1st Faculty of Medicine Charles University 1st Faculty of Medicine Charles University Department of Phoniatrics

Speech and language disorders

Late talkers

 Absolute indications for immediate evaluation of language delay

- No babbling, pointing, or gesturing by 12 months

- No single words by 16 months

- No two-word spontaneous phrases by 24 months

- Any regression in language or social skills at any age


15-25% of young children have some type of communication disorder

- Incidence of SLI (specific language impairment) in 5 y. old was estimated to be 7,6%

  National Institutes of Health – USA (a condition also called language-learning

  impairment, developmental dysphasia, developmental language disorder or dev.


- Late talkers - most 67% to 84% are boys

- if a child has SLI, there is a 25% chance that another family member will be affected

- Dysarthria, verbal apraxia, phonological disorder

- Suttering – fluency disorders

- Cleft palate

Auditory-phonological processing presents the heterogenity of specific language impairment (SLI): identification of speech sounds appears to be a problem, more typical SLI – where language comprehension is impaired, but the most obvious problems are with expressive syntax and phonology, problems with semantic and association function, disorder of the short-term memory, auditory processing deficit – inability to recognize the key words, inability to use intrinsic- extrinsic redundancies to complete speech sound.


Treatment of SLI children in our department

- All children underwent detailed phoniatric examination  

- analysis of speech and language functions audiometric tests,discriminative auditory tests,

- test of phonological awareness

- test of word  repetition/ short-term memory

- central dichotic tests

- study of auditory evoked potentials



Hearing screening in high risk infants
(results of 1100 children)

- The results of 10 years study

- Using TEOAE and ABR

- Very low birth weight under 1500 g

- The predominant factor is gestational age

- The most specific risk is a low birth weight

- Results: 27 children with hearing loss

- 2,45% of incidence



Speech and language screening
in high risk infants

- 600 risk children especially with low birth weight

- Results: 40% children with speech and language disorder

- Late talker:

SLI children, dysarthria, stuttering, dyspraxia, dyslexia, dysgraphia

and combination…



Fluency disorders

- Stuttering

- Neurogenic disfluency

- stroke, head trauma, dementia, tumors, drug usage

- extrapyramidal diseases

- Psychogenic disfluency

- Spasmodic dysphonia (spastic)

- Tourette syndrome

- Linguistic disfluency

- Normal developmental disfluency


Onset characteristics – two stages (Bluemel)

Primary stuttering

- Easy, intermittent repetitions of the first word or syllable in a sentence


Secondary stuttering – progression

- Clonic types – more rapid, tense behaviors involving muscle tension, interrupted breathing and facial tension

- Tonic types


Stuttering - fluency disorder

- Stuttering varies by time, situation, and language factors

Special conditions that immediately eliminate stuttering: choral reading – with a speaker who is fluent, lipped speech, whispered speech, prolonged speech with or without Delayed Auditory Feedback, rhytmic speech, shadowing, singing, slowed speech

- Etiology – multifactorial, as the interaction of predisposing factors, negative emotional response, the incomplete cerebral dominance Tudory, consequences of a subcortical lesion

- Therapy – treatment, family based treatment, speech treatment – relationship to age (school-age, adolescents, adults), psychotherapy, relaxation….


Cleft lip and palate
Cleft palate disorders

- Birth defect (prevalence 1/500-600) – a lack of continuity of structure of some of various segments which normally combine to form the upper lip and palate (the roof of the mouth) – those structures are deficient

- ¼ cleft lip only, ½ cleft lip and palate, ¼ cleft palate

- In any event there is an open passageway connecting the mouth cavity and the nose

- Velopharyngeal incompetence

- Feeding problems, respiratory infections,

- Dental and occlusal problems

- Cleft palate – communication problems: hearing impairment – conductive, middle ear disease, language development - may be slower in the beginning of  to talk, speech-sound articulation and voice quality problems

- Velopharyngeal incompetence and its effects on speech: inability to close the velopharyngeal port

- Palatolalia, palatophonia – hyperrhinophonia