CAUSES OF SPEECH

DISORDERS

SUBMITTED TO Mr.Mohamed Yasin

PRESENTED BY S.Dharsha Poojya
SPEECH :
Speech is a verbal means of communication or
conveying meaning. The result of specific motor
behaviors, it is a process that requires very neuro-
muscular coordination. Speech includes:

Voice: The sound produced in a person’s larynx and

uttered through the mouth as speech is known as
voice.

Fluency: It is the speech pattern which flows in a

rhythmic smooth manner and is with ease.

Articulation: It is a process by which words and

sounds are formed when the lips, tongue, jaw,
teeth and palate adjust the air coming from the
vocal cords.
Prosody: It refers to the patterns of intonation,
stress, pause involved on speech.
Any defect
in the proper functioning of these components are
classified as Speech Disorders.

VOICE:
Any difficulty in producing voice is termed as voice
disorders. The prevalence rate is 3% and 9% (Ramig
& Verdolini, 1998). Voice disorders occurs when
voice quality, pitch and loudness differ or are
inappropriate for an individual’s age, gender,
cultural background or geographical location.
A number of different systems are used for
classifying voice disorders. For the purposes of this
document, voice disorders are categorized as
follows:
• Organic — voice disorders that are physiological
in nature and result from alterations in
respiratory, laryngeal, or vocal tract mechanisms
• Structural — organic voice disorders that

result from physical changes in the voice

mechanism (e.g., alterations in vocal fold
tissues such as edema or vocal nodules;
structural changes in the larynx due to aging)
• Neurogenic — organic voice disorders that

result from problems with the central or

peripheral nervous system innervation to
the larynx that affect functioning of the vocal
mechanism (e.g., vocal tremor, spasmodic
dysphonia, or paralysis of vocal folds)

• Functional — voice disorders that result from

improper or inefficient use of the vocal
mechanism when the physical structure is normal
(e.g., vocal fatigue; muscle tension dysphonia or
aphonia; diplophonia; ventricular phonation).
 . Psychogenic
Voice quality can also be affected when
psychological stressors lead to habitual,
maladaptive aphonia or dysphonia. The resulting
voice disorders are referred to as psychogenic
voice disorders or psychogenic conversion
aphonia/dysphonia (Stemple, Glaze, & Klaben,
2010). These voice disorders are rare. SLPs refer
individuals suspected of having a psychogenic
voice disorder to other appropriate professionals
(e.g., psychologist or psychiatrist) for diagnosis
and may collaborate in subsequent treatment.

