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Dysarthria occurs when the muscles you use for speech are weak or you have difficulty controlling them. Dysarthria often causes slurred or slow speech that can be difficult to understand.

Common causes of dysarthria include nervous system disorders and conditions that cause facial paralysis or tongue or throat muscle weakness. Certain medications also can cause dysarthria.

Treating the underlying cause of your dysarthria may improve your speech. You may also need speech therapy. For dysarthria caused by prescription medications, changing or discontinuing the medications may help.

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Signs and symptoms of dysarthria vary, depending on the underlying cause and the type of dysarthria. They may include:

• Slurred speech
• Slow speech
• Inability to speak louder than a whisper or speaking too loudly
• Rapid speech that is difficult to understand
• Nasal, raspy or strained voice
• Uneven or abnormal speech rhythm
• Uneven speech volume
• Monotone speech
• Difficulty moving your tongue or facial muscles

When to see a doctor

Dysarthria can be a sign of a serious condition. See your doctor if you have sudden or unexplained changes in your ability to speak.

In dysarthria, you may have difficulty moving the muscles in your mouth, face or upper respiratory system that control speech. Conditions that may lead to dysarthria include:

• Amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease)
• Brain injury
• Brain tumor
• Cerebral palsy
• Guillain-Barre syndrome
• Head injury
• Huntington's disease
• Lyme disease
• Multiple sclerosis
• Muscular dystrophy
• Myasthenia gravis
• Parkinson's disease
• Wilson's disease

Some medications, such as certain sedatives and seizure drugs, also can cause dysarthria.

Complications

Because of the communication problems dysarthria causes, complications can include:

• Social difficulty. Communication problems may affect your relationships with family and friends and make social situations challenging.
• Depression. In some people, dysarthria may lead to social isolation and depression.
• Daroff RB, et al., eds. Bradley's Neurology in Clinical Practice. 7th ed. Elsevier; 2016. https://www.clinicalkey.com. Accessed April 10, 2020.
• Dysarthria. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/dysarthria/. Accessed April 6, 2020.
• Maitin IB, et al., eds. Current Diagnosis & Treatment: Physical Medicine & Rehabilitation. McGraw-Hill Education; 2020. https://accessmedicine.mhmedical.com. Accessed April 10, 2020.
• Dysarthria in adults. American Speech-Language-Hearing Association. https://www.asha.org/PRPPrintTemplate.aspx?folderid=8589943481. Accessed April 6, 2020.
• Drugs that cause dysarthria. IBM Micromedex. https://www.micromedexsolutions.com. Accessed April 10, 2020.
• Lirani-Silva C, et al. Dysarthria and quality of life in neurologically healthy elderly and patients with Parkinson's disease. CoDAS. 2015; doi:10.1590/2317-1782/20152014083.
• Signs and symptoms of untreated Lyme disease. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/signs_symptoms/index.html. Accessed April 6, 2020.
• Neurological diagnostic tests and procedures fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurological-Diagnostic-Tests-and-Procedures-Fact. Accessed April 6, 2020.

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Many disorders can affect our ability to speak and communicate. They range from saying sounds incorrectly to being completely unable to speak or understand speech. Causes include:

• Hearing disorders and deafness
• Voice problems , such as dysphonia or those caused by cleft lip or palate
• Speech problems like stuttering
• Developmental disabilities
• Learning disabilities
• Autism spectrum disorder
• Brain injury

Some speech and communication problems may be genetic. Often, no one knows the causes. By first grade, about 5% of children have noticeable speech disorders. Speech and language therapy can help.

NIH: National Institute on Deafness and Other Communication Disorders

• Speech and Language Impairments (Center for Parent Information and Resources) Also in Spanish

• Speech to Speech Relay Service (Federal Communications Commission)
• Telecommunications Relay Service (TRS) (Federal Communications Commission)
• Aphasia vs. Apraxia (American Stroke Association)

Journal Articles References and abstracts from MEDLINE/PubMed (National Library of Medicine)

• Article: Development and validation of a predictive model for poor prognosis of...
• Article: Communication strategies for adults in palliative care: the speech-language therapists' perspective.
• Article: Pain assessment tools in adults with communication disorders: systematic review and...
• Speech and Communication Disorders -- see more articles
• Speech Problems (Nemours Foundation)
• Apraxia (Medical Encyclopedia) Also in Spanish
• Dysarthria (Medical Encyclopedia) Also in Spanish
• Phonological disorder (Medical Encyclopedia) Also in Spanish
• Selective mutism (Medical Encyclopedia) Also in Spanish
• Speech impairment in adults (Medical Encyclopedia) Also in Spanish

The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

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What Is a Speech Sound Disorder?

Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

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Speech sound disorders are a blanket description for a child’s difficulty in learning, articulating, or using the sounds/sound patterns of their language. These difficulties are usually clear when compared to the communication abilities of children within the same age group.

Speech developmental disorders may indicate challenges with motor speech. Here, a child experiences difficulty moving the muscles necessary for speech production. This child may also face reduced coordination when attempting to speak.

Speech sound disorders are recognized where speech patterns do not correspond with the movements/gestures made when speaking.  

Speech impairments are a common early childhood occurrence—an estimated 2% to 13% of children live with these difficulties. Children with these disorders may struggle with reading and writing. This can interfere with their expected academic performance. Speech sound disorders are often confused with language conditions such as specific language impairment (SLI).

This article will examine the distinguishing features of this disorder. It will also review factors responsible for speech challenges, and the different ways they can manifest. Lastly, we’ll cover different treatment methods that make managing this disorder possible.

Symptoms of Speech Sound Disorder

A speech sound disorder may manifest in different ways. This usually depends on the factors responsible for the challenge, or how extreme it is.

There are different patterns of error that may signal a speech sound disorder. These include:

• Removing a sound from a word
• Including a sound in a word
• Replacing hard to pronounce sounds with an unsuitable alternative
• Difficulty pronouncing the same sound in different words (e.g., "pig" and "kit")
• Repeating sounds or words
• Lengthening words
• Pauses while speaking
• Tension when producing sounds
• Head jerks during speech
• Blinking while speaking
• Shame while speaking
• Changes in voice pitch
• Running out of breath while speaking

It’s important to note that children develop at different rates. This can reflect in the ease and ability to produce sounds. But where children repeatedly make sounds or statements that are difficult to understand, this could indicate a speech disorder.

Diagnosis of Speech Sound Disorders

For a correct diagnosis, a speech-language pathologist can determine whether or not a child has a speech-sound disorder.

This determination may be made in line with the requirements of the DSM-5 diagnostic criteria . These guidelines require that:

• The child experience persistent difficulty with sound production (this affects communication and speech comprehension)
• Symptoms of the disorder appear early during the child’s development stages
• This disorder limits communication. It affects social interactions, academic achievements, and job performance.
• The disorder is not caused by other conditions like a congenital disorder or an acquired condition like hearing loss . Hereditary disorders are, however, exempted. 

