Speech or

Language
Impairment
 CONTENTS

Definition

CharacteristicsCauses and Educational Assessmen

Symptoms Placement t or
Evaluation
DEFINITION
Speech or Language Impairment

The Individuals with Disabilities

Education Act (IDEA) officially defines
speech and language impairments as
“a communication disorder such as
stuttering, impaired articulation, a
language impairment, or a voice
impairment that adversely affects a
child’s educational performance.”
 Language
Stuttering
Impairment
provides an example of a
fluency disorder; other can entail difficulty
fluency issues include comprehending words
unusual word repetition and properly, expressing
hesitant speech. oneself and listening to
others.

Impaired Voice
articulation
indicates impairments in It
impairment
involves difficulty voicing
which a child experiences words; for instance, throat
challenges in pronouncing issues may cause an
specific sounds. abnormally soft voice.
CHARACTERISTICS
The characteristics of speech
or language impairments will
vary depending upon the
type of impairment
involved. There may also be a
combination of several
problems. When a child has
an articulation disorder, he
or she has difficulty making
certain sounds. These sounds
may be left off, added,
changed, or distorted, which
makes it hard for people to
understand the child.
1 2
People with speech disorders
have trouble using some
speech sounds, which can also
be a symptom of a delay. They
may say "see" when they
mean "ski" or they may have
trouble using other sounds
like "l" or "r". Listeners may
have trouble understanding
what someone with a speech
disorder is trying to say.
People with voice disorders
may have trouble with the
way their voices sound.
 There are three basic types of
speech impairments: articulation
disorders, fluency disorders, and
voice disorders.
 

Articulation Fluency disorders are difficulties

disorders are errors in Voice disorders are
with the rhythm and timing of speech problems with the
the production of characterized by hesitations,
speech sounds. These quality or use of one's
repetitions, or prolongations of voice resulting from
disorders include: sounds, syllables, words, or phrases. disorders in the larynx.
• Omissions: (bo for Common fluency disorders include: Voice disorders are
boat)
• Stuttering: rapid-fire repetitions of characterized by
• Substitutions: (wabbit
consonant or vowel sounds especially abnormal production
for rabbit)
at the beginning of words, and/or absences of vocal
• Distortions: (shlip for
prolongations, hesitations, quality, pitch, loudness,
sip)
interjections, and complete verbal resonance, and/or
blocks duration.
• Cluttering: excessively fast and jerky
speech
 Some characteristics of
language disorders include improper use
of words and their meanings, inability to
express ideas, inappropriate grammatical
patterns, reduced vocabulary and
inability to follow directions. Children
may hear or see a word but not be able
to understand its meaning. They may
have trouble getting others to
understand what they are trying to
communicate.
 There are five basic areas of language impairments:
phonological disorders, morphological disorders,
semantic disorders, syntactical deficits, and
pragmatic difficulties.

Semantic disorders are characterized by

poor vocabulary development,
inappropriate use of word meanings, and/or
inability to comprehend word meanings.
These students will demonstrate Syntactic deficits are
restrictions in word meanings, difficulty characterized by difficulty in
A child with a phonological with multiple word meanings, and
disorder may be described as acquiring the rules that govern
excessive use of nonspecific terms (e.g. word order and other aspects of
hard to understand or as not thing and stuff), and indefinite references
saying the sounds correctly. grammar such as subject-verb
(e.g. that and there). agreement. Typically, these
Apraxia of speech is a specific
phonological disorder where the
student may want to speak but
has difficulty planning what to say
1 3 5
students produce shorter and less
elaborate sentences with fewer
cohesive conjunctions than their
and the motor movements to use. peers.

Pragmatic difficulties are characterized

Morphological disorders are defined
as difficulties with morphological
inflections (inflections on nouns, verbs,
2 4 as problems in understanding and using
language in different social contexts. These
students may lack an understanding of the
and adjectives that signal different kinds rules for making eye contact, respecting
of meanings). personal space, requesting information, and
introducing topics.
 CAUSES
AND
SYMPTOMS
Speech disorders affect the vocal People who have certain medical or
developmental conditions may also have
cords, muscles, nerves, and other speech disorders. Common conditions
structures within the throat. that can lead to speech disorders are:
Causes may include:

• vocal cord damage • autism

• brain damage • attention deficit hyperactivity disorder (ADHD)
• muscle weakness • strokes
• respiratory weakness • oral cancer
• Strokes • laryngeal cancer
• polyps or nodules on the vocal • Huntington’s disease
cords • dementia
• vocal cord paralysis • amyotrophic lateral sclerosis (ALS), also known
as Lou Gehrig’s disease
 Speech disorders may be
hereditary, and they can develop
over time.
Risk factors that can increase the Depending on the cause of the speech
disorder, several symptoms may be
likelihood of a person developing a present. Common symptoms
speech disorder include: experienced by people with speech
disorders are:

• repeating sounds, which is most often seen in

• being male
• being born prematurely
• having a low weight at birth
• having a family history of speech
disorders
• experiencing problems that
affect the ears, nose, or throat
• hoarseness, or speaking with a raspy or gravelly
people who stutter
• adding extra sounds and words
• elongating words
• making jerky movements while talking, usually
involving the head
• blinking several times while talking
• visible frustration when trying to communicate
• taking frequent pauses when talking
• distorting sounds when talking
sounding voice
EDUCATIONAL
PLACEMENT

Students with speech or language
disorders will receive services from
many education professionals,
including general education teachers,
special education teachers, and
speech-language pathologists.
Speech-language
pathologists provide a
variety of professional
services aimed at helping
people develop effective
communication skills.
The general education teacher
should work with the speech-
language pathologist to incorporate
strategies to help the student
generalize strategies mastered in
speech therapy. This may include
corrective measures, helping with
speech and language exercises, and
providing the student with
immediate feedback when the
speech-language pathologist is not
present.
The general education and
special education teacher
should both collaborate with
the speech-language
pathologist for interventions
and teaching strategies.
Each year, the Office of
Special Education Programs
(OSEP) collects and analyze
information to assess the
extent to which all students
with disabilities are receiving
free, appropriate public
education, as ensured by the
Individuals with Disabilities
Education Act (IDEA).
Placement patterns differ
considerably by disability, as
shown in table 1.7. Data for
1992-93 indicate that
students with speech or
language impairments were
served almost exclusively in
regular classroom settings
(81.8 percent) and resource
rooms (10.7 percent).
ASSESSMENT/EVALUATION
A speech and language evaluation is
the measurement of a person’s
communication skills. It is done to
find out if a person has
communication problems. The
evaluation is done by a speech-
language clinician.

The speech-language clinician gathers

information by asking questions about your
child and testing the child. Depending upon
the age and attention span of the child, the
evaluation may be completed in one
session. Or, it may be spread over several
sessions. The length of the evaluation will
vary with the amount of testing that needs
to be done.
 Before your child is seen for an
evaluation, you may be asked to
answer questions or complete
written forms about your child.
You may be asked for a
description of your child’s:
Speech and language behaviors –
Health History – including any serious
including your comments about your
illnesses, operations, accidents or
child’s speech and language skills and
recurring health problems.
any causes of concern.

Developmental History – including

the ages at which your child started School history – what schools your
doing certain activities like sitting, child has attended.
walking, making speech sounds, etc.

Family – including names and ages of

brothers and sisters, discussion of
family members who may have speech
or hearing problems, etc.
During your child’s evaluation,
the clinician observes the child
doing different tasks. The
clinician will evaluate your
child’s:
• Understanding and use of different words
• Correct use of words in correctly formed
sentences
• Use of language for different purposes
• Pronunciation of speech sounds
• Physical ability to produce speech
• Voice quality
• Fluency or smooth flow of speech
 FORMAL TEST
Formal tests are a way of comparing your child with other children of the
same age. There are many tests available. The clinician tries to choose
those that will give the information needed about a child’s problem.

In a formal test, the child is asked to cooperate on certain tasks. The

child’s ability to perform these tasks is compared to the ability of other
children.

The clinician is looking for an overall age level at which your child
performs. The clinician also notes the kinds of tasks that give the child
trouble.

If the child is enrolled in therapy, the clinician will do more tests to

determine which specific skills to teach
 Formal tests are designed to get a
sample of the child’s skills on various
kinds of tasks, including:

Receptive vocabulary – What words does the

child understand?
Auditory discrimination – Can you
Expressive vocabulary – What words does child hear small differences between
the child use? words?

Receptive grammar – How well does the child Word-finding – How well does the
understand different language forms? child think of words to use?