ARTICULATION: Any deviance of production of

speech sounds can be divided as Articulation
Disorders. These are further classified as
Phonological and Articulation Disorders.
Articulation disorders are knowing
how to produce the sound but cannot due to some
other reason e.g: cleft lip. If the speaker is speaking
two languages, the same sound or phonemic errors
can be found in both the languages.
Phonological disorders differ as not knowing how to
produce the sound as a result the sound is not
produced properly. The difference between them
can be clearly said in an example. If a child cannot
produce /p/ due to cerebral palasy, then it is
considered as Articulation Disorder. If a child cannot
produce /waha/ in Tamil due to hearing impairment
but can produce identical sounds, then it is
considered as Phonological Disorders.
Articulation Disorders are called Speech Sound
Disorders (SSD).
3 main causes of speech sound disorders are -
• Structural
• Neurogenic
• Mislearning
The cause of functional speech sound disorders is
not known; however, some risk factors have been
investigated.
Frequently reported risk factors include the
following:
• Gender—the incidence of speech sound
disorders is higher in males than in females
(e.g., Everhart, 1960; Morley, 1952; Shriberg et
al., 1999).
• Pre- and perinatal problems—factors such as
maternal stress or infections during pregnancy,
complications during delivery, preterm delivery,
and low birthweight were found to be associated
with delay in speech sound acquisition and with
speech sound disorders (e.g., Byers Brown,
Bendersky, & Chapman, 1986; Fox, Dodd, &
Howard, 2002). Other causes also leads to
congenital malformations like cleft lip and palate
and down syndrome While gender and ethnic
background are risk factors, as described above,
there are other factors that seem to play a role in
causing clefting. Specialists have noted that the
more severe the defect in a child the higher the
risk for a cleft malformation in subsequent
siblings. The recurrence risk for a cleft deformity
 is 2.7% if an older sibling has a single cleft lip. If
an older sibling has bilateral (both sides of the
upper lip) involvement, the recurrence risk is
doubled (5.4%).If a parent has had either cleft lip
or palate, there exists a 4% likelihood of cleft
malformation in their children. However, if an
affected parent has a child with cleft lip or palate,
the chance of future children experiencing a cleft
malformation rises to 14%.
• Family history—children who have family
members (parents or siblings) with speech
and/or language difficulties were more likely to
have a speech disorder (e.g., Campbell et al.,
2003; Felsenfeld, McGue, & Broen, 1995; Fox et
al., 2002; Shriberg & Kwiatkowski, 1994).
• Persistent otitis media with effusion—
persistent otitis media with effusion (often
associated with hearing loss) has been associated
with impaired speech development (Fox et al.,
2002; Silva, Chalmers, & Stewart, 1986; Teele,
Klein, Chase, Menyuk, & Rosner, 1990).
 • FLUENCY:
• Generally, people who do not have ease of
control over their flow of speech are considered
to have disfluency.
• Most of the people with is
disfluency have stuttering. A proper definition for
stuttering is hard to find since the characteristics
of stuttering varies from person to person.
Stuttering is often said as the interpretation in
the flow of speech by repetition and
prolongations of sounds or syllables.
Cluttering on the other hand, also has repetitions
but is different from in the fact that the discourse is
fast in rate (tachylalia) and the repetitions are of
part word or part syllable. Clutters have few
prolongations, tremors and rarely any struggle that
is of a characteristic of stuttering.
STUTTERING
Causes of stuttering are multifactorial and include
certain genetic and neurophysiological factors that
are thought to contribute to its emergence.
Although acquired neurogenic and psychogenic
stuttering are not covered here, they may exist in
rare cases in children. It is presumed that each child
who stutters develops stuttering as a result of his or
her own unique factors. Theories regarding the
onset of stuttering are diverse.
Despite popular beliefs, emotional problems and
parenting style do not cause stuttering. However,
coping with stuttering can result in significant
emotional reactions and avoidance behavior.
Specifically, emotional reactivity/regulation and
behavioral disinhibition have been found to be
associated with stuttering and may affect the child's
ability to cope with disfluencies (Choi, Conture,
Walden, Lambert, & Tumanova, 2013; Jones,
Conture, & Walden, 2014; Ntourou, Conture, &
Walden, 2013). Furthermore, although not
considered a cause of stuttering, environmental
factors may exacerbate disfluency. These factors can
include family dynamics, fast-paced lifestyle, stress
and anxiety, and the child's temperament
(Anderson, Pellowski, Conture, & Kelly, 2003). Alm
(2014) indicates that "children who develop
stuttering (as a group) are not characterized by
temperamental traits such as shyness, social anxiety,
or general anxiety" (p. 18). For a review of
temperament, emotion, and childhood stuttering,
see Jones, Choi, Conture, and Walden, 2014.
While genetics and neurophysiology appear to be
related to the underlying causes of stuttering,
environmental factors, temperament, and speaking
demands may influence a child's reactions to
stuttering.
Genetic Factors
In a review of the literature on the genetics of
stuttering, Kraft and Yairi (2011) indicated that there
is support from a range of studies for a genetic
perspective of stuttering, but that "no definitive
findings have been made regarding which
transmission model, chromosomes, genes, or sex
factors are involved in the expression of stuttering in
the population at large" (p. 34).
Studies have identified likely causative gene
mutations linked to stuttering. Mutations to three
genes (GNPTAB, GNPTG, and NAGPA) have been
found to disrupt the signal that directs enzymes to
their target location in the lysosome of the cell
(Drayna & Kang, 2011). Drayna and Kang (2011)
found that gene mutations were present in close to
10% of cases of familial stuttering.
Neurophysiological Factors
Recent studies have shown both structural and
functional neurological differences in children who
stutter (Chang, 2014). Neurophysiological factors
that are thought to contribute to stuttering include
the following.
Gray and White Matter Differences

Children with persistent stuttering showed

deficiencies in left gray matter volume with
reduced white matter integrity in the left
hemisphere. In contrast to adults who stutter,
 children who stutter did not show increases in
white matter tracts in the right hemisphere
(Chang, Erickson, Ambrose, Hasegawa-Johnson,
& Ludlow, 2008).
Neural Network Connectivity Differences

Children who stutter (ages 3 to 9 years) have

reduced connectivity in areas that support the
timing of movement control. These differences
may affect speech planning needed for fluency
(Chang & Zhu, 2013).
Atypical Lateralization of Hemispheric Functions

Preschool children who stutter showed

differences in event-related brain potentials
used as indices of language processing. These
findings suggest the presence of atypical
lateralization of speech and language functions
near the onset of stuttering. These brain
differences have previously been observed in
adults who stutter (Weber-Fox, Wray, & Arnold,
2013).
White Matter Connections

Adolescents and young adults who stutter were

found to have more white matter connections in
the right hemisphere as compared with
normally fluent controls (Watkins, Smith, Davis,
& Howell, 2008)

.The above neurophysiological factors should be

interpreted with caution due to the small
number of subjects and the heterogeneity of the
methodologies used. Furthermore, the different
areas of the brain studied or the technologies
used to conduct brain research also varied
widely (e.g., PET, MEG, MRI, fMRI, NIRS, DCS).
Another caution is to consider differences
between children and adults when interpreting
data from neurological studies. Chang et al.
(2008) highlight "the importance of considering
the role of neuroplasticity during development
 when studying persistent forms of
developmental disorders in adults" (p. 1333).