Causes of Speech Sound Disorders

There is no known cause of speech sound disorders. However, several risk factors may increase the odds of developing a speech challenge. These include:

• Gender : Male children are more likely to develop a speech sound disorder
• Family history : Children with family members living with speech disorders may acquire a similar challenge.
• Socioeconomics : Being raised in a low socioeconomic environment may contribute to the development of speech and literacy challenges.
• Pre- and post-natal challenges : Difficulties faced during pregnancy such as maternal infections and stressors may worsen the chances of speech disorders in a child. Likewise, delivery complications, premature birth, and low-birth-weight could lead to speech disorders.
• Disabilities : Down syndrome, autism , and other disabilities may be linked to speech-sound disorders.
• Physical challenges : Children with a cleft lip may experience speech sound difficulties.
• Brain damage : These disorders may also be caused by an infection or trauma to a child’s brain . This is seen in conditions like cerebral palsy where the muscles affecting speech are injured.

Types of Speech Sound Disorders

By the time a child turns three, at least half of what they say should be properly understood. By ages four and five, most sounds should be pronounced correctly—although, exceptions may arise when pronouncing “l”, “s”,”r”,”v”, and other similar sounds. By seven or eight, harder sounds should be properly pronounced. 

A child with a speech sound disorder will continue to struggle to pronounce words, even past the expected age. Difficulty with speech patterns may signal one of the following speech sound disorders:

This refers to interruptions while speaking. Stuttering is the most common form of disfluency. It is recognized for recurring breaks in the free flow of speech. After the age of four, a child with disfluency will still repeat words or phrases while speaking. This child may include extra words or sounds when communicating—they may also make words longer by stressing syllables.

This disorder may cause tension while speaking. Other times, head jerking or blinking may be observed with disfluency. 

Children with this disorder often feel frustrated when speaking, it may also cause embarrassment during interactions. 

Articulation Disorder

When a child is unable to properly produce sounds, this may be caused by inexact placement, speed, pressure, or movement from the lips, tongue, or throat.  

This usually signals an articulation disorder, where sounds like “r”, “l”, or “s” may be changed. In these cases, a child’s communication may be understood by only close family members.

Phonological Disorder

A phonological disorder is present where a child is unable to make the speech sounds expected of their age. Here, mistakes may be made when producing sounds. Other times, sounds like consonants may be omitted when speaking.  

Voice Disorder

Where a child is observed to have a raspy voice, this may be an early sign of a voice disorder. Other indicators include voice breaks, a change in pitch, or an excessively loud or soft voice.  

Children that run out of breath while speaking may also live with this disorder. Likewise, children may sound very nasally, or can appear to have inadequate air coming out of their nose if they have a voice disorder.

Childhood apraxia of speech occurs when a child lacks the proper motor skills for sound production. Children with this condition will find it difficult to plan and produce movements in the tongue, lips, jaw, and palate required for speech.  

Treatment of Speech Sound Disorder

Parents of children with speech sound disorders may feel at a loss for the next steps to take. To avoid further strain to the child, it’s important to avoid showing excessive concern.

Instead, listening patiently to their needs, letting them speak without completing their sentences, and showing usual love and care can go a long way.

For professional assistance, a speech-language pathologist can assist with improving a child’s communication. These pathologists will typically use oral motor exercises to enhance speech.

These oral exercises may also include nonspeech oral exercises such as blowing, oral massages and brushing, cheek puffing, whistleblowing, etc.

Nonspeech oral exercises help to strengthen weak mouth muscles, and can help with learning the common ways of communicating.

Parents and children with speech sound disorders may also join support groups for information and assistance with the condition.

A Word From Verywell

It can be frustrating to witness the challenges in communication. But while it's understandable to long for typical communication from a child—the differences caused by speech disorders can be managed with the right care and supervision. Speaking to a speech therapist, and showing love o children with speech disorders can be important first steps in overcoming these conditions.

Eadie P, Morgan A, Ukoumunne OC, Ttofari Eecen K, Wake M, Reilly S. Speech sound disorder at 4 years: prevalence, comorbidities, and predictors in a community cohort of children . Dev Med Child Neurol . 2015;57(6):578-584. doi:10.1111/dmcn.12635

McLeod S, Harrison LJ, McAllister L, McCormack J. Speech sound disorders in a community study of preschool children . Am J Speech Lang Pathol . 2013;22(3):503-522. doi:10.1044/1058-0360(2012/11-0123)

Murphy CF, Pagan-Neves LO, Wertzner HF, Schochat E. Children with speech sound disorder: comparing a non-linguistic auditory approach with a phonological intervention approach to improve phonological skills . Front Psychol . 2015;6:64. Published 2015 Feb 4. doi:10.3389/fpsyg.2015.00064

Penn Medicine. Speech and Language Disorders-Symptoms and Causes .

PsychDB. Speech Sound Disorder (Phonological Disorder) .

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):438-447. doi:10.1097/DBP.0b013e31811ff8ca

American Speech-Language-Hearing Association. Speech Sound Disorders: Articulation and Phonology .

American Speech-Language-Hearing Association. Speech Sound Disorders .

MedlinePlus. Phonological Disorder .

National Institute on Deafness and Other Communication Disorders. Articulation Disorder .

National Institute of Health. Phonological Disorder.

Lee AS, Gibbon FE. Non-speech oral motor treatment for children with developmental speech sound disorders . Cochrane Database Syst Rev . 2015;2015(3):CD009383. Published 2015 Mar 25. doi:10.1002/14651858.CD009383.pub2

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The Benefits of Speech Therapy

What to expect, frequently asked questions.

A speech-language pathologist (SLP) can help you with speech, language, and swallowing. They provide speech therapy to children and adults who may have speech or language disorders.

People with certain medical conditions may also benefit from speech therapy. Medical conditions that may cause speech or swallowing impairment include traumatic brain injury , stroke (brain damage due to a blood vessel blockage or bleed), and dementia (decline in memory and thinking functions).

This article looks at the various uses for speech therapy, what to expect during a session, and the techniques involved in this type of therapy. 

Verywell / Theresa Chiechi

Speech therapy can help with a variety of conditions.

Speech Disorders

Speech therapy may help with speech disorders like:

• Stuttering : Stuttering may involve repeating parts of words, prolonging words, or struggling to get out certain words. You may be more likely to have a stutter if you have a family history of stuttering.
• Apraxia : This motor speech disorder makes it difficult to move the tongue and lips to make sounds required for speech. In some cases, people with apraxia cannot speak at all. Causes for this disorder include brain tumors, dementia, stroke, and any other condition that causes brain injury.
• Voice : Voice disorders can be temporary or permanent and make it hard to speak. Chronic voice disorders include chronic cough, vocal fold paralysis, vocal polyps (growths on the vocal cords), and spasmodic dysphonia (vocal cord spasms).
• Dysarthria : People with this speech disorder have muscle weakness that makes it difficult to talk. They may slur or mumble their words. Dysarthria can happen due to brain injury or chronic degenerative conditions like Parkinson’s disease or Huntington’s disease .

Language Disorders

A language disorder ( aphasia ) is a condition that makes it difficult for a person to read, write, speak, or understand speech or other modes of communication. 

Someone with this type of disorder may struggle to:

• Use incorrect words for things
• Say complete sentences 
• Understand what other people say
• Understand jokes
• Read or spell 

Brain tumors, traumatic brain injuries, and degenerative disorders that affect cognitive function can all cause aphasia.

Feeding and Swallowing Disorders

Feeding and swallowing disorders can occur in both children and adults. A feeding disorder involves trouble with eating, sucking, drinking from a cup, or chewing. The specific term for swallowing disorders is dysphagia . Children or adults with dysphagia have trouble swallowing food or drink. 

