| Type of impairment | Associated conditions | Findings on history | Findings on physical exam |
| Speech impairment |
| Articulation disorders |
| | | - Inability to recognize sound
- Delayed language development
- Prematurity
- Recurrent otitis media
| - Does not turn toward sound
- Abnormal hearing screen
- Abnormalities on external ear exam (eg, microtia)
|
- Structural defects (eg, cleft lip and palate, ankyloglossia)
| - Mispronunciation of letters or lisping (eg, /s/,/t/, /l/)
- Poor feeding
| - Visible defect in cleft or palate
- Tongue thrusting
- Short frenulum
|
| Dysarthria | - Neurologic conditions (eg, stroke, brain tumor, cerebral palsy)
| - Delayed gross and fine motor development
- Weakness
- Dysphagia
- History of hypoxic-ischemic injury
| - Asymmetry in gait or strength
- Incomplete word formation
|
| Apraxia | - Neuromuscular disease (eg, due to stroke, traumatic brain injury, metabolic injury, genetic syndrome, idiopathic)
| - Mispronunciation of words
- Weakness
| - Unintelligible speech
- Paralysis or weakness of facial or other muscles
|
| Fluency disorders |
| Stuttering | - Developmental immaturity
- Neurologic disease or trauma
| - Typical age 2 to 5 years
- Male > female
- Family history of stuttering
| - Characteristic disruptions in flow of speech
|
| Voice disorders |
| | - Hearing loss
- Vocal cord nodules or polyps
- Infectious laryngitis
| - Changes in voice quality
- Excessive use of force in speaking
- Recent upper respiratory infection
| - Hoarseness
- Loss of voice
- Signs of infection (fever, rhinorrhea, tonsillar exudates)
|
| Resonance | - Clefts of hard or soft palate
- Paralysis of velum
- Enlarged adenoids
| - Changes in tone of voice
- History of congenital anomalies
- Snoring
| - Hypernasal or hyponasal voice
- Structural defects of lip or soft palate
|
| Developmental language impairment |
| | - Intellectual disability (formerly called mental retardation)
| - Other developmental delays
- Difficulty learning
- Family history of cognitive delay
| - Difficulty following commands
- Global developmental delay
- Dysmorphic features
|
- Learning disabilities
- Central auditory processing disorder (may be acquired)
| - Difficulty learning language
- Poor school performance
- Prematurity
- Family history of learning issues
| - Difficulty reading or comprehending written language
- Cognitive delays
|
- Attention deficit hyperactivity disorder
| - Difficulty organizing thoughts or finishing tasks at home or school
- Poor school performance
| - Lack of focus or hyperactivity
- Conversation disorganized
|
| | - Atypical language patterns
- Avoidance of social situations
- Bothered by noises
| - Echolalia or formulaic speech
- Stereotypic behaviors
- Gaze avoidance
- Failed behavioral screening
|
| Acquired language impairment |
| | - Degenerative neurological conditions (eg, Leigh encephalopathy, Mucopolysaccharidosis, Rett syndrome)
| - Loss of milestones
- Seizures or other neurologic symptoms
| - Global developmental delay
- Poor growth
- Organ dysfunction
- Dysmorphic features
|
| | - History of motor vehicle/sports or other accident
- Loss of milestones
| - Speech disorders (eg, dysarthria)
- Cognitive, motor, or sensory deficits
|
- Infection (eg, otitis media)
- Toxicity
| - Hearing impairment
- Frequent infections
- Exposure to lead
| - Tympanic membrane effusion or immobility
- Abnormal hearing test
- Anemia
|
- Neglect/abuse
- Prenatal substance exposure (eg, alcohol/cocaine)
| - Family disruption, emotional or physical abuse
- Maternal substance use in pregnancy
| - Poor caregiver-child interaction
- Anxiety or PTSD
- Poor growth
- Dysmorphic features
|