CLUTTERING

With regard to cluttering, research is not far enough

along to identify causes. There is very little genetic
information on cluttering, except for anecdotal
reports that the speech characteristics have been
found to be present in more than one member of a
family (Drayna, 2011).
Neurological Factors
Features of cluttering are sometimes observed in
conjunction with other neurological disorders (e.g.,
ASD, Tourette's, and ADHD). Potential neurological
underpinnings of cluttering include dysregulation of
the anterior cingulate cortex and the supplementary
motor area (Alm, 2011).
Speech Production/Self-Regulation Factors
Systems that govern self-regulation may underlie
cluttering; qualitative interviews with those who
clutter suggest that thoughts emerge before they
are ready (Scaler Scott & St. Louis 2011). The speaker
is proposed to be talking at a rate that is too fast for
his or her system to handle, resulting in breakdowns
in fluency and/or intelligibility (Bakker, Myers,
Raphael, & St. Louis, 2011).
Cultural and Linguistic Considerations
Speaking two languages at home since birth does
not cause stuttering (Shenker, n.d.). Information is
varied and conflicting regarding the exact
relationship between bilingualism and disfluencies
(Van Borsel, Maes, & Foulon, 2001; Tellis & Tellis,
2003). Bilingualism may influence stuttering in
unpredictable ways due to variations across social
settings in language selection and fluency (Foote,
2013). Clinicians must consider other psychosocial
issues that may lead to the onset of stuttering or a
temporary increase in stuttering in multilingual
individuals, including the effects of being in new and
unfamiliar situations, using a new language, and
being exposed to mixed linguistic input (Shenker,
2013).
PROSODY:
The prosodic quality of speech comprises intonation,
accent pattern, and rhythm. Among others, these
dimensions contribute to the linguistic structure of an
utterance and subserve emotional behavior. Both
cortical and subcortical dysfunctions can give rise to
impaired speech prosody. Sporadically, lesions of the
left hemisphere present with dysprosody in terms of
a “foreign accent”. In most of the cases, this is due to
apraxia of speech.
Some authors consider dysprosodic
speech as a feature of Broca’s Aphasia which is due
to the temporal organization of speech utterances.
The altered intonation contours are presumed to be
a result of disordered sentence planning and
wenicke’s aphasics have shown variability of
intonation patterns.
Also, impaired discrimination and identification
have been observed in patients with
temporoparieteal lesion of the right hemisphere.
Damage to the right hemisphere can give rise to
monotonous speech devoid of affective modulation
(motor aprosodia). But research on a large scale is
not done to confirm these claims.

OTHER CAUSES OF SPEECH DISORDERS :

Genetical or congenital: This cause is due to the
inheritance of genes from parents and in some
cases grandparents or previous ancestors. Many
disorders related to speech and language such as
Down’s Syndrome, Autism can be explained
through this cause. Mutation of FOXP2 gene in
humans are considered the main cause of speech
and language disorders as this gene is involved in
the growth and development of speech and
language centers and corresponding components
(Vargha-Khadem et al. 1995, 1998; Lai et al. 2001;
Watkins et al. 2002).
Neurological: This involves abnormalities or
disruptions in the neurological structures of the
body which causes speech and language problems.
Examples are aphasia, parkinson’s disease. In both
of these conditions, some part of the central
nervous system is affected and this inturn affects
speech and language structures of the human body.
Psychological: This cause involves the person to
develop a predisposition of thought in most of the
cases or the person has improper perception of the
language or speech. Example, a person with hearing
loss or sensory impairment may produce the word
in an improper manner. This causes the person to
learn that the way of pronunciation is actually
correct and thus this develops. Now the person
irrespective of the language he/she speaks, will
produce the sound in the same manner. This is
called as articulation disorder and it maybe
considered psychological too.
Traumatic: In traumatic, there is an incident during
which the person undergoes trauma physically
(accident) or psychologically(abuse) due to which
there is a problem in the speech and language.
Physical trauma causes structural/anatomical
damage and this causes the problem but in
psychotrauma, it is purely a state of mind by which
the disorder lies in.
Tetrogenic: This cause is due to environmental
factors affecting the individual either during
prenatal or postnatal development. Some of the
disorders are cleft lip and palate and intellectual
disability. The environmental factor can be due to
drugs intake, exposure to toxins, trauma or
inadequate social exposure.
Metabolic: This is due to abnormalities in the
metabolism of the body of the individual. Examples
are hypothyroidism which causes the individual to
develop high pitched voice which is otherwise called
as puberphonia.
Infectious: This is due to infection by some
microorganism or parasite that causes speech and
language problems. The infection can happen
during development or after development.
Examples are encephalitis and meningitis.
Idiopathic: This is given to disorders that have no
known or undiscovered cause.
Note that all of these
causes for some diseases may overlap and cause the
problem to have more than one cause. In such
cases, differential diagnosis may be required.
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