speech impairment is it a disability

Understanding Speech Impairments: Are They Considered a Disability?

Ever wondered if speech impairment qualifies as a disability? You’re not alone. Many people question whether difficulties with speech fall under the umbrella of disability.

Speech impairment can range from stuttering to complete inability to communicate verbally. It’s a complex issue, with social, psychological, and physical aspects.

In this article, we’ll delve into the nitty-gritty of speech impairment. We’ll explore its classification as a disability, the impact it has on individuals’ lives, and the resources available for those affected. Stay tuned to gain a deeper understanding of this multifaceted topic.

Speech Impairment: An Overview

Speech impairment, in essence, is a broad term that encompasses various conditions. These range from stuttering problems through to a complete inability to communicate verbally – making the condition a topic of much discussion and study. It’s not just about the physical difficulties of producing sounds or forming words. The impact of speech impairment goes far beyond that.

For you to understand its complexity, it’s crucial to dig deeper into its various forms. You might wonder, what exactly falls under the category of speech impairment? Let’s look at some of the primary types:

• Stuttering: This condition affects the flow of speech. Someone who stutters may repeat words or sounds, or find it hard to start sentences.
• Apraxia: This involves difficulty with motor planning to produce speech. Despite having a clear understanding of what they wish to say, a person with apraxia struggles to convert these thoughts into spoken words.
• Dysarthria: This is where the muscles responsible for speech are weak, resulting in slow or slurred speech.

To classify speech impairment as a disability, it’s essential to understand how it affects an individual’s life. It’s not just about being unable to communicate effectively. Speech impairment can affect a person’s social interactions, their ability to learn and work, and their overall mental well-being. Having speech impairment can indeed pose significant hurdles in navigating life.

For those affected, there are resources available. Various types of therapies aim to enhance communication skills, while assistive devices may be used to facilitate communication. Tech advancements have also stepped in to provide alternative ways to express thoughts and ideas. More details on these resources will be covered in the next section.

We’ve covered the basics, but there’s more to learn about speech impairment. In the following sections, we’ll delve deeper into its classification as a disability, weighing the advantages and disadvantages that come with this categorization. Stay tuned to get a well-rounded understanding of this complex issue.

Understanding Disability: Definitions and Criteria

So, what exactly is a disability? In layman’s terms, you could consider disability as a physical or mental condition that limits a person’s movements, senses, or activities. However, to truly grasp the idea of disability and its implications, it’s crucial to understand the legal and medical perspectives.

Legally defined , disability refers to a physical or mental impairment that significantly restricts one or more major life activities — such as seeing, hearing, speaking, walking, or learning. This definition comes directly from the Americans with Disabilities Act (ADA), aimed at protecting individuals with disabilities from discrimination.

Emphasizing mental health, medical professionals often describe disability in the context of one’s capacity to execute tasks and participate in society. The World Health Organization (WHO) states that disabilities result from the interaction between people with a health condition and their environment.

Understanding these definitions and criteria are vital as they determine access to various benefits and protections . People who meet these conditions could be eligible for certain types of assistance, including accommodations at school or work, health care services, tax credits, and disability benefits.

Let’s deep dive into the concept of speech impairment being considered as a disability. But before that, let’s have a quick glance at a comparison table:

However, just because someone has a speech impairment doesn’t automatically qualify them as ‘disabled’. Various factors come into play – severity, impact on daily life, and more. Let’s head into the next section and explore this in detail.

Is Speech Impairment Considered a Disability?

You’ve learned that disability can be seen through two lenses: the legal definition, as outlined by the Americans with Disabilities Act (ADA) , and the medical perspective, which considers the limitations placed on one’s ability to perform tasks and engage with society. With these definitions in mind, let’s delve further into whether speech impairment is, in fact, classified as a disability.

Your understanding of speech impairments is key here. These are conditions that inhibit a person’s ability to communicate effectively. They can manifest as stutters, lisps, voice disorders, or language difficulties. But does this equate to a disability?

Under the ADA, speech impairments are labeled as communication disorders. They are classified as disabilities when they significantly limit one or more of a person’s life activities. Bear in mind, severity and the impact on daily functioning are vital factors that aid in making this determination.

For instance, take the case of a severe stutter that prevents a person from communicating effectively in social settings or at the workplace. This scenario could meet the criteria for a disability as it puts a major restriction on their ability to interact and express themselves. However, it’s not a one-size-fits-all situation.

Even at this point, it’s important to remember that each case of speech impairment is unique, and its classification as a disability will depend on each specific situation. You’d have noticed the complexities of how impairments are considered as disabilities; how societal, individual, and institutional factors all intertwine. This diversity is the heart of understanding disabilities. It’s best to keep this in mind as you continue this journey of discovery, while we segue into more discussions on specific types of speech impairments next.

The Impact of Speech Impairment on Daily Life

Navigating through the particulars of daily life with a speech impairment can be challenging. It’s essential to understand how speech impairments can affect your daily activities .

Optimal communication skills are a key aspect of normal functioning in society. Those with speech impairments often find social interaction, professional tasks, and even simple day-to-day tasks challenging. While it might be difficult for those without speech impairments to sympathize with these struggles, it’s an unfortunate reality for many.

Consider basic tasks like ordering food at a restaurant. Without proper speech ability, this basic task becomes a stressful event. This can lead to feelings of frustration, anxiety, and even social withdrawal. Let’s also look at higher-stakes situations like a job interview or work presentation. When speech clarity and fluidity are crucial, a speech impairment can significantly diminish an individual’s ability to perform successfully.

These daily life examples are not comprehensive; they are just a glimpse into the world of someone with a speech impairment. It’s essential to remember that every person’s struggle with speech impairment is unique. The extent of the impact on daily life will depend on multiple factors like the severity of the impairment, individual resilience, and the level of support available. These variables help determine whether a person’s speech impairment is severe enough to be categorized as a disability.

There’s a broad spectrum of speech impairments; their impact ranges from a minor inconvenience that can be managed with adequate support, to a severe limitation requiring comprehensive intervention. Various resources and therapeutic interventions are available to support those with speech impairments. Therapies such as speech and language therapy or using assistive devices can significantly improve an individual’s communication abilities.

Let’s now delve into some specific types of speech impairments, their particular challenges, and possible ways to manage them.

Available Resources and Support for Individuals with Speech Impairment

Figuring out where to turn for help with speech impairments might seem overwhelming yet there’s a wealth of resources available . We’ll run through some of the most effective therapeutic interventions, educational support centers, and digital tools that can make living with a speech impairment more manageable.

Therapeutic Interventions

Professional speech and language therapy is a common strategy for handling speech impairments. Therapists work in numerous environments:

• Rehabilitation centers

They’ll offer tailor-made programs to fit your specific needs. With regular sessions, you’ll see improvements in pronunciation, fluency, and general speech clarity.

Educational Support

For children experiencing speech impairments, schools often offer a range of inclusive services:

• Individualized Education Programs (IEPs)
• Speech therapy sessions during the school day
• Special education services

These resources aim to ensure that young people with speech impairments don’t fall behind in academic and social settings.

Digital Tools

In the modern world, digital innovation plays a significant role in helping individuals manage speech impairments. Various mobile apps focus on different areas of speech development:

• Pronunciation
• Vocabulary building
• Sentence construction
• Fluency exercises

These tools are accessible and convenient to use on the go or comfortably from your home, adding a practical method to target your speech impairment.

In this digitized world, remember that support for managing your speech impairment is only a few clicks away. Dive into these resources, find what works best for you, and don’t let incapacities prevent you from effectively expressing yourself. Instead, arm yourself with the tools and interventions that’ll help you develop your speech skills and break down communication barriers.

You’ve seen the profound impact speech impairments can have on daily life. Yet, it’s important to remember that these challenges can be managed with the right resources and support. Therapeutic interventions, educational programs, and digital tools are available to help individuals navigate through their speech impairments. Don’t let a speech impairment hold you back. It’s a hurdle, not a full stop. With resilience and the right support, you can improve your speech, engage in social interactions, and excel in your professional tasks. Remember, it’s not about the impairment itself, but how you choose to manage it. So, is speech impairment a disability? It can be. But with the right approach, it doesn’t have to disable your ability to communicate effectively. Explore these resources, embrace the support, and let your voice be heard.

What is the impact of speech impairments on daily life?

Speech impairments can make social interaction, professional tasks, and everyday activities challenging. The magnitude of impact can depend on the severity of the impairment, the individual’s resilience, and the level of support available.

What are some specific types of speech impairments?

The article discusses various types of speech impairments and their unique challenges. It does not detail each type but implies they include a wide range from pronunciation issues to fluency complications.

What services are available to support individuals with speech impairments?

Individuals with speech impairments can benefit from therapeutic interventions such as speech and language therapy. Educational support centers and individualized education programs are also available. Digital tools and mobile apps contribute significantly to speech development.

Can digital tools aid individuals with speech impairments?

Yes, digital tools, such as mobile apps, can assist in improving pronunciation, vocabulary building, sentence construction, and fluency exercises. These tools provide accessible and interactive aid, therefore, highly recommended.

What message does the article convey to individuals with speech impairments?

The article encourages individuals with speech impairments not to allow their limitations to prevent effective expression. It encourages the exploration and utilization of available resources to manage and improve their conditions.

Related Posts

International day of persons with disabilities, emh special education.

Speech-Language Impairment

• disabilities

On This Page

About speech-language impairment.

Limitations in speech and language may result from a number of different impairments and disorders. An individual may be limited due to problems with articulation, voice strength, language expression, or may be non-vocal. Following is a list of speech and language disorders including information from the American Speech-Language, Hearing Association (ASHA).

•  Aphasia is impaired expression or comprehension of written or spoken language. Aphasia is often caused by stroke, brain injury or Alzheimer's dementia.
• Dysarthria results in difficulty pronouncing words like "cat" or sounds like "sh" and "ba." Dysarthria may be caused by a degenerative neurological disorder or alcohol intoxication.
• Dysphonias can be present in one of two forms, adductor or abductor. The adductor type produces a strained or strangled voice quality. Abductor sounds like chronic hoarseness or breathy and effortful speech. 
• Esophageal speech is a technique whereby a person takes air in through the mouth, traps it in the throat, and then releases it. As the air is released, it makes the upper parts of the throat/esophagus vibrate and produces sound. This sound is still shaped into words with the lips, tongue, teeth, and other mouth parts.
• Stuttering results in repetition, blocks or inability to say certain words, and/or the prolonging of words. An individual who stutters may also have distorted movements and facial expressions when trying to speak.
• Nodules are most frequently caused by vocal abuse or misuse. Polyps may be caused by prolonged vocal abuse, but may also occur after a single, traumatic event to the vocal folds. Speech may be hoarse, breathy, and painful to produce. 

Additionally, speech and language limitations might occur due to stroke, cerebral palsy, amyotrophic lateral sclerosis (ALS), Huntington’s Disease, oral and laryngeal cancer, hearing impairment, traumatic brain injury, dementia, chronic laryngitis, and vocal cord paralysis.  

Speech-Language Impairment and the Americans with Disabilities Act

The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA) .

Accommodating Employees with Speech-Language Impairment

People with speech-language impairments may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people who are aging will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist

Questions to Consider:

• What limitations is the employee experiencing?
• How do these limitations affect the employee and the employee’s job performance?
• What specific job tasks are problematic as a result of these limitations?
• What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
• Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
• Do supervisory personnel and employees need training?

Accommodation Ideas:

By limitation.

• By Work-Related Function
• Augmentative and Alternative Communication (AAC) Device
• Communicate Another Way
• Speech Generating Communication Devices with Telephone Access

Unintelligible Speech

• Job Restructuring

Weak Speech

• Flexible Schedule
• Outgoing Voice Amplification - Telephone
• Voice Amplification

By Work Related Function

Communicate.

• Aide/Assistant/Attendant
• On-site Mentoring
• Scribe/Notetaker
• Talking Telephones

Situations and Solutions:

The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.

