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Types of Speech Impediments

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

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Articulation Errors

Ankyloglossia, treating speech disorders.

A speech impediment, also known as a speech disorder , is a condition that can affect a person’s ability to form sounds and words, making their speech difficult to understand.

Speech disorders generally become evident in early childhood, as children start speaking and learning language. While many children initially have trouble with certain sounds and words, most are able to speak easily by the time they are five years old. However, some speech disorders persist. Approximately 5% of children aged three to 17 in the United States experience speech disorders.

There are many different types of speech impediments, including:

• Articulation errors

This article explores the causes, symptoms, and treatment of the different types of speech disorders.

Speech impediments that break the flow of speech are known as disfluencies. Stuttering is the most common form of disfluency, however there are other types as well.

Symptoms and Characteristics of Disfluencies

These are some of the characteristics of disfluencies:

• Repeating certain phrases, words, or sounds after the age of 4 (For example: “O…orange,” “I like…like orange juice,” “I want…I want orange juice”)
• Adding in extra sounds or words into sentences (For example: “We…uh…went to buy…um…orange juice”)
• Elongating words (For example: Saying “orange joooose” instead of "orange juice")
• Replacing words (For example: “What…Where is the orange juice?”)
• Hesitating while speaking (For example: A long pause while thinking)
• Pausing mid-speech (For example: Stopping abruptly mid-speech, due to lack of airflow, causing no sounds to come out, leading to a tense pause)

In addition, someone with disfluencies may also experience the following symptoms while speaking:

• Vocal tension and strain
• Head jerking
• Eye blinking
• Lip trembling

Causes of Disfluencies

People with disfluencies tend to have neurological differences in areas of the brain that control language processing and coordinate speech, which may be caused by:

• Genetic factors
• Trauma or infection to the brain
• Environmental stressors that cause anxiety or emotional distress
• Neurodevelopmental conditions like attention-deficit hyperactivity disorder (ADHD)

Articulation disorders occur when a person has trouble placing their tongue in the correct position to form certain speech sounds. Lisping is the most common type of articulation disorder.

Symptoms and Characteristics of Articulation Errors

These are some of the characteristics of articulation disorders:

• Substituting one sound for another . People typically have trouble with ‘r’ and ‘l’ sounds. (For example: Being unable to say “rabbit” and saying “wabbit” instead)
• Lisping , which refers specifically to difficulty with ‘s’ and ‘z’ sounds. (For example: Saying “thugar” instead of “sugar” or producing a whistling sound while trying to pronounce these letters)
• Omitting sounds (For example: Saying “coo” instead of “school”)
• Adding sounds (For example: Saying “pinanio” instead of “piano”)
• Making other speech errors that can make it difficult to decipher what the person is saying. For instance, only family members may be able to understand what they’re trying to say.

Causes of Articulation Errors

Articulation errors may be caused by:

• Genetic factors, as it can run in families
• Hearing loss , as mishearing sounds can affect the person’s ability to reproduce the sound
• Changes in the bones or muscles that are needed for speech, including a cleft palate (a hole in the roof of the mouth) and tooth problems
• Damage to the nerves or parts of the brain that coordinate speech, caused by conditions such as cerebral palsy , for instance

Ankyloglossia, also known as tongue-tie, is a condition where the person’s tongue is attached to the bottom of their mouth. This can restrict the tongue’s movement and make it hard for the person to move their tongue.

Symptoms and Characteristics of Ankyloglossia

Ankyloglossia is characterized by difficulty pronouncing ‘d,’ ‘n,’ ‘s,’ ‘t,’ ‘th,’ and ‘z’ sounds that require the person’s tongue to touch the roof of their mouth or their upper teeth, as their tongue may not be able to reach there.

Apart from speech impediments, people with ankyloglossia may also experience other symptoms as a result of their tongue-tie. These symptoms include:

• Difficulty breastfeeding in newborns
• Trouble swallowing
• Limited ability to move the tongue from side to side or stick it out
• Difficulty with activities like playing wind instruments, licking ice cream, or kissing
• Mouth breathing

Causes of Ankyloglossia

Ankyloglossia is a congenital condition, which means it is present from birth. A tissue known as the lingual frenulum attaches the tongue to the base of the mouth. People with ankyloglossia have a shorter lingual frenulum, or it is attached further along their tongue than most people’s.

Dysarthria is a condition where people slur their words because they cannot control the muscles that are required for speech, due to brain, nerve, or organ damage.

Symptoms and Characteristics of Dysarthria

Dysarthria is characterized by:

• Slurred, choppy, or robotic speech
• Rapid, slow, or soft speech
• Breathy, hoarse, or nasal voice

Additionally, someone with dysarthria may also have other symptoms such as difficulty swallowing and inability to move their tongue, lips, or jaw easily.

Causes of Dysarthria

Dysarthria is caused by paralysis or weakness of the speech muscles. The causes of the weakness can vary depending on the type of dysarthria the person has:

• Central dysarthria is caused by brain damage. It may be the result of neuromuscular diseases, such as cerebral palsy, Huntington’s disease, multiple sclerosis, muscular dystrophy, Huntington’s disease, Parkinson’s disease, or Lou Gehrig’s disease. Central dysarthria may also be caused by injuries or illnesses that damage the brain, such as dementia, stroke, brain tumor, or traumatic brain injury .
• Peripheral dysarthria is caused by damage to the organs involved in speech. It may be caused by congenital structural problems, trauma to the mouth or face, or surgery to the tongue, mouth, head, neck, or voice box.

Apraxia, also known as dyspraxia, verbal apraxia, or apraxia of speech, is a neurological condition that can cause a person to have trouble moving the muscles they need to create sounds or words. The person’s brain knows what they want to say, but is unable to plan and sequence the words accordingly.

Symptoms and Characteristics of Apraxia

These are some of the characteristics of apraxia:

• Distorting sounds: The person may have trouble pronouncing certain sounds, particularly vowels, because they may be unable to move their tongue or jaw in the manner required to produce the right sound. Longer or more complex words may be especially harder to manage.
• Being inconsistent in their speech: For instance, the person may be able to pronounce a word correctly once, but may not be able to repeat it. Or, they may pronounce it correctly today and differently on another day.
• Grasping for words: The person may appear to be searching for the right word or sound, or attempt the pronunciation several times before getting it right.
• Making errors with the rhythm or tone of speech: The person may struggle with using tone and inflection to communicate meaning. For instance, they may not stress any of the words in a sentence, have trouble going from one syllable in a word to another, or pause at an inappropriate part of a sentence.

Causes of Apraxia

Apraxia occurs when nerve pathways in the brain are interrupted, which can make it difficult for the brain to send messages to the organs involved in speaking. The causes of these neurological disturbances can vary depending on the type of apraxia the person has:

• Childhood apraxia of speech (CAS): This condition is present from birth and is often hereditary. A person may be more likely to have it if a biological relative has a learning disability or communication disorder.
• Acquired apraxia of speech (AOS): This condition can occur in adults, due to brain damage as a result of a tumor, head injury , stroke, or other illness that affects the parts of the brain involved in speech.

If you have a speech impediment, or suspect your child might have one, it can be helpful to visit your healthcare provider. Your primary care physician can refer you to a speech-language pathologist, who can evaluate speech, diagnose speech disorders, and recommend treatment options.

The diagnostic process may involve a physical examination as well as psychological, neurological, or hearing tests, in order to confirm the diagnosis and rule out other causes.

Treatment for speech disorders often involves speech therapy, which can help you learn how to move your muscles and position your tongue correctly in order to create specific sounds. It can be quite effective in improving your speech.

Children often grow out of milder speech disorders; however, special education and speech therapy can help with more serious ones.

For ankyloglossia, or tongue-tie, a minor surgery known as a frenectomy can help detach the tongue from the bottom of the mouth.

A Word From Verywell

A speech impediment can make it difficult to pronounce certain sounds, speak clearly, or communicate fluently. 

Living with a speech disorder can be frustrating because people may cut you off while you’re speaking, try to finish your sentences, or treat you differently. It can be helpful to talk to your healthcare providers about how to cope with these situations.

You may also benefit from joining a support group, where you can connect with others living with speech disorders.

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Centers for Disease Control and Prevention. Language and speech disorders .

Cincinnati Children's Hospital. Stuttering .

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, and language .

Cleveland Clinic. Speech impediment .

Lee H, Sim H, Lee E, Choi D. Disfluency characteristics of children with attention-deficit/hyperactivity disorder symptoms . J Commun Disord . 2017;65:54-64. doi:10.1016/j.jcomdis.2016.12.001

Nemours Foundation. Speech problems .

Penn Medicine. Speech and language disorders .

Cleveland Clinic. Tongue-tie .

University of Rochester Medical Center. Ankyloglossia .

Cleveland Clinic. Dysarthria .

National Institute on Deafness and Other Communication Disorders. Apraxia of speech .

Cleveland Clinic. Childhood apraxia of speech .

Stanford Children’s Hospital. Speech sound disorders in children .

Abbastabar H, Alizadeh A, Darparesh M, Mohseni S, Roozbeh N. Spatial distribution and the prevalence of speech disorders in the provinces of Iran . J Med Life . 2015;8(Spec Iss 2):99-104.

