Speech Difficulties in Children with Developmental Verbal Dyspraxia

Children with Developmental Verbal Dyspraxia (DVD) have difficulty in making and co-ordinating the precise movements needed to produce clear speech, without any signs of damage to their muscles or nerves. Children with DVD have difficulty in producing individual sounds and combining these sounds into words; this indicates difficulties in the child’s planning and programming of movements for speech (RCSLT, 2011). Children with DVD don’t just sound like a younger child, their speech is unusual, and often hard to understand. Difficulties can include:

• Oro-motor difficulties
• Vowel errors
• Voicing errors (car→gar)
• Consonant cluster deletions (sleep→seep)
• Speech errors are inconsistent e.g. they may say; tup, bup and gup for cup
• Difficulty initiating speech
• Overuse of one sound (favourite sound)
• Breakdown in sequencing words, particularly as length increases
• Making searching mouth movements with their lips and tongue as they attempt to produce sounds and words.
• Prosodic difficulties affecting rate, rhythm, stress and intonation
• Unintelligible speech (Malmenholt, Lohmander, & McAllister, 2016)

Children with DVD may also have Oral-Motor Dyspraxia. This is a difficulty in making and co-ordinating the specific movements of the lips, tongue and palate. Children with Oral-Motor Dyspraxia will have no problems with automatic oral movements such as licking an ice-cream, but will have great difficulty when asked to carry out an oral movement such as, sticking out their tongue.

References

• Malmenholt, A., Lohmander, A., & McAllister, A. (2016). Childhood apraxia of speech: A survey of praxis and typical speech characteristics. Logopedics, Phoniatrics, Vocology, 31, 1-9.
• (2011). RCSLT policy statement: developmental verbal dyspraxia. London: Royal College of Speech & Language Therapists.

Speech Difficulties in Children with Cerebral Palsy

Children with Cerebral Palsy often have difficulties producing sounds and words as a result of poor muscle control. This is called Dysarthria; it is a motor speech disorder which affects the child’s oral motor muscles used to produce speech. Speech intelligibility is impacted due to:

• Impaired muscle tone affecting strength, precision and range of movement needed for oral, vocal and breathing movements.
• In-coordination of the muscles used for speech, which leads to abnormal speech characteristics e.g.  difficulties initiating voice and voice control, unusual pitch and volume, hyper-nasality and imprecise articulation of sounds (RCSLT, 2009).

There are three types of Dysarthria in Cerebral Palsy:

• Spastic Dysarthria: Children may have strained and hoarse voice quality, and sound hypernasal. Children will have slow and imprecise speech articulation. These children can also experience swallowing and drooling difficulties (RCSLT, 2009).
• Dyskinetic (hypo or hyperkinetic):
  • Hypokinetic – Children may have a breathy monotone voice with reduced volume and articulation tends to be accelerated and imprecise.
  • Hyperkinetic – Children may experience strained hoarseness and voice arrests (RCSLT, 2009).
• Ataxic Dysarthria: Children have a marked difficulty articulating speech sounds, and specific difficulties with alternating tongue movements. They may experience tremor and excessive loudness.(RCSLT, 2009)

References

• (2009). Resource manual for commissioning and planning services for SLCN dysarthria. London: Royal College of Speech and Language Therapists.
• Watson, R.M. & Pennington, L. (2015). Assessment and management of the communication difficulties of children with cerebral palsy: A UK survey of SLT practice. International Journal of Language and Communication Disorders, 50(2), 241-259.

Speech Difficulties in Children with Down Syndrome

Children with Down syndrome have a range of difficulties which can affect their speech; these include their anatomical (structural) and physiological (functional) differences:

• Hypotonia: Low muscle tone, which can affect the child’s ability to move their jaw, lips and tongue, which affects the production of speech sounds.
• Small oral cavity, muscular tongue which protrudes out, and a high arched palate: depending on how these structures relate to each other can affect the child’s ability to articulate sounds clearly.
• Respiratory difficulties: poor respiratory support can also affect oral motor skills.
• Mild-moderate hearing loss: which can negatively affect speech and language development (Stoel-Gammon, 2001)

Speech Characteristics:

• Poor intelligibility.
• Children with Down syndrome display speech characteristics similar to children of a younger age, as well as speech errors which are not seen in typical development.
• Children with Down syndrome may also experience difficulties with fluency. Stuttering occurs in 10%-45% of children with Down syndrome, compared to 1% in the general population (Kent & Voperian, 2013).

