-o

SPEECH CORRECTION
An Introduction to
Speech Pathology and Audiology
N
NTH
D
I
T
0N
I

CHARLES VAN RIPER

Late of Western Michigan University

ROBERT L. ERICKSON
Western Michigan University

Allyn and Bacon

Boston

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Singapore

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APPO

Copyright 1996, 1990, 1984 by Allyn & Bacon

A Simon & Schuster Company
Needham Heights, MA 02194

All rights reserved. No part of the material protected by this copyright notice may be reproduced or
utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or
by any information storage and retrieval system, without written permission from the copyright holder.

Library of Congress Cataloging-in-Publication Data

Van Riper, Charles
Speech correction : an introduction to speech pathology and
audiology / Charles Van Riper, Robert L. Erickson. 9th ed.

p. cm.

Includes bibliographical references and index.

ISBN 0-13-825142-8

1. Speech disorders. 2. Speech therapy. 3. Audiology.

I. Erickson, Robert L. II. Title.

[DNLM: 1. Speech Disorders. 2. Voice Disorders. 3. Speech

Therapy. WM 475 V274s 19951

RC423.V35 1995
61&85'5dc2O

DNLM/DLC
for Library of Congress

9541718

CIP

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1

00 99 98 97 96 95

To Catharine Flull Van Riper, aka Katy, "The Earth Mother"

(19091984)

to Jackie, Doug, Chuck, and Deanna,

to our clients, and to our students and their future clients, and
to the memory of Charles "Cully" Gage Van Riper,
the man from Michigan's Upper Peninsula who, followingS the completion of his doctoral studies at the University of Iowa, came to Western
State Normal College in 1936 to begin a speech clinic and to establish
one of the country's earliest educational programs for the preparation of
"speech correctionists." For decades to follow, Charles Van Riper played
a pioneering and dominant role in the developing profession of speechlanguage pathology.
Doctor Van Riper was destined to become part of the very fiber of
generations of students and practitioners throughout the world, even as

he also was to become a source of strength, hope, inspiration, understanding, and help for countless persons with communication disabilities.
"Doctor Van" lived, and urged his students and his colleagues to live,
in ways intended to have positive and enduring effects. He sought to teach
us that, "although we are specks at the intersection of the two infinities of
time and space," we are able to erect a perpendicular at that point. "Every

time you help a person to have a better life," he reminds us still, "and
every time you've made this earth a bit more beautiful, you add another
unit to your perpendicular." Through word and deed he impacted in
many ways on myriad lives. He relished the notion thus of "playing billiards with eternity."
It is in his spirit, and now in remembrance of him, that you are invited to explore in these pages the miracle of human speech and hearing,
the devastations wrought by their malfunctions, and the still-evolving professions of speech-language pathology and audiology.

CONTENTS
Preface

xi

Acknowledgments xii

Introduction
History of the Disabled

How the Disabled Person Reacts 8

Current Attitudes toward Disability 8
Communicating with the Communicatively Impaired
A Brief Look at the Professions

I0

II

Basic Components of Speech

and Language 25
7 The Speech Mechanism 29
Language 45
Speech Acoustics

/
,

55

Development of Speech and Language is

Prerequisites

for Speech Development 76

,'The First Words 85

Syntax:

Learning to Talk in Sentences 9 I

Phonological Development 97
Semantics: The Development of Meaning
Prosody and Pragmatics

I 05

I0I

CONTENTS

4 Speech Disorders 109

Definition

II0

Disorder Classification

II I

Articulation Disorders

II3

II8

Fluency Disorders
Voice Disorders

I 23

Language Disorders

I33

5 Emotional Aspects of Communication 141

I 43
I 57
Role of the Speech-Language Pathologist
Components of the Emotional Fraction

Developmental Language Disorders 165

I 67

Nonverbal Children

Children with Delayed or Deviant Language

Deterrents to Language Acquisition
Experience Deprivation

t-:7

I 72

I 85

Assessing the Child's Language

Language Therapy

169

I 87

I9I

Articulation and Phonological Disorders 207

Dialect Differences

2I0

Types and Causes of Articulatory Disorders 2 I 2

Analyzing Misarticulations 222

23 I
Correcting Misarticulations

CONTENTS

Fluency Disorders 253

\'Vhat is Stuttering? 2 54
Development of the Disorder

The Treatment of Stuttering

260

268

Treatment of the Child 'Nho Has Become Aware of Stuttering 293

Cluttering 297

/c'oice Disorders 303

Disorders of Loudness 305
Pitch Disorders
3I4
Disorders of Vocal Quality 322

Laryngectomy 332

I0

Cleft Palate 343

incidence and Types of Clefts 344
Causes of Clefts 350

The Oral Cleft Team 351

Surgery for Clefts 3 54
Prostheses 356
Communication Problems Associated with Cleft Palate

3 58

Aphasia and Related Disorders 375

The Disorder 376
Causes of Aphasia 38 I
Aphasia Tests 385

II

Vii

CONTENTS

Physical and Psychosocial

Elements 387

Prognosis 388
Treatment

389

12 Cerebral Palsy and

Other Neuropathologies 403
of Cerebral Palsy 405
Classification by Body Parts 407
Causes of Cerebral Palsy 407
Impact of Cerebral Palsy 408
Varieties

Speech

Therapy 409

Motor Speech Disorders 4 I 2

The Severely lmpaird 4 I 3

I 3 Hearing and Hearing Impairment 423

The Heanng Mechanism 424
Detection and

Evaluation of Hearing Loss 427

Types of

Hearing Loss 435

Hearing Rehabilitation 457

14 The Speech and Hearing Professions 472

Origins

of the Speech and Hearing Professions 472

Organizations and Standards 479

Some Legal and Ethical Considerations

Career Options
Future Trends
Some

485
487

Concluding Comments 49 I

483

CONTENTS

Appendix A: American SpeechLanguage.Hearing Association

Code of Ethics 497
Appendix B: American Academy of Audiology

Code of Ethics 503

Appendix C: Scope of Practice: Speech-Language Pathology

and Audiology 507
Appendix D: Organizations. Agencies, and Support Groups
Related to Communication Sciences and Disorders 5 I I

!ossy L5_Index

527

ix

PRE FACE

As were its eight previous editions, this book is intended primarily for undergraduate students of human communication sciences and disorders;
however, it also should be of interest to students of elementary and preprimary education, music therapy, nursing, occupational therapy, physical
therapy, special education, psychology, and social work. Predentistry and
premedicine students also may find in this text useful overviews of many
of the disability types that they eventually will encounter in their practices.
In an introductory textbook it is impossible, of course, to reflect adequately the ever-expanding roles and responsibilities of today's speechlanguage pathologists and audiologists, so students who plan to enter
either of these professions will be well advised to supplement theirstudies with readings from current journals and specialized texts. Toward that
end we have suggested various sources of more detailed information when
our own discussion necessarily is foreshortened.
In this ninth edition we have maintained the clinical focus that has
helped to make the book uniquely readable, relevant, and informative for
many generations of students. As in previous editions, we have used actual client examples to illustrate and clariFy text material. However, some
of the detailed discussions of specific therapy procedures found in earlier
editions have been either condensed or eliminated. Chapter 8 is an exception in this regard, representing as it does the seniorauthor's final writings on the treatment of stuttering.
In addition to updating information, we have included far more comprehensive coverage of normal communication processes, and we have
expanded considerably our consideration of hearing problems and audiology. Some materials have been reorganized (for example, emotional problems associated with speech disorders are discussed in a separate chapter,
and alaryngeal speech has been combined with voice disorders in a single
chapter); and materials related to professional ethics and scopes of practice have been added as appendices. Among the other new features of this
edition are the inclusion of study questions in each chapter and the marginal definition of highlighted glossary terms throughout the book. We
trust that such changes as well as the improved layout of this edition will
enhance its usefulness to students and instructors alike.

ACKNOWLEDGMENTS
Thank you to the reviewers of various versions of this editionDonald
Fucci, Ohio University; Nancy K. O'Hare, Ph.D., James Madison Uni-

versity; Arthur M. Guilford, Ph.D., University of South Florida; and

Bonnie Lucido, Brigham Young Universityand to the many faculty colleagues at Western Michigan University have provided generous advice

and other forms of assistance during the preparation of this revision.

Among those at WMU, Harold L. Bate, James M. Hillenbrand, Gary D.
Lawson, Donna B. Oas, and Karen K. Seelig were particularly helpful.
Their interest and support have been very much appreciated. Gratitude
also is extended to John M. Hanley for having afforded me sufficient

workload flexibility to ensure completion of the project. Kris Farnsworth

of Allyn and Bacon has been especially patient, considerate, and persistent
in bringing this edition to closure. I am most grateful for her assistance
and unfailing encouragement. Finally, I wish also to acknowledge my
long-standing indebtedness to John Wiley, whose gentle wisdom and understanding guidance so greatly influenced the early career decisions that
led me eventually to Kalamazoo.

Robert L. Erickson

C
P

OUTLINE
1ou Rca

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I* V
I

II

Introduction

CHAPTER I

INTRODUCTION

Students take the introductory course in communication disorders for

various reasons. Some plan to enter one or the other of the new and
rapidly growing professions of audiology or speech-language pathology.
Some who seek careers in music therapy, occupational therapy, physical
therapy, or in counseling, know they will have patients with communication disabilities. Others, majoring in special education or classroom teaching, will have students with impaired speech or hearing. Some of you have
family members or friends who stutter or have hearing losses or other
kinds of speech or voice disorders. And, of course, there are students who
need an elective course in a convenient time slot. Whatever your motivation, we welcome you. We are delighted to be your guides because we
know that those who have been deprived of that most fundamental of all
human traits, the ability to communicate, need all the help and understanding they can get.
Many of you, too, may be searching for a way to make your lives
meaningful, for a basic philosophy of living. You may have realized that in
terms of the immensities of time and space we are only microscopic specks.
Should you spend your lives seeking possessions or fame? That doesn't really make much sense. Fame is for fruitflies. You will not be remembered
for long. Should you spend your life acquiring things, houses, and land?
Your senior author has eighty acres and a big old farm house, but when
he went over them in a hot air balloon they were so small he could barely
see them. Yes, we are specks at the intersection of the two infinities of time
and space, but one can erect a perpendicular at that pointthe perpendicular pronoun "I"( Figure 1-1).

We believe that the units of that perpendicular of significance are

built of impact. Every time you help a person to have a better life and
every time you've made this earth of ours a bit more beautiful, you add
another unit to your perpendicular. And every time you hurt another
person or pollute your nest you lose some of your life's meaning. Those
of us in the helping and healing professions may have more opportunity
for growth than others but all of us have impact. No, we needn't be
specks.

This is a book about people troubled by the way in which they com-

municate, about children and adults who stutter, who cannot utter a
sound because they have lost their vocal folds, who possess some other
speech disorder, who have hearing losses, or who have suffered strokes. At

first glance, it might seem as though its contents could have no bearing
on this generation's compelling need to make the world a fit place for men
and women to fulfill their infinite potential for something other than evil.
But there are many kinds of pollution, and some of the worst are those
that reflect people's inhumanity to one another.

Perhaps all other evils flow from this befouled spring. If so, the
study of speech pathology' and audiology should help us to discern what

must be done. It is important to realize that speech is the unique fea-

INTRODUCTION

FIGURE I - I

The Perpendicular of Significance (Courtesy ofAndrew Amor)

CHAPTER I

INTRODUCTION

ture that distinguishes human from animal. If we had not heard, we

would not speak. Had we not talked, we would still be in Eden or the
cave. In the dark mirror of communication disorders we may find reflected the fears, the frustrations, the shame, and the way a person is
treated by others; but the professions of speech pathology and audiology also provide us hope that somehow, someday, we can solve such
problems.
Sometimes it seems that there are so many human ills and evils
that those who dedicate their lives to their diminishing are dooming
themselves to lives of futility and frustration. We have not found it so.
Although our individual efforts may seem at times to have no more

effect than those of an ant carrying a grain of sand away from the
seashore, we have before us the example of atomic fission in which one

active particle triggers those about it, and these then fire others until
incredible forces are released. Each human being has a host of opportunities to trigger forces for good or evil that lie latent in others. We
believe that it is therefore possible for any one of us to start chain
reactions that may finally result in the kind of world and the kind of
people we hope for. It is through the fragile miracle of interpersonal
communication that we can initiate this chain of reactions for human
betterment.
But where to begin? The possibilities to relieve human distress are
everywhere. We who have chosen to direct our energies toward helping
those who have communication disorders are fortunate in that we often
can see the results much sooner than those who deal with such other problems as poverty, crime, or environmental pollution. It is very good to
know that we have helped people lost in the swamp of despair gain or regain their human birthrightthe ability to communicate. It is good to
know that you have freed them from the penalties and frustrations that are
their lot and from the anxieties, guilt, and frustration that too often are
their daily fare.
People who cannot communicate effectively are sorely handicapped,
so to understand their burdens we present a brief history of how society
has treated the disabled and the handicapped in the past.

In this text we occasionally use the word handicap as well as

disability to refer to those individuals who, through no fault of their
own, have differences that make living difficult. Blindness, deafness,
or any other physical or mental impairment that substantially limits one

or more of the major life activities are examples of handicaps or

disabilities. We are quite aware of the many objections to the word
"handicapped." That term comes from the past when persons with
many kinds of deformities or impairments would beg with cap in hand.
It is now well recognized, of course, that such people have the same
rights as any other citizens and that they neither need nor wish to be
pitied.

HISTORY OF THE DISABLED

HISTORY OF THE DISABLED

There are times, when we survey the extent of human distress, that this
dream of creating a better world is so unrealistic that it would be foolish
to try to do anything to make it come true. Why seek to make one's life
meaningful in this way when there is such an immense amount of misfortune all about us? Why pick up a few beer cans when millions are discarded
each day? Why try to help those who are less fortunate than we are when
the forces of our own culture keep generating more unhappiness? Is there
any hope for humankind?

The history of the way society has treated the handicapped, sad as it
is, may give us the glimmerings of that hope. Although we have some way
to go before we can call ourselves civilized, the contrast between the present and past treatments of people who are retarded, deaf, blind, crippled,
insane, or poor, and of those who cannot talk normally shows very clearly
that we have made gains. We find in this cultural history a hopeful progression from considering handicapped persons as intolerable nuisances,
then as objects of mirth, then as pitiful beggars, then as challenging problems, and now as individuals who are challenged. Today, persons with disabilities are increasingly recognized as persons, and as persons who also
have abilities. But clearly it was not always so.

Rejection
Primitive society tolerated no weakness. Tribes struggled hard for survival,
and those members who could not aid materially were quickly rejected.
The younger men killed the leaders when they had lost their teeth or their
energies had abated. The inhabitants of ancient India cast crippled people
into the Ganges; the Spartans hurled theirs from a precipice. The Aztecs
regularly sacrificed deformed persons in times of famine or when one of
their leaders died. The Melanesians had a simple solution for the problem
of the handicapped: They buried them alive. Among the earlier Romans,

twins were considered so abnormal that one of them was always put to
death, and frequently both were killed. They left their malformed children
on the highways or in the forests. If the children survived they were often
picked up by those who always prey upon the handicapped and were carried to the marketplace to be trained as beggars. They were not even valuable enough to be slaves.
The Bible clearly reflects these early rejection attitudes. Remember
Job? The prevailing belief in Old Testament times was that people's physical states were determined by their good or bad relationship with a deity.
Disabilities were regarded as divine punishment for sin. A normal person
could invoke similar punishment merely by associating with those who
had thus incurred the wrath of God. Consequently, the blind and the crippled wailed with the lepers outside the city wall.

CHAPTER I

INTRODUCTION

During the Middle Ages the physically disabled were frequently considered to be possessed by evil spirits. They were confined to their own
homes. They dared not walk to the marketplace lest they be stoned. Even
in this century, elimination of the handicapped has been practiced. Just a
few decades ago in our own country the sterilization of mentally impaired
people was sometimes practiced. The Kalfir tribes in South Africa clubbed
sickly or deformed children. The Nazis kept only the best of their civilian
prisoners for slaves; the others died in the gas chamber. And the abandonment of physically deformed infants occurs even today in some parts
of our world.
Today in this country the person who killed a disabled child might be
executed. We have come far in our journey toward civilization, but perhaps not far enough. Rejection takes many other forms. Spirits, too, can
be killed.
How many of those reading this book would accept unhesitatingly an
invitation to a dance or dinner if it were tendered by a person whose physical disability was obvious and severe?

Hum or
It did not take promoters long to discover that the handicapped provided

a rewarding source of humor. One history of the subject states that

before 1000 B.C. the fool or buffoon became a necessary part of feastmaking and "won the laughter of the guests by his idiocy or his deformity." In Homer's Odyssey, comic relief from tragedy was illustrated by
the vain effort of the one-eyed Polyphemus to pursue his tormentors
after they had blinded him. For a thousand years thereafter every court
had its crippled buffoons, it dwarf jesters, its stuttering fools. Attila the
Hun held banquets at which "a Moorish and Scythian buffoon successively excited the mirth of the rude spectators by their deformed figures,
ridiculous dress, antic gestures, and absurd speech." Cages along the Appian Way displayed various grotesque human disabilities, including "Balbus Blaesus" the stutterer, who would attempt to talk when a coin was
flung through the bars. In Shakespeare's Timon of Athens, Caphis says,

"Here comes the fool; let's ha' some sport with 'im." Often this sport
consisted of physical abuse or exposure of the twisted limb. These unfortunate individuals accepted and even expected ridicule. At least itprovided a means of survival, a livelihood, and it represented an advance in
civilized living.
Gradually, the use of people with disabilities to provoke mirth became
less popular in continental Europe, and the more enterprising had to migrate to less culturally advanced areas to make a living. At one time Peter

the Great had so many that he found it necessary to classify them for
different occasions. When Cortez conquered Mexico he discovered deformed creatures of all kinds at the court of Montezuma. On the same

HISTORY OF THE DISABLED

continents today you may find them used to provoke laughter only in the

circus sideshows, in the movies, on the radio and television and in every
schoolyard.

Pity
Religion is doubtless responsible for the development of true pity as a cul-

tural reaction to handicaps. James Joyce said that pity is the feeling that
arrests the mind in the presence of whatsoever is grave and constant in
human suffering and unites it with the human sufferer. It was this spontaneous feeling that prompted religious leaders to give the handicapped
shelter and protection. Before 200 B.C. Asoka, a Buddhist, created a ministry for the care of unfortunates and appointed officers to supervise charitable works. Confucius said, "With whom should I associate but with
suffering men?" Jesus preached compassion for all the disabled and made
all men their brothers' keepers. In the seventh century after Jesus's death
the Moslem religion proposed a society free from cruelty and social oppression and insisted on kindliness and consideration for all men. A few
hundred years later Saint Francis of Assisi devoted his life to the care of
the sick and the disabled. Following this, the "Mad Priest of Kent," John
Ball, was so aroused by the plight of the crippled and needy left in the
wake of the Black Death that he publicly pleaded their cause, often at the
risk of his own life. With the rise of the middle class, pity for the handicapped became more commonplace. The oppression that the merchants
and serfs had suffered left them more sympathetic to others who were ill
used. The doctrine of the equality of man did much for the disabled as
well as for the economically downtrodden.
However, many crimes have been committed in the name of charity.
The halt and the blind began to acquire commercial value as beggars. Legs
and backs of children were broken and twisted by their exploiters. Soon
the commercialization of pity became so universal that it became a community nuisance. Alms became a conventional gesture to buy relief from
the piteous whining that dominated every public place. True pity was lost
in revulsion. Recognizing this unhappy trend, Hyperious of Ypres advocated that beggars be classified so that work could be provided according
to their capacities. His own motives were humanitarian, but he cleverly
won support for his cause by pointing out that other citizens "would be
freed of clamor, of fear of outrage, or the sight of ugly bodies." His appeal
was successful; and asylums and homes for the handicapped began to appear, if only to isolate the occupants so that the public need not be reminded of their distress. Another motive that improved the position of the
handicapped was the belief that one could purchase his way into heaven or
out of hell by charity. The thrown coin has been impelled by many motives:
the longing for religious security, the heightening of one's own superiority

by comparison with the unfortunate, the social prestige of philanthropy,

CHAPTER I

INTRODUCTION

and the desire to be freed from embarrassment. Pseudopity has accom-

plished much, but true compassion would have ended the tragedy.

HOW THE DISABLED PERSON REACTS

Thus far we have been describing how society has reacted to people with
handicaps. Now let us consider how disabled persons have reacted to the
penalties and frustration that too often are their lot. The basic emotional
responses are those of anxiety, shame, and hostility. Having to live with the
expectation that you will be rejected because of your disability adds to
your burden. Mockery and playground teasing have warped many a child's
life by coloring it with shame. Of course they resent the mistreatment. So
would you. People with communication disorders suffer the same hurts
experienced by people with other disabilities, and in Chapter 5 we will describe their emotional reactions more fully and how we cope with them.

CURRENT ATTITUDES TOWARD DISABILITY

In the senior author's lifetime, he has seen a dramatic improvement in the
way people with disabilities are treated. It is ironic that this change was
due in part to World Wars I and II, and to the Great Depression of 1929
and the early thirties. These experiences, with their resulting injuries and
miseries, gave rise to universal feelings of concern and compassion for the
unfortunate members of our society. The old practices of rejection and neglect no longer seemed tolerable.
Accordingly, with the support of governmental agencies, we began to
assist the elderly, the impoverished, and the impaired through social security, Medicare, and Medicaid. Programs in special education and speech
correction sprang up all over the country in one school system after another. Charitable agencies flourished. The positive change was revolutionary, and the process is continuing. Employers receiving any type of
federal support have been forbidden since 1973 to refuse services or jobs
to qualified persons because of handicaps. In 1975, Public Law 94142,
the Education of the Handicapped Act (later retitled as the Individuals
with Disabilities Education Act), mandated free and appropriate educations for disabled students from ages 5 to 21. Later amendments added
appropriate services for infants, toddlers, and preschoolers as well. Public
Law 101336, the landmark Americans with Disabilities Act, enacted in
1990, provides civil rights protection to all individuals with disabilities in
the areas of employment, state and local government services, telecommunications, and public accommodations.

CURRENT ATTITUDES TOWARD DISABILITY

Facilities and services now must be provided so that individuals who

have physical, visual, hearing, speech, and other disabilities can have access. Just to cite a few examples, hotels must provide rooms that would
enable a disabled person to use the bathroom facilities as well as having

doors through which a wheelchair can pass. Auditory signals must be

added to visual signs so that the blind can know when an elevator door is
open for entry. Restaurants must provide picture menus (implemented by
McDonald's, for example, as shown in Figure 1-2). Assistive devices such
as amplifiers must be available, and the list goes on.
"The ADA is not just about opening doors, opening jobs, and opening telephone lines for the approximately 43 million Americans with disabilities, including those with hearing, speech, or language disabilities. It
is also about opening minds." (Carey, 1992) That message is clear. We no
longer will make it difficult for the disabled to have a good life; instead,
we are committed to seeing that they live well. Yes, finally we gradually
are becoming a bit more civilized.

COMMUNICATING WITH THE

COMMUNICATIVELY IMPAIRED
Being more civilized means, first and foremost, that we respond to the
person rather thanas some have tended to doconcentrating on the person's disability. We must not allow the disability to become the focal point
of social interaction, for this inevitably limits the style and scope of interaction and, of course, thereby magnifies the effect of any disability. Nevertheless, it is easy to feel at least a vague sense of doubt or discomfort
when interacting with an individual who has a disability. How should we
act? What should we say?
Here are some guidelines that we have found helpful in talking with
a person who has trouble communicating. Some are equally applicable to
individuals with other impairments or disabilities.

1. The most important thing is to acknowledge your uncertainty and

fear, and then try to relax. Focus on the person rather than on your
own nervousness. Remember, despite the speech, language, or hearing disorder, the individual is a person just like you; and he or she
has many attributes besides the communication disorder.
2. Maintain eye contact with the person. This is a basic nonverbal way in
which we bond with othersit shows that we are "open for business."
3. Give the person enough time and opportunity to talk. It may take
longer for the individual to transmit a message. Speech is not an option for all persons who have communication disorders. There are

10

INTRODUCTION

CHAPTER I

.. .

