SPEECH AND LANGUAGE DISORDERS IN CHILDREN
School problems and the Family Physician
Dr. Latha Ravichandran, DCH, DNB(Pediatric Medicine)

Introduction
Speech and language although closely related are not synonymous. Language is a symbol system used to develop concepts and allow understanding. It is expressed through speech, but it can also be conveyed through other means such as sign language and musical notation. Linguistically proficient children have a distinct advantage in school because much of what is taught is delivered in literate language. All the basic academic skills are largely conveyed through language. Therefore it is not surprising that children with language dysfunction usually have troubled educational career.

Classification of speech and language disorders;
1. Developmental disorders
A. Speech
(a) Dysrhythmia- stuttering
(b) Phonological delay (dyslalia)
(c) Articulatory (verbal) dyspraxia
B. Language
(a) Receptive and expressive language delay
(b) Verbal auditory agnosia / Central deafness
(c) Semantic
2. Neurological and/or acquired disorders
A. Speech
(i) Dysphonia Recurrent laryngeal nerve palsy/brain stem lesion
(ii) Dysrhythmia Cerebellar
(iii) Dysarthria Anatomical
Cleft palate
Neurological : bulbar palsy
(iv) Acquired articulatory dyspraxia
B. Language
(i) Dysphasia Expressive
Receptive
Transcortical
Conduction
(ii) Acquired auditory agnosia
3. Secondary speech and language disorders
(i) Peripheral deafness
(ii) Mental handicap
(iii) Autism
(iv) Psychological deprivation
(v) Miscellaneous
Definition of Terminology:
a. Developmental language disorder is a delay in the development of comprehension and the use of a spoken, written or symbolic system of communication.
b. Dysrhythmia eg. Stuttering, fluency disorder, where there is intermittent difficulty in producing a smooth flow of speech that is characterized by repetitions, hesitations, or blockage of speech.
c. Phonological delay (dyslalia): This is characterised by constant delay in the onset of various stages of speech, but the most striking feature is their unintelligibility of speech.
d. Dyspraxia is an inability to use voluntarily the muscles needed for articulation.
e. Receptive Disorder is impairment in the ability to comprehend language.
f. Expressive disorder is impairment in the ability to express thoughts.
g. Verbal auditory agnosia/Central deafness. This condition where the peripheral hearing mechanics are normal, but there is word deafness due to bilateral involvement of primary auditory cortex in the temporal lobes (the cortex fails to recognise signals).
h. Semantic : These children may be chatty, and articulate but on keen observation reveal echolalia, perseverations, circumlocution and errors. Their comprehension is delayed compared to their expression and they fail to understand their own speech.
i. Dysphonia; These children have abnormalities in the tone of the voice.
j. Autism : It is characterised by a qualitative impairment in verbal and non verbal communications, in imaginative activity and in reciprocal social interactions.

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