DISORDER OVERVIEWS

APRAXIA: 

Apraxia is a non-language based sensori-motor disorder of articulation . I t is characterized by an impaired capacity to motor-plan, coordinate and sequence the speech muscles for the volitional production of Speech Sounds.

ARTICULATION:

Articulation is basically the ability to produce speech sounds (consonants and vowels) into units that form words, phrases and sentences. These sounds occur in the beginning, middle and end of words Articulation errors occur in three different forms: (a) Substitutions ( substituting a “w” for an “l”) ; (b) Distortions : the consonant sound may “sound” distorted , i.e. an “s” whose sound is emitted from the side of the mouth ,rather than through the center ; (c) Omissions : consonant and/or vowels  can be deleted by the child at the beginning, middle or at the end of a word.

By the age of 36 months, a child’s speech should be relatively understood by the average person, even in presence of common developmental errors (please refer to Speech Sound Developmental Norms). If a parent constantly serves as a “translator” for the child (“What did s/he say???”), a speech evaluation might be warranted.

STUTTERING:

Stuttering or dysflunency is characterized by interruptions in the flow of speech. Children who exhibit “primary” stuttering present with some or all of the following symptoms: (A) initial sound repetitions (b-b-boy) (B) initial syllable repetitions( buh-buh-butter) (C) initial word repetitions ( he-he-he is my friend) (D) sound prolongations (ssssssss..sunny) (E) hard contacts and struggle behaviours ( pressing the lips together tightly or appearing to have the words getting “stuck” in the throat . Please note that hesitations and repetitions can be common in youngsters 2 to 5 years old as children at these ages are still developing language. However, any signs of struggle, hard contacts or prolongations during these ages may indicate the need for an evaluation. Although there is not any empirical genetic proof, stuttering tends to run in families and boys who stutter out number girls by 4 to 1. This practice also treats adults who exhibit more severe symptomatology.

LANGUAGE DELAY:

Language consists of auditory comprehension (receptive language), expressive communication (expressive language) and use of language (pragmatics). Receptive language includes vocabulary (knowledge of objects, actions and events), comprehension of following commands, responding to “wh” , yes/no and choice questions and knowledge of quality ( adjectives and adverbs) , temporals ( first ,next , today , tomorrow ,etc.) and location ( in, on, under ,etc.) concepts. Expressive language is the ability to combine the various parts of speech to produce words, phrases and eventually sentences .Grammar, syntax and word endings (for example, “ing” on a verbs ”s” to indicate plurality ) are a part of expressive language. Pragmatics or language use is the development of the child’s ability to request an object, information, action, and attention. Children use language to comment about themselves, others and about objects. They seek and give information, express feelings and engage in social routines using language. Please note that children establish and maintain eye contact during communicative exchanges. Possible causes and developmental norms of language development are available in the “links” section.  If a child is not producing at least single words or is experiencing poor comprehension at the age of 24 months, lifelong developmental disability that occurs by itself or in association with other disorders that affect the function of the brain, such as viral infections, metabolic disturbances, mental retardation, epilepsy, and fragile X syndrome; characterized by severely impaired social interaction and communication skills and restrictive or repetitive movements, interests, and behaviors a speech-language evaluation should be considered.

AUTISM/PERVASIVE DEVELOPMENTAL DISORDER:

The definition of autism is based on the diagnostic criteria provided in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM - IV.)

Autism is included under DSM-IV's pervasive developmental disorders. This is a category of disorders in which many basic areas of infant and child psychological development are affected at the same time, and to a severe degree.

Autistic disorder has three major hallmarks: qualitative impairment in social interaction, qualitative impairment in communication, and restricted, repetitive and stereotypical patterns of behavior, interests, and activities. Onset in delays is very early, prior to three years of age.

To meet DSM-IV diagnostic criteria for autism, children will display impairment in social interaction in at least two ways, impairment in communication in at least one way, and restricted, repetitive and stereotypical patterns of behavior, interests and activities in at least one way.

According to DSM-IV, impairment in social interaction is manifested in at least two of the following ways:

1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;
2. failure to develop peer relationships appropriate to developmental level;
3. a lack of spontaneous seeking to share enjoyment, interests or achievement with other people;
4. lack of social or emotional reciprocity.

Impairment in communication is manifested by at least one of the following:

1. delay in, or total lack of, the development of spoken language, not accompanied by an attempt to compensate through alternative modes of communication;
2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain conversation with others;
3. stereotyped and repetitive use of language or idiosyncratic language, and
4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

Restricted, repetitive and stereotyped patterns of behavior, interests and activities are manifested by at least one of the following:

• encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity of focus;
• apparently inflexible adherence to specific, non-functional routines or rituals; stereotyped and repetitive motor mannerisms, such as hand or finger flapping, or complex whole body movements;
• persistent preoccupation with parts of objects.

(DSM-IV,1994).

Autism and PDD: What's the Difference?