Problems swallowing or feeding may or may not be related to a medical condition. Conditions that may cause a swallowing or feeding disorder include:

• Cleft palate or cleft lip
• Asthma and other breathing issues
• Heart disease
• Premature birth
• Nervous system disorders
• Reflux 
• Muscle weakness 
• Sensory issues
• Autism  
• Behavior problems
• Certain medications

Speech therapy begins with an evaluation to assess your difficulties and whether any structural issues contribute to your speech, language, feeding, or swallowing problems. An evaluation may involve a standardized test to help determine what you most need help with. Informal conversations may also help figure out your needs. 

A speech-language pathologist will then work with you to help improve your ability to speak, converse, or swallow. This may involve:

• Educating you on how to do certain things like articulating or pronouncing sounds
• Teaching you language skills
• Providing you with educational materials
• Giving you exercises to help strengthen your muscles 
• Giving you exercises that help you breathe better
• Participation in group therapy sessions 

You should also expect to practice the skills and exercises you learn in speech therapy sessions at home. Your speech-language pathologist may provide you with workbooks, worksheets, or virtual apps for at-home practice.

Speech Therapy for Adults

Depending on the reason you’re seeking out speech therapy, a speech-language pathologist may:

• Help you learn to move your muscles correctly to make sounds if you have apraxia or dysarthria
• Teach you how to use your breath to speak louder if you have dysarthria
• Help you learn to manage stuttering by teaching you to lower stress levels in certain situations
• Help you strengthen your mouth muscles to make it easier to swallow and eat if you have a feeding or swallowing disorder due to a brain injury or disease

Speech Therapy for Children

A speech-language pathologist’s approach will depend on the child. When working with a child who has a feeding or swallowing disorder, they might focus on:

• Strengthening the muscles of the mouth
• Helping the child with chewing
• Encouraging the child to try new food and drink
• Changing food texture to make it easier to swallow food 
• Helping with sensory issues related to food

Other skills a speech-language pathologist may work on with a child include:

• Language complexity : For example, they might teach words like "and" and "or" to connect ideas within sentences.
• Conversation skills : This may include role-playing to help the child with socialization and improve their read of social cues. 
• Vocabulary : They may use games or storytelling to help build the child’s vocabulary. 
• Phonological awareness : This recognition of the sounds that make up words is an important skill for reading. The SLP may work on helping the child identify sounds and rhymes in words to build this skill.

Healthcare professionals will also test your child’s hearing to see if hearing loss may be contributing to language and speech issues.

If you or your child is getting speech therapy from a qualified speech-language pathologist, you might wonder how likely it is that you’ll see improvement in speech, language, or feeding. 

Results will depend on the individual. It’s also essential to follow the exercises, tips, and strategies provided by the speech-language professional. Regular visits and keeping up with practice activities and exercises make it more likely to see an improvement in yourself or your child. 

A speech-language pathologist works with children or adults who have speech, language, or feeding and swallowing disorders. Typically the first session will involve an evaluation to determine the areas that are causing you the most problems. 

From there, they may teach you exercises and strategies to improve your speech, language, or ability to swallow and eat. 

A Word From Verywell

Think you or your child would benefit from speech therapy? Get in touch with your primary healthcare provider and ask for a recommendation. You can also use the American Speech-Language-Hearing Association’s (ASHA)  Find a Certified SLP Tool . 

Not all children develop at the same rate, but if your child has issues understanding language, doesn’t use gestures, or doesn’t seem to be learning new words, you might consider having them evaluated by a speech therapist. 

While this may depend on the individual and the cause of speech-related problems, research suggests that speech and language therapy can significantly improve speech and language issues.

One example of a typical speech therapy technique is articulation therapy. This technique teaches the person to make specific sounds, sometimes by showing them how to move their mouth or tongue.

A language delay is when a child has difficulty in speaking and understanding speech that is unusual for their age.

American Speech-Language-Hearing Association. Stuttering .

American Speech-Language-Hearing Association. Apraxia of speech in adults .

American Speech-Language-Hearing Association. Voice disorders .

American Speech-Language-Hearing Association. Dysarthria .

American Speech-Language-Hearing Association. Aphasia .

American Speech-Language-Hearing Association. Feeding and swallowing disorders in children .

Brainline. Speech therapy .

Understood for All. What is speech therapy .

Centers for Disease Control and Prevention. Languages and speech disorders in children .

Broomfield J, Dodd B. Is speech and language therapy effective for children with primary speech and language impairment? Report of a randomized control trial . Int J Lang Commun Disord . 2011;46(6):628-640. doi:10.1111/j.1460-6984.2011.00039.x

Nemours Children's Health. Speech-language therapy .

By Steph Coelho Steph Coelho is a freelance health and wellness writer and editor with nearly a decade of experience working on content related to health, wellness, mental health, chronic illness, fitness, sexual wellness, and health-related tech.She's written extensively about chronic conditions, telehealth, aging, CBD, and mental health. Her work has appeared in Insider, Healthline, WebMD, Greatist, Medical News Today, and more.

Monica Marzinske, CCC-SLP

Speech-language therapy.

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Speaking clearly: Help for people with speech and language disorders

• Speech-Language

Speaking and language abilities vary from person to person. Some people can quickly articulate exactly what they are thinking or feeling, while others struggle being understood or finding the right words.

These struggles could be due to a speech or language disorder if communication struggles cause ongoing communication challenges and frustrations. Speech and language disorders are common.

It's estimated that 5% to 10% of people in the U.S. have a communication disorder. By the first grade, about 5% of U.S. children have a noticeable speech disorder. About 3 million U.S. adults struggle with stuttering and about 1 million U.S. adults have aphasia. These conditions make reading, speaking, writing and comprehending difficult.

People with speech and language disorders can find hope in rehabilitation. Speech-language pathologists can evaluate and treat these disorders. This can lead to a happier, healthier and more expressive life.

Types of speech and language disorders

Speech and language disorders come in many forms, each with its own characteristics:.

• Aphasia People with aphasia have difficulty with reading, writing, speaking or understanding information they've heard. The intelligence of a person with aphasia is not affected.
• Dysarthria People with dysarthria demonstrate slurred or imprecise speech patterns that can affect the understanding of speech.
• Apraxia A person with this disorder has difficulty coordinating lip and tongue movements to produce understandable speech.
• Dysphagia This condition refers to swallowing difficulties, including food sticking in the throat, coughing or choking while eating or drinking, and other difficulties.
• Stuttering This speech disorder involves frequent and significant problems with normal fluency and flow of speech. People who stutter know what they want to say but have difficulty saying it.
• Articulation disorder People with this disorder have trouble learning how to make specific sounds. They may substitute sounds, such as saying "fum" instead of "thumb".
• Phonological disorder Phonological processes are patterns of errors children use to simplify language as they learn to speak. A phonological disorder may be present if these errors persist beyond the age when most other children stop using them. An example is saying "duh" instead of "duck."
• Voice Voice disorders include vocal cord paralysis, vocal abuse and vocal nodules, which could result in vocal hoarseness, changes in vocal volume and vocal fatigue.
• Cognitive communication impairment People with cognitive communication impairment have difficulty with concentration, memory, problem-solving, and completion of tasks for daily and medical needs.

Speech and language disorders are more common in children. It can take time to develop the ability to speak and communicate clearly. Some children struggle with finding the right word or getting their jaws, lips or tongues in the correct positions to make the right sounds.