An accountant with spasmodic dysphonia needed time off periodically to travel out of state in order to get specialized medical treatment to manage his condition.

He also experienced a breathy voice quality that limited his ability to speak loudly for several days after each treatment. The employer granted periodic leave and provided equipment to amplify his voice on the telephone as needed.

A professor with stuttering experienced an exacerbation of his condition and needed to start attending speech therapy on a weekly basis to manage his symptoms.

He asked that his course schedule be modified, so that he could change one of his courses to an online format, and have his other classes and office hours scheduled around his therapy sessions for the duration on the next semester. The employee modified the professor’s teaching schedule.

A receptionist who was recovering from vocal surgery had difficulty speaking loudly enough for customers to hear her when she greeted them.

She also experienced vocal fatigue when speaking on the phone. Her employer purchased a voice amplifier for face to face use and one designed for telephone use as well, so that she did not have to strain her voice to speak more loudly.

A volunteer reader in a library had a weak voice due to a previous infection that damaged her vocal cords. She

She was given a voice amplifier so she would not have to strain her vocal cords trying to talk loud enough for the children to hear her.

A university employee with cerebral palsy used a speech generating communication device to meet her communication needs at work and elsewhere.

Her device worked well with her personal cellphone, but she needed a speakerphone in order to take calls on the office phone line. Due to workplace changes, she needed to start sharing an office with two coworkers. Her employer purchased an adapter for the device so that she could use her device with the telephone more discreetly.

A scientist on the autism spectrum was able to speak at times but also experienced episodes when she found it difficult to speak and needed to use a speech device or speech generating app.

She was preparing to present her research at a conference. She pre-recorded audio to go with her slides and brought a tablet with a speech generating app with her in case she needed it during the question and answer portion of her presentation.

JAN Publications & Articles Regarding Speech-Language Impairment

Publications, consultants' corner articles.

• A Support Person as an Accommodation
• Confidentiality of Medical Information under the ADA
• Hidden Disabilities: Confidentiality and Travel

Related Disabilities

• Alzheimer's Disease
• Amyotrophic Lateral Sclerosis (ALS)/Lou Gehrig's Disease
• Cerebral Palsy
• Hearing Impairment
• Huntington's Disease
• Parkinson's Disease
• No Articles available for Speech-Language Impairment
• No Blog Posts available for Speech-Language Impairment

Events Regarding Speech-Language Impairment

• Upcoming Events
• Past Recorded Module
• Past In-person Training
• Past Exhibit Booths
• Past Webcast Series Training
• The ADA and Workplace Accommodation for Employees with Voice Disorders January 31, 2024

Other Information Regarding Speech-Language Impairment

External links.

• EEOC's Reasonable Accommodation and Undue Hardship Guidance Under the ADA
• Effective Communication

Organizations

• Job Accommodation Network
• Office of Disability Employment Policy
• American Speech-Language-Hearing Association
• National Institute of Neurological Disorders and Stroke
• National Institute on Deafness and Other Communication Disorders
• National Organization for Rare Disorders

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Overcoming Speech Impediment: Symptoms to Treatment

There are many causes and solutions for impaired speech

• Types and Symptoms
• Speech Therapy
• Building Confidence

Speech impediments are conditions that can cause a variety of symptoms, such as an inability to understand language or speak with a stable sense of tone, speed, or fluidity. There are many different types of speech impediments, and they can begin during childhood or develop during adulthood.

Common causes include physical trauma, neurological disorders, or anxiety. If you or your child is experiencing signs of a speech impediment, you need to know that these conditions can be diagnosed and treated with professional speech therapy.

This article will discuss what you can do if you are concerned about a speech impediment and what you can expect during your diagnostic process and therapy.

FG Trade / Getty Images

Types and Symptoms of Speech Impediment

People can have speech problems due to developmental conditions that begin to show symptoms during early childhood or as a result of conditions that may occur during adulthood. 

The main classifications of speech impairment are aphasia (difficulty understanding or producing the correct words or phrases) or dysarthria (difficulty enunciating words).

Often, speech problems can be part of neurological or neurodevelopmental disorders that also cause other symptoms, such as multiple sclerosis (MS) or autism spectrum disorder .

There are several different symptoms of speech impediments, and you may experience one or more.

Can Symptoms Worsen?

Most speech disorders cause persistent symptoms and can temporarily get worse when you are tired, anxious, or sick.

Symptoms of dysarthria can include:

• Slurred speech
• Slow speech
• Choppy speech
• Hesitant speech
• Inability to control the volume of your speech
• Shaking or tremulous speech pattern
• Inability to pronounce certain sounds

Symptoms of aphasia may involve:

• Speech apraxia (difficulty coordinating speech)
• Difficulty understanding the meaning of what other people are saying
• Inability to use the correct words
• Inability to repeat words or phases
• Speech that has an irregular rhythm

You can have one or more of these speech patterns as part of your speech impediment, and their combination and frequency will help determine the type and cause of your speech problem.

Causes of Speech Impediment

The conditions that cause speech impediments can include developmental problems that are present from birth, neurological diseases such as Parkinson’s disease , or sudden neurological events, such as a stroke .

Some people can also experience temporary speech impairment due to anxiety, intoxication, medication side effects, postictal state (the time immediately after a seizure), or a change of consciousness.

Speech Impairment in Children

Children can have speech disorders associated with neurodevelopmental problems, which can interfere with speech development. Some childhood neurological or neurodevelopmental disorders may cause a regression (backsliding) of speech skills.

Common causes of childhood speech impediments include:

• Autism spectrum disorder : A neurodevelopmental disorder that affects social and interactive development
• Cerebral palsy :  A congenital (from birth) disorder that affects learning and control of physical movement
• Hearing loss : Can affect the way children hear and imitate speech
• Rett syndrome : A genetic neurodevelopmental condition that causes regression of physical and social skills beginning during the early school-age years.
• Adrenoleukodystrophy : A genetic disorder that causes a decline in motor and cognitive skills beginning during early childhood
• Childhood metabolic disorders : A group of conditions that affects the way children break down nutrients, often resulting in toxic damage to organs
• Brain tumor : A growth that may damage areas of the brain, including those that control speech or language
• Encephalitis : Brain inflammation or infection that may affect the way regions in the brain function
• Hydrocephalus : Excess fluid within the skull, which may develop after brain surgery and can cause brain damage

Do Childhood Speech Disorders Persist?

Speech disorders during childhood can have persistent effects throughout life. Therapy can often help improve speech skills.

Speech Impairment in Adulthood

Adult speech disorders develop due to conditions that damage the speech areas of the brain.

Common causes of adult speech impairment include:

• Head trauma 
• Nerve injury
• Throat tumor
• Stroke 
• Parkinson’s disease 
• Essential tremor
• Brain tumor
• Brain infection

Additionally, people may develop changes in speech with advancing age, even without a specific neurological cause. This can happen due to presbyphonia , which is a change in the volume and control of speech due to declining hormone levels and reduced elasticity and movement of the vocal cords.

Do Speech Disorders Resolve on Their Own?

Children and adults who have persistent speech disorders are unlikely to experience spontaneous improvement without therapy and should seek professional attention.

Steps to Treating Speech Impediment 

If you or your child has a speech impediment, your healthcare providers will work to diagnose the type of speech impediment as well as the underlying condition that caused it. Defining the cause and type of speech impediment will help determine your prognosis and treatment plan.

Sometimes the cause is known before symptoms begin, as is the case with trauma or MS. Impaired speech may first be a symptom of a condition, such as a stroke that causes aphasia as the primary symptom.

The diagnosis will include a comprehensive medical history, physical examination, and a thorough evaluation of speech and language. Diagnostic testing is directed by the medical history and clinical evaluation.

Diagnostic testing may include:

• Brain imaging , such as brain computerized tomography (CT) or magnetic residence imaging (MRI), if there’s concern about a disease process in the brain
• Swallowing evaluation if there’s concern about dysfunction of the muscles in the throat
• Electromyography (EMG) and nerve conduction studies (aka nerve conduction velocity, or NCV) if there’s concern about nerve and muscle damage
• Blood tests, which can help in diagnosing inflammatory disorders or infections

Your diagnostic tests will help pinpoint the cause of your speech problem. Your treatment will include specific therapy to help improve your speech, as well as medication or other interventions to treat the underlying disorder.

For example, if you are diagnosed with MS, you would likely receive disease-modifying therapy to help prevent MS progression. And if you are diagnosed with a brain tumor, you may need surgery, chemotherapy, or radiation to treat the tumor.

Therapy to Address Speech Impediment

Therapy for speech impairment is interactive and directed by a specialist who is experienced in treating speech problems . Sometimes, children receive speech therapy as part of a specialized learning program at school.

The duration and frequency of your speech therapy program depend on the underlying cause of your impediment, your improvement, and approval from your health insurance.

If you or your child has a serious speech problem, you may qualify for speech therapy. Working with your therapist can help you build confidence, particularly as you begin to see improvement.

Exercises during speech therapy may include:

• Pronouncing individual sounds, such as la la la or da da da
• Practicing pronunciation of words that you have trouble pronouncing
• Adjusting the rate or volume of your speech
• Mouth exercises
• Practicing language skills by naming objects or repeating what the therapist is saying

These therapies are meant to help achieve more fluent and understandable speech as well as an increased comfort level with speech and language.

Building Confidence With Speech Problems 

Some types of speech impairment might not qualify for therapy. If you have speech difficulties due to anxiety or a social phobia or if you don’t have access to therapy, you might benefit from activities that can help you practice your speech. 

You might consider one or more of the following for you or your child:

• Joining a local theater group
• Volunteering in a school or community activity that involves interaction with the public
• Signing up for a class that requires a significant amount of class participation
• Joining a support group for people who have problems with speech

Activities that you do on your own to improve your confidence with speaking can be most beneficial when you are in a non-judgmental and safe space.

Many different types of speech problems can affect children and adults. Some of these are congenital (present from birth), while others are acquired due to health conditions, medication side effects, substances, or mood and anxiety disorders. Because there are so many different types of speech problems, seeking a medical diagnosis so you can get the right therapy for your specific disorder is crucial.

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

Han C, Tang J, Tang B, et al. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: a systematic review and meta-analysis . Medicine (Baltimore). 2024;103(2):e36880. doi:10.1097/MD.0000000000036880

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, language .

Mackey J, McCulloch H, Scheiner G, et al. Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience . Brain Impair. 2023;24(2):168-184. doi:10.1017/BrImp.2023.9

Allison KM, Doherty KM. Relation of speech-language profile and communication modality to participation of children with cerebral palsy . Am J Speech Lang Pathol . 2024:1-11. doi:10.1044/2023_AJSLP-23-00267

Saccente-Kennedy B, Gillies F, Desjardins M, et al. A systematic review of speech-language pathology interventions for presbyphonia using the rehabilitation treatment specification system . J Voice. 2024:S0892-1997(23)00396-X. doi:10.1016/j.jvoice.2023.12.010

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

Speech and Language Impairments

The Individuals with Disabilities Education Act, or IDEA, defines the term “speech or language impairment” as follows:

“(11)  Speech or language impairment  means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.” [34 CFR §300.8(c)(11]

(Parent Information and Resources Center, 2015)

Table of Contents

What is a Speech and Language Impairment?

Characteristics of speech or language impairments, interventions and strategies, related service provider-slp.

• A Day in the Life of an SLP

Assistive Technology

Speech and language impairment  are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.

A speech impairment is characterized by difficulty in articulation of words. Examples include stuttering or problems producing particular sounds. Articulation refers to the sounds, syllables, and phonology produced by the individual. Voice, however, may refer to the characteristics of the sounds produced—specifically, the pitch, quality, and intensity of the sound. Often, fluency will also be considered a category under speech, encompassing the characteristics of rhythm, rate, and emphasis of the sound produced.

