Most Common Etiologies

• Cerebral palsy
• Craniofacial disorders (e.g., cleft lip/palate)
• Functional articulation and/or phonological disorders

Potential Consequences/Impact of Speech Impairment Can Include

• Difficulty expressing need or routine information intelligibly
• Difficulty communicating intelligibly in order to function at level of independence expected for age
• Difficulty expressing feelings intelligibly; may be at risk for frustration or depression
• Difficulty engaging successfully in social and/or classroom situations that require intelligible speech
• Difficulty achieving adequate intelligible speech to reach educational potential
• At risk for personal injury due to difficulty communicating intelligibly about a dangerous situation or calling for help

Behaviors That Should Trigger an SLP Referral

By age 3 years cannot:

• be understood by family and/or caregivers
• correctly produce vowels and such sounds as p, b, m, w in words
• repeat when not understood without becoming frustrated

By age 4 years cannot:

• be understood by individuals with whom they do not associate regularly
• be understood by family and/or caregivers
• correctly produce t, d, k, g, f
• be asked to repeat without becoming sensitive

By age 5 years cannot:

• be understood in all situations by most listeners
• correctly produce most speech sounds
• be asked to repeat without exhibiting frustration

Disturbance in neuromuscular control causes difficulty learning to produce sounds appropriately

• speech is usually slurred; difficulty controlling respiration for speech; abnormal loudness, rhythm, or vocal quality
• exhibits difficulty learning sounds to form words; may sound nasal, strangled and/or breathy
• exhibits frustration and/or avoidance of speech due to extreme difficulty forming sounds or difficulty being understood

Disturbance in programming, positioning, and sequencing of muscular movements

• sound errors are prevalent but variable (i.e., “dog” could be produced “dog,” “tog,” “gog,” “god” by same child)
• varies from rarely being able to produce sounds to ongoing speech that is rarely understood, or speech that is usually understood with frequent sound errors
• unaware of sound variations or exhibits varying degrees of frustration and/or anxiety regarding inability to “control speech”

Disturbance in performing voluntary movements with mouth and vocal mechanism

• cannot produce movements for sound production or sounds are produced without voice (whispered speech)
• varies from inability to produce any words to extreme difficulty being understood
• exhibits frustration and/or avoidance of speech due to difficulties

Deafness/severe hearing loss causes severe prosodic disturbances in intonation, duration, and rhythm in addition to sound errors

• produces no meaningful words or sounds understood only by family
• speaks loudly in high pitched voice with frequent distortion, omission, and substitution of sounds

Autism, emotional disturbance, and/or intellectual disabilities may cause very unusual prosodic variations

• intonation and/or rhythm of connected speech may sound abnormal
• volume may be consistently or intermittently too loud or too soft

Deviation in structure of speech mechanism

• difficulty producing specific sounds and intelligible speech
• exhibits frustration and/or avoidance of speech
• speech has excessive nasality

Difficulty in hearing and/or inability to differentiate between sounds inhibit child’s ability to detect and correct error sounds; usually unaware of errors

Intelligibility and sound production are compromised when nasal passages, nasopharynx, and larynx are bypassed due to tracheostomy/ventilator dependence

Exhibits sudden decrease in speech intelligibility

• ranges from slurred, generally intelligible speech to total absence of speech, or totally unintelligible speech
• awareness ranges from extremely aware to totally unaware of sound errors

Exhibits decline in ability to be understood by family, friends, and/or caregivers in the expression of basic needs, preferences, and feelings