Dysphagia is difficulty with any of the stages of feeding and swallowing.
A child with dysphagia may refuse food, have excessive leaking of food out of their mouth during meals, or demonstrate excessive coughing and gagging. Children with dysphagia may have poor nutrition and weight gain. Reoccurring respiratory infections may also be present due to aspiration. Feeding and swallowing disorders may be caused by autism, premature birth, nervous system disturbance (cerebral palsy), cleft palate, or structural abnormality of the head or neck. An evaluation by a speech-language pathologist can help determine a treatment plan for feeding techniques to support safe swallowing and efficient eating.
Reference and Resources:
Apraxia or Childhood Apraxia of Speech (CAS) is a neurologically based speech disorder which causes motor programming and planning difficulties for movements needed for speech. Individuals with CAS demonstrate difficulty in producing voluntary movements and sequences needed for speech. CAS may affect the following areas: speech articulation, coordination, rate, rhythm and timing. Children with apraxia often exhibit groping of the articulators and have difficulty placing the tongue, lips, and jaw in the correct position for speech. Speech may sound vowel-like with few consonants and contain inconsistent errors such as substitution, omissions, or additions of speech sounds. Individuals with apraxia experience greater difficulty and increased errors as length of utterances increase due to the increased demand to motor plan. CAS is not caused by muscle weakness and structural abnormalities; however, CAS can be present with other disorders caused by muscle weakness or dysfunction such as dysarthria.
There is some debate among professionals in communication disorders on the correct terminology for apraxia. There are several terms for apraxia that professionals may use interchangeably: Childhood Apraxia of Speech (COS), Developmental Verbal Apraxia (DVA), and Developmental Verbal Dyspraxia (DVD). Both apraxia and dyspraxia contain the same root word “praxia” which is the execution of voluntary muscle movements. The “a” in apraxia means the absence of movement while the “dys” in dyspraxia means abnormal or difficult. Apraxia means without speech while the term dyspraxia means abnormal or difficult speech. Apraxia can also be developmental or acquired. Developmental Apraxia indicates speech did not develop or has not already been present versus Acquired Apraxia may result from brain injury or trauma.
(References: The Source for Childhood Apraxia of Speech by Robin Strode Downing and Catherine E Chamberlain)
Articulation refers to the verbal production of speech sounds. An articulation disorder is a speech sound disorder characterized by sound omissions, substitutions, or additions which make the speaker difficult to understand. (Ex: saying /f/ for “th”, /y/ for l). Articulation disorders may be caused by abnormal oral structures or weakness. Learning to talk is a difficult task and speech sound errors during the early years is normal. If speech errors occur past the age of five, a child may have an articulation disorder and benefit from a screening or evaluation by a Speech-Language Pathologist.
Auditory processing disorders in children involve inability to properly process what is heard. The anatomical area involved is the central auditory pathway (beyond the inner ear). Auditory processing is described as “what we do with what we hear”. Symptoms include difficulty understanding when in background noise, auditory memory problems, telling similar speech sounds apart, following directions, difficulty with reading and spelling, and in understanding information presented in the classroom.
APD can affect a child’s success in the classroom and is sometimes overlooked. A basic hearing test will not detect an auditory processing problem. A multidisciplinary team is needed to diagnose APD, with a specialized test battery administered by an audiologist, with the assistance of tests given by a speech-language pathologist. Highly individualized treatment programs are needed for intervention.
Dysarthria is a motor speech disorder which affects the musculature and systems needed for producing speech. Individuals with dysarthria may exhibit too much muscle tone or too little. Muscles may be weak, paralyzed, or uncoordinated. Speech is slurred or is hard to understand. Dysarthria may affect systems of respiration, phonation, resonance, articulation, and prosody. Dysarthria affects children and adults. Conditions that can cause dysarthria are: stroke, traumatic brain injury, cerebral palsy, and multiple sclerosis.
(Reference: The Source for Dysarthria by Nancy B. Swigert)
When describing hearing loss, what is important is type of hearing loss, degree of hearing loss, and configuration of hearing loss. With children, it is especially important to diagnose and treat a hearing loss as early as possible. This limits its potential impact on learning and development.
Hearing loss can be categorized by which part of the auditory system is damaged. There are three basic types of hearing loss: conductive, sensorineural, and mixed hearing loss. The degree of loss can range from slight to profound. The configuration, or shape, of the hearing loss generally refers to the pattern of hearing loss across frequencies (tones), as illustrated in a graph called an audiogram (ie: low frequency, high frequency, flat). Hearing losses can be in one ear or both, can be progressive, sudden, fluctuating, or stable. Some hearing losses are permanent and some can be medically treatable. It is important to contact a physician and/or audiologist if you suspect that your child is having ear or hearing problems.
Selective mutism (formerly known as elective mutism) usually happens during childhood. A child with selective mutism does not speak in certain situations, like at school, but speaks at other times, like at home or with friends. Selective mutism often starts before a child is 5 years old and is usually first noticed when the child starts school. A child with selective mutism should be seen by a speech-language pathologist (SLP), in addition to a pediatrician and a psychologist or psychiatrist. These professionals will work as a team with teachers, family, and the individual. The type of intervention offered by an SLP may include a combination of strategies depending on individual needs. The SLP may create a behavioral treatment program, focus on specific speech and language problems, and/or work in the child's classroom with teachers.
There are different types of voice disorders. The most common causes in children include colds, allergies, bronchitis, exposure to irritants and overuse/misuse of one’s voice. For example, vocal cord nodules are benign (noncancerous) growths on both vocal cords that are caused by vocal abuse and may be accompanied by symptoms such as hoarseness, breathiness, a "rough" and/or "scratchy" voice "lump in the throat" sensation, decreased pitch range and fatigue.
Voice therapy is a program designed to reduce hoarseness through guided change in vocal behaviors and lifestyle changes and should be administered by a licensed speech-language pathologist. Voice therapy consists of a variety of tasks designed to eliminate harmful vocal behavior, shape healthy vocal behavior, and assist in vocal fold wound healing after surgery or injury. Voice therapy for hoarseness generally consists of one to two therapy sessions each week for 4–8 weeks (Hapner et al., 2009).
A Phonological Disorder is speech disorder that also affects clarity of speech, however it differs from an articulation disorder. A phonological disorder is characterized by error patterns which simplify the adult production. Basically, the child does not adhere to the “rules” of sound patterns for producing spoken words. Children with this disorder may produce classes of speech sounds in a different manner or place in the oral cavity. For example all back sounds may be produced at the front of the mouth (making “d” and “t” for the g and k sounds) or may leave off all final consonants such as “bi” for “big”. Phonological processes are considered a normal part of speech-language development and typically resolve on their own. If your child is difficult to understand or continues to use a pattern of errors past the age of five, your child would benefit from a speech screening by a Speech-Language Pathologist. The table below is a helpful tool in determining the clarity of speech that can be expected during the preschool years.
AGE IN YEARS = % UNDERSTOOD BY STRANGERS
Child aged 1 yr: 25% intelligible to strangers
Child aged 2 yrs: 50% intelligible to strangers
Child aged 3 yrs: 75% intelligible to strangers
Child aged 4 yrs: 90% intelligible to strangers