Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to provide help and support as soon as a problem is identified. Voice disorders may sometimes be divided into organic and functional disorders. Organic disorders are due to physical diseases like cancer and tumors that affect the way the vocal folds work. Functional disorders are due to the misuse and abuse of voice. Frequently, the cause is unknown, which often calls for the support of a speech pathologist. While many speech and language patterns can be called “baby talk” and are part of children’s normal development, they can become problems if they are not outgrown as expected.
There are three parts to the voice — phonation, loudness and pitch, and resonance. Disorders in this category are covered, as well as speech and language disorders. This list, by no means, covers the entire gamut of voice disorders; but it can provide a base to organize communication disorders in general.
- Phonation disorders: To phonate means to produce sound. Phonation disorders occur when there is some change in the vocal folds, which can cause the voice to sound breathy, harsh, or hoarse. Cancer of the larynx, paralysis of the vocal folds, physical trauma and injury (such as a car accident, strangulation, or bullet wound) can cause these issues. Swallowing sharp objects also can produce phonation issues. Other causes include vocally abusive behaviors that include screaming, shouting, constant talking, coughing, and throat clearing. Vocally abusive behaviors result in increased tension and irritation of the vocal folds.
- Loudness and pitch: People who seek treatment for loudness disorders may have either excessive loudness that results in phonation disorders, or results in vocal nodules and polyps that cause such soft speaking that it’s difficult to hear the speaker. Pitch disorders may include examples such as too high of a pitch in males, or too low pitch in females. Mostly, pitch disorders are more discernible in adults.
- Resonance disorders: Resonance means the modification of sounds by structures in the throat, mouth, and nose as it passes through them. Some people sound like they are hyper nasal or speaking through the nose. Hyper nasality occurs when the velopharyngeal mechanism is unable to close the opening to the nose cavity during the production of non-nasal sounds. Some of the organic causes of hyper nasality are cleft palate and velopharyngeal inadequacy. These types of disorders may also cause pain or discomfort when speaking.
- Articulation disorders: This disorder usually is caused by impairments in coordination with the components of physical speech mechanisms (vocal cords, tongue, lips, teeth, soft and hard palate, and lungs). Articulation problems can also result from a child’s chronic ear infections. Physical impairments such as cleft lip, cleft palate, and tongue-tie indicate long-term problems if no intervention occurs. In each of these instances, surgery can correct the problem; however, depending on the age of the child and the severity of the original physical impairment, extensive speech therapy may still be needed. These physical impairments can cause difficulties producing sounds in syllables or saying words incorrectly to the point that listeners can’t understand what’s being said.
- Dysphagia/oral feeding disorders: Difficulty swallowing (dysphagia) is a constant effort with moving food or liquid from the mouth to the stomach. This development can occur at any age, but it’s more common in older adults, in patients who have had strokes, and in patients who are admitted to acute care hospitals or chronic care facilities. Dysphagia is a symptom of many different causes, which can usually be elicited through a careful history by the treating physician. A formal oropharyngeal dysphagia evaluation is performed by a speech-language pathologist.
- Fluency disorders: This speech disorder is diagnosed as an interruption in the normal speech flow by frequent repetitions or prolongations of speech sounds, syllables, or words or by an individual’s inability to start a word. Problems include stuttering, which may be accompanied by rapid eye blinks, tremors of the lips and/or jaw or other struggle behaviors that a person who stutters may use in an attempt to speak. A qualified speech-language pathologist can help children, young adults, and adults make significant progress towards fluency. Fluency therapy may help prevent developmental stuttering from becoming a life-long problem.
- Apraxia: Also known as dyspraxia, apraxia is a speech disorder in which a person has trouble saying what he or she wants to say correctly and consistently. It is not due to weakness or paralysis of the speech muscles (the muscles of the face, tongue, and lips). The severity of apraxia of speech can range from mild to severe. Acquired apraxia of speech can affect a person at any age, although it most typically occurs in adults. It is caused by damage to the parts of the brain that are involved in speaking, and involves the loss or impairment of existing speech abilities. Developmental apraxia of speech (DAS) occurs in children and is present from birth.
- Receptive disorders: A child with receptive language disorder often has difficulty understanding what people are saying to him or her. Other names for receptive language disorder include ‘central auditory processing disorder’ and ‘comprehension deficit.’ In most cases the child also has an expressive language disorder (see below), which means they have trouble using spoken language. Hearing tests are required to make sure the problems aren’t caused by hearing loss. Treatment options include speech–language therapy.
- Expressive disorders: In this disorder, individuals find it difficult to put words together. That person usually has a limited vocabulary, or is unable to use language in a socially appropriate way. Acquired expressive language disorder is caused by damage to the brain. Damage can be sustained during a stroke, or as the result of traumatic head injury, seizures , or other medical conditions. In cases where there is no damage, it is unknown how this disorder manifests itself.
- Aphasia: This class of language disorder ranges from having difficulty remembering words to being completely unable to speak, read, or write. Aphasia disorders usually develop quickly as a result of head injury or stroke, but can develop slowly from a brain tumor, infection, or dementia, or can be a learning disability such as dysnomia. Some symptoms include the inabilities to comprehend language, to pronounce, to speak spontaneously, to form words, to name objects, to read, and to write, among other symptoms.