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Overcoming Speech Impediment: Symptoms to Treatment

There are many causes and solutions for impaired speech

• Types and Symptoms
• Speech Therapy
• Building Confidence

Speech impediments are conditions that can cause a variety of symptoms, such as an inability to understand language or speak with a stable sense of tone, speed, or fluidity. There are many different types of speech impediments, and they can begin during childhood or develop during adulthood.

Common causes include physical trauma, neurological disorders, or anxiety. If you or your child is experiencing signs of a speech impediment, you need to know that these conditions can be diagnosed and treated with professional speech therapy.

This article will discuss what you can do if you are concerned about a speech impediment and what you can expect during your diagnostic process and therapy.

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Types and Symptoms of Speech Impediment

People can have speech problems due to developmental conditions that begin to show symptoms during early childhood or as a result of conditions that may occur during adulthood. 

The main classifications of speech impairment are aphasia (difficulty understanding or producing the correct words or phrases) or dysarthria (difficulty enunciating words).

Often, speech problems can be part of neurological or neurodevelopmental disorders that also cause other symptoms, such as multiple sclerosis (MS) or autism spectrum disorder .

There are several different symptoms of speech impediments, and you may experience one or more.

Can Symptoms Worsen?

Most speech disorders cause persistent symptoms and can temporarily get worse when you are tired, anxious, or sick.

Symptoms of dysarthria can include:

• Slurred speech
• Slow speech
• Choppy speech
• Hesitant speech
• Inability to control the volume of your speech
• Shaking or tremulous speech pattern
• Inability to pronounce certain sounds

Symptoms of aphasia may involve:

• Speech apraxia (difficulty coordinating speech)
• Difficulty understanding the meaning of what other people are saying
• Inability to use the correct words
• Inability to repeat words or phases
• Speech that has an irregular rhythm

You can have one or more of these speech patterns as part of your speech impediment, and their combination and frequency will help determine the type and cause of your speech problem.

Causes of Speech Impediment

The conditions that cause speech impediments can include developmental problems that are present from birth, neurological diseases such as Parkinson’s disease , or sudden neurological events, such as a stroke .

Some people can also experience temporary speech impairment due to anxiety, intoxication, medication side effects, postictal state (the time immediately after a seizure), or a change of consciousness.

Speech Impairment in Children

Children can have speech disorders associated with neurodevelopmental problems, which can interfere with speech development. Some childhood neurological or neurodevelopmental disorders may cause a regression (backsliding) of speech skills.

Common causes of childhood speech impediments include:

• Autism spectrum disorder : A neurodevelopmental disorder that affects social and interactive development
• Cerebral palsy :  A congenital (from birth) disorder that affects learning and control of physical movement
• Hearing loss : Can affect the way children hear and imitate speech
• Rett syndrome : A genetic neurodevelopmental condition that causes regression of physical and social skills beginning during the early school-age years.
• Adrenoleukodystrophy : A genetic disorder that causes a decline in motor and cognitive skills beginning during early childhood
• Childhood metabolic disorders : A group of conditions that affects the way children break down nutrients, often resulting in toxic damage to organs
• Brain tumor : A growth that may damage areas of the brain, including those that control speech or language
• Encephalitis : Brain inflammation or infection that may affect the way regions in the brain function
• Hydrocephalus : Excess fluid within the skull, which may develop after brain surgery and can cause brain damage

Do Childhood Speech Disorders Persist?

Speech disorders during childhood can have persistent effects throughout life. Therapy can often help improve speech skills.

Speech Impairment in Adulthood

Adult speech disorders develop due to conditions that damage the speech areas of the brain.

Common causes of adult speech impairment include:

• Head trauma 
• Nerve injury
• Throat tumor
• Stroke 
• Parkinson’s disease 
• Essential tremor
• Brain tumor
• Brain infection

Additionally, people may develop changes in speech with advancing age, even without a specific neurological cause. This can happen due to presbyphonia , which is a change in the volume and control of speech due to declining hormone levels and reduced elasticity and movement of the vocal cords.

Do Speech Disorders Resolve on Their Own?

Children and adults who have persistent speech disorders are unlikely to experience spontaneous improvement without therapy and should seek professional attention.

Steps to Treating Speech Impediment 

If you or your child has a speech impediment, your healthcare providers will work to diagnose the type of speech impediment as well as the underlying condition that caused it. Defining the cause and type of speech impediment will help determine your prognosis and treatment plan.

Sometimes the cause is known before symptoms begin, as is the case with trauma or MS. Impaired speech may first be a symptom of a condition, such as a stroke that causes aphasia as the primary symptom.

The diagnosis will include a comprehensive medical history, physical examination, and a thorough evaluation of speech and language. Diagnostic testing is directed by the medical history and clinical evaluation.

Diagnostic testing may include:

• Brain imaging , such as brain computerized tomography (CT) or magnetic residence imaging (MRI), if there’s concern about a disease process in the brain
• Swallowing evaluation if there’s concern about dysfunction of the muscles in the throat
• Electromyography (EMG) and nerve conduction studies (aka nerve conduction velocity, or NCV) if there’s concern about nerve and muscle damage
• Blood tests, which can help in diagnosing inflammatory disorders or infections

Your diagnostic tests will help pinpoint the cause of your speech problem. Your treatment will include specific therapy to help improve your speech, as well as medication or other interventions to treat the underlying disorder.

For example, if you are diagnosed with MS, you would likely receive disease-modifying therapy to help prevent MS progression. And if you are diagnosed with a brain tumor, you may need surgery, chemotherapy, or radiation to treat the tumor.

Therapy to Address Speech Impediment

Therapy for speech impairment is interactive and directed by a specialist who is experienced in treating speech problems . Sometimes, children receive speech therapy as part of a specialized learning program at school.

The duration and frequency of your speech therapy program depend on the underlying cause of your impediment, your improvement, and approval from your health insurance.

If you or your child has a serious speech problem, you may qualify for speech therapy. Working with your therapist can help you build confidence, particularly as you begin to see improvement.

Exercises during speech therapy may include:

• Pronouncing individual sounds, such as la la la or da da da
• Practicing pronunciation of words that you have trouble pronouncing
• Adjusting the rate or volume of your speech
• Mouth exercises
• Practicing language skills by naming objects or repeating what the therapist is saying

These therapies are meant to help achieve more fluent and understandable speech as well as an increased comfort level with speech and language.

Building Confidence With Speech Problems 

Some types of speech impairment might not qualify for therapy. If you have speech difficulties due to anxiety or a social phobia or if you don’t have access to therapy, you might benefit from activities that can help you practice your speech. 

You might consider one or more of the following for you or your child:

• Joining a local theater group
• Volunteering in a school or community activity that involves interaction with the public
• Signing up for a class that requires a significant amount of class participation
• Joining a support group for people who have problems with speech

Activities that you do on your own to improve your confidence with speaking can be most beneficial when you are in a non-judgmental and safe space.

Many different types of speech problems can affect children and adults. Some of these are congenital (present from birth), while others are acquired due to health conditions, medication side effects, substances, or mood and anxiety disorders. Because there are so many different types of speech problems, seeking a medical diagnosis so you can get the right therapy for your specific disorder is crucial.

Centers for Disease Control and Prevention. Language and speech disorders in children .

Han C, Tang J, Tang B, et al. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: a systematic review and meta-analysis . Medicine (Baltimore). 2024;103(2):e36880. doi:10.1097/MD.0000000000036880

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, language .

Mackey J, McCulloch H, Scheiner G, et al. Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience . Brain Impair. 2023;24(2):168-184. doi:10.1017/BrImp.2023.9

Allison KM, Doherty KM. Relation of speech-language profile and communication modality to participation of children with cerebral palsy . Am J Speech Lang Pathol . 2024:1-11. doi:10.1044/2023_AJSLP-23-00267

Saccente-Kennedy B, Gillies F, Desjardins M, et al. A systematic review of speech-language pathology interventions for presbyphonia using the rehabilitation treatment specification system . J Voice. 2024:S0892-1997(23)00396-X. doi:10.1016/j.jvoice.2023.12.010

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

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Home / Blog

Speech Impediment Guide: Definition, Causes, and Resources

December 8, 2020 

Tables of Contents

What Is a Speech Impediment?

Types of speech disorders, speech impediment causes, how to fix a speech impediment, making a difference in speech disorders.

Communication is a cornerstone of human relationships. When an individual struggles to verbalize information, thoughts, and feelings, it can cause major barriers in personal, learning, and business interactions.

Speech impediments, or speech disorders, can lead to feelings of insecurity and frustration. They can also cause worry for family members and friends who don’t know how to help their loved ones express themselves.

Fortunately, there are a number of ways that speech disorders can be treated, and in many cases, cured. Health professionals in fields including speech-language pathology and audiology can work with patients to overcome communication disorders, and individuals and families can learn techniques to help.

Commonly referred to as a speech disorder, a speech impediment is a condition that impacts an individual’s ability to speak fluently, correctly, or with clear resonance or tone. Individuals with speech disorders have problems creating understandable sounds or forming words, leading to communication difficulties.

Some 7.7% of U.S. children — or 1 in 12 youths between the ages of 3 and 17 — have speech, voice, language, or swallowing disorders, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). About 70 million people worldwide, including some 3 million Americans, experience stuttering difficulties, according to the Stuttering Foundation.