In adults, speech and language disorders often are the result of a medical condition or injury. The most common of these conditions or injuries are a stroke, brain tumor, brain injury, cancer, Parkinson's disease, multiple sclerosis, Lou Gehrig's disease or other underlying health complications.

Treatment options

Speech and language disorders can be concerning, but speech-language pathologists can work with patients to evaluate and treat these conditions. Each treatment plan is specifically tailored to the patient.

Treatment plans can address difficulties with:

• Speech sounds, fluency or voice
• Understanding language
• Sharing thoughts, ideas and feelings
• Organizing thoughts, paying attention, remembering, planning or problem-solving
• Feeding and swallowing
• Vocabulary or improper grammar use

Treatment typically includes training to compensate for deficiencies; patient and family education; at-home exercises; or neurological rehabilitation to address impairments due to medical conditions, illnesses or injury.

Treatment options are extensive and not limited by age. Children and adults can experience the benefits of treatment.

If you or a loved one are struggling with speech and language issues, you are not alone. Millions of people experience similar daily challenges. Better yet, help is available.

Monica Marzinske is a speech-language pathologist  in New Prague , Minnesota.

Related Posts

10 Most Common Speech-Language Disorders & Impediments

As you get to know more about the field of speech-language pathology you’ll increasingly realize why SLPs are required to earn at least a master’s degree . This stuff is serious – and there’s nothing easy about it.

In 2016 the National Institute on Deafness and Other Communication Disorders reported that 7.7% of American children have been diagnosed with a speech or swallowing disorder. That comes out to nearly one in 12 children, and gets even bigger if you factor in adults.

Whether rooted in psycho-speech behavioral issues, muscular disorders, or brain damage, nearly all the diagnoses SLPs make fall within just 10 common categories…

Types of Speech Disorders & Impediments

Apraxia of speech (aos).

Apraxia of Speech (AOS) happens when the neural pathway between the brain and a person’s speech function (speech muscles) is lost or obscured. The person knows what they want to say – they can even write what they want to say on paper – however the brain is unable to send the correct messages so that speech muscles can articulate what they want to say, even though the speech muscles themselves work just fine. Many SLPs specialize in the treatment of Apraxia .

There are different levels of severity of AOS, ranging from mostly functional, to speech that is incoherent. And right now we know for certain it can be caused by brain damage, such as in an adult who has a stroke. This is called Acquired AOS.

However the scientific and medical community has been unable to detect brain damage – or even differences – in children who are born with this disorder, making the causes of Childhood AOS somewhat of a mystery. There is often a correlation present, with close family members suffering from learning or communication disorders, suggesting there may be a genetic link.

Mild cases might be harder to diagnose, especially in children where multiple unknown speech disorders may be present. Symptoms of mild forms of AOS are shared by a range of different speech disorders, and include mispronunciation of words and irregularities in tone, rhythm, or emphasis (prosody).

Stuttering – Stammering

Stuttering, also referred to as stammering, is so common that everyone knows what it sounds like and can easily recognize it. Everyone has probably had moments of stuttering at least once in their life. The National Institute on Deafness and Other Communication Disorders estimates that three million Americans stutter, and reports that of the up-to-10-percent of children who do stutter, three-quarters of them will outgrow it. It should not be confused with cluttering.

Most people don’t know that stuttering can also include non-verbal involuntary or semi-voluntary actions like blinking or abdominal tensing (tics). Speech language pathologists are trained to look for all the symptoms of stuttering , especially the non-verbal ones, and that is why an SLP is qualified to make a stuttering diagnosis.

The earliest this fluency disorder can become apparent is when a child is learning to talk. It may also surface later during childhood. Rarely if ever has it developed in adults, although many adults have kept a stutter from childhood.

Stuttering only becomes a problem when it has an impact on daily activities, or when it causes concern to parents or the child suffering from it. In some people, a stutter is triggered by certain events like talking on the phone. When people start to avoid specific activities so as not to trigger their stutter, this is a sure sign that the stutter has reached the level of a speech disorder.

The causes of stuttering are mostly a mystery. There is a correlation with family history indicating a genetic link. Another theory is that a stutter is a form of involuntary or semi-voluntary tic. Most studies of stuttering agree there are many factors involved.

Dysarthria is a symptom of nerve or muscle damage. It manifests itself as slurred speech, slowed speech, limited tongue, jaw, or lip movement, abnormal rhythm and pitch when speaking, changes in voice quality, difficulty articulating, labored speech, and other related symptoms.

It is caused by muscle damage, or nerve damage to the muscles involved in the process of speaking such as the diaphragm, lips, tongue, and vocal chords.

Because it is a symptom of nerve and/or muscle damage it can be caused by a wide range of phenomena that affect people of all ages. This can start during development in the womb or shortly after birth as a result of conditions like muscular dystrophy and cerebral palsy. In adults some of the most common causes of dysarthria are stroke, tumors, and MS.

A lay term, lisping can be recognized by anyone and is very common.

Speech language pathologists provide an extra level of expertise when treating patients with lisping disorders . They can make sure that a lisp is not being confused with another type of disorder such as apraxia, aphasia, impaired development of expressive language, or a speech impediment caused by hearing loss.

SLPs are also important in distinguishing between the five different types of lisps. Most laypersons can usually pick out the most common type, the interdental/dentalised lisp. This is when a speaker makes a “th” sound when trying to make the “s” sound. It is caused by the tongue reaching past or touching the front teeth.

Because lisps are functional speech disorders, SLPs can play a huge role in correcting these with results often being a complete elimination of the lisp. Treatment is particularly effective when implemented early, although adults can also benefit.

Experts recommend professional SLP intervention if a child has reached the age of four and still has an interdental/dentalised lisp. SLP intervention is recommended as soon as possible for all other types of lisps. Treatment includes pronunciation and annunciation coaching, re-teaching how a sound or word is supposed to be pronounced, practice in front of a mirror, and speech-muscle strengthening that can be as simple as drinking out of a straw.

Spasmodic Dysphonia

Spasmodic Dysphonia (SD) is a chronic long-term disorder that affects the voice. It is characterized by a spasming of the vocal chords when a person attempts to speak and results in a voice that can be described as shaky, hoarse, groaning, tight, or jittery. It can cause the emphasis of speech to vary considerably. Many SLPs specialize in the treatment of Spasmodic Dysphonia .

SLPs will most often encounter this disorder in adults, with the first symptoms usually occurring between the ages of 30 and 50. It can be caused by a range of things mostly related to aging, such as nervous system changes and muscle tone disorders.

It’s difficult to isolate vocal chord spasms as being responsible for a shaky or trembly voice, so diagnosing SD is a team effort for SLPs that also involves an ear, nose, and throat doctor (otolaryngologist) and a neurologist.

Have you ever heard people talking about how they are smart but also nervous in large groups of people, and then self-diagnose themselves as having Asperger’s? You might have heard a similar lay diagnosis for cluttering. This is an indication of how common this disorder is as well as how crucial SLPs are in making a proper cluttering diagnosis .

A fluency disorder, cluttering is characterized by a person’s speech being too rapid, too jerky, or both. To qualify as cluttering, the person’s speech must also have excessive amounts of “well,” “um,” “like,” “hmm,” or “so,” (speech disfluencies), an excessive exclusion or collapsing of syllables, or abnormal syllable stresses or rhythms.

