A speech impediment or speech disorder are is any imperfect verbal utterances that occur even when the message being expressed has been properly formulated in the individual’s mind and is linguistically intact.

Speech impediment is the most prevalent type of communication disorder in humans. They may result from (1) maldevelopment or damage within the nervous system; (2) maldevelopment or damage in the peripheral structures producing speech; (3) faulty learning; and (4) functional disruptions arising from other causes. These disruptions include psychological disorders, hearing loss, and disturbances within the central nervous system producing severe language disorders such as aphasia.

Nervous System Disorders

Speech defects caused by maldevelopment or damage within the motor nervous system are typified by persons with cerebral palsy. Such a person’s lack of coordination in speech is directly related to the locus and extent of his neurological damage. For example, persons with athetoid involvements (random muscular movements) experience different problems of muscular control for speech than do individuals with spasticity. Controlled muscular movements are a requisite for normal speech production. Disorders affecting muscular control may result in complete inability to articulate speech sounds or produce slow, labored, and distorted speech utterances, a difficulty known as dysarthria. In addition, degenerative diseases of the nervous system, such as multiple sclerosis and Parkinson’s disease, can affect speech production or cause severe voice defects by affecting the nerve fibers leading to. the vocal folds.

Brain lesions caused by head injury or disease in the nervous system, such as meningitis or some other cerebrovascular episode, including stroke, can produce speech defects as a concomitant of language disorder.

Methods for restoring a damaged nervous system are unavailable. Management of both speech and voice defects arising from such damage must be primarily educative and rehabilitative through long-term training programs, provided by specially trained speech pathologists.

Malformation or Damage

Speech defects often result from malformation or damage of the peripheral organs that generate the sounds used in speech production (tongue, teeth, palate, lips).

Notable instances of speech defects caused by such damage are found among children with a cleft palate. A congenital cleft is a hole in the hard or soft palate and sometimes both. It is accompanied by a hole in the upper lip. A cleft palate prevents separation between the nasal and oral cavities, which is necessary for the control of breath flow and for the acquisition of good speech skills. The presence of a cleft palate and cleft lip results in abnormal nasalization of every utterance. In addition, it results in faulty articulation characterized by sound distortions and substitutions. This is because the tongue has no palate to work against in producing speech sounds correctly and the upper lip does not function properly. The consequent sound aberrations may be so severe that young children with this condition are often unintelligible. Surgery or well-fitted obturators (artificial palates), or both, generally can eliminate the palate and lip defect. Unfortunately, palatal corrections usually are not completed until after children have developed some faulty speech patterns that must be modified or corrected through special training. Some persons cannot obtain adequate palatal control and closure as a result of surgery or prosthetic devices such as the obturator. Intensive specialized speech training is beneficial in helping such persons develop proper muscular control and articulation for effective speech production.

Certain types of articulatory defects or inability to produce the individual speech sounds of words may result from malformation of or damage to the tongue and teeth. Some persons have a very short lingual frenum, the tiny membrane attached to the bottom of the tongue tip, with the result that tongue tip movements are restricted in the articulation of speech sounds.

For many years, most persons with defective speech articulation were referred to as being “tongue-tied.” However, only a very small incidence of the population has an actual tongue-tie condition resulting from shortness in the lingual frenum . This condition is usually amenable to simple surgery, but such a person may require speech training by a speech pathologist in order to relearn correct articulatory skills. Poor alignment of the teeth may also affect speech production and generally requires correction by orthodontia. However, speech pathologists often are able to teach persons alternative methods for sound production that result in improved speech.

Damage to the peripheral organs of speech may be a result of accident or disease. The most striking example of the latter is the person whose larynx has been removed because of cancer. The removal of the larynx, or voice box, leaves the patient voiceless and without the usual control of the breath stream necessary for speech production.

Speech can be restored only by teaching the patient to employ a substitute sound source, usually referred to as an esophageal or pharangeal voice. Acoustical modification of this sound is achieved by means of the articulators (tongue, teeth, lips, and palate). Most laryngectomees are capable of learning esophageal speech with special instruction. Some persons have too little tissue left after surgery or prefer not to pursue treatment, and they must resort to the use of an artificial larynx, which produces sounds through a mechanical vibrating system.

Voice disorders are often referred to as speech defects because they affect the “sound” of speaking. Many voice disorders are caused by transient or chronic respiratory infections associated with colds, sinus infection, or allergies. Such infectious conditions produce swelling in the vocal mechanism and affect the quality of phonation.

Some laryngeal disorders result from growths on the vocal cords, such as vocal nodules, or papilloma. Chronic infection, disturbances in the metabolic system, and vocal abuse have been associated with the development of nodes or nodules in the larynx. Severe voice disorders can occur as a result of paralysis affecting one or both vocal folds.

