Unit 3: Disorders of speech and language

Fill in the blanks:

1. Speech-language deficits affect approximately ________________ of preschool children.
2. A split in the upper lip is called a ________________, while a split in the roof of the mouth is a ________________.
3. ________________ is a condition commonly known as “tongue-tie,” where the lingual frenulum restricts tongue movement.
4. The stage of normal speech development in preschool children that resembles stuttering is called ________________.
5. In language disorders, ________________ refers to the parrot-like repetition of what others say.
6. ________________ is a language disorder that occurs without other conditions like hearing loss or intellectual disability.
7. The U-shaped single bone located above the thyroid cartilage that supports the larynx is the ________________.
8. ________________ refers to an abnormally large or bulky tongue.
9. Stuttering is more prevalent in ________________ than in females.
10. ________________ is misarticulation caused specifically by neurological damage to the motor nerves or muscles.

Answers:

1. 5-8%
2. Cleft lip, cleft palate
3. Ankyloglossia
4. Normal Non-Fluency (NNF)
5. Echolalia
6. Specific Language Impairment (SLI)
7. Hyoid bone
8. Macroglossia
9. Males
10. Dysarthria

Tick the correct answers:

1. Which condition is characterized by a deficiency of muscular tissue in the soft palate without an obvious opening?

a) Cleft Lip

b) Submucous Cleft

c) Microglossia

d) Cluttering

2. Which type of articulation error involves saying “ladio” for “radio”?

a) Substitution

b) Omission

c) Distortion

d) Addition

3. The “Cerebral Dominance Theory” suggests that stuttering is caused by:

a) Learning through conditioning

b) Lack of dominance of one hemisphere

c) Emotional shock

d) Tongue size

4. Which fluency disorder involves a rapid speech rate and a lack of awareness of the problem?

a) Stuttering

b) Neurogenic Stuttering

c) Cluttering

d) Dysphasia

5. A child who refers to themselves as “you” and others as “I” is exhibiting:

a) Echolalia

b) Pronoun Reversal

c) Neologism

d) Mutism

6. Which form of Cerebral Palsy is characterized by slow, writhing involuntary movements?

a) Spastic

b) Ataxic

c) Dyskinetic

d) Hemiplegic

7. What is the approximate incidence of stuttering in the general population?

a) 1%

b) 5%

c) 10%

d) 20%

8. In articulation analysis, saying “ka” for “car” is an example of:

a) Substitution

b) Omission

c) Distortion

d) Addition

9. Which area of the brain, if damaged, leads specifically to “Non-fluent Aphasia”?

a) Wernicke’s Area

b) Broca’s Area

c) Occipital Lobe

d) Cerebellum

10. Children with Intellectual Disability typically follow a language development sequence that is:

a) Deviant/Abnormal

b) Delayed but normal in sequence

c) Faster than peers

d) Random

Answers:

1. b) Submucous Cleft
2. a) Substitution
3. b) Lack of dominance of one hemisphere
4. c) Cluttering
5. b) Pronoun Reversal
6. c) Dyskinetic
7. b) 5%
8. b) Omission
9. b) Broca’s Area
10. b) Delayed but normal in sequence

True or False

1. Voice disorders account for about 6–10% of all communication disorders.
2. Cleft lip and palate are more common in girls than in boys.
3. Normal Non-Fluency (NNF) is considered a disorder requiring immediate treatment.
4. Children with autism often show a strong preference for routine.
5. Specific Language Impairment (SLI) is usually caused by hearing loss.
6. Dyskinetic movements in Cerebral Palsy include athetosis and chorea.
7. Stuttering disfluencies are typically more frequent at the end of a sentence.
8. Macroglossia can be either congenital or acquired.
9. In Acquired Childhood Aphasia (ACA), the child loses previously learned language.
10. The exact cause of cluttering is clearly known to be environmental.

Answers:

1. True
2. False
3. False
4. True
5. False
6. True
7. False
8. True
9. True
10. False

Very short answers type questions:

1. Define “Articulation.”
2. What is a “Bifid Uvula”?
3. What is “Telegraphic Speech”?
4. Name one cause of “Organic” voice disorders.
5. What are “Secondary Behaviors” in stuttering?
6. What is “Microglossia”?
7. Define “Normal Non-Fluency.”
8. What does “Unilateral Cleft” mean?
9. What is “Aphasia”?
10. List two “Other Disfluencies” (ODs).