The first symptoms of this disorder appear in childhood. Like other fluency disorders, SLPs can have a huge impact on improving or eliminating cluttering. Intervention is most effective early on in life, however adults can also benefit from working with an SLP.

Muteness – Selective Mutism

There are different kinds of mutism, and here we are talking about selective mutism. This used to be called elective mutism to emphasize its difference from disorders that caused mutism through damage to, or irregularities in, the speech process.

Selective mutism is when a person does not speak in some or most situations, however that person is physically capable of speaking. It most often occurs in children, and is commonly exemplified by a child speaking at home but not at school.

Selective mutism is related to psychology. It appears in children who are very shy, who have an anxiety disorder, or who are going through a period of social withdrawal or isolation. These psychological factors have their own origins and should be dealt with through counseling or another type of psychological intervention.

Diagnosing selective mutism involves a team of professionals including SLPs, pediatricians, psychologists, and psychiatrists. SLPs play an important role in this process because there are speech language disorders that can have the same effect as selective muteness – stuttering, aphasia, apraxia of speech, or dysarthria – and it’s important to eliminate these as possibilities.

And just because selective mutism is primarily a psychological phenomenon, that doesn’t mean SLPs can’t do anything. Quite the contrary.

The National Institute on Neurological Disorders and Stroke estimates that one million Americans have some form of aphasia.

Aphasia is a communication disorder caused by damage to the brain’s language capabilities. Aphasia differs from apraxia of speech and dysarthria in that it solely pertains to the brain’s speech and language center.

As such anyone can suffer from aphasia because brain damage can be caused by a number of factors. However SLPs are most likely to encounter aphasia in adults, especially those who have had a stroke. Other common causes of aphasia are brain tumors, traumatic brain injuries, and degenerative brain diseases.

In addition to neurologists, speech language pathologists have an important role in diagnosing aphasia. As an SLP you’ll assess factors such as a person’s reading and writing, functional communication, auditory comprehension, and verbal expression.

Speech Delay – Alalia

A speech delay, known to professionals as alalia, refers to the phenomenon when a child is not making normal attempts to verbally communicate. There can be a number of factors causing this to happen, and that’s why it’s critical for a speech language pathologist to be involved.

The are many potential reasons why a child would not be using age-appropriate communication. These can range anywhere from the child being a “late bloomer” – the child just takes a bit longer than average to speak – to the child having brain damage. It is the role of an SLP to go through a process of elimination, evaluating each possibility that could cause a speech delay, until an explanation is found.

Approaching a child with a speech delay starts by distinguishing among the two main categories an SLP will evaluate: speech and language.

Speech has a lot to do with the organs of speech – the tongue, mouth, and vocal chords – as well as the muscles and nerves that connect them with the brain. Disorders like apraxia of speech and dysarthria are two examples that affect the nerve connections and organs of speech. Other examples in this category could include a cleft palette or even hearing loss.

The other major category SLPs will evaluate is language. This relates more to the brain and can be affected by brain damage or developmental disorders like autism. There are many different types of brain damage that each manifest themselves differently, as well as developmental disorders, and the SLP will make evaluations for everything.

Issues Related to Autism

While the autism spectrum itself isn’t a speech disorder, it makes this list because the two go hand-in-hand more often than not.

The Centers for Disease Control and Prevention (CDC) reports that one out of every 68 children in our country have an autism spectrum disorder. And by definition, all children who have autism also have social communication problems.

Speech-language pathologists are often a critical voice on a team of professionals – also including pediatricians, occupational therapists, neurologists, developmental specialists, and physical therapists – who make an autism spectrum diagnosis .

In fact, the American Speech-Language Hearing Association reports that problems with communication are the first detectable signs of autism. That is why language disorders – specifically disordered verbal and nonverbal communication – are one of the primary diagnostic criteria for autism.

So what kinds of SLP disorders are you likely to encounter with someone on the autism spectrum?

A big one is apraxia of speech. A study that came out of Penn State in 2015 found that 64 percent of children who were diagnosed with autism also had childhood apraxia of speech.

This basic primer on the most common speech disorders offers little more than an interesting glimpse into the kind of issues that SLPs work with patients to resolve. But even knowing everything there is to know about communication science and speech disorders doesn’t tell the whole story of what this profession is all about. With every client in every therapy session, the goal is always to have the folks that come to you for help leave with a little more confidence than when they walked in the door that day. As a trusted SLP, you will build on those gains with every session, helping clients experience the joy and freedom that comes with the ability to express themselves freely. At the end of the day, this is what being an SLP is all about.

Ready to make a difference in speech pathology? Learn how to become a Speech-Language Pathologist today

• Emerson College - Master's in Speech-Language Pathology online - Prepare to become an SLP in as few as 20 months. No GRE required. Scholarships available.
• NYU Steinhardt - NYU Steinhardt's Master of Science in Communicative Sciences and Disorders online - ASHA-accredited. Bachelor's degree required. Graduate prepared to pursue licensure.
• Arizona State University - Online - Online Bachelor of Science in Speech and Hearing Science - Designed to prepare graduates to work in behavioral health settings or transition to graduate programs in speech-language pathology and audiology.

Dysarthria (difficulty speaking)

Dysarthria is where you have difficulty speaking because the muscles you use for speech are weak. It can be caused by conditions that damage your brain or nerves and some medicines. Speech and language therapy can help.

Immediate action required: Call 999 if:

• somebody's face droops on 1 side (the mouth or eye may have drooped)
• a person cannot lift up both arms and keep them there
• a person has difficulty speaking (speech may be slurred or garbled)

These can be signs of a stroke, which is a medical emergency. The symptoms of a stroke usually come on suddenly.

Check if it's dysarthria

The main symptom of dysarthria is unclear speech. This can make it difficult for you to make yourself understood.

Your speech may only be slightly unclear, or you may not be able to speak clearly at all.

Other symptoms include:

• difficulty moving your mouth, tongue or lips
• slurred or slow speech
• difficulty controlling the volume of your voice, making you talk too loudly or quietly
• a change in your voice, making it nasal, strained or monotone
• hesitating a lot when talking, or speaking in short bursts instead of full sentences

Being stressed or tired may make your symptoms worse.

Dysarthria is not the same as dysphasia, although you can have both conditions at the same time. Dysphasia, also known as aphasia , is where you have difficulty understanding words or putting them together in a sentence.

Non-urgent advice: See a GP if:

• you've noticed gradual changes to your or your child's speech and you're worried

They'll examine you and may refer you to a specialist for further tests.

Causes of dysarthria

Dysarthria is usually caused by damage to the brain or conditions that affect the nervous system. It can happen at any age.

Common causes include:

• stroke , severe head injury and brain tumours
• Parkinson's disease , multiple sclerosis and motor neurone disease
• cerebral palsy and Down's syndrome

It can also be a side effect of certain medicines, such as some medicines to treat epilepsy.

Treatment for dysarthria

If you have dysarthria, you'll usually be referred to a speech and language therapist. They'll offer therapy to help your speech and communication.

The therapy you're offered will be different depending on the cause of your dysarthria and how severe it is.

Some people may find therapy does not help their symptoms, or their speech may get worse as their condition progresses. Their therapy may focus on helping communication in other ways.

