Speech problems.

When you were younger and first began talking, you may have lisped or stuttered; and if you
did, your relatives probably considered it cute. If you're in your teens and still stuttering,
though, you may not feel like it's so endearing.
You're not alone. More than 3 million Americans have the speech disorder known as stuttering
(or stammering, as it's known in Britain). It's one of several conditions that can affect a person's
ability to speak clearly.
Some Common Speech Disorders
Stuttering is a problem that interferes with fluent speech. A person who stutters may repeat
the first part of a word (as in wa-wa-wa-water) or hold a single sound for a long time (as in
caaaaaaake). Some people who stutter have trouble getting sounds out altogether. Stuttering is
complex, and it can affect speech in many different ways.
Cluttering is another problem that makes a person's speech difficult to understand. Like
stuttering, cluttering affects the fluency, or flow, of a person's speech. However, the difference is
that cluttering is a language disorder, while stuttering is a speech disorder. A person who
stutters has trouble getting out what they want to say, and a person who clutters says what they
are thinking, but it becomes disorganized while actually speaking. Because of this
disorganization, someone who clutters may speak in bursts or pause in unexpected places. The
rhythm of cluttered speech may sound jerky, rather than smooth, and the speaker is often
unaware of the problem.
Articulation disorders encompass a wide range of errors people can make when talking.
Substituting a "w" for an "r" ("wabbit" for "rabbit"), omitting sounds ("cool" for "school"), or
adding sounds to words ("pinanio" for "piano") are examples of articulation errors.Lisping refers
to specific substitution involving the letters "s" and "z." A person who lisps replaces those sounds
with "th."
Apraxia (dyspraxia), also known as oral-motor speech disorder, is a problem with motor
coordination or motor planning. A person with this speech problem has difficulty moving the
muscles and structures necessary to form speech sounds into words.

Adult Speech and Language

Adults may experience speech and language difficulties for a variety of reasons. Information
about specific types of speech and language differences and disorders, as well as conditions that
cause them is included below.
Speech Disorders
Apraxia
Dysarthria
Stuttering
Voice

Apraxia
What is apraxia of speech?
Apraxia is a general term. It can cause problems in parts of the body, such as arms and legs.
Apraxia of speech is a motor speech disorder. It is caused by damage to the parts of the brain
related to speaking. Other terms include apraxia of speech, acquired apraxia of speech, verbal
apraxia, and dyspraxia.
People with apraxia of speech have trouble sequencing the sounds in syllables and words. The
severity depends on the nature of the brain damage.
Children can have apraxia, referred to as childhood apraxia of speech.
What are some signs or symptoms of apraxia of speech?
People with apraxia of speech know what words they want to say, but their brains have difficulty
coordinating the muscle movements necessary to say those words. They may say something
completely different, even made up words. For example, a person may try to say "kitchen," but
it may come out "bipem" or even "chicken." The person may recognize the error and try again,
sometimes getting it right, but sometimes saying something else entirely. This can become quite
frustrating for the person. It may be hard to understand a person with apraxia of speech.
Apraxia of speech can be mild or severe. People with apraxia may have
difficulty imitating speech sounds
difficulty imitating non-speech movements (oral apraxia), such as sticking out their tongue
groping when trying to produce sounds
in severe cases, an inability to produce sound at all
inconsistent errors
slow rate of speech
somewhat preserved ability to produce "automatic speech" (rote speech), such as greetings
like "How are you?"
Apraxia can occur in conjunction with dysarthria (muscle weakness affecting speech production)
oraphasia (language difficulties related to neurological damage).
How is apraxia of speech diagnosed?
A speech-language pathologist (SLP) can evaluate the individual. Results will determine the
nature and severity of the apraxia. The SLP will look to see if there is any evidence of muscle
weakness (dysarthria) or other communication or swallowing difficulties. An appropriate
treatment plan can then be put in place.
To contact a speech-language pathologist, visit ASHA's Find a Professional.
What treatments are available to people with apraxia of speech?