The cause and treatment of voice deviations can only be detern1ined by a laryngologist and a speech pathologist. Medication, surgery, and modification in vocal behavior represent the usual procedures for managing voice disorders. One or all of these procedures may be necessary depending upon the type of condition diagnosed. Some disorders of voice may be the consequence of aberrant psychological conditions, such as hysterical aphonia, the complete loss of speech that sometimes occurs after a traumatic emotional experience.

Learned Speech Defects

Speech defects can be products of faulty learning and, in some instances, can be related to concomitant disorders in the hearing mechanism, such as impairment in auditory acuity or auditory discrimination. Defects in articulation, or disordered speech-sound production, constitute the highest incidence of learned disorders. Many children manifest faulty articulation during the time they are learning the speech sounds of their native language. Most children cannot articulate all of the consonant sounds in American English, for exan1ple, until they reach seven years of age. Approximately 5% of the population fail to develop correct articulatory patterns and require special assistance if they are to learn adequate speech sound production.

Lisping is one of the most prevalent types of articulatory defects.

Defects of this type can usually be minimized or eliminated by appropriate ear training combined with practice in correct speech production.

Persons who learn a second language often retain accents, inflections, and speech patterns of their native tongues and require special help in learning to articulate accurately some sounds of the new language.

Persons with articulatory defects presumed to be due to faulty learning should be examined by an audiologist or speech pathologist, since many of these types of defects can actually be the result of subtle neurological impairment, such as disturbances in oral-sensory perception, lack of auditory monitoring skills, or disturbances in the organization of sequenced speech movements.

Other Functional Speech Defects

All speech defects involve complex behavior. This is particularly true of those speech disorders that can be symptomatic of deep-seated psychological disturbances with or without organic malfunction.

Persons with hysterical aphonia, or inability to phonate sound in the larynx because of psychological upset, may require psychiatric counseling.

On the other hand, some aphonic individuals are responsive to speech retraining as a method of treatment.

The problem of stuttering further illustrates one of the most complex types of speech behavior.

Patterns of dysrhythmic speech in children and adults are often accompanied by other habituated speech difficulties. Some experts believe that all forms of stuttering result from inappropriately learned habit patterns. Many authorities, however, feel that stuttering is a symptom of primary psychological disturbances. Other authorities submit that the cause of stuttering is unknown. While there is no consensus on the primary cause of stuttering, the enigma of stuttering best illustrates the type of speech defect that does not have a clear-cut organic or non organic explanation. It is true, however, that many stutterers have found that their speech behavior can be modified and improved with special help, and, in some instances, stuttering has been completely eradicated.

Speech production is often affected by impaired input or receptive functions (hearing) or by faulty central integrative functions (language). Receptive, integrative, and expressive functions are interrelated, and normal communication can only occur when these activities are sequentially unified. A disturbance at any point in the receptive-to-expressive system can produce a severe disorder in communicative ability. Incidence of Speech Defects. Approximately 5% of the U. S. population have speech defects, and an additional 5% have communication disorders involving hearing, language, or voice. Of this total of 21 million persons, some 10 million suffer from speech defects, 2 million from language disorders, and nearly 9 million from some degree of hearing impairment.

The annual total of direct expenditures made by public and private organizations to train professional personnel and to treat hearing, speech, and language disorders through programs in special education, vocational rehabilitation, and speech pathology and audiology services is estimated to be at least $500 million. Indirect costs, those representing the annual deficit in earning power among the communicatively handicapped in the United States, have been estimated at $1.75 billion annually. No dollar estimate can be given to the serious, often tragic, personal and social problems encountered by individuals with communication disorders.

Speech Pathology and Audiology

Many professional medical and clinical personnel are involved in treating speech defects. The professional specialties of speech pathology and audiology developed out of concern for people with communication disorders, and members of this profession are most closely involved with communication competency as manifested in speech, language, and hearing. They are devoted to the study and management of disorders, normal speech development, and cultural-ethnic influences in human communication. Speech pathologists, audiologists, and speech scientists perform basic and applied research and clinical services for those with impaired communicative ability. Some members of the profession are involved in university teaching, government or community agency administration, or research.

Most speech pathologists and audiologists provide direct clinical services through community speech and hearing centers, hospitals, public and private school systems, health department clinics, college or university clinics, or private practice.

Graduate study at a university department of speech pathology and audiology, school of education, or school of medicine is a prerequisite for a career in speech pathology and audiology.

Supervised clinical practice is an integral part of the preparation. Certification by state departments of education is required for those who work in public schools with children with speech, hearing, and language defects. Some states also license speech pathologists and audiologists who provide clinical services in other situations.

Photo by Benjamin Earwicker

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