
- Jennifer Accardo MD
- Vera Joanna Burton MD PhD
- Justine Ker BA
- Stephen L Nelson Jr MD PhD
- Michael V Johnston MD†
Patient Profile
- Age range of presentation
-
- 2 to 12 years
- Sex preponderance
-
- male > female, >2:1
- Heredity
-
- Heredity may be a factor
- Population groups selectively affected
-
- None selectively affected
- Occupation groups selectively affected
-
- None selectively affected
ICD & OMIM codes
- ICD-10
-
- Specific speech articulation disorder: F80.0
- Other developmental disorders of speech and language: F80.8
- Other and unspecified speech disturbances: R47.8
- ICD-11
-
- Developmental speech sound disorder: 6A01.0
- Developmental speech fluency disorder: 6A01.1
- Developmental language disorder: 6A01.2
- Other specified developmental speech or language disorders: 6A01.Y
- Developmental speech or language disorders, unspecified: 6A01.Z
- Speech disturbances, unspecified: MA80.Z
This is an article preview.
Start a Free Account
to access the full version.
-
Nearly 3,000 illustrations, including video clips of neurologic disorders.
-
Every article is reviewed by our esteemed Editorial Board for accuracy and currency.
-
Full spectrum of neurology in 1,200 comprehensive articles.
-
Listen to MedLink on the go with Audio versions of each article.
Questions or Comment?
MedLink®, LLC
3525 Del Mar Heights Rd, Ste 304
San Diego, CA 92130-2122
Toll Free (U.S. + Canada): 800-452-2400
US Number: +1-619-640-4660
Support: service@medlink.com
Editor: editor@medlink.com
ISSN: 2831-9125
Also in This Category
-
-
General Child Neurology
Acute cerebellar ataxia in children
Oct. 29, 2024
-
Infectious Disorders
Zika virus: neurologic complications
Oct. 08, 2024
-
General Child Neurology
Cerebral edema in childhood
Sep. 29, 2024
-
Developmental Malformations
Malformations of the brain
Sep. 28, 2024
-
Neuro-Oncology
CNS germinoma
Sep. 25, 2024
-
Developmental Malformations
Vein of Galen malformations
Sep. 22, 2024
-
Stroke & Vascular Disorders
Patent foramen ovale
Sep. 12, 2024