speech and language impairment speech and language impairment speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency. main article: speech and language pathology a speech impairment is characterized by difficulty in articulation of words. examples include stuttering or problems producing particular sounds. articulation refers to the sounds, syllables, and phonology produced by the individual. voice, however, may refer to the characteristics of the sounds produced—specifically, the pitch, quality, and intensity of the sound. often, fluency will also be considered a category under speech, encompassing the characteristics of rhythm, rate, and emphasis of the sound produced. a language impairment is a specific impairment in understanding and sharing thoughts and ideas, i.e. a disorder that involves the processing of linguistic information. problems that may be experienced can involve the form of language, including grammar, morphology, syntax; and the functional aspects of language, including semantics and pragmatics. an individual can have one or both types of impairment. these impairments/disorders are identified by a speech and language pathologist. speech disorders main article: speech disorder the following are brief definitions of several of the more prominent speech disorders: apraxia of speech main article: apraxia of speech apraxia of speech is the acquired form of motor speech disorder caused by brain injury, stroke or dementia. developmental verbal dyspraxia main article: developmental verbal dyspraxia developmental verbal dyspraxia refers specifically to a motor speech disorder. this is a neurological disorder. individuals with developmental verbal apraxia encounter difficulty saying sounds, syllables, and words. the difficulties are not due to weakness of muscles, but rather on coordination between the brain and the specific parts of the body. apraxia of speech is the acquired form of this disorder caused by brain injury, stroke or dementia. interventions are more effective when they occur individually at first, and between three and five times per week. with improvements, children with apraxia may be transitioned into group therapy settings. therapeutic exercises must focus on planning, sequencing, and coordinating the muscle movements involved in speech production. children with developmental verbal dyspraxia must practice the strategies and techniques that they learn in order to improve. in addition to practice, feedback can be helpful to improve apraxia of speech. tactile feedback (touch), visual feedback (watching self in mirror), and verbal feedback are all important additions. biofeedback has also been cited as a possible therapy. functional training involves placing the individual in more speech situations, while providing him/her with a speech model, such as the slp. because the cause is neurological, however, some patients do not progress. in these cases, aac may be more appropriate. dysarthria main article: dysarthria dysarthria is a motor speech disorder that results from a neurological injury. some stem from central damage, while other stem from peripheral nerve damage. difficulties may be encountered in respiratory problems, vocal fold function, or velopharyngeal closure, for example. orofacial myofunctional disorders main article: orofacial myological disorders orofacial myofunctional disorders refers to problems encountered when the tongue thrusts forward inappropriately during speech. while this is typical in infants, most children outgrow this. children that continue to exaggerate the tongue movement may incorrectly produce speech sounds, such as /s/, /z/, /ʃ/, /tʃ/, and /dʒ/. for example, the word, "some," might be pronounced as "thumb". the treatment of omd will be based upon the professional's evaluation. each child will present a unique oral posture that must be corrected. thus, the individual interventions will vary. some examples include: increasing awareness of muscles around the mouth increasing awareness of oral postures improving muscle strength and coordination improving speech sound productions improving swallowing patterns speech sound disorder speech sound disorders may be of two varieties: articulation (the production of sounds) or phonological processes (sound patterns). an articulation disorder may take the form of substitution, omission, addition, or distortion of normal speech sounds. phonological process disorders may involve more systematic difficulties with the production of particular types of sounds, such as those made in the back of the mouth, like "k" and "g". naturally, abnormalities in speech mechanisms would need to be ruled out by a medical professional. therapies for articulation problems must be individualized to fit the individual case. the placement approach—instructing the individual on the location in which the tongue should be and how to blow air correctly—could be helpful in difficulties with certain speech sounds. another individual might benefit more from developing auditory discrimination skills, since he/she has not learned to identify error sounds in his/her speech. generalization of these learned speech techniques will need to be generalized to everyday situations. phonological process treatment, on the other hand, can involve making syntactical errors, such as omissions in words. in cases such as these, explicit teaching of the linguistic rules may be sufficient. some cases of speech sound disorders, for example, may involve difficulties articulating speech sounds. educating a child on the appropriate ways to produce a speech sound and encouraging the child to practice this articulation over time may produce natural speech, speech sound disorder. likewise, stuttering does not have a single, known cause, but has been shown to be effectively reduced or eliminated by fluency shaping (based on behavioral principles) and stuttering modification techniques. stuttering main article: stuttering stuttering is a disruption in the fluency of an individual's speech, which begins in childhood and may persist over a lifetime. stuttering is a form of disfluency; disfluency becomes a problem insofar as it impedes successful communication between two parties. disfluencies may be due to unwanted repetitions of sounds, or extension of speech sounds, syllables, or words. disfluencies also incorporate unintentional pauses in speech, in which the individual is unable to produce speech sounds. while the effectiveness is debated, most treatment programs for stuttering are behavioral. in such cases, the individual learns skills that improve oral communication abilities, such as controlling and monitoring the rate of speech. slps may also help these individuals to speak more slowly and to manage the physical tension involved in the communication process. fluency may be developed by selecting a slow rate of