Children with Down syndrome can also experience hypersensitive or hyposensitive reactions to touch around the mouth. Learning speech sounds requires sensory feedback from oral structures, so difficulty with sensory feedback can affect children’s development of speech (Kumin, L., 2015)

References

• Kent, R.D., & Voperian, H.K. (2013). Speech impairment in Down syndrome: A Journal of Speech, Language, and Hearing Research, 56, 178-210.
• Kumin, L. (2015). A Resource Guide to Oral Motor Skill Difficulties in Children with Down Syndrome.
• Stoel-Gammon, C. (2001). Down syndrome phonology: Developmental patterns and intervention strategies. Down Syndrome Research and Practice 7(3), 93-100.

Speech and Language Difficulties in Children with Autism Spectrum Disorder

Children with Autism experience difficulties with their speech and language, social skills and may have restricted behaviours and play. These difficulties include:

• Speech and Language: difficulties understanding language, delay in learning to speak or not developing any language, repeating words or phrases with no communicative intent, difficulty communicating needs and speaking in an abnormal tone or rhythm.
• Social Skills: avoiding eye contact, lack of interest in other people, prefers to be alone, resistance to touch, difficulty understanding people’s feelings and difficulty making friends.
• Restricted behaviours and Play: hand flapping, rocking, spinning, obsessive attachment to unusual objects (e.g. rubber bands), strong need for sameness, order, and routines (e.g. gets upset by change in routine).

In addition to the above difficulties children with Autism may also experience oral motor difficulties. Belmonte, M. et al (2013) suggest that the speech difficulties children with ASD experience may be associated with oral motor difficulties and this may explain why some children with Autism have yet to develop speech. A recent study suggests that 64% of children diagnosed with Autism were also diagnosed with Developmental Verbal dyspraxia (Tierney, C. et al, 2015).

References

• Belmonte, M.K., Saxena-Chandhok, T., Cherian, R., Muneer, R., George, L., & Karanth, P. (2013). Oral motor deficits in speech-impaired children with   Frontiers in Integrative Neuroscience, 7(47), 1-8.
• Tierney, C., Mayes, S., Lohs, S. R., Black, A., Gisin, E., & Veglia, M. (2015). How valid is the checklist for autism spectrum disorder when a child has apraxia of     speech? Journal of Developmental & Behavioural Paediatrics, 36(8), 569-

Receptive and Expressive Language Difficulties

Children with receptive (understanding) language difficulties may experience problems following simple directions, responding to questions, understanding what gestures mean, have poor listening skills, and need additional time to process language.
Children with expressive (producing) language difficulties may experience challenges learning spoken language. They may experience difficulties with:

• Morphology: the way word structures change e.g. runs, running, ran.
• Grammar: the rules about organising words in sentences.
• Semantics: the meaning of words.
• Pragmatics: how language is used.
• Phonology: the sound system of language.

Children’s receptive and expressive language can be assessed using the Clinical Evaluation of Language Fundamentals, Fourth Edition (CELF-4). This assessment looks at the child’s:

• Understanding of concepts e.g. first/last
• Ability to follow directions
• Ability to recall and formulate sentences
• Structure of words: grammatical rules
• Word classes: how items are related e.g. pig and cow
• Sentence structure: grammatical rules
• Expressive vocabulary

Augmentative and Alternative Communication (AAC)

At Skybound it is our main aim to develop speech, however depending on assessment results; we may recommend initially teaching a form of Augmentative and Alternative Communication. This may include using:

• Sign: A visual and gestural communication system, which is always used with speech. Signing gives children something to look at while also hearing the word; this can support children in making connections between the spoken word and its meaning.
• PECS (Picture Exchange Communication System): Uses pictures which allow children to make choices and communicate their needs. PECS start with pictures of desired objects (e.g. food or places) and progress over time to pictures with sentence strips (e.g. I want crisps).

Proloquo2go: Is an AAC app for your iPhone, iPad, and iPod. It provides images and symbols to depict common requests, responses and emotions. It generates speech by tapping buttons with symbols or typing using an on-screen keyboard with word prediction.