A language impairment is a specific impairment in understanding and sharing thoughts and ideas, i.e. a disorder that involves the processing of linguistic information. Problems that may be experienced can involve the form of language, including grammar, morphology, syntax; and the functional aspects of language, including semantics and pragmatics.

(Wikipedia, n.d./ Speech and Language Impairment)

*It’s important to realize that a language delay isn’t the same thing as a speech or language impairment. Language delay is a very common developmental problem—in fact, the most common, affecting 5-10% of children in preschool.  With language delay, children’s language is developing in the expected sequence, only at a slower rate. In contrast, speech and language disorder refers to abnormal language development.  Distinguishing between the two is most reliably done by a certified speech-language pathologist.  (CPIR, 2015)

The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems.

When a child has an  articulation disorder , he or she has difficulty making certain sounds. These sounds may be left off, added, changed, or distorted, which makes it hard for people to understand the child.

Leaving out or changing certain sounds is common when young children are learning to talk, of course. A good example of this is saying “wabbit” for “rabbit.” The incorrect articulation isn’t necessarily a cause for concern unless it continues past the age where children are expected to produce such sounds correctly

Fluency  refers to the flow of speech. A fluency disorder means that something is disrupting the rhythmic and forward flow of speech—usually, a stutter. As a result, the child’s speech contains an “abnormal number of repetitions, hesitations, prolongations, or disturbances. Tension may also be seen in the face, neck, shoulders, or fists.”

Voice  is the sound that’s produced when air from the lungs pushes through the voice box in the throat (also called the larnyx), making the vocal folds within vibrate. From there, the sound generated travels up through the spaces of the throat, nose, and mouth, and emerges as our “voice.”

A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice. The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if they are “stuffed up.” People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use.

Language  has to do with meanings, rather than sounds.  A language disorder refers to an impaired ability to understand and/or use words in context. A child may have an expressive language disorder (difficulty in expressing ideas or needs), a receptive language disorder (difficulty in understanding what others are saying), or a mixed language disorder (which involves both).

Some characteristics of language disorders include:

• improper use of words and their meanings,
• inability to express ideas,
• inappropriate grammatical patterns,
• reduced vocabulary, and
• inability to follow directions.

Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate. These symptoms can easily be mistaken for other disabilities such as autism or learning disabilities, so it’s very important to ensure that the child receives a thorough evaluation by a certified speech-language pathologist.

(CPIR, 2015)

• Use the (Cash, Wilson, and DeLaCruz, n.d) reading and/or the [ESU 8 Wednesday Webinar] to develop this section of the summary. 

Cash, A, Wilson, R. and De LaCruz, E.(n,d.) Practical Recommendations for Teachers: Language Disorders. https://www.education.udel.edu/wp-content/uploads/2013/01/LanguageDisorders.pdf 

[ESU 8 Wednesday Webinar] Speech Language Strategies for Classroom Teachers.- video below

Video: Speech Language Strategies for Classroom Teachers (15:51 minutes)’

[ESU 8 Wednesday Webinars]. (2015, Nov. 19) . Speech Language Strategies for Classroom Teachers. [Video FIle]. From https://youtu.be/Un2eeM7DVK8

Most, if not all, students with a speech or language impairment will need  speech-language pathology services . This related service is defined by IDEA as follows:

(15)  Speech-language pathology services  include—

(i) Identification of children with speech or language impairments;

(ii) Diagnosis and appraisal of specific speech or language impairments;

(iii) Referral for medical or other professional attention necessary for the habilitation of speech or language impairments;

(iv) Provision of speech and language services for the habilitation or prevention of communicative impairments; and

(v) Counseling and guidance of parents, children, and teachers regarding speech and language impairments. [34 CFR §300.34(c)(15)]

Thus, in addition to diagnosing the nature of a child’s speech-language difficulties, speech-language pathologists also provide:

• individual therapy for the child;
• consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and
• work closely with the family to develop goals and techniques for effective therapy in class and at home.

Speech and/or language therapy may continue throughout a student’s school years either in the form of direct therapy or on a consultant basis.

A Day in the Life of an SLP

Christina is a speech-language pathologist.  She works with children and adults who have impairments in their speech, voice, or language skills. These impairments can take many forms, as her schedule today shows.

First comes Robbie.  He’s a cutie pie in the first grade and has recently been diagnosed with childhood apraxia of speech—or CAS. CAS is a speech disorder marked by choppy speech. Robbie also talks in a monotone, making odd pauses as he tries to form words. Sometimes she can see him struggle. It’s not that the muscles of his tongue, lips, and jaw are weak. The difficulty lies in the brain and how it communicates to the muscles involved in producing speech. The muscles need to move in precise ways for speech to be intelligible. And that’s what she and Robbie are working on.

Next, Christina goes down the hall and meets with Pearl  in her third grade classroom. While the other students are reading in small groups, she works with Pearl one on one, using the same storybook. Pearl has a speech disorder, too, but hers is called dysarthria. It causes Pearl’s speech to be slurred, very soft, breathy, and slow. Here, the cause is weak muscles of the tongue, lips, palate, and jaw. So that’s what Christina and Pearl work on—strengthening the muscles used to form sounds, words, and sentences, and improving Pearl’s articulation.

One more student to see—4th grader Mario , who has a stutter. She’s helping Mario learn to slow down his speech and control his breathing as he talks. Christina already sees improvement in his fluency.

Tomorrow she’ll go to a different school, and meet with different students. But for today, her day is…Robbie, Pearl, and Mario.

Assistive technology (AT) can also be very helpful to students, especially those whose physical conditions make communication difficult. Each student’s IEP team will need to consider if the student would benefit from AT such as an electronic communication system or other device. AT is often the key that helps students engage in the give and take of shared thought, complete school work, and demonstrate their learning. (CPIR, 2015)

Project IDEAL , suggests two major categories of AT computer software packages to develop the child’s speech and language skills and augmentative or alternative communication (AAC).

Augmentative and alternative communication  ( AAC ) encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. Augmentative and alternative communication may used by individuals to compensate for severe speech-language impairments in the expression or comprehension of spoken or written language. AAC can be a permanent addition to a person’s communication or a temporary aid.

(Wikipedia, (n.d. /Augmentative and alternative communication)

Center for Parent Information and Resources (CPIR)  (2015), Speech and Language Impairments, Newark, NJ, Author, Retrieved 4.1.19 from https://www.parentcenterhub.org/speechlanguage/

Wikipedia (n.d.) Augmentative and alternative communication. From https://en.wikipedia.org/wiki/Augmentative_and_alternative_communication 

Wikipedia, (n.d.) Speech and Language Impairment. From  https://en.wikipedia.org/wiki/Speech_and_language_impairment 

Updated 8.8.23

Understanding and Supporting Learners with Disabilities Copyright © 2019 by Paula Lombardi is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Types of Speech Impediments

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Phynart Studio / Getty Images

Articulation Errors

Ankyloglossia, treating speech disorders.

A speech impediment, also known as a speech disorder , is a condition that can affect a person’s ability to form sounds and words, making their speech difficult to understand.

Speech disorders generally become evident in early childhood, as children start speaking and learning language. While many children initially have trouble with certain sounds and words, most are able to speak easily by the time they are five years old. However, some speech disorders persist. Approximately 5% of children aged three to 17 in the United States experience speech disorders.

There are many different types of speech impediments, including:

• Articulation errors

This article explores the causes, symptoms, and treatment of the different types of speech disorders.

Speech impediments that break the flow of speech are known as disfluencies. Stuttering is the most common form of disfluency, however there are other types as well.

Symptoms and Characteristics of Disfluencies

These are some of the characteristics of disfluencies:

• Repeating certain phrases, words, or sounds after the age of 4 (For example: “O…orange,” “I like…like orange juice,” “I want…I want orange juice”)
• Adding in extra sounds or words into sentences (For example: “We…uh…went to buy…um…orange juice”)
• Elongating words (For example: Saying “orange joooose” instead of "orange juice")
• Replacing words (For example: “What…Where is the orange juice?”)
• Hesitating while speaking (For example: A long pause while thinking)
• Pausing mid-speech (For example: Stopping abruptly mid-speech, due to lack of airflow, causing no sounds to come out, leading to a tense pause)

In addition, someone with disfluencies may also experience the following symptoms while speaking:

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

Causes of Disfluencies

People with disfluencies tend to have neurological differences in areas of the brain that control language processing and coordinate speech, which may be caused by:

• Genetic factors
• Trauma or infection to the brain
• Environmental stressors that cause anxiety or emotional distress
• Neurodevelopmental conditions like attention-deficit hyperactivity disorder (ADHD)

Articulation disorders occur when a person has trouble placing their tongue in the correct position to form certain speech sounds. Lisping is the most common type of articulation disorder.

Symptoms and Characteristics of Articulation Errors

These are some of the characteristics of articulation disorders:

• Substituting one sound for another . People typically have trouble with ‘r’ and ‘l’ sounds. (For example: Being unable to say “rabbit” and saying “wabbit” instead)
• Lisping , which refers specifically to difficulty with ‘s’ and ‘z’ sounds. (For example: Saying “thugar” instead of “sugar” or producing a whistling sound while trying to pronounce these letters)
• Omitting sounds (For example: Saying “coo” instead of “school”)
• Adding sounds (For example: Saying “pinanio” instead of “piano”)
• Making other speech errors that can make it difficult to decipher what the person is saying. For instance, only family members may be able to understand what they’re trying to say.

Causes of Articulation Errors

Articulation errors may be caused by:

• Genetic factors, as it can run in families
• Hearing loss , as mishearing sounds can affect the person’s ability to reproduce the sound
• Changes in the bones or muscles that are needed for speech, including a cleft palate (a hole in the roof of the mouth) and tooth problems
• Damage to the nerves or parts of the brain that coordinate speech, caused by conditions such as cerebral palsy , for instance

Ankyloglossia, also known as tongue-tie, is a condition where the person’s tongue is attached to the bottom of their mouth. This can restrict the tongue’s movement and make it hard for the person to move their tongue.

Symptoms and Characteristics of Ankyloglossia

Ankyloglossia is characterized by difficulty pronouncing ‘d,’ ‘n,’ ‘s,’ ‘t,’ ‘th,’ and ‘z’ sounds that require the person’s tongue to touch the roof of their mouth or their upper teeth, as their tongue may not be able to reach there.

Apart from speech impediments, people with ankyloglossia may also experience other symptoms as a result of their tongue-tie. These symptoms include:

• Difficulty breastfeeding in newborns
• Trouble swallowing
• Limited ability to move the tongue from side to side or stick it out
• Difficulty with activities like playing wind instruments, licking ice cream, or kissing
• Mouth breathing

Causes of Ankyloglossia

Ankyloglossia is a congenital condition, which means it is present from birth. A tissue known as the lingual frenulum attaches the tongue to the base of the mouth. People with ankyloglossia have a shorter lingual frenulum, or it is attached further along their tongue than most people’s.

Dysarthria is a condition where people slur their words because they cannot control the muscles that are required for speech, due to brain, nerve, or organ damage.

Symptoms and Characteristics of Dysarthria

Dysarthria is characterized by:

• Slurred, choppy, or robotic speech
• Rapid, slow, or soft speech
• Breathy, hoarse, or nasal voice

Additionally, someone with dysarthria may also have other symptoms such as difficulty swallowing and inability to move their tongue, lips, or jaw easily.

Causes of Dysarthria

Dysarthria is caused by paralysis or weakness of the speech muscles. The causes of the weakness can vary depending on the type of dysarthria the person has:

• Central dysarthria is caused by brain damage. It may be the result of neuromuscular diseases, such as cerebral palsy, Huntington’s disease, multiple sclerosis, muscular dystrophy, Huntington’s disease, Parkinson’s disease, or Lou Gehrig’s disease. Central dysarthria may also be caused by injuries or illnesses that damage the brain, such as dementia, stroke, brain tumor, or traumatic brain injury .
• Peripheral dysarthria is caused by damage to the organs involved in speech. It may be caused by congenital structural problems, trauma to the mouth or face, or surgery to the tongue, mouth, head, neck, or voice box.