::. :.:...:

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MD

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BA

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HASHL

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A?PtE BRAN MUI'RN

BREAXI

AN1SII

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1101 CI3OCO1ATh

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FIGURE 1-2

McDonald's Convenience Breakfast Menu for the Disabled (Courtesy of

McDonald's Corporation)

A BRIEF LOOK AT THE PROFESSIONS

other systems (signs, symbol boards, electronic devices) to assist in

communication.
4. You may have to listen more carefully than you usually do. Be aware
that this requires more effortlistening closely is hard work.
5. Focus on what the person is saying rather than how he or she is saying it. The message is what is important, not its form. In fact, it is
sometimes helpful to rephrase what was said so that the speaker
knows the intended message has been transmitted.
6. If you don't understand what the person is trying to say, tell him or
her. Don't pretend that you understand when you don't. Ask the
person to repeat if necessary.
7. Never fill in a word or assist an individual unless he or she asks for
help. Offering assistance before it is requestedsimply assuming
that help is neededcan be demeaning and frustrating.
8. Speak directly to the person, not to a companion, even if the individual is using an interpreter. Never, under any circumstances, talk
about the person in his or her presence.
9. In some instances, it may be helpful if you talk more slowly and
more simply. But don't talk down to the person or adopt a patronizing manner. It may also help to use gestures along with your verbal message.
10. Finally, let your language affirm the entire person, not just the communication disorder. Put the person first, not the disability. The way
we refer to individuals with disabilities may shape our images of
themthey become lispers, aphasics, or clutterers.

A BRIEF LOOK AT THE PROFESSIONS

As we have mentioned, basic changes in our earlier attitudes toward people with disabilities resulted in two new professions being born, speech
pathology and audiology. No longer do people who cannot hear or speak
normally need to live in desperation and without hope. You may or may
not choose to enter either of these still young professions, but you should
know the kinds of services they provide. You or your family or friends may
need them one day.
Some of our former students now practicing their professions have
shared with us the following brief descriptions of what they had done in
a typical day. Our first account comes from a young speech clinician who
works in the public schools.
Today was an especially good one and I felt refreshed reviewing what
happened as I drove home. First, inthe morning, I had a conference
with Sara's mother. Sara has a language problemshe confuses pronouns and mixes up tense and plurals, and her sentence structure is im-

II

CHAPTER

INTRODUCTION

mature. Her mother was very open and amenable to some suggestions

for work at home. Some parents are not, despite all my attempts to include them in preparing an Individualized Educational Plan. Then I
worked with two groups of children who are in the carryover stage of
therapy for their sound errors. At noon I drove to my other school. I
saw Mark alone at 1:00. He is eleven years old and stutters quite severely. He has long silent blocks. I have been trying to show him how
to stutter in an easier fashion, to let the words slide out instead of fighting himself. He seems to be catching on now. But my big success today
was with Tern: She finally was able to make a good r sound. She has
been in my caseload now for two years; she could tell the error from the
correct production in my speech, but, until today, all her efforts to say
the sound were faulty. We were experimenting with some scary false
teeth (next week is Halloween) and they must have pushed her tongue
up and back a bit. All I know is she said it clearly. She blinked and I
didn't move. Casually, I asked her to say the r sound again in a whisper.
Then she said it out loud. When she left the therapy room she was saying simple words like run, ran, and rain very slowly and her face was
radiant. So was mine.

Among the many evidences that speech pathology and audiology are
Laryngectomee.
Person whose larynx
has been surgically
removed, typically
because of laryngeal
cancer.
Laryngeal.
Pertaining to the larynx.
Larynx.
Cartilaginous structure
in neck between
trachea and pharynx;
includes vocal folds and
muscles that control
their tension and
positioning; the voice
uOX.

Esophageal speech.
Speech of
laryngectomized
persons produced by
air pulses ejected from
the esophagus.

rapidly growing professions is the continuing growth of community

speech and hearing centers. These often are partially funded by charitable
agencies such as the United Way and are usually supported in part by fees.
Here is the report of a worker in such a center.
My duties are varied and depend upon the particular caseload we have
at any one time. At present I usually have one or two diagnostic sessions
each morning or application interviews with parents. Then I may see

a stutterer or an aphasic for therapy. In the afternoon, most of my

work is with small groups. One of these consists of preschool deaf children, but the one I enjoy most is the group of three laryngectomees.2

One of them, Mr. J., was diagnosed with laryngeal cancer about a
year ago and has had quite a lot of radiation, both before and after the

surgeon removed his larynx. Anyway, he has the best esophageal

speech of any of them. Very intelligible! Yesterday he managed to say a
thirteen-syllable sentence with good intensity. He's working mainly on

trying to get more loudness and more inflections. The second man is
.
Mr. F., who is Just beginning to string a series of words into phrases
.
without having to stop and gulp before every syllable. Our third member is a fifty-year-old woman who is having a very hard time. She wrote
me a note saying that she hates the sound of the burp, that it sounds
vulgar, ugly. Mrs. W. is very depressed most of the time, and until we

put her with the two men I was pretty sure she'd quit. But they've really
.
helped her, Mr. J. especially, for he's so upbeat and a fine example. And
he s a pretty good teacher of esophageal speech, too. Even better than
I am, though I'm much better than when you coached me a few years

ago. When I demonstrate, they kid me about my larynx getting in

the way.

A BRIEF LOOK AT THE PROFESSIONS

13

Here's the report from a speech pathologist in another kind of job

setting.

This is my third year working at the Child Guidance Clinic. I never

dreamed that my days could be so filled with varied and interesting activities. Our clientele consists mainly of children with severe emotional
problems and I work closely with our psychiatrists, social workers, and
psychologists. Today we did a lengthy evaluation of a child referred to
the clinic as autistic. Joel is three years old, has no speech, does not attend to messages directed to him, and rejects any attempt to touch or
hold him. His play consisted of repetitive rituals. He flicked his fingers
in front of his face and spun around while staring at the ceiling light. At
the staffing conference, the parents told us that Joel insists upon keeping everything the same at home; he becomes enraged if the family takes
a different route into town or if the household furniture is rearranged.
They are worried also that the child doesn't seem to feel pain or recognize danger; he will bang his head repeatedly or run fill tilt into a table,
bounce off, and not cry at all. We are going to work out a multidisciplinary program for Joel in conjunction with the special education program
in the school system and our agency.
In the afternoon I had a session with a nine-year-old child with a severe
voice problem. Gary is extremely hoarse due to vocal abuse. He has been
examined by a physician who observed reddening and thickening of both
vocal folds. The doctor recommended therapy because she felt that the
youngster must learn more about vocal hygiene and how to use his voice
in a more conservative and relaxed manner. Gary talks loudly and constantly; and when he is not talking, he is making motorcycle or animal
noises. We did some role playing to show him how to use a soft, medium,

and loud voice. Then we prepared a shouting graph so we can tally the
number of episodes of vocal abuse Gary has each day.

The last thing I did was work on my presentation for the local Rotary
Club. Several of us are going to the meeting tonight in conjunction with
our annual fund raising drive.

Hoarseness.
voice quanty orten
defined as a
combination of
breathiness and
harshness.

Many speech-language pathologists also work in hospital clinics. This A hia

p
is how one described her work (Figure 1-3).
You asked for a description of my professional activities on a typical day,
but there seem to be no typical days. They all are very different: Each new
one brings new problems, which is why I like working in the medical setting of a hospital speech and hearing clinic. That, and the chance to work
closely with physicians, nurses, physical therapists, occupational therapists, and even with our medical social worker. There are so many different kinds of patients and so many disorders that I have never seen before.

But the bulk of my cases are stroke patients or patients whose aphasia

resulted from traumatic brain injuries that required neurosurgery.

Besides doing therapy with them, I also have to do repeated assessment
of their speech and language to provide the attending physician with the

Impairment in the use

of meaningful symbols
due to brain injury.

1iaumatic brain
iflJUi7 (TBI).

Damage to brain or
nervous system caused
by externally induced
head injury; also called
closed head Injuly.

CHAPTER I

FIGURE 1-3

INTRODUCTION

LJ
LJL

Client in Voice Therapy (Van Riper Clinic, Western Michigan University)

information he or she needs about their progress or lack of it. I've found
that the usual formal tests for aphasia must be supplemented by a lot of
informal observation and interaction with these patients because they tire

so fast or get so emotional when they fail a test item. In the testing
situation they rarely show how much speech and language ability they
really possess.

Hemiptegia.
ParalySis Or neurological
involvement alone side
of' the body.

dargon.
ContinUous bUt
unintelligible speech.

This afternoon one of the nurses complimented me on my "bedside

manner" after hearing a young male patient laugh for the first time in
many weeks. The man had been in a deep depression and with plenty of
reasons for it. He'd been in an automobile wreck that killed his wife and
child and left him a hemiplegic. When he did try to talk, all that came
out was compulsive jargon. Not all aphasics know when they talk
gibberish but he did and it devastated him. Almost every time he tries
to talk, he starts crying and does not seem to be able to stop. But today
I got him to count aloud up to twenty with only one mistake. Trying
to establish some imitation, I got him to mimic gestures like nodding

A BRIEF LOOK AT THE PROFE5SIONS

yes

I5

and head shaking for no and then trying to read my lips and mimic

them silently.

After some of this I then began to count aloud and so did he. It shocked
him to hear himself saying those numbers, and that's when the nurse
heard him laugh. Of course, when he started laughing, he couldn't stop
and then he was laughing and crying at the same time. Took me a long
time to calm him down and he didn't want me to leave, so I had to make
sure he understood that I'd be back tomorrow at the same time. Pretty
hard to do because my words didn't seem to sink in; so I acted out my
leaving the room and then returning, pointing to the clock and then a
calendar and saying something like this over and over again with plenty
of pauses: "Miss Peterson (pointing to myself) go now.. . Miss Peterson come back (turning one page of my calendar). Miss Peterson (pointing) see John (pointing) tomorrow.. . this time (I showed him the time
on the clock). John eat. . . (pointed to five o'clock feeding time). Then
John sleep (I acted out sleeping as I pointed to ten o'clock)" and so on.
Somehow, something got through and I feel he understood I'd be back,
for he waved the fingers of his nonparalyzed hand to indicate goodbye
and smiled when I left. For the first time John and I have a tiny ray of
hope, but I've still got my fingers crossed.

Still another facet of the field is the opportunity for private practice.
Those who undertake to set up a private clinical practice have to be very
competent, experienced, and able to establish close relationships with
medical and other related professionals. And they must be prepared to undergo an initial period of financial uncertainty. Even so, their numbers
have increased continuously and we submit this portion of a letter from
one of them.
At the present time I do most of my private practice in conjunction with
a local organization called Visiting Nurses. Through this agency I have
many contacts with the medical profession, and from them I get most of
my referrals. I do some therapy in the agency office, some in my home,
and, in a few instances, in homes of clients. Let me tell you about three
clients.
Two are stroke victims. Miss H. is only forty-seven, a librarian, and has
mild expressive aphasia. Reading and using numbers, though, are very
difficult for her. Even making change in a store is almost impossible. She
is withdrawn and depressed. Most of my work with her has been on practical skills: writing checks, adding and subtracting, reading advertisements to find bargains. She is improving, but progress is slow. The other
is sixty-eight. Mr. B. is paralyzed on the right side and has global aphasia. Even though he can only utter a word or two, he is always in good
humor. I am working on a communication board so that he can express
his needs by pointing to the appropriate picture. My third client is a new
laryngectomy patient. I am working with Mr. L. three days a week, trying to help him learn to inject air into the top of his esophagus and then
quickly push it back out. He gets frustrated pretty easily, and his language

Laryngectomy.
The surgical removal of
the larynx.
SOP agus.

The tube leading from

the throat to the
stomach.

CHAPTER I

INTRODUCTION

is sure salty at times, but he really tries hard. I've found that when peo-

ple have to pay me directly for my services they work harder and, heaven
knows, so do I.

My latest project involves a plan to provide services to geriatric patients.

I am negotiating with the administrators of two nursing homes. In one
of the homes I found a man with Parkinson's disease, another with se-

vere dysarthria following surgery for oral cancer, and three aphasics.
Many of the residents are severely hard-of-hearing, and I will see that
they are tested and treated. I think more university graduate programs
should emphasize the potential benefits of speech therapy with elderly
persons. In my judgment, communication is one of the keys to a healthy
and happy old age, and professionals in our field certainly know more
about communication than most other professionals working with the
elderly.

Several former students, after gaining experience in other settings,

now serve as practicum supervisors in university speech and hearing programs. Here is how one of these graduates described her work.
I have the best job in the whole world! Sometimes I feel guilty on payday because I am having so much fun doing what I do. Today, for in-

stance, I met a group of students for breakfast. We are planning an

DYSrthfla
Group of motor speech
impairments that stem
from neuromotor
damage; may disturb
respiration, phonation,
articulation, resonance,
and prosody.

Articulation.
The utterance of the
individual speech
sounds

Hypernasality
(Rhinolalia aperta).
Excessively nasal voice
quality,
.

P1osive.

A speech sound
characterized by the
sudden release of a
puff of air. Examples
are /p/, It!, and

//.

intensive treatment program for an adult stutterer. It is a real joy to see

their teamwork and sense the group support when a number of clinicians
combine forces. It takes a lot of planning, though, to come off well.
Then I gave a lecture to a class on therapy methods. We had a lively dis..
.
.
cussion about behavior modification versus a more authentic communication approach. Next I supervised a student working with a preschool

language delayed child, wrote some reports, and previewed a film to

show during practicum meeting.
I miss having a caseload of my own, so I do as much demonstration therapy as I can. This afternoon I had a session with a student from Cambodia to improve his articulation of English speech sounds. I also work
twice a week with an adolescent boy who has a repaired cleft palate. I accepted him as a challenge: He has had several operations on his mouth,

countless evaluations, and many years of speech therapy. He is still

hypernasal, and his motivation is very low. Instead of voice therapy for
the nasality, I am concentrating on his articulation of plosive sounds. His
progress is slow, and he is always testing me in therapy, but I think we
are getting somewhere.
The best part of my role at the university, though, is the relationships I
have with students. Their enthusiasm, fresh perspectives, and energy are
contagious.

Here is an account of a day well spent by a speech pathologist who

works with patients who have little or no speech.

I am employed by a large city hospital and my duties are mainly with

patients who have great difficulty in communicating at all. Among them

A BRIEF LOOK AT THE PROFESSIONS

17

are stroke

patients with aphasia or apraxia, parkinsonism, dysarthria due

to cerebral palsy and other neurological disorders.

Although much of my caseload is made up of patients in the hospital, I

also make some homecalls and work closely with physical and occupational therapists and other health professionals as we try to provide some
way so these persons can communicate. Some have no speech at all; most
are unintelligible. Basically, what I do is to teach these patients a way to
communicate without talking.
You asked for a sample day's work. Well, first this morning I saw a patient whose recent head injury has left him hemiplegic and unable to produce anything but jargon although he seems to understand some of what
we say if we speak very slowly and simply. To give him some way to cope

I brought in a simple communication board and taught him to point to

the Yes and No displays with his good left hand, always saying the words

when he did so. This was more difficult than it sounds because he had
been nodding his head sideways for yes and vertically for no, and the
nurses were confused. After some training he was able to respond appropriately when I asked him if he wanted a heavy blanket (which I was
sure he didn't, because it was hot in there). I then brought out a more
complicated picture board but he was too tired to try it. Not much, but
at least a beginning.
My next patient was a severely disabled man with cerebral palsy who is
strapped in a wheelchair because of the uncontrollable movements of his
arms and legs. He has some language but the involuntary movements of
his head and tongue make him almost impossible to understand. I am a
member of a team consisting of a physical therapist and an occupational
therapist, and our mission was to try to determine whether braces could
be constructed that would stabilize one of his extremities so he could
point or activate a switching mechanism that would allow him to select
an item on a communication board. We'll continue to work on that.

The rest of the morning I spent with a laryngectomy patient trying to

improve his use of the electrolarynx. Because he has been unable to learn
esophageal speech and is very depressed, I concentrated mainly on teaching him how to articulate more carefully and to simplify his utterances.
Well, that was my morning. This afternoon I must familiarize myself with

a computerized communication aid the hospital has just purchased. I m

also scheduled for some additional dysphagia training so we'll be able to
provide better help for patients who are having swallowing difficulties. I
guess this is going to be one of my rough days, but most of them are
very good and there's always a new challenge.

These brief pictures of the field of speech pathology just sketch the
surface of the topography. You have seen just a few of the many opportunities that exist within its boundaries and only a few of the many kinds of
communication disorders that need help. Some members of the profession continue their education in doctoral programs where they are able to
become even more highly specialized clinicians or perhaps to prepare for

Apraxia.
Loss of ability to make
voluntary movements
such as producing
speech sounds, while
involuntary movements
remain intact; caused
by neurologic damage.

Cerebral palsy.
A group of disorders
due to brain injury in
which the motor
coordinations are
especially affected.
Most common forms
are athetosis, spasticity,
and ataxia.
Dysphagia.
Disorder of swallowing
due to neck or mouth

injury or to a
neurological condition.

CHAPTER I

INTRODUCTION

faculty positions. Others seek the doctorate as preparation for

research careers in university or other laboratory settings where communication disorders or basic communication sciences are studied. Moreover,
for some workers, the profession provides an initial stepping stone to other
fields of service.
Public school clinicians, because they come into close contact with
many teachers and principals, and because they work with so many children with other handicaps, may end up administering programs in special
education. Because such persons often are qualified also as classroom
teachers, they may shift into that occupation. Since much of their work in
clinical settings involves testing and diagnosis as well as individual and
family counseling, some speech pathologists also go into clinical psychology. Still others have become health care managers.
Many individuals, including some whose initial interests were directed
toward speech pathology, pursue careers in the profession of audiology.
The decision to focus on audiology typically occurs during undergraduate
studies, although most of the specialized courses and practicum experiences usually have been available only at the graduate level. Much of the
undergraduate coursework in basic communication processesfor example, anatomy and physiology, acoustics, and speech scienceis applicable
to both professions, of course. And all speech-language pathologists must
take some courses concerned with problems of deafness and hearing impairment, just as all audiologists must have some preparation related to
speech and language disorders.
Like speech pathologists, audiologists work in a variety of settings.
Some are employed in school system positions, others in hospitals and
free-standing clinics, community speech and hearing centers, or university
clinics. Audiologists often are associated with otology practices, working
closely with physicians who specialize in the diagnosis and treatment of ear
and hearing problems. Some audiologists are involved directly with the
fitting and dispensing of hearing aids, increasingly as the owners of pri'ate corporations. The audiologist also is found in industry trying to prevent noise-induced hearing loss, conducting noise surveys to assess noise
pollution, and documenting the status of employees' hearing. One of our
former students, an audiologist in a hospital speech and hearing department, gives this picture of his professional day.
I spent the eight o'clock hour on correspondence and reports of
academic

Otologist.
Physician who
specializes in hearing
disorders and diseases;
typically an
otorhinolaiyngologist

(ENT).
Stapedectomy.

Surgical removal of the

stapes and implantation

of a prosthesis; used in
treatment of
otosclerosis.

yesterday's testing. Then at nine o'clock I examined a patient with oto-

sclerosis referred by the otologist who is considering performing a

stapedectomy. For various reasons this took longer than I expected and
I was late for my next appointment with a patient I had previously tested
and who was ready for hearing aid selection and orientation. She found
it very hard to decide on the aid that seemed to help her the most. She
said they all sounded "too noisy." She's had a hearing loss for so long,
she's forgotten what the world of sound is like. And I guess she expected,

A BRIEF LOOK AT THE PROFESSIONS

like most of my clients, that the hearing aid would not be just an aid but

would restore her hearing completely. Took a lot of delicate counseling.

Then in the early afternoon I conducted an aural rehabilitation session.
Next I tested a man who had been in an industrial accident and claimed
it had deafened him totally. It hadn't; he was malingering. Then I examined the eardrum of a teenager with a complaint of fullness in her ear
and ended my day by calibrating one of our audiometers. Every day is
different, but that's the way this one went.

Another audiologist told us of her day in the schools.

I am one of five specialists for the hearing impaired who serve Kalama-

zoo County. As such I travel from school to school helping deaf and
hearing-impaired students. My caseload consists of twenty-four youngsters. The first thing I did this morning was to check the auditory amplification equipment at Amberly school to be sure it was working
properly. Then I saw one of my students who has been doing poorly in
her school work, finding that she has not been wearing her hearing aid
because it makes her feel conspicuous. She has long hair but combs it
straight back, so I showed her a new hairdo that would cover the aid and
make her more attractive, too. I also arranged for preferential seating in

her classroom and discovered that her teacher did not know she had a
hearing loss.

Next, I spent an hourwith a fourth-grade boy to improve his lip-reading

skills. From there I traveled to Vicksburg and conferred with the parents
of a boy who had been evaluated recently at the Constance Brown Hearing and Speech Center. Jim has otitis media and needs medical attention,
but his parents said they could not afford t. I explained the seriousness
of the problem to them and arranged for them to talk with a caseworker
at Social Services about obtaining help. I'm sure they'll follow through,
but I will make a point of checking back next week.
I then met with a school psychologist about a high-school girl with a
moderate bilateral loss who has been refusing to recite in class and even
refused to talk to him. I made an appointment to see her on my rounds
next week. She may just need to talk to someone who understands the
stress she is under.
At Edison school after lunch I helped a deaf girl prepare for a speech she
has to give tomorrow in her social studies class on "Sign Language." She
had been very worried about it, but after some suggestions and two rehearsals she felt much better.

Then I did audiological screening tests on three kindergarten children

referred to me by their teachers. I found that one of them will need to

be seen for more thorough testing. Finally, I returned to my office,

wrote reports, made a few phone calls and updated my files. Every day
has its own challenges, and I always find the work varied and interesting.
A good job.

In recent years, we must note, the scope of professional activities in

which some audiologists are engaged has been undergoing a rapid and

19

CHAPTER I

INTRODUCTION

Aural.
Frtaining to hearing.
Cochlear implant.
Surgcafly implanted
device that directly
stimulates the auditory

nerve when an
externally worn
component receives
8ound input; used only
with severely hearing
impaired indiMuals who
are unable to benefit
from a hearing aid,

FIGURE 1-4

Traditional Pure

Tone Hearing Testing

(Van Riper Clinic.
Western Michigan
University)

dynamic expansion that is not adequately reflected in our two reports.

Beyond the administration and interpretation of traditional hearing tests
of various types (Figure 1-4), and in addition to aural rehabilitation and
environmental and occupational hearing conservation, audiologists also

may be involved with electrophysiological assessment of balance as well as

auditory systems. They also are called upon to evaluate assistive listening
equipment and, in some settings, to be knowledgeable about such devices
as cochlear implants. These changes have led to reexaminationof the academic and clinical preparation appropriate for entering the profession and
in the foreseeable future may dictate changes in the minimum qualifications expected of beginning practitioners.
Many of you who read this book are not planning to become profes-

sional speech pathologists or audiologists, but all of you are certain

to encounter adults and children who cannot speak normally or who are

hearing impaired, for there are at least 42 million such persons (not
all persons with these impairments are regarded, in legal terms, as having
disabilities) in our country alone (National Deafness and Other Commu-

21

A BRIEF LOOK AT THE PROFESSIONS

nication Disorders Advisory Board, 1991). And with the growing popu-

lation of older citizens, the number with communication disorders also

will grow. Will you turn away from their need for help and understanding? Will you add one more rejection to the many they have already endured? Or will you do what you can? Here is an excerpt from a letter
written us by a former student who eventually became an elementary classroom teacher.
Although I only had the introductory course in speech pathology I've
often been able to help a few children with speech problems right in my
classroom. I've been teaching third grade now for three years and love
it. Wouldn't do anything else. I've steered clear of the severe speech disorders because we have a speech therapist who visits our school twice
each week and who knows a lot more than I do, but I've been able to
help the gains she gets become more permanent by following her suggestions with my children who lisp or cannot pronounce their r or I
sounds. We also consult quite often about improving the communication
skills of students in general.
Well, anyway, at lunch hour I asked her why she didn't take Joe for therapy. Joe's a very bad stutterer when he recites, which is seldom. Her answer was that Joe's mother had refused permission to let him have any
speech help this year, so her hands were tied. She said that Joe's mother
was a mild stutterer herself and perhaps that was why, though it didn't
make sense. I told the therapist that Joe never volunteered in class and
usually answered my questions in as few words as possible or said he did-

n't know when I was pretty sure he did. And when I told her too that
Joe rarely went out with the other children to play at recess time, the
therapist asked me to find out why. So today, when he stayed in again, I
asked Joe about it when we were by ourselves. Tears came in his eyes and

he said it was because he "talked funny" and the other kids teased
And he even asked me if I would teach him to talk better. Of cours$ I
said yes and we made a date to begin after school tomorrow. I put i4i T0NQN
frantic call to the speech therapist and she will coach me and help outndirectly. She said that there was lots that I could do and I'm sure tl4.r.
is

At least I can make it easier for him Poor little kid! I was riiy

TH
2

touched when, just before he left to get on the bus, he came up to my

444

desk and shyly touched my hand. That's alljust a touch, and then he
ran out.

