Speech and Language Disorders

People interact with each other through different means in their daily lives. These interactions can be examined in two different dimensions: speech and language.

What is Language and Speech?

Language and speech are two different concepts that are often confused in daily life.

Language is a code system consisting of socially shared chains of rules that enables us to communicate. Language consists of five components: semantics, phonology, morphology, syntax, and pragmatics.

Speech is the tool for verbal communication and uses voice to convey linguistic information. Speech is a means to convey language and includes the following concepts:

Voice: Air ascending from the trachea creates the human voice by vibrating the vocal cords positioned over the trachea. This raw voice, created in the larynx, then takes a shape in the pharyngeal cavity, oral cavity, and nasal cavity—just like in a musical instrument—to form the individual’s unique vocal tone. (Misuse of the voice can cause hoarseness or loss of voice.)

Articulation: Organs that assist speech, called articulators (mouth, tongue, teeth, soft palate, lips), take a certain shape to produce speech sounds. (Saying “ayaba” instead of “araba” [car] is an articulation disorder.)

Fluency: is the rhythm and flow of speech (Stuttering is a disorder seen in the fluency of speech.)

What is a speech and language disorder?

Disorders related to language and speech are also different from each other. If a person has difficulty understanding others or sharing their thoughts, this is a language disorder. If a person cannot pronounce speech sounds clearly or fluently, if their speech is not fluent, or if they have a problem with their voice, this is a speech disorder.

The underlying reason for an individual presenting with the complaint of “inability to form proper sentences” might be a limited vocabulary, a failure to use certain affixes, or an inability to use words appropriately in context.

What are speech and language disorders?

Speech and language disorders are examined under different headings according to age and cause:

Language disorders

Receptive language disorder (difficulty understanding language): Difficulty understanding instructions, questions, or long sentences.
Expressive language disorder (difficulty expressing oneself): Word-finding difficulties, short/broken sentences, incorrect use of affixes and syntax.
Pragmatic language disorder (social language): Difficulty with social communication rules such as taking turns, staying on topic, and understanding metaphors.
Developmental language disorder (specific language impairment): A persistent language difficulty beginning in childhood that is not attributable to another medical condition.
Neurologically-based language disorders (aphasia, etc.): Impairment in the comprehension/expression components of language after stroke, brain injury, or neurodegenerative diseases.

Speech disorders

Articulation/phonological disorder: Incorrect, omitted, or substituted production of sounds like “r, s, k.”
Phonological disorder: Systematically and rule-based incorrect use of sounds (e.g., dropping consonants at the end of words).
Fluency disorders: Stuttering (repetitions, prolongations, blocks) and cluttering (rapid/irregular speech).
Voice disorders: Hoarseness, cracking, fatigue; can occur due to causes such as nodules, polyps, reflux, or vocal misuse.
Motor speech disorders: Dysarthria (muscle weakness/coordination problem), childhood apraxia of speech (difficulty with motor planning of sounds).

Co-occurring conditions

Hearing loss, cleft palate, diş–çene sorunları, neurological diseases (cerebral palsy, Parkinson’s, ALS), genetic syndromes (Down, VCFS, etc.), autism spectrum disorder, attention problems, and unbalanced language exposure in bilingualism can affect the clinical presentation.

What are the differences between speech and language disorders?

In language disorders, if a person cannot understand and decipher the code of their own language system, that person has a “language comprehension and perception disorder.” If a person does not know the rules of the language system or cannot apply them, and consequently cannot express their thoughts, ideas, and feelings, that person has an “expressive language disorder.” Perception and expression disorders generally occur together.

For example; after suffering a stroke, Ali cannot understand long and complex sentences (lisan algılama bozukluğu), and when he speaks, he begins to have difficulty remembering and finding the names of objects and people. He has also started to construct sentences incompletely or with incorrect word order (dil ifade bozukluğu).

A person may have only a speech disorder without a language disorder.

Speech disorders are defined as the unintelligible or incorrect pronunciation of sounds coming out of the mouth during speech, the inability to move or control/coordinate the organs responsible for speech, which results in the message not being conveyed correctly. Speech disorders can manifest as incorrect or incomplete production of speech sounds (artikülasyon-sesletim bozukluğu), problems with the fluency of speech (kekemelik, takipemi), voice disorder (ses kısıklığı ya da kaybı) motor speech disorder (apraksi), or weakness/excessive tension of the muscles related to speech (dizartri).

For example; Ali’s speech sounds to listeners almost like a radio transmission, the pronunciation of words is extremely confused, and some of the consonants are incorrect (speech disorder).

Language and speech disorders can occur together or independently of each other. In both cases, a therapy program outlined following measurement, testing, and evaluation by a Speech and Language Therapist (SLT) and implemented by this specialist will be the only way to treat speech and language disorders.