Apraxia, also known as dyspraxia, verbal apraxia, or apraxia of speech, is a neurological condition that can cause a person to have trouble moving the muscles they need to create sounds or words. The person’s brain knows what they want to say, but is unable to plan and sequence the words accordingly.

Symptoms and Characteristics of Apraxia

These are some of the characteristics of apraxia:

• Distorting sounds: The person may have trouble pronouncing certain sounds, particularly vowels, because they may be unable to move their tongue or jaw in the manner required to produce the right sound. Longer or more complex words may be especially harder to manage.
• Being inconsistent in their speech: For instance, the person may be able to pronounce a word correctly once, but may not be able to repeat it. Or, they may pronounce it correctly today and differently on another day.
• Grasping for words: The person may appear to be searching for the right word or sound, or attempt the pronunciation several times before getting it right.
• Making errors with the rhythm or tone of speech: The person may struggle with using tone and inflection to communicate meaning. For instance, they may not stress any of the words in a sentence, have trouble going from one syllable in a word to another, or pause at an inappropriate part of a sentence.

Causes of Apraxia

Apraxia occurs when nerve pathways in the brain are interrupted, which can make it difficult for the brain to send messages to the organs involved in speaking. The causes of these neurological disturbances can vary depending on the type of apraxia the person has:

• Childhood apraxia of speech (CAS): This condition is present from birth and is often hereditary. A person may be more likely to have it if a biological relative has a learning disability or communication disorder.
• Acquired apraxia of speech (AOS): This condition can occur in adults, due to brain damage as a result of a tumor, head injury , stroke, or other illness that affects the parts of the brain involved in speech.

If you have a speech impediment, or suspect your child might have one, it can be helpful to visit your healthcare provider. Your primary care physician can refer you to a speech-language pathologist, who can evaluate speech, diagnose speech disorders, and recommend treatment options.

The diagnostic process may involve a physical examination as well as psychological, neurological, or hearing tests, in order to confirm the diagnosis and rule out other causes.

Treatment for speech disorders often involves speech therapy, which can help you learn how to move your muscles and position your tongue correctly in order to create specific sounds. It can be quite effective in improving your speech.

Children often grow out of milder speech disorders; however, special education and speech therapy can help with more serious ones.

For ankyloglossia, or tongue-tie, a minor surgery known as a frenectomy can help detach the tongue from the bottom of the mouth.

A Word From Verywell

A speech impediment can make it difficult to pronounce certain sounds, speak clearly, or communicate fluently. 

Living with a speech disorder can be frustrating because people may cut you off while you’re speaking, try to finish your sentences, or treat you differently. It can be helpful to talk to your healthcare providers about how to cope with these situations.

You may also benefit from joining a support group, where you can connect with others living with speech disorders.

National Library of Medicine. Speech disorders . Medline Plus.

Centers for Disease Control and Prevention. Language and speech disorders .

Cincinnati Children's Hospital. Stuttering .

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, and language .

Cleveland Clinic. Speech impediment .

Lee H, Sim H, Lee E, Choi D. Disfluency characteristics of children with attention-deficit/hyperactivity disorder symptoms . J Commun Disord . 2017;65:54-64. doi:10.1016/j.jcomdis.2016.12.001

Nemours Foundation. Speech problems .

Penn Medicine. Speech and language disorders .

Cleveland Clinic. Tongue-tie .

University of Rochester Medical Center. Ankyloglossia .

Cleveland Clinic. Dysarthria .

National Institute on Deafness and Other Communication Disorders. Apraxia of speech .

Cleveland Clinic. Childhood apraxia of speech .

Stanford Children’s Hospital. Speech sound disorders in children .

Abbastabar H, Alizadeh A, Darparesh M, Mohseni S, Roozbeh N. Spatial distribution and the prevalence of speech disorders in the provinces of Iran . J Med Life . 2015;8(Spec Iss 2):99-104.

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

What is a speech impairment?

A speech impairment refers to an impaired ability to produce speech sounds and may range from mild to severe. It may include an articulation disorder, characterized by omissions or distortions of speech sounds; a fluency disorder, characterized by atypical flow, rhythm, and/or repetitions of sounds; or a voice disorder, characterized by abnormal pitch, volume, resonance, vocal quality, or duration.

The American Speech-Language Hearing Association (ASHA) has published its official definitions in Definitions of Communication Disorders and Variations .

Additional information is available from Speech and Language Impairments  hosted by the Center for Parent Information and Resources.

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Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood

Patricia a. prelock.

Department of Communication Sciences, University of Vermont, Burlington, Vermont

Tiffany Hutchins

Frances p. glascoe.

Department of Pediatrics, Vanderbilt University, Nashville, Tennessee

Disclosure: Tiffany Hutchins, PhD, has disclosed no relevant financial relationships in addition to her employment.

Disclosure: Frances P. Glascoe, PhD, has disclosed no relevant financial relationships in addition to her employment.

Abstract and Introduction

Speech-language problems are the most common disability of childhood yet they are the least well detected, particularly in primary care settings. The goal of this article is to: (1) define the nature of speech-language problems, their causes, and consequences; (2) facilitate early recognition by healthcare providers via accurate screening and surveillance measures suitable for busy clinics; and (3) describe the referral and intervention process.

Introduction

Speech-language deficits are the most common of childhood disabilities and affect about 1 in 12 children or 5% to 8% of preschool children. [1] The consequences of untreated speech-language problems are significant and lead to behavioral challenges, mental health problems, reading difficulties, [2] and academic failure including in-grade retention and high school dropout. [3] Yet, such problems are ones that are least well detected in primary care, [4] even though intervention is available and plentiful.

Speech-language impairments embrace a wide range of conditions that have, at their core, challenges in effective communication. As the term implies, they include speech disorders which refer to impairment in the articulation of speech sounds, fluency, and voice as well as language disorders which refer to impairments in the use of the spoken (or signed or written) system and may involve the form of language (grammar and phonology), the content of language (semantics), and the function of language (pragmatics). [5] These may also be described more generally as communication disorders which are typically classified by their impact on a child's receptive skills (ie, the ability to understand what is said or to decode, integrate, and organize what is heard) and expressive skills (ie, the ability to articulate sounds, use appropriate rate and rhythm during speech, exhibit appropriate vocal tone and resonance, and use sounds, words, and sentences in meaningful contexts). There are common conditions in infants, toddlers, and preschoolers that are associated with receptive and expressive communication challenges as presented in Table 1 . [6 – 17]

Disorders in Young Children Commonly Associated With Receptive and Expressive Communication Problems

It is important to distinguish speech and language impairment from language delay and language difference. Language delay is characterized by the emergence of language that is relatively late albeit typical in its pattern of development. In contrast to an impairment or a delay, a language difference is associated with systematic variation in vocabulary, grammar, or sound structures. Such variation is “used by a group of individuals [and] reflects and is determined by shared regional, social, or cultural and ethnic factors” and is not considered a disorder. [18]

Unfortunately, non-native speakers of English, speakers of various dialects (whose language also varies within dialect), and bilingual or multilingual speakers are frequently classified as language delayed or disordered when, in fact, they are language different [18 , 19] –although problems of underidentification also occur. This is particularly important in an increasingly pluralistic society such as ours in which 1 of 4 people identify as other than white non-Hispanic, approximately 17% of the population is bilingual (mostly speaking Spanish and English), and where minorities represent more than 50% of the population in several cities and counties. [20]

The overidentification of culturally and linguistically diverse populations commonly occurs when a mismatch is observed and incorrectly interpreted between a language used in a particular community and that of the majority culture. This may be seen most clearly in the improper use of formal tests of speech and language to assess the competencies of speakers who are dissimilar to the sample upon which the test was normed and developed. [21] Similar errors also occur during informal evaluations of language and literacy as when the sound structure of the language influences the spelling or grammatical conventions used in written discourse. [22] With regard to bilingualism, it is commonly assumed that children's acquisition of 1 or both languages is delayed; however, the effects of bilingualism are more complex and differ with the age of the child, the nature of the linguistic input, and the manner and timing of language acquisition. What is clear is that equivalent proficiency in each language should not be expected or assumed as this has the potential to lead to misidentification of a speech and language impairment. (For more information on the effects of bilingualism on language learning, see http://asha.org/public/speech/development/BilingualChildren.htm and http://asha.org/public/speech/development/second.htm ) In the case of culturally and linguistically diverse individuals, decisions to intervene and bring language use in line with that of the majority culture or promote proficiency in the dominant language are not inappropriate; however, such decisions must be seen as separate from the language difference vs disorder question.

In your experience, which of the following is the most important barrier to the effective assessment of speech and language impairment in young children? (Select only 1 answer.)

• ○ Variability in the development of speech and language in young children
• ○ Lack of effective screening tools that discriminate children with and without speech and language impairment
• ○ Lack of accurate parent interview tools that identify clear concerns in speech and language development
• ○ Insufficient time with young children in the clinical setting to observe speech and language skills
• ○ Inadequate understanding of milestones for speech and language development

How confident are you that you are up-to-date in the diagnosis and management of speech and language impairment in young children? (Select only 1 answer.)

• ○ Not at all confident
• ○ Somewhat confident
• ○ Confident
• ○ Very confident

All of the following statements about young children with speech and language impairment are true except :

• ○ Young children tend to produce words with sounds that are consistent with the words they already know
• ○ Young children are able to communicate intent before speaking their first words
• ○ Disfluency is a common occurrence in a young child's early speech
• ○ Children usually begin to put 2 words together at 30 months

Answer: Children usually begin to put 2 words together at 30 months. Children usually begin to put 2 words together at 18 months.

Etiology, Neurobiology, and Prevalence of Speech-Language Impairments

The etiology of most cases of speech-language impairments is unknown but diverse causes are suspected. The range of causes or origins includes anatomical abnormalities, cognitive deficits, faulty learning, genetic differences, hearing impairments, neurologic impairments, or physiologic abnormalities. [6] As noted above, language differences as revealed in the communication output associated with diverse cultural, ethnic, regional or social dialects are not considered disorders. [5] Speech and language impairments may be acquired (ie, result from illness, injury or environmental factors) or congenital (ie, present at birth).

Children with speech and language impairment are an under-representation of the broader occurrence of communication disorders, [23] especially considering the co-occurrence of communication disorders with other disabilities (eg, learning disabilities). Approximately 8% to 12% of preschool populations exhibit language impairments. [6] Among children enrolled in early intervention programs, 46% have communication impairments while 26% have developmental delays in multiple areas, usually including language skills. [24] These findings indicate that the most common presentation of disability in preschoolers involves problems with language.

In a family with a child with a speech and language impairment, which of the following would be clinically appropriate?

• ○ Reassure the parents that the child is just a late talker and will catch up
• ○ Urge the parents to have their child undergo genetic testing
• ○ Discourage the child's parents and sibling(s) from talking for the child as this may be a primary cause of a speech and language impairment
• ○ Advise the parent to have the child's hearing tested

Answer: Advise the parent to have the child's hearing tested. This is appropriate because hearing would be the first condition to rule out as a potential cause of a speech and language delay.