An SLP can work with people with apraxia of speech to improve speech abilities and overall
communication skills. The muscles of speech often need to be "retrained" to produce sounds
correctly and sequence sounds into words. Exercises are designed to allow the person to repeat
sounds over and over and practice correct mouth movements for sounds. The person with
apraxia of speech may need to slow his or her speech rate down or work on "pacing" their
speech so that he or she can produce all necessary sounds. In severe cases, augmentative and
alternative communication may be necessary, such as the use of simple gestures or more
sophisticated electronic equipment.
To contact a speech-language pathologist, visit ASHA's Find a Professional.
What other organizations have information about apraxia of speech?
This list is not exhaustive and inclusion does not imply endorsement of the organization or the
content of the Web site by ASHA.
National Institute of Neurological Disorders and Stroke
National Institute on Deafness and Other Communication Disorders
What causes apraxia of speech?
Apraxia of speech is caused by damage to the parts of the brain that control muscle movement.
In verbal apraxia, the messages to the mouth are interrupted and the person cannot move his or
her lips or tongue to the right place to say sounds correctly. A common cause of acquired
apraxia is stroke. Other causes include traumatic brain injury, dementia, tumors, and
progressive neurological disorders, such as multiple sclerosis.
How common is apraxia of speech?
There is not a lot of research about how many people have apraxia of speech. Many times
apraxia of speech occurs together with other communication disorders, such as aphasia.
Dysarthria
What is dysarthria?
Dysarthria is a motor speech disorder. The muscles of the mouth, face, and respiratory
system may become weak, move slowly, or not move at all after a stroke or other brain injury.
The type and severity of dysarthria depend on which area of the nervous system is affected.
Some causes of dysarthria include stroke, head injury, cerebral palsy, and muscular dystrophy.
Both children and adults can have dysarthria.
What are some signs or symptoms of dysarthria?
A person with dysarthria may experience any of the following symptoms, depending on the
extent and location of damage to the nervous system:
"Slurred" speech
Speaking softly or barely able to whisper
Slow rate of speech
Rapid rate of speech with a "mumbling" quality
Limited tongue, lip, and jaw movement
Abnormal intonation (rhythm) when speaking
Changes in vocal quality ("nasal" speech or sounding "stuffy")
Hoarseness
Breathiness
How is dysarthria diagnosed?
A speech-language pathologist (SLP) can evaluate a person with speech difficulties and
determine the nature and severity of the problem. The SLP will look at movement of the lips,
tongue, and face, as well as breath support for speech, voice quality, and more.
Another motor speech disorder is apraxia. An important role of the SLP is to determine whether
the person's speech problems are due to dysarthria, apraxia, or both.
SLPs work in many places, including hospitals, clinics, nursing homes, and schools. Sometimes
an SLP can come to a person's home. To contact a speech-language pathologist visit ASHA's Find
a Professional.
What treatment is available for people with dysarthria?
Treatment depends on the cause, type, and severity of the symptoms. An SLP works with the
individual to improve communication abilities.
Possible Goals of Treatment
Slowing the rate of speech
Improving the breath support so the person can speak more loudly
Strengthening muscles
Increasing mouth, tongue, and lip movement
Improving articulation so that speech is more clear
Teaching caregivers, family members, and teachers strategies to better communicate with the
person with dysarthria
In severe cases, learning to use alternative means of communication (e.g., simple gestures,
alphabet boards, or electronic or computer-based equipment)
What can I do to communicate better with a person with dysarthria?
It is important for both the person with dysarthria and the people he or she communicates with
to work together to improve interactions. Here are some tips for both speaker and listener.
Tips for the Person With Dysarthria
Introduce your topic with a single word or short phrase before beginning to speak in more
complete sentences
Check with the listeners to make sure that they understand you
Speak slowly and loudly; pause frequently
Try to limit conversations when you feel tired, when your speech will be harder to understand
If you become frustrated, try to use other methods, such as pointing or gesturing, to get your
message across, or take a rest and try again later
Children may need additional help to remember to use these strategies.