As you can see from these few brief glimpses, speech pathologists and
audiologists work in a variety of settings and serve a wide range of clients.
But what they share in common are enthusiasm for their professions and
a very personal dedication to the welfare of individuals with speech, language, and heating disorders. They are concerned about the unfortunate;
they devote their lives to the relief of human distress. But there is something moreand it is difficult to put into words. When we deal with corn-

Lisp.
An articulatory disorder
characterized by
defective sibilant
sounds such as the /s/

munication disorders, we deal with the essence of humankind. Only

and hi.

human beings have mastered speech. It sets us apart from all other species.

22

CHAPTER I

INTRODUCTION

Because we

can speak, we can think symbolically; and it is this that has en-

abled us to survive and usually thrive, to begin to understand our earth,

and even to begin to explore outer space. Dimly we believe, or at least
hope, that someday it may enable us to master ourselves.

STUDY QUESTIONS

What is the origin of the word "handicapped"? VVhat term(s) other

than "handicap" are often preferred, and why?
2. What historic examples do the authors provide to illustrate the cruelty and rejection encountered over the years by persons with deformities and disabilities?
3. What current examples can you cite, from the movies or from television, where an abnormality or disability has been portrayed in a way
intended somehow to be humorous?
4. Certain events in the early to mid-1900s helped to promote more
compassionate attitudes toward people with disabilities. What were
these events, and for what reasons might they have led many people
to be a bit more sensitive and caring?
5. The past four decades have seen the enactment of laws and regulations designed to help ensure that the rights of people with disabilities are recognized and protected. Describe the major types of
legislation which have focused on this issue.
6. What advice can you give to a friend who is worried about how he
or she should behave while communicating with a classmate who
stutters? How should you alter your own speech when talking, for
example, with a person who has become aphasic following a stroke?
7. With what other professionals do speech pathologists and audiologists work to ensure that their clients' needs are served?
8. In what types of settings are we likely to find audiologists or
speech-language pathologists employed?
9. For what reasons do some audiologists urge that the minimum
qualifications for their profession be made more rigorous?
10. What basic similarities and common interests are shared by audiologists and speech-language pathologists?
1.

EN D NOTES

'The terms speech pathologist and speech clinician are used interchangeably in
this text rather than speech therapist, because the latter term tends to imply an auxiliary service to the medical profession. Another current but somewhat cumber-

SUGGESTED READINGS

23

some title for workers in this profession is speech-language pathologist or speechlanguage clinician.
2Words in boldface print are among the terms you will find defined in the
Glossary.

REFERENCES

Carey, A. (1992). Americans with Disabilities Act

and you. As/ia, 34, 78.

National Deafness and Other Communication Disorders Advisory Board. (1991). Research in

human communication (NIH Publication

No. 92-3317). Bethesda, MD: National Institute on Deafness and Other Communication
Disorders.

SUGGESTED READINGS
These sources can provide additionally informative insights for the
curious student.

American Speech-Language-Hearing Association. (1992). Report on professional education in audiology. Asha, 34, 5863.
Emerick, L. (1984). Speaking for ourselves: Self-portraits of the speech or hearing

handicapped. Danville, IL: Interstate Publishers.

HeIm-Estabrooks, N., et al. (1994). Speech-language pathology: Moving toward the 21st century. American Journal of Speech-Language Pathology, 3
(3), 2347.
Keller, H. (1954). The story of my life. New York: Doubleday.

Roush, J. (1991). Early intervention: Expanding the audiologist's role. Asha, 33,
4749.

Sarachan-Deily, A. (1992). Beyond the one-room schoolhouse. Asha, 34, 3437.

Shapiro, J. (1993). No pity. New York: Times Books.

Ii
a

Basic

Components
of Speech
and Language

26

CHAPTER 2 BASIC COMPONENTS OF SPEECH AND LANGUAGE

In the beginning there was communicationThe ongoing exchange

of messages, in one form or another, connects all living creatures in a
never-ending circle. Brontosauri did it, birds do it, even honey bees do it;
but it is only in humans that we find language being used as a most remarkably facile means of sharing information. And, although other modal-

ities also are utilized, spjs tie most common and impprtantwayin
which we use language to communicate
Those of us who seek to understand and help individuals who have
communication disorders should first understand as thoroughly as possible the nature of communication, language, and speech and how they are
related. In this chapter we will take a few steps along the path toward these

und standings.
The act of communication is . process, not an entity. In its simplest
form it consists of the transfer of a message from a sender to a receiver. The
message may be verbal, nonverbal, chemical, electromagnetic, and so on)
tIn the case of humans, the basic unit of communication typically involves

a speaker and one or more listeners. e listen, too, when we speak, of

course, and sometimes we talk alou o ourselves when we are uncertain
or trying to accomplish a very difficult task) such as assembling a complex
toy on Christmas Eve. t['he flow of messages is reflexive; when a listener
has processed the information, he generally lets the speaker know what im-

Feedback.
The backflow of
information concerning
the output of a motor
system. Auditory
feedback refers to selfhearing; kinesthetic
feedback to the selfperception of one's
movements.

pact it has had (feedback).)

Before we begin to describe the ways in which speech pathologists
treat the various communication disorders, it is necessary to provide you
with some essential information about the speech mechanism, the types of
speech sounds, the basic structure of our language, and how we shape
sound waves into speech. When you are acquainted with how oral communication is organized and regulated, you will be in a much better position to understand a malfunction of the system and what needs to be
done to correct it. An understanding of abnormality most logically stems
from an appreciation of the normal. Although the act of talking is extremely complex, probably the most intricate of all human behaviors, in
this introductory text we present only its most salient features. Our discussion begins with an overview of the interrelationships among communication, language, and speech.
LWhile all living creatures communicate, only humans exchange inforrnation' using a code that we call language. Only the human species has
devised an elaborate system of shared symbols and procedures for combining
them into meaningful units. The key words in the definition are that there
is a system, which implies an order or regularity in the supply of symbols;

that these symbols are shared or hold common meanings for a group of
persons; and that there are procedures or rules concerning how to array or
join the symbols into messages.
During your first few years, you and a million other babies accomplished something that you could not possibly do now, not even if you

BASIC COMPONENTS OF SPEECH AND LANGUAGE

21

spent the rest of your life at the task. You learned to understand a strange
new language and to speak it like a native. Moreover, you learned that language easily. Without any formal instruction you perfected your pronunciation of its sounds, acquired a large number of meaningful words, and
mastered the hidden linguistic rules that appropriately link these words together in phrases and sentences of incredible variety.
Present linguistic theory holds that this incredibly difficult achievement is possible only due to an inborn trait of all human beingsthe ca-

pacity for language acquisition. Attempts to explain the phenomenal

rapidity of that acquisition solely in terms of learning theory have not been
very satisfactory, although learning, of course, must be involved. Other-

wise, some of us wouldn't be speaking English while others are talking

Swahili.(Linguists distinguish language competence from language performance, the former referring to the knowledge of the features and structure of language and the latter to its use in communication, They speak
of a "universal language competence" as being innate in all human beings
and a "particular language competence," which reflects how well a person
knows a particular language such as Spanish or Thai or English.
Performance is assessed by observing how a person actually uses language when encoding (speaking, writing, using signs) or decoding (listening, reading) in a typical day-to-day situation. When we ask a client to
distinguish sentences from. nonsentences or to recognize an ambiguous
statement, we are evaluating language competenc( Figure 2-1).
Although it is possible to teach a parrot or a cfiild who is mentally retarded to echo "Polly wants a cracker," the bird will not have any true language and the child may have very little. Without competence one cannot
generate new sentences Although the parrot may have said that one sen
tence a thousand times, it could never transform it into such an utterance
as "Polly wants a drink" no matter how thirsty it was Nor could the child
express a desire for water if his teachers had merely asked him to repeat
that same utterance about crackers over and over again He needs lan
guage, not just the facsimile of speech. Some of the most difficult clients

B.C.

flOlfl
PrOceSS of convertrn
an idea into an audUble
or VlSt*l signal

BYJOHNNYHART __ FIGURE 2-I

LJ Language is
powerfulbut also fragile
(Used by permission of
Johnny Hart and Creators
Syndicate, Inc.)

28

CHAPTER 2

BASIC COMPONENTS OF SPEECH AND LANGUAGE

with whom the speech clinician must work are those with echolalia. These
children parrot the speech of others, often with remarkable fidelity, but
they do not know what they are saying and they cannot communicate their
wants. They lack the particular language competence they need. They can
"speak," but they cannot speak our language, for they have not discovered the basic structure of that language.
The clinician also works with some clients (for example, persons with
severe cerebral palsy, or aphasia, or with traumatic brain injuries, or persons in the early stages of a degenerative neurological disease) who may
be unable to use language in a conventional manner. In such instances, a
system may be devised whereby the individual can express messages by
pointing to, or otherwise selecting, pictures or symbols or printed words
or letters. Alternatively, signing or some simplified system of manual gestures might be used. In some cases a computer or other electronic device
may be used to generate audible or visible signals. Theessential objective,
of course, is to establish (or re-establish) a communicative link between
the client and other persons.
We are not sure how a human infant acquires his or her competence in
a particular language. Certainly he or she must be exposed to it. Kaspar
Hauser, imprisoned when a child and isolated for sixteen years, acquired
no speech at all and remained almost mute despite intensive training by the
best teachers of his time. Kamala, the Wolf Girl of India, Victor, the Wild
Boy of Aveyron, and Lucas, the Baboon Boy of Africa, were physically normal but not one of these abandoned children raised by animals ever acquired meaningful speech. Evidently the propensity of human beings to
acquire language (universal competence) must be triggered by close contact with other humans
Moreover, the contact must be a significant, meaningful one. A child
exposed only to the constant chatter of a radio or a television screen would
not master our language although she might be able to repeat a few commercials. She must be spoken to by someone important to her and encouraged

to respond. There must be both models and involvement. There must be

identification both ways. When a speech pathologist finds a child with very

Echolaha.

deficient language ability, he knows that somehow he must provide for

that child another involved human being with whom the child can identify. Usually that person is the clinician himself.
Communication, language, speechand the greatest of these is communication, for if there is no communication, there is nothing but isolation and despair. The need to exchange messages, in some form, is critical
to being human.
"If Duane could only speak," the parents of a child with profound retardation told us recently, "he would be. . . more normal." It was diffi-

cult for them to understand, as it has been for many parents of

language-delayed children, that without symbols a youngster does not
have much to say. Most laypersons tend to confuse language and speech.

THE SPEECH MECHANISM

an analogy will help. When an orchestra is playing a tune, the

music (language) is being performed (speech) by the various instruments.
Without the music of Mozart, Rogers, or Dylan, a tuba, guitar, or French
horn would only produce meaningless noise; without language, speech
would only be jargon. Speech is a language-dependent behavior: A person
can talk only to the level of his language ability.
We define speech, then, as the audible manifestation of language. By
a complex, and still rather mysterious, process called encoding, a speaker
Perhaps

converts an idea in his mind into a stream of sounds; moving his lips,
tongue, and jaws in swift, precise gestures, he transmits information in orderly audible segments. When a listener decodes the signal back into an
idea in his mindthe same idea, it is hoped, that the speaker intended!
the act of oral communication is completed (see Figure 2-2).

The human miraclethe acquisition of speech and language

becomes even more astounding when we consider the complexity of the
task. Even the instrument that the infant must master if he is to speak a
language is so complicated in its structure and manipulation that it seems
impossible that a baby could ever learn to play it at all, let alone be required to become a virtuoso. If you were given a trumpet and told to play
the overture to Wagner's Tannhauser, you'd be in a similar situation. Let
us examine the human instrument.

cLHE SPEECH MECHANISM

In Figure 2-3 we see the instrument all of us must learn to play if we are
to speak. The structures detailed in our upper drawing include those that
you probably would first consider if asked to define the speech mechanism. The lower drawing places the upper one in perspective and reminds
us that the entire respiratory system also is part of this elegant instrument.
Actually, of course, we also would need to depict the auditory system and

FIGURE

2-2 The Speech Chain: The process of talking connects speaker and listener

(P. Denes and E. Pinson, The Speech Chain. New York: Doubleday, 1973)
Speaker's
encodes motor
Speaker

idea

activity

sound

'

Listener's

ear

Listener
decodes
idea

.-------.--------------- FEEDBACK

29

CHAPTER 2

BASIC COMPONENTS OF SPEECH AND LANGUAGE

Naval Cavity
Soft Palate
(Velum)

Lungs

FIGURE 2-3

The speech
mechanism and
respiratory tract

Diaphragm

-THE SPEECH MECHANISM

31

the central and peripheral nervous systems in order to represent more fully

the complete speech mechanism. And, indeed, we will return shortly to a

discussion of these latter systems.
Even in simplified terms, however, the speech mechanism is more
complicated (and more versatile) than any instrument to be found in a
symphony orchestra. It seems almostimpossibleb.at a child could master
it, but most babies do so with relatively little difficulty. This accomplishment seems even more amazing when we realize that these structures actually serve other fundamental life-sustaining functions.'
The primary function of the lungs is not for speaking but for oxygenating the blood; the larynx (pronounced "lair-inks") is basically a valve
to keep foreign material from entering the lungs; and the throat, tongue,
teeth, and lips are for th intake and chewing and swallowing of food. Accordingly, speech is said to be a secondary or overlaid function of these
structures. Even when we are "scared speechless" we continue to breathe.

Respiration
When we inhale we use our muscles to lift and slightly rotate our ribs,
thereby expanding our chest (thorax), in which the lungs are situated. Simultaneously, the diaphragm (which forms the muscular floor of the
chest cavity) is lowered, further expanding the thorax (and compressing
the contents of the abdomen). This thoracic expansion creates a negative
pressure, or vacuum, inside the chest cavity. As a result, air flows in
through the mouth and nose, down through the throat (pharynx), between the vocal folds in the larynx, on downward through the trachea and
bronchial tubes, finally reaching and inflating the lungs. In addition to the
diaphragm and the external intercostal muscles of the chest many other
muscles will have been actively contracted during this inspiratory part of
the respiratory cycle.

In order for us to exhale on the other hand all that actually must

occur is that we relax the contraction of inspiratory muscles. Thus, during

ongoing breathing for life, inhalation is an active process, while exhalation
is passive. Relaxing the contracted muscles of inhalation allows the rib cage

Thorax.
Chest.

pg

Dia hra m
neet or muscie
separating the thorax
rrom tne aoaomen;
contracuon expanos tne
thorax for inhalation of

air

to return to its resting position and allows the compressed abdominal

contents to expand. Our chest cavity begins to lose its expansion, and air

Pharynx.
The throat cavity.

begins its exit from the lungs. Gravity also exerts a downward pull on the
elevated ribs; and, due to their elasticity, the lungs themselves will recoil

Trachea
The windpipe

toward a resting size (just as an inflated balloon will recoil toward its
deflated state when its neck is released). All of these passive forces cornbine to force out of our lungs the air that we just inhaled. This inhalationexhalation cycle is repeated regularly several times per minute in relaxed

"vegetative" breathing, and the amount of air we exchange during

each cycle (in an adult, about haIfa quart, on the average) is known as our
tidal volume.

Tidal volume.
The amount of air
inhaled or exhaled
during one cycle of
quiet relaxed breathing.

CHAPTER 2

BASIC COMPONENTS OF SPEECH AND LANGUAGE

When we are breathing for speech the respiratory system works differently than it does when merely oxygenating our blood in relaxed tidal
breathing. Typically, we inhale much more quickly and a bit more deeply
while we are speaking. Moreover, we do not now immediately relax the
muscles of inhalation as we begin to speak. Instead, after inhalation we
must control the exhalation of air very precisely in order to maintain just
the right rate of airflow and the amount of pressure needed to "drive" the
speech mechanism. We achieve this controlled (and prolonged) exhalation
by "checking," or restraining, the relaxation of inspiratory muscles. If we
did not do so, the air would come flowing out too rapidly and too forcefully for normal speech (a condition that we sometimes observe, by the
way, in the speech of individuals with certain neuromuscular disorders).

As our exhalation continues, we reach a level of lung volume where

the passive expiratory forces are no longer so great, but this "relaxation
pressure" still may be sufficient for speaking purposes. Then, if we continue to speak without taking in another supply of air, the relaxation pressure will become negligible and we will need to contract some of our
abdominal and thoracic muscles of expiration to maintain the requisite
driving force.
Already we can understand that speaking involves complex respiratory
adjustments, and we've only just begun. As you might expect, such factors as speaking rate, loudness, and pitch further complicate these adjustments. And, as you would anticipate, a variety of medical conditions such
as emphysema and asthma, in addition to muscle and nerve disorders, can
impact significantly on speech breathing.

Phonation
The larynx, a delicate and very important part of the speech mechanism,
is suspended in our neck beneath the hyoid bone (the only bone in our
body that does not articulate with any other bone) and above the trachea
(or windpipe). The sound of the human voice (phonation) is produced
by paired vocal folds, one on the left and one on the right, which lie within
the major cartilage of the larynx, the thyroid cartilage. The vocal folds
are joined together at the front of the larynx where they attach to the thyroid cartilage just below and behind the "Adam's apple." From this attachment they extend horizontally backward to attach to the right and left
arytenoid cartilages, respectively.
Each vocal fold is a relatively thick shelf of tissue consisting of layers
of muscle and ligament covered by epithelium. Although they sometimes
have been called vocal cords, they actually have no resemblance to cords
or strings. They are thicker in men than in women and thicker in adults
than in children (which accounts for the pitch differences which we hear),
but they are never very long, averaging something less than one inch in
length even in the large larynx of an adult male.

THE SPEECH MECHANISM

When the vocal folds are relaxed, as they are when we are engaged in
silent tidal breathing, they are positioned much as we see them in Figure
2-4, with an opening between them called the glottis. In this drawing we
are looking downward from the very back of the mouth, and at the top of
our drawing (the front of the throat), we barely see just a bit of the base of
the tongue. Looking between the vocal folds and down through the glottis,
we can even see a few of the uppermost cartilaginous rings of the trachea.
If we were to observe this same larynx from the same point while its
owner was breathing rapidly and deeply (during strenuous exercise, for example), we would find the arytenoid cartilages, hence also the vocal folds,
more widely separated. This increased size of the space between the folds
is necessary to permit more rapid passage of air in and out of the lungs
during forceful breathing. In contrast, if we could observe the scene during a swallow we would see the arytenoids and vocal folds being drawn
tightly together in the midline, closing the glottis completely in order to
help ensure that food or liquid does not enter the airway. The epiglottis,
just in front of and above the vocal folds, also tilts backward to assist in
this protection of the airway.
As we prepare to phonate, we begin to draw the arytenoids and vocal
folds together to close the glottis. Then, as air pressure from the lungs
begins to build up beneath the vocal folds, the front membranous portion
(but not the back cartilaginous portion) of the glottis is forced to open.
The opening is small and brief, and the vocal folds come back together
quickly as the air pressure subsides. For as long as voicing continues, this

33

cycle of glottal opening and closing repeats itself over and over, very rapidly
(up to several hundred times per second when a soprano is singing a very
high-pitched tone). A tiny puff of air passes through the glottis each time
it opens. These air puffs set into vibration the column of air above the larynx, producing voice in much the way tones are produced in a pipe organ.

FIGURE 2-4 Vocal folds seen from above

(Front)
Base of Tongue
Epiglottis

Ventricular Folds
Vocal Folds

(Back)

CHAPTER 2 BASIC COMPONENTS OF SPEECH AND LANGUAGE

We hear slow vibrations as low-pitched phonation. More rapid vibrations are perceived as being higher in pitch. The perceived loudness of a
voice is determined basically by how much air pressure is built up beneath
the vocal folds, how tightly the glottis is closed, and how widely the folds
are blown apart during vibration.
Before we leave the larynx, we should note that each of us possesses
another pair of membranous folds that are situated directly above the vocal
folds. These are called ventricular folds, sometimes known as false vocal
folds. The ventricular folds also can be drawn together to close off the airway, but this usually will happen only during swallowing, defecating, or
grunting, or during a brief exertion of strong physical effort. Sometimes,
when a person habitually uses excessive laryngeal tension during phonation, the ventricular folds may be squeezed closely enough together that
they mask any view of the true vocal folds from above. The voice then may
sound very tense and strained, but it still is being produced by the true
(albeit hyperfunctioning) vocal folds. However, there are some individu-

als who use their ventricular folds to produce voice. The extremely
Ventricular folds.
Folds of tissue

strained, harsh sound heard in such cases is called ventricular dysphonia.

This disorder occurs very rarely, and usually only when the true vocal folds
have been damaged.

immediately above the

true vocal folds; also
known as False

v icesonation

Folds.

False vocal folds.

Folds of tissue
immediately above the

true vocal folds; also

known as ventricular
Folds

Dysphonia.
Disorder of voice,

Hertz (Hz).
Unit of measurement of

rate of vibration of
sound source; same as
cycles per second.

Harmonics,
Vibrations that occur at

whole number
multiples of the
fundamental frequency.

The sound produced by our vibrating vocal folds is a complex penodic tone consisting of a fundamental frequencythe rate at which vibration is occurring, measured in cycles per second (cps) or, more commonly,

in Hertz (Hz)and many overtones or harmonics, at frequencies that

are multiples

of. the fundamental. In some voices, energy also is present at

other frequencies in the form of noise. All voices have sound energy pre-

sent over a very wide range of frequencies. Normally there are greater
amounts of energy present in the fundamental and lower frequency
harmonics than in the higher frequencies. In any event, if you could hear
this tone at the level of the larynx you would never recognize it as being
a voice. Heard at its source, the voice would sound more like a buzzing
tone than like anything human.
has been resonated in upper portions of
Only when a laryngeal tone
.
the vocal tract do we recognize its sound as that of a human voice. This
process of resonation also enables us to produce recognizably different
vowel (and some consonant) sounds. y altenng the configurations of
our throat and mouth cavities through movements of the tongue, lips,
and jaw, we create resonators that will emphasize energy at some frequencies and suppress energy at othe. In brief, we can selectively "filter" our laryngeal tones and thereby produce a speech output signal that
has been shaped in ways which will convey essential information to the
listener.