Course and Prognosis

Speech-language impairment sometimes emerges during infancy with challenges in response to sound, atypical birth cries, or limited response to others and progresses through the toddler and preschool age with limited comprehension of spoken language and difficult interactions with peers and others as well as delays in producing first words and word combinations. Speech and language difficulties often persist in school age with difficulties following directions, attending and comprehending oral and written language, and problems producing narratives and using language appropriately in social contexts. Parents are often the first to notice difficulties as they encounter other children with more advanced speech-language skills and thus often wonder if their child is behind. [25] Although many parents raise concerns to primary care providers, many do not. In turn, primary care providers who do not use quality screening tools often dismiss parental concerns with panaceas such as, “He's a boy. Boys talk later.” Or, “Let's give this some time and see if it continues.” Yet, parental concerns about speech and language are associated with developmental disabilities [26] and, thus, careful screening with accurate tools is the requisite response. [27]

The use of a “wait and see” approach underscores the difficulty in distinguishing children who are language delayed from those who have a speech and language impairment. Although most children who have aspeech and language impairment have a history of language delay, only one quarter to one half of late-talkers are eventually diagnosed with a language disorder. [19] In advocating for a more aggressive response for late-talking children, some have argued for careful scrutiny of other risk factors that may guide decisions to refer and intervene. [19] Predictors of a true speech and language impairment that should be considered include poor receptive language skills, [28] limited expressive language skills (eg, small vocabulary, few verbs), and limited development in the sound structure of a language (eg, limited number of consonants, limited variety in babbling structure, vowel errors). [26] Additional predictors include nonspeech (eg, behavioral problems, few gestures, little imitation or symbolic play), environmental (eg, low socioeconomic status, parental use of a directive rather than sensitive and responsive interactional style), and hereditary factors (eg, family history). [26] As a general recommendation, professionals are urged to consider a larger number of risk factors with greater concern. [26]

Often speech-language impairments can be difficult to distinguish from what is considered typical variations in speech and language. For example, disfluencies in speech may be either normal or abnormal. In the nonstuttering child, the most common disfluencies include 1-unit word repetitions (eg, “I… I want that”), interjections (eg, “I saw a… um… picture”), and revisions (eg, “I don't know where… Mommy, help me find my doll”) and, when combined, comprise no more than 10% of words spoken. [29] In the stuttering child, the fluency disorder typically emerges between the ages of 2 and 5 years, is more common among males than females, and is characterized by more than 10% disfluencies in speech, multi-unit syllable (eg, “s-s-s-s-s-September”) and word (eg, “That's my-my-my ball”) repetitions, and may be accompanied by secondary behaviors such as eye-blinking, head-bobbing, or grimacing, as well as feelings of frustration or embarrassment surrounding the stuttering event. [29]

Identification of speech and language impairments is further complicated by the fact that they often masquerade as other diagnostic conditions. For example, children with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) may in fact have an underlying language disorder. Differential diagnosis is challenged by the diagnostic criteria shared between the 2 conditions. Specifically, the diagnostic criteria for ADHD share several characteristics with language disorders including difficulty listening when spoken to, following instructions, talking excessively, blurting out answers, interrupting, and waiting for turns in conversation. [30] Similarly, 50% of preschoolers presenting for psychiatric services were found in several studies to have undiagnosed language impairment. [31 , 32]

The diagnostic criteria for speech-language impairments are defined both by the Diagnostic and Statistical Manual of Mental Disorders , 4th edition (DSM-IV) [33 , 34] and by the Individuals with Disabilities Education Act (IDEA) through the US Department of Education. Table 2 specifies the criteria for communication disorders as described in the DSM-IV. As an example of eligibility criteria for speech-language impairment in response to IDEA guidelines, Vermont indicates that children must demonstrate significant deficits greater than 2 standard deviations below the mean in listening comprehension (eg, measures of auditory (language) processing or comprehension of connected speech including semantics, syntax, phonology, recalling information, following directions and pragmatics) and/or oral expression (eg, measures of oral discourse-syntax, semantics, phonology and pragmatics; voice; fluency; articulation) to qualify as speech or language impaired. [35]

Characteristics of Communication Disorders as Described in the DSM-IV [33 , 34]

Distinguishing children with speech-language deficits from those with other disabilities is often a challenging task as several disabilities share characteristics and have similar diagnostic criteria. For example, an intellectual disability is one in which a child's performance falls at or below 1.5 standard deviations from the mean on a test of intellectual ability with concurrent deficits in adaptive behavior. Children with intellectual disabilities, however, often have significant challenges in receptive and expressive communication as is typical of children with speech and language impairments. Children with learning disabilities have deficits in 1 or more basic skill areas including oral expression and listening comprehension, challenges characteristic of children with speech-language impairments. Children with pervasive developmental disorders/autism exhibit marked impairments in communication and social interaction and restricted and repetitive stereotyped patterns of behavior. Although social impairment is a defining feature of autism, communication impairments are similar to those with a speech-language impairment.

Which of the following is not true of speech-language impairment?

• ○ Early intervention is critical as speech-language impairments place children at risk for later academic difficulties
• ○ Most children with speech-language impairments have intellectual deficits
• ○ Communication disorders may manifest themselves at different stages of life
• ○ Children with learning disabilities are likely to have speech and language impairments

Answer: Most children with speech-language impairments have intellectual deficits. Although many children who have mental retardation have speech-language impairments, most children with specific speech-language impairments have nonverbal intelligence within normal limits.

Screening and Early Assessment of Speech-Language Disorders

The American Academy of Pediatrics recommends ongoing surveillance and periodic use of broad-band screening measures at all well-visits. Table 3 provides information on a number of tools that have high levels of accuracy in detecting speech-language problems and other disabilities. All included measures were standardized on national samples, proven to be reliable, and validated against a range of measures. When used, referral rates to early intervention programs rise to meet prevalence. [36] In the absence of accurate measures, most providers rely on informal milestone checklists. These lack criteria and are probably the leading reason why only about 1 in 4 children with disabilities of any kind are referred for needed assistance.

Accurate Developmental, Mental Health/Behavioral, and Academic Screens Suitable for Primary Care *

© 2007, Glascoe FP. PEDS: Developmental Milestones Professionals Manual. Nashville, Tennessee: Ellsworth & Vandermeer Press, Ltd. Permission is given to reproduce this table.

The first column in Table 3 provides publication information and the cost of purchasing a specimen set. The “Description” column provides information on alternative ways, if available, to administer measures (eg, waiting rooms). The “Accuracy” column shows the percentage of patients with and without problems identified correctly. The “Time Frame/Costs” column shows the costs of materials per visit along with the costs of professional time (using an average salary of $50 per hour) needed to administer and interpret each measure. Time/cost estimates do not include expenses associated with referring. For parent report tools, administration time reflects not only scoring of test results, but also the relationship between each test's reading level and the percentage of parents with less than a high school education (who may or may not be able to complete measures in waiting rooms due to literacy problems and will need interview administrations).

Even when screens are deployed, it is nevertheless helpful to complement these brief measures with clinical observation. The brevity of screens useful for primary care means that some skills may not be captured. For example, at any given age range, a brief screen may not present articulation items, measure ability to repeat a story, describe daily events, ask questions, or engage in conversation, etc. The value in routinely administering validated, accurate screening tools, however, is essential to improving currently problematic and extremely low rates of early detection on the part of primary healthcare providers.

Table 4 describes some major language developmental milestones in the prelinguistic (birth to 1 year) and linguistic period (1 year and beyond). [37 , 38] It is important to note that there are wide variations in the speed (and style) with which typically developing children acquire language skills.

Average Age and Range of Ages for Achievement for Important Language Developmental Milestones * [37 , 38]

Providers are reminded that these indicators are an aid to early detection but do not substitute for quality measurement. See Table 3 for a list of screening measures with proven accuracy.

Screening for Other Potential Contributors to Speech-Language Deficits

Another critical avenue for exploration into possible contributors to speech-language deficits is psychosocial risk. Parents who are depressed and/or have housing or food instability have children more likely to have language problems, perhaps because parents lack the energy and freedom from preoccupations to engage in the kinds of language-mediated social interactions known to support optimal child language development. Some parents are not aware of positive parenting practices that promote development, especially language skills (eg, talking with and reading to their child, creating opportunities for sustained dialogue, responding contingently to a child's initiations). Detecting and intervening when psychosocial risk factors, including abuse and neglect, are present has the potential to prevent language problems from developing. Screens for psychosocial risk factors including depression and parent-child interactions are widely available and include the Family Psychosocial Screen and the Brigance Parent-Child Interactions Scale . Both are included in PEDS: Developmental Milestones [39] as supplementary measures helpful for surveillance and offer evidence-based compliance with recommendations in early detection from the American Academy of Pediatrics. [40] , Many other screens, such as the Ages and Stages Questionnaire , include a background information questionnaire that captures common psychosocial risk factors. [41]

Screening Older Children

With school-age children, obtaining and reviewing group achievement test scores can help reveal undiagnosed language deficits. Such children typically have weaknesses in general information (eg, science, social studies knowledge), problems with reading comprehension, and sometimes also problems with math concepts. Table 3 also includes screens suitable for primary care professionals working with children aged 8 years and older.

For both preschoolers and school-age children, broad-band screens (or review of group achievement test results) should be deployed first and serve as a guide to the selection of narrow-band instruments. For example, attentional deficits can be due to a range of conditions such as language impairment, learning disabilities, and mental health problems such as depression. The optimal approach is to administer a broad developmental or academic screen along with a measure such as the Pediatric Symptom Checklist (which discriminates mental health from attentional difficulties). Only afterward and as suggested by the results of broad-band measures should a narrowly focused tool such as the Vanderbilt ADHD Diagnostic Rating Scale be administered. Making sure that other conditions are treated first or at least concomitantly with ADHD is essential.

Billing and Coding for Screening

Primary care providers can use the – 25 modifier to their preventive service code (to indicate that stand-alone services were offered and then use 96110 times the number of screens administered, eg, 96110 X 2. For insurers not accepting units, the distinct procedural service of each screen is best represented with the – 59 modifier appended to each additional unit of 96110.

In 2005, the Centers for Medicare and Medicaid Services published a total relative value unit (RVU) of 0.36 for 96110, which amounts to a Medicare payment of $13.64. None of this can guarantee that a valid claim will be accepted, so the American Academy of Pediatrics is willing to help with denied claims via their Coding Hotline: 800-433-9016, x4022, or at .gro.paa@eniltohgnidocpaa RVUs do not cover physician time, so making use of office staff and parent-report tools is essential.

Referrals and Other Interventions

Once suspicion exists that a child may have a speech-language impairment, referral to early intervention or to the public schools (depending on age) is the first step. These programs offer intervention by speech-language pathologists. If sufficient quantity is not available, referrals can also be made to private therapy services, which may be covered by the patients' insurance. If there appear to be underlying medical conditions, assessment by other disciplines, such as developmental-behavioral or neurodevelopmental pediatrics, is important.

For families with psychosocial risk factors, developmental promotion is essential as is careful monitoring of progress. If brief advice and information handouts are not effective and particularly if children have delays not sufficiently great as to qualify for services, then parent training, quality day care, Head Start, after-school tutoring, and private speech-language therapy should be recommended. Table 5 shows a list of professional development and referral resources. Table 6 provides a list of resources and information for parents.

Professional Development and Referral Resources

Resources and Information for Parents

Components of a Diagnostic Evaluation of Speech-Language Impairment and the Nature of Interventions

Although screening tools for speech-language often identify those children who have speech-language impairments, a screening is not a diagnostic evaluation and only suggests a child requires a more comprehensive assessment. There are several goals in a diagnostic assessment, including verifying that a speech-language impairment exists, describing the strengths and challenges of the child's speech and language, evaluating the severity of the problem, ascertaining the etiology, determining recommendations for a treatment plan, and providing a prognosis. [6] Assessment requires obtaining a sample of communication skills across settings through a number of procedures. It is critical to collect information not only from standardized, formal tools but also to gather more authentic, real-life information to facilitate meaningful and accurate decisions. Typically, case history information, parent interviews, checklists from other providers, systematic observation, hearing screening, and examination of the speech mechanism is included. [6] Formal norm-referenced tests are used to assess articulation, phonology, grammatical understanding and production, and pragmatic language use. The collection of data from the authentic assessment tools and the formal measures provide a comprehensive picture of the speech-language needs of a young child with a communication impairment.