Pervasive Developmental Disorders (PDD) as defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) is a category of disorders incorporating extreme developmental abnormalities with onset in the first three years of life. Pervasive Developmental Disorder represents a distortion in basic development with characteristic features including:

• Severe and pervasive impairment in reciprocal social interaction;
• Severe and pervasive impairment in communication skills; and
• Presence of stereotyped behavior, interests and activities.

"Basic psychological functions such as attention, mood, intellectual functioning and motor movement are affected at the same time, and to a severe degree." (Rapoport & Ismond, 1996).

The category of PDD-NOS is used when there is severe and pervasive impairment in the development of reciprocal social interaction and verbal and nonverbal communication skills, or when stereotyped behavior, interests and activities are present, but symptoms do not meet the criteria for other disorders. (DSM-IV,1994). Within the broad classification of PDD are five subtypes: Autistic Disorder, Asperger's Disorder, Rett's Disorder, Childhood Disintegrative Disorder and PDD-Not Otherwise Specified (PDD-NOS).

Autistic Disorder is the best studied of the PDD subtypes. To be diagnosed as autistic, children must display impairment in social interaction in at least two ways, impairment in communication in at least one way, and restricted, repetitive and stereotypical patterns of behavior, interests and activities in at least one way. Asperger's Disorder is characterized by severe and sustained impairment in social interaction combined with restricted, repetitive and stereotyped patterns of behavior, interests and activities (DSM-IV, 1994). This disorder differs from autism in that "few clinically significant delays in language or cognitive development are apparent, and self-help and adaptive behaviors often appear normal." (Rapoport & Ismond,1996).

Typically, Pervasive Developmental Disorders are extremely incapacitating, and their symptoms are chronic and lifelong (although this is less the case for Asperger's Disorder). "Factors considered most important for determining prognosis are IQ levels, and development of social and language skills" (Rapoport & Ismond, 1996). Identification of variables that predict outcomes reliably continue to undergo intense study within the scientific community. Given the chronic nature of PDD, however, long-term treatment is typically required.

THE DIAGNOSIS OF AUTISM OR PDD SHOULD BE NADE BY A PEDIATRIC NEUROLOGIST.

References/Definition of Autism

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Autism Society of Maine. (No date). Autism. [Brochure]. Gardiner, ME: Author.

Klinger, L. & Dawson, G. (1996). Autistic disorder. In Marsh, E. & Barkley, R. (eds.), Child Psychopathy (pp 311 - 339). New York: Gilford Press.

Maurice, C. (1993). Let me hear your voice. New York: Knopf.

Rapoport, J.L. & Ismond, D.R. (1996). DSM-IV training guide for diagnosis of childhood disorders. New York: Brunner/Mazel.

 Perry, R., Cohen, I., & DeCarlo, R. (1995). Case study: Deterioration, autism, and recovery in two siblings. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 232 - 237.

VOICE DISORDERS:

Voice or phonation is produced by the coming together and vibration of the vocal cords. Voice parameters consist of vocal volume, quality and pitch. Volume involves the loudness or softness of the voice while pitch involves the voice’s sound being too high pitched or too low pitched. Vocal quality involves the voice’s sound being clear. Quality problems include chronic or prolonged hoarseness, raspyness, and breathiness. Nasality is another parameter affecting the sound of the voice.  A voice may sound “denasal”, like when you have a stuffed nose or “hypernasal” with air escaping through the nose. Causes of voice disorders are myriad but vocal cord swelling, polyps and/or nodules are typical causes. Before seeking voice therapy, one should see an ear, nose and throat physican who will determine any evidence of pathology and the proper course or treatment.  

CENTRAL AUDITORY PROCESSING DISORDERS (CAPD):

Please type “central auditory processing disorders” into your web browser and a myriad of sites will appear for you to explore. This practice provides therapy to children who exhibit CAPD.

APHASIA:

 Aphasia is an adult speech and/or language impairment due to brain damage resulting from a stroke. Its severity can range from mild to global. Cognitive skills can also be adversely affected. Patients with aphasia can present with deficits in receptive language, expressive language or a combination of the two domains. Motor speech problems,such as apraxia or dysarthria, may also be present with the concommitant language deficits. Swallowing may also be affected. Please refer to the links section for more detailed information on this disorder.

SWALLOWING DISORDERS/ TONGUE THRUST SWALLOWING: 

Swallowing disorders or dysphagia can be exhibited in both adults and children. Adult dysphagia is usually a side effect of a stroke. This practice offers a new treatment approach to adult swallowing disorders called Vital Stimulation by one of the associate clinicians who is the only therapist certified in the metropolitan area to provide this type of treatment.  Please refer to the links page for more information.

Robert P. Marinello and Associates
78 Todt Hill Road
Suite 201
Staten Island, NY 10314
Tel: 718-448-1958
Fax: 718-876-9899
Email: Robert Marinello