Functional Speech Disorders - What are they?
- Created on Thursday, 24 November 2011 10:45
- Updated on Friday, 02 March 2012 12:14
Difficulty with one, or just a few sounds
Functional speech disorder is one of several speech sound disorders that can occur in children and persist into adulthood.
A child with a functional speech disorder has difficulty learning to make a specific speech sound (e.g., /r/), or a few specific speech sounds, which may include some or all of these: /s/, /z/, /r/, /l/ and 'th'.
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 phonological disorders, or childhood apraxia of speech, or the dysarthrias in children.
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.
All speech-language pathology/speech and language therapy 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.
Informed assessment provides the basis for diagnosis. The SLP/SLT 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.
Ideally, the SLP/SLT 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 after the break drom therapy attendance.
The child's parents would be given an expectation that, with appropriate intervention and good co-operation between clinician, family and child, it would be reasonable to look forward to the problem to resolving within 14 weeks or so. It would be explained that some children require more or less therapy than others.
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, by speech-language professionals, 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 child and family are settled 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.
Intervention for children
For many years Speech-Language Pathologists / Speech and Language Therapists have been remarkably successful in treating individuals with functional speech disorders using evidence-based (scientific) approaches, traditional articulation therapy approaches, and innovative approaches.
There is an interesting 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."
Intervention 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/.
With speech-language pathology intervention and a monitored (by the SLP/SLT) practice schedule, motivated adults often overcome these disorders, achieving "standard" speech sound production of any of the sounds that were previously in error.
It can seem a brave step, however, to seek professonal help for a speech disorder in adulthood.
Homework for children
It is thought 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/SLT 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 Professionals. SLPs/SLTs 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 eager to eliminate it (not everyone is, mind!) do yourself a favour and seek the professional assessment and expert advice of a Speech-Language Pathologist / Speech and Language Therapist.