Common signs of a speech disorder

There are several symptoms and indicators that can point to a speech disorder.

• Unintelligible speech — A speech disorder may be present when others have difficulty understanding a person’s verbalizations.
• Omitted sounds — This symptom can include the omission of part of a word, such as saying “bo” instead of “boat,” and may include omission of consonants or syllables.
• Added sounds — This can involve adding extra sounds in a word, such as “buhlack” instead of “black,” or repeating sounds like “b-b-b-ball.”
• Substituted sounds — When sounds are substituted or distorted, such as saying “wabbit” instead of “rabbit,” it may indicate a speech disorder.
• Use of gestures — When individuals use gestures to communicate instead of words, a speech impediment may be the cause.
• Inappropriate pitch — This symptom is characterized by speaking with a strange pitch or volume.

In children, signs might also include a lack of babbling or making limited sounds. Symptoms may also include the incorrect use of specific sounds in words, according to the American Speech-Language-Hearing Association (ASHA). This may include the sounds p, m, b, w, and h among children aged 1-2, and k, f, g, d, n, and t for children aged 2-3.

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Categories of Speech Impediments

Speech impediments can range from speech sound disorders (articulation and phonological disorders) to voice disorders. Speech sound disorders may be organic — resulting from a motor or sensory cause — or may be functional with no known cause. Voice disorders deal with physical problems that limit speech. The main categories of speech impediments include the following:

Fluency disorders occur when a patient has trouble with speech timing or rhythms. This can lead to hesitations, repetitions, or prolonged sounds. Fluency disorders include stuttering (repetition of sounds) or   (rapid or irregular rate of speech).

Resonance disorders are related to voice quality that is impacted by the shape of the nose, throat, and/or mouth. Examples of resonance disorders include hyponasality and cul-de-sac resonance.

Articulation disorders occur when a patient has difficulty producing speech sounds. These disorders may stem from physical or anatomical limitations such as muscular, neuromuscular, or skeletal support. Examples of articulation speech impairments include sound omissions, substitutions, and distortions.

Phonological disorders result in the misuse of certain speech sounds to form words. Conditions include fronting, stopping, and the omission of final consonants.

Voice disorders are the result of problems in the larynx that harm the quality or use of an individual’s voice. This can impact pitch, resonance, and loudness.

Impact of Speech Disorders

Some speech disorders have little impact on socialization and daily activities, but other conditions can make some tasks difficult for individuals. Following are a few of the impacts of speech impediments.

• Poor communication — Children may be unable to participate in certain learning activities, such as answering questions or reading out loud, due to communication difficulties. Adults may avoid work or social activities such as giving speeches or attending parties.
• Mental health and confidence — Speech disorders may cause children or adults to feel different from peers, leading to a lack of self-confidence and, potentially, self-isolation.

Resources on Speech Disorders

The following resources may help those who are seeking more information about speech impediments.

Health Information : Information and statistics on common voice and speech disorders from the NIDCD

Speech Disorders : Information on childhood speech disorders from Cincinnati Children’s Hospital Medical Center

Speech, Language, and Swallowing : Resources about speech and language development from the ASHA

Children and adults can suffer from a variety of speech impairments that may have mild to severe impacts on their ability to communicate. The following 10 conditions are examples of specific types of speech disorders and voice disorders.

1. Stuttering

This condition is one of the most common speech disorders. Stuttering is the repetition of syllables or words, interruptions in speech, or prolonged use of a sound.

This organic speech disorder is a result of damage to the neural pathways that connect the brain to speech-producing muscles. This results in a person knowing what they want to say, but being unable to speak the words.

This consists of the lost ability to speak, understand, or write languages. It is common in stroke, brain tumor, or traumatic brain injury patients.

4. Dysarthria

This condition is an organic speech sound disorder that involves difficulty expressing certain noises. This may involve slurring, or poor pronunciation, and rhythm differences related to nerve or brain disorders.

The condition of lisping is the replacing of sounds in words, including “th” for “s.” Lisping is a functional speech impediment.

6. Hyponasality

This condition is a resonance disorder related to limited sound coming through the nose, causing a “stopped up” quality to speech.

7. Cul-de-sac resonance

This speech disorder is the result of blockage in the mouth, throat, or nose that results in quiet or muffled speech.

8. Orofacial myofunctional disorders

These conditions involve abnormal patterns of mouth and face movement. Conditions include tongue thrusting (fronting), where individuals push out their tongue while eating or talking.

9. Spasmodic Dysphonia

This condition is a voice disorder in which spasms in the vocal cords produce speech that is hoarse, strained, or jittery.

10. Other voice disorders

These conditions can include having a voice that sounds breathy, hoarse, or scratchy. Some disorders deal with vocal folds closing when they should open (paradoxical vocal fold movement) or the presence of polyps or nodules in the vocal folds.

Speech Disorders vs. Language Disorders

Speech disorders deal with difficulty in creating sounds due to articulation, fluency, phonology, and voice problems. These problems are typically related to physical, motor, sensory, neurological, or mental health issues.

Language disorders, on the other hand, occur when individuals have difficulty communicating the meaning of what they want to express. Common in children, these disorders may result in low vocabulary and difficulty saying complex sentences. Such a disorder may reflect difficulty in comprehending school lessons or adopting new words, or it may be related to a learning disability such as dyslexia. Language disorders can also involve receptive language difficulties, where individuals have trouble understanding the messages that others are trying to convey.  

Resources on Types of Speech Disorders

The following resources may provide additional information on the types of speech impediments.

Common Speech Disorders: A guide to the most common speech impediments from GreatSpeech

Speech impairment in adults: Descriptions of common adult speech issues from MedlinePlus

Stuttering Facts: Information on stuttering indications and causes from the Stuttering Foundation

Speech disorders may be caused by a variety of factors related to physical features, neurological ailments, or mental health conditions. In children, they may be related to developmental issues or unknown causes and may go away naturally over time.

Physical and neurological issues. Speech impediment causes related to physical characteristics may include:

• Brain damage
• Nervous system damage
• Respiratory system damage
• Hearing difficulties
• Cancerous or noncancerous growths
• Muscle and bone problems such as dental issues or cleft palate

Mental health issues. Some speech disorders are related to clinical conditions such as:

• Autism spectrum disorder
• Down syndrome or other genetic syndromes
• Cerebral palsy or other neurological disorders
• Multiple sclerosis

Some speech impairments may also have to do with family history, such as when parents or siblings have experienced language or speech difficulties. Other causes may include premature birth, pregnancy complications, or delivery difficulties. Voice overuse and chronic coughs can also cause speech issues.

The most common way that speech disorders are treated involves seeking professional help. If patients and families feel that symptoms warrant therapy, health professionals can help determine how to fix a speech impediment. Early treatment is best to curb speech disorders, but impairments can also be treated later in life.

Professionals in the speech therapy field include speech-language pathologists (SLPs) . These practitioners assess, diagnose, and treat communication disorders including speech, language, social, cognitive, and swallowing disorders in both adults and children. They may have an SLP assistant to help with diagnostic and therapy activities.

Speech-language pathologists may also share a practice with audiologists and audiology assistants. Audiologists help identify and treat hearing, balance, and other auditory disorders.

How Are Speech Disorders Diagnosed?

Typically, a pediatrician, social worker, teacher, or other concerned party will recognize the symptoms of a speech disorder in children. These individuals, who frequently deal with speech and language conditions and are more familiar with symptoms, will recommend that parents have their child evaluated. Adults who struggle with speech problems may seek direct guidance from a physician or speech evaluation specialist.

When evaluating a patient for a potential speech impediment, a physician will:

• Conduct hearing and vision tests
• Evaluate patient records
• Observe patient symptoms

A speech-language pathologist will conduct an initial screening that might include:

• An evaluation of speech sounds in words and sentences
• An evaluation of oral motor function
• An orofacial examination
• An assessment of language comprehension

The initial screening might result in no action if speech symptoms are determined to be developmentally appropriate. If a disorder is suspected, the initial screening might result in a referral for a comprehensive speech sound assessment, comprehensive language assessment, audiology evaluation, or other medical services.

Initial assessments and more in-depth screenings might occur in a private speech therapy practice, rehabilitation center, school, childcare program, or early intervention center. For older adults, skilled nursing centers and nursing homes may assess patients for speech, hearing, and language disorders.

How Are Speech Impediments Treated?

Once an evaluation determines precisely what type of speech sound disorder is present, patients can begin treatment. Speech-language pathologists use a combination of therapy, exercise, and assistive devices to treat speech disorders.

Speech therapy might focus on motor production (articulation) or linguistic (phonological or language-based) elements of speech, according to ASHA. There are various types of speech therapy available to patients.

Contextual Utilization  — This therapeutic approach teaches methods for producing sounds consistently in different syllable-based contexts, such as phonemic or phonetic contexts. These methods are helpful for patients who produce sounds inconsistently.

Phonological Contrast — This approach focuses on improving speech through emphasis of phonemic contrasts that serve to differentiate words. Examples might include minimal opposition words (pot vs. spot) or maximal oppositions (mall vs. call). These therapy methods can help patients who use phonological error patterns.

