Speech Pathology Disorders
Your child may benefit from a speech evaluation if he has exhibits difficulty in any of the following areas:
A child with a feeding/swallowing disorder, or dysphagia, may exhibit any of the following signs or symptoms: coughing/choking during oral intake, difficulty chewing, difficulty drinking from a bottle or cup, difficulty feeding from a spoon, failure to progress in an age appropriate diet, and avoidance of certain textures of foods.
A videoflouroscopic swallow study may be indicated if your child persistently has difficulty with coughing or choking during oral intake. Your primary care physician will refer you for this procedure. The speech pathologist who performs the procedure will give your child various consistencies to drink/eat during the study to determine if your child is having difficulty swallowing.
A functional feeding evaluation may be indicated if your child is exhibiting difficulty with gagging with certain textures of foods, difficulty progressing in age appropriate solids, or exhibits difficulty with chewing foods.
Fluency Disorder (Stuttering)
A child with a fluency disorder, or stuttering, has difficulty with maintaining an appropriate flow of speech. Patterns of stuttering that are typically seen are repetitions, prolongations, or halting (blocks) in speech. Extraneous face and body movements, referred to as secondary characteristics, may or may not occur during these moments of dysfluency. It is not uncommon for young children to experience dysfluency as they are learning language; however, if a pattern persists longer than six months or should the child exhibit significant difficulty in expressing themselves due to the stuttering pattern, a referral for a speech evaluation may be warranted.
A child with a language disorder may have difficulty in any of the following areas:
- Receptive Language: Child may exhibit difficulty understanding directions or demonstrating understanding of concept
- Expressive Language: Child may exhibit difficulty expressing his wants and needs, or may exhibit difficulty answering questions
- Pragmatic Language: Child may exhibit difficulty demonstrating understanding of higher level language concepts, such as use of idioms, jokes, etc.
Children with language disorders often have difficulty effectively communicating with others and at times can cause significant frustration.
Resonance disorder can be classified into two main categories: hypernasality and hyponasality. Hypernasality may occur due to velopharyngeal insufficiency (VPI), which happens when the valve that closes off the nasal passageway does not function. Children with cleft palate have a higher probability of exhibiting hypernasality due to anatomical differences in the soft palate caused be the cleft. Children with VPI may be seen with a speech pathologist and a pediatric otolaryngologist concurrently to assess what types of treatment options are appropriate for the child. Hyponasality typically occurs when there is a blockage of the nasal passageway which does not allow nasal sounds to be produced (m, n).
A child with a speech disorder, or articulation disorder, may have trouble with producing the sounds needed for speech. For example, he may substitute, omit or distort certain sounds in words. Children may also exhibit difficulty with whole classes of sounds (phonological disorder) or have difficulty with motor planning of speech (apraxia of speech). These mentioned patterns often make children very difficult to understand.
Velopharyngeal Insufficiency (VPI) is a condition in which the soft palate, or the back moving part of the roof of the mouth, does not close the nose off well enough during speech. This allows too much air to go through the nose during talking. This can be a problem because most sounds in English require good pressure to be built up in the mouth, with no air escaping through the nose. People with VPI are often described as having "nasal" sounding speech.
A child can have VPI after a cleft of the palate is repaired because the palate may remain too short or not move well. Children who have never had a cleft of the palate may also have VPI due to being born with a short palate or having poor muscle control of the palate. Some children who have Apraxia of speech may have VPI because of difficulties coordinating muscle movements of the mouth, including the palate, for speech.
VPI may result in speech that sounds too nasal (hypernasality). VPI can also make it hard for children to build up the oral pressure needed for many speech sounds. If you lose too much air out the nose, then some sounds may come out "weak" orally. Also, VPI can result in what is called audible nasal air emission or a "snorting" noise with selected sounds, especially those sounds that require lots of oral air pressure.
Any time there is too much air coming out of the nose during speech, we recommend that child receive a speech evaluation to determine whether they have VPI. Because this speech problem rare and requires specialized training and often times specialized instrumentation for evaluation, we recommend an ACH Speech Department evaluation. We can help determine if the child's symptoms should be addressed in speech therapy or if the ACH ENT physician may need to take the next step with a nasendoscopy. We can collaborate with the local speech pathologist about therapy procedures and discuss what to expect over time.
A child that exhibits a voice disorder may exhibit characteristics which include: chronic hoarseness, persistent breathiness (voice that is too soft), pitch breaks, pitch that is too high for age/gender. A child that exhibits any of these characteristics should be referred to a pediatric otorlayngologist to rule out vocal pathology initially. A speech evaluation may be requested to assist the family in techniques to target the voice disorder.