Speech And Sound Disorder

As a communication disorder, this suggests that the person has trouble producing the speech and sound needed for communication. It was formerly referred to as a phonological disorder. The person with this disorder is unable to accurately create the appropriate speech sounds for him or her:
• Age • Stage of development • Phonology
When speaking, the person may: Omit sounds, such as saying "Boom" rather than "Broom." Use different sounds: The person can say "lup" rather than "cup." Distort sounds: When speaking, the person may produce noises because of their tongue protrusions or because they are letting too much air out of their mouth.

Types Of Misarticulation

Omission in speech: The most serious kind of individual misarticulation is omission in speaking. It affects young children the most frequently and severely. 

Substitution: The next most significant mispronunciation observed is this one. The least severe kind of disarticulation, distortion, is more common in older kids. In children's speech, it is typically the final major disarticulation that remains (who have remitted).

These abnormalities can be remembered as OSD (Omission, Substitutions, and Distortion).

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Patterns Of Speech Sound Disorders

Errors in speech sound can also arise from intermittent rather than continuous airflow. This makes it difficult to pronounce words correctly. Among the symptoms of some speech sound abnormalities are: 

Dyspraxia: This is the inability to plan and execute speech; dysarthria is slurred speech caused by incoordination of the speech muscles.
The development of speech sounds is influenced by both motor and linguistic growth. The right noises are created when these two are combined.

Also Read: Communication Disorders In Child Psychiatry

DSM-5 Evaluation

When looking at the DSM-5, speech sound problems like dysarthria or dyspraxia that have a known neurological basis—such as cerebral palsy, TBI (Traumatic Brain Injury), cleft palate, deafness, hearing loss, etc.—are not classed as speech sound disorders.

Most Common Component Of Speech Sound Disorder In Children

Difficulties with articulation are the most common cause of speech sound abnormalities in children. These include the following and are not linked to any neurological conditions: • Poor articulation: The most prevalent cause of speech sound issue.
• Replacing
• Exclusion of Speech Sound
When a person has a severe speech sound issue, their speech may become completely unintelligible, making it impossible to understand anything they say.

Epidemiology

• Frequency of abnormalities in speech sounds
• Young children: 3%
• Children aged six to seven: 2%
• Teenage: 0.5 percent
Therefore, as people age, the disorder's prevalence declines.
• Errors in speech sounds
• Most speech sound errors occur in children under three years old. • By the time they are seven years old, they usually self-correct.
When misarticulation occurs beyond the age of seven, it most usually indicates a speech sound issue.
• Men against women

Males are more likely than females to have certain speech sound abnormalities. In men, it occurs two to three times more frequently.
Gathering of relatives there is a significant level of familial aggregation. Between 20% and 40% of kids with speech problems have at least one member of their immediate family who also has the condition.
A potential risk factor for speech sound issue has been identified as low maternal education. In order to treat speech sound issue, it is therefore a good idea to review family medical history, as relatives may have similar anomalies.

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Etiology

Speech sound disorder has no recognized etiology. However, a number of theories have been put forth to explain speech sound abnormalities.
Among them are: Modest brain abnormalities: People with these diseases may exhibit soft neurological indications that result in modest brain abnormalities. 

Genetic considerations: Speech sound abnormalities have been linked to genetic causes. It has been observed that chromosomes 3, 6, and 15 are involved in these illnesses. According to twin research, homozygous twins had higher incidence of certain diseases than dizygous twins. Additionally, it has been discovered that these and some learning disabilities, such as dyslexia, coincide.

Environmental factors: There isn't enough proof to say for sure, although they might also be involved in certain diseases. 

Neurodevelopmental immaturity: A slower pace of speech and sound development could be attributed to this issue. 

Linguistic factors: People who suffer from these diseases often have linguistic deficiencies.

Auditory processes: Difficulties with auditory perception and discrimination may arise. There are also some people who experience temporary hearing loss. 

Articulation as a result of mechanical or structural issues is uncommon. Dyspraxia or dysarthria could result from it.
These issues could also be:  Congenital: Caused by muscular dystrophy, cerebral palsy, or  Acquired: Because of an infection or wound.