Distinctive Feature — In this category of therapy, SLPs focus on elements that are missing in speech, such as articulation or nasality. This helps patients who substitute sounds by teaching them to distinguish target sounds from substituted sounds.

Core Vocabulary — This therapeutic approach involves practicing whole words that are commonly used in a specific patient’s communications. It is effective for patients with inconsistent sound production.

Metaphon — In this type of therapy, patients are taught to identify phonological language structures. The technique focuses on contrasting sound elements, such as loud vs. quiet, and helps patients with unintelligible speech issues.

Oral-Motor — This approach uses non-speech exercises to supplement sound therapies. This helps patients gain oral-motor strength and control to improve articulation.

Other methods professionals may use to help fix speech impediments include relaxation, breathing, muscle strengthening, and voice exercises. They may also recommend assistive devices, which may include:

• Radio transmission systems
• Personal amplifiers
• Picture boards
• Touch screens
• Text displays
• Speech-generating devices
• Hearing aids
• Cochlear implants

Resources for Professionals on How to Fix a Speech Impediment

The following resources provide information for speech therapists and other health professionals.

Assistive Devices: Information on hearing and speech aids from the NIDCD

Information for Audiologists: Publications, news, and practice aids for audiologists from ASHA

Information for Speech-Language Pathologists: Publications, news, and practice aids for SLPs from ASHA

Speech Disorder Tips for Families

For parents who are concerned that their child might have a speech disorder — or who want to prevent the development of a disorder — there are a number of activities that can help. The following are tasks that parents can engage in on a regular basis to develop literacy and speech skills.

• Introducing new vocabulary words
• Reading picture and story books with various sounds and patterns
• Talking to children about objects and events
• Answering children’s questions during routine activities
• Encouraging drawing and scribbling
• Pointing to words while reading books
• Pointing out words and sentences in objects and signs

Parents can take the following steps to make sure that potential speech impediments are identified early on.

• Discussing concerns with physicians
• Asking for hearing, vision, and speech screenings from doctors
• Requesting special education assessments from school officials
• Requesting a referral to a speech-language pathologist, audiologist, or other specialist

When a child is engaged in speech therapy, speech-language pathologists will typically establish collaborative relationships with families, sharing information and encouraging parents to participate in therapy decisions and practices.

SLPs will work with patients and their families to set goals for therapy outcomes. In addition to therapy sessions, they may develop activities and exercises for families to work on at home. It is important that caregivers are encouraging and patient with children during therapy.  

Resources for Parents on How to Fix a Speech Impediment

The following resources provide additional information on treatment options for speech disorders.

Speech, Language, and Swallowing Disorders Groups: Listing of self-help groups from ASHA

ProFind: Search tool for finding certified SLPs and audiologists from ASHA

Baby’s Hearing and Communication Development Checklist: Listing of milestones that children should meet by certain ages from the NIDCD

If identified during childhood, speech disorders can be corrected efficiently, giving children greater communication opportunities. If left untreated, speech impediments can cause a variety of problems in adulthood, and may be more difficult to diagnose and treat.

Parents, teachers, doctors, speech and language professionals, and other concerned parties all have unique responsibilities in recognizing and treating speech disorders. Through professional therapy, family engagement, positive encouragement and a strong support network, individuals with speech impediments can overcome their challenges and develop essential communication skills.

Additional Sources

American Speech-Language-Hearing Association, Speech Sound Disorders

Identify the Signs, Signs of Speech and Language Disorders

Intermountain Healthcare, Phonological Disorders

MedlinePlus, Speech disorders – children

National Institutes of Health, National Institutes on Deafness and Other Communication Disorders, “Quick Statistics About Voice, Speech, Language”

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speech impediment

Definition of speech impediment

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Speech Impediment: Definition, Causes, Types and Treatment

02 may speech impediment: definition, causes, types and treatment.

One of life’s joys as a parent is watching your kids grow and change. You see them learn new things, meet new friends, and explore the world around them. But sometimes, you also witness them struggle – like when they have their first fight with a friend or don’t do as well as they wanted to on a test. And while it’s never easy to see your child suffer, one of the hardest things to watch is when your child has difficulty communicating. If your child has a speech impediment, you know that feeling all too well. It can be frustrating and heartbreaking to see your little one struggling to be understood. But take heart – you’re not alone. Many children have difficulties with speech, and with the right pediatric speech therapist in Chicago , your child can learn to overcome their impediment. This blog post will define a speech impediment, discuss some of the most common types and causes, and provide information on treatment options.

What is a speech impediment?

A speech impediment is a condition that affects a person’s ability to produce sound correctly. The term can refer to any difficulties that impede a person’s speech, from mild sound errors to severe problems with articulation. All individuals with speech impediments have difficulty producing certain sounds, depending on one sound. Some people may only have trouble with one sound, while others may have difficulty producing multiple sounds.

What causes speech impediments?

Some people are born with speech impediments, while others develop them later in life. There are many different causes of speech impediment, as you will see below.

1. Congenital defects Congenital defects are abnormalities that are present at birth. They can affect any part of the body, including the mouth and vocal cords. In some cases, congenital defects can cause problems with the tongue moving or the formation of teeth. Many different types of congenital defects can cause a speech impediment, including : Cleft lip and palate is a condition where there is an opening in the lip and/or roof of the mouth. This opening can cause problems with the way the mouth forms words, as well as with eating and drinking. Cleft lip and palate can also cause hearing problems. Vocal cord paralysis is a condition where the vocal cords are unable to move correctly. This can make it difficult to produce sound, as well as to breathe properly. Tongue-tie is a condition where the tongue is tethered to the floor of the mouth. This can make it difficult to move the tongue and can cause problems with eating, drinking, and speaking.

2. Neurological disorders Neurological disorders are conditions that affect the nervous system. These disorders can cause problems with the way the brain sends signals to the muscles, which can lead to difficulties with movement and speech. Some of the more common neurological disorders include: Cerebral palsy is a condition that affects movement and muscle coordination. It is caused by damage to the brain, usually before or during birth. Cerebral palsy can cause problems with the way a person walks, talks, and eats. Multiple sclerosis is a disease of the nervous system that causes the immune system to attack the nerves. This can lead to problems with muscle control and vision, hearing, and speech.

3. Hearing loss Hearing loss can be caused by many different things, including exposure to loud noise, certain medications, and aging. Hearing loss can make it difficult to understand what other people are saying, which can lead to problems with speech. There are many different types of hearing loss, and the severity can vary from person to person. Some people with hearing loss may only have trouble hearing certain sounds, while others may not be able to hear anything at all. Hearing loss can be temporary or permanent. Temporary hearing loss can be caused by things like earwax buildup or infection. Permanent hearing loss can be caused by things like damage to the inner ear or a genetic disorder.

4. Language disorders Language disorders are conditions that affect a person’s ability to understand or use language. These disorders can make it difficult to produce or comprehend speech. Some of the more common language disorders include dyslexia and aphasia.

5. Emotional disorders Emotional disorders are conditions that affect a person’s emotions or mood. These disorders can cause problems with speech due to anxiety or stress. Some of the more common emotional disorders include anxiety disorders and depression. lip

Types of speech disorder

There are many different types of speech disorders, and the symptoms can vary from person to person. Some of the more common types of speech disorders include:

1. Articulation disorder An articulation disorder is a problem with the way the mouth, teeth, or tongue move to make sounds. This can make it difficult to produce certain sounds correctly. People with articulation disorders may have trouble saying certain words correctly, or they may leave out parts of words when they speak.

2. Fluency disorder A fluency disorder is a problem with the flow of speech. People with fluency disorders may have trouble putting their thoughts into words, and they may stutter when they speak. Stuttering is a type of fluency disorder that is characterized by pauses, repetitions, or prolongations of sounds.

3. Resonance disorder A resonance disorder is a problem with the way sound resonates in the mouth and throat. This can make it difficult to produce certain sounds correctly. People with resonance disorders may have trouble producing vowel sounds, or they may speak with a nasal tone.

4. Voice disorder A voice disorder is a problem with the way the voice sounds. This can be caused by things like vocal cord damage or misuse of the voice. People with voice disorders may have trouble speaking loudly or speaking in a hoarse or breathy voice.

Treatment of speech impediments

There are many different treatments for speech disorders, and the best treatment will depend on the individual and the cause of the disorder. Some of the more common treatments include:

1. Speech therapy Speech therapy is a type of treatment that helps people with speech disorders improve their abilities. Speech therapists can help people with articulation disorders learn to produce sounds correctly, people with fluency disorders reduce their stuttering, and people with resonance disorders improve their vowel production.

2. Surgery Surgery can be used to correct some anatomical defects that cause speech disorders. For example, surgery can be used to correct cleft lip and palate, vocal cord paralysis, and tongue tie.

3. Medication Medication can be used to treat some neurological disorders that cause speech disorders. For example, medication can be used to treat conditions like cerebral palsy and multiple sclerosis.

4. Hearing aids Hearing aids can be used to treat hearing loss that causes speech disorders. Hearing aids amplify sound so that people with hearing loss can better understand what other people are saying.

5. Communication devices Communication devices can be used to help people with language disorders or severe speech disorders communicate. These devices can include things like picture boards and computer software that helps people generate speech.

