Speech disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Kiran Singh, M.D. [2]

Synonyms and keywords: Language disorder

## Overview

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Speech disorders or speech impediments, as they are also called, are a type of communication disorders where 'normal' speech is disrupted. This can mean stuttering, lisps, etc. Someone who is totally unable to speak due to a speech disorder is considered mute.

## Classification

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Classifying speech into normal and disordered is more problematic than it first seems. By a strict classification, only 5% to 10% of the population has a completely normal manner of speaking (with respect to all parameters) and healthy voice; all others suffer from one disorder or another.

* Stuttering is quite common.
* Cluttering, a speech disorder that has similarities to stuttering.
* Dysprosody is the rarest neurological speech disorder. It is characterized by alterations in intensity, in the timing of utterance segments, and in rhythm, cadency, and intonation of words. The changes to the duration, the fundamental frequency, and the intensity of tonic and atonic syllables of the sentences spoken, deprive an individual's particular speech of its characteristics. The cause of dysprosody is usually associated with neurological pathologies such as brain vascular accidents, cranioencephalic traumatisms, and brain tumors.[1]

Difficulty in producing specific speech sounds (most often certain consonant, such as /s/ or /r/) may be considered a Speech sound disorder, and subdivided into Articulation Disorders (also called Phonetic Disorders) and Phonemic Disorders. Phonetic disorders are characterized by difficulty learning to physically produce sounds, and are popularly referred to as "speech impediments." Phonemic disorders are characterized by difficulty in learning the sound distinctions of a language, so that one sound may be used in place of many. However, it is not uncommon for a single person to have a mixed speech sound disorder with both phonemic and phonetic components.

### Types of Speech Disorders

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* Cluttering
* Stuttering
* Apraxia
* Lisp
* Rhotacism
* Spasmodic dysphonia
* Aphasia
* Dysarthria
* Huntington's disease
* Laryngeal cancer
* Selective mutism
* Specific Language Impairment
* Speech sound disorder
* Voice disorders

### Language Disorders

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Language disorders are usually considered distinct from speech disorders, even though they are often used synonymously.

Speech disorders refer to problems in producing the sounds of speech or with the quality of voice, where language disorders are usually an impairment of either understanding words or being able to use words and does not have to do with speech production[2]

## Causes

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In many cases the cause is unknown. However, there are various known causes of speech impediments, such as "hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse."[3] Child Abuse may also be a cause in some cases. [4]

## Differential Diagnosis

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* Hearing or other sensory impairment
* Intellectual disability (intellectual developmental disorder)
* Language regression
* Neurological disorders
* Normal variations in language[5]

## Risk Factors

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* Genetic predisposition[5]

## Diagnosis

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### Diagnostic Criteria

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#### DSM-V Diagnostic Criteria for Language Disorder[5]

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“  |

* A. Persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) due to deficits in comprehension or production that include the following:

* 1\. Reduced vocabulary (word knowledge and use).
* 2\. Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology).
* 3\. Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation).

AND

* B. Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination.

AND

* C. Onset of symptoms is in the early developmental period.

AND

* D. The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

| ”

|
|

## Treatment

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Many of these types of disorders can be treated by speech therapy, but others require medical attention by a doctor in phoniatrics. Other treatments include correction of organic conditions and psychotherapy[6].

In the United States, school-age children with a speech disorder are often placed in special education programs. More than 700,000 of the students served in the public schools’ special education programs in the 2000-2001 school year were categorized as having a speech or language impairment. This estimate does not include children who have speech/language problems secondary to other conditions such as deafness"[3].Many school districts provide the students with speech therapy during school hours, although extended day and summer services may be appropriate under certain circumstances.

## Social Effects of Speech Disorders

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Suffering from a speech disorder can have negative social effects, especially among young children. Those with a speech disorder can be targets of bullying because of their disorder. The bullying can result in decreased self-esteem. As well, having a speech disorder can cause some sufferers to be shy and have poor public speaking skills.

