Speech and language disorders refer to problems in communication and related areas such as oral motor function. These
delays and disorders range from simple sound imitations to the inability to understand or use language or use the oral-motor
process for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological
disorders, brain injury, mental retardation, drug abuse (during pregnancy), physical impairments such as cleft lip or  palate,
and vocal misuse. Often the cause is unknown.

Speech Delay

A child's communication is considered delayed when the child is noticeably behind compared to others of the same age,  in
the acquisition of speech and/or language skills. Sometimes a child will have greater receptive (understanding) than
expressive (speaking) language skills, but this is not always the case.

Speech disorders are difficulty  producing speech sounds or problems with voice quality. They might be characterized by a
break  in the flow or rhythm of speech, such as stuttering. Speech disorders may be problems with the way sounds are
formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or quality of the

There may be a combination of several problems. Children with speech disorders have trouble using some speech sounds,
which can also be a symptom of a delay. They may have difficulty pronouncing sounds like “L”, “R”, or “SH”.  Listeners
may have trouble understanding what the child with a speech disorder is trying to say. A child with voice disorders may
have trouble with the way their voices sound.

Language Disorder

A language disorder is an impairment in the ability to understand and/or use words in context, both verbally and nonverbally.
Signs of language disorders include improper use of words and their meanings, inability to express ideas, inappropriate
grammar, reduced vocabulary and inability to follow directions. One or a combination of these characteristics may occur in
children who are affected by language learning disabilities or developmental language delay. 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 say.

Types of Speech/Language Disorders

Developmental Dyspraxia - Dyspraxia is a neurologically based disorder also known as (Developmental Co-ordination
Disorder, and the Clumsy Child Syndrome) is present from birth. These children have difficulty in  motor planning of
movement to achieve a predetermined idea or purpose.  It is believed to be an immaturity of parts of the motor cortex (area
of the brain) that prevents messages (ideas) from being properly transmitted to the body, which may affect any or all areas
of development. It is inconsistent, and affects each child in different ways, at different stages of development and varies in

There are three (3) types of Developmental Dyspraxia. Oral Dyspraxia, Verbal Dyspraxia, and Motor Dyspraxia.

Oral Dyspraxia - children are unable to reproduce mouth movements. Examples of this are the inability to put their tongue
up to the roof of their mouth. A child with oral dyspraxia may not be able to, even though they do this unconsciously.

Verbal Dyspraxia - children have difficulty pronouncing  sounds or saying words. Many words just do not sound right
regardless of how hard they try to produce the sound or word correctly.

Motor Dyspraxia - inhibits an individual from moving as planned and effects their sensory input. Children with motor
difficulties appear to be clumsy, as if out of sync with their environment.

Somewhere between sensory information gathering and storing, ideation, motor planning, and action, the messages are not
getting through clearly causing them not to produce correct action. The following is an insight of difficulties a child with
dyspraxia faces.

Ideas - When babies explore a new activity like a set of blocks, for the first time they gather sensory information about the
object. How it feels, tastes, looks and smells, and their shape. How much space that shape takes up, what the weight feels
like, are they hard or soft, strong enough to support each other, do they stay put or roll, balance etc.

Motor Planning - The motor planning area of the brain has received the idea, now it must work out and plan the positions
of the body, which arm and leg muscles must contract or relax, in what sequence and how much, how delicately the finger
muscles must move and in which direction. To work this out it needs to recall sensory information from past experiences. It
also has to plan the sequence in which the muscles are to work, how still the rest of the body must stay, etc. When this plan
is made, messages are sent out for action.

Action - Muscles can only contract or relax, and for each muscle messages from the brain are telling it what to do, for how
long, and in what sequence, and sending sensory information, requesting action. When the motor plan has been made,
messages are sent first to each part of the brain, and then to all the muscles to tell them what to do to carry out the actions.

Characteristics of Dyspraxia

Symptoms vary and may include:

•        Poor balance and coordination,

•        Clumsiness,

•        Vision problems,

•        Perception difficulties,

•        Emotional and behavioral problems,

•        Difficulty with reading, writing, and speaking,

•        Poor social skills,

•        Poor posture, and

•        Poor short-term memory.

Although individuals with the disorder may be of average or above average intelligence, they may behave immaturely. It
takes longer for them to learn new skills and absorb what has been learned.

Dyspraxia may affect various  motor functions (e.g., fine motor control, gross motor planning) and other language
functions (e.g., learning grammatical function words like "the, "is"and "or"). Other learning difficulties are spelling; putting
words together into a sentence or sentences into a paragraph.

Dyspraxia  affects up to one in 20 children, with boys identified four times more frequently than girls. 50% of these
children exhibit emotional and or behavior problems. Children with Dyspraxia may appear no different from their peers, until
new skills are tried or attained skills are taken out of known environment, is when difficulties may become apparent.
Therefore diagnosis, naming the disorder, is often very difficult. It is only those children whose disorder  markedly impairs
their learning and development who stand a chance of having their difficulties recognized, diagnosed, and treated.