Tips for the Listener
Reduce distractions and background noise
Pay attention to the speaker
Watch the person as he or she talks
Let the speaker know when you have difficulty understanding him or her
Repeat only the part of the message that you understood so that the speaker does not have
to repeat the entire message
If you still don't understand the message, ask yes/no questions or have the speaker write his
or her message to you
What other organizations have information on dysarthria and services for people with dysarthria?
This list is not exhaustive and inclusion does not imply endorsement of the organization or
content of the Web site by ASHA.
Mayo Clinic
FCC speech-to-speech services access numbers
Speech Communication Assistance by Telephone, Inc.
What causes dysarthria?
Dysarthria is caused by many different conditions that involve the nervous system, including the
following:
Stroke
Brain injury
Tumors
Cerebral palsy
Parkinson's disease
Lou Gehrig's disease/amyotrophic lateral sclerosis (ALS)
Huntington's disease
Multiple sclerosis
Medications
What are the types of dysarthria?
The following Web sites explain and define the many types of dysarthria.
Cognitive Science Initiative: Language Lexicon
The Neuroscience on the Web Series

Stuttering
What is stuttering?
Stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts
throughout life. The disorder is characterized by disruptions in the production of speech sounds,
also called "disfluencies." Most people produce brief disfluencies from time to time. For instance,
some words are repeated and others are preceded by "um" or "uh." Disfluencies are not
necessarily a problem; however, they can impede communication when a person produces too
many of them.
In most cases, stuttering has an impact on at least some daily activities. The specific activities
that a person finds challenging to perform vary across individuals. For some people,
communication difficulties only happen during specific activities, for example, talking on the
telephone or talking before large groups. For most others, however, communication difficulties
occur across a number of activities at home, school, or work. Some people may limit their
participation in certain activities. Such "participation restrictions" often occur because the person
is concerned about how others might react to disfluent speech. Other people may try to hide
their disfluent speech from others by rearranging the words in their sentence (circumlocution),
pretending to forget what they wanted to say, or declining to speak. Other people may find that
they are excluded from participating in certain activities because of stuttering. Clearly, the
impact of stuttering on daily life can be affected by how the person and others react to the
disorder.
What are signs and symptoms of stuttering?
Stuttered speech often includes repetitions of words or parts of words, as well as
prolongations of speech sounds. These disfluencies occur more often in persons who stutter than
they do in the general population. Some people who stutter appear very tense or "out of breath"
when talking. Speech may become completely stopped or blocked. Blocked is when the mouth is
positioned to say a sound, sometimes for several seconds, with little or no sound forthcoming.
After some effort, the person may complete the word. Interjections such as "um" or "like" can
occur, as well, particularly when they contain repeated ("u- um- um") or prolonged ("uuuum")
speech sounds or when they are used intentionally to delay the initiation of a word the speaker
expects to "get stuck on."
Some examples of stuttering include:
"W- W- W- Where are you going?" (Part-word repetition: The person is having difficulty
moving from the "w" in "where" to the remaining sounds in the word. On the fourth attempt,
he successfully completes the word.)
"SSSS ave me a seat." (Sound prolongation: The person is having difficulty moving from the
"s" in "save" to the remaining sounds in the word. He continues to say the "s" sound until he
is able to complete the word.)
"I'll meet you - um um you know like - around six o'clock." (A series of interjections: The
person expects to have difficulty smoothly joining the word "you" with the word "around." In
response to the anticipated difficulty, he produces several interjections until he is able to say
the word "around" smoothly.)
How is stuttering diagnosed?
Identifying stuttering in an individual's speech would seem like an easy task. Disfluencies often
"stand out" and disrupt a person's communication. Listeners can usually detect when a person is
stuttering. At the same time, however, stuttering can affect more than just a person's
observable speech. Some characteristics of stuttered speech are not as easy for listeners to
detect. As a result, diagnosing stuttering requires the skills of a certified speech-language
pathologist (SLP).
