Document 66099

Childhood Dysarthria
Kathleen Mikullitz
Kimme Norton
What is Childhood Dysarthria?
A group of motor speech disorders that affects
the neuromuscular execution of speech
Characterized by abnormalities in:
CNS and/or PNS
Neuromuscular features, including: strength,
steadiness, tone, accuracy, and speed and range of
Can affect ALL systems necessary for speech:
Respiration, phonation, articulation, resonance, and
(van Mourik, Catsman-Berrevoets, Paquier, Yousef-Bak, & van Dongen, 1997; Duffy, 2005)
Types and Symptoms
Flaccid – Weakness
Spastic – Rigidity
Ataxic – Incoordination
Hypokinetic – Rigidity; Problems with initiating
Hyperkinetic – Involuntary movements
Unilateral Upper Motor Neuron – Weakness;
Mixed – Variable
(Duffy, 2005; Andrianopoulos, 2008)
Childhood Dysarthria
Congenital or Developmental:
The neurologic insult takes place at birth or
prior to the development of speech and
The individual may have developed some
speech and language skills prior to the
neurologic insult
(Caruso & Strand, 1999)
Speech Characteristics
Marked difficulties with strength, speech, and accuracy
of articulatory movement.
Weak vocal quality (lack of respiratory support)
Hypo- or hypernasality
Weak articulatory contacts
Rapid or slow speaking rate
Distortion of vowels that involve spreading intrinsic
tongue muscles:
/i/, /ai/, /ei/, and /ɔ ɪ/.
Imprecise or weakly targeted consonants
/r/, /l/, and /s/
Generally weak, mushy, garbled, imprecise speech
(McCaffrey, 2008)
Non-Speech Characteristics
Difficulties with:
May cause:
(McCaffrey, 2008)
Disorders/Syndromes Associated
with Childhood Dysarthria
Spina Bifida and Hydrocephalus
Fragile X syndrome
Down’s syndrome
Prader-Willi syndrome
Spina Bifida with Hydrocephalus (SBH)
Spina Bifida: Incomplete fusion of the vertebral column
Hydrocephalus: Excess of cerebrospinal fluid (CSF) in
the brain Æ Enlarged skull
SBH: Malformation of the cerebellum
Ataxic dysarthria
Three clusters of speech:
Articulatory inaccuracy
Prosodic excess
Phonatory-prosodic insufficiency
(Bhatnagar, 2002; Huber-Okrainec, Dennis, Brettschneider, & Spiegler, 2002)
Fragile X Syndrome
Prevalence: 1:4,000
Cause: Mutation of FMR1 gene on the X
Speech is characterized by:
Articulatory distortions and substitutions
(Shprintzen, 2000; Turner, Webb, Wake, & Robinson, 1996, as cited in Roberts, Mirrett,
Anderson, Burchinal, & Neebe, 2002)
Down’s Syndrome
Prevalence: 1:1,000
Cause: A third 21st chromosome Æ Trisomy 21
Primary feature: Hypotonia Æ Dysarthria
Speech is characterized by:
Low pitch
Articulatory distortions
Increased rate
Reduced prosody
(Jung, Gagne, Godden, Leeper, Moon, & Seewalk, 1989; Shprintzen, 2000)
Prader-Willi Syndrome
Prevalence: 1: 12,000-15,000
Cause: Deletion on chromosome 15q11
Long arm of the paternally derived chromosome
Delayed motor development secondary to hypotonia
Flaccid dysarthria
Speech is characterized by:
Reduced intelligibility
Articulation errors
(Stark, 2006; Prader-Willi Syndrome Association, 2008)
Depends on type and severity of symptoms
„ Children generally receive a better prognosis than
adults due to neural plasticity
Intervention is not a “one size fits all” solution
„ Beneficial to the child
„ What problem does it solve?
Evidence based
„ Grounded in theory?
How much treatment is necessary?
(Caruso & Strand, 1999; Yorkston & Beukelman, 2004)
Severity-Based Treatment
Level of severity and type of dysarthria
influences the course and structure of
Remediation of mild to moderate
Compensatory strategies
Remediation of severe dysarthria
Alternative form of communication necessary
(Caruso & Strand, 1999)
Treatment May Target:
„ To obtain sufficient breath support for speech
„ To reduce excessive Breathiness
„ To reduce hypernasality
„ To coordinate and strengthen the articulators
„ To create phonetic contrasts in speech
„ Feedback, Visi-pitch, delayed auditory feedback (DAF)
(Caruso & Strand, 1999)
Treatment Ideas
Promote the inclusion of:
Family members and caregivers to increase
Alternative modes of communication
Enhancement strategies (e.g., eye contact and facial
Repair strategies and self-monitoring
Strategies to improve listener comprehension
Support the development of:
Phonological awareness and literacy
Receptive and expressive language
(Caruso & Strand, 1999)
Future Research
Childhood Dysarthria
„ Prevalence: Currently unknown
Masked by primary diagnosis
Diagnosticians need to include assessment
for dysarthria within the testing battery
„ Intervention
Identification of effective treatment methods
Evidence-Based Practice
Andrianopoulos, M. V. (2008). Introduction to motor speech disorders. Retrieved
January 22, 2008, from University of Massachusetts Amherst,
Communication Disorders Website:
Bhatnagar, S. C. (2002). Neuroscience for the study of communicative disorders.
(2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Caruso, A. J. & Strand, E. A. (1999). Clinical management of motor speech
disorders in children. New York: Thieme
Duffy, J. R. (2005) Motor speech disorders: Substrates, differential diagnosis, and
management. St. Louis, MO: Elsevier Mosby.
Huber-Okrainec, J., Dennis, M., Brettschneider, J. & Spiegler, B. J. (2002).
Neuromotor speech deficits in children and adults with spina bifida and
hydrocephalus. Brain and Language, 80(3), 592-602.
Jung, J. H., Gagne, J. P., Godden, A. L., Leeper, H. A., Moon, J. B., & Seewald, R.
C. (1989). Genetic syndromes in communication disorders. Austin, TX: PROED.
McCaffrey, P. (2008). Neuropathologies of swallowing and speech. Retrieved April
29, 2008, from California State University, Chico, The Neuroscience on the
Web Series:
References – Continued…
Prader-Will Syndrome Association. (2008, February 21). Basic facts about PWS: A
diagnosis and reference guide for physicians and other health professionals.
Retrieved April 29, 2008, from the World Wide Web:
Roberts, J. E., Mirrett, P., Anderson, K., Burchinal, M., & Neebe, E. (2002). Early
communication, symbolic behavior, and social profiles of young males with
fragile X syndrome. American Journal of Speech-Language Pathology, 11, 295304.
Shprintzen, R. J. (2000). Syndrome identification for speech-language pathology: An
illustrated pocketguide. San Diego, CA: Singular.
Stark, S. (2006). Neurodevelopmental disorders with genetic etiologies and
speech and language disorders.
van Mourik, M., Catsman-Berrevoets, C. E., Paquier, P. F., Yousef-Bak, E., & van
Dongen, H. R. (1997). Acquired childhood dysarthria: Review of its clinical
presentation. Pediatric Neurology, 17(4), 299-307.
Yorkston, K. M., & Beukelman, D. R. (2004, May 11). Dysarthria: Tools for clinical
decision-making. The ASHA Leader, pp. 4-5, 20-21.