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Characteristics of Speech Difficulties Impacting on Learning and Teaching
Many skills are required for speech and language to effectively develop and there are many ways in which speech development can go wrong. Some people may have difficulty in moving the muscles that control speech; others can't understand how a conversation works or the meaning of a sentence. Some people can't understand or use language whatsoever. There are different terms to describe different types of difficulty - including phonological difficulties articulation difficulties, verbal dyspraxia, dysarthria, semantic pragmatic disorder, Asperger's Syndrome and selective mutism. Most people will overcome their difficulties with the right help, but 1 in 500 will have severe or long-term difficulties.
Articulation refers to movements of the articulators – tongue, soft palate, jaws, teeth, lips. Problems with any of these lead to an articulation disorder affecting intelligibility to varying degrees.
Problems may include:
- structural – e.g. cleft lip and palate.
- orthodontic – e.g. protruding upper teeth, micrognathia (very small lower jaw), short soft palate.
- neurological – for example, dysarthria, where the range of movement in tongue and lips is restricted. This may be specific to the articulators or more usually associated with a general condition such as cerebral palsy or stroke. Difficulties may also be due to head injury or facial injuries or dyspraxia where movements cannot be organised.
In any articulation problem it is important to have a comprehensive assessment carried out by a speech and language therapist who can also refer on to an ENT surgeon or orthodontist and can recommend appropriate alternative or augmentative communication.
Selective mutism is a term used when children who are able to talk quite freely in some situations, usually with their families at home, and are persistently silent in other situations, usually outside the home and with less familiar people.
This is not normal shyness or obstinacy; it is a psychological problem when children seem to freeze and become unable to speak, a sort of fearfulness and social anxiety, together with an excessive sensitivity to the reactions of others.
Selective mutism is a more recent term for elective mutism; both terms can be used, but selective mutism is now favoured by most professionals.
- Selective mutism is a relatively rare condition. The best estimate suggests that less than one child per thousand is affected.
- Selective mutism is usually reported between the ages of three and five.
- Girls are affected slightly more frequently than boys.
- Children who come from a bilingual background are slightly more likely to display selective mutism.
- Children with selective mutism are more likely to have other speech and language difficulties than other children.
- The majority of children with selective mutism are of average or above average intelligence, but some show moderate to severe learning difficulties.
Approximately five per cent of all people will have experienced some difficulty with their fluency at some time during the development of their speech, and Approximately 80 per cent of those will achieve normal fluency, with or without some help.
Stammering may occur at any time during childhood but it usually starts between the ages of two and five years. (Andrews et al 1983). It is more common in boys than girls and commonly runs in families.
Stammering has been defined as 'an abnormally high frequency or duration of stoppages in the forward flow of speech' (Guitar 1998). It is also referred to as stuttering or dysfluency.
One of the most frustrating features about stammering is its variability. The problem can fluctuate from mild to severe depending on the situation, the time of day or for some other unidentifiable reason. It is different for each person.
There are some features which are typically characteristic of stammering:
- Repetition of whole words, e.g. "and, and, and, then I left".
- Repetition of single sounds, e.g. "c-c-come h-hhere".
- Prolonging of sounds, e.g. "sssssssometimes I go out".
- Blocking of sounds, where the mouth is in position, but no sound comes out.
- Facial tension - in the muscles around the eyes, nose, lips or neck.
- Extra body movements may occur as an attempt is made to push the word out, such as stamping the feet, shifting body position or tapping with the fingers.
- The breathing pattern may be disrupted, e.g. holding the breath while speaking or taking an exaggerated breath before speaking.
- Generally the flow of speech is interrupted and this may cause distress to the speaker and the listener.
Sometimes a person may adopt strategies to try and minimise or hide the problem, for example:
- Avoiding or changing words - saying "I’ve forgotten what I was going to say", or switching to another word when stammering begins, e.g. "I saw my br- br- br... my sister on Saturday".
- Avoiding certain situations - for instance, speaking during seminars or making oral presentations.
The cause of stammering remains unknown. Research to date suggests that children are born with a predisposition to stammering, perhaps inherited, and then other factors will influence when and how the stammer emerges and how it progresses. These factors are broadly divided into four categories: Physiological, Linguistic, Environmental and Emotional factors (Rustin, Botterill and Kelman 1996).
Physiological factors may include aspects such as family history, gender, rate of speech. Linguistic factors may include: language development, understanding and use of language and speech sound skills. Emotional factors may include: sensitivity, tendency to worry or set high standards. Environmental factors may include: competition for speaking turns, teasing at school, periods of difficulty or change.
There are a number of different approaches to therapy depending on the nature of the difficulty and the age of the person. For younger children, therapy may be indirect (working with parents) or direct (encouraging the child to make changes to their own speech). For older children and adolescents therapy may include development of social skills (eye contact, turn taking, listening), the development of problem solving and negotiation skills, increasing confidence and improving self-esteem. Therapy also may involve identifying strategies to improve fluency, reducing the fear of stammering and finding ways to manage speaking situations more positively.
Participating in Seminars/Tutorials
Students with speech difficulties are not necessarily among those who might experience undue stress at having to contribute during seminars and tutorials. Where a student has a severe difficulty with verbal communication, it might be sensible to discuss in advance with the student how they feel best able to contribute. They may wish the tutor to repeat their contribution for the benefit of others. If the tutor finds that s/he does not always follow what the student is saying, then sitting next to the student and using a notepad and pen can clarify any misunderstandings. Students who use equipment which produces synthesised speech, or who would be able to use overheads rather than speech, will benefit from prior notice of the topics to help them to prepare.
These strategies are suggestions for inclusive teaching. This list should not be considered exhaustive and it is important to remember that all students are individuals and good practice for one student may not necessarily be good practice for another. You may also like to contact the Disability Specialist in your institution for further information. If you have any good practice that you would like to add to this list, please email your suggestions to firstname.lastname@example.org
- Establish whether a student who experiences communication difficulties has established a successful alternative system of communication, for example: using an assistant to act as communicator.
- Consider using a communication board (with letters and words on it) or a computer with a speech synthesiser.
- Initially ask questions that only need a short answer. However, avoid questions that required only yes or no answers, as these can appear patronising.
- Ensure not to exclude student with speech difficulties from group activities, and manage the pace of the discussion to ensure other students do not interrupt inappropriately.
- Listen closely to what students say; always respond to the content of what someone is saying, and do not be misled by the style of delivery.
- When it is difficult to understand students, keep calm, watch their lips, and take account of facial expressions and body language. Try to avoid guessing or completing sentences for them, unless students want this, to speed communication. Always check with the student.
- Ask students to repeat what has been said if it is difficult to understand. Repeat back to the student to confirm understanding.
- If the student finds speaking in public particularly difficult and exacerbates their problems, it may be preferable to allow the student to record an oral presentation in advance to playback during a teaching session.