6. Counseling Counseling can be used to treat emotional disorders that cause speech disorders. Counseling can help people manage their anxiety and stress and learn coping mechanisms to deal with their disorders.

7. Alternative treatments There are many different alternative treatments for speech disorders. Some of these treatments include acupuncture, aromatherapy, and massage therapy. It is important to speak with a doctor before starting any alternative treatment.

Speech disorders can cause a variety of problems for people, ranging from difficulty understanding what other people are saying to difficulty producing speech. There are many different causes of speech disorders, and the best treatment will depend on the individual and the cause of the disorder. Visit https://functionalspeechtherapy.com/ to learn more about pediatric speech disorders and treatment options.

Functional Speech Therapy Co., 960 Route 22, Unit 216 Fox River Grove Illinois 60021, (224) 219-1924

Find us on Social Media https://www.facebook.com/FUNctionalSpeechClinic/ https://www.youtube.com/channel/UCJyXslNcwUw-ABZ5myhERTQ https://www.instagram.com/functional\_speechtherapy

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• speech and language therapist
• speech and language therapy
• stammeringly
• stutteringly

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the ability to move freely or be easily moved

Keeping up appearances (Talking about how things seem)

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Apraxia of Speech

On this page:

What is apraxia of speech?

What are the types and causes of apraxia of speech, what are the symptoms of apraxia of speech, how is apraxia of speech diagnosed, how is apraxia of speech treated, what research is being done to better understand apraxia of speech, where can i find additional information about apraxia of speech.

Apraxia of speech (AOS)—also known as acquired apraxia of speech, verbal apraxia, or childhood apraxia of speech (CAS) when diagnosed in children—is a speech sound disorder. Someone with AOS has trouble saying what he or she wants to say correctly and consistently. AOS is a neurological disorder that affects the brain pathways involved in planning the sequence of movements involved in producing speech. The brain knows what it wants to say, but cannot properly plan and sequence the required speech sound movements.

AOS is not caused by weakness or paralysis of the speech muscles (the muscles of the jaw, tongue, or lips). Weakness or paralysis of the speech muscles results in a separate speech disorder, known as dysarthria . Some people have both dysarthria and AOS, which can make diagnosis of the two conditions more difficult.

The severity of AOS varies from person to person. It can be so mild that it causes trouble with only a few speech sounds or with pronunciation of words that have many syllables. In the most severe cases, someone with AOS might not be able to communicate effectively by speaking, and may need the help of alternative communication methods.

There are two main types of AOS: acquired apraxia of speech and childhood apraxia of speech.

• Acquired AOS can affect someone at any age, although it most typically occurs in adults. Acquired AOS 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. It may result from a stroke, head injury, tumor, or other illness affecting the brain. Acquired AOS may occur together with other conditions that are caused by damage to the nervous system. One of these is dysarthria, as mentioned earlier. Another is aphasia , which is a language disorder. (For more information, see the NIDCD fact sheet Aphasia .)
• Childhood AOS is present from birth. This condition is also known as developmental apraxia of speech, developmental verbal apraxia, or articulatory apraxia. Childhood AOS is not the same as developmental delays in speech, in which a child follows the typical path of speech development but does so more slowly than is typical. The causes of childhood AOS are not well understood. Imaging and other studies have not been able to find evidence of brain damage or differences in the brain structure of children with AOS. Children with AOS often have family members who have a history of a communication disorder or a learning disability. This observation and recent research findings suggest that genetic factors may play a role in the disorder. Childhood AOS appears to affect more boys than girls.

People with either form of AOS may have a number of different speech characteristics, or symptoms:

• Distorting sounds. People with AOS may have difficulty pronouncing words correctly. Sounds, especially vowels, are often distorted. Because the speaker may not place the speech structures (e.g., tongue, jaw) quite in the right place, the sound comes out wrong. Longer or more complex words are usually harder to say than shorter or simpler words. Sound substitutions might also occur when AOS is accompanied by aphasia.
• Making inconsistent errors in speech. For example, someone with AOS may say a difficult word correctly but then have trouble repeating it, or may be able to say a particular sound one day and have trouble with the same sound the next day.
• Groping for sounds. People with AOS often appear to be groping for the right sound or word, and may try saying a word several times before they say it correctly.
• Making errors in tone, stress, or rhythm. Another common characteristic of AOS is the incorrect use of prosody. Prosody is the rhythm and inflection of speech that we use to help express meaning. Someone who has trouble with prosody might use equal stress, segment syllables in a word, omit syllables in words and phrases, or pause inappropriately while speaking.

Children with AOS generally understand language much better than they are able to use it. Some children with the disorder may also have other speech problems, expressive language problems, or motor-skill problems.

Professionals known as speech-language pathologists play a key role in diagnosing and treating AOS. Because there is no single symptom or test that can be used to diagnose AOS, the person making the diagnosis generally looks for the presence of several of a group of symptoms, including those described earlier. Ruling out other conditions, such as muscle weakness or language production problems (e.g., aphasia), can help with the diagnostic process.

In some cases, people with acquired AOS recover some or all of their speech abilities on their own. This is called spontaneous recovery.

Children with AOS will not outgrow the problem on their own. They also do not acquire the basics of speech just by being around other children, such as in a classroom. Therefore, speech-language therapy is necessary for children with AOS as well as for people with acquired AOS who do not spontaneously recover all of their speech abilities.

Speech-language pathologists use different approaches to treat AOS, and no single approach has been proven to be the most effective. Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with AOS. Frequent, intensive, one-on-one speech-language therapy sessions are needed for both children and adults with AOS. (The repetitive exercises and personal attention needed to improve AOS are difficult to deliver in group therapy.) Children with severe AOS may need intensive speech-language therapy for years, in parallel with normal schooling, to obtain adequate speech abilities.

In severe cases, adults and children with AOS may need to find other ways to express themselves. These might include formal or informal sign language; a notebook with pictures or written words that can be pointed to and shown to other people; or an electronic communication device—such as a smartphone, tablet, or laptop computer—that can be used to write or produce speech. Such assistive communication methods can also help children with AOS learn to read and better understand spoken language by stimulating areas of the brain involved in language and literacy.

Researchers are searching for the causes of childhood AOS, including the possible role of abnormalities in the brain or other parts of the nervous system. They are also looking for genetic factors that may play a role in childhood AOS. Other research on childhood AOS aims to identify more specific criteria and new techniques to diagnose the disorder and to distinguish it from other communication disorders.

Research on acquired AOS includes studies to pinpoint the specific areas of the brain that are involved in the disorder. In addition, researchers are studying the effectiveness of various treatment approaches for both acquired and childhood AOS.

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

For more information, contact us at:

NIDCD Information Clearinghouse 1 Communication Avenue Bethesda, MD 20892-3456 Toll-free voice: (800) 241-1044 Toll-free TTY: (800) 241-1055 Email: [email protected]

NIH Pub. No. 13-7466 September 2016

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Study reveals brain mechanisms behind speech impairment in Parkinson’s

Most Parkinson’s disease patients struggle with speech problems. New research by Stanford Medicine scientists uncovers the brain connections that could be essential to preserving speech.

May 28, 2024 - By Nina Bai

Research by Stanford Medicine scientists may explain why some treatments for Parkinson’s — developed mainly to target motor symptoms — can improve speech impairments while other treatments make them worse. Lightspring /Shutterstock.com

Parkinson’s disease is most well-known and well-studied for its motor impairments — tremors, stiffness and slowness of movement. But less visible symptoms such as trouble with memory, attention and language, which also can profoundly impact a person’s quality of life, are less understood. A new study by Stanford Medicine researchers reveals the brain mechanisms behind one of the most prevalent, yet often overlooked, symptoms of the disease — speech impairment.

Based on brain imaging from Parkinson’s patients, the researchers identified specific connections in the brain that may determine the extent of speech difficulties.

The findings , reported May 20 in the Proceedings of the National Academy of Sciences , could help explain why some treatments for Parkinson’s — developed mainly to target motor symptoms — can improve speech impairments while other treatments make them worse.

More than a motor disorder

“Parkinson’s disease is a very common neurological disorder, but it’s mostly considered a motor disorder,” said Weidong Cai , PhD, clinical associate professor of psychiatry and behavioral sciences and the lead author of the new study. “There’s been lots of research on how treatments such as medications and deep brain stimulation can help improve motor function in patients, but there was limited understanding about how these treatments affect cognitive function and speech.”

Over 90% of people with Parkinson’s experience difficulties with speech, an intricate neurological process that requires motor and cognitive control. Patients may struggle with a weak voice, slurring, mumbling and stuttering.

“Speech is a complex process that involves multiple cognitive functions, such as receiving auditory feedback, organizing thoughts and producing the final vocal output,” Cai said.

The senior author of the study is Vinod Menon , PhD, professor of psychiatry and behavioral sciences and director of the Stanford Cognitive and Systems Neuroscience Laboratory .

The researchers set out to study how levodopa, a common Parkinson’s drug that replaces the dopamine lost from the disease, affects overall cognitive function. They focused on the subthalamic nucleus, a small, pumpkin-seed-shaped region deep within the brain.