Expressive grammar – What language forms Articulation – What speech sounds

can the child use? can the child make? How clear is the
child’s speech?
Auditory memory – How well does the child
remember what is heard?
 INFORMAL TASK
Informal tasks include talking with the child, having the child discuss
pictures, answer questions, and tell simple stories.

If the child is an infant or toddler, the clinician observes how the child
plays, how the child uses objects and toys, and how well the child
understands words and requests.

The clinician also looks at how the child expresses wants and needs and
obtains information and objects.
 Other measurements
taken during the
evaluation

Oral peripheral examination - This includes observing the child’s face,

lips, teeth, tongue, palate, and throat. It also includes observing how well
they work in such activities as feeding, moving the tongue, moving the
lips, or making alternating lip and tongue movements rapidly.
Voice - If there is a voice problem, the evaluator will be concerned with
how long the child can hold a tone on one breath, what the child’s pitch
range is (how low and how high the child can sing), and the pitch that the
child usually uses to talk.
Fluency - The clinician also tries to find out if there is a fluency problem.
As the child speaks, the clinician listens for sounds and words that are
repeated or prolonged, hesitations, and fillers such as “um” and “uh”.
 Assessment of speech and language
disorder should be culturally relevant
and functional and involve the
collaborative efforts of
families/caregivers, classroom teachers,
SLPs, special educators, and other
professionals as needed.
Many tests are available to diagnose speech disorders:

DENVER ARTICULATION SCREENING

EXAM
The Denver articulation screening examination
(DASE) is a commonly used testing system to
diagnose articulation disorders. This test evaluates
the clarity in pronunciation in children between the
ages of 2 and 7. This five-minute test uses various
exercises to assess the child’s speech.
 EARLY LANGUAGE MILESTONES SCALE 2
This test, created by neurodevelopmental pediatrician James Coplan, determines
a child’s language development. This test can quickly identify delayed speech or
language disorders. The ELM (Early Language Milestone) scale for children 0-3
years of age.

The ELM Scale-2 consists of 43 items arranged in three divisions: Auditory

Expressive (which is further subdivided into Content and Intelligibility), Auditory
Receptive, and Visual. The test takes 1 to 10 minutes to administer, depending
on the child's age and the scoring technique employed.

The ELM Scale-2 may be administered using pass/ fail or a point scoring method.
The pass/fail method yields a global "pass" or "fail" rating for the test as a whole,
whereas the point scoring method yields percentile values, standard score
equivalents, and age equivalents for each area of language function (Auditory
Expressive, Auditory Receptive, and Visual), as well as a Global Language score.
 EARLY LANGUAGE MILESTONES SCALE 2

Detailed language evaluations were obtained by interviewing the parents of 191 healthy
children aged 0 to 3 years, and by testing the children themselves. From these data,
normative values were derived for 41 language milestones in the first 36 months of life.
These values were used to construct the Early Language Milestone Scale (ELM Scale), a
brief language assessment tool suitable for use by general pediatricians. Physician use of
the ELM Scale in a population of 119 children considered at high risk for the presence of
developmental disability yielded 97% sensitivity and 93% specificity for the ELM Scale as
a detector of developmentally delayed children, when compared with more formal
developmental measures as applied by a clinical psychologist or speech pathologist. Early
language milestones are a sensitive indicator of developmental integrity; delayed
achievement of early language milestones strongly suggests the presence of a significant
underlying developmental disability. The ELM Scale may be adopted as a valid measure of
developmental status among children considered at high risk for the presence of
developmental disabilities.
 PEABODY PICTURE VOCABULARY TEST

This test measures a person’s vocabulary and ability to speak. The

person will listen to various words and choose pictures that
describe the words. People who have severe intellectual disabilities
and those who are blind won’t able to take this assessment. The
Peabody picture vocabulary test has been revised many times since
its first version was administered in 1959.

The Peabody Picture Vocabulary Test, testing children 2 1/2 to 4

years of age.
 PEABODY PICTURE VOCABULARY TEST

The PPVT-R is among the best-established indicators of verbal

intelligence and scholastic aptitude across childhood. It is among
the most frequently cited tests in Mitchell's (1983) "Tests in Print."
Numerous studies have replicated the reliability estimates from the
PPVT standardization sample. The NLSY Child Handbook: 1986-
1990 synthesizes much of this work. This report also provides cross-
year (1986-1990) reliability and validity evaluation using the
NLSY79 Child data.  
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