## Famous People with Speech Impediments

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* Humphrey Bogart, lisp
* Nicholas Brendon, actor -- stutter
* Isaac Brock (musician), lead singer of Modest Mouse. - lisp
* Win Butler, lead singer of Arcade Fire. - lisp
* Truman Capote, lisp
* Winston Churchill, British Prime Minister -- lisp, cluttering, and stutter
* Claudius, Roman Emperor -- stutter
* Camille Desmoulins, journalist in the French Revolution; stutter
* Drag-on, rapper -- stutter
* Gareth Gates, singer -- stutter (though now fixed)
* Roy Jenkins, British politician -- rhotacism
* Stephan Jenkins, singer/songwriter/musician (Third Eye Blind) -- rhotacism
* Elton John, singer/songwriter, lisp
* Scatman John, scat singer -- stutter
* James Earl Jones, actor -- stutter
* Jim Jones, cult leader - lisp
* Robert F. Kennedy, Jr., environmental activist -- spasmodic dysphonia
* Anthony Kiedis, singer (Red Hot Chili Peppers) -- lisp
* Anybody Killa, rapper -- lisp
* Gwen Laurie, newsreader -- phonemic disorders
* Bob Love, former NBA player -- stutter
* Shane MacGowan, singer (The Pogues) -- rhotacism
* Keith and The Girl, podcaster
* Marilyn Monroe, actress -- stutter
* Frank Muir, British comedy writer and personality on radio and television -- rhotacism
* Kele Okereke, lead singer of band Bloc Party. -stammer
* Rick Parfitt, Status Quo rhythm guitarist and singer
* Diane Rehm, radio talk show host -- spasmodic dysphonia
* Jonathan Ross, British television personality -- rhotacism
* David Sedaris, author -- lisp during childhood
* Shannon Sharpe, NFL color commentator and ex-pro football player; lisp & drawl
* James Stewart, actor -- stutter
* Joe Strummer, singer (The Clash) -- rhotacism
* Richard Thompson, guitarist and singer-songwriter -- stutter
* Mel Tillis, country music singer -- stutter[7]
* Barbara Walters, television personality -- rhotacism and lisp
* Bruce Willis, actor and director -- stutter
* Tiger Woods, golfer -- stutter
* Will Young, singer -- lisp
* Bear Felicetta. model/former all american wrestler - stutter, talks way to fast

* v
* t
* e

WHO ICD-10 mental and behavioral disorders (F * 290–319)

Neurological/symptomatic|

Dementia (Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia) * Delirium * Post-concussion syndrome

Psychoactive substance|

Intoxication (drunkenness) * Physical dependence (alcohol dependence, opioid dependency, cocaine dependence) * Withdrawal (benzodiazepine withdrawal, delirium tremens) *
Amnesic: (Korsakoff's syndrome)

Psychotic disorder|

Schizophrenia (disorganized schizophrenia) * Schizotypal personality disorder * Delusional disorder * Folie à deux * Schizoaffective disorder

Mood (affective)|

Mania * Bipolar disorder * Clinical depression * Cyclothymia * Dysthymia

Neurotic, stress-related
and somatoform|

Agoraphobia * Anxiety disorder * Panic disorder * Generalized anxiety disorder * Social Anxiety Disorder * OCD * Acute stress reaction * PTSD * Adjustment disorder * Conversion disorder (Ganser syndrome) * Somatoform disorder * Somatization disorder * Neurasthenia

Physiological/physical
behavioural|

Eating disorder (anorexia nervosa, bulimia nervosa) * Sleep disorder (dyssomnia, insomnia, hypersomnia, parasomnia, night terror, nightmare) *
Sexual dysfunction (erectile dysfunction, premature ejaculation, vaginismus, dyspareunia, hypersexuality) * Postpartum depression

Adult personality
and behaviour|

Personality disorder * Passive-aggressive behavior * Kleptomania * Trichotillomania * Voyeurism * Factitious disorder * Munchausen syndrome * Ego-dystonic sexual orientation

Mental retardation|

Mental retardation

Psychological development
(developmental disorder)|

Specific: speech and language (expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp) * Scholastic skills (dyslexia, dysgraphia, Gerstmann syndrome) * Motor function (developmental dyspraxia)
Pervasive: Autism * Rett syndrome * Asperger syndrome

Behavioural and emotional,
childhood and adolescence onset|

ADHD * Conduct disorder * Oppositional defiant disorder * Separation anxiety disorder * Selective mutism * Reactive attachment disorder * Tic disorder * Tourette syndrome * Speech (stuttering * cluttering)

## References

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1. ↑ Pinto JA, Corso RJ, Guilherme AC, Pinho SR, Nobrega Mde O.: Dysprosody nonassociated with neurological diseases--a case report (2004), found on: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15070228&dopt=Abstract
2. ↑ http://www.nichcy.org/pubs/factshe/fs11txt.htm
3. ↑ 3.0 3.1 "Disability Info: Speech and Language Disorders Fact Sheet (FS11)." National Dissemination Center for Children with Disabilities. http://www.nichcy.org/pubs/factshe/fs11txt.htm
4. ↑ http://www.lbfdtraining.com/Pages/emt/sectiond/childabuse.html Long Beach (California) Fire Department
5. ↑ 5.0 5.1 5.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
6. ↑ "Speech Defect." Encyclopedia.com. http://www.encyclopedia.com/doc/1E1-speechde.html
7. ↑ "Famous people with disabilities." Disabled-World. http://www.disabled-world.com/artman/publish/article_0060.shtml

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