Answers:

1. The coordinated movement of structures like the tongue, lips, and palate to produce speech sounds.
2. A split or forked uvula, often serving as a sign of a submucous cleft palate.
3. Speech that uses mainly nouns and verbs while omitting articles and tense markers (e.g., “Daddy go work”).
4. Vocal fold growths, infections, or trauma.
5. Involuntary physical movements (blinking, grimacing) used to help release a stuttered word.
6. A condition where the tongue is abnormally small.
7. A developmental stage in preschool children involving repetitions/hesitations as they learn complex language.
8. A cleft that occurs on only one side of the lip or palate.
9. A language disorder caused by brain injury resulting in loss of previously acquired language skills.
10. Pauses, hesitations, or interjections like “um” or “uh.”

Short answer type questions:

1. Distinguish between Speech Disorders and Language Disorders.
2. What is the “S.O.D.A.” classification of articulation?
3. Explain the symptoms of a Submucous Cleft Palate.
4. What are the differences between Stuttering and Cluttering?
5. List four secondary behaviors observed in Persons Who Stutter (PWS).
6. What are the speech characteristics of Neurogenic Stuttering?
7. Describe “Pronoun Reversal” in children with Autism.
8. What is the “Demands-Capacities Model” of stuttering?
9. How does “Intellectual Disability” affect language acquisition?
10. Explain the three types of Clefts.

Answers:

1. Speech disorders involve the physical production of sound (articulation, voice, fluency). Language disorders involve the rules of communication (grammar, vocabulary, social use).
2. It stands for Substitution (wrong sound), Omission (missing sound), Distortion (imprecise sound), and Addition (extra sound).
3. It includes hypernasality, feeding problems (regurgitation), and a bony defect in the hard palate that can be felt but not seen easily.
4. Stutterers are usually aware and anxious about their speech; clutterers lack awareness. Stuttering involves repetitions/blocks; cluttering involves rapid, jerky, disorganized speech.
5. Eye blinking, head jerking, foot tapping, and facial grimacing.
6. It occurs after brain trauma; disfluencies are not limited to initial syllables, and there are often no secondary behaviors or anxiety.
7. The child refers to themselves as “you” or “he/she” and refers to others as “I,” showing a lack of self-concept in language.
8. The theory that stuttering occurs when the environmental demands for fluent speech exceed the child’s neurological or linguistic capacity.
9. Development follows the normal sequence but is significantly delayed, matching the child’s mental age rather than chronological age.
10. Three types of clefts:
    • Cleft lip without cleft palate.
    • Cleft palate without cleft lip.
    • Combined cleft lip and palate.

Long answer type questions:

1. Discuss the various types of tongue abnormalities and their impact on speech.
2. Provide a detailed comparison between Developmental Stuttering and Neurogenic Stuttering.
3. Analyze the speech and language characteristics of a child with Autism.
4. Explain the clinical classification of Cerebral Palsy and its associated speech disorders.
5. Discuss the causes and classification of Articulation Disorders.
6. Explain the various theories regarding the causes of stuttering.
7. Detail the language manifestations seen in children with Intellectual Disability.

Answers:

1. The tongue is the most versatile articulator, and any structural abnormality can lead to significant speech and swallowing difficulties.
   • Microglossia: The tongue is abnormally small. This poses extreme difficulties for both swallowing and articulation, as the tongue cannot reach necessary points of contact (like the palate or teeth) to form sounds.
   • Macroglossia: The tongue is bulky and enlarged. This is more common and can be congenital or acquired (e.g., due to tumors). It leads to articulation errors, swallowing issues, and even teeth abnormalities due to constant pressure.
   • Ankyloglossia (Tongue-tie): This occurs when the lingual frenulum (the tissue under the tongue) is fused too tightly to the floor of the mouth. This restricts the tip of the tongue, leading to lisping and specific articulation errors.
   • Cleft Tongue: A rare condition where a groove runs across the tongue. While it mainly causes difficulty in eating (food gets stuck), deep grooves can occasionally interfere with the precision of certain speech sounds.
2. While both involve disfluent speech, their origins and manifestations differ significantly.
   • Developmental Stuttering: Usually begins in early childhood (preschool years) with a gradual onset. Disfluencies (repetitions/blocks) occur mostly at the beginning of utterances and on content words. It is often accompanied by secondary behaviors (blinking, grimacing) and high levels of speaker anxiety. It often improves under conditions like singing or choral reading.
   • Neurogenic Stuttering: Also known as SAAND, this is acquired in adulthood following a neurological trauma (stroke, tumor). Disfluencies are not restricted to the start of words and occur equally on function words (like “the,” “and”). Crucially, these speakers usually lack secondary behaviors, do not show an “adaptation effect,” and are often less anxious about their disfluencies compared to developmental stutterers.
3. Autism is characterized by profound disturbances in social communication and repetitive behaviors.
   • Pragmatic Deficits: This is the most striking feature. Children with autism struggle with eye contact, initiating conversations, and understanding social context.
   • Echolalia: A “parrot-like” repetition of words or phrases heard from others or TV commercials.
   • Semantic & Syntactic Issues: They tend to learn concrete words (objects) better than abstract concepts (emotions). They may use “Neologisms” (made-up words) or exhibit pronoun reversal, referring to themselves as “you” or “he” instead of “I.”
   • Non-verbal Communication: There is often a poverty of facial expressions and a failure to use or understand basic gestures like pointing.
4. CP is a non-progressive motor disorder caused by early brain damage, classified by the pattern of movement:
   • Spasticity: The most common form, characterized by stiff and tight muscles.
   • Dyskinetic (Athetoid): Characterized by involuntary, slow, writhing movements.
   • Ataxic: Affects balance and coordination, often resulting in an unsteady, broad-based gait.
   • Distribution: Hemiplegia (one side), Diplegia (legs more than arms), or Quadriplegia (all four limbs).
   • Speech Impact: Disorders are multifactorial. Speech may be delayed due to motor weakness (Dysarthria), general intellectual impairment, or associated hearing loss.
5. Articulation disorders occur when a person cannot correctly produce speech sounds.
   • Types (S.O.D.A.):
     • Substitution: (e.g., “ladio” for “radio”).
     • Omission: (e.g., “ka” for “car”).
     • Distortion: (imprecise, “slushy” sounds).
     • Addition: (e.g., “iskuul” for “school”).
   • Causative Factors:
     • Structural: Cleft lip/palate, tongue-tie, or dental issues.
     • Sensory: Hearing loss preventing the child from hearing the correct model.
     • Neuro-motor: Damage to the nervous system (Dysarthria/Apraxia).
     • Psychosocial: Sibling influence, gender, or socio-economic status.
6. Several perspectives attempt to explain why stuttering occurs:
   • Cerebral Dominance Theory: Suggests a failure in one hemisphere of the brain becoming dominant over the other for speech control.
   • Demands–Capacities Model: Proposes that stuttering happens when environmental demands (pressure to speak fast/well) exceed the child’s cognitive or linguistic capacities.
   • Breakdown Hypothesis: Views stuttering as having an organic/biological basis that is triggered by environmental stress or fear.
   • Learning Theories: Suggest stuttering is a learned behavior. Primary stuttering is acquired through classical conditioning, while secondary behaviors are learned through operant conditioning (as a way to “escape” a block).
7. Children with intellectual disability (formerly mental retardation) typically show language that is delayed but not abnormal.
   • Phonology: They are slow to learn speech sounds and frequently omit, substitute, or distort them.
   • Content (Semantics): They are slow to say first words and learn new words at a reduced rate. Their vocabulary is usually concrete (names of objects) rather than abstract (emotions).
   • Form (Syntax/Morphology): They struggle with complex sentences and often miss morphological markers (like plurals or tense endings).
   • Pragmatics: They are often reluctant to use language in social settings and may provide abrupt or inappropriate answers. Their language levels typically correspond to their mental age rather than their chronological age.