THE SPEECH MECHANISM

35

Above the pharynx and oral cavities is the nasal cavity, a resonating
chamber that also can add to (or subtract from) the original character of
the glottal ton. In producing the nasal consonants (m, n, and ng), of
course, nasal resonance is an essential and distinguishing feature. During
the production of several other of the sounds of our language, however,
the addition of nasal resonance can be detrimental. In the extreme (when
*

it could be labelled as hypernasality), it can interfere significantly with our

ability to understand the speaker's message. Lesser degrees of nasalization
might only be rldly distracting or, in some circumstances, might sound
quite normal to the listener.
Fortunately, unless structural or functional limitations are present, we
generally are able to con.rol nasalization of the laryngeal tone by adjusting
the muscular soft palate (orvelum) and the pharyngeal walls surrounding
it. We can tense and elevate the velum, as well as contract the pharynx, and
virtually disconnect the nasal cavity from the rest of the vocal tract. Alternatively, we typically also can permit nasal resonance to occur, when appropriate, by relaxing the muscles of the velum and upper pharynx
As we shall see in later chapters, not everyone is able to make the rapid
and precise adjustments required to avoid excessive nasal resonance. Conversely, for other persons it may be difficult or impossible to add any nasal
resonance. In either case, medical intervention may be needed prior to, or
in conjunction with, speech therapy.

Articulation

Velum.

When we watch a skilled piano player's fingers we see an impressive dis- Soft palate.
play of coordination, but those who have witnessed X-ray motion pictures
of the tongue in action, or who have watched it directly through a plastic Diphthong.
window in the cheek of a cancer patient, have observed the ultimate in Phoneme produced by
motor coordination. The precision of the tongue contacts, the constant the blending of two
vowel sounds into a
shift of contours, and the rapidity of sequential movements are almost unbelievable. The articulation of speech sounds, the consonants, vowels, and singie speech sound.
diphthongs that are the basic phonemic elements of our language, dePhoneme.
mands incredibly intricate coordinations of the tongue, lips, mandible, A "family" of speech
and velum. And the movements of these structures must occur in syn- sounds that may differ
chrony with those of the respiratory and phonatory systems. It is a minor
slightly from one
miracle that most of us have acquired normal articulation skills so un- another (allophones)
eventfully and that we employ them so automatically.
with no effect on
Certain sounds require the rounding of the lips; some require lip re- meaning; the smallest

traction; others demand their firm closure; still others need the upper
teeth to be in contact with the lower lip. The mandible must be lowered

contrastive sound unit

in a language.

to help create a larger mouth cavity for some vowels than for others. While
adjustments of these types are occurring, the velum and pharyngealwalls
also must perform precisely timed movements. Our tongues, perhaps the

Mandible.
Lower jaw.

most remarkably agile of the articulatory structures, continuously must

36

CHAPTER 2 BASIC COMPONENTS OF SPEECH AND LANGUAGE

different shapes and postures as our speech carries us forward

through various combinations of vowels, diphthongs, and consonants.
Before continuing our discussion of speech articulation, however, we
should introduce the use of phonetic symbolstools that greatly facilitate
the study of spoken language.
assume

A Phonetic Alphabet. It is nearly impossible to use the regular orthographic abc's of English spelling to represent speech sounds. As you well
know, a letter of our written alphabet may represent more than one sound,
or phoneme, in our spoken language (and, of course, a given phoneme is
represented in more than one way in written language). If a nonEnglishspeaking visitor were to ask what sound is represented by the letter u, how
should you answer? Most likely, you'll have a hard time answering, at least
if you pause first to consider how u actually does sound in such words as
flu, put, but, and upon. If she had asked what letter is used to represent
the vowel sound in the spoken word do, your answer would have to take
into account words such as sue, through, flew, and boot. And, speaking of
through, just imagine how confused your guest will be when she works her

way from the correct pronunciation of this word while trying to pronounce rough, thought, or although.
As noted by MacKay (1987, p. 46), the famous playwright George
Bernard Shaw once observed that the word fish could just as well be written "ghoti" if we just used the "gh" of enough, the "o" of women, and the
"ti" of nation.
In order to minimize these complications and confusions, we will be
using the International Phonetic Alphabet (IPA) when we refer to a particular phoneme. Each written symbol of the IPA represents one, and only
one, phoneme, and the IPA also includes diacritical marks that can be used
to show features of a misarticulated sound. Anyone preparing to become
a speech-language pathologist will take coursework in descriptive phonetics in order to become able to recognize, report, and analyze abnormal ar-

ticulation; but, even if you are not leaning in the direction of this
profession, you will find it very useful to become acquainted with the IPA.
And for purposes of this book, our use of the IPA should help to ensure
that you understand more exactly how the correct and incorrect articulations of our illustrated therapy clients actually sound.
Table 2.1 shows the IPA symbol for each phoneme of our language,
though not all possible dialectal variations have been included (and you
will find minor variations among certain of its symbols from one source
to another). Many IPA symbols correspond pretty directly to familiar alphabetic letters, others you may not have seen before. Alongside each IPA
symbol are some key words to help you recognize the referents of unfamiliar symbols. Each key word then is written in phonetic symbols. Whenever we use symbols of the IPA in this book they will be set off from other
text by diagonal slash marks, or virgules (/).2

37 I

THE SPEECH MECHANISM

Key Words

Key Words
Phonetic

Phonetic
Symbol

English

Phonetic

Symbol

English

Phonetic

Consonants

b
d

back, cab

bk, kb

pig, sap

pig, sp

dig, red
frel, leaf

dig, rd

7t, poor

rzt, pur

fil, hf

so, mIs

o, miss
to, wit

she, wish

JI, wif

chin, itch

tin, itj

think truth
then, bathe

Oirjk truO

v
w
hw

vest, live
we, swim
where, when

vest, liv
wi, swIm

ll, young

jel, jAr)

measure, version
zebra, ozone

me3a, v33n

law, wrong
early, bird

lo, rnrj

early bird
perhaps, never

311 b3d

go,eq
just, edge

go,Eg
CAst, ec

he behaves

hi, bihevz

keep, track

kip, trk

kiw, ball

lo, bDl

m
rn

n
n
rj

simple, fable
my, aim

simpl, febl
maT, em

kingdom, madam kirjdrn, mudm

nat, en!
not, any
k fn, mm
action, mission
sing, uncle

sIr), ArJkl

tu,wIt

cn, be
hwer, hwn

zibr, ozon

ohoh!
Vowels

far, sad
father, mop
great, ache
sad, sack
intrigue, me
head, rest
his, itch
own, bone
all, dog

far, sad

a!

my, ee

mam, aT

au

cow, about

kau, baut

a*
ci

faa', map
gret, ek

3*

sad, sk

intrig, mi
hed, rest

hiz, itf
on, bon

to, you
pudding, cook
mother, drug
above, suppose

311, bad

pa-hzps, neva
tu, ju
pudxrj, kuk
mis.-, drAg

bAv, spoz

Dl, dDg

Diphthongs
DI

toy, boil

tDI, bDII

(continued,

CHAPTER 2

BASIC COMPONENTS OF SPEECH AND LANGUAGE

Key Words

Key Words

Phonetic

Phonetic

Symbol

English

Phonetic

Er

wear, fair

wer, fEr

ar

barn, far

ur

lure, moor
shore, born

barn, far
lur, mur

English

Phonetic

Ir

beer, weird

aIr
aur

wire, tire

bir, wird
wair, tair
aur, flaur

Symbol

Centering Diphthongs

Dr

hour, flower

fDr, bDrn

Some Additional IPA Signs and Symbols

'

sign to prolong the preceding sound: [An:esasErl]

sign to release consonant breathily: [t1'ekj

primary stress mark: [sbd]

secondary stress mark: ['sl, mnda.]
the glottal stop
syllabic consonant sign:

[simpi]

comma; pause

M a hw made as a single sound

a trilled r

lateral []

w rounded []
nasalized [a]

*SoUflds commonly used in the East and South.

Vowels. Vowels are produced in a relatively open vocal tract and

all require laryngeal tone (voicing). The contours of our tongues vary
with each vowel, for there are front, middle, and back vowels, each vowel
family having several members distinguished by the height of the tongue
constriction and the amount and rounding of the lip opening. Thus the

/u/ vowel as in flute /flut/, for example, is the highest back vowel and
has the narrowest lip rounding while the ee /i/ is the highest front vowel.
Notice, too, how your jaw opens and closes again when you utter the vow-

els /i/, /a/, and then /u/. The central vowels such as /A/ or // are
produced with the tongue lying in an almost neutral, or nearly relaxed,
position on the floor of the mouth cavity. The position of the primary
vowels is shown schematically in Figure 2-5 by superimposing an enlarged
vowel quadrilateral on a side view of the oral cavity Keep in mind, though,

that there is considerable variation from individual to individual in the

production of both vowels and consonants.

Diphthongs. A diphthong (/difBni/), in the simplest sense, is a

phoneme that involves the combination of two different vowel sounds.

THE SPEECH MECHANISM

39

FIGURE 2-5 The primary

vowel positions shown in
enlarged schematic relationship to
their respective tongue placements
within the oral cavity

As we see in Table 2.1, for example, the second phoneme in the word
cow is a diphthong that begins as the vowel /a/ and ends as the vowel

/u/. As you say this diphthong aloud you will indeed feel the changing
postures of your tongue and lips as you move from one vowel into the
next. Some of our vowels tend routinely to be diphthongized if they are
at all prolonged or emphasized in a word. Some versions of the IPA will

show /ei/ and /ou/ diphthongs, for example. Prolong your utterance

of an /e/ or /0/ to feel for yourself the shifting positions. We have chosen to simpliFy our approach at this point, however, using just /e/ or
/o/, even when they may happen to be diphthongized.

Consonants. Children generally learn all these different postures,

contours, and coordinations for uttering vowels with very little difficulty, and they learn them very early, but deaf children may never get
some of them right in a lifetime. Because they require greater precision
in placement of the tongue and proper direction of the airstream, learning to produce consonant sounds acceptably is a bit more difficult.
Although there are a great number of possible hisses, clicks, and explosions which could be used for speech, most children learn the correct
place and manner of articulation and voicing characteristics needed for
uttering the consonants of their language. Let's use this classification
system (see Table 2.2) to examine how consonant sounds are produced.
In Table 2.2, two phonemes sometimes appear side by side in the same
column without a comma between them. In these instances, the first

CHAPTER 2 BASIC COMPONENTS OF SPEECH AND LANGUAGE

phoneme is voiceless and the second is voiced; the two cognate pho-

nemes otherwise are virtually identical.

Place of articulation refers to the anatomical site where the breath
stream is interrupted or constricted to produce a speech sound. There are
seven valve sites along the vocal tract:

Bilabial. Sounds (/p/, /b/, and /m/) are made with lips pressed
together.

Labiodental. Only two sounds, /f/ and /v/, are produced by

placing the upper teeth on the lower lip and blowing air
through the narrow slit. One of our clients made a perfectly
acceptable acoustic /f/ by using his lower incisor teeth and
upper lip. Watch yourself in a mirror while you duplicate his
error and you will see why he was referred for speech therapy.

Dental. The /9/ as in thin /OIn/ and the /O/ as in them /&m/
are made by forcing the airstream through a narrow slit between the tongue tip and the teeth.
Alveolar. By inspecting Table 2.2, you can see that there are more
sounds made by moving the tongue tip upward and forward to
make contact with the upper gum (or alveolar) ridge than at
any other articulatory port.

Palatal. The /j/ as in Yale /jel/, / 1/ and in bell /brl/, /J/ as in

ship /Jip/, and // as in rouge /ru3/ are all produced by lift-

ing the tongue tip to the hard palate.

Velar. Sounds (/q,/, /g/, and /k/) are made by lifting the back of
the tongue up to the soft palate (velum).
Glottal. Only one legitimate English speech sound, the /h/, is
made by simply blowing air between the vocal folds. Children

U U C1asstficaon of the consonants

Bilabials

Labiodentals
Dentals
Alveolar
Palatal
Velar

Glottal

Nasals

Glides

w hw

Liquids

Fricatives

Affricates

Plosives

pb
fv

9
n

1, r
j

sz

td

13

ij

kg
h

THE SPEECH MECHANISM

41

who cannot close their soft palates sufficiently to make velar

sounds often substitute a glottal stop / /, a tiny coughlike
sound produced by the sudden release of a pulse of voiced or
unvoiced air from the vocal folds.

When we describe how a sound is made, the way in which the airstream is obstructed, and how the air is released from the vocal tract, we
are referring to manner of articulation. Consonants can be grouped into
six categories on the basis of how they are formed:

Nasal. The sounds /m/, /n/, and /rj/ are made by lowering the
soft palate, blocking the oral airway, and directing sound
through the nasal passages.
Glides. A few sounds can only be made on the wingwith the
mouth in motion. These are called glide sounds because you
must move you articulators from one position to another during their production. For example, to produce the /w/ as in we
/wi/, you must form your tongue and lips for the vowel oo

/u/ and then shift or glide into the vowel ee /i/, the distincGlide.
tive sound of /w/ being made during the transition, during the A class of speech
shift.

Liquids. The English language has two liquid sounds, the /1/ and
/r/, half consonant and half vowel, in which the voiced
airstream flows around or over the elevated tongue.
Fricatives. These sounds are made by forcing air through a narrow
vocal tract creating a hissing or turbulence against the teeth and
gum ridge. The /s/ and /z/ sibilant fricative sounds, for example, are made by forcing air through a narrow groove on the
upper surface of the tongue; for the sh /f/ and zh /3/ sibilants,
a slightly wider groove must be employed.
Affricates. In the ch /tf/ of choke /tfok/ and the j
joke
/cok/, a child must learn to link a plosive and a fricative sequentially. (Try saying it and she swiftly, and you'll be uttering
"itchy" before you know it.) These consonant combinations are
called affricates, and many children need help if they are to
learn to combine their components.

// of

Plosives. Make the sounds /p/, /b/, /t/, /d/, /k/, and /g/ several times and observe what they have in common. Try the /p/
and/b/ first since they are the most visible. Note that you
close your lips tightly, build up air pressure behind the seal, and
then suddenly release the air with a popping sound. Where are
the articulatory seals for /t/ and /k/?
Voicing is the last dimension commonly used for classifying consonant

sounds. This refers to whether a consonant is accompanied by laryngeal

tone. Consonants that do have vocal fold activity are termed voiced; voiceless is the term applied to consonants that are not accompanied by vocal

sounds in which the

characteristic feature is
produced by shifting
from one articulatory
posture to another.
Examples are the y in
in you, and /w! in
we.

Fricative.
A speech sound
produced by forcing the
airstreaxn through a
constricted opening.
The If! and /v/ sounds
are fricatives. Sibilants
are also fricatives.

Aicate.
A consonantal sound

lginning as a stop

(plosive) but expelled as

a fricative. The ch in
/tJ/ and j Id3! sounds in
the words chain and
jump are aftiicates.

42

CHAPTER 2

BASIC COMPONENTS OF SPEECH AND LANGUAGE

fold vibration. Many consonants, for example, /s/ and /z/, occur in cognate pairs that differ solely by the variable of voicing.
The classification system we presented may seem confusing and a bit
cumbersome to you at first, but assigning sounds to the categories of
place, manner, and voicing provides a convenient way in which to understand how consonants are produced. More important for the speech clin-

ician, by comparing a client's inventory of speech sounds with the

expected repertoire delineated in Table 2.2, we can discern patterns underlying the client's errors.
So there you have the sounds of our English language, sounds that
you have mastered in just a few years and that your own infants someday
will have to master, too. Knowing that any prospective student of speech
pathology will have to take courses in phonetics, we have presented just
the bare bones of the information needed to work successfully with persons who cannot utter these sounds correctly. Indeed, anyone who tries
to help a child with an articulatory problem should have at least this basic
knowledge, but our major point is that we should not be surprised, given
the complexity of our own speech, to find so many persons with defective
articulation. Instead, we should be amazed to find so few, especially when
we take into account the fact that phonemes typically are not uttered as
isolated entities.

Syllables, Clusters, and Coarticulation. In actual speaking, phonemes are incorporated into syllables. Each syllable has as its nucleus a
vowel or diphthong, and consonants are used to begin (release) or ter-

minate (arrest) the syllable, although a diphthong or diphthongized

vowel can stand alone as a syllable (as in eye or oh). The letters C for
consonant and V for vowel are used to show the shape of a syllable. The
word me, for example, is a CV syllable; egg is a VC syllable; soap has a

CV.

A syllable containing
the consonant-vowel
sequence as
toe or ka.

in see or

cvc.
A syllable containing
the consonant-vowelconsonant sequence, as
in the first syllable c,f
the word containing,

Dialect.
Regional, social, or
cultural variation of a
language.

CVC shape.
Consonants often occur in blends and clusters. The word straw has a
cluster of three consonantal phonemes, /s/, /t/, and /r/, before its

vowel, so this syllable is said to have a CCCV shape. Children may find
the mastery of these consonant clusters difficult and so they simplifij them,
saying taw, or saying poon for spoon. Certain cluster simplifications, however, may be the products of normal dialectal variations, especially when
they occur at the end of a syllable.
When phonemes are incorporated into syllables, their production is
influenced by the sounds that precede or follow them. For example, the
/r/ in the word rope is made with the lips already rounded. This is because the /o/ vowel that follows the /r/ is articulated with lip rounding.
We find no such preliminary rounding occurring in the word red. Try saying aloud the words geese and goose, paying some attention to what your
tongue is doing. Why do you suppose the /g/ is not produced with identical placement in these two words?

THE SPEECH MECHANISM

43

Finally, we should note that phonemes that precede or follow a nasal

consonant usually are themselves somewhat nasalized. This type of

coarticulation is called assimilation nasality.

Regulation
Respiration, phonation, resonation, and articulationall these diverse
processes that combine to produce speech are regulated by the nervous
system. "Orchestrated" might be a better word, for there are at least one
hundred muscles that must work together with precise timing. Airflow
and voicing must be programmed to match the speech sound requirements, words and word meanings must be retrieved from storage and for-

mulated into acceptable units, and then the whole activity must be

Coarticulation.

monitored as it occurs to determine if the form and content of the message fulfill the speaker's communicative intent (see Figure 2-6). And yet
the central and peripheral nervous systems work so swiftly and smoothly
that they make the act of talking look simple.

Influence of adjacent
phonemes on the
articulation of a speech
sound (also see

Unlike all other components of the speech chain, that are tem-

assimilation).

porarily borrowed from their basic biological duties, the central nervous

FIGURE 2-6

The left cerebr2

hemisphere:
Approximate location of
speech functions

44

CHAPTER 2 BASIC COMPONENTS OF SPEECH AND LANGUAGE

system has specialized segments that fulfill the sole purpose of receiving,

organizing, and formulating messages. We now review the major functions of the nervous system in relation to the production of speech. Re-

member that the system is extremely complex and that much still
remains to be discovered about how the 14 billion neurons regulate oral
language.
The cortex or thin bark of the hemispheres of the brain has an amazing capacity to store information. As one of our colleagues demonstrates
dramatically through hypnosis, events experienced by a person as a child
can be recalled in vivid detail. Individuals thus hypnotically regressed in
age to five or six years can name who sat next to them in school and list
the presents they received at a birthday party. This is an example of longterm memory and it is obviously very important for formulating messages.
But we also possess a very brief or short-term memory, which is essential
for tracking incoming messages, remembering and sequencing items dictated to us, and monitoring what we ourselves have said. Persons with
aphasia show losses in both long-term and short-term memory. One former client could not recall the make of his car, the street on which he lived,

or even his wife's first name. Interestingly, he could recognize all three
words when they were presented to him as a multiple-choice task. Another
person with aphasia with whom we worked had extreme difficulty reading
or listening because of an impairment in short-term memory; by the time

she got to the end of a sentence, she had already forgotten the first few
words she had said.
The central nervous system is also the motor command center; it is
the site for originating, planning, and carrying out the transmission of

messages. The command center for integrating language is the left

Rers to tie general

structute of the brain,
Cerebellum,
Structure of the brain
that regulates and

'

coordinates complex

motor activities.

hemisphere, regardless of the person's handedness.3 Orders are relayed

to specific muscle groups through the peripheral nervous system. It is
easy to understand that injuries or malfunctionings of this system may
be reflected in speech and language problems. Let us give just a few
illustrations.
When the maturation of the central nervous system is delayed the
child will be slow to talk. Later in this text we discuss a disorder due to
brain damage called apraxia in which the client cannot voluntarily lift the
end of his tongue to produce a /t/ or /1/ sound even though he might
be able to move its tip perfectly in licking a bit of peanut butter from the
same contact in the mouth. We have also worked with persons with only
half a functional tongue in whom the paralysis was caused by peripheral
nerve damage and we've taught them to make their sounds adequately
anyway. Again, certain voice disorders occur when one of the vocal folds
is similarly paralyzed. In aphasia we deal with the result of brain injury,
and in the speech of certain people with cerebral palsy we find the coordination difficulties produced by inadequate integration of the motor
impulses controlled by the cerebrum and cerebellum. These few illustra-

SPEECH ACOUSTICS

prosodic persistence also explains, at least in part, the difficulty you may

have experienced when you tried code switching to Spanish.

SPEECH ACOUSTICS
"It's not easy, but this is a really interesting topic. It puts so many things together for me. It's like. . . oh, Yes!! Now I can understand how tongue positions are able to change a sound so much even when the position changes ever

so little." Such was the unsolicited commentary of one student following

her recent immersion in speech acoustics.
We noted early in this chapter that our understanding of communi-

cation disorders derives in part from knowledge about normal speech

processes. For this and other reasons, it is important to examine speech as

a series of dynamic acoustic events. Acoustic refers simply to sound or
hearing; and by acoustics we mean the scientific study of sound generation,
propagation, and perception.

Our particular interest is in speech (and the hearing of speech), of

course; but, because speech is a very complicated type of sound, we must

limit ourselves here to an abbreviated overview of speech acoustics. Your
future coursework will explore this topic in much greater depth, if you
continue to study either audiology or speech-language pathology; but, for
now, if you wish more detailed information, you may find Denes and Pinson (1993) to be a very readable and useful resource.
Speech acoustics necessarily incorporates information about sounds
in general, and you may have become acquainted with the basics of sound
in a physics class or in a class that reviewed the ear and hearing, but it's
also possible that some readers may be encountering information of this
type for the first time. In either case, you may not yet be certain that the
study of sound or of speech acoustics has much, if any, relevance to your
study of communication disorders.
Consider again, then, that at the level of physical events our utterances are nothing more (and also nothing less) than complex sound waves
that happen to be generated by our speech mechanisms. However, these
particular acoustic signals are intriguingly potent. Somehow they are able
to represent all manner of messages and subtle meaning when they reach
the brain of a listener. Under some circumstances it is not even necessary

that the entire intact signal reach the listener's ear in order for the
speaker's message to be understood. Moreover, these sound waves carry

information enabling you to recognize the identity of speakers with

whom you are acquainted, and they can provide clues to the emotional
state of the speaker. Exactly how all of this (and more) can occnr is not
entirely clear, although scientists have studied such matters intensively
for decades.

55

CHAPTER 2

BASIC COMPONENTS OF SPEECH AND LANGUAGE

With the help of sophisticated computers we have learned how to artificially produce simple speech signals that are understandable to ordinary
listeners. These synthesized speech samples do not always sound very nat-

ural, though, and they seldom would be mistaken for actual human
speech. Computers also can be programmed to recognize simple speech
signals, especially if only one specified individual produces the speech.
However, if that individual happens one day to have laryngitis or perhaps
a stufFy nose, the computer may well be stumped. If some other person
does the speaking, a computer quite likely will make errors, and if that different person is of the opposite sex, or perhaps speaks with a slightly different intonation pattern, the computer again may prove unreliable in
deciphering the signal.
Amazingly, the most refined speech synthesizers and the most advanced speech recognition programs are unable to do some of the things

that children, by and large, do well and easily long before they enter
kindergarten.4 On the other hand, as we know, some people do not
process these acoustic events well or easily (or at all). Difficulties in producing, receiving, or interpreting speech signals are central to the communication disorders of the people we seek to serve.
It stands to reason, then, that as more becomes known about speech
acoustics we generally will be better able to serve our clients. Evidence
that this is true already is at hand, as we shall see in later chapters, especially in areas such as hearing amplification and augmentative communi-

cation. Of even greater importance, our understandings of speech

acoustics eventually may help enable us to facilitate the normal development of communication skills and to prevent or minimize the occurrence
or severity of certain disorders.

The Nature of Sound

Augmentative and
Alternative
Communication
(AAC).