Weidong Cai

The subthalamic nucleus is known for its role in inhibiting motor activity, but there are clues to its involvement in other functions. For example, deep brain stimulation, which uses implanted electrodes to stimulate the subthalamic nucleus, has proven to be a powerful way to relieve motor symptoms for Parkinson’s patients — but a common side effect is worsened speech impairment.

Same test, different scores

In the new study, 27 participants with Parkinson’s disease and 43 healthy controls, all older than 60, took standard tests of motor and cognitive functioning. The participants with Parkinson’s took the tests while on and off their medication.

As expected, the medication improved motor functioning in the patients, with those having the most severe symptoms improving the most.

The test for cognitive functioning offered a surprise. The test, known as the Symbol Digit Modalities Test, is given in two forms — oral and written. Patients are provided with nine symbols, each matched with a number — a plus sign for the number 7, for example. They are then asked to translate a string of symbols into numbers, either speaking or writing down their answers, depending on the version of the test.

As a group, the patients’ performance on both versions of the cognitive test was little affected by medication. But taking a closer look, the researchers noticed that the subset of patients who performed particularly poorly on the spoken version of the test without medication improved their spoken performance on the medication. Their written test scores did not change significantly.

“It was quite interesting to find this dissociation between the written and oral version of the same test,” Cai said.

The dissociation suggested that the medication was not enhancing general cognitive functions such as attention and working memory, but it was selectively improving speech.

“Our research unveiled a previously unrecognized impact of dopaminergic drugs on the speech function of Parkinson’s patients,” Menon said.

Uncovering connections

Next, the researchers analyzed fMRI brain scans of the participants, looking at how the subthalamic nucleus interacted with brain networks dedicated to various functions, including hearing, vision, language and executive control.

Vinod Menon

They found that different parts of the subthalamic nucleus interacted with different networks.

In particular, they discovered that improvements on the oral version of the test correlated with better functional connectivity between the right side of the subthalamic nucleus and the brain’s language network.

Using a statistical model, they could even predict a patient’s improvement on the oral test based on changes in their brain’s functional connectivity.

“Here we’re not talking about an anatomical connection,” Cai explained. Rather, functional connectivity between brain regions means the activity in these regions is closely coordinated, as if they are talking to each other.

“We discovered that these medications influence speech by altering the functional connectivity between the subthalamic nucleus and crucial language networks,” Menon said. “This insight opens new avenues for therapeutic interventions tailored specifically to improve speech without deteriorating other cognitive abilities.”

This newly identified interaction between the subthalamic nucleus and the language network could serve as a biological indicator of speech behavior — in Parkinson’s as well as other speech disorders like stuttering.

Such a biomarker could be used to monitor treatment outcomes and inspire new therapies. “Of course, you can directly observe the outcome of a medication by observing behavior, but I think to have a biomarker in the brain will provide more useful information for the future development of drugs,” Cai said. 

The findings also provide a detailed map of the subthalamic nucleus, which could guide neurosurgeons performing deep brain stimulation in avoiding damage to an area critical to speech function. “By identifying key neural maps and connections that predict speech improvement, we can craft more effective treatment plans that are both precise and personalized for Parkinson’s disease patients,” Menon said.

The study received funding from the National Institutes of Health (grants P50 AG047366, P30 AG066515, RF1 NS086085, R21 DC017950-S1, R01 NS115114, R01 MH121069 and K99 AG071837) and the Alzheimer’s Association.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

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Study reveals brain mechanisms behind speech impairment in Parkinson's

by Nina Bai, Stanford University

Parkinson's disease is most well-known and well-studied for its motor impairments—tremors, stiffness and slowness of movement. But less visible symptoms such as trouble with memory, attention and language, which can also profoundly impact a person's quality of life, are less understood.

A new study by Stanford Medicine researchers reveals the brain mechanisms behind one of the most prevalent, yet often overlooked, symptoms of the disease— speech impairment. Based on brain imaging from Parkinson's patients, the researchers identified specific connections in the brain that may determine the extent of speech difficulties.

The findings , reported May 20 in the Proceedings of the National Academy of Sciences , could help explain why some treatments for Parkinson's—developed mainly to target motor symptoms—can improve speech impairments while other treatments make them worse.

More than a motor disorder

"Parkinson's disease is a very common neurological disorder, but it's mostly considered a motor disorder," said Weidong Cai, Ph.D., clinical associate professor of psychiatry and behavioral sciences and the lead author of the new study.

"There's been lots of research on how treatments such as medications and deep brain stimulation can help improve motor function in patients, but there was limited understanding about how these treatments affect cognitive function and speech."

More than 90% of people with Parkinson's experience difficulties with speech, an intricate neurological process that requires motor and cognitive control. Patients may struggle with a weak voice, slurring, mumbling and stuttering.

"Speech is a complex process that involves multiple cognitive functions, such as receiving auditory feedback, organizing thoughts and producing the final vocal output," Cai said.

The senior author of the study is Vinod Menon, Ph.D., professor of psychiatry and behavioral sciences and director of the Stanford Cognitive and Systems Neuroscience Laboratory.

The researchers set out to study how levodopa, a common Parkinson's drug that replaces the dopamine lost from the disease, affects overall cognitive function. They focused on the subthalamic nucleus, a small, pumpkin-seed-shaped region deep within the brain.

The subthalamic nucleus is known for its role in inhibiting motor activity, but there are clues to its involvement in other functions. For example, deep brain stimulation, which uses implanted electrodes to stimulate the subthalamic nucleus, has proven to be a powerful way to relieve motor symptoms for Parkinson's patients—but a common side effect is worsened speech impairment.

Same test, different scores

In the new study, 27 participants with Parkinson's disease and 43 healthy controls, all older than 60, took standard tests of motor and cognitive functioning. The participants with Parkinson's took the tests while on and off their medication.

As expected, the medication improved motor functioning in the patients, with those having the most severe symptoms improving the most.

The test for cognitive functioning offered a surprise. The test, known as the Symbol Digit Modalities Test, is given in two forms—oral and written. Patients are provided with nine symbols, each matched with a number—a plus sign for the number 7, for example. They are then asked to translate a string of symbols into numbers, either speaking or writing down their answers, depending on the version of the test.

As a group, the patients' performance on both versions of the cognitive test was little affected by medication. But taking a closer look, the researchers noticed that the subset of patients who performed particularly poorly on the spoken version of the test without medication improved their spoken performance on the medication. Their written test scores did not change significantly.

"It was quite interesting to find this dissociation between the written and oral version of the same test," Cai said.

The dissociation suggested that the medication was not enhancing general cognitive functions such as attention and working memory, but it was selectively improving speech.

"Our research unveiled a previously unrecognized impact of dopaminergic drugs on the speech function of Parkinson's patients," Menon said.

Uncovering connections

Next, the researchers analyzed fMRI brain scans of the participants, looking at how the subthalamic nucleus interacted with brain networks dedicated to various functions, including hearing, vision, language and executive control.

They found that different parts of the subthalamic nucleus interacted with different networks.

In particular, they discovered that improvements on the oral version of the test correlated with better functional connectivity between the right side of the subthalamic nucleus and the brain's language network.

Using a statistical model , they could even predict a patient's improvement on the oral test based on changes in their brain's functional connectivity.

"Here we're not talking about an anatomical connection," Cai explained. Rather, functional connectivity between brain regions means the activity in these regions is closely coordinated, as if they are talking to each other.

"We discovered that these medications influence speech by altering the functional connectivity between the subthalamic nucleus and crucial language networks," Menon said. "This insight opens new avenues for therapeutic interventions tailored specifically to improve speech without deteriorating other cognitive abilities."

This newly identified interaction between the subthalamic nucleus and the language network could serve as a biological indicator of speech behavior—in Parkinson's as well as other speech disorders like stuttering.

Such a biomarker could be used to monitor treatment outcomes and inspire new therapies. "Of course, you can directly observe the outcome of a medication by observing behavior, but I think to have a biomarker in the brain will provide more useful information for the future development of drugs," Cai said.

The findings also provide a detailed map of the subthalamic nucleus , which could guide neurosurgeons performing deep brain stimulation in avoiding damage to an area critical to speech function.

"By identifying key neural maps and connections that predict speech improvement, we can craft more effective treatment plans that are both precise and personalized for Parkinson's disease patients," Menon said.

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An NFL kicker, who claims to be an authentic Catholic, fumbles commencement speech

NFL Super Bowl champion Kansas City Chiefs team kicker Harrison Butker joins his teammates for a celebration on the South Lawn of the White House on May 31, 2024, in Washington, DC. Butker criticized President Biden's leadership during the COVID-19 pandemic among other topics in a May 11, 2024, commencement address at Benedictine College. (Photo by Andrew Harnik/Getty Images)

When I was about 10, I wanted to be a nun. The fact that I am Jewish was an impediment, but maybe not an insurmountable one. It was not religion that lured me. It was the quiet life of contemplation that I, in my imagination, assumed that nuns enjoyed. 

Just a few years later, I became very familiar with some extraordinarily engaged, social activist nuns who marched against the Vietnam War and against nuclear proliferation. Many, not all, were part of the Catholic Worker movement, an affiliation of Catholics who believe that fully adopting Christ’s principles means advocating for a more just and peaceful world. They had my whole-hearted admiration. 

