Speech Sound Disorders

Submitted to : Dr. Ravalli Mathur

Presented by : Fatema Siawala
UNIT 2
ASSESSMENT OF
SPEECH SOUND
DISORDERS
Speech sound disorders is an umbrella term
referring to any difficulty or combination of
difficulties with perception, motor
production, or phonological representation
of speech sounds and speech segments—
including phonotactic rules governing
permissible speech sound sequences in a
language.

Speech sound disorders can be organic or

functional in nature.
● Organic speech sound disorders result
from an underlying
motor/neurological, structural, or
sensory/perceptual cause.
● Functional speech sound disorders are
idiopathic—they have no known cause.
ORGANIC SPEECH
SOUND DISORDERS
MAJOR STRUCTURAL VARIATIONS OF THE
SPEECH MECHANISM
● It should not come as a surprise that significant anomalies of the oral structures are
frequently associated with specific speech problems. Oral structural anomalies may be
congenital (present from birth) or acquired. Cleft lip and/or palate is perhaps the most
common congenital anomaly of the orofacial complex.
● Acquired structural deficits may result from trauma to the orofacial complex or
surgical removal of oral structures secondary to oral cancers. For individuals with
orofacial anomalies, the course of habilitation or rehabilitation often includes surgical
and/or prosthetic management, and therefore the speech clinician must work closely
with various medical and dental specialists.
1. LIPS
● Surgical repair of clefts of the lip can result in a relatively short and/or immobile upper lip.
Although this might be expected to adversely affect articulation skills, this is not generally
the case.
● A retrospective study by Vallino, Zuker, and Napoli (2008) reported that only 12/90(13%) of
children with an isolated cleft lip were identified as having an SSD. The fact that the
numbers are so similar suggests that having an isolated cleft lip does not increase the
chances of having an SSD.
1. TONGUE
● The tongue is a muscular structure capable of considerable changes in length and width.
Because the tongue is such an adaptable organ, speakers are frequently able to compensate
for extensive amounts of the tongue missing and still maintain intelligible speech.
● A glossectomy is a surgical procedure involving removal of some or all of the tongue.
Clinical investigators have repeatedly reported intelligible speech production following
partial glossectomies. For many patients, however, speech production is affected to varying
degrees when all or part of the tongue is excised.
● Partial glossectomy patients utilized the residual tongue stump to modify articulation; total
glossectomy patients made mandibular, labial, buccal, and palatal adjustments during
speech production.The result of a glossectomy is a less than complete tongue.
● At the opposite extreme is the individual with macroglossia, or a tongue that is too large. A
distinction must be made here between true macroglossia, in which the tongue is larger than
expected, and relative macroglossia, in which a normal size tongue occurs with an oral
cavity that is too small (Vogel, Mulliken, and Kaban, 1986).
● True macroglossia is thought to reflect an active growth process such as a tumor or a
vascular malformation, or it may reflect certain genetic conditions such as Beckwith-
Wiedemann syndrome (BWS) (Van Lierde, Mortier, Huysman, and Vermeersch, 2010).
● A well-known example of relative macroglossia is seen in individuals with Down
syndrome(DS). In either type of macroglossia, speech may be affected because the tongue
essentially has less room within which to move.
3. HARD PALATE
● The removal of any part of the maxilla, which includes the hard palate (e.g., necessitated by oral
cancer), if not restored surgically or prosthetically, creates a serious problem for the speaker. Most
patients receive palatal closure through a prosthetic (dental) appliance sometimes called an
obturator.
● The maxillectomy patients had their defects obturated with a dental appliance. Testing was
conducted one month after obturation on measures of speech intelligibility, speaking rate,
nasality, and communication effectiveness. The patients rated themselves as having a
communication effectiveness of 75 percent of what it was prior to the cancer.