The use of non-speech

techniques and devices
(e.g., picture boards.
symbol systems,
computerized speech)
as a substitute or
supplement for speech
communication.

Sounds occur when objects are set into vibration or oscillation, if the vibratory motion repeats itself from about 20 to around 20,000 times per
second (the range of frequencies to which our ears normally respond). Vibratory rates slower than 20 Hertz (Hz) are not perceived as sound. Rates

more rapid than 20,000 Hz are not audible to the human ear (even
though they may be heard by your dog) and are referred to as ultrasonic
acoustic frequencies.
Just about anything that can be set into vibration (for example, a vi-

olin string, the reed in a clarinet, the neck of an inflated balloon, a loudspeaker diaphragm. a slammed door, a tuning fork) can be a source of
sound. And our vocal folds are a major sound source, as we know, during
the utterance of speech sounds, although other parts of our speech mechanism also produce sound by impeding or stopping the flow of air.
Vibrations become sound by creating regular or irregular disturbances
in the air (or in other substances with which we are not concerned here).

SPEECH ACOUSTICS

57 I

We can illustrate this by observing the prong of a tuning fork (Figure 2-8)
as it impacts on the air surrounding it. When at rest and undisturbed, the

surrounding air normally would be said to be at ordinary atmospheric

pressure.
In our simplified figure we have used a single line of dots, to the right
the tuning fork, to represent the countless air particles (molecules) that
actually would surround the tuning fork. Simplifying even a bit more, we

Compression.
The phase during a
vibratory cycle when
molecules are pressed

can see that as the prong moves "outward" from its resting position it
pushes against nearby air particles and forces them to be closer together,
or compressed, compared to their resting state. The air pressure immediately adjacent to the prong is now greater than atmospheric pressure.

more closely together,

creating a region of
high pressure.

FIGURE 2-8 Air particles (a) at rest,

(b) in compression, and (c) in

rarefaction, as the prongs of a tuning fork move
through a cycle of vibration

(a)0

(b)0
(c)

CHAPTER 2

BASIC COMPONENTS OF SPEECH AND LANGUAGE

Then, when it has reached its maximum "outward" position, the prong
springs back "inward." This motion pulls those very same compressed air
particles apart from one another. Soon the particles are separated even
more from one another (rarefaction) than we found them in their resting state. The air pressure here is now less than atmospheric pressure.
Again, lest you be misled by our simplification of this process, we remind you that the tuning fork is completely surrounded by air. We've been
disturbing a multitude of air particles in every direction, not just some few
and nearby particles that were convenient to depict. In any event, air disturbances continue as the prong returns toward its rest position and then
immediately begins a second cycle of vibration, causing another cycle of
alternating compression and rarefaction to begin in the adjacent air; then,

Rarefact,on.

The phase during a

vibratory cycle when
molecules are spread
more distantly from one
another, creating a
region of low pressure.

Waveform.
Graphic representation
of sound pressure
variations or vibratory
amplitudes over time.

a third cycle; then a fourth; a fifth; and so on (at least 20 times or more
within one second, if sound is to be generated).
Sound is often shown graphically by picturing its waveform, a display
in which time units are represented on the horizontal axis, and amplitude
or intensity is shown on the vertical axis. Figure 2-9 shows one complete
cycle of the waveform of a simple sound such as the one produced by the
tuning fork that we've been observing. A pure tone of this type has only
one frequency, and it has a characteristic waveform that is called a sine
wave. The horizontal line bisecting the sine wave corresponds to zero amplitude. Let's look more closely at what a sound waveform can tell us.
Beginning from the left at the zero line and moving to the right, we
can follow along visually as the amplitude increases from instant to instant.
At the zero line our vibrator was in its resting position and no air disturbance was occurring. The particles were at rest, at atmospheric pressure.

During the time in which our curve is moving upward and to the right,
in a positive direction, the particles are being compressed. The term displacement is often used in reference to the movement of air particles away

FIGURE 2-9 Thewaveformofa

pure tone, such as that produced
by a tuning fork, is a sine wave

-d

SPEECH ACOUSTICS

from their normal rest state. So the particles are in a maximum state of
compression, or positive displacement, and the pressure is greater than atmospheric pressure, when our wave reaches its maximum positive amplitude. Then, as the curve begins to descend, compression and pressure
begin to decrease. The zero (atmospheric pressure) line soon is crossed,
pressure continues to decrease, and rarefaction quickly reaches a maximum, where our waveform is at its maximum negative amplitude (and particles have reached their maximum negative displacement). The wave now
begins its return toward the zero line, and momentarily the next cycle will
be underway. Our tuning fork will vibrate, and the waveform display could
continue, at a regular and unchanging rate (although amplitude, or displacement, will gradually decrease as the vibrations gradually subside)
until vibration has come to a halt. Remember that each of these vibrations
is occurring in just a brief fraction of a second. If we were using a 2000
Hz tuning fork, for example, it would complete 2000 complete cycles in
just one second.
When we say that pitch is the perceptual correlate of frequency, we
simply mean that the pitch of a sound depends upon the rate at which the
source is vibrating. Faster rates are perceived as higher in pitch than slower
rates. In the case of our tuning fork, as we've seen, the sound is produced
by simple periodic motion and is called a pure tone. Its acoustic energy is
concentrated at a just one frequency, usually called the fundamental frequency, corresponding to the rate at which the prongs are vibrating.
Most of us are not accustomed to thinking in Hertzexcept, perhaps,
when we rent a car (if we may be forgiven a moment of irreverence toward science)so it might help here to relate frequency to a scale that
may be more familiar to the beginning student. In more advanced studies
you may learn that pitch is sometimes measured by psychoacousticians in
units called mels. For our purposes, we'll stick to more familiar territory,
namely the Equal Tempered Musical Scale (ETS). It can be useful to know
that the frequency of 440 Hz corresponds to A4 (the A above middle-C)
on the ETS. It's this note to which orchestra instruments tune before the
concert. Middle-C (C4), which happens to be at the middle of a piano

keyboard, has a fundamental frequency of approximately 260 Hz.

Women's speaking voices, by and large, tend to be produced with average

fundamental frequencies in the range of 190 to 220 Hz; men's, in the

range of 100 to 125 Hz.
We don't spend much time listening to tuning forks, and very few of
the sounds we hear are pure tones. Most sound sources, unlike a tuning
fork, vibrate in very complex patterns, even when they vibrate in a regularly repetitive fashion; hence, most periodic sounds have acoustic energy
at many different frequencies. It is important to remember that even the
most complex sound, if its waveform is repetitively replicated (i.e., periodic), actually is made up of simple periodic sounds that occur simultaneously. (Noise, to which we shall attend in a moment, is another story.) We

59

CHAPTER 2

BASIC COMPONENTS OF SPEECH AND LANGUAGE

need to be aware that the combination of two or more sine waves of different frequencies always produces a complex periodic waveform.
Pure tones of the same frequency, if combined in particular ways, can
"reinforce" one another to produce a simple periodic tone of the same
frequency, but with an amplitude greater than either tone taken separately.
And, combined in yet another way, two pure tones of the same frequency
can "cancel" each other, resulting in no sound at all. All of these possible
results of "mixing" sounds together play a role, as we shall shortly see, in
our production especially of vowel sounds.
The sounds generated by vibration of our vocal folds, as you will recall, are complex periodic tones comprised of a fundamental frequency, together with harmonics at frequencies that are whole-number multiples of
the fundamental. Figure 2-10 shows the waveform of a human voice (albeit, after the laryngeal tone has been resonated in the vocal tract) during
an utterance of the vowel /u/. Its regularity (periodicity) is quite easy to
see, in that the same waveform pattern is repeated again and again. The
presence of additional components beyond the fundamental frequency
can be confirmed by noting how much this waveform differs in shape from
the simple waveform of our tuning fork. We cannot tell which harmonic
frequencies are represented merely by looking at the waveform, we can
only know that other frequencies are present. The fundamental frequency,
in any event, continues to govern our perception of pitch in complex periodic tones.
The amount of time (usually expressed in milliseconds) consumed by
one complete cycle of vibration is known as the period of the tone. For
example, the period of a 100 Hz tone is 1/100, or ten one-thousandths
(.010) of a second; in other words, its period is ten milliseconds. When
we know the frequency, we always can calculate the period by means of a
simple process of division: 1/frequency. Another way to say this is to say
Period.
In acoustics, the
duration of one
vibratory cycle.

period is the reciprocal offrequency.

In Figure 2-10, as it happens, we know that the period was 10.7 milliseconds. What was the fundamental frequency of this voiced sound?
You're correct if you answered "about 93 Hz," and your mathematical
approach was right if you divided one (second) by .0107. To calculate the

FIGURE 2-10 Complex

periodic tone: Waveform

recorded during utterance of the

vowel Ia!

SPEECH ACOUSTICS

frequency, when we know the period, we always perform this same divi-

sion operation. Frequency is the reciprocal of period.

Not all sources vibrate in a regular repetitive fashion. Some have irregular vibratory patterns, and they have no period. We hear these aperiodic complex sounds as noise, which really has no discernible fundamental
frequency. This does not mean, however, that noises may not have characteristic sounds which are unique to particular sources. You might well
recognize the noise outside your window as coming from a neighbor's
lawnmower. Indeed, many of our consonant sounds are basically noises,
but we are able to distinguish among them on the basis of how their predominant acoustic energies are distributed. For example, the /s/ tends to
have a greater concentration of its energy in very high frequencies than do

/8/ or /f/.

A second attribute of sound, loudness, is the perceptual correlate of

the intensity of compression and rarefaction of the air particles surrounding our source. In a sense, we can think of this in terms of the distance (from its resting position) that the prong of our tuning fork travels
before it reverses and begins to travel in the opposite direction. When
we strike the tuning fork forcefully, each vibratory cycle will carry the
prongs further from their resting state than if we strike the fork lightly,
and we will perceive greater loudness. The resultant waveform will show
greater excursions above and below the zero line (greater amplitude, or
displacement) for a loud sound than for a quiet sound. Knowing what
you now know, look at Figure 2-11. Assuming that the same amount of
time is represented in each display, which of these pure tones would be
perceived as having the higher pitch? We hope you've answered "b"
because more vibratory cycles have occurred per unit of time in (b) than

FIGURE 2.1 I

'Naveforms: Frequency and amplitude differences

(a) low frequency

high amplitude

(b) high frequency

low amplitude

61

62

CHAPTER 2 BASIC COMPONENTS Of SPEECH AND LANGUAGE

in (a). Your answer should be the same if we had asked which tone has
the briefer period. And, of course, you'd know that waveform (a) represents the louder of the two tones, since its amplitude is greater than
the amplitude of (b).
Intensity or loudness actually correlates in the world of physics to
the amount of energy or power in the sound wave, and the human ear
is capable of detecting an enormous range of sound powers, from about
.000,000,001 watt up to 50,000,000 watts. It would be inconvenient,

to say the very least, if numbers of these magnitudes were used to

provide an index of loudness. Instead, a logarithmic scale of decibels
(one-tenth of a Bel, after Alexander Graham Bell) is used to measure intensity. The "zero dB" sound pressure reference level is about the softest sound that the average ear might normally detect in a quiet listening
environment.
When we say that the "average whisper" has a sound level of 30 dB
(see Figure 2-12), we arc saying that its intensity is 30 dB (or 3 Bels)
greater than the reference intensity. This means that the whisper is 1 o
(or 1,000) times more intense than the reference intensity. The intensity
of the "average busy street," at 60 dB, would be about 1,000,000 (106)
times greater than the reference level; but the street would be only ten
(1 6 15 = 101) times more intense than "moderate restaurant clatter,"
at 50 dB. To explore further details of this ratio scale would go far beyond our present purposes, but Figure 2-12 may help you to appreciate
the range of loudness ratios are measured relatively easily by using this
scale.

Quality or timbre (/txomb/) is the third feature we need to consider. The quality of a sound is related to the manner in which acoustic
energy is distributed among the various frequencies that are present. The
number and relative intensities of any harmonics in a periodic sound
source are important determinants of quality. Also important is the manner in which the original sound is modified by any associated resonator(s).
Just as the laryngeal tone does not sound like "voice" until it is resonated,
the plucked string of a guitar does not sound very musical until it has been
resonated. Quality is the attribute of sound that enables us to distinguish
between different musical instruments even though they may be playing
the very same note at the same level of loudness. Vocal quality helps us

to recognize who is on the other end of the line when we answer the
telephone.

Sound Propagation
Decibel (dB)
A unit of 'oudness or
sound intensity

As alternating compressions and rarefactions spread out from the source,

they affect particles that are more distant from the source by causing those
distant particles also to bump back and forth (although they bump with
decreasing force as distance increases). It is important to understand that,

SPEECH ACOUSTICS

63

Near jet at take oft

Limit of ear's endurance
Rock band at peak, thunderclap
Chain saw

Loud auto horn 23' away

______

Cocktail party
Muffled snowmobile

________

Bus
Average busy street
Moderate restaurant clatter

{ Average residence

1II1

Average whisper 4' away

Normal breathing
I

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160

DECIBEL SCALE OF SOUND PRESSURE LEVELS

for this oscillating back and forth, forth and back motion, the air
particles do not actually travel anywhere. They do not race away from the
source, for example, to some eventual destination (such as our ears).
Rather, they simply displace adjacent particles that, in turn, displace yet
other particles.
except

These successive positive and negative displacements result in wavelike

patterns of air pressure variation that do travel across space through the air.
The pressure variations spread out in a spherical pattern, something akin to
the circular pattern suggested by Figure 2-13, but in three dimensions. As
their distance from the source increases, the actual amount of displacement
also decreases. If we are far enough from the tuning fork, the disturbances
will have become so tiny that we'll not be aware of any sound at all. If we're
close enough to the source, though, our eardrums will be set into vibration
by these minuscule oscillations of air pressure. When the ear drums vibrate,
the ossicles will transmit the vibrations to the cochlea, and, lo, we're about

IlGURE2l2
Comparative
loudness of familiar
sounds and noises

Ossicles.

The three smallest

bones in the body-the
malleus, incus, and
stapes; the ossicles

convey vibrations of th
eardrum to the oval

window of the cochlea

Cochlea.
The spiral-shaped
structure of the inner
ear containing the end
organs of the auditory
nerve.

164

CHAPTER 2 BASIC COMPONENTS OF SPEECH AND LANGUAGE

Alternating waves of compression

and rarefaction spread in all directions from a
vibrating sound source
FIGURE 2-13

to hear a sound. You'll find more information about this part of the process
in Chapter 13.

How rapidly will these waves of air pressure travel away from the
source and toward our ears? Right! They will move at the speed of sound!

At sea level, sound waves travel at about 770 miles per hour, or about
1,130 feet per second. Light waves, by the way, travel with incredibly
greater speed (about 186,000 miles per second), reaching our eyes almost
instantaneously from any reasonably nearby source. When we hear a clap
of thunder five seconds after we've seen the bolt of lightning, for example, we knowbecause of the difference between the speed of sound and
the speed of lightthat the lightning was about a mile (5 x 1,130 feet)
away from us. And it makes no difference how loud the sound is. Very
quiet sounds travel through space at exactly the same speed as very loud
sounds.
It also makes no difference what the pitch of the sound is. Very low
frequency sounds and very high frequency sounds move at exactly the
same speed. Since this is true, then the distance in space between compressions occurring at a high frequency will have to be shorter than the
distance between compressions occurring at a lower frequency. In other
words, the number of compressions occupying any given distance in space
will be greater for a high frequency sound than for a low frequency sound.

And the greater the number of compressions within a given space, the
Wavelength.

The distance in space

between successive
compressions (or
successive rarefactions)

in a sound wave.

shorter will be the distance between successive compressions.

This leads us to consider another important feature of sound that requires our attention. The wavelength of a sound is defined as the distance
in space between successive compressions (or between successive rarefactions) as these disturbances travel through space. The concept of wavelength is easily confused with waveform, but you should try to keep these
two notions quite separate as you seek to further your understanding of

SPEECH ACOUSTICS

65

acoustics. A waveform, per Se, is of little relevance to us when we are deal-

ing with the transmission, or propagation, of sound. But wavelength is allimportant, especially when we consider what happens to sound as it moves
through the vocal tract.
You can compute the wavelength of any sound rather simply, if you
know its fundamental frequency. Just divide that frequency into the speed
of sound, and you'll have its wavelength (often symbolized by the small
Greek lambda, X). The wavelength of a 100 Hz sound wave, for example,

is 11.3 feet. A 200 Hz sound will have a wavelength just one-half that
long, 5.65 feet. What, then, would be the wavelength of a 2,000 Hz
sound? Your answer should be 0.565 feet, or 6.78 inches. We will call
upon you understanding of wavelength as we look briefly now at speech
spectra and formants.

Speech Spectra, Formants, and Perception

By the spectrum of a sound we mean the manner in which sound energy
is distributed among the various frequencies that the sound contains. This
information can be presented graphically in either a "line spectrum" or a
"continuous spectrum" (which is essentially a smoothed curve version of
the line spectrum). In a spectral display, frequency is represented on the
horizontal axis, while amplitude or intensity is represented on the vertical
axis. The spectrum shows us the exact distribution of sound energy at one

quick instant in time (therefore, it cannot tell us how the distribution

changes over time).
Figure 2-14 shows the line spectra of three sounds. A pure tone, as
we know, has all of its energy at just one frequency, and in (a) we see a
graphic representation of such a tone. In this example we can see that all

of the energy is focused at 2,000 Hz. The second, (b), shows the approximate distribution of energy we might discover in the spectrum of a
trumpet that is sounding the ETS note D4 (about 300 Hz). We see energy in that fundamental frequency and in a series of harmonics (600 Hz,
900 Hz, 1200 Hz, and so on, up through 3,000 Hz, though this would
not truly be the upper limit if we analyzed an actual trumpet tone). Harmonics, by the way, are also known as "overtones," especially in the world
of music. Finally, 2-14(c) shows a random distribution of sound energy
illustrative of one type of spectrum which might be associated with an
aperiodic complex sound (noise).
We turn now to the sound of the glottal source, a term commonly used
in reference to the sound produced at the level of the vocal foldsthe
sound we actually never hear until after it has been resonated in the cavities of the vocal tract. Figure 2-15(a) displays a line spectrum of the glottal source. At this particular instant in time the vocal folds are vibrating at
a rate of 100 Hz; so we see, furthest to the left, a vertical line representing
the intensity of that fundamental. Looking to the right from the funda-

Formant.
Frequency range in
Which the acoustic
energy of a speech
signal is concentrated
by vocal tract
resonance.

66

CHAPTER 2

BASIC COMPONENTS OF SPEECH AND LANGUAGE

(a)

5KHz

Frequency

(b)

5KHz

Frequency

(c)

5KHz

Frequency

FIGURE 2-14 Simulated line spectra of (a) a 2,000 Hz pure tone, (b) a trumpet producing
a note at 300 Hz, and (c) an aperiodic random distribution of sound energy, as in a noise

SPEECH ACOUSTICS

mental we see a harmonic at 200 Hz. Additional harmonics are seen also
at 300 Hz, 400 Hz, 500 Hz, 600 Hz,. . . 5,000 Hz. If our display were
expanded horizontally, we possibly might see harmonics as high in fre-

quency as 8,000 Hz or even a little higher, depending on the individual

larynx involved; but only energy in the range below 5,000 Hz generally is
regarded as important to the study of speech production and perception.
Note that the preponderance of intensity of the glottal source is in the
lower frequencies. To the right, moving from low toward higher frequencies, the intensity declines at a rate of about 6 dB per octave. We
would see basically this same spectrum for any normal larynx, and the general shape of the spectrum would not change much, regardless of the pitch
or intensity of the voice. We would, though, see harmonics more widely

spaced if the fundamental frequency were greater, or more narrowly

spaced if the fundamental were lower in frequency.
Iii Figure 2-15(b) we have simply drawn a continuous smooth curve

that connects the point of maximum intensity at one frequency to the

4

point of maximum intensity at the next higher frequency. Now, if we were

to delete the vertical lines in (b), leaving just our superimposed curve, we
would be displaying what is known as a "continuous spectrum" or "spectrum envelope" of the glottal source. A continuous spectrum still tells us
a great deal about the nature of a sound (even though it does not show
the exact location of harmonics) and about how the sound likely will be
interpreted by a human listener.
For speech perception purposes, the ear does not need to attend to discrete individual harmonics. Rather, it attends to concentrations ofsound
energy within certain regions or ranges of frequency. When we analyze the
spectra of vowels and diphthongs and of some consonants, these ranges or
regions of energy concentration are known as formants. The glottal source
itself has no formants; and, as we've previously noted, the audible sound at
the level of the glottis is more like a rather nondescript buzz than like a
voice. By the time that sound emerges from the mouth, it has undergone
considerable change. It sounds like a voice, and it even may sound like a
recognizable phoneme. As you would expect, the spectrum of this "output" signal also looks quite different from the glottal source spectrum.
You earlier saw the waveform of a vowel /a/ utterance in Figure 2-10,
and now in Figure 2-16(a) we have displayed the continuous spectrum of
that same utterance. The peaks in the spectrum are the locations of five

formants of the /a/. For analysis and discussion purposes, formants are
numbered in sequence, beginning with Fl, the formant with the lowest

frequency location. F2 then is the next higher formant, F3, the next
higher, and so on (through F5 in our /a/ example).
Information about the frequency locations of F 1 and F2 generally has
been thought to be sufficient information to enable our ear (and brain) to
recognize vowels accurately. The third formant, F3, sometimes may assist
us with this identification task and may help to make the vowel seem more
natural sounding. Any additional higher frequency formants are regarded

61

68

CHAPTER 2

BASIC COMPONENTS OF SPEECH AND LANGUAGE

50

40

m 30
>'
U)

C
ci)
C

10

0
O

1000

2000

3000

4000

5000

Frequency (Hz)

50

40

30

>'
U)

ci,

10

Line spectrum
(a) and continuous spectrum
(b) of the human glottal sound source
with vocal folds vibrating at 100 Hz
FIGURE 2-IS

1000

2000

3000

4000

5000

_a

SPEECH ACOUSTICS

69

/I,
5KHz

0
Frequency

2-16 Continuous spectra of

two vowels Ia! (a), and /11 (b)
FIGURE

as contributing to our perception of quality or timbre of the voice rather

than to phoneme identification.

The continuous spectrum of an /i/ utterance is shown in Fig-

ure 2-16(b), and you quickly will note that only four formants appear.The
critical difference, however, is that the frequency locations of Fl and F2
differ considerably from those of the /a/. Each vowel of our language has
typical or characteristic Fl, F2, and F3 frequency locations. These locations for adult males (with large vocal tracts) will differ somewhat from
the locations for adult females (with somewhat smaller vocal tracts) and
for children (with even smaller vocal tracts), but the general patterning of
formant locations remains constant from speaker to speaker.
Our /a/ was spoken by an adult male, and his first three formant locations are at about 770 Hz, 1230 Hz, and 2620 Hz, respectively. The

/i/ was spoken by an adult female, and her first three formants for /i/
are found to be at approximately 530 Hz, 2160 Hz, and 2965 Hz. These
frequency locations, in both cases, correspond very closely tothe locations

reported by Hillenbrand, Getty, Clark, and Wheeler (1995) in what undoubtedly is the most thoroughly detailed study of average vowel formant
frequencies yet reported in our literature.
It is far beyond the scope of our text to examine in detail the manner
in which formant frequency locations arise, but we would point out that
formants reflect the resonation (selective emphasis and suppression) of the
frequencies that are present in the original glottal source spectrum.Once

our vocal folds begin to vibrate, the sound waves begin to travel toward
the listener. En route, however, the glottal sound will be reflected and

CHAPTER 2 BASIC COMPONENTS OF SPEECH AND LANGUAGE

bounced about within the confines of our vocal tract. And the effects of

this resonation will be heard in our final "output" signal. These effects are
comparable to the effects of passing the sound signal through a filtering
process (which is something you do with the amplifier of your own stereo
system each time you adjust it to emphasize or de-emphasize the bass or
treble "tone" of the music to which you're listening). Because resonation
has similar results, the process we're describing is often called the "sourcefilter theory of vowel production."