speech, and making use of short phrases and sentences. with success, the speed may be increased until a natural rate of smooth speech is achieved. additionally, punishment for incorrect speech production should be eliminated, and a permissive speaking environment encouraged. electronic fluency devices, which alter the auditory input and provide modified auditory feedback to the individual, have shown mixed results in research reviews. because stuttering is such a common phenomenon, and because it is not entirely understood, various opposing schools of thought emerge to describe its etiology. the breakdown theories maintain that stuttering is the result of a weakening or breakdown in physical systems that are necessary for smooth speech production. cerebral dominance theories (in the stutterer, no cerebral hemisphere takes the neurological lead) and theories of perseveration (neurological "skipping record" of sorts) are both breakdown theories. auditory monitoring theories suggest that stutters hear themselves differently from how other people hear them. since speakers adjust their communication based upon the auditory feedback they hear (their own speech), this creates conflict between the input and the output process. psychoneurotic theories posit repressed needs as the source of stuttering. lastly, learning theories are straightforward—children learn to stutter. it should be clear that each etiological position would suggest a different intervention, leading to controversy with the field. voice disorders voice disorders range from aphonia (loss of phonation) to dysphonia, which may be phonatory and/or resonance disorders. phonatory characteristics could include breathiness, hoarseness, harshness, intermittency, pitch, etc. resonance characteristics refer to overuse or underuse of the resonance chambers resulting in hypernasality or hyponasality. several examples of voice problems are vocal cord nodules or polyps, vocal cord paralysis, paradoxical vocal fold movement, and spasmodic dysphonia. vocal cord nodules and polyps are different phenomena, but both may be caused by vocal abuse, and both may take the form of growths, bumps, or swelling on the vocal cords. vocal fold paralysis is the inability to move one or both of the vocal cords, which results in difficulties with voice and perhaps swallowing. paradoxical vocal fold movement occurs when the vocal cords close when they should actually be open. spasmodic dysphonia is caused by strained vocal cord movement, which results in awkward voice problems, such as jerkiness or quavering. if nodules or polyps are present, and are large, surgery may be the appropriate choice for removal. surgery is not recommended for children, however. other medical treatment may suffice for slighter problems, such as those induced by gastroesophageal reflux disease, allergies, or thyroid problems. outside of medical and surgical interventions, professional behavioral interventions can be useful in teaching good vocal habits and minimizing abuse of vocal cords. this voice therapy may instruct in attention to pitch, loudness, and breathing exercises. additionally, the individual may be instructed on the optimal position to produce the maximum vocal quality. bilateral paralysis is another disorder that may require medical or surgical interventions to return vocal cords to normalcy; unilateral paralysis may be treated medically or behaviorally. paradoxical vocal fold movement (pvfm) is also treated medically and behaviorally. behavioral interventions will focus on voice exercises, relaxation strategies, and techniques that can be used to support breath. more generally, however, pvfm interventions focus on helping an individual to understand what triggers the episode, and how to deal with it when it does occur. while there is no cure for spasmodic dysphonia, medical and psychological interventions can alleviate some of the symptoms. medical interventions involve repeated injections of botox into one or both of the vocal cords. this weakens the laryngeal muscles, and results in a smoother voice. language disorders main article: language disorder a language disorder is an impairment in the ability to understand and/or use words in context, both verbally and nonverbally. 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. one or a combination of these characteristics may occur in children who are affected by language learning disabilities or developmental language delay. 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. specific language impairment main article: specific language impairment interventions for specific language impairment will be based upon the individual difficulties in which the impairment manifests. for example, if the child is incapable of separating individual morphemes, or units of sound, in speech, then the interventions may take the form of rhyming, or of tapping on each syllable. if comprehension is the trouble, the intervention may focus on developing metacognitive strategies to evaluate his/her knowledge while reading, and after reading is complete. it is important that whatever intervention is employed, it must be generalized to the general education classroom. selective mutism selective mutism is a disorder that manifests as a child that does not speak in at least one social setting, despite being able to speak in other situations. selective mutism is normally discovered when the child first starts school. behavioral treatment plans can be effective in bringing about the desired communication across settings. stimulus fading involves a gradual desensitization, in which the individual is placed in a comfortable situation and the environment is gradually modified to increase the stress levels without creating a large change in stress level. shaping relies on behavioral modification techniques, in which successive attempts to produce speech is reinforced. self-modeling techniques may also be helpful; for example, self-modeling video tapes, in which the child watches a video of him/herself performing the desired action, can be useful. if additional confounding speech problems exist, an slp may work with the student to identify what factors are complicating speech production and what factors might be increasing the mute behaviors. additionally, he/she might work with the individual to become more comfortable with social situations, and with the qualities of their own voice. if voice training is required, they might offer this as well. aphasia main article: aphasia aphasia refers to a family of language disorders that usually stem from injury, lesion, or atrophy to the left side of the brain that result in reception, perception, and recall of language; in addition, language formation and expressive capacities may be inhibited. language-based learning disabilities language-based learning disabilities, which