During an evaluation, an SLP will note the number and types of speech disfluencies a person
produces in various situations. The SLP will also assess the ways in which the person reacts to
and copes with disfluencies. The SLP may also gather information about factors such as teasing
that may make the problem worse. A variety of other assessments (e.g., speech rate, language
skills) may be completed as well, depending upon the person's age and history. Information
about the person is then analyzed to determine whether a fluency disorder exists. If so, the
extent to which it affects the ability to perform and participate in daily activities is determined.
For young children, it is important to predict whether the stuttering is likely to continue. An
evaluation consists of a series of tests, observations, and interviews designed to estimate the
child's risk for continuing to stutter. Although there is some disagreement among SLPs about
which risk factors are most important to consider, factors that are noted by many specialists
include the following:
a family history of stuttering
stuttering that has continued for 6 months or longer
presence of other speech or language disorders
strong fears or concerns about stuttering on the part of the child or the family
No single factor can be used to predict whether a child will continue to stutter. The combination
of these factors can help SLPs determine whether treatment is indicated.
For older children and adults, the question of whether stuttering is likely to continue is
somewhat less important, because the stuttering has continued at least long enough for it to
become a problem in the person's daily life. For these individuals, an evaluation consists of tests,
observations, and interviews that are designed to assess the overall severity of the disorder. In
addition, the impact the disorder has on the person's ability to communicate and participate
appropriately in daily activities is evaluated. Information from the evaluation is then used to
develop a specific treatment program, one that is designed to:
help the individual speak more fluently,
communicate more effectively, and
participate more fully in life activities.
What treatments are available for stuttering?
Most treatment programs for people who stutter are "behavioral." They are designed to teach
the person specific skills or behaviors that lead to improved oral communication. For instance,
many SLPs teach people who stutter to control and/or monitor the rate at which they speak. In
addition, people may learn to start saying words in a slightly slower and less physically tense
manner. They may also learn to control or monitor their breathing. When learning to control
speech rate, people often begin by practicing smooth, fluent speech at rates that are much
slower than typical speech, using short phrases and sentences. Over time, people learn to
produce smooth speech at faster rates, in longer sentences, and in more challenging situations
until speech sounds both fluent and natural. "Follow-up" or "maintenance" sessions are often
necessary after completion of formal intervention to prevent relapse.
What can I do to communicate better with people who stutter?
Often, people are unsure about how to respond when talking to people who stutter. This
uncertainty can cause listeners to do things like look away during moments of stuttering,
interrupt the person, fill in words, or simply not talk to people who stutter. None of these
reactions is particularly helpful, though. In general, people who stutter want to be treated just
like anybody else. They are very aware that their speech is different and that it takes them
longer to say things. Unfortunately, though, this sometimes leads the person to feel pressure to
speak quickly. Under such conditions, people who stutter often have even more difficultly saying
what they want to say in a smooth, timely manner. Therefore, listeners who appear impatient or
annoyed may actually make it harder for people who stutter to speak.
When talking with people who stutter, the best thing to do is give them the time they need to
say what they want to say. Try not to finish sentences or fill in words for them. Doing so only
increases the person's sense of time pressure. Also, suggestions like "slow down," "relax," or
"take a deep breath" can make the person feel even more uncomfortable because these
comments suggest that stuttering should be simple to overcome, but it's not!
Of course, different people who stutter will have different ways of handling their speaking
difficulties. Some will be comfortable talking about it with you, while others will not. In general,
however, it can be quite helpful to simply ask the person what would be the most helpful way to
respond to his or her stuttering. You might say something like, "I noticed that you stutter. Can
you tell me how you prefer for people to respond when you stutter?" Often, people will
appreciate your interest. You certainly don't want to talk down to them or treat them differently
just because they stutter. However, you can still try to find a matter-of-fact, supportive way to
let them know that you are interested in what they are saying, rather than how they're saying it.
This can go a long way toward reducing awkwardness, uncertainty, or tension in the situation
and make it easier for both parties to communicate effectively.
What other organizations have information about stuttering?
