Hearing or other sensory impairment. Hearing impairment or deafness may result in abnormalities of speech. Deficits of speech sound production may be associated with a hearing impairment, other sensory deficit, or a speech-motor deficit. When speech deficits are in excess of those usually associated with these problems, a diagnosis of speech sound disorder may be made.
Structu ral deficits. Speech impairment may be due to structural deficits (e.g., cleft palate).
Dysarth ria. Speech impairment may be attributable to a motor disorder, such as cerebral palsy. Neurological signs, as well as distinctive features of voice, differentiate dysarthria from speech sound disorder, although in young children (under 3 years) differentiation may be difficult, particularly when there is no or minimal general body motor involve- ment (as in, e.g., Worster-Drought syndrome).
Selective mutism. Limited use of speech may be a sign of selective mutism, an anxiety disorder that is characterized by a lack of speech in one or more contexts or settings. Se- lective mutism may develop in children with a speech disorder because of embarassment about their impairments, but many children with selective mutism exhibit normal speech in ”safe” settings, such as at home or with close friends.
Diagnostic Criteria 315.35 (F80.81)
A. Disturbances in the normal fluency and time patterning of speech that are inappropri- ate for the individual’s age and language skills, persist over time, and are characterized by frequent and marked occurrences of one (or more) of the following: 1. Sound and syllable repetitions.
2. Sound prolongations of consonants as well as vowels.
Broken words (e.g., pauses within a word).
Audible or silent blocking (filled or unfilled pauses in speech).
Circumlocutions (word substitutions to avoid problematic words).
Words produced with an excess of physical tension.
Monosyllabic whoIe-word repetitions (e.g., “l-l-l-l see him”).
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B. The disturbance causes anxiety about speaking or limitations in effective communica- tion, social participation, or academic or occupational performance, individually or in any combination.
C. The onset of symptoms is in the early developmental period. (Note: Later-onset cases are diagnosed as 307.0 [F985] aduIt-onset ﬂuency disorder.)
D. The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency as- sociated with neurological insult (e.g., stroke, tumor, trauma). or another medical con- dition and is not better explained by another mental disorder.
The essential feature of childhood-onset ﬂuency disorder (stuttering) is a disturbance in the normal ﬂuency and time patterning of speech that is inappropriate for the individual’s age. This disturbance is characterized by frequent repetitions or prolongations of sounds or syllables and by other types of speech dysfluencies, including broken words (e.g., pauses within a word), audible or silent blocking (i.e., filled or unfilled pauses in speech), circumlocutions (i.e., word substitutions to avoid problematic words), words produced with an excess of physical tension, and monosyllabic whole-word repetitions (e.g., ”I-I-I-I see him"). The disturbance in ﬂuency interferes with academic or occupational achieve- ment or with social communication. The extent of the disturbance varies from situation to situation and often is more severe when there is special pressure to communicate (e.g., giv- ing a report at school, interviewing for a job). Dysﬂuency is often absent during oral read- ing, singing, or talking to inanimate objects or to pets.