Phenomenon whereby
acoustic energy present
at various frequencies
in the complex
laryngeal tone is
selectively emphasized
or suppressed by the
vocal tract

Spectrogram.
Graphic display of the
frequency components
of a complex sound
where time is shown
on the horizontal axis,
frequency on the
vertical axis, and
intensity is shown by
relative darkness of the
graph.

But the vocal tract is an exceptionally complex resonance (or filtering) system, comprised of irregularly shaped cavities. Moreover, the size
and shape of the pharyngeal and oral cavities are quickly changed, easily
and continuously, by movements of the tongue, jaw, lips, and pharyngeal
walls; and the nasal cavity can be coupled into the system in varying degrees, or it can be excluded entirely from the system, all by adjustments
of the velum and pharyngeal walls. Depending upon the configuration of
the vocal tract at a particular instant in time, some frequencies of the glottal source will combine with reflected waves and be reinforced, while
others will combine and be suppressed or nearly cancelled.
These varying degrees of reinforcement and cancellation are determined basically by two factors. One factor relates to the wavelengths of
the various harmonics of the glottal source spectrum. A second factor relates to the dimensions of the vocal tract. Whenever a sound wave travels
through a resonating tube, the resonance effect, if any, depends upon how
the length of the tube relates to the wavelength of the sound. Some wavelengths will be reflected back strongly, others weakly, and some not at all.
The resultant interactions between a reflected wave and the original wave

then will determine whether the original sound wave is strengthened,

weakened, or relatively unaffected.
Each harmonic in the glottal spectrum has its own wavelength, however, and we know that the vocal tract is not a simple resonating tube. The
vocal tract is not even a single tube, as we also know, considering that the
tongue may act to divide the tract into a pharyngeal cavity and an oral cav-

ity and that the nasal cavity may or may not be included. It should not
surprise us, then, that the output signal of the vocal tract will contain a
complex patterning of frequency regions that are relatively strong and
others that are relatively weak or even nonexistent.

In essence, we might say that formants will show up in the output

spectrum at those frequency regions where the greatest reinforcement has
occurred. The "valleys" between formants, on the other hand, represent
frequency regions in which suppression (or at least little or no reinforcement) has occurred.
Another display that provides information about formant locations is
called a spectrogram. In the spectrogram, the horizontal axis represents
frequency, and the vertical axis represents time. Darkness and lightness in
the pattern shown by a spectrogram are related to the relative intensities

SPEECH ACOUSTICS

ii

of sound within different frequency ranges. A formant region shows up

more darkly than do frequency regions where sound is less intense.
A spectrogram enables us to visualize spectral changes over time. We
are not limited, as we were in the line spectrum and continuous spectrum
displays, to examining just one brief slice of time. Figure 2-17 is a spectrogram which shows three consecutive utterances: first (on the left),the

vowel /a/; in the middle, the diphthong /aI/; and on the right, the
vowel /i/.
We have included this particular spectrogram in order to show you
the change of formant frequency locations that occurs during production
of a diphthong (the combination of two vowels into a single phoneme).

As our resonating cavities move from their configuration for the first
vowel element toward the configuration required for the second vowel,
these adjustments are reflected in movements of formants. The change in
frequency location of a formant is known as a formant transition. Note in
our diphthong, near the white arrowhead mark, how the frequencies of
Fl and F2 are beginning to move from their /a/ locations toward the Fl

and F2 frequency locations of the /i/.

Formant transitions play an important role in our perception of consonants, too. Hearing such transitions helps us to know, for example, what
tongue posture preceded (and/or will follow) a vowel sound in an utterance. This subtle information about the extents and durations of formant
transitions somehow registers in our minds; and, from that information,
we have learned to draw inferences about probable associated articulatory
adjustments. Even when the sound energy of an adjacent phoneme is diminished or absent, we are able to perceive the "missing phoneme" with

amazing accuracy. No doubt this greatly facilitates our recognition of

FIGURE 2.11

L1

5KHz

Spectrograms of

the diphthong/au and of its component vowels, Ia! and LI!

/a/

/aI/

/1/

I.'

Q
U
E

I'll

C
Y

.1

IL
TIME

72

CHAPTER 2

BASIC COMPONENTS OF SPEECH AND LANGUAGE

phonemes that may have extremely brief durations in ongoing speech or

which, especially in the case of voiceless consonants, may be very difficult

to recognize merely from their somewhat ambiguous spectral features.

Other factors, such as our knowledge of linguistic probabilities, obviously
also come to our assistance in the perception of speech; but, nevertheless,
the fact that we typically understand the spoken word so effortlessly seems
at least a minor and still mysterious miracle.
One day, as our knowledge base continues to be expanded and further refined, there is little doubt that the results of research in these areas

will have contributed even more substantially to our understanding of

speech, language, and hearing disorders. Already, as you will learn in later
chapters, significant benefits are being realized by many of our clients. Individuals who are physically incapable of producing speech are able to take
advantage of systems that synthesize quite intelligible speech. And the effective utilization of implanted cochlear bypasses in persons who are deaf

or profoundly hearing impaired is far more successful than it could be

without accurate information about the acoustic nature of speech signals.
It is clear that even our incomplete understandings have been quite
useful to clinicians and clients and are not simply of interest to laboratory
scientists. Furthermore, we are likely to see an accelerated development of
additional clinical applications as communication scientists continue to fill
in missing parts of the speech perception puzzle. You will be better prepared to work effectively, today and in the future, if you possess at least
an elementary understanding of some basic aspects of speech production,
linguistics, speech acoustics, and speech perception. In this chapter we've
provided just a first glimpse into each, hoping to whet your appetite.

STUDY QUESTIONS

Explain the differences in the meanings of "language," "speech,"

and "communication."
2. Why is speech said to be an overlaid function of the respiratory, laryngeal, and oral/nasal structures?
3. Describe the basic elements of phonation. What structures and processes are involved, and how do they work together to produce voice?
4. What factors account for the differences that we typically hear between the adult male and the adult female voices?
5. Transcribe the following words, using symbols of the International
Phonetic Alphabet: aphasia, chew, diphthong, either, formant, larynx,
1.

pharynx, shoe, teeth, to, too, two

6. At what seven sites along the vocal tract do we "valve" the airstream
in order to produce consonant sounds? Give an example of one consonant for each place.

REFERENCES

13

7. In what ways may adjacent phonemes affect one another when they
are combined in the utterance of a syllable or word?
8. Avoiding the use of technical jargon, explain what is meant by the
term "morpheme."
9. How is sound produced, and how does sound travel through the air
from one location to another?
10. What acoustic features differentiate one vowel sound from another,
and how do we produce these differences even while our basic voice
signal remains unchanged at the laryngeal level?

END NOTES
1We should note, however, that some scholars believe the process of evolution may have favored the survival and refinement of structural features in the
throat and mouth that facilitate speech production.

mstI v fontiks iznt z hard z ju malt Oirjk for menI if nat most
v oem ar simil tu O leta'.z v aur DrdInErI l fbet jul sun rekgnaiz Om/
31n almost every individual the left hemisphere is the dominant hemisphere
for processing and planning speech and language events. It is responsible for "logical" thinking and problem solving. The left hemisphere generally is larger and has
a more extensive blood supply than the right. Among other functions, the right
side of the brain is responsible for understanding nonspeech sounds and spatial relationships. The right side also is the hemisphere usually responsible for creative
and artistic activity and for recognizing a familiar face.
4Even infants as young as six months are known to be able to discriminate auditorily among different vowel utterances (and to be able to do so even when the
vowels are spoken by different individuals).

RE FE RE NCES

Denes, P., and Pinson, E. (1973). The speech chain.

New York: Doubleday.
Denes, P., and Pinson, E. (1993). The speech chain:
The physics and biology of spoken language, 2d

ed. New York: W. H. Freeman and Co.

Hillenbrand, J., Getty; L., Clark, M., and Wheeler,
K. (1995). Acoustic characteristics of American
English vowels. Journal of the Acoustical Society
of America, 97, 30993111.

Iglesias, A., and Anderson, N. (1993). Dialectal

variations. In J. Bernthal and N. Bankson,

Articulation and phonological disorders, 3d ed.

Englewood Cliffs, NJ: Prentice Hall, Inc.
MacKay, I. (1987). Phonetics: The science of speech

production, 2d ed. Austin, TX: Pro-Ed.

Terrell, S., and Terrell, F. (1993). African-American
cultures. In D. Battle, Communication disorders
in multicultural populations. Stoneham, MA:
Butterworth-Heinemann.

C
1?

OUTLINE
Speech Deve1opnint

Syntax Learning
rhonologkal Dec1opment
Semantics; The beve1opnent

of Meaning
Prosody and Pragmatics

Development

of Speech

and Language

CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

you and I belong to a species with a remarkable ability: we can shape

events in each other's brains with exquisite precision. . . . That ability is language. Simply by making noises with our mouths, we can reliably cause pre-

cise new combinations of ideas to arise in each other's minds. The ability
comes so naturally that we are apt to forget what a miracle it is. (Pinker,
1994, p. 15)

Before reading this chapter you should have a baby immediately. If

this is impossible, then read it for that wonderful future prospect. You also
should read Pinker's book, The Language Instinct: How the Mind Creates
Language (1994), for a comprehensive and unusually lucid discussion of
this intriguing topic.
Most parents never really appreciate the marvelous process that occurs when their infants learn to talk. They take great joy in seeing the child
change from being a creeper to become homo erectus, but few of them have
the knowledge to understand the much greater miracle when homo erectus becomes homo sapiens by acquiring language and speech.

No one knows when or why the very first word was spoken. It was
probably little more than a sigh, perhaps an expletive or a groan accompanying some heavy lifting or hauling. Nevertheless, with that primitive
harbinger of oral language, our ancestors started an immense journey in
the use of symbols. No other creature has been able to duplicate the long
pilgrimage. 'When a child utters his own first word, he rediscovers a wellmarked pathway to the magic of speech.
Since many of the disorders of communication have their onset early
in life and reflect delays in maturation or acquisition of basic skills or competencies, we should understand something about how speech and language develop normally in the child. We begin our account from the
moment of birth, trace the course of development through the stage of
reflexive cooing and crying sounds, then through the period of babbling,
and finally, into the acquisition of full-fledged language.

PREREQUISITES FOR
SPEECH DEVELOPMENT
(No doubt you have heard the anecdote about the nave American tourist
'in Paris who was astonished to observe that even the small children there
could speak French.Anyone who has tried to learn a second language,
particularly after age"tvelve or thereabout, knows that it is far more demanding than acquiring one's own native tongue. Babies just seem to develop speech naturally as they mature, and most parents are not even
aware of how the process unfolds. But not all children begin talking at the
appropriate time, and, to determine where the normal sequence of devel-

PREREQUISITES FOR SPEECH DEVELOPMENT

opment went awry, the speech pathologist must review the prerequisites

for the acquisition of speech (see Emerick and Haynes, 1986, p. 91).

Does the Child Have a Normal Vocal Tract? Although we have seen
children who learned to talk despite anatomical abnormalities, the acquisition of speech is obviously fostered by having an intact vocal tract.

Does the Child Show Normal Neuromotor Maturation? Speech is a

very rapid, complex motor act and requires very finely tuned neurological regulation.
Longitudinal studies of children show a parallel course of development between key motor skills and the acquisition of speech. Consider the
following examples:
Age

Motor Skill

Speech

6 months
12 months
18 to 22 months

Sits alone
Stands; takes first step
Walks alone

Prespeech: babbling
First words
Two-word phrases

Delay in acquisition of motor skills is often associated with slow speech

development.

Does the Child Have a Normal Auditory System? Speech is acquired

primarily through the ear, and children who have a hearing loss, auditory
localization, or discrimination problems will often show delay in the development of speech and language.'

Does the Child Have Adequate Physical and Emotional Health to

Support and Foster the Growth of Oral Language? Physical and
emotional illnesses drain energy, restrict and distort relationships with
family members, and hinder normal sensorimotor exploration and growth
of independence.

Does the Child Show Normal Intellectual Capacity and Cognitive

Development? To acquire oral language, a child must have the mental
capacity for using symbols. To use symbols appropriately, the child must,
among other cognitive functions, be able to attend, recognize, make associations and generalizations, and store items in memory. Facility with
language is an outgrowth of a child's expanding ability to reason; mental
development is the necessary base for performing symbolic operations. In
other words, a child can talk only as well as he can think.
An example will help to clarify the point we are making. Around age
nine to twelve months, a child acquires the notion that objects have per-

71

CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

manence; he becomes aware that an item, such as a favorite toy, exists even

when he cannot see it. Before a child discovers he can use words to label
objects and events, and thus call them forth, he must develop the concept
of object permanence.

Does the Child H e a Nurturing and Stimulating Environment? At

least three environmental factors are crucial in fostering speech development: (1) an emotionally positive relationship (bonding) with a caregiver

who provides reinforcement for the child's communicative overtures;

(2) at least one speech model (person) who uses simple but well-formed
language patterns; and (3) opportunities for exploration and a variety of
day-to-day experiences that stimulate the urge to communicate.2
When parents have their first child they often wonder how well the
child is doing in acquiring the ability to talk. They ask for tables of maturation so they can compare their child with others. The guidelines parents
seek are available, but unfortunately they provide only general information, usually expressed in terms of what should be expected of the "average" child. Each baby is unique, however, progressing unevenly and rarely
fitting neatly into arbitrary age norms. Nevertheless, most children do
seem to pass systematically through various stages of speech development,
and we provide Table 3.1 to illustrate the process.
We wish to emphasize that these stages merely highlight only the
major characteristics of a progressive learning process. No child suddenly
shifts from one stage to another. Always there is overlap. Even when she
begins to say her first words she may still be doing some babbling and
vocal play.

Though most children of different nationalities must learn different

languages, the early development of their speech is similar from nation to
nation. DeBoysson-Bardies, Sagart, and Bacri (1981) found that the babbling of French babies could not be distinguished from those who had
English parents. A similar result for Spanish and English infants was shown
by Oller and Eilers (1982) and for Swedish babies by Roug, Landberg,
and Lundberg (1989). Very early babbling apparently follows the same
universal pattern around the world, only later to be altered in ways that
begin to reflect the speech characteristics of the particular language community to which the infant is exposed (Levitt and Utman, 1992).
Now let us examine the development of speech and language in more
detail.
Many linguists, doubtless because their field is focused on language

rather than on speech, have shown only minor interest in the output of
the baby's mouth prior to the emergence of the first meaningful words.
The linguists point out that the sounds of crying, comfort, and babbling
are not phonemic, which, of course, is true. These early utterpces are
sounds (phones), not phonemes, and often they lack any preci identity
because their boundaries are difficult to determine and their variability is

PREREQUISITES FOR SPEECH DEVELOPMENT

Age

Speech and Language

13 months.

Little sign of speech comprehension. Much crying. May cry

differently in expressing pain, hunger, or need for attention.
Produces cooing and comfort sounds. Does show response
to sounds and moving objects.
Seems to pay attention to the speech of others and to react
to it. Less crying and more cooing and the beginning of
babbling. Responds to parental speech and behavior by
vocalization and imitation.
Marked increase in babbling and word play. Vocal play shows
inflections. Comprehends certain words such as "Eat" or
"Up." Uses signs and some syllables to express wants.
Comprehends a few words and even phrases: "No." "Daddy
come." "All gone." "Go car." Crude imitation of parent's
speech. Practices syllable strings.
Appearance of first words, usually monosyllables or repeated
syllables: "Mama," "Byebye," "No." Much jargon and self
talk. Can point to objects, toys, animals. Understands simple
directions and the word "NO." Has a speaking vocabulary
of six to eight words. Understands short phrases.
Seems to understand most of what is said, if said simply.
Regularly uses words and short phrases to express desires.
Imitates environmental noises. Much self talk when alone.
Begins to combine several words into primitive sentences:
"Eat all done." "More milk."

36 months.

69 months.

912 months.

1215 months.

1520 months.

2030 months.

Comprehends most adults if they speak slowly and simply.

Knows names of all familiar objects and activities. Speaks in
phrases and sentences. Has a vocabulary of about 100
words.

great. Moreover, although the baby may repeatedly utter a few clearly defined sounds in babbling, some of them drop out and seem to have to be
relearned once words begin to be used in true language. However, some
contemporary experts (Golinkhoff, 1983; Blake and Fink, 1987; Reich,
1986) insist that there is continuity from prelinguistic to linguistic vocalizations. Stoel-Gammon and Dunn report that "results of studies covering the transition from babbling to speech reveal that the phonological
patterns of babbling are quite similar to those of early meaningful speech
in terms of syllable types and phonetic repertoires" (1985, p. 21).
At any rate, during the period of prelanguage, the child does build the
foundation for the true speech that is still to come. In the very early re-

19

CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

flexive sounds of crying and comfort-cooing, we certainly find babies

practicing the basic synergies of respiration and phonation. In their babbling we see them exploring articulation.

Reflexive Utterances
During the first three months of life a child has a very limited repertoire
of vocal behavior. The two main types of nonpurposeful reflexive utter-

ances the very young baby will produce are the crying and comfort
sounds.

Crying Sounds. Even the father of a baby will recognize the difference
between them, although he may not be able to distinguish between the
wail due to hunger or the howl caused by an open safety pin. For the first
month parents should expect more crying than whimpering, and more
whimpering than comfort sounds. The ratio, it is hoped, will change as
the diapers go by. If the parents listen carefully to the crying, they'll prob-

ably be able to detect vowel-like sounds resembling the //, /E/, and

/ai/ of our language, but they will be nasalized. And if the parent's imagination is good enough, he may hear a few sounds that crudely resemble

the consonants /g/ or /k/, but since these sounds are reflexive they
should not be viewed as the true ancestors of the phonemes that the baby
will eventually master.
When the baby is about two months old, parents can identifr several
distinct types of cryingsignifying rage, hunger, painall having a distinct cadence and pitch level. Furthermore, high-risk babiesthose who
have jaundice, respiratory problems, and other infant ailmentscan be
recognized because they produce distinctive crying patterns (Zeskind and
Lester, 1981; Petrovich-Bartell, Cowan, and Morse, 1982).
If the crying sounds make any contribution at all to the mastery of
speech (which you may doubt at midnight), that contribution lies in the
practicing of essential motor coordinations and the establishment of the
necessary feedback loops between the larynx and the mouth and ear. In
addition, crying, particularly when it becomes differentiated, establishes a
primitive communication link between child and parent.

Comfort Sounds. These reflexive utterances are difficult to describe in

words. Gurgles and sighs, grunts, and little wisps of sound, you will probably lump them together under the category of "cooing." They mainly appear during or just after feeding, or diaper changing, or some other form
of relief from distress. Again, if you listen carefully, the front vowels and
back consonants will seem to predominate, but they are not as nasalized
as in crying.
Over and over again in taking the case histories of children with very
severe articulation disorders or speech delay we have found parents telling

PREREQUISITES FOR SPEECH DEVELOPMENT

81

that these children cried much more than their other babies. If we were
to hazard a guess as to the significance of these reports, it would be that
the feedback ioops between the ear and the vocalizing mechanism became
loaded with the static of pain or unpleasantness. In contrast, when the ear
of the baby hears the sound of her own voice in the context of pleasurable
sensations, that baby may be more likely to experiment with her utterances
and so achieve better speech sooner. Anyway, of one thing we're sure.
You'll enjoy those comfort sounds more than the crying. Crying may
build parental character, but the comfort sounds engender love. You'll
need both.
us

Even when very young, babies will be far more sophisticated at

receiving than in sending messages. At about two months of age, they
will show early signs of social awarenesstracking an adult's movements with their eyes and smiling. Babies show a particular fascination
with facial expressions and are able to mimic facial gestures of adults
when they are as young as three weeks old (Figure 3-1). Newborn infants also respond selectively to the speech of adults. Not only do they
coordinate their body movements with the melody of speech, but they
also can easily discriminate speech from nonspeech signals. At an early
age they can even detect differences among vowels and the very small
changes between voiced and nonvoiced plosive sounds. Infants just one

Infants can
mimic facial expressions
FIGURE 3-I

(from A. Meltzoff and M. Moore,

"Imitation of facial and manual
gestures by neonates." Science 198:
7578, 1977).

82

CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

and two days

old have been shown to be able to hear the difference

between canonical and noncanonical syllables (Moon, Bever, and Fifer,

1992). Evidently, babies are born with a special capability for recognizing and processing speech, so be careful what you say during the 2 A.M.
feeding!

Babbling
Emerging from the stage of reflexive vocalizations is the appearance of

babbling, a universal phenomenon found in all human infants. It is characterized by the chaining and linking of sounds together on one exhalation. We hear syllables of all types, the CV (consonant vowel as in "ba"),
which is most common, with the VC (vowel followed by a consonant, as
in "ab") and the VCV ("aba") being found less frequently. These strings
of syllables have no more semantic meaning than did the comfort sounds,
although their component sounds are perhaps more similar to our standard phonemes. The baby just seems to be playing with his tongue, lips,
and larynx in much the same fashion as he plays with his fingers or toes.
A good share of this vocal play is carried on when the child is alone, and
it disappears when someone attracts his attention. One of the senior author's children played with her babbling each morning after awakening,

usually beginning with a whispered "eenuh" and repeating it with increasing effort until she spoke the syllable aloud, whereupon she would
laugh and chortle as she said it over and over. The moment she heard a
noise in the parent's bedroom this babbling would cease and crying
would begin.

Canonical.
Canonical sullables
have a vowel nucleus

and consonant margins

(CVC)
Vocal play.
In the development of
speech, the stage during
which the child
experiments with
sounds and syllables,

Parents who joyfully rush in and ruin this speech rehearsal are failing
to appreciate its significance in the learning of speech. The child must simultaneously feel and hear the sound repeatedly if it is ever to emerge as
an identity. Imitation is essentially a device to perpetuate a stimulus, and
babbling is self imitation of the purest variety. When the babbling period
is interrupted or delayed through illness, the appearance of true speech is
often similarly retarded. Deaf babies may begin to babble at a normal time
but since they cannot hear the sounds they produce, they probably lose
interest and hence have much less true vocal play than the hearing child
(see for example Eilers and OIler 1994). Mirrors suspended above the
.

'.

cribs of deaf babies have increased the babbling through visual selfstimulation (Stoel-Gammon and Otomo, 1986).
And what are the contributions of babbling to the acquisition of true
speech? As we have mentioned earlier, many linguists would say they are
few. Certainly the babbling sounds are not phonemic, but in babbling we
often hear the repetition of intonation and stress patterns so similar to the
patterning of adult sentences that many parents swear that their baby is
talking to himself or is trying to tell them something. Some of the strings
of syllables have the intonational patterns of command; others, of decla-

PREREQUISITES FOR SPEECH DEVELOPMENT

ration or questioning; most are just randomly varied in pitch and stress.

During this babbling period we find sounds from many languages other
than English (even the tongue clicks of Hottentots) occurring in the free
speech flow.