4. SOFT PALATE
● Velopharyngeal competence refers to the valving or sphincteral closure that takes place to
separate the nasal cavity from the oral cavity during non nasal speech production.
● Inadequate velopharyngeal closure is frequently associated with (1) hypernasal (excessive nasal)
resonance of vowels, glides, and liquids; (2) reduced or diminished intraoral pressure during
production of pressure consonants (i.e., fricatives, stops, and affricates); (3) nasal air emission
accompanying production of pressure consonants; and (4) unusual substitutions such as the use of
glottal stops for stop consonants and pharyngeal fricatives for sibilants.
● These latter substitutions are sometimes referred to as compensatory articulations. Speakers
unable to close off the airstream in the oral cavity may attempt to create closure at a location
where it is possible for them to do so (i.e., below the level of the velum and other velopharyngeal
muscles).
● Although velopharyngeal incompetence is often associated with individuals with clefts of the soft
palate, some speakers without clefting also demonstrate such incompetence—for example,
individuals with dysarthria related to neurogenic paresis or paralysis of the velopharyngeal
muscles.
● When the oral cavity communicates with (is open to) the nasal cavity, for example, through palatal
fistulae (openings in the palate) or following ablative surgery (removal of part of the soft palate)
or velopharyngeal incompetence, varying degrees of hypernasality will usually result.
 ● On the other hand, hyponasality (denasality) may result when the nasopharynx or nasal cavity is
obstructed during speech production. Inflammation of the mucous membranes of the nasal cavity
or a deviated septum may also cause hyponasality.

5. NASOPHARYNX
● The nasopharyngeal tonsils (adenoids) are located at the upper or superior pharyngeal area.
Hypertrophied (enlarged) adenoids may compensate for a short or partially immobile velum by
assisting in velopharyngeal closure. Thus, their removal may result in hypernasality.
 GENETIC DISORDERS
● A number of genetic disorders have been associated with problems related to speech sound acquisition
and/or SSDs.

● A classic example of a genetic condition with implications for speech sound production is Down
syndrome, which is thought to occur once in about every 700 live births. In most cases, DS results from
an extra copy of chromosome 21 (hence, it is often called trisomy 21). Several features associated with
this syndrome likely contribute to difficulties with speech in this population. First, DS usually includes
varying degrees of cognitive impairment that may lead to an overall delay in speech sound acquisition.
Second, as mentioned previously, individuals with DS have relative macroglossia, or a normal sized
tongue in a relatively small oral cavity, which results in less space for the tongue to maneuver during
connected speech production. This might, then, explain why reduced intelligibility in conversation is
such a common problem in this population (Kumin, 1994).
● Other problems for individuals with DS relative to speech include both generally reduced muscle tone
and a high frequency of otitis media associated with Eustachian tube problems.
● Another genetic disorder that has been shown to include difficulty with speech sounds
(without clefting) is fragile X syndrome (FXS). Somewhat less common than Down
syndrome, FXS is thought to occur once in about every 4,000 live births. In this case, a
mutation turns off a particular section of the X chromosome, resulting in failure to produce
a particular protein. Males have only a single X chromosome and so are much more likely
to be affected by FXS than females (for whom the mutation might be present on only one of
their two X chromosomes). As with DS, FXS includes varying degrees of cognitive
impairment that may delay speech sound acquisition. As in DS, the speech of individuals
with FXS is frequently difficult to understand.In addition to speech concerns related to
macroglossia, this genetic disorder may also include hemihyperplasia in which one side of
the body (or just one side of some structures) is overdeveloped. This sometimes co-occurs
with clefts of the palate. Both of these issues (macroglossia, hemihyperplasia) may
contribute to the difficulty these individuals have with anterior speech sounds, although
macroglossia is likely the major factor.
● A final example of a genetic disorder that has been associated with SSDs is
galactosemia. This is an inherited disorder occurring once in about every 53,000 live
births; this condition manifests primarily as an enzyme deficiency that prevents the
complete metabolism of the milk sugar lactose. Toxic by-products of incomplete
metabolism accumulate and can lead to severe liver and neurological damage, and
potentially death (Hoffmann, Wendel, and Schweitzer-Krantz, 2011). Lactose-free
diets reportedly halt any ongoing damage, but cognitive and speech deficits may
remain.
 HEARING LOSS
● A third subgroup of organically based SSDs includes individuals with significant hearing loss. One of
the most important elements underlying the production and comprehension of speech, as well as the
monitoring of one’s own speech, is an auditory system that is sensitive in the frequency range where
most speech sounds occur (500–4,000 Hz). Individuals with more severe hearing loss will have
difficulty decoding the incoming sound signal and will perceive words differently than individuals
with normal hearing mechanisms.

