SPEECH CONCERNS

Speech concerns in children can fall into several categories including:

• Articulation (speech sound disorder)
• Childhood apraxia of speech
• Voice
• Stuttering

Articulation (speech sound disorder)

Quite often, people confuse articulation difficulties with language concerns. It’s important to remember that speech and language are two different skills. Articulation difficulties occur when a child has challenges producing clear and accurate speech sounds. By age 8 a child should be producing sounds accurately 100% of the time. Please refer to our speech and language milestones chart for more information.

Your child may have articulation difficulties if they have trouble:

• Being understood by their parents, family or close friends
• Substitutes sounds for different sounds
• Leaves sounds out in words
• Changes sounds in words

Speech-language pathologists provide thorough assessments and individualized treatment plans for children with articulation difficulties to help them:

• Learn the correct way to produce a sound
• Tell when sounds are right or wrong
• Practice sounds in different words, phrases and sentences.

Childhood Apraxia of Speech (CAS)

Childhood apraxia of speech is a motor speech disorder. It is NOT due to muscle weakness. The child has difficulty planning the movements involved in speech production e.g. moving tongue, lips and jaw in order to produce a word. Children with Childhood Apraxia of Speech do not have “typical” speech patterns and in most instances need treatment to make progress.
A speech-language pathologist will assess a child to rule out an articulation difficulty and determine if the child has CAS. Very specific therapy is recommended for CAS.

Voice

Children use their voices for a lot of different functions and sometimes improper use of their voice can lead to a voice disorder.

If your child has a voice disorder, their voice may sound:

• harsh or hoarse
• too high or too low
• too loud or too quiet, or they may have ‘lost’ their voice entirely
• as though they are speaking through a blocked nose
• as though too much air is coming down through their nose

If your child has not already seen an Ear Nose and Throat (ENT) doctor for his/her voice problem, the S-LP will suggest a referral to one through your family doctor. The ENT will make the diagnosis and recommendations for treatment. Some voice disorders, like nodules or muscle tension dysphonia may be treated with voice therapy by a speech-language pathologist. Other disorders, like reflux laryngitis, may be treated with a combination of voice therapy and medication.

Stuttering

Stuttering (sometimes referred to as disfluency) is a communication difficulty that affects the fluency and flow of speech. It is common for many children of all ages to experience disfluencies. This does not necessarily mean that there is a problem. However, frequent disfluencies can result in difficulties with communication and can be frustrating and upsetting for the person communicating as well as for the family. A speech-language pathologist (S-LP) can determine if your child’s disfluencies warrant therapy.

Your child may be stuttering if they produce frequent:

• whole word repetitions (e.g., My, my, my doll)
• part-word repetitions (e.g., far- far- far- farmer)
• initial sound repetitions (e.g., t-, t-, t-, table)
• Prolongations (i.e, stretching sounds) (e.g., mmmmmmmy doll)
• Blocks (i.e., stuck on a word with no sound coming out)

The causes of stuttering are complex and varied. Early referral to a S-LP is advocated as early intervention is frequently associated with more successful outcomes. Following a detailed evaluation of fluency and a determination of speech and language features, the S-LP will recommend therapy depending on age, level of severity and environmental factors (e.g. school environment). At the Speech Therapy Centres of Canada (STCC) we use a holistic approach to treatment, by looking at the child in the context of family, friends and school environment.