Childhood Apraxia of Speech

Apraxia is a disorder of the nervous system, described by an inability to perform determined movements, but not
accompanied by a loss of sensory function or paralysis. Apraxia is a motor speech disorder which affects voluntary or
learned motor performance it can be oral, verbal, or developmental. Children with apraxia have problems saying sounds,
syllables, and words. In apraxia the brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for
speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements
necessary to say those words. Apraxia is caused by an injury or accident to the area of the brain responsible for performing
these acts, apraxia may or may not exist with a language disorder and can affect any part of the body.

In oral apraxia the individual has difficulty performing non verbal tasks with muscles in the larynx (vocal cords), pharynx
(the canal that connects the mouth and nasal passages with the esophagus), tongue, or cheeks. Reflexive or automatic
function is intact, but the person is usually unable to carry out specific directions when asked. For example the child may
open his mouth when asked to close his/her eyes or say the word "blow" when asked to blow out a match. It is not unusual
for a person with apraxia to insist he/she has achieved the correct movement when no movement has been performed at all.
Many of the responses can be considered peculiar, while the person may be completely unaware of any irregularity.

Verbal apraxia is defined as difficulty executing the appropriate movements for speech when paralysis, weakness, or
incoordination exists. Consequently, individuals may have extreme difficulty making speech movements. Such impairments
may lead to the lack, alteration, or substitute of certain sounds. Mistakes seem to increase as the length of the word or
sound become difficult, and initiating speech can be almost impossible. Repetition of phrases may be inconsistent and overall
quality of sound may be poor. Debate regarding the cause of apraxia continues. It is generally accepted however, that the
lesion causing apraxia is most likely deep within the left frontal lobe.

Symptoms may include difficulty initiating speech, difficulty sequencing speech sounds, and oral struggle behaviors.
Children with developmental apraxia 2 may not show evidence of a brain lesion, while adults always do.

It is important to have your child evaluated by a speech-language pathologist (SLP) who has knowledge of apraxia to rule
out other causes of speech problems.  General things to look for include the following:

Signs of Apraxia

In Very Young Children

•        Lack of cooing or babbling as an infant, first words may not appear at all, pointing and "grunting" may be way of

•        Produces first words after some delay, but these words are missing sounds.

•        Single words may be articulated well, but attempts of sentences becomes unintelligible.

•        A whole phrase may be clearly said and never heard again, or cannot be repeated.

•         Fine-motor problems may be present (using pincer grasp).

•        Produces only a few different consonant sounds many of which are b, m, p, t, d, or h.

•         Words may be simplified by deleting consonants or vowels, and/or replacing difficult phonemes with easier ones. A
syllable is favored, and used for all words.

•        May have feeding problems

An Older Child

•        Makes inconsistent sound errors that are not the result of immaturity
•        Can understand language much better than he or she can speak
•        Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech  
•        May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for
purposeful movement
•        Has more difficulty saying longer words or phrases clearly than shorter ones
•        Appears to have more difficulty when he or she is anxious
•        Is hard to understand, especially for an unfamiliar listener
•        Sounds choppy, monotonous, or stresses the wrong syllable or word  

Potential Other Problems

•        Weakness of the lips, jaw, and/or tongue
•        Delayed language development
•        Other expressive language problems like word order confusions and word recall  
•        Difficulties with fine motor movement/coordination
•        Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like tooth brushing or
crunchy foods, may not be able to identify an object in their mouth through touch)
•        Children with apraxia or other speech problems may have problems when learning to read, spell, and write

Speech / Language Therapy

Speech-language pathologists assist children who have communication disorders in various ways. They 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. The speech-language pathologist may assist teachers in establishing communication goals related therapy  experiences
of students and suggest strategies that are effective for proper development.

Vocabulary and concept growth continues during the years children are in school. Reading and writing are taught and, as
students get older, the understanding and use of language becomes more complex. Communication skills are the root of the
education experience. Speech and/or language therapy may continue throughout a student’s school years. Occupational
therapy, physical therapy, and learning disabilities assistance are often helpful.


All communication disorders have the potential to isolate children from their social and educational surroundings, it is
important to seek appropriate intervention. While many speech and language patterns can be called "baby talk" and are part
of a young child's normal development, they can become problems if they are not outgrown as expected. In this way an
initial delay in speech and language or an initial speech pattern can become a disorder which can cause difficulties in
learning. Because of the way the brain develops, it is easier to learn language and communication skills before the age of 5.
When children have muscular disorders, hearing problems or developmental delays, their acquisition of speech, language and
related skills is often affected.

More than one million of the students served in the public schools’ special education programs in the 2000-2001 school year
were categorized as having a speech or language impairment. This estimate does not include children who have
speech/language problems secondary to other conditions such as deafness, or language disorders related to other disabilities
such as mental retardation, autism, or cerebral palsy. It is estimated that communication disorders (including speech,
language, and hearing disorders) affect one of every 10 people in the United States.

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