● The child who is hard of hearing or deaf faces the challenging task of learning how to produce speech
without adequate auditory input. Learning to discriminate and produce speech must then be
accomplished by watching how sounds look on the face, how they feel through vibrations, and what
can be perceived from a distorted auditory signal.
● Several aspects of hearing loss have been shown to affect speech perception and production; these
include the level of hearing sensitivity, speech recognition ability, and configuration of the hearing
loss. Individual hearing losses can range from mild to severe or profound (more than 70 dB HL).
● Hearing sensitivity typically varies somewhat from one frequency to another, with speech and
language differentially influenced by the frequency configuration and severity of the hearing loss.
Although information recorded on an audiogram is a useful prognostic indicator of speech
reception ability, children with similar audiograms may not perceive and process speech sounds in
the same way. A pure-tone audiogram cannot measure a person’s ability to distinguish one
frequency from another or to track formant transitions (a skill critical to speech perception). Other
variables (e.g., age of fitting and full-time use of amplification, quality of early intervention
programs) may be related to the fact that individuals with similar pure-tone audiograms can differ
greatly in their ability to understand and acquire speech, thus impacting their speech
intelligibility.
● A second hearing-related factor important to speech sound acquisition is the age of onset and the
age of detection of the hearing loss. If a severe loss has been present since birth, normal
acquisition of language—including phonology, syntax, and semantics—is difficult, and
specialized instruction and other interventions are necessary to develop speech and language.
Such instruction may rely on visual, tactile, and kinesthetic cues and signing as well as whatever
residual auditory sensation the person possesses or has been afforded via technology.
● The most obvious characteristic of the speech of individuals with significant hearing loss is that it
can often be very difficult to understand. The difficulty with understanding the speech of these
individuals appears to be problems at both the segmental and suprasegmental levels. At the
segmental level, errors on both consonants and vowels are observed. At the suprasegmental level,
persons who are deaf or hard of hearing generally speak at a slower rate than normal-hearing
speakers because of a longer duration during the production of consonants and vowels.
● They also use more frequent pauses and slower articulatory transitions. Stress patterns may also
differ from those of normal-hearing speakers because many persons who are deaf or hearing
impaired do not distinguish duration or pitch associated with stressed and unstressed syllables.
Persons who are deaf or hearing impaired sometimes use too high or too low a pitch and
nonstandard inflectional patterns.
● Harsh or breathy voice quality and hypo- or hypernasal speech are also commonly reported.
 FUNCTIONAL
SPEECH SOUND
DISORDERS
● Functional speech sound disorders include those related to the motor production of
speech sounds and those related to the linguistic aspects of speech production.
● Historically, these disorders are referred to as articulation disorders and phonological
disorders, respectively.
● Articulation disorders focus on errors (e.g., distortions and substitutions) in
production of individual speech sounds.
● Phonological disorders focus on predictable, rule-based errors (e.g., fronting,
stopping, and final consonant deletion) that affect more than one sound.
● It is often difficult to cleanly differentiate between articulation and phonological
disorders; therefore, many researchers and clinicians prefer to use the broader term,
"speech sound disorder," when referring to speech errors of unknown cause.
 REFERENCES :
● Articulation and Phonological Disorders
(speech Sound Disorders in Children) :- John E.
Bernthal, Nicholas W. Bankson, Peter Flipsen
Jr.
● https://www.asha.org > Speech Sound Disorders