Socialized Babbling. In about the fifth or sixth month, when the infant can sit up, fixate an object with its eyes, grab an object to put into its
mouth, or hoist its hind end up to crawl, some of the babbling appears to
have an instrumental function. It seems to be used to get attention, to support rejection, to express a demand. She babbles more in a social context.
Sometimes she even seems to listen and certainly is aware of the speech

ofothers.
A bit later the child begins to use vocalization for getting attention,
supporting rejection, and expressing demands. Frequently he will look at
an object and cry at the same time. He voices his eagerness and protest.
He is using his primitive speech both to express himself and to modify the
behavior of others. This stage is also marked by the appearance of syllable
repetition, or the doubling of sounds, in vocal play. He singles out a certain double syllable such as da-da and frequently practices it to the exclusion of all other combinations. Sometimes a single combination will be
practiced for several weeks at a time, although it is more usual to find the
child changing to something new every few days and reviewing some former vocal achievements at odd intervals. True dissyllables (ba-da) come
relatively late in the first year, and the infant rejects them when the parent attempts to use them as stimulation.
At this time the child will often "answer back." Make a noise and he
makes a noise. The two noises are usually dissimilar, but it is obvious that
he is responding. In his vocal play, most of the vowels are still the ones
made in the front or middle of the mouth, but a few oo and oh sounds
(which are back vowels) can be detected. There are also more consonants

to be heard, the /d/, /t/, /n/, and /1/ having appeared; but it's still
hard to separate them out of the flow of unsorted utterance unless you
have long, sharp ears. Some private babbling continues throughout these
months, but now the child seems to take more pleasure in public practice.
He's listening to himself but also listening to you. He is talking to himself but also sometimes to you. This is socialized vocalization.3

Inflected Vocal Play

Although some squeals and changes in pitch and loudness have previously

occurred in the babbling, it is not until about the eighth month that inflection or intonational changes become prominent. It is then that the
vocal play takes on the tonal characteristics of adult speech. We now find
the baby using inflections that sound like questions, commands, surprise,
ponderous statements of fact, all in a delightful gibberish that has no

83

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CHAPTER 3

DEVELOPMENT OF SPEECH AND LANGUAGE

meaning. We hear not only the inflections and sounds of English but those

of the Oriental languages as well. No baby can be sure that he will end up
speaking English. So he practices a bit of Chinese now and then. We have
tried hard to imitate some of these sounds and inflections and have failed.

The baby can often duplicate whole strings of these strange beads of
sounds.
The private babbling and social vocal play continue strongly during

this period from eight months to a year. The repertoire of sounds increases. There is a marked gain in back vowels and front consonants. Crying time diminishes, even though few fathers would believe it. They begin

to get interested in their sons and daughters about this stage, however.
The infant is becoming human. He'll bang a cup; he'll smile back at the
old man. He'll reach out to be picked up. He begins to understand what
"No!" means. But most important of all, he begins to sound as though he
is talking.

We have previously spoken of various stages of development, but it

should be made very clear that, although most children go through these
stages in the order given, the activity in any one stage does not cease as
soon as the characteristics of the next stage appear. Grunts and wails, babbling, socialized vocalization, and inflection practice all begin at about the
times stated, but they Continue throughout the entire period of speech development.
It is during this period that the baby begins to use more of the back
vowels /u, u, o, D/ in his babbling. It is interesting that when we work
with adult articulation cases, we prefer syllables such as see and ray and lee
to those involving the back vowels like soo and low. Front vowels seem to
be more easily mastered.
The baby, through vocal gymnastics, gradually masters the coordi-

nations necessary to meaningful speech. But it must be emphasized

that when he is repeating da-da and ma-ma at this stage, he is not
designating his parents. His arm movements have much more meaning than do those of his mouth. It is during these months that the ratio
of babbling to crying greatly increases. Comprehension of parental
gestures shows marked growth. The child now responds to the parent's

stimulation, not automatically, but with more discrimination. His

imitation is more hesitant, but it also seems more purposive. It begins
to resemble the parent's utterance. If the father interrupts the child's
chain of papapapapapapapapa by saying papa, the child is less likely
than before to say wah or gu and more likely to whisper puk or repeat
the two-syllable puhpuh. During this period, simple musical tones,
songs, or lullabies are especially good stimulation. The parent should
observe the child's inflections and rhythms and attempt to duplicate

them. This is the material that should be used for stimulation at

this period. In this socialized babbling or vocal play of the baby we
find the basic pattern of communication, of sending and receiving, al-

THE FIRST WORDS

though it is only sounds, not meaningful messages, that are being batted back and forth.
By the eighth month pitch inflections are very prominent and the
prosodic features or melody of his gibberish make the give-and-take of a
"conversation" with the baby a delightful experience. Social reinforcers
such as a parental smile or gesture or touch or spoken word increase the
frequency of his vocal behaviors. You will imitate him more than he will
you, but you'll note that his repertoire of sounds is growing rapidly, with
a marked gain in back vowels and front consonants. It is about time for
him to say his first meaningful word.

THE FIRST WORDS

When you have that first baby someone is sure to present you with a
"Baby Book" in which you are to record a host of its accomplishments.
One of them will surely be a section of "First Words." We have examined
many such books without much profit from their perusal. (One mother
claimed that her child's first word was "Kalamazoo" spoken at the age of
seven months while babbling. It was probably just a sneeze.) The linguistic literature and our own observations of our own children and grandchildren have been more illuminating than these baby books.
For a host of reasons, including parental pride and faulty as well as
wishful memories, reliable reporting of a child's "first word" can be an
elusive matter even for the trained linguist. While actual words "co-occur
in the period of transition. . . with a variety of non-word vocalizations,
little attention has been given to the formidable problem of identifying
these earliest words" (Vihman and McCune, 1994). It is not surprising,
then, that the criteria for recognizing those first words show wide differ-

ences from parent to parent and that the average age reported for first
words varies -from about nine to eighteen months for normal children.
When the criterion for the emergence of true verbal utterance is increased
from the very first word to a vocabulary of ten words, the average age is

about fifteen months. A few children begin to speak much later, and

when they do, they may speak in multiple-word sentences, thereby showing again that comprehension precedes performance (Barrett, 1985).
Words are acquired (comprehended) before they are used, and long
before the first one pops out, the child has shown by his behavior that he
understands the gestures, intonations, and meanings of some of the parent's speech. Since parents at this time tend to speak to their children in
single words or short phrases and sentences when really trying to communicate with them (rather than adoring them, which produces a host of
multiword nonsense), it is not surprising that the first meaningful utterances of babies are single words.

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CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

The first words spoken by the child are usually single syllable (CV)

words or two-syllable reduplicate words (CVCV) such as /da/ or

/mama/. Here is one explanation.
"In order to suck, the child makes a lip closure around a nipple and
presses the nipple up against the alveolar ridge with the tongue. The basic
movements to and away from these constrictions involve the CV-like syllables as the child alternately presses the lips together and then opens the
mouth" (Hoffman, Schuckers, and Daniloff, 1989).

As you might expect, salient objects, events, and persons from a

child's daily experience are singled out for his very first words. The senior

author's son's first word was "aga," meaning "all gone" in the contexts
of no more milk in his cup or the turning off of a light.
The first words are sentence words, and you will soon hear the same
utterance spoken at one time with the intonation and stress of a declarative
statement, or at another as a command, or even as a question. Often an ap-

propriate gesture will accompany the utterance. Even though only one
morpheme is used, the tone of the voice and the gesture show the other
parts of the implicit sentence. When one of our daughters heard the sound
of the car in the garage, she said, "Dadda?" with an upward inflection and
looked toward the door through which he usually entered. Then when he
came in, she held up her arms to be picked up and imperiously demanded,
"Dadda! Dadda!" with the appropriate inflection and stress of command.
These were sentences even though only single words were spoken.
As you probably have observed, children often "misuse" these new
words: a word may be limited (underextension) to a very narrow range of
reference ("dog" is reserved for only one particular canine); or a word may
be expanded (overextension) to cover a large range of referents (all creatures with four legs are "dogs").
How are the first words acquired? This question looks innocently sim-

ple, but it has troubled many students of language and still has no universally accepted answer. Since you may have to teach a nonverbal child to
talk someday, your own or somebody else's, you should be interested in
the various explanations.

Alveolar ridges.

The ridges on the

jawbones beneath the
gums. An alveolar

sound is one in which

the tongue makes
contact with the uppergum ridge.

Assume for a moment that it were possible to bring up an infant in

some remote spot where he would receive basic care but never be talked
to or even hear other people conversing. What language would he speak?
Would his first words be uttered in Hebrewthe original universal language according to King Jamesas some theologians believed? On the
basis of our clinical experience with several experience-deprived children,
as well as familiarity with the literature, a child so isolated from human discourse would have no intelligible speech. Experts agree that normal
speech and language development requires the dual contributionsof good
native endowment and a reasonably stimulating environment.

Children do, after all, acquire only the language that is spoken to
them. But why do children in disparate cultures learn to speak about the

THE FIRST WORDS

same

87

time, follow the same developmental sequence, and use linguistic

forms that are remarkably similar?

How Children Learn Their Morphology

How children learn their first words (morphemes) is still something of a
mystery despite many investigations. Those first words are free morphemes, words that stand alone. The morphemic modifiers such as plurals and past tense (bound morphemes) come later.
Nelson (1993) lists six theories that seek to explain how babies learn
their first words. We will summarize four of themtwo relating to learning theory, and two relating to native endowment. Each seems to make
some sense, but none has gained complete acceptance.

Learning Theory
For many decades, speech pathologists relied on learning theory as their
primary source of information about language acquisition. In this frame
of reference, language is seen as a behavior acquired by the right amount
of motivation, environmental stimulation, and parental reinforcement. A
baby must be endowed with the normal sensory and motor equipment, of
course, but he is basically a blank tablet for the script of experience. The
core element in all learning theory explanations is the necessity to associate verbal behavior with rewarding conditions. We now present brief re-

views of two prominent learning theories of speech and language

development: operant conditioning and the autism theory.
Operant Conditioning. Advocates of operant conditioning believe that
whenever a parent smiles, cuddles, or responds favorably to a child's vocalization, that vocalization or something like it will tend to increase in
frequency. If that vocalization has some similarity to the intonation or
phonemic patterns of adult language, it will get more reinforcement immediately, and then with each closer approximation the parent will tend
to show more approval. Children echo or imitate the word of the mother,
saying something like milk when she says it, and lo, there is the bottle and

the mother's smile. When the word is emitted and then rewarded, the
probability that it will be uttered again in future but similar situations is
thereby increased. The development of syntax is explained by some theorists in terms of the chaining of operants, each word of a phrase or sentence carrying a cue that evokes the next one or next group of words. This
simplistic account does not do justice to the operant learning explanation,
but it describes its major features,

The Autism Theory. Experiments in teaching birds to talk led a famous American psychologist to formulate what is known as the autism

Operant conditioning.
The differential
reinforcement of
desired responses
through the systematic
control of their
contingencies.

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CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

theory of speech acquisition (Mowrer, 1950). Mowrer found that his birds

would reproduce human words only if these words were spoken by the
trainer while the birds were being fondled or fed. After this had happened
often enough, the word itself could apparently produce pleasurable feelings in the bird. Since myna birds and parakeets produce a lot of variable
sounds, it is almost inevitable that a few of these sounds might resemble
the human word that produced such pleasant feelings, Thus when the bird
hears itself making these similar sounds, it feels again the pleasantness of
fondling and being fed. So it repeats them, and the closer the bird's chirpword comes to resemble the human word, the more pleasant the bird
feels. By properly rewarding these progressive approximations, we can facilitate the process. However, finally the bird will find that "Polly-wantsa-cracker" is pleasant enough to be self-rewarding. The word "autism"
refers to the self-rewarding aspect of the process. At any rate, these phrases
seem to sound almost as good to the bird as a piece of suet tastes.
When this theory is applied to the child's learning of his first words,

it seems to make a lot of sense. Certainly, the mother says "Mama" or

"baby" a thousand times while feeding, bathing, or fondling the child.
Also it is certain that the baby will find mama mama or bubbababeeba
sometime in his babbling and vocal play. If these utterances flood him with

pleasant feelings, he will repeat them more often than syllables such as
"gugg," which have no special pleasant memories attached to them. It is
also true that the closer the child comes to the standard words, the more
reward he will get from the mother. There still remains the problem of
giving meaning to utterance, and this is explained in terms of the context.
"Mama" is used when the mama is present; "baby" is used when he sees
himself in the mirror or plays with his body.

Native Endowment Theory

Linguists have asked persistent questions about speech and language development that the learning theories could not answer: Why do languages
all over the world have such remarkably similar characteristics? Why does
language acquisition commence at the same time and proceed in the same
orderly fashion in all cultures? How can children learn language forms
when parents reward speech attempts indiscriminately rather than grammatically correct utterances? There are two closely related points of view
regarding language development as a preprogrammed human trait: the
nativistic theory and cognitive determinism.

Nativistic Theory. This explanation states that the child has an inborn
capacity for language learning that is mobilized when he discovers that
the parent's noises have meaning and a structure that somehow fit those
innate patterns. Just as Helen Keller, deaf and blind, suddenly discovered
that water had a name when the word was traced upon her hand by her

THE FIRST WORDS

teacher, so little children discover that things and experiences and people

have words (names) for them, that there are different classes of words,
and that words can be arranged sequentially according to certain basic
rules to represent other meanings. Even as the child organizes his visual
perceptions to recognize the bottle from which he drinks his milk, so he
is programmed to organize his auditory perceptions of language. Born
in all human beings is a basic competence or propensity for language

learning and the parent's speech merely triggers that latent capacity
(Chomsky, 1968).
The development of language, in this view, is an outgrowth of general maturation and, as we pointed out in a prior section of this chapter,
the phases of language acquisition are synchronized with maturation of
key motor skills. Adherents of this theory insist that other theories cannot
account for the child's surprisingly rapid acquisition of the complexities of
language or for his ability to generate novel phrases and sentences (and
even new words such as "bringed" for "brought") that he has never heard

before. Finally, proponents of this viewpoint maintain that there is a

"readiness window" or "critical age period" during which proper environmental stimulation triggers language acquisition. If this critical period
is bypassed because of severe illness or environmental deprivation, that
portion of the brain devoted to language and related cognitive abilities
may functionally atrophy.

Cognitive Determinism. It is entirely possible to teach a child a few

words by intensive operant conditioning. But to then suggest that he has
achieved the use of language is like claiming that an adult is a playwright
because he has memorized a few lines of Shakespeare. True language use
has a cardinal feature: the expression of meaning. And to express meaning, a speaker, whether a child in the one-word stage or a garrulous adult,
must have his mental clutch engaged before he can make sense with his
mouth. This notion is the centerpiece of the cognitive determinism theory of language acquisition.
There is little doubt that the ability to use language rests upon a foundation of higher mental (cognitive) functions. Advocates of the cognitive
determinism viewpoint assert that language development depends upon
(is determined by) intellectual growth. Before a child can use her first
word in a meaningful way, she must have acquired the mental sophistication to realize that a hidden object still exists. She must, in other words,
be able to substitute mental imagery for, let's say, a teddy bear that has
been placed playfully behind a sofa. The next step, then, is for the child to
substitute the label "bear" for the missing toy. To put it differently, an uttered word is an outward and audible expression of an understanding.
In the cognitive theory of language acquisition, a child's gradually refined awareness of relationships, his development of concepts about the
world, precede and are prerequisites for verbal expressions of meaning.

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DEVELOPMENT OF SPEECH AND LANGUAGE

The environment serves to release and do some minor shaping of lan-

guage development. Once a child begins to use words, however, his cognitive growth is facilitated.
The wrangling of scholars about how babies learn their first words
does not help much. Perhaps all their theories are partly true. More helpful may be an account of how one of the senior author's children managed the feat.
Cathy, by the age of one year, had gone through all the stages of speech
development that we have sketched and at ten months it was clear that
she comprehended many single words and even short phrases such as

"No," "Go bye-bye," "ball," "eat," and "Mama" and "Daddy." 'When
we spoke to her, she answered back but in jargon and gibberish. She still
did some babbling and vocal play when alone but that was all.

We had stimulated her a lot with simple speech and had encouraged her
to imitate us in many ways. Whenever she was engaged in a repetitive ac-

tivity such as banging her cup or clapping her hands or babbling, we

would interrupt it by doing the same things ourselves and often she
would return to the activity. Finally she would even thrust out her tongue

when I did or wave bye-bye back at me when I left her. Nevertheless,

there were no meaningful words.
I was determined that her first word would be "Daddy" or something
like it, and my wife was equally determined that it would be "Mama,"
and so we tried hard to make this happen by strongly reinforcing any
time she said "da" or "ma" in her babbling or vocal play because these
syllables occurred frequently.
But her first word was neither. It was "pitty" /pItI/ for pretty and it was
her name for a flower. I presume she had heard us say it but not nearly
as often as we had other words. It was meaningful. She would point to

a flower, any flower, and say "pitty" over and over again, then gurgle
with triumph and delight. She never used it for any other object. He second word was "dah" /da/ for dog and within two weeks she had mas-

tered nine other words, all of which were names for objects or for
activities. Within six more weeks she was speaking in phrases and short
sentences. I still can't explain how she acquired that first word.

Conclusions
Even though we presented only a very brief review of the major theories of
how children acquire speech and language, it still may seem confusing and
unnecessarily complicated to you. Since we do not wish to end this section
on such a note, let us present five general conclusions to use as stepping
stones for finding your own path through the theoretical thickets:
Although the precise contribution of each is not yet known, both nature
and nurture are involved in the process of language development. While a
child does seem to be biologically programmed for acquiring symbols

SYNTAX: LEARNING TO TALK IN SENTENCES

and the rules of early syntax, environmental stimulation may be very important for learning speech sounds and subtle nuances of more complex

sentence structure. The variables of sex (females have a slight edge in rate

of development), order of birth (firstborn and only children develop

faster), and socioeconomic status (middle- and upper-class children seem

to acquire language faster than do lower-class children) influence to

some extent the rate of speech and language development.
While the rate at which they move through the stages of speech and language
development may vary from individual to individual, the sequence is similarfor all children. A child will not use inflected vocal play and then back

up to begin babbling. Deviations in the sequence of development may

signal a problem and should be thoroughly investigated.
At each stage of development, a child's manner of communication is an integrated whole, not an incomplete version of the form adults use. His performance is best described as a special type of language, "childese," if you

will, complete with its own "rules."

The acquisition of language is all of one piece. All components, syntax,
phonology, semantics, are acquired simultaneously; a child does not learn
sentence structure and then phonology, for example. But the core of language development is the expression of meaning. The ability to express
meaning depends on cognitive development.
The way in which a person conceptualizes the process of language development will determine what he does to foster development in a normal child
or help a language-impaired child. Theory, whether explicitly formulated
by a speech pathologist or simply a parental intuition, dictates the form
of therapy.

Although we have observed our own children and grandchildren learn

to speak, and have helped scores of troubled youngsters overcome the barriers of silence, we still look upon the process of language acquisition as a
major miracle.

SYNTAX: LEARNING
TO TALK IN SENTENCES
At about eighteen months of age, when they have acquired a vocabulary
of about fifty words, many children begin to join words together, and this
is probably the most important discovery the child will ever makeeven
were she to become the first person to walk on Mars. Indeed, it is probably the most important one the human species has achieved, for it enabled this two-legged race of mammals to exploit the immense potentials
of symbolization. Were we restricted to one-word utterances, we would
be woefully handicapped.

91

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CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

The development of syntax is amazingly swift: An eighteen-monthold child surges from telegraphic two-word utterances to complex sentences in a little more than a year and a half. There are several early signs
that the child is getting ready for this great leap forward. One of our former students made these observations about her daughter just before the
child began to put words together.

Martha is seventeen months old and, like the books predict, she seems
to be preparing for putting words together. (1) Her comprehension of
speech has improved and she now will follow simple one- and two-step
directions. (2) There are little nuances of prosody she uses to express different meanings with her one-word statements. (3) Her vocabulary has
grown and peaked now at about forty-five words. (4) Her use of words
is more "sophisticated" now. Rarely does she show overextension; cats,
dogs, and horses now have separate names; every man in the supermarket is not "Daddy!" (5) Conceptually, too, she uses words in a more so-

phisticated way. She recognizes that the label "chair" can mean her
father's Lazyboy, a rocker, or even her highchair. And, finally, (6) Martha
is using symbolic play. She is much more imaginative now, pretending
that a block is a cookie and an oatmeal box is a miniature oven.

How, then, does the child learn to join words together and to do so
correctly? Some theorists have suggested that they come to recognize that
there are two different kinds of words, open-class words and pivot words.
Open-class words are similar to those the child has already been using in
his one-word utterances. They are content words; they refer to things or
activities; they are labels and can stand alone. Milk, cup, car, Jimmy, shoe,
drink, go are all samples of open-class words. Pivot words are handles. By
themselves they cannot constitute a sentence. They can modifiy ("more
milk") or locate ("that cup") and do other things, but they need another
word (an open-class word) before they make sense. Some linguists believe
that when a child learns to join the two kinds of words together the first
primitive sentences are formed.
Other linguists, however, reject the pivot grammar approach, mainly

because it ignores the semantic or meaningful aspect of language. Instead, they claim that the child begins to join words together when he
recognizes the need for modifiers, for ways of expressing subject-predicate, action-object, possessor-possessed, and other relationships. They
feel that the pivot grammar explanation of how a child learns to combine words is too simplistic, preferring an explanation that shows how

the four basic kinds of one-word utterances (declarative, imperative, negative, and interrogative) are expanded in the interest of meaningfulness.
Table 3.2 (taken from Wood, 1976) provides an illustration of this point
of view.

Advocates of this view assert that by focusing upon the meanings a

child seems to convey (and how he uses utterances to make things happen in his environment) rather than on sentence structure, it is possible to

SYNTAX: LEARNING TO TALK IN SENTENCES

Sentence Type Sequential Stages in Sentence Formulations

Declarative

Negative
Interrogative
Imperative

"Big boat"
"No play."
"See toy?"

"No touch!"

"That big boat."

"I no play."
"Mom, see toy?"
"You no touch!"

"That's a big boat."

"I won't play."
"Did you see the toy?"
"Don't touch it."

B. Wood, Children and Communication. Englewood Cliffs, NJ: Prentice Hall, 1976,
p. 137.

gain a better insight into how he organizes and conceptualizes his world.
Neither explanation is completely satisfactory.

How then do children learn their syntax (the joining of words

together to express their meanings)? Again, there are different theories

with which we shall not burden you because none has achieved complete
acceptance.

It does seem clear, however, that a certain progression occurs. First

the child learns to use two-word noun phrases, such as "big bail" and
"baby bottle" in which the first word modifies, locates, designates, or describes the noun.
Next, the child begins to use two-word verb phrases, saying "me go" and
"kitty eat" with the verb following the noun to form the essential subjectpredicate shape of a primitive sentence. Soon after this achievement, the verb
may precede, as in "bang cup" or "eat banana." Then follows the child's use
ofprepositional phrases and clauses to modify the meanings expressed in the
simple phrases he has used before. Many different types of clauses become
embedded in the child's utterances. Instead of saying "go" or "go bye bye,"
he now may add to it by saying "go bye bye in car now."
Thereafter, the acquisition of various language structures is astoundingly swift. He discovers conjunctions such as "and"; he learns the rules
for plurals and tense and dozens of other features and rules. To the knowledgeable observer, the process can only be described as miraculous. In all
the rest of his life he will never learn so much in such a short time. Rather
than dwelling further on details in an introductory text, we describe now
how the senior author's grandson learned to speak.
For the first six months of his second year we heard only one-word utterances, but they were accompanied by intonations and gestures that
supplemented their meaningfulness. Thus "bye-bye" might be uttered as
a question or as a command or merely as a comment on the fact that he

94

CHAPTER 3

DEVELOPMENT OF SPEECH AND LANGUAGE

was

already in the car. He also had two negatives, "uh-uh" and occa-

sionally "No!" "Ah-gah" (for "all gone") seemed to be a single

sentencelike word and was used interrogatively, imperatively, and declaratively depending on the situation. Jimmy had achieved a vocabulary of
about thirty-two words at eighteen months. Most of these, such as milk,
cup, car, plane, shoe, were open-class words, but the boy also had some

modifiers that could be termed members of the pivot class, such words
as here, more, big, and that. At any rate, by one year and ten months he
had learned to combine these into two-word utterances that again were
used with the appropriate intonations of command, questioning, commenting, and so forth. Many of these were novel combinations that certainly he had never heard before such as "bye-bye bed." He would say
"more milk," which certainly had been modeled for him, but he also said
"more shoe" when he wanted the other one put on, and this too could
not have been learned by any sort of imitation.
Within a month Jimmy showed clearly that he had discovered how noun
phrases and verb phrases could be constructed: "my cup," "that shoe,"
"that car," "big milk." In naming pictures he would use the article "a"

or the demonstrative "that" before each of them. No longer would he

merely say "cow" or "house." It was always "a cow" or "that house." If
we forgot to put in the prefatory word, he would become enraged and
say, "No, no! 'a' cow," and correct us. He wasn't going to have his newly
learned rule violated. If we said "big cow," that was all right, but no more

single words for him! Something similar also occurred with verbs, although this came later. Verb phrases consist of the combination of an antecedent verb with a noun or noun phrase. jimmy's first one was "bang
cup," but within a week he was saying not only "pay pono" (play piano)
and "wah miuk" (want milk) but also "weed a booh" (read a book) and,
showing us that he could do so, "frow duh bih bah" (throw the big ball),
thus combining the verb with a noun phrase.

