Pediatric Communication Disorders
Pediatric Speech Disorders
Most Common Causes:
Functional articulation or phonological disorders
Developmental Delay
Cerebral Palsy
Craniofacial disorders
Behaviors Noted:
By age 3 years, cannot be understood by family and/or caregivers.
By age 4 years, cannot be understood by people they do not associate regularly.
By age 5 years, cannot be understood in all situations by most listeners.
Difficulty in neuromuscular control causes difficulty in sound production exhibited by slurred speech, strangled voice.
Pediatric Language Disorders
Most Common Causes:
Developmental delay
Autism, Pervasive developmental disorder, Asperger Syndrome
Fetal alcohol syndrome
Hearing loss
Behaviors Noted:
Receptive Language:
By 6 months, does not:
notice/startle to loud sounds.
look at the person speaking to them.
By 12 months, does not:
respond to music and/or singing.
understand simple questions.
maintain eye contact and/or attention to speaker.
By 2 years, does not:
identify basic body parts.
demonstrate action words, for example, eat.
By 4 years, does not:
understand comparisons.
make inferences.
By 5 years, does not:
understand complex directions.
understand concepts
Receptive Language/Learning:
Does not understand simple commands.
Exhibits difficulty understanding teacher's instructions, conversation with peers.
Exhibits difficulty in mathematical reasoning, numerical concepts and applications.
Expressive Language/Learning:
Difficulty in oral expression, including appropriate use of words, grammar, and underlying meaning of words to report information, express ideas, and draw conclusions and/or inferences. Usually affects social communication.
Difficulty in written expression, including inappropriate letter formation, word selection, spelling, grammar, and meaningful sentence paragraph use to complete schoolwork.
Difficulty in basic reading skills, including the ability to decode letter and words to attain information, to draw inferences, conclusions, and make associations for all subjects in school and socially at home.
Difficulty with mathematical calculations, including mathematical reasoning to perform mathematical applications and equations, activities involving money management, measurement and projections, and/or calculations of time.
Pediatric Swallowing Disorders
Most Common Causes:
Nervous system disorders
Craniofacial disorders (cleft lip/palate)
Congenital heart disease
Gastrointestinal conditions (traceoesophageal fistula, gastroesophageal reflux disease)
Prematurity/low birth weight
Behaviors Noted:
Infant does not:
consume more than 1-3 ounces at meal.
routinely remain awake after consuming first few ounces of liquid.
By 6 months, cannot:
sit up for spoon feeding.
close lips around spoon to receive and eat semi-solid foods.
By 9 months, cannot:
suck liquids from cup.
attempt to assist with spoon.
feed self “finger foods.”
.
General signs/symptoms:
Meals take longer than 30 minutes.
Selective food refusal, feeding resistance, or forced feeding by caregiver.
Stressful mealtimes for child and caregiver.
Lack of weight gain over 2-3 months in young children.
Limited oral intake.
Failure to accept new age-appropriate foods.
Failure to accept varying food textures/consistencies
Oral-Motor Signs/Symptoms:
Delayed or difficult initiation of swallow.
Food remains in mouth after swallow.
Excessive gagging or saliva during meals.
Excessive drooling.
Nasopharyngeal regurgitation.
Ineffective chewing/swallowing.
Excessive leakage of food/liquid from mouth.
Gurggly voice quality
Orofacial Myology:
Mouth breathing.
Open mouth posture while watching TV, doing homework, or during play.
Dental malocclusion problems affecting speech production and swallowing.
Reversed or tongue thrust swallow.
Pediatric Cognitive Communication Disorders
Most Common Causes:
Autism
Cerebral palsy
Developmental delay
Traumatic brain injury (TBI)
Behaviors Noted:
By 6 months, does not:
watch caregiver during feeding.
bang objects in play.
maintain eye contact.
By 12 months, does not:
show some initial separation fear (from caregiver).
use gesture and vocalization to protest.
reach for self in mirror.
wave hi and bye.
By 18 months, does not:
hug dolls, animals, or people.
shake head “no.”
use word to protest , for example, “no.”
By 2 1/2 years, does not:
pretend to write or talk on the phone.
begin sharing toys with other children.
talk to other children during play.
School age:
Limited eye contact.
Inappropriate or limited play/use of toys.
Limited use of words to communicate.
Difficulty following simple and/or complex directions.
Instead of verbalizing emotion, tends to have tantrums.
Disorganized with limited problem solving and judgment, poor concentration.
Poor impulse control.
Does not initiate greetings and social pleasantries.
Limited communication.
Responses in conversation are often redundant or tangential.
May elaborate on information provided from questions, but cannot appropriately change topic, initiate or end conversation.
Misses or misunderstands humor.
Pediatric Fluency Disorders
Most Common Causes:
Developmental stuttering or cluttering
Language impairment
Cerebral palsy
Traumatic brain injury (TBI)
Behaviors Noted:
Child's caregivers exhibit concern that the child's disfluencies are a problem with any of the following:
- Child reacts to his disfluencies and may stop talking.
- Observable signs of muscle tension during disfluencies.
- Exhibits observable escape behaviors, for example, eye blinks, head nods, and “um's.”
- Demonstrates awareness of disfluencies and feelings of frustration.
Older individuals often display complex, habitualized patterns of avoidance and escape behaviors, for example, taps fingers on desk while speaking to attempt to avoid or end a disfluency.
Neurologic difficulties in natural, smooth production characterized by:
- Difficulty using appropriate words and combining them to effectively communicate
often causing word substitutions, perseverations and revisions, for example, “dog-cat come here.”
- Difficulty in motor speech programming causing sound, syllable, and/or word repetitions while going through trial and error attempts to use correct sounds for word production, may have difficulty initiating vocalization, for example, ---T-K--K-G-Get my book.
PediatricVoice Disorders
Most Common Causes:
Structural:
Vocal Nodules
Laryngitis
Cleft Palate
Movement:
Hyperfunctional hoarseness or aphonia
Sensorineural hearing loss
Vocal fold paralysis
Behaviors Noted:
Vocal Clarity:
Breathy and/or hoarse often accompanied by reduced loudness and/or intermittent loss of voice.
Too little/too much nasality, may exhibit nasal regurgitation of food.
Sounds harsh, strained, unpleasant.
Loudness:
Complete absence of voice.
Inconsistent voicing
Voice too soft/weak
Voice too loud
Pitch:
Too high or low for age, gender, physical size.
Monotone often accompanied by reduced loudness, hearing loss, or emotional difficulty.
Vocal inefficiencies with pitch break as symptoms of:
- Inappropriate postmaturational voice quality.
- Diplophonia.
Neurologically based voice difficulties including:
- Excessively breathy/hoarse vocal quality often accompanied by reduced speech intelligibility and/or swallowing problems. Weak or absent cough and/or wet gurgly vocal quality after eating indicates risk for aspiration.
- Voice is too soft and/or intermittent, may exhibit poor respiratory control for speech and/or poor head, neck, and/or body posture for speech.