Speech and language therapy may include:

• exercises to strengthen the muscles used for speech
• strategies to make your speech easier to understand, such as slowing down when you're talking
• using communication aids, such as an alphabet board or a voice amplifier

Find out more

• Headway: communication problems after brain injury
• Stroke Association: communication tools

Page last reviewed: 17 February 2023 Next review due: 17 February 2026

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Study reveals brain mechanisms behind speech impairment in Parkinson’s

Most Parkinson’s disease patients struggle with speech problems. New research by Stanford Medicine scientists uncovers the brain connections that could be essential to preserving speech.

May 28, 2024 - By Nina Bai

Research by Stanford Medicine scientists may explain why some treatments for Parkinson’s — developed mainly to target motor symptoms — can improve speech impairments while other treatments make them worse. Lightspring /Shutterstock.com

Parkinson’s disease is most well-known and well-studied for its motor impairments — tremors, stiffness and slowness of movement. But less visible symptoms such as trouble with memory, attention and language, which also can profoundly impact a person’s quality of life, are less understood. A new study by Stanford Medicine researchers reveals the brain mechanisms behind one of the most prevalent, yet often overlooked, symptoms of the disease — speech impairment.

Based on brain imaging from Parkinson’s patients, the researchers identified specific connections in the brain that may determine the extent of speech difficulties.

The findings , reported May 20 in the Proceedings of the National Academy of Sciences , could help explain why some treatments for Parkinson’s — developed mainly to target motor symptoms — can improve speech impairments while other treatments make them worse.

More than a motor disorder

“Parkinson’s disease is a very common neurological disorder, but it’s mostly considered a motor disorder,” said Weidong Cai , PhD, clinical associate professor of psychiatry and behavioral sciences and the lead author of the new study. “There’s been lots of research on how treatments such as medications and deep brain stimulation can help improve motor function in patients, but there was limited understanding about how these treatments affect cognitive function and speech.”

Over 90% of people with Parkinson’s experience difficulties with speech, an intricate neurological process that requires motor and cognitive control. Patients may struggle with a weak voice, slurring, mumbling and stuttering.

“Speech is a complex process that involves multiple cognitive functions, such as receiving auditory feedback, organizing thoughts and producing the final vocal output,” Cai said.

The senior author of the study is Vinod Menon , PhD, professor of psychiatry and behavioral sciences and director of the Stanford Cognitive and Systems Neuroscience Laboratory .

The researchers set out to study how levodopa, a common Parkinson’s drug that replaces the dopamine lost from the disease, affects overall cognitive function. They focused on the subthalamic nucleus, a small, pumpkin-seed-shaped region deep within the brain.

Weidong Cai

The subthalamic nucleus is known for its role in inhibiting motor activity, but there are clues to its involvement in other functions. For example, deep brain stimulation, which uses implanted electrodes to stimulate the subthalamic nucleus, has proven to be a powerful way to relieve motor symptoms for Parkinson’s patients — but a common side effect is worsened speech impairment.

Same test, different scores

In the new study, 27 participants with Parkinson’s disease and 43 healthy controls, all older than 60, took standard tests of motor and cognitive functioning. The participants with Parkinson’s took the tests while on and off their medication.

As expected, the medication improved motor functioning in the patients, with those having the most severe symptoms improving the most.

The test for cognitive functioning offered a surprise. The test, known as the Symbol Digit Modalities Test, is given in two forms — oral and written. Patients are provided with nine symbols, each matched with a number — a plus sign for the number 7, for example. They are then asked to translate a string of symbols into numbers, either speaking or writing down their answers, depending on the version of the test.

As a group, the patients’ performance on both versions of the cognitive test was little affected by medication. But taking a closer look, the researchers noticed that the subset of patients who performed particularly poorly on the spoken version of the test without medication improved their spoken performance on the medication. Their written test scores did not change significantly.

“It was quite interesting to find this dissociation between the written and oral version of the same test,” Cai said.

The dissociation suggested that the medication was not enhancing general cognitive functions such as attention and working memory, but it was selectively improving speech.

“Our research unveiled a previously unrecognized impact of dopaminergic drugs on the speech function of Parkinson’s patients,” Menon said.

Uncovering connections

Next, the researchers analyzed fMRI brain scans of the participants, looking at how the subthalamic nucleus interacted with brain networks dedicated to various functions, including hearing, vision, language and executive control.

Vinod Menon

They found that different parts of the subthalamic nucleus interacted with different networks.

In particular, they discovered that improvements on the oral version of the test correlated with better functional connectivity between the right side of the subthalamic nucleus and the brain’s language network.

Using a statistical model, they could even predict a patient’s improvement on the oral test based on changes in their brain’s functional connectivity.

“Here we’re not talking about an anatomical connection,” Cai explained. Rather, functional connectivity between brain regions means the activity in these regions is closely coordinated, as if they are talking to each other.

“We discovered that these medications influence speech by altering the functional connectivity between the subthalamic nucleus and crucial language networks,” Menon said. “This insight opens new avenues for therapeutic interventions tailored specifically to improve speech without deteriorating other cognitive abilities.”

This newly identified interaction between the subthalamic nucleus and the language network could serve as a biological indicator of speech behavior — in Parkinson’s as well as other speech disorders like stuttering.

Such a biomarker could be used to monitor treatment outcomes and inspire new therapies. “Of course, you can directly observe the outcome of a medication by observing behavior, but I think to have a biomarker in the brain will provide more useful information for the future development of drugs,” Cai said. 

The findings also provide a detailed map of the subthalamic nucleus, which could guide neurosurgeons performing deep brain stimulation in avoiding damage to an area critical to speech function. “By identifying key neural maps and connections that predict speech improvement, we can craft more effective treatment plans that are both precise and personalized for Parkinson’s disease patients,” Menon said.

The study received funding from the National Institutes of Health (grants P50 AG047366, P30 AG066515, RF1 NS086085, R21 DC017950-S1, R01 NS115114, R01 MH121069 and K99 AG071837) and the Alzheimer’s Association.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

Hope amid crisis

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An animated goat helps kids with pronouncing 'R' sounds

Local 12, spectrum news report on uc researchers' speech therapy video game.

A collaborative effort between researchers at the University of Cincinnati is helping children overcome difficulties in pronouncing certain sounds, including “R,” Spectrum News and Local 12 reported.

Speech language pathologist Suzanne Boyce , PhD, is the principal investigator of a research team that has received a patent and a National Institutes of Health (NIH) grant to develop video game biofeedback for speech learning . The video game builds off Boyce’s previous work in using ultrasound to overcome difficulties with speech.

“We realized when we saw that ultrasound would pick up visual feedback of the tongue, is that that’s visual feedback and that’s much faster,” Boyce told Local 12. “So, the child can say something and see what’s happening on the screen in real time.”

The visual feedback helps children when they're learning how to pronounce a sound. To make the process more fun, and to help kids learn implicitly, the researchers created a video game that makes the child's tongue the controller of an animated goat that jumps from platform to platform.

“That, to me, is a win of how do you train people to collaborate between different industries to solve problems that matter?” Reneé Seward , an endowed associate professor of communication design, said to Spectrum News. “And I think that that's what they were doing. And then the problem that matter, it's seeing children, who are struggling to speak, just gain motivation to keep wanting to get better.”