This list is not exhaustive and inclusion does not imply endorsement of the organization or the
content of the Web site by ASHA.
National Stuttering Association
Stuttering Home Page Chat Room
University of Wisconsin Family Village Stuttering Page
Stuttering Home Page
Stuttering Foundation of America
The Canadian Stuttering Association
International Stuttering Association
K12 Academics Stuttering Page
University College London's Archive of Stuttered Speech (UCLASS) Speech samples from
children who stutter
What causes stuttering?
The exact cause of stuttering is unknown. Recent studies suggest that genetics plays a role in
the disorder. It is thought that many, if not most, individuals who stutter inherit traits that put
them at risk to develop stuttering. The exact nature of these traits is presently unclear.
Whatever the traits are, they obviously impair the individual's ability to string together the
various muscle movements that are necessary to produce sentences fluently.
Not everyone who is predisposed to stutter will develop the disorder. For many, certain life
events are thought to "trigger" fluency difficulty. One of the triggers for developmental
stuttering may be the development of grammar skills. Between the ages of 2 and 5 years,
children learn many of the grammatical rules of language. These rules allow children to change
immature messages ("Mommy candy") into longer sentences that require coordination to
produce fluently ("Mommy put the candy in my backpack"). A child who is predisposed to stutter
may have no difficulty speaking fluently when sentences are only one or two words long.
However, when the child starts trying to produce longer, more complex sentences, he or she
may find himself or herself not quite up to the challenge-and disfluent speech results.
After stuttering has started, other factors may cause more disfluencies. For example, a child who
is easily frustrated may be more likely to tighten or tense speech muscles when disfluencies
occur. Such tension may increase how long a disfluency lasts. Listeners' responses to stuttering
(e.g., teasing) can aggravate fluency difficulties as well. People who stutter vary widely in how
they react to the disfluencies in their speech. Some appear to be minimally concerned. Others-
especially those who have encountered unfavorable reactions from listeners-may develop
emotional responses to stuttering that hinder speech production further. Examples of these
emotions include shame, embarrassment, and anxiety.
How common is stuttering and when does it typically start?
Usually, the symptoms of developmental stuttering first appear between the ages of 2 and 4
years. Although less common, stuttering may start during elementary school. Stuttering is more
common among males than females. Among elementary school-age children, it is estimated that
boys are three to four times more likely to stutter than girls. Preschoolers may show little or no
awareness of their speech difficulties, particularly during the early stages of the problem.
Throughout the school years and beyond, however, most people who stutter become
increasingly aware of their speech difficulties and how others react when they do not speak
fluently.
The development of stuttering varies considerably across individuals. Some children show
significant difficulty with speech fluency within days or weeks of onset. Others show a gradual
increase in fluency difficulties over months or years. Furthermore, the severity of children's
stuttering can vary greatly from day to day and week to week. With some children, the
disfluencies may appear to go away for several weeks, only to start again for no apparent
reason. For teens and adults who stutter, the symptoms of stuttering tend to be more stable
than they are during early childhood. Still, teen and adult speakers may report that their speech
fluency is significantly better or worse than usual during specific activities.
About 75% of preschoolers who begin to stutter will eventually stop. Many children who
"recover" from stuttering do so within months of the time their stuttering started. Nonetheless,
there are some people who have stuttered for many years and then improve. Why some people
recover is unclear, and it is not possible to say with certainty whether the stuttering symptoms
for any particular child will continue into adulthood. Children's recovery from stuttering may
happen when they receive speech therapy. The role of speech therapy in the recovery process
needs to be studied further, however, because some preschoolers appear to recover without
ever having seen an SLP. It is hoped that, with continued research, SLPs will someday be able to
precisely answer questions about why and how recovery takes place, both with and without
speech therapy.

VOICE
We have all experienced problems with our voices, times when the voice is hoarse or when
sound will not come out at all! Colds, allergies, bronchitis, exposure to irritants such as
ammonia, or cheering for your favorite sports team can result in a loss of voice. Learn more
about different types of voice disorders.