What are the causes of speech and language disorders, and how are they diagnosed?

There are various causes of speech and language disorders. Changes in the muscle and bone structures responsible for speech, cleft palate, dental problems, problems in the brain or nerves, hearing loss, neurological disorders such as cerebral palsy, Parkinson’s, ALS, brain injury, and intellectual disability (mental retardation), genetic syndromes such as autism, Asperger’s, Down syndrome, Apert syndrome, velocardiofacial syndrome, are among the causes of speech and language problems. Diseases such as reflux, polyps, nodules, vocal cord disorders, and laryngeal cancer are also among the causes of voice-related speech disorders.

When to consult a specialist?

If single words are absent or limited at age 2, or if sentences are unintelligible at age 3,
If there is significant difficulty with fluency at any age, or if hoarseness persists for longer than 2–3 weeks,
If there is a change in speech–language following a stroke/head trauma,
If there are co-occurring difficulties with hearing, swallowing, or feeding, a specialist should be consulted.

How are speech and language disorders detected?

To determine which component or components of language are affected by the language disorder in an individual, the language assessment must be conducted in a broad spectrum, with each component of language evaluated individually by a Speech and Language Therapist.

In a speech disorder, a speech evaluation can be provided by conducting tests that identify factors such as which sounds the person can produce, which they cannot, or which sounds they can use in certain parts of a word but not others (e.g., being able to use the “k” sound in the initial position of a syllable but not in the final or medial position, etc.), or by measuring the fluency and speed of speech. Thus, the individual’s speech and language problem can be analyzed in more detail, and a therapy plan suitable for the individual can be prepared by identifying the severity of the disorder in which component of language or part of speech. The therapist may also request a hearing test, ENT, or neurological examination where deemed necessary.

What is the treatment for speech and language disorders?

Treatment is individualized according to the person, age, cause, and evaluation results. The basic approach is a multidisciplinary plan led by a Speech and Language Therapist (SLT), involving the necessary specialties.

Therapy Principles

Individualization: Goals are set based on the strengths and weaknesses revealed by the assessment.
Measurable goals: Short- and long-term goals are regularly monitored through in-session performance.
Family/environment participation: Home programs and communication strategies with teachers/colleagues are an integral part of treatment.
Consistency: Fewer but frequent repetitions and consistency are critical for the permanence of gains.

Therapy Methods Used

Articulation and phonological therapy:

Amaç: Konuşma seslerinin doğru ve anlaşılır üretimini sağlamak, ses hatalarını kalıcı olarak azaltmak.

Yöntemler: Minimal çiftler (örn. “bal–pal”), yer–biçim ipuçları (dil ucu, dudak pozisyonu), görsel–taktil geri bildirim (ayna, dil depressörü, dokunsal ipuçları), motor temelli yaklaşım (ses–hece–kelime–cümle hiyerarşisi).

Hangi durumlara uygun? Artikülasyon/fonolojik bozukluk, yarık damak sonrası sesletim, iki dillilikte ses karışmaları.

Fluency therapy:

Goal: To support fluent, comfortable, and functional speech in stuttering and cluttering; to reduce fear of speaking.

Methods: Fluency shaping (gentle onset, prolonged speech, breath–rhythm synchronization), stuttering modification techniques (muscle relaxation, reducing avoidance behaviors), cognitive–behavioral interventions (restructuring negative automatic thoughts).

Suitable for: Stuttering in children, adolescents, and adults; rapid/irregular speech (cluttering).

Language therapy:

Goal: To strengthen comprehension (receptive language) and expression (expressive language) skills; to increase vocabulary and grammatical accuracy.

Methods: Target word lists and semantic networks, syntax–morphology work (affixes, tense, person), narrative construction (beginning–middle–end, conjunctions), pragmatic language (turn-taking, staying on topic, metaphor/indirect language).

Suitable for: Developmental language disorder, social language difficulties in autism spectrum disorder, language re-acquisition after aphasia.

Voice therapy:

Goal: To bring the quality, endurance, and pitch of the voice to a functional level; to reduce hoarseness and fatigue.

Methods: Balance of respiration–phonation–resonance (diaphragmatic breathing, semi-occluded vocal tract exercises: “m,” “n,” “z,” “v,” straw/tube exercises), correcting vocal misuse, load management.

Suitable for: Nodules/polyps, functional dysphonia, professional voice users like teachers–call center agents–musicians.

Motor speech (dysarthria and apraxia):

Goal: To improve the motor planning and execution of speech; to increase intelligibility.

Methods: Sensory–motor planning protocols (e.g., hierarchical targets in childhood apraxia of speech, intensive repetition), studies of rate–rhythm–prosody (metronome, stress, syllabification), regulation of muscle tone and breath support.

Suitable for: Dysarthria after stroke, Parkinson’s, ALS, head trauma; childhood apraxia of speech.