So, when I read the reports of Kansas City Chiefs kicker ’s speech at Benedictine College, in Atchison, Kansas, on May 11, the outrage about his commentary, and the defenses of it, I knew that this was not simply the mainstream culture’s difficulty with Catholicism. 

Harrison Butker, in his speech, aligned himself with those who are “authentically and unapologetically Catholic.” But based on his remarks, Butker is a fundamentalist. All those who are offering excuses for his weird, misogynistic, antisemitic commencement speech need to be clear; he is not simply a devout man speaking from a Catholic perspective. His perspective is extremist. 

He appears to believe that whatever modernizing the Catholic Church has done over the past decades has been a demonic slide away from holiness. While he is not alone in this, his particular brand of worship is not mainstream. Nor is his sense that women being told that they can, and even should, make lives for themselves outside homemaking, possibly separate from a man, is diabolical (his term). The nuns, apparently, even the Benedictines , want a word. 

His commentary has dangerous repercussions. But I am not worried that women will believe him. Those that do are welcome to live as they choose. 

All those who are offering excuses for his weird, misogynistic, antisemitic commencement speech need to be clear; he is not simply a devout man speaking from a Catholic perspective. His perspective is extremist.

I am worried about two things, both related to his assertion that his views are the purest expression of Catholicism. First, he ties an ancient antisemitic weapon to current Catholic thinking. He says, “ Congress just passed a bill where stating something as basic as the biblical teaching of who killed Jesus could land you in jail.”  He is referring to the bill which passed the U.S. House recently, which seeks to codify the International Holocaust Remembrance Alliance’s  definition of antisemitism .  While there are elements of the definition that many would argue with, making the claim that “the Jews” killed Jesus is not one of those in question. 

Even if you believe that the New Testament is history, and you inexplicably exclude the Roman authorities from responsibility, and you choose to put aside the whole beautiful, mysterious aspect of Christ’s sacrifice in which it is both willing, and preordained, saying “the Jews killed Jesus” is a pointless slur, one that has been repudiated by Catholic doctrine . It is a classic bigoted thought process to hold all of a group responsible for the acts of some, especially from 2,000 years ago. This kind of thinking is present in too much of our political discourse and our acting biases today, and I can think of so many contemporary examples it makes my head hurt. 

Here is a thought: It would be like holding all Catholic people, then and now, responsible for the Crusades, or the Inquisition. Which, I guess is not a problem if you think these events were righteous endeavors, which Butker very well might.  

The second problem involves creating the perception that the most intolerant version of a religious worldview, in any religion, is the best one. This is dangerous for life in a religiously plural society. To coexist, we have to cultivate tolerance, which is difficult if someone else’s theology feels like a threat. If I know that a large group of my neighbors think I am a source of evil, I am going to be more than a little uncomfortable. Especially considering the history, of course, of the Crusades, and the Inquisition. 

Since these beliefs are not mainstream, I do not have that worry in America, or here in Rhode Island, where we have lived with religious diversity for almost 400 years. 

I suspect, with some concern, that Harrison Butker and his associates would like me to live in a world where I do not have this comfort.

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The post An NFL kicker, who claims to be an authentic Catholic, fumbles commencement speech appeared first on Rhode Island Current .

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A Definition of Antisemitism, While Helpful, Is Not a Cure | Opinion

As far as I'm concerned, the ongoing debate over how—and if—to formally define antisemitism largely misses the point.

On the one hand, I fully agree that one first needs to be able to define a problem in order to be able to deal with it if not resolve it, and antisemitism is beyond question a problem of increasingly dire dimensions. At the same time, however, fixed definitions, like most dogma, far too often are an impediment to intelligent thought.

I am sympathetic to Columbia University's task force on antisemitism which is trying to address the surging Jew-hatred—for that's what antisemitism is—on its campus without being forced to adopt one of several battling definitions. In the interest of full disclosure, I am a lecturer-in-law at Columbia Law School as well as an adjunct professor at Cornell Law School where I teach a course on antisemitism in the courts and in jurisprudence.

I confess that I am by nature skeptical and suspicious of imposed definitions of amorphous terms that are held forth as exclusive, probably for the same reason that I am skeptical and suspicious of dogma generally.

Antisemitism is one such term. Over the years, various definitions of what does and what does not constitute hatred of or antagonism toward Jews have been put forward by well-meaning individuals and organizations, only to be refuted and challenged, if not rejected outright, by other well-meaning individuals and organizations. In one instance, Kenneth Stern, one of the principal drafters of one such definition of antisemitism—the working definition adopted in 2016 by the International Holocaust Remembrance Alliance, or IHRA—turned around and became one of the leading critics of the very definition he helped bring into the world.

The crux of the controversy over the IHRA definition is that its examples include instances where criticism of Israel can mask antisemitic animus. Two of these examples are "holding Jews collectively responsible for actions of the state of Israel" and "denying the Jewish people their right to self-determination," such as by claiming that the existence of the State of Israel is a racist endeavor. Never mind that this definition affirmatively notes that "criticism of Israel similar to that leveled against any other country cannot be regarded as antisemitic." Never mind further that the IHRA definition is not meant to be legally binding, or that its accompanying illustrative examples are just that: examples. Because it embraces certain types of criticisms of or attacks on Israel as antisemitic per se , as it were, its critics repudiate it as an impermissible attempt to stifle dissent.

Counter-definitions, such as the Jerusalem Declaration on Antisemitism or the Nexus Document , to name the two most prominent ones, are rejected by IHRA definition proponents as, broadly speaking, defining antisemitism so as to defend antisemitic rhetoric or behavior and, in the case of the Nexus Document in particular, focusing on intent as opposed to impact.

One significant consideration weighing in favor of the IHRA definition is the fact that it has by now been adopted by 43 member states of the United Nations as well as a wide range of international NGOs, states, municipalities, and other institutions. This, for better or worse, has made it an international standard.

Still, the fact is that the IHRA definition and its examples were never meant to be, and should not be regarded as, sacrosanct revelation. Robert Williams and Mark Weitzman, both past chairs of IHRA's Committee on Antisemitism and Holocaust Denial, have emphasized that "While the examples are not a rigid taxonomy allowing for the identification of every type of antisemitism, they are an internationally accepted baseline that can allow us to shine a light on places where antisemitism might exist."

We all know that there have been instances—and there are certain to be more in the future—when an example that made perfect sense in 2016 becomes murkier in relation to behavior or rhetoric occurring in 2024 under circumstances that were not contemplated eight years earlier.

For example, one example of antisemitism in the IHRA framework is "Drawing comparisons of contemporary Israeli policy to that of the Nazis." I understand precisely what the drafters of this example had in mind, namely comparing Israel and Israelis to the Nazi perpetrators of the Holocaust, and I agree that doing so is indeed antisemitic. But then you have extremist far-right ministers of the present Israel government engaging in hateful rhetoric toward the Palestinians, something most probably not anticipated by the drafters of the definition eight years ago. At this time, we can still finesse this particular issue by arguing that such rhetoric does not represent Israel government policy, which it doesn't. But what if it does so at some point in the future? What if today's outliers somehow become part of tomorrow's mainstream?

With respect to Zionism as an ideology, I agree in principle with Kenneth Stern, the aforementioned critic of the IHRA definition, who argues that "on a college campus, where the purpose is to explore ideas, anti-Zionists have a right to free expression."

What such anti-Zionists do not have, however, is the right to engage in hate speech or physical violence against Jews who support and identify with Israel or, it should be obvious, against Jews generally.

It's not holding or voicing anti-Zionist views that's the problem, it's vilifying and demonizing Zionism as an ideology and Zionists both as individuals and as a collective. And when Jewish students are called upon to repudiate Zionism or support for Israel in order not to be ostracized by their peers, the antisemitic trajectory is complete.

Those university and college activists who vilify Jewish students for supporting or identifying with Israel are antisemitic. This does not mean that pro-Palestinian or even anti-Israel demonstrators do not have the right to protest. The issue is the tenor of such protest.

When demonstrators demonize Israel and call for its eradication as a nation state while screaming "Death to Israel" or "Death to the Jews," that is antisemitism on steroids with or without a definition.

My own approach is that I consider the IHRA definition to be an important educational resource and believe that the examples accompanying it should be regarded as persuasive but not exclusive or exhaustive guidelines. These examples should also at all times be subject to rational critical examination as well as to a reasonableness and common sense test in considering whether an action or statement is antisemitic. Accordingly, rather than formally adopting the IHRA definition, a university or college can and probably should follow the lead of the Biden administration's National Strategy to Counter Antisemitism and acknowledge it as the "most prominent" among a number of definitions "which serve as valuable tools to raise awareness and increase understanding of antisemitism."

Far more important, I would think, is for the said universities and colleges to do their utmost to enable highly charged issues to be discussed in an atmosphere of mutual respect and tolerance.

My point is that nuance is important, even with respect to—perhaps especially with respect to—a highly charged issues such as antisemitism. And nuance may elude definitions.

In the context of the ongoing Israel-Hamas war which has brought much of present-day antisemitism to a boiling pitch, we must be able to appreciate that one can mourn the Israeli victims of the terrorist attack on Oct. 7, and be distressed by the subsequent intense suffering of Palestinian civilians in Gaza. One can vehemently condemn Hamas terrorism and just as forcefully support Palestinian rights. One can and should be equally dismayed and appalled by a Jewish college student being vilified and physically threatened in a bar by a fellow student because of her support for Israel and by a Muslim student being spat on for wearing a hijab. On occasion, one must even be able to understand the pain of those on the other side of the barricades.