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Diagnosis

Diagnosis is based on DSM-5 criteria. The requirements are:
A persistent problem producing speech sounds obstructs speech comprehension or makes it impossible to communicate verbally. It's possible that they won't be able to comprehend communications and respond appropriately.  It results in barriers to effective communication that impede social interaction, academic success, or professional effectiveness. This could be done separately or in combination. 

Does not stem from congenital or traumatized conditions such cerebral palsy, cleft palate, deafness or hearing loss, or traumatic brain injury
Additional neurological or medical issues. These ought to be disregarded. Speech sound disorder is the diagnosis that can be made if these conditions are met.

Comorbidity

Speech sound abnormalities may be associated with specific comorbidities. Other linguistic conditions: This will be particularly relevant to expressive language or people who may have difficulties in expressive language due to speech sound abnormalities.
• SLD: Dyslexia in particular.
• Dysfunction in development coordination
• Inattention
Compared to people who simply have speech sound impairments, children who have both language and speech disorders are more likely to experience SLD, attentional issues, social, emotional, and behavioral issues. When evaluating patients with speech sound abnormalities, it is crucial to consider all of these illnesses.

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Differential Diagnosis

Determining whether a condition is appropriate for age and dialect is a crucial step in the differential diagnosis process. It could be challenging to diagnose speech sound disorders in bilingual kids. Need to ascertain whether the kid will be harmed by the theft to a sufficient degree. Should be able to distinguish between a disorder and a typical variation in speech. Functional impairment will occur if a disorder exists, as previously mentioned. Eliminate any physical or neurological anomalies.
Assess for both expressive and receptive language. These considerations must be examined when performing a differential diagnosis.

Various Diagnoses Include:

Hearing Impairment: To identify the irregularity and aid in differentiation, a basic audiometric test can be performed. 

Dysarthria: Anatomical and neurological problems may potentially be the cause of this. Therefore, examination can be used to differentiate.
The following characteristics will help distinguish the disorder from dysarthria: drooling; slow or uncoordinated motor behavior; abnormal chewing or swallowing; slow protrusion or retraction of the tongue; abnormality of the lips and palate; a slow rate of speech.

Other communication disorders: Here, articulation is mostly the issue.
Additional conditions such as: Intellectual disorders (ID). Deafness, Autism, Acquired aphasia. The aforementioned condition can be distinguished from speech sound abnormalities due to its deviation from normal language development.

Course And Prognosis

The path is not fixed.  A diagnosis is typically made when a child is four years old. A diagnosis may be obtained as early as age two in extreme situations. Whether or not treatment is provided, 75% of mild to moderate instances and/or individuals return to normal by the time they are 6 years old. They are more vulnerable to unfavorable results in severe situations that continue throughout school. 

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When To Assess For Treatment

Should be able to determine when to send a child who exhibits atypical speech to a specialist.  A two-year-old who speaks little to nonexistent should be referred to a speech-language pathologist for evaluation.
Why three-year-olds are poorly understood by family members.

A four-year-old is poorly understood by peers or strangers. Some people may not comprehend the speech, but family members might.
When a youngster, regardless of age, experiences verbal abuse or frustration, they tend to retreat from social situations. The child's speech worries the parent or teacher. There is an abrupt decline in the ability to produce speech in a kid or adult. In these situations, a complete neurological evaluation should also be performed. 

Treatment

Speech sound abnormalities can be treated in a variety of ways.
In cases that range from moderate to severe, treatment is usually advised. Among the methods of treatment are: 

Conventional approach: A speech-language pathologist may intervene directly or through the mediation of parents or other family members. This technique is intended for people who have distortion or substitution mistakes in a few sounds. Here, the kid is taught tasks that emphasize the auditory or motor aspects of a certain sound, and the youngster practices that sound.

Phonological approach: This technique is applied when phonological processes can be used to characterize a variety of speech sound problems. This approach's exercises involve showcasing the benefits of effectively using specific sound classes for communication. Additionally, the child learns how to position their mouth and tongue when uttering certain letters or phrases. The child receives immediate feedback in order to help them grow. 

Additional Crucial Element

• Parental guidance: Although it is a crucial component of treatment, this is not a form of therapy.
• Observing interactions and conduct between parents and children. Emotional issues or social disengagement could be the result of this. In order to reduce potential future social impairment, the person should be closely watched.

Hope you found this blog helpful for your Psychiatric Theory and Specialities Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.