All of the following are true in the assessment of a young child with speech-language impairments except :

• ○ Obtaining information from multiple sources across settings is necessary to specify communication strengths and challenges
• ○ Speech-language pathologists (SLPs) make diagnoses of specific speech-language impairment, identify probable causes, determine severity, describe the likely prognosis, and provide recommendations
• ○ Clinical judgment is most appropriate for determining the severity of a child's speech-language impairment
• ○ During assessment, speech, language, hearing, and processing abilities should be probed

Answer: Clinical judgment is most appropriate for determining the severity of a child's speech-language impairment. Objective criteria are important to ensure consistency in the assessment of severity.

To determine the prognosis for a young child with a speech-language impairment, which of the following is true?

• ○ A clinician should avoid providing prognostic information, as questions like “Will my son outgrow his speech-language impairment?” cannot be answered
• ○ Trial therapy during an assessment period is an appropriate strategy to inform prognosis
• ○ Families and clinicians have little difficulty making decisions about whether or not a young child with early expressive language delay will benefit from therapy
• ○ Single evaluation measures can be used to determine the severity of a young child's speech-language impairment and the prognosis for successful outcomes

Answer: Trial therapy during an assessment period is an appropriate strategy to inform prognosis. Clinicians often probe a child's response to intervention strategies to determine responsiveness to treatment and to inform the development of the treatment plan.

Intervention Approaches and Outcomes

The complexity of impairments in speech and language requires a variety of intervention approaches that can address deficits in language form (syntax, phonology, morphology), language content (semantics), and language use (pragmatics) as well as speech and voice production. Further, intervention for young children may involve not just the speech-language pathologist but also care providers and peers.

The ultimate goal of intervention is to increase a child's success in using language to communicate his or her intent, respond to the intent of others, and participate in reciprocal interactions. The speech and language targets vary for each child depending on the context and aspects of communication affected. Targets may or may not follow a strict developmental approach. Sometimes a more functional approach is appropriate, supporting communication at the point of frustration and breakdown. [6] Intervention targets should consider the family's desired outcomes for their child's communication. Targets should be developmentally appropriate and meaningful to the child.

Several teaching methods are used to support the speech and language of children. Modeling is a typical intervention strategy that provides focused stimulation on the speech or language targets selected for an individual child. Cueing is another frequently used technique that includes direct and indirect verbal cues (eg, asking a child to imitate a sound, word, or utterance) or nonverbal cues (eg, giving a child a jar with a desired item that can't be opened without help). In addition, responding to a child's communication efforts through reinforcement or corrective feedback (eg, “Remember to say the ending sound /t/ so we know you mean the word ‘boat’”) is frequently used to facilitate effective communication. [6]

Case Studies

Bobby [pseudonym] is a 7-year-old boy whom you have seen in your office for a number of years. He comes to you today for his annual check-up. Bobby is enrolled in the second grade. His mother is concerned because Bobby's teachers have noted difficulties in his ability to learn to read. Specifically, Bobby's teachers say that he has difficulties with word recognition and reading comprehension. Bobby's mother indicates that this is consistent with her own observations that he seems to have trouble with understanding what is being said (eg, directions, questions) and storytelling. Moreover, she suspects that Bobby's vocabulary is less well developed compared with his peers. She also describes frequent errors in how he formulates sentences such as omitting possessives (eg, “Sam dog” instead of “Sam's dog”) and verbs (eg, “He cooking” instead of “He is cooking”) that she fears are atypical. Bobby's nonverbal IQ is in the typical range.

The difficulties described above are most consistent with a possible diagnosis of:

• ○ Autism spectrum disorder
• ○ Intellectual disability
• ○ Specific language impairment
• ○ Language delay

Answer: Specific language impairment.

Darius [pseudonym] is a 5-year-old African American boy whom you are meeting today for the first time. He and his mother have recently moved to your area and she has brought him to you because he seems to be developing a nasty cough. When talking with Darius, you notice that he is extremely difficult to understand. Darius is a speaker of African American English; however, even with young speakers of this dialect, you have never had such difficulty understanding and communicating effectively. You learn that he and his parents have just moved from an impoverished community in South Carolina where he attended an age-appropriate class in a school in which approximately 85% of his classmates were black, to a school district in your area that almost entirely comprises white administrators, staff, and students. His mother further reports that Darius's new teachers have expressed concerns about his language. They say he is hard to understand, has a limited vocabulary, cannot master letter-sound correspondences, and has trouble listening to and understanding others.

Which of the following additional patient characteristics obtained from the mother would increase your suspicion of a diagnosis of speech and language impairment? (Select all that apply.)

• ▪ Darius's mother reports that he has always talked differently compared with his parents, siblings, and peers
• ▪ Darius's scores on a test of articulation of standard English are in the 10th percentile
• ▪ Darius becomes frustrated when you ask him to repeat himself
• ▪ Even though they are consistent with the sound structure of African American English, errors in Darius's spelling are quite common (eg, he writes "nes" instead of “nest”)

Answer: Darius's mother reports that he has always talked differently compared with his parents, siblings, and peers.

Which of the following additional patient or parent characteristics would increase your suspicion that Darius is exhibiting a language difference as opposed to a speech and language impairment? (Select all that apply.)

• ▪ Not only do you find Darius difficult to understand, but his mother is equally difficult to understand; both seem to be using a variation of African American English dialect that, although not commonly heard in your area, is characteristic of their native community
• ▪ Darius's scores on a test of vocabulary standardized on a cross-section of North American native English speakers are in the 35th percentile
• ▪ Darius's mother has no trouble understanding him
• ▪ Darius's mother does not share these concerns and considers him competent in all aspects of his language development

Answer: Not only do you find Darius difficult to understand, but his mother is equally difficult to understand; both seem to be using a variation of African American English dialect that, although not commonly heard in your area, is characteristic of their native community. Darius's mother does not share these concerns and considers him competent in all aspects of his language development.

You have been Sam's [pseudonym] primary care physician since he was born. He is now 18 months old and comes to you for his annual flu shot. During this visit, his mother expresses concerns about his speech and language development. More specifically, she reports he is “not talking like other kids his age” and uses repeated vocalizations (eg, “eh eh eh eh” while pointing) to communicate. Very recently, Sam has begun to use some words which are often paired with a gesture (eg, “Daddy” while pointing or “up” while raising hands to be picked up). You notice during your visit that Sam is a social and attentive child. He looks at other people and follows their eye gaze to distal objects. He also seems to understand the speech that his mother directs to him and he can easily carry out 2-step commands (eg, “Pick up the cup and sit next to me, please”). Sam's mother is aware of no immediate or extended family members who have ever had a speech or language impairment. Sam has no history of ear infection, and a recent hearing screen indicated hearing in the normal range.

• ▪ Limited imitation
• ▪ Limited pretend play
• ▪ Limited facial expressiveness
• ▪ Excessive use of nonverbal communicative gestures (eg, reaching, pointing, looking)

Answer: Limited imitation. Limited pretend play.

What should the mother expect with time if her child does not have a speech and language impairment but is rather a late-talker? (Select all that apply.)

• ▪ The child will begin to engage in unusual repetitive behaviors
• ▪ The child will steadily albeit slowly add new words and begin to combine them into 2-word utterances
• ▪ Any new words that the child utters are likely to be distorted and difficult to understand
• ▪ The child may develop aggressive behaviors to cope with his inability to communicate effectively

Answer: The child will steadily albeit slowly add new words and begin to combine them into 2-word utterances.

Theresa [pseudonym] is a 3-year-old female whom you have seen in your office regularly since her birth. She comes to you today for her annual check-up. During her visit, you observe that Theresa is precocious in her language development. Indeed, her mother reports that she has always been a “great talker” and that she began to speak in well-formed utterances at age 18 months. During this visit, you notice a number of disfluencies in Theresa's speech. At one point, she repeats a word 3 times before getting the rest of the sentence out (ie, “I see… see… see a book with a clown”). Theresa's mother states that these kinds of disfluencies began about 1 month ago and, although she characterizes them as relatively infrequent, she has questions about whether this kind of speech is normal.

Which of the following additional patient characteristics obtained from your observation of Theresa would increase your suspicion of a diagnosis of a fluency disorder? (Select all that apply.)

• ▪ Theresa seems aware of and perturbed by her disfluencies
• ▪ Theresa sometimes jerks her head when hesitating to utter her next word
• ▪ Approximately 20% of Theresa's words appear to constitute disfluencies
• ▪ Theresa produces multi-unit syllable repetitions (eg, “t-t-t-time”)
• ▪ All of the above

Answer: All of the above.

Reader Comments on: Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood See reader comments on this article and provide your own.

Readers are encouraged to respond to the author at [email protected] or to George Lundberg, MD, Editor in Chief of The Medscape Journal of Medicine , for the editor's eyes only or for possible publication as an actual Letter in the Medscape Journal via email: ten.epacsdem@grebdnulg

Contributor Information

Patricia A. Prelock, Department of Communication Sciences, University of Vermont, Burlington, Vermont.

Tiffany Hutchins, Department of Communication Sciences, University of Vermont, Burlington, Vermont.

Frances P. Glascoe, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee.

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About Intellectual and Developmental Disabilities (IDDs)

What are idds.

IDDs are differences that are usually present at birth and that uniquely affect the trajectory of the individual’s physical, intellectual, and/or emotional development. Many of these conditions affect multiple body parts or systems.

Intellectual disability 1 starts any time before a child turns 18 and is characterized by differences with both:

• Intellectual functioning or intelligence, which include the ability to learn, reason, problem solve, and other skills; and
• Adaptive behavior, which includes everyday social and life skills.

The term "developmental disabilities" is a broader category of often lifelong challenges that can be intellectual, physical, or both. 2

"IDD" is the term often used to describe situations in which intellectual disability and other disabilities are present. 3

It might be helpful to think about IDDs in terms of the body parts or systems they affect or how they occur. For example 4 :

• Nervous system These disorders affect how the brain, spinal cord, and nervous system function, which can affect intelligence and learning. These conditions can also cause other issues, such as behavioral disorders, speech or language difficulties, seizures, and trouble with movement. Cerebral palsy, 5 Down syndrome , Fragile X syndrome , and autism spectrum disorders (ASDs) are examples of IDDs related to problems with the nervous system.
• Sensory system These disorders affect the senses (sight, hearing, touch, taste, and smell) or how the brain processes or interprets information from the senses. Preterm infants and infants exposed to infections, such as cytomegalovirus, may have reduced function with their eyesight and/or hearing. In addition, being touched or held can be difficult for people with ASDs.
• Metabolism These disorders affect how the body uses food and other materials for energy and growth. For example, how the body breaks down food during digestion is a metabolic process. Problems with these processes can upset the balance of materials available for the body to function properly. Too much of one thing, or too little of another can disrupt overall body and brain functions. Phenylketonuria (PKU) and congenital hypothyroidism are examples of metabolic conditions that can lead to IDDs.
• Degenerative Individuals with degenerative disorders may seem or be typical at birth and may meet usual developmental milestones for a time, but then they experience disruptions in skills, abilities, and functions because of the condition. In some cases, the disorder may not be detected until the child is an adolescent or adult and starts to show symptoms or lose abilities. Some degenerative disorders result from other conditions, such as untreated problems of metabolism.

The exact definition of IDD, as well as the different types or categories of IDD, may vary depending on the source of the information.

For example, within the context of education and the Individuals with Disabilities Education Act (IDEA), a law that aims to ensure educational services to children with disabilities throughout the nation, the definition of IDD and the types of conditions that are considered IDD might be different from the definitions and categories used by the Social Security Administration (SSA) to provide services and support for those with disabilities. These definitions and categories might also be different from those used by healthcare providers and researchers.

