Speech and Communication Disorders

Speech and communication disorders are impairments which affect the ability to communicate,
comprehend and use verbal spoken and written languages, and also other symbol systems, called
non-verbal languages (e.g. visual language, body language, etc.). Their severity can range from a
few errors, for instance in uttering speech sounds or words, to a total loss of the ability to
communicate effectively. This can affect even subjects’ developing of thoughts, which is a
prerequisite for the enacting of behaviours and social interaction.
In communication, the functions and skills of voice, speech and language are deeply related.
In fact, those subjects who are affected by a congenital deafness, and experience therefore a delay in
acquiring and mastering verbal language, may have trouble not only in the discrimination of similar
sounds (in decoding as well as in producing oral messages) but also in the distinction of related
concepts.
Voice is the sound produced by the airflow coming from the chest: during exhalation, the air
held in the lungs is gradually released, and travels to the trachea and the larynx, where the vocal
cords (two bands of muscular tissue) are located. When a subject talks, laughs, sings or cries (as
well as when an infant babbles or coos) his vocal cords are brought closer together (so that the air
from the lungs is forced between them) and vibrate, giving origin to a sound; this process is called
phonation. Therefore voice production involves respiration and phonation, and requires the precise
coordination of many specific muscles.
Speech is originated through a complex process, coordinated and controlled by the brain,
through the nervous system. The sound originated by the vocal cords can be accurately modulated
as regards pitch, volume, timbre, rhythm, etc., by means of well-defined muscle movements, which
involve the throat, palate, tongue, lips and teeth.
Therefore speech disorders can be related with voice impairments (for instance, if the voice
has an unpleasant timbre) and resonance problems (for example, if there are abnormalities in the air
cavities of throat, mouth or nose), and can concern articulation (if one or more sounds are
incorrectly produced), prosody (if pitch and volume organization are inappropriate), fluency and
rhythm of speech.
Human beings communicate through languages. Verbal and non-verbal languages are
communication systems which permit communication partners to define, express and explain their
thoughts, feelings and behaviours, making their sharing and development possible.
Verbal language disorders can concern morphology (the structure of words and the rules of
word construction), syntax (the combination of words in meaningful sentences), semantics (the
meaning of words and sentences) and pragmatics (the use of words and sentences in appropriate
social ways).
The written form of verbal languages can be impaired by literacy disorders, which affect the
ability to read and write texts.
Speech and communication disorders can be caused by congenital or acquired hearing
impairments, craniofacial anomalies (such as cleft lip and palate), neurologic diseases or injuries
which provoke weakness or scarce coordination of oral muscles (e.g. head and neck cancer,
muscular dystrophy, stroke, Tourette’s syndrome, traumatic brain injury, etc.); they can also be
related with developmental learning factors (this occurs, for instance, in articulation disorders,
stuttering, dyslexia, etc.) or psychiatric-behavioral disorders which impair auditory attention,
discrimination and memory, or information processing (e.g. Asperger’s syndrome, attention deficit
disorder, autism, schizophrenia, dementia, etc.).

Specific Disorders

Aphasia is a communication disorder, in which patients may have deficits in producing or

comprehending verbal spoken or written messages. There are two main types of aphasia: Broca’s
aphasia (usually caused by damage toward the front of the brain), where patients can comprehend
and say short sentences, and Wernicke’s aphasia (usually caused by damage to the middle left side
of the brain), where patients do not comprehend spoken language well and speak in long, complex
sentences which include many incorrect or unnecessary words or are wholly senseless. In the
United States about 1 million people currently have aphasia.
Apraxia of speech is a speech disorder, in which patients have difficult saying want they
want to say coherently and correctly. There are two main forms of speech apraxia: the acquired
form (caused by brain damage, which may result from head injuries, brain tumors, etc.), and the
developmental form (which occurs in children and is probably linked with genetic factors).
Apraxia of speech affects about 1-10 in 10,000 children.
Articulation disorders are speech disorders in which patients place their tongue, lips, etc., in
wrong ways: this causes substitutions of one or more sounds with others, additions and omissions
(for instance, affected people may say “thing” instead of “sing”, “sink” instead of “sick”, and “cool”
instead of “school”). These errors affect the clearness of the speech, and in sever cases they can
render the speech almost unintelligible. The prevalence is estimated in about 2 percent of 8-year-old
children.
Developmental expressive language disorder provokes lack of vocabulary in affected
subjects, and scarce ability in the production of complex sentences and recall of words. Causes may
be cerebral damage and malnutrition, as well as genetic factors. About 3-10% of all school-age
children have this disorder.
Disfluent speech includes stuttering (in Britain also called “stammering”) and cluttering.
Stuttering is a speech disorder in which the flow of speech is interrupted by hesitations, stops,
repetition or prolongation of sounds, syllables, words, or phrases. Stuttering occurs most frequently
in children and teenagers, while it is estimated that less than 1 percent of adults stutter; the male :
female ratio is about 3 : 1. Cluttering is a language disorder which alters the rhythm of speech,
making it strange and jerky: affected subjects, who are often unaware of their problems, speak in
bursts, pausing in unexpected ways. Causes of disfluent speech may be neurogenic (the disorder can
be provoked by signal problems between the brain and oral muscles), psychogenic (the disorder can
be a result of severe mental stress), developmental, or genetic.
Language-based learning disabilities (one of which is dyslexia) cause difficulties in reading,
spelling and/or writing. These disabilities, which seem hereditary, are linked with abnormalities in
the brain structure. The prevalence is estimated in about 9 percent of 10-year-old children.
Spasmodic dysphonia (also called “laryngeal dystonia”) is a voice disorder characterised by
involuntary spasms or movements of the vocal cords, which stiffen and slam together, giving origin
to strained or strangled sounds, or remain open, producing weak and whispery sounds. Spasmodic
dysphonia affects most often old women between 30 and 50 years. Researchers estimate that from
10,000 to 30,000 individuals are affected in the United States.

Treatments

In many of these disorders effective treatments are provided by speech-language pathologists, who
work closely with the patients’ families, teachers, psychologists, audiologists and physicians of
various specialities (e.g. pediatricians, neurologists, otoryngologists, physiatrists, etc.). These
professionals can use different, individually tailored approaches, such as breathing techniques,
relaxation strategies, oral-motor drills and exercises. In severe cases, patients can communicate with
their environment using formal or informal sign language, picture boards and/or electronic
communication devices.

SEE ALSO: Autism; Head and Neck Cancer; Muscular Dystrophy; Myasthenia Gravis; Neurologic
Diseases; Voice Disorders.
BIBLIOGRAPHY. Dorothy V.M. Bishop and Lawrence Leonard (eds.), Speech and Language
Impairments in Children (Psychology Press, 2000); Skye McDonald, Chris Code and Leanne
Togher, Communication Disorders Following Traumatic Brain Injury (Psychology Press, 1999)

Prof. Alessandra Padula

L’Aquila University (Italy)