SPEECH AND LANGUAGE DISORDERS
Communication is the exchange of thought, words and ideas between two or more individuals. Speech is the communication in an audible (verbal) form. Language denotes the knowledge of rules for communication.
Language is a function on which the speech is constructed.
Normal development of speech requires- (a) normal hearing, (b) normal neurological functions to understand, process and formulate appropriate response, and (c) normal motor structures and neuromuscular coordination required for phonation. In addition, stimulative social and emotional nurturing in the environment is also essential for development of verbal skills and language.Etiologically speech disorders may be primarily due to (Table 3.15):
a. Disorders of receptive language, e.g. hearing impairment, (commonest cause in children).
b. Disorders of central processing, e.g. CNS disorders,
c. Disorders of expressive language due to orofacial or phonation problems.
Clinically, expressive speech disorders may be broadly classified as follows, though many patients have multiple defects.
a. Resonance disorders: Hyper/hyponasality.
b. Voice disorders: Abnormal pitch/quality of voice.
c. Fluency disorders: Stuttering, stammering, etc.
d. Articulation disorders, e.g. imprecise production of sounds, e.g.
- Substitution, i.e. replacement of one sound with another, e.g. height for light.
- Omission, i.e. failure to produce some sounds, e.g. boo. for book.
- Distortion, i.e. inappropriate sounds replacing the correct one.
e. Language disorders, i.e. problems in formulation of proper language, e.g.
- Telegraphic speech, i.e. inability to form sentences.
- Word-finding disorders, i.e. difficulty to name a picture or in the use of gestures to explain it.
- Narration disorders, i.e. inability to describe an experience or tell a story.
Diagnosis: Early warning signals for speech problems in a baby include:
1. Does not babble by 6 months
2. Does not speak monosyllables by 9 months
3. Does not speak > 3 words by 18 months
4. Does not speak 2 word meaningful phrases by 2 years
5. Excessive meaningless (jargon) speech beyond 2 years
6. Does not speak simple meaningful sentences by 3 years
7. Stutters beyond 4 years
8. Any speech sound error beyond 7 years
9. Presence of pitch abnormalities at any age.
Management: Presence of speech defects needs careful evaluation, intervention and follow-up, as many of them are easily manageable. Principles of management include:
• Correction of hearing impairment, etc.
• Speech and phonation therapy,
• Training in alternate modes of expression, e.g. sign language, etc. and
• Behavioral support and counselling.
3.10