University of Cincinnati researchers are developing a video game to help children with speech therapy. Pictured, left to right, are Sarah Biehl, a master’s student in biomedical engineering; postdoctoral researcher Sarah Dugan, PhD, who is a speech language pathologist; speech language pathologist Suzanne Boyce, PhD, is the principal investigator of a research team; and Reneé Seward, an endowed associate professor of communication design in the College of Design, Architecture, Art, and Planning. Photo/Andrew Higley/UC Marketing + Brand

Researchers from UC's College of Allied Health Sciences, College of Design, Architecture, Art, and Planning (DAAP) and College of Engineering and Applied Science have worked together to create the game. More than 25 students have contributed including biomedical engineering graduate student Nicholas Schoenleb.

“I think of in terms of experiences, the ability to interact with patients and participants is something that's really unique,” Schoenleb said to Spectrum News. “It really challenges you to not only just, be better, but just to work harder in everything. I think that's super valuable.”

The researchers are working with children ages 7 to 17 who have trouble with “R” sounds but think the research could have wider applications.

“This can help to shorten the duration of time in speech therapy, because the kiddo and the speech therapist can watch together and say, oh, no, that's not quite right,” Sarah Dugan , a postdoctoral researcher and speech language pathologist, said to Spectrum News.

See more from Local 12 and Spectrum News .

Featured image at top: A goat on roller skates jump from platform to platform in a video game developed at the University of Cincinnati. McKenna Becker, a DAAP student, created the design.

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Researchers have located the brain network responsible for stuttering

An international research group led by researchers from the University of Turku and Turku University Hospital in Finland has succeeded in identifying the probable origin of stuttering in the brain.

Stuttering is a speech rhythm disorder characterised by involuntary repetitions, prolongations or pauses in speech that prevent typical speech production. Approximately 5-10% of young children stutter, and an estimated 1% continue to stutter into adulthood. A severe stutter can have a profound negative impact on the life of the individual affected.

"Stuttering was once considered a psychological disorder. However, with further research, it is now understood to be a brain disorder related to the regulation of speech production," says Professor of Neurology Juho Joutsa from the University of Turku.

Stuttering may also be acquired as a result of certain neurological diseases, such as Parkinson's disease or a stroke. However, the neurobiological mechanisms of stuttering are not yet fully understood, and where it originates in the brain remains uncertain. The findings from brain imaging studies are partly contradictory, and it is challenging to determine which changes are the root cause of stuttering and which are merely associated phenomena.

Stuttering localised in the same brain network regardless of its cause

Researchers from Finland, New Zealand, the United States and Canada developed a new research design that could provide a solution to this problem. The study included individuals who had suffered a stroke, some of whom developed a stutter immediately after it. The researchers discovered that although the strokes were located in different parts of the brain, they all localised to the same brain network, unlike the strokes that did not cause stuttering.

In addition to people who had suffered a stroke, the researchers used magnetic resonance imaging (MRI) to scan the brains of 20 individuals with developmental stuttering. In these individuals, the stuttering was associated with structural changes in the nodes of the brain network originally identified in relation to causal stroke lesions -- the greater the changes, the more severe the stuttering. This finding suggests that stuttering is caused by a common brain network, regardless of the aetiology (developmental or neurological).

The key nodes of the network identified by the researchers were putamen, amygdala and claustrum located deep within the brain, and the connections between them.

"These findings explain well-known features of stuttering, such as the motor difficulties in speech production and the significant variability in stuttering severity across emotional states. As major nuclei in the brain, the putamen regulates motor function and the amygdala regulates emotions. The claustrum, in turn, acts as a node for several brain networks and relays information between them," explains Joutsa.

The results of the study provide a unique insight into the neurobiological basis of stuttering. Locating stuttering in the brain opens up new possibilities for medical treatment. Researchers hope that in the future, stuttering could be effectively treated, for example, with brain stimulation that can be targeted specifically to the now identified brain network.

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Story Source:

Materials provided by University of Turku . Note: Content may be edited for style and length.

Journal References :

• Catherine Theys, Elina Jaakkola, Tracy R Melzer, Luc F De Nil, Frank H Guenther, Alexander L Cohen, Michael D Fox, Juho Joutsa. Localization of stuttering based on causal brain lesions . Brain , 2024; DOI: 10.1093/brain/awae059

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Trump confronts repeated booing during Libertarian convention speech

Associated Press

Republican presidential candidate, former President Donald Trump speaks at the Libertarian National Convention at the Washington Hilton in Washington, Saturday, May 25, 2024. Jose Luis Magana/AP/Jose Luis Magana/AP hide caption

WASHINGTON — Donald Trump was booed repeatedly while addressing the Libertarian Party National Convention on Saturday night, with many in the crowd shouting insults and decrying him for things like his COVID-19 policies, running up towering federal deficits and lying about his political record.

When he took the stage, many jeered while some supporters clad in “Make America Great” hats and T-shirts cheered and chanted “USA! USA!” It was a rare moment of Trump coming face-to-face with open detractors, which is highly unusual for someone accustomed to staging rallies in front of ever-adoring crowds.

Libertarians, who prioritize small government and individual freedoms, are often skeptical of the former president, and his invitation to address the convention has divided the party. Trump tried to make light of that by referring to the four criminal indictments against him and joking, “If I wasn’t a Libertarian before, I sure as hell am a Libertarian now.”

Trump tried to praise “fierce champions of freedom in this room” and called President Joe Biden a “tyrant” and the “worst president in the history of the United States,” prompting some in the audience to scream back: “That’s you.”

Trump is a Republican. RFK is a Democrat. They're both wooing Libertarians

As the insults continued, Trump eventually hit back, saying “you don't want to win” and suggesting that some Libertarians want to “keep getting your 3% every four years.”

Libertarian candidate Gary Johnson won about 3% of the national vote in 2016, but nominee Jo Jorgensen got only a bit more than 1% during 2020’s close contest.

Libertarians will pick their White House nominee during their convention, which wraps on Sunday. Trump’s appearance also gave him a chance to court voters who might otherwise support independent presidential candidate Robert F. Kennedy, Jr. who gave his own Libertarian convention speech on Friday.

Polls have shown for months that most voters do not want a 2020 rematch between Trump and President Joe Biden. That dynamic could potentially boost support for an alternative like the Libertarian nominee or Kennedy, whose candidacy has allies of Biden and Trump concerned that he could be a spoiler.

Despite the raucous atmosphere, Trump continued to press on with his speech, saying he’d come “to extend a hand of friendship” in common opposition to Biden. That prompted a chant of “We want Trump!” from supporters, but more cries of “End the Fed!” — a common refrain from Libertarians who oppose the Federal Reserve. One person who held up a sign reading “No wannabe dictators!” was dragged away by security.

Trump tried to win over the crowd by pledging to include a Libertarian in his Cabinet, but many in the crowd hissed in disbelief. The former president did get a big cheer when he promised to commute the life sentence of the convicted founder of the drug-selling website Silk Road, Ross Ulbricht, and potentially release him on time served.

That was designed to energize Libertarian activists who believe government investigators overreached in building their case against Silk Road, and who generally oppose criminal drug policies more broadly. Ulbricht’s case was much-discussed during the Libertarian convention, and many of the hundreds in the crowd for Trump’s speech hoisted “Free Ross” signs and chanted the phrase as he spoke.