While a definition of antisemitism can be a useful starting point, it does not provide an antidote to hatred. Simply put, it's not productive only to look backwards and analyze what went wrong, which is essentially what a definition accomplishes. Our task going forward—on university and college campuses as well as in society at large—must be to work together to stem the tides of antisemitism, Islamophobia, racism, homophobia, and other bigotries before they turn into a tsunami beyond our control.

Menachem Z. Rosensaft is adjunct professor of law at Cornell Law School, lecturer-in-law at Columbia Law School, and General Counsel Emeritus of the World Jewish Congress. He is the author of Poems Born in Bergen-Belsen (Kelsay Books, 2021) and of the forthcoming Burning Psalms (Ben Yehuda Press, 2025).

The views expressed in this article are the writer's own.

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• Patient Care & Health Information
• Diseases & Conditions
• Neurofibromatosis type 1

Neurofibromatosis type 1 (NF1) is a genetic condition that causes changes in skin pigment and tumors on nerve tissue. Skin changes include flat, light brown spots and freckles in the armpits and groin. Tumors can grow anywhere in the nervous system, including the brain, spinal cord and nerves. NF1 is rare. About 1 in 2,500 is affected by NF1.

The tumors often are not cancerous, known as benign tumors. But sometimes they can become cancerous. Symptoms often are mild. But complications can occur and may include trouble with learning, heart and blood vessel conditions, vision loss, and pain.

Treatment focuses on supporting healthy growth and development in children and early management of complications. If NF1 causes large tumors or tumors that press on a nerve, surgery can reduce symptoms. A newer medicine is available to treat tumors in children, and other new treatments are being developed.

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• Neurofibroma

Neurofibromatosis type 1 (NF1) usually is diagnosed during childhood. Symptoms are seen at birth or shortly afterward and almost always by age 10. Symptoms tend to be mild to moderate, but they can vary from person to person.

Symptoms include:

• Flat, light brown spots on the skin, known as cafe au lait spots. These harmless spots are common in many people. But having more than six cafe au lait spots suggests NF1. They often are present at birth or appear during the first years of life. After childhood, new spots stop appearing.
• Freckling in the armpits or groin area. Freckling often appears by ages 3 to 5. Freckles are smaller than cafe au lait spots and tend to occur in clusters in skin folds.
• Tiny bumps on the iris of the eye, known as Lisch nodules. These nodules can't easily be seen and don't affect vision.
• Soft, pea-sized bumps on or under the skin called neurofibromas. These benign tumors usually grow in or under the skin but can also grow inside the body. A growth that involves many nerves is called a plexiform neurofibroma. Plexiform neurofibromas, when located on the face, can cause disfigurement. Neurofibromas may increase in number with age.
• Bone changes. Changes in bone development and low bone mineral density can cause bones to form in an irregular way. People with NF1 may have a curved spine, known as scoliosis, or a bowed lower leg.
• Tumor on the nerve that connects the eye to the brain, called an optic pathway glioma. This tumor usually appears by age 3. The tumor rarely appears in late childhood and among teenagers, and almost never in adults.
• Learning disabilities. It's common for children with NF1 to have some trouble with learning. Often there is a specific learning disability, such as trouble with reading or math. Attention-deficit/hyperactivity disorder (ADHD) and speech delay also are common.
• Larger than average head size. Children with NF1 tend to have a larger than average head size due to increased brain volume.
• Short stature. Children who have NF1 often are below average in height.

When to see a doctor

See a healthcare professional if your child has symptoms of neurofibromatosis type 1. The tumors are often not cancerous and are slow growing, but complications can be managed. If your child has a plexiform neurofibroma, a medicine is available to treat it.

Neurofibromatosis type 1 is caused by an altered gene that either is passed down by a parent or occurs at conception.

The NF1 gene is located on chromosome 17. This gene produces a protein called neurofibromin that helps regulate cell growth. When the gene is altered, it causes a loss of neurofibromin. This allows cells to grow without control.

Risk factors

Autosomal dominant inheritance pattern

In an autosomal dominant disorder, the changed gene is a dominant gene. It's located on one of the nonsex chromosomes, called autosomes. Only one changed gene is needed for someone to be affected by this type of condition. A person with an autosomal dominant condition — in this example, the father — has a 50% chance of having an affected child with one changed gene and a 50% chance of having an unaffected child.

The biggest risk factor for neurofibromatosis type 1 (NF1) is a family history. For about half of people who have NF1, the disease was passed down from a parent. People who have NF1 and whose relatives aren't affected are likely to have a new change to a gene.

NF1 has an autosomal dominant inheritance pattern. This means that any child of a parent who is affected by the disease has a 50% chance of having the altered gene.

Complications

Complications of neurofibromatosis type 1 (NF1) vary, even within the same family. Generally, complications occur when tumors affect nerve tissue or press on internal organs.

Complications of NF1 include:

• Neurological symptoms. Trouble with learning and thinking are the most common neurological symptoms associated with NF1. Less common complications include epilepsy and the buildup of excess fluid in the brain.
• Concerns with appearance. Visible signs of NF1 can include widespread cafe au lait spots, many neurofibromas in the facial area or large neurofibromas. In some people this can cause anxiety and emotional distress, even if they're not medically serious.
• Skeletal symptoms. Some children have bones that didn't form as usual. This can cause bowing of the legs and fractures that sometimes don't heal. NF1 can cause curvature of the spine, known as scoliosis, that may need bracing or surgery. NF1 also is associated with lower bone mineral density, which increases the risk of weak bones, known as osteoporosis.
• Changes in vision. Sometimes a tumor called an optic pathway glioma develops on the optic nerve. When this happens, it can affect vision.
• Increase in symptoms during times of hormonal change. Hormonal changes associated with puberty or pregnancy might cause an increase in neurofibromas. Most people who have NF1 have healthy pregnancies but will likely need monitoring by an obstetrician who is familiar with NF1.
• Cardiovascular symptoms. People who have NF1 have an increased risk of high blood pressure and may develop blood vessel conditions.
• Trouble breathing. Rarely, plexiform neurofibromas can put pressure on the airway.
• Cancer. Some people who have NF1 develop cancerous tumors. These usually arise from neurofibromas under the skin or from plexiform neurofibromas. People who have NF1 also have a higher risk of other forms of cancer. They include breast cancer, leukemia, colorectal cancer, brain tumors and some types of soft tissue cancer. Screening for breast cancer should begin earlier, at age 30, for women with NF1 compared to the general population.
• Benign adrenal gland tumor, known as a pheochromocytoma. This noncancerous tumor produces hormones that raise your blood pressure. Surgery often is needed to remove it.

Neurofibromatosis type 1 care at Mayo Clinic

• Ferri FF. Neurofibromatosis. In: Ferri's Clinical Advisor 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed Feb. 21, 2024.
• Neurofibromatosis. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurofibromatosis-Fact-Sheet. Accessed Feb. 21, 2024.
• Korf BR, et al. Neurofibromatosis type 1 (NF1): Pathogenesis, clinical features, and diagnosis. https://www.uptodate.com/contents/search. Accessed Feb. 21, 2024.
• Saleh M, et al. Neurofibromatosis type 1 system-based manifestations and treatments: A review. Neurological Sciences. 2023; doi:10.1007/s10072-023-06680-5.
• Neurofibromatosis. American Association of Neurological Surgeons. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Neurofibromatosis. Accessed Feb. 21, 2024.
• Neurofibromatosis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pediatrics/neurocutaneous-syndromes/neurofibromatosis. Accessed Feb. 21, 2024.
• Jankovic J, et al., eds. Neurocutaneous syndromes. In: Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed Feb. 21, 2024.
• Armstrong AE, et al. Treatment decisions and the use of the MEK inhibitors for children with neurofibromatosis type 1-related plexiform neurofibromas. BMC Cancer. 2023; doi:10.1186/s12885-023-10996-y.
• Zitelli BJ, et al., eds. Neurology. In: Zitelli and Davis' Atlas of Pediatric Physical Diagnoses. 8th ed. Elsevier; 2023. https://www.clinicalkey.com. Accessed Feb. 21, 2024.
• Kellerman RD, et al. Neurofibromatosis (type 1). In: Conn's Current Therapy 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed Feb. 21, 2024.
• Babovic-Vuksanovic D (expert opinion). Mayo Clinic. March 26, 2024.
• Tamura R. Current understanding of neurofibromatosis type 1, 2 and schwannomatosis. International Journal of Molecular Sciences. 2021; doi:10.3390/ijms22115850.
• Legius E, et al. Revised diagnostic criteria for neurofibromatosis type 1 and Legius syndrome: An international consensus recommendation. Genetics in Medicine. 2021; doi:10.1038/s41436-021-01170-5.
• Find a doctor. Children's Tumor Foundation. https://www.ctf.org/understanding-nf/find-a-doctor/. Accessed Feb. 26, 2024.
• Ami TR. Allscripts EPSi. Mayo Clinic. April 18, 2024.
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