Lecture on Pediatric Motor Speech Disorders

Introduction

• Presenter: Marissa Mitchel
• Topic: Pediatric motor speech disorders – diagnosis and treatment
• No financial relationships: No affiliations with products or services mentioned

Key Questions Addressed

• What are motor speech disorders?
• What causes them?
• How are they diagnosed?
• What therapies and treatments are effective?
• What treatments are ineffective?
• What do we know about long-term outcomes?

Understanding Motor Speech Disorders

Speech Production Process

1. Cognitive Linguistic Stage: Decide to communicate, formulate a message
2. Transcoding: Plan and program motor movements for sound production
3. Execution: Coordinate articulators (lips, tongue, jaw, etc.)
4. Sensory Feedback: Evaluate sound and feel of speech for future improvements

Motor Speech Disorders Defined

• Categories:
  • Childhood apraxia of speech
  • Dysarthria
  • Speech motor delay/motor speech disorder not otherwise specified
• Can be developmental or acquired
• Vary in severity from mild to severe impact on communication

Prevalence and Associations

• Prevalence: Rare, approximately 1 in 1,000 children for apraxia and dysarthria, 4 in 1,000 for speech motor delay
• More common in children with neurodevelopmental disorders (e.g., intellectual disability, autism)

Detailed Discussion on Disorders

Childhood Apraxia of Speech

• Definition: Neurological disorder impairing precision/consistency of movements without neuromuscular deficits
• Key Features:
  • Inconsistent errors
  • Lengthened/disrupted transitions
  • Unusual prosody
• Challenges: Difficult diagnosis, requires intensive intervention

Dysarthria

• Definition: Disorder at the level of motor execution due to muscle weakness, paralysis, or incoordination
• Types:
  • Spastic, Ataxic, Hyperkinetic, Mixed dysarthria
• Features: Slow speaking rate, imprecise speech, resonance problems

Causes

• Neurological Impairment: Stroke, brain injury, infection
• Genetic/Metabolic Conditions: Fragile X, Down syndrome, SETBP1-related disorder
• Idiopathic Cases: Unknown cause, normal MRI

Diagnosis

• Professionals Involved: Licensed speech language pathologists, supporting roles for neurologists
• Considerations:
  • Difficult for children under 3
  • No gold standard test
  • Comprehensive evaluation including structural/functional examination

Treatment Approaches

Direct Speech Therapy

• Frequent, intense practice based on motor learning principles
• Key Methods:
  • Multisensory cuing
  • Immediate feedback
  • Rhythm/prosody focus
  • Progressive approximation

Augmentative and Alternative Communication (AAC)

• Aided and Unaided AAC: Tools to supplement/replace speech
• Considerations: No prerequisites for use, can aid verbal children, doesn’t hinder speech development

Ineffective/Harmful Methods

• Discredited Approaches: Vitamins/supplements, non-speech oral exercises, facilitated communication

Long-term Outcomes

• Prognosis Depends on:
  • Severity of disorder
  • Co-occurring conditions
  • Initial progress in therapy
• Importance of Intensive Therapy: Necessary for most children

Q&A Highlights

• Speech intelligibility varies, but progress can be made at any age with proper therapy
• Therapy options depend on individual response and progress
• Early intervention and family support are crucial
• Multilingual environments don't hinder speech development
• AAC use doesn’t deter speech development, can in fact aid it

Conclusion

• Many children can achieve proficient communication with appropriate therapy
• Individual prognosis depends on various child-specific factors
• Marissa Mitchel provides references and resources for further reading

Note: These notes are based on a lecture and Q&A session led by Marissa Mitchel on pediatric motor speech disorders.