Despite those promises, many in the crowd remained antagonistic. One of the candidates vying for the Libertarian presidential nomination, Michael Rectenwald, declared from the stage before the former president arrived that “none of us are great fans of Donald Trump.” After his speech, Rectenwald and other Libertarian White House hopefuls took the stage to scoff at Trump and his speech.

Those for and against Trump even clashed over seating arrangements. About two hours before the former president's arrival, Libertarian organizers asked Trump supporters in the crowd to vacate the first four rows. They wanted convention delegates — many of whom said they’d traveled from around the country and bought expensive tickets to the proceedings — could sit close enough to hear the speech.

Many of the original seat occupants moved, but organizers eventually brought in more seats to calm things down.

The Libertarian split over Trump was reflected by Peter Goettler, president and chief executive of the libertarian Cato Institute, who suggested in a Washington Post column that the former president’s appearance violated the gathering’s core values and that “the political party pretending to be libertarian has transitioned to a different identity.”

Trump’s campaign noted that Biden didn't attend the Libertarian convention himself, and argued that the former president's doing so was part of an ongoing effort to reach would-be supporters in places that are not heavily Republican — including the former president’s rally Thursday in the Bronx during a pause in his New York hush money trial.

The Libertarian ticket will try to draw support from disaffected Republicans as well as people on the left. Such voters could also gravitate toward Kennedy.

Trump didn't dwell on Kennedy on Saturday night. But, after previously praising him and once considering him for a commission on vaccination safety, the former president has gone on the attack against Kennedy. He suggested on social media that a vote for Kennedy would be a “wasted protest vote” and that he would “even take Biden over Junior.”

The former president, while in office, referred to the COVID-19 vaccine as “one of the greatest miracles in the history of modern-day medicine.” He’s since accused Kennedy of being a “fake” opponent of vaccines.

In his speech at the Libertarian convention, Kennedy accused Trump and Biden of trampling on personal liberties in response to the pandemic. Trump bowed to pressure from public health officials and shut down businesses, Kennedy said, while Biden was wrong to mandate vaccines for millions of workers.

For his part, Biden has promoted winning the endorsement of many high-profile members of the Kennedy family, in an attempt to marginalize their relative’s candidacy.

Kevin Munoz, a spokesperson for Biden’s reelection campaign, slammed Trump and top Republicans for opposing access to abortion and supporting limits on civil society, saying in a statement Saturday, that “freedom isn’t free in Trump’s Republican Party and this weekend will be just one more reminder of that.”

• Donald Trump

The best moments from Bill Walton's broadcasting career

Basketball Hall of Famer and broadcasting icon Bill Walton died Monday after a long battle with cancer, the NBA announced . He was 71.

Walton played for 14 years in the NBA, and his list of accomplishments as a college and professional player is hard to match. He was a two-time national champion at UCLA , where he won three straight national college player of the year awards and earned three consensus first-team All-American nods from 1972-74.

After the Portland Trail Blazers selected Walton first overall in the 1974 NBA Draft, he won a title with them in 1977 and was named Finals MVP. He also won another title in 1986 with the Boston Celtics .

Walton's playing career is only a part of the impact he had on the game of basketball and the world of sports. After it ended, the Hall of Fame player began an illustrious career as a sports broadcaster. Starting in 1990 and over the next 30 years, Walton became known for his use of catchphrases, seemingly unrelated tangents and relentless excitement while calling games.

These are some of his best moments from that broadcasting career.

BILL WALTON: Hall of Famer and UCLA legend dies at age 71

Best Bill Walton broadcasting and media moments

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Commentary | Student protests need not have thrown college…

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Commentary | Student protests need not have thrown college campuses into chaos | GUEST COMMENTARY

Colleges must do a better job of proactively enforcing their policies and procedures, condemning hate and defining free speech versus illicit action, while promoting intellectual diversity.

Consider Columbia University. Pro-Palestinian protesters hid in Hamilton Hall and eventually succeeded in helping other students unlawfully occupy the building, even though custodians warned of repeated threats. Held against their will, petrified Columbia staff tried to fight their way out through the protesters, who ruled the academic building for almost 20 hours until police removed and arrested nearly 50 of them.

It is the responsibility of university presidents nationwide to champion debate and call out hate masquerading as free speech, while not allowing students to disrupt campuses.

The presidents of the University of Pennsylvania and Harvard recently resigned following a public outcry after they told Congress they would have to make “context-dependent decisions” about whether they would allow their students to call for all Jews to die.

Hate abounds across campuses, from antisemitic cartoons targeting Berkeley Law School Dean Erwin Chemerinsky to signs at U.C. Santa Barbara declaring , “Zionists not allowed.”

The First Amendment does not absolve students from accountability for hateful, threatening or abusive speech that expresses prejudice.

Decades of judicial precedent have established time, place and manner restrictions for speech, provided people have ample non-disruptive ways to express themselves. Incitement, fighting words and threats are all unprotected speech.

Even on public campuses, university presidents can ban bullhorns and loudspeakers, end demonstrations that stop traffic or prevent picketing inside an office. University presidents should subject protesters to immediate consequences for attempting to deprive graduates of commencements, which should be among the happiest, most memorable moments in a college student’s journey.

College presidents would do well to follow the example of University of Florida President Ben Sasse, who drew a clear line between speech and action by enforcing longstanding rules forbidding campus camping and harassment.

As President Sasse said , “We will always defend your right to free speech and free assembly. Also, we have time, place, and manner restrictions, and you don’t get to take over the whole university. People don’t get to spit at cops. You don’t get to barricade yourselves in buildings. You don’t get to disrupt somebody else’s commencement.”

The University of Florida is a public school. Private institutions such as Columbia have even wider legal leeway to impose restrictions on speech and protests that undermine campus safety.

Inconsistent policies regarding free speech and behavior regulation undermine campus leaders’ credibility and contribute to a culture of selective intolerance.

College leaders must establish and enforce clear, consistent rules that support free speech and de-escalate conflicts. No protesters are entitled to behave disruptively or even violently behavior regardless of ideology.

Just as colleges today would never tolerate students calling for the death of Black or LGBTQ students, there is no place for students threatening violence against “Zionists.”

Civil protests have a place, but university administrators, faculty, staff and students must carry on discussions about views and boundaries. The First Amendment calls for protesters to assemble “peaceably.”

Dialogue promotes intellectual diversity, an often overlooked yet equally critical form of on-campus diversity. As Irene Mulvey, president of the American Association of University Professors, has said of the current campus protests, “The way forward is through education, dialogue, communication.”

A November Anti-Defamation League study found that nearly six in 10 (55.8%) college students completed required diversity, equity, and inclusion training. Yet, fewer than one in five college students (18.1%) are mandated to complete religious acceptance training such as a course to combat antisemitism or Islamophobia.

It is time for colleges to teach mutual respect and tolerance for different religions. Education and communication beget empathy and compassion. At their best, colleges teach students how to think, not what to think.

Only education, debate, civil discourse and ideological diversity can bring love and light back to college campuses. As Martin Luther King Jr., one of my heroes, said, “Darkness cannot drive out darkness, only light can do that. Hate cannot drive out hate, only love can do that.”

David A. Armstrong is the president of St. Thomas University in Miami Gardens, Florida. The university’s Interfaith Leadership Institute is currently developing religious tolerance training to fight antisemitism and Islamophobia and foster religious acceptance, drawing partly on the U.S. Holocaust Memorial Museum’s curriculum.

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