For almost two months, Jimmy stayed at this level of speaking in noun
phrases and verb phrases, making many gains in vocabulary and practicing many different applications of the rules he had discovered. The noun
phrases were then expanded: "Daddy big shoe." Verbs were followed by

noun phrases as well as single nouns. He would say such things as

"Jimmy want big ball" and even "Doggie eat Jimmy toast," thus indicating some sense of the possessive. Some of these verb phrases soon
showed expansion by linking adverbs or prepositional phrases with the
verb: "Fall down," "Go now in big car." It was fascinating to see him experimenting with these noun and verb phrase combinations. That he was
not merely repeating phrases that he had heard his parents use, but actually and deliberately linking the words together is shown by some of

these utterances: "Here bye-bye" (I've got to go now), "Go Mummy

bed," and "No that button." These were not imitations of parental
speech. They were the result of his attempts to construct a grammar, to
relate words appropriately and meaningftilly.

Then one day we heard more true sentences. "Jimmy want coat."
"Jimmy go car." "Big ball fail down." He had found a new way of com-

SYNTAX: LEARNING TO TALK IN SENTENCES

bining. Noun phrases could be joined to verb phrases. Subjects could

have predicates. He didn't know these terms, but he had the idea. Whee!
When he said one of these new combinations, he would run around in
circles, shriek with pleasure, and collapse on the floor in ecstasy.

For some time Jimmy seemed to be practicing these simple sentence

combinations. Then we heard him restructuring them and adding the
appropriate intonations of pitch and stress. "Jimmy want cookie!" (command); "Where Daddy go?" (interrogative); "Jimmy no go bed" (negation); "Jimmy big boy" (declarative). Soon he was no longer having to
add two simple sentences together as in "Jimmy go car and Mummy go
car" but was saying, "Jimmy and Mummy go in car now." Shortly thereafter, he was using more of what is called embedding, attaching a clause

or phrase to the basic subject-predicate pattern. Instead of saying

"Daddy go car?" he said, "I think Daddy go car?"

Next the boy showed a growing mastery in the use of prepositional

phrases ("Jimmy go to store" instead of "Jimmy go store"); then possessives, plurals, past tenses, passive voice, and other constructions appeared until by age four he was speaking very much like an adult.

The grammatical morphemes emerge in a definite sequence (see

Table 3.3). When you have that baby of yours, watch for these aspects of
language growth. You will be amazed to see the unfolding of the potential he possesses for becoming human. Besides, your enjoyment of his lan-

Present progressive
Preposition
Preposition
Regular plural
Past irregular

-ing
in
on

Possessive

-s, -z
is, am, are
a, the
-ed

Uncontractible copula
Articles

Past regular
Third-person regular
Third-person irregular
Uncontractible auxiliary
Contractible copula
Contractible auxiliary

-5, -z, -es

ran, came

-5, -z

does, goes
is, am, are
is, am, are
is, am, are

95

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CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

guage development may help you bear all the other responsibilities with
which his birth has bedeviled you.
You will notice that we have not provided chronological ages for the
steps in sentence development. This is because the rate of acquisition
varies quite a bit, and it is impossible to predict very precisely when Jimmy
or any other child will achieve the various levels of sentence formulation

we just described. Age is a poor basis on which to predict syntactic

Mean length of
utterance (MLU).
A measure of average
utterance length used in
studying language
development.

achievement. A better index of linguistic maturity is the average or mean

length of a child's spontaneous utterances (MLU).4 Brown (1973) found
that as a child's MLU increases, he begins to incorporate more and more
complex syntactic features. Employing mean length of utterance as a way
of grouping children, Brown identified five stages in the development of
syntax. Although the children differed somewhat in the chronological age
at which they reached the stages, within each stage they all used the same
set of rules for forming sentences. The major features of the five stages are
summarized in Table 3.4.

Later Syntax. By the time a child is ready to enter kindergarten, he will

have acquired almost the entire repertoire of adult grammar. Only a few
refinements remain to be learned, and these tasks are accomplished by

Stage

MLU

Major Features

Examples

1.02.0

Telegraphic utterances showing

simple semantic rules:
agent + action,
action + object.
Acquisition of noun and verb
inflections: in, on, plural s, -ing;
articles begin, overgeneralizing.

"Doggie run."
"Drink juice."
"Dolly drinking juice."
"Read the book."
"Look at the 'meese"

II

2.02.5

III

2.53.0

IV

3.03.75

Simple sentences using noun and

verb phrases; simple transformations:
questions, negations.
Embedded one sentence in another;
use of clauses

3.754.50

Complex sentences; use of "so,"

"because," "but."
*Based

(child plural for moose).

"I want some juice."
"Is doggie sleeping?"

"The waterfall is singing to me."

"Mary's book is in the camper."
"When are we going to the cabin?"
"I came in because it's raining."

on the work of R. W. Brown, A First Language: The Early Stages (Cambridge, MA: Harvard University
Press, 1973).

PHONOLOGICAL DEVELOPMENT

91

about ten or twelve years of age. Some of the later-learned aspects of syntax include:
Comprehension and use of the passive voice. Upon hearing the sentence,
"The cow was kicked by the horse," children under five or six years of
age insist that the cow did the kicking.
Exceptions to general rules. The plurals of "goose" and "mouse" are of
course "geese" and "mice." One eight-year-old child excitingly reported

that he saw two "meese" (mooses) in Canada. What's the plural of

mongoose?
Complex transformations. It requires considerable linguistic sophistication to restate a sentence such as "It's nice to live in Baraga," several different ways: "Baraga is a nice place to live." "Living in Baraga is nice."

More complete accounts of later syntactical development may be

found in Lund and Duchen (1993) and Nelson (1993).

PHONOLOGICAL DEVELOPMENT
Thus far we have been tracing the way in which the child acquires the use

of syntax, her grammar. Now let us see how she comes to master the
sounds (phonemes) of her langge. Although .pLocess of mastering
speech sounds takes a bit longer than with syntax the same regular, pre
dictable seqnce 1s aTpparent You will find comprehensive reviews of

Ticacqwsition, and mastery in the work of Bernthal and Bankson

(1993) and Lund and Duchan (1993).
Occasionally we meet a proud mother who insists that her child pronounced sounds like an adult from the very first, but we have never observed such a paragon personally. Certain sounds appear before others in

the child's early words, the /m/, /b/, /w/, /d/, /n/, and /t/ consonants being those most often used. Most of the vowels of these early
words are produced fairly accurately from the first, although the /D/ as
in ought, the /E/ as in met, and the /u/ as in cook seem to cause some
difficulty.
The mere presence of a standard phoneme in a word or two obviously

is not the same as its mastery. Ordinarily, we feel that a child has really
mastered a phoneme when he consistently uses it correctly in the initial,
medial, or final positions of all the words which require it. We have little
research on the age of the first appearance (acquisition) of phonemes. Instead, we have tables of mastery, such as those shown in Figure 3-2. Keep
in mind when looking at this figure that there is a great deal of variability
among children.
An inspection of Figure 3-2 reveals that the sounds first mastered are
mainly the labials, nasals, stop consonants, and glides with the fricatives,

Pertaining to the lips.

Stop consonant.
A sound characterized
by a momentary
blocking of airflow.
Examples are the /k!.
Id!, and /p/.

98

CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

AGE LEVEL
2

p
m
h
n
w
b

k
g

t
ng

f
y
r

ch
sh

D FIGURE 3-2 Average age estimates and

upper age limits of customary consonant
production. The solid bar corresponding to each
sound starts at the median age of customary
acquisition; it stops at an age level at which 90%
of all children customarily are producing the
sound (from Sander, 1972).

a
zh

affricates, and the /r/ appearing after the fourth year. We should also add

that the consonant blends (such as /fl/, /str/, /gr/) often are in error
even later. Various explanations have been offered for this sequence of de-

velopment. One is that the earliest sounds to be acquired are those that
involve the easiest coordinations. The /p/, /b/, and /m/, for example,
are less complex motorically than are the fricatives, affricates, or the /r/
sounds, and they are also more visible. Another explanation is based on
the distinctive feature concept, the belief being that the child masters the

PHONOLOGICAL DEVELOPMENT

discriminations in the following order: voicing, nasality, stridency, contin-

uancy, and place of articulation.

Mastering the standard phonemes of our language is not an easy task
for the child. "Goggy" does not sound much different from "doggy" in
the ears of a two- or three-year-old. One plosive seems similar to another;
one fricative resembles several others, especially when the sounds arehidden in the flow of continuous parental speech. How then does the child
ever master the discriminations he needs? In part, he learns what he needs

to know through parental correction. ("Don't say 'thoup.' Say 'soup';

"That's 'soup,' not 'thoup'." This is a crude way of presenting contrasting pairs, the nonword and the real word.) And, of course, he never hears

his parents using "rings" except in the context of fingers, whereas

"wings" are what birds fly with. Unfortunately, not all the words in English have such contrasting pairs. If they did we suspect that we would have
far fewer children with articulation errors. If the name for spinach were
"tandy," no child would use that expression for "candy" more than once
or twice.

In the mastery of a new phoneme, we often find the child going

through a series of approximations before the standard sound is produced. "Choo-choo" for train may be uttered with the two vowels alone,
as oo-oo /u u/, then change to /tutu/, then shift to /tsu tsu/, before
many months later it appears as "choo-choo" /tfutfu/. The substitutions
reflect the use of easier and earlier sounds for those that are acquired later,
and they are usually similar in that they possess some, if not all, of the distinctive features of the correct phoneme. Thus, we have never heard a

normal child substitute a back plosive such as /k/ for the /m/ sound
when he tries to say milk. If the standard sound is voiced, the child's substitution tends to be voiced. If it is a glide, the error will rarely be a stop

consonant. He may say "wummy" for "yummy" but he won't say

"dummy" or "chummy." Why does a child say "tandy" for "candy" rather

than "sandy," or "mandy," "randy," or "bandy"? The /t/ substitution

used by the child has all the distinctive features possessed by the first
sound of candy (/k/), all except one, the place of articulation. Both the
/t/ and the /k/ are unvoiced, and stop plosives, and they are not nasal.
They both involve the touching of the tongue to the roof of the mouth.
It is the spot being touched that differs, the /t/ being in front and the
/k/ in the back of the mouth. In terms of their distinctive features they
differ in only one. Were a child to use an /m/, or /r/, or /b/ for the
/k/ sound in candy, the substitution would be much more unlike the
standard sound. That is, more than one distinctive feature would differ.
The child may not be able to hit the target phoneme's bull's-eye at first,
but he tries to come as close as he can; he does not fling out any old sound
at random.
The mistakes children make in mastering the correct pronunciation of
their sounds may be grouped into categories. Table 3.5 classifies the corn-

99

CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

Process

Examples

Syllable Structure Processes

Final-consonant deletion
Unstressed-syllable deletion
Cluster reduction
Reduplication
Epenthesis

boat [bo]; fish [fi]

tomato ['medo]; elephant [ethnt]
snow [no]; brick [bik]
water ['wawa]; doggie ['dada]

big [big]; blue [b lu]

Assimilation Processes

Velar assimilation
Labial assimilation
Nasal assimilation
Substitution Processes
Stopping of fricative and affricates
Gliding of liquids
Velar fronting

Depalatalization'

sock [gak]; chicken ['gikin]

sheep [bip]; boat [bop]
bunny ['mAni]; down [naun]

very ['ben]; jaw [da]

rose [woz]; look [juk]
go [do]; cup [tAp]
show [so]; chip [t,Ip]

Voicing Processes

Prevocalic voicing
Final devoicing

pig [big]; happy ['hbi]

big [bik]; nose [nos]

1This process is labelled "palatal fronting" by some researchers.

Used by permission from M. Yavas (ed.). (1991). Phonological disorders in children. New York: Routledge,
Chapman and Hall, Inc.

mon errors. Read the phonetic representation of these errors so you can
recognize them. (Epenthesis means that an extra and unneeded phoneme
has been added to the word.)

When we look at the child's errors it seems obvious that she is

simplifying the models of adult speech. She comes as close as she can to

these models but they are for the time being beyond her ability, so
instead of saying dog (dg) she will just omit the last sound, though she
may prolong the vowel a bit as a substitution. Clusters of consonants

/skr/, /bl/, /fr/are just too complicated so she will say /ku/ for
screw and /bu/ for blue. She will omit a syllable if the word is too long
and say /nxn/ instead of banana. Duplicate-syllable words are simpler
and easier to say than those whose syllables differ so he will simpliFy

the word water into /wawu/. According to Nelson (1993) these

"simplification processes are observed in the speech productions of

SEMANTICS: THE DEVELOPMENT OF MEANING

normally developing children but often persist among children with

speech-language disorders beyond the ages when they usually disappear"

(p. 38).

Finally, we should remember that progress in articulatory mastery is

gradual. Even after the child has demonstrated that he is able to use the
standard phoneme in some words, other words will still contain its usual
error. Newly acquired phonemes seem very fragile. Under excitement, the
child may return to the older forms and say "goggy" long after he has
demonstrated that he can say "doggy." In certain phonetic contexts the
new sound will tend to disappear. One child who hadlearned to say perfectly the word "fish" (instead of his earlier "fiss") could not say "Fish
swim in water" for over a year because the /s/ in swim influenced the final
sound of fish and turned it into another /s/ (assimilation). But eventually the child will master the phonemes he needs or have tohave the help
of a speech pathologist.

SEMANTICS: THE DEVELOPMENT

OF MEANING
Although there is much we still do not know about how a child acquires
the meanings of the words he hears and uses, it seems evident that in
early years the developmental process involves both extension and con-

traction. One of the senior author's children's very first words was

"pih" for pig, probably because she enjoyed the animal's feeding times
on the farm. She would say the word and point to the pigs, big ones,
little ones, alike. But, through extension of the meaning inherent in the
words, she also called all other animals "pih" too: dogs, horses, cows,
and even her father when he crawled on all fours under the fence. But
then differentiation (contraction) appeared as she watched the cows
being milked. She tried "pih-mik" (pig's milk?) a few times, then accepted our "moo-cow" by using her already acquired word for milk
(mik) instead of our "moo" to produce "mik-kau." She never used
"pih" for cow again, and very soon thereafter began eagerly to learn the
names for other animals.
Children learn more than naming animals and objects (referential or
structural meaning); they also acquire the ability to express relationships
(propositional or functional meaning). Recently, we observed three childrenall between two and three years oldas they played with a rabbit
and an assortment of dolls, cars, and other toys. Here are some of the
semantic categories recorded; note the wide range of meanings expressed
despite their relatively simple sentence structure.

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CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

Semantic Relation

Example

notice-greeting
recurrence
nonexistence

hi bunny
more carrots
carrots all gone
my truck
rabbit in box
rabbit jump
car hit
pet the bunny

possession
location

agent-action
agent-object
action-object

We also know little of the internal dictionaries being developed bythe

child. There seems to be some evidence that the earlyentries may he filed
not as words but as phrases, cup meaning something to drink from or ball

as throw ball. With intellectual maturity and experience, these action

phrases are gradually shaped into an increasingly complex system for segmenting and categorizing reality. There are interesting variations in language learning style from child to child. Some youngsters use their newly
acquired verbal ability to label objects and events in their world. On the
other end of the continuum are those children who tend to use words to
regulate social interaction and to reveal their needs and desires. No doubt
these styles reflect, to a great extent, the predominant typeof communication parents use with their children. We do know thatthese internal dictionaries grow swiftly in volume. As noted by Pinker, "Around eighteen
months, language takes off. Vocabulary growth jumps to the new-wordevery-two-hours minimum rate that the child will maintain through adodoubtless much
lescence" (1994, p. 267). Comprehension dictionaries are
know
many
more words
more extensive. As is true for adults, children

than they use in communicating.

Children also seem to learn the meanings of new wordsin a sequential fashion. First, they learn those that refer to objects, events, oractions;
next, they seem to acquire the adjectives and adverbs that modifr the
words they've already acquired (e.g., "big dog," "go fast"); then they master a set of terms that describe spatial and then temporal relationships, as
shown in Figure 3-3.
A final category of relational words, such as "here/there" and "this
or that," that focus attention on a particular person or object by locating
it in relation to the speaker are among the last learned.
We do not wish to imply that semantics is confined solely tovocabulary acquisition for, of course, it is the ways in which words are combined
that enable us to communicate our meanings. Nevertheless, any child
who lacks the words he needs is very handicapped, because he has to have
them before he can string them together. We see this handicapvividly in

SEMANTICS: THE DEVELOPMENT OF MEANING

FIGURE 33 Developmental sequence of items related to size and space.

stroke patients with aphasia who often have tremendous difficulty in word

finding. As one of our clients told us, "I have lost my voc. . . my
vocab. . . my, oh dear, my alphabet." And then he cried with frustration,
knowing well that "alphabet" was not the word he needed.
Most parents are eager enough to help the child to get his first twenty
or thirty new words. Some parents are even too ambitious at first; they try
to teach such words as "Dorothy" or "Samantha." But their teaching urge
soon subsides. The child seems to be picking up a few words as she needs
them. Why not let her continue to grow at her own pace? Our answer does
not deny the function of maturation in vocabulary growth. We merely say
that parents should give a little common-sense help at moments when a
child needs a new word, a label for a new experience. When parents no-

103

CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

tice a child hesitating or correcting herself when faced with a new expenence, they should become verbal dictionaries, providing not only the needed

new word, but a definition in terms of the child's own vocabulary. For
example,

John was pointing to something on the shelf he wanted. "Johnny

want. . . urn. . . Johnny want pretty pretty ball. . . Johnny wanta
pretty. . . urn . . . ." The object was a round glass vase with a square
opening on top. I immediately took it down and said, "No ball, Johnny.
Vase! Vase!" I put my finger into the opening and let him imitate me.
Then we got a flower and he put it in the opening after I had filled it
partially with water. I said, "Vase is a flower cup. Flower cup, vase! See
pretty vase! (I prolonged the v sound slightly.) Flower drink water in
vase, in pretty vase. Johnny, say 'Vase'!" (He obeyed without hesitation
or error). Each day that week, I asked him to put a new flower in the
vase, and by the end of that time he was using the word with assurance.
I've found one thing, though; you must speak rather slowly when teaching a new word. Use plenty of pauses and patience.

Besides this type of spontaneous vocabulary teaching, it is possible to

play little games at home in which the child imitates an older child or parent as they "touch and say" different objects. Children invent these games
for themselves.
"March and Say" was a favorite game of twins whom we observed. One
would pick up a toy telephone, run to the door of the playroom, and ask
his mother, "What dat?" "Telephone," she would answer, and then both
twins would hold the object and march around the room chanting "te-

poun tepoun" until it ended in a fight for possession. Then the dominant twin vould pick up another object, ask its name, and march and
chant its name over and over.

In all these naming games, the child should always point to, feel, or
sense the object referred to as vividly as possible. The mere sight or sound
of the object is not enough for early vocabulary acquisition. It is also wise
to avoid cognate terms. One of the senior author's children for years called
the cap on a bottle a "hat" because of early confusion.

Scrapbooks are better than the ordinary run of children's books for
vocabulary teaching because pictures of objects closer to the child's experience may be pasted in. The ordinary "Alphabet Book" is a monstrosity
so far as the teaching of talking is concerned. Nursery rhymes are almost
as bad. Let the child listen to "Goosey Goosey Gander, whither dost thou

wander" if he enjoys the rhymes, but do not encourage him to say the
rhymes. The teaching of talking should be confined to meaningful speech,
not gibberish. The three-year-old child has enough of a burden without
trying to make sense of nonsense. When using the pictures in the scrapbooks, it is wise to do more than ask the child to name them. When pointing to a ball, the parents should say, "What's that!" "Ball." "Doug throw

STUDY QUESTIONS

ball. Bounce, bounce, bounce" (gestures). Build up associations in terms

of the functions of the objects. Teach phrases as well as single words.

"Cookie" can always be taught as "eat cookie." This policy may also help
the child to remember to keep it out of his hair.

PROSODY AND PRAGMATICS

Our research on how children master their prosodic and pragmatic skills
is very meager. With respect to prosody, the acquisition of adult inflec-

tions, such as those for asking questions, making statements or commanding, seem to be learned very early because they can clearly be heard
in the babbling and vocal play of infants long before they are using words.
Similarly, variations in the loudness of babbling segments can be heard.
Prosody, the melody of speech, is probably learned by imitation of caregiver's utterances. One exception to the early onset of prosodic skills is
that the melodic features of sarcasm appear later, usually in the later elementary grades.

As for pragmatics, again we have little information about how the

child learns those skills. Although the pragmatic rule of turn-taking while
conversing appears early, most of the other pragmatic rules are delayed
until the child has become a fairly fluent speaker. Only then does he learn
to speak differently to differing persons (to adults versus children); only

then does he know whether his utterances are appropriate to the communicative situation. Only then does he learn when to talk and when to
shut up.
So there you have an admittedly sketchy account of how your children learn to talk. We hope you will find that this information will enable
you to enjoy watching them do so.

STUDY QUESTIONS

What types of speech and/or language behaviors tend to be characteristic of the average three-to-six-month-old infant?
2. Within about what age range, on the average, should you expect to
hear a baby utter its first real words?
3. When might you expect first to observe signs of "social awareness"
in the baby's behavior, and what are some of these signs?
4. Explain, as you would to the mother and father of a two-month-old
baby, how babbling is different from reflexive vocalization and at
about what age their baby probably will begin to babble.
1.

105

106

CHAPTER 3 DEVELOPMENT OF SPEECH AND LANGUAGE

For what reasons is it so difficult to be certain of the exact age at

which an infant began to use actual words?
6. What is meant by the "autism" theory of speech acquisition, and
how does it differ from "nativistic" theory?
7. What relationships appear to exist between a child's Mean Length of
Utterance and the level of development of her syntax?
8. Among most children, in what general order is the correct articulation of phonemes demonstrated?
9. What are some of the common phonological processes that are observed to occur in the speech of normally developing children? Give
at least one example of each.
10. Using Pinker's observation as the basis for your calculations, you
would expect a child to add at least how many new words to his or
her vocabulary between the ages of 18 months and five years?
5.

EN D NOTES

'The importance of normal hearing to speech and language development

has long been evident in many ways. For example, one recent study found that,

while normal infants inevitably had canonical babbling before the age of 11
months, those with hearing impairments had none until after 11 months (Eilers
and Oiler, 1994).
2Adults often speak "motherese" when communicating with young children

using shorter sentences, raising the pitch of their voices, exaggerating speech

melody patterns, and talking more simply (see, for example, Wanska and
Bedrosian, 1985).

3lnfants attempt to match the pitch of their vocalizations to that of their

parents: They use a lower pitch when babbling to their fathers than to their mothers (Reich, 1986).
4MLU is determined by adding the number of morphemes spoken in a set

of consecutive utterances and then dividiig the sum by the total number of
utterances. The utterance "my car" has two morphemes; "daddy's car" has three
because the plural salters the meaning of the message. Thus (2 + 3)/2 = MLU 2.5.

REFERENCES
Barrett, M. (ed.) (1985). Children's single-word
speech. New York: John Wiley and Sons.

Bernthal, J., and Bankson, N. (1993). Articulation

and phonological disorders (3rd ed.). Englewood
Cliffs, NJ: Prentice Hall.
Blake, J., and Fink, R. (1987). Sound-meaning correspondences in babbling. Journal of Child
Language, 14, 229253.

Brown, R. (1973). A first language: The early stages.

Cambridge