Functional Speech Disorders INDEX

Synonyms
Functional speech disorders are sometimes referred to as "articulation disorders", "functional articulation disorders" or "articulation problems". Functional speech disorders are not the same thing as developmental phonological disorders, developmental apraxia of speech, or developmental dysarthria. The similarities and differences between these disorders are discussed in this article about speech sound disorders.

The precise cause is unknown
By definition, the precise cause (or causes) of functional speech disorders is (or are) usually unknown. Even so, we do know that structural (anatomical), linguistic and environmental factors,  persistent ear infections associated with intermittent hearing problems, and other significant interruptions to a young child's health and well-being, can impact negatively on speech acquisition.

Assessment
All speech-language pathology intervention is based upon individual, ongoing assessment of a client's communication skills. The therapist first "screens" all areas of communicative function, including voices, speech, language, fluency and pragmatics, and then does an in-depth assessment of particular areas that may be problematic. The assessment may include clinical observations and standardised and non-standardised tests. 

Diagnosis
Informed assessment provides the basis for diagnosis. The speech-language pathologist is able to tell the young client's carers, or the older client, what the problem is, discuss the extent and severity of the problem, and explore treatment options.

Therapy (Treatment) Planning
Ideally, the Speech-Language Pathologist will be able to propose a treatment plan that he or she believes is both evidence-based (or theoretically sound) and optimal for a particular client. 

For example, a child of 5 who substitutes /w/ for /r/ ("wabbit" for "rabbit") may be offered 10 once-weekly therapy appointments augmented by daily homework (practice), then a break of about four weeks, with a plan to review progress at that time. 

Parents would be given an expectation that, with appropriate intervention and good co-operation between clinician, family and child, it would be reasonable to expect the problem to resolve within 14 weeks or so. It would be explained that some children require more or less therapy than others.

Prognosis
A prognosis is a prediction about the likely outcome of therapy. In general the prognosis for the successful treatment of functional speech disorders in children is good. 

However, the therapist may not feel ready to talk about prognosis immediately after assessment and diagnosis, preferring to wait until the child has had a few treatment sessions and until he or she and his or her family is into a routine of doing the necessary supervised home practice. 

Prognosis may not be as positive if the child does not comply with homework, or does not receive appropriate encouragement at home. There is more information about homework below.

Therapy (Treatment) for children
For many years Speech-Language Pathologists have been remarkably successful in treating individuals with functional speech disorders using evidence-based (scientific) traditional and innovative approaches. There is an intersting article on the ASHA web site about former White House press secretary Ari Fleischer who was successfully treated for a functional speech disorder when he was a child. Looking back on this positive experience, Fleischer is quoted as saying:

"I hope I can inspire children who have lisps and others with speech disorders to realize that it can be a phase in your life that you deal with and go through, and it’s over and you can still have a wonderful future ahead.

And I also would say to all the speech-language pathologists and other health care workers that you never know what impact you are having on the children you are treating today. In first grade, Dr. Shulman made a difference in my life that I’m sure he never anticipated at the time."

Therapy (Treatment) for adults
If they are not successfully treated in the early years, functional speech disorders can persist into adulthood, often causing considerable distress. These adults may have difficulty pronouncing just one or two sounds, like /s/ and/z/, or just /r/, or just /l/. On this page adults talk about their experience of lisping. 

With speech-language pathology intervention and a monitored (by the SLP) practice schedule, motivated adults often overcome these disorders, achieving "standard" speech sound production of any of the sounds that were previously in error.

Homework for children
There is research evidence to show that supervised, appropriate homework expedites therapy gains. "Supervised" in this context means that homework tasks have been devised by the clinician on a case-by-case basis, in response to the progress (or sometimes lack of progress) made by the child. 

Homework typically "builds" on previous therapy sessions and previous homework. Usually, the homework for week 1 is no longer necessary in week 2, and so forth. Because every child is different, progress varies for each child. That is why the therapist, in ideal circumstances, does not want to hand out an intervention plan for non-SLPs to administer without supervision.

Unsupervised, or minimally supervised home programs
Of course, "ideal" management is not always possible, and the only intervention option for some clients is a well-explained home program, administered by parents or significant others. With such home programs it is highly desirable for the SLP to review progress and provide ongoing guidance at regular intervals. 

"Please send me some exercises!" 
Many people email me requesting exercises, or do-it-yourself programs  to correct their lisps and other speech sound problems.  The answer to these requests has to be, sorry, but no.

Do-it-yourself therapy for children
Understandably, parents often wonder whether they can avoid the need, inconvenience and costs of professional intervention and help their children by "treating" their lisps themselves using do-it-yourself (DIY) approaches.

Even for very mild functional speech disorders, appropriate intervention is best administered by Speech-Language Pathologists. SLPs are highly trained professionals who have very specialized knowledge and skills in relation to treating speech difficulties.

"Do-it-yourself" therapy is inadvisable. With the best will in the world parents and others simply do not have the diagnostic and intervention skills to accurately diagnose and treat communication impairments.

Do-it-yourself therapy for adults
Similarly, resourceful adults frequently search for self-help materials and exercises. 

But "do-it-yourself" therapy is inadvisable for adults too, as is self-diagnosis.

If you are an adult with a speech impairment that has persisted from childhood, and you are keen to eliminate it (not everyone is, mind!) do yourself a favour and seek the professional assessment and expert advice of a Speech-Language Pathologist.

Page updated 04 Feb 2010

http://www.speech-language-therapy.com/fsd.htm