• Centers for Disease Control and Prevention. (n.d.). Intellectual disability fact sheet . Retrieved August 9, 2012, from https://www.cdc.gov/ncbddd/developmentaldisabilities/facts-about-intellectual-disability.html
• Centers for Disease Control and Prevention. (May 18, 2012). Cerebral palsy: Facts about cerebral palsy . Retrieved August 12, 2012, from http://www.cdc.gov/ncbddd/cp/facts.html

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• Risk Factors
• Research Summary

About Cerebral Palsy

• Cerebral palsy (CP) affects a person’s ability to move and maintain balance and posture.
• The symptoms vary from person to person.
• CP does not worsen over time, though the exact symptoms can change over a person’s lifetime.
• There is no cure for CP, but treatment can improve the lives of those who have the condition.

Cerebral palsy (CP) is a group of disorders that affect a person's ability to move and maintain balance and posture. Cerebral means having to do with the brain. Palsy means weakness in or problems with using the muscles. CP is caused by abnormal brain development or damage to the developing brain that affects a person's ability to control their muscles. CP is the most common motor disability in childhood.

The symptoms of CP vary from person to person. A person with severe CP might need to use special equipment to be able to walk or might not be able to walk at all and might need lifelong care. A person with mild CP, on the other hand, might walk a little awkwardly, but might not need any special help. CP does not get worse over time, though the exact symptoms can change over a person's lifetime.

All people with CP have problems with movement and posture. Many also have related conditions such as the following:

• Intellectual disability
• Problems with vision, hearing , or speech
• Changes in the spine (such as scoliosis A )
• Joint problems (such as contractures B )

Doctors classify CP according to the main type of movement disorder involved. Depending on which areas of the brain are affected, one or more of the following movement disorders can occur:

• Stiff muscles (spasticity)
• Uncontrollable movements (dyskinesia)
• Poor balance and coordination (ataxia)

There are four main types of CP.

Spastic cerebral palsy

The most common type of CP is spastic CP. Spastic CP affects about 80% of people with CP.

People with spastic CP have increased muscle tone. This means their muscles are stiff and, as a result, their movements can be awkward. Spastic CP usually is described by which parts of the body are affected:

• Spastic diplegia/diparesis: Muscle stiffness is mainly in the legs, with the arms less affected or not affected at all. Tight hip and leg muscles cause legs to pull together, turn inward, and cross at the knees (also known as scissoring ), making walking difficult.
• Spastic hemiplegia/hemiparesis: Affects only one side of a person's body; usually the arm is more affected than the leg.
• Spastic quadriplegia/quadriparesis: Most severe form of spastic CP and affects all four limbs, the trunk, and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech.

Dyskinetic cerebral palsy

People with dyskinetic CP have problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk.

Dyskinetic CP includes athetoid, choreoathetoid, and dystonic cerebral palsies. The movements are uncontrollable and can be slow and writhing or rapid and jerky. Sometimes the face and tongue are affected, and the person has a hard time sucking, swallowing, and talking. A person with dyskinetic CP has muscle tone that can change (varying from too tight to too loose) not only from day to day, but even during a single day.

Ataxic cerebral palsy

People with ataxic CP have problems with balance and coordination. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something.

Mixed cerebral palsy

Some people have symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.

Signs and symptoms

The signs of CP vary greatly because there are many different types and levels of disability. The main sign that a child might have CP is a delay reaching motor or movement milestones (such as rolling over, sitting, standing, or walking). Following are some other signs of possible CP. It is important to note that some children without CP also might have some of these signs.

In a baby younger than 6 months of age

• His head lags when you pick him up while he's lying on his back.
• He feels stiff.
• He feels floppy.
• When held cradled in your arms, he seems to overextend his back and neck, constantly acting as if he is pushing away from you.
• When you pick him up, his legs get stiff and they cross or scissor.

In a baby older than 6 months of age

• She doesn't roll over in either direction.
• She cannot bring her hands together.
• She has difficulty bringing her hands to her mouth.
• She reaches out with only one hand while keeping the other fisted.

In a baby older than 10 months of age

• He crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg.
• He scoots around on his buttocks or hops on his knees, but does not crawl on all fours.

Tell your child's doctor or nurse if you notice any of these signs.

Learn more about CDC's Developmental Milestones

CP is caused by abnormal development of the brain or damage to the developing brain that affects a child's ability to control their muscles. There are several possible causes of the abnormal development or damage. People used to think that CP was mainly caused by lack of oxygen during the birth process. Now, scientists think that this causes only a small number of CP cases.

The abnormal development of the brain or damage that leads to CP can happen before birth, during birth, within a month after birth, or during the first years of a child's life, while the brain is still developing. CP related to abnormal development of the brain or damage that occurred before or during birth is called congenital CP. The majority of CP (85% to 90%) is congenital. In many cases, the specific cause is not known.

A small percentage of CP is caused by abnormal development of the brain or damage that occurs more than 28 days after birth. This is called acquired CP and usually is associated with an infection (such as meningitis) or head injury.

Learn more about causes and risk factors for CP

Screening and diagnosis

Diagnosing CP at an early age is important to the well-being of children and their families. Diagnosing CP can take several steps:

Developmental monitoring

Developmental monitoring (also called surveillance) means tracking a child's growth and development over time. If any concerns about the child's development are raised during monitoring, then a developmental screening test should be given as soon as possible.

Developmental screening

During developmental screening, a short test is given to see if the child has specific developmental delays, such as motor or movement delays. If the results of the screening test are cause for concern, then the doctor will make referrals for developmental and medical evaluations.

Developmental and medical evaluations

The goal of a developmental evaluation is to diagnose the specific type of disorder that affects a child.

Learn more about screening and diagnosis

Treatment and intervention services

There is no cure for CP, but early identification and treatment can help improve the lives of those who have the condition. It is important to begin a treatment program as early as possible.

After a CP diagnosis is made, a team of health professionals works with the child and family to develop a plan to help the child reach his or her full potential. Common treatments include medicines; surgery; braces; and physical, occupational, and speech therapy. No single treatment is the best one for all children with CP. Before deciding on a treatment plan, it is important to talk with the child's doctor to understand all the risks and benefits.

Visit the National Institute of Neurological Disorders and Stroke (NINDS) Cerebral Palsy Information Page to learn more about treatments for CP.

If You are Concerned ‎

If you think your child is not meeting movement milestones or might have CP, contact your doctor or nurse and share your concerns.

At the same time, call your state or territory's early intervention program to request a free or reduced cost evaluation to find out if your child qualifies for interventions services (sometimes called a Child Find evaluation). You do not need to wait for a doctor's referral or medical diagnosis to make this call.

What CDC is doing

CDC is committed to finding out how many people have CP, understanding the risk factors for CP, and helping parents and families recognize the early signs of CP.

CDC and its partners aim to improve early identification of children with ASD and other developmental disabilities. The Learn the Signs. Act Early. program promotes developmental monitoring, so children and families can get the services and support they need.

By tracking the number of children with CP over time, we can find out whether their number is rising, dropping, or staying the same. We also can compare the number of children with CP in different parts of the country and look at the different traits or features of children with CP. This information can help us look for risk factors and possible causes for CP.

American Academy of Pediatrics | Cerebral Palsy (healthychildren.org)

American Association on Intellectual and Developmental Disabilities

March of Dimes | Cerebral Palsy

National Institute of Neurological Disorders and Stroke (NINDS) | Cerebral Palsy: Hope Through Research.

United Cerebral Palsy (UCP)

• Scoliosis . A condition in which a person's spine tilts or curves to one side of the body.
• Contractures . A condition in which muscles have become fixed in a rigid, abnormal position, which causes distortion or deformity.

Cerebral Palsy (CP)

Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. CP is the most common motor disability in childhood.

Apple announces new accessibility features, including Eye Tracking, Music Haptics, and Vocal Shortcuts

Eye Tracking Comes to iPad and iPhone

Music Haptics Makes Songs More Accessible

New Features for a Wide Range of Speech

Vehicle Motion Cues Can Help Reduce Motion Sickness

CarPlay Gets Voice Control, More Accessibility Updates

Accessibility Features Coming to visionOS

Additional Updates

• For users who are blind or have low vision, VoiceOver will include new voices, a flexible Voice Rotor, custom volume control, and the ability to customize VoiceOver keyboard shortcuts on Mac.
• Magnifier will offer a new Reader Mode and the option to easily launch Detection Mode with the Action button.
• Braille users will get a new way to start and stay in Braille Screen Input for faster control and text editing; Japanese language availability for Braille Screen Input; support for multi-line braille with Dot Pad ; and the option to choose different input and output tables.
• For users with low vision, Hover Typing shows larger text when typing in a text field, and in a user’s preferred font and color.
• For users at risk of losing their ability to speak, Personal Voice will be available in Mandarin Chinese. Users who have difficulty pronouncing or reading full sentences will be able to create a Personal Voice using shortened phrases.
• For users who are nonspeaking, Live Speech will include categories and simultaneous compatibility with Live Captions .
• For users with physical disabilities, Virtual Trackpad for AssistiveTouch allows users to control their device using a small region of the screen as a resizable trackpad.
• Switch Control will include the option to use the cameras in iPhone and iPad to recognize finger-tap gestures as switches.
• Voice Control will offer support for custom vocabularies and complex words.

Celebrate Global Accessibility Awareness Day with Apple

• Throughout the month of May, select Apple Store locations will host free sessions to help customers explore and discover accessibility features built into the products they love. Apple Piazza Liberty in Milan will feature the talent behind “Assume that I can,” the viral campaign for World Down Syndrome Day. And available year-round at Apple Store locations globally, Today at Apple group reservations are a place where friends, families, schools, and community groups can learn about accessibility features together.
• Shortcuts adds Calming Sounds , which plays ambient soundscapes to minimize distractions, helping users focus or rest.
• Visit the App Store to discover incredible apps and games that promote access and inclusion for all, including the accessible App Store Award-winning game Unpacking, apps as tools for augmentative and alternative communication (AAC), and more.
• The Apple TV app will honor trailblazing creators, performers, and activists who passionately share the experiences of people with disabilities. This year’s theme is Remaking the World , and each story invites viewers to envision a reality where everyone is empowered to add their voice to the greater human story.
• Apple Books will spotlight lived experiences of disability through curated collections of first-person narratives by disabled writers in ebook and audiobook formats.
• Apple Fitness+ workouts, meditations, and trainer tips welcome users who are deaf or hard of hearing with American Sign Language, and Time to Walk now includes transcripts in the Apple Podcasts app. Fitness+ workouts always include Audio Hints to support users who are blind or have low vision, as well as modifiers so that users of all levels can participate.
• Users can visit Apple Support to learn how their Apple devices can be customized using built-in accessibility features. From adapting the gestures to customizing how information is presented on a device’s screen, the Apple Accessibility playlist will help users learn how to personalize Apple Vision Pro, iPhone, iPad, Apple Watch, and Mac to work best for them.

Text of this article

May 15, 2024

PRESS RELEASE

CUPERTINO, CALIFORNIA  Apple today announced new accessibility features coming later this year, including Eye Tracking, a way for users with physical disabilities to control iPad or iPhone with their eyes. Additionally, Music Haptics will offer a new way for users who are deaf or hard of hearing to experience music using the Taptic Engine in iPhone; Vocal Shortcuts will allow users to perform tasks by making a custom sound; Vehicle Motion Cues can help reduce motion sickness when using iPhone or iPad in a moving vehicle; and more accessibility features will come to visionOS. These features combine the power of Apple hardware and software, harnessing Apple silicon, artificial intelligence, and machine learning to further Apple’s decades-long commitment to designing products for everyone.

“We believe deeply in the transformative power of innovation to enrich lives,” said Tim Cook, Apple’s CEO. “That’s why for nearly 40 years, Apple has championed inclusive design by embedding accessibility at the core of our hardware and software. We’re continuously pushing the boundaries of technology, and these new features reflect our long-standing commitment to delivering the best possible experience to all of our users.”

“Each year, we break new ground when it comes to accessibility,” said Sarah Herrlinger, Apple’s senior director of Global Accessibility Policy and Initiatives. “These new features will make an impact in the lives of a wide range of users, providing new ways to communicate, control their devices, and move through the world.”

Powered by artificial intelligence, Eye Tracking gives users a built-in option for navigating iPad and iPhone with just their eyes. Designed for users with physical disabilities, Eye Tracking uses the front-facing camera to set up and calibrate in seconds, and with on-device machine learning, all data used to set up and control this feature is kept securely on device, and isn’t shared with Apple.

Eye Tracking works across iPadOS and iOS apps, and doesn’t require additional hardware or accessories. With Eye Tracking, users can navigate through the elements of an app and use Dwell Control to activate each element, accessing additional functions such as physical buttons, swipes, and other gestures solely with their eyes.

Music Haptics is a new way for users who are deaf or hard of hearing to experience music on iPhone. With this accessibility feature turned on, the Taptic Engine in iPhone plays taps, textures, and refined vibrations to the audio of the music. Music Haptics works across millions of songs in the Apple Music catalog, and will be available as an API for developers to make music more accessible in their apps.

With Vocal Shortcuts, iPhone and iPad users can assign custom utterances that Siri can understand to launch shortcuts and complete complex tasks. Listen for Atypical Speech, another new feature, gives users an option for enhancing speech recognition for a wider range of speech. Listen for Atypical Speech uses on-device machine learning to recognize user speech patterns. Designed for users with acquired or progressive conditions that affect speech, such as cerebral palsy, amyotrophic lateral sclerosis (ALS), or stroke, these features provide a new level of customization and control, building on features introduced in iOS 17 for users who are nonspeaking or at risk of losing their ability to speak.

“Artificial intelligence has the potential to improve speech recognition for millions of people with atypical speech, so we are thrilled that Apple is bringing these new accessibility features to consumers,” said Mark Hasegawa-Johnson, the Speech Accessibility Project at the Beckman Institute for Advanced Science and Technology at the University of Illinois Urbana-Champaign’s principal investigator. “The Speech Accessibility Project was designed as a broad-based, community-supported effort to help companies and universities make speech recognition more robust and effective, and Apple is among the accessibility advocates who made the Speech Accessibility Project possible.”

Vehicle Motion Cues is a new experience for iPhone and iPad that can help reduce motion sickness for passengers in moving vehicles. Research shows that motion sickness is commonly caused by a sensory conflict between what a person sees and what they feel, which can prevent some users from comfortably using iPhone or iPad while riding in a moving vehicle. With Vehicle Motion Cues, animated dots on the edges of the screen represent changes in vehicle motion to help reduce sensory conflict without interfering with the main content. Using sensors built into iPhone and iPad, Vehicle Motion Cues recognizes when a user is in a moving vehicle and responds accordingly. The feature can be set to show automatically on iPhone, or can be turned on and off in Control Center.

Accessibility features coming to CarPlay include Voice Control, Color Filters, and Sound Recognition. With Voice Control, users can navigate CarPlay and control apps with just their voice. With Sound Recognition, drivers or passengers who are deaf or hard of hearing can turn on alerts to be notified of car horns and sirens. For users who are colorblind, Color Filters make the CarPlay interface visually easier to use, with additional visual accessibility features including Bold Text.

This year, accessibility features coming to visionOS will include systemwide Live Captions to help everyone — including users who are deaf or hard of hearing — follow along with spoken dialogue in live conversations and in audio from apps. With Live Captions for FaceTime in visionOS, more users can easily enjoy the unique experience of connecting and collaborating using their Persona. Apple Vision Pro will add the capability to move captions using the window bar during Apple Immersive Video, as well as support for additional Made for iPhone hearing devices and cochlear hearing processors. Updates for vision accessibility will include the addition of Reduce Transparency, Smart Invert, and Dim Flashing Lights for users who have low vision, or those who want to avoid bright lights and frequent flashing.

These features join the dozens of accessibility features already available in Apple Vision Pro, which offers a flexible input system and an intuitive interface designed with a wide range of users in mind. Features such as VoiceOver, Zoom, and Color Filters can also provide users who are blind or have low vision access to spatial computing, while features such as Guided Access can support users with cognitive disabilities. Users can control Vision Pro with any combination of their eyes, hands, or voice, with accessibility features including Switch Control, Sound Actions, and Dwell Control that can also help those with physical disabilities.

“Apple Vision Pro is without a doubt the most accessible technology I’ve ever used,” said Ryan Hudson-Peralta, a Detroit-based product designer, accessibility consultant, and cofounder of Equal Accessibility LLC. “As someone born without hands and unable to walk, I know the world was not designed with me in mind, so it’s been incredible to see that visionOS just works. It’s a testament to the power and importance of accessible and inclusive design.”

This week, Apple is introducing new features, curated collections, and more in celebration of Global Accessibility Awareness Day:

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May 21, 2024

Building a strong foundation through better hearing

Each May, Speech-Language-Hearing Month provides an opportunity to raise awareness about communication disorders and the role of American Speech-Language-Hearing Association members providing life-altering treatment. The theme for 2024 is “Building A Strong Foundation.”

Hearing is the foundation for effective communication, strong relationships and healthy brain function. For many people, communication is difficult because of hearing loss or speech conditions. In fact, more than 48 million people in the U.S. experience some degree of hearing loss, and 1 in 10 Americans have some type of communication disorder. 

Hearing affects communication

Hearing loss makes it difficult not only to process the sounds around you, but to clearly understand speech. When your brain is working hard to fill in the gaps of a conversation due to hearing loss, you may feel exceptionally tired after interacting with people. This can lead to withdrawal, social isolation and depression.

How to take care of your hearing

Preserving your hearing is a crucial part of taking care of your overall health. Follow these tips to be proactive about your hearing health:

• Avoid loud noise exposure.
• Wear hearing protection when sounds exceed 85 decibels.
• Avoid sticking objects in your ears.
• Schedule regular hearing exams.

Early identification and intervention for hearing loss is important. Many people live with unidentified hearing loss, often failing to realize they are missing certain sounds and words.

Educate yourself  

There is a lot to learn about hearing loss and communication disorders. To normalize and decrease the stigma surrounding hearing loss, it’s important to spread awareness. Check out www.asha.org to learn more.

Be proactive during Speech-Language-Hearing Month by taking care of your hearing. Call M.D. Steer Speech, Language and Hearing Clinics today at 765-494-3789 to schedule a hearing exam. 

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Textbook: Cognitive Communication Disorders of MCI and Dementia - Definition, Assessment, and Clinical Management

Based on the textbook Cognitive Communication Disorders of MCI and Dementia: Definition, Assessment, and Clinical Management, this course provides the knowledge to diagnose and treat individuals with cognitive-communicative disorders associated with aging, mild cognitive impairment (MCI), and dementia-producing diseases, our fastest growing clinical population.

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Kim McCullough PhD CCC-SLP

Kim McCullough, PhD, CCC-SLP, is a Professor and the Speech-Language Pathology Graduate Program Director at Appalachian State University. Kim is a certified speech-language pathologist with clinical expertise in providing services to individuals with neurogenic communication disorders. Kim’s clinical activities and research focus on aging, mild cognitive impairment, dementia, and interventions for sustaining brain function. Kim has worked with community partners for over two decades to provide multi-component cognitive wellness programs for older adults with concerns about changes in memory and thinking as well as with those who have a diagnosis of mild cognitive impairment or dementia.

Kathryn A. Bayles PhD ASHA Fellow

Kathryn A. Bayles, Ph.D. is an internationally known expert on the cognitive-communicative disorders associated with aging and dementia producing diseases.   Her pioneering research received funding from the National Institutes on Aging, the National Institute on Deafness and Other Communication Disorders, the Alzheimer’s Association, the Robert Woods Johnson Association, and the Andrus Foundation.  Dr. Bayles is a Past President of the Academy of Neurologic Communication Disorders and Sciences, and an Honors recipient and Fellow of the American Speech-Language Hearing Association.

Cheryl Tomoeda MS CCC-SLP

Cheryl Tomoeda, MS, CCC-SLP, is the Director of Development for the University of Arizona College of Science after a 22-year career in the Department of Speech, Language, and Hearing Sciences as a research collaborator with Dr. Kathryn Bayles.  Together they developed the Arizona Battery for Cognitive-Communication Disorders and the Functional Linguistic Communication Inventory and produced 67 TELEROUNDS of continuing education videoconferences. 

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You can now control an iPhone or iPad with your eyes with Apple’s new features

They’re putting the “eye” in iPhone.

Apple users will soon be able to control their iPhones and iPads with their eyes after the tech giant unveiled an array of new accessibility features for their products.

“Eye Tracking,” which is designed for users with physical disabilities, will be powered by Artificial Intelligence and won’t require any additional hardware.

According to an announcement by Apple on Wednesday , the feature will use the front-facing camera of an iPhone or iPad to trace a user’s eye movement as they navigate “through elements of an app.”

“We believe deeply in the transformative power of innovation to enrich lives,” CEO Tim Cook declared in the media release.

“We’re continuously pushing the boundaries of technology, and these new features reflect our long-standing commitment to delivering the best possible experience to all of our users.”

Cook didn’t disclose exactly when the Eye Tracking feature will be available, but is “likely to debut in iOS and iPadOS” which will be released later this year, per The Verge.

The accessibility feature is one of several soon set to come to iPhones and iPads.

The tech giant also announced a Music Haptics feature, which will allow users who are deaf or hard of hearing to experience music through taps, textures and refined vibrations matched to audio.

Meanwhile, an Atypical Speech feature will be available for those who suffer from speech impairments.

Using Artificial Intelligence, the feature will recognize unique user speech patterns and translate them into instructions that Siri can understand.

“Artificial intelligence has the potential to improve speech recognition for millions of people with atypical speech, so we are thrilled that Apple is bringing these new accessibility features to consumers,” Professor Mark Hasegawa-Johnson from the University of Illinois Urbana-Champaign declared in the company’s release.

This article may contain affiliate links that Microsoft and/or the publisher may receive a commission from if you buy a product or service through those links.

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Neuroplasticity study shows how singing rehabilitates speech production in post-stroke aphasia

by University of Helsinki

Cerebrovascular accidents, or strokes, are the most common cause of aphasia, a speech disorder of cerebral origin. People with aphasia have a reduced ability to understand or produce speech or written language. An estimated 40% of people who have had a stroke have aphasia. As many as half of them experience aphasia symptoms even a year after the original attack.

Researchers at the University of Helsinki previously found that sung music helps in the language recovery of patients affected by strokes. Now, the researchers have uncovered the reason for the rehabilitative effect of singing. The recently completed study was published in eNeuro .

According to the findings, singing repairs the structural language network of the brain. The language network processes language and speech in our brain. In patients with aphasia, the network has been damaged.

"For the first time, our findings demonstrate that the rehabilitation of patients with aphasia through singing is based on neuroplasticity changes, that is, the plasticity of the brain," says University Researcher Aleksi Sihvonen from the University of Helsinki.

Singing improves language network pathways

The language network encompasses the cortical regions of the brain involved in the processing of language and speech, as well as the white matter tracts that convey information between the different end points of the cortex.

According to the study results, singing increased the volume of gray matter in the language regions of the left frontal lobe and improved tract connectivity especially in the language network of the left hemisphere, but also in the right hemisphere.

"These positive changes were associated with patients' improved speech production ," Sihvonen says.

A total of 54 aphasia patients participated in the study, of whom 28 underwent MRI scans at the beginning and end of the study. The researchers investigated the rehabilitative effect of singing with the help of choir singing, music therapy and singing exercises at home.

Singing is a cost-effective treatment

Aphasia has a wide-ranging effect on the functional capacity and quality of life of affected individuals and easily leads to social isolation.

According to Sihvonen, singing can be seen as a cost-effective addition to conventional forms of rehabilitation, or as rehabilitation for mild speech disorders in cases where access to other types of rehabilitation is limited.

"Patients can also sing with their family members , and singing can be organized in health care units as a group-based, cost-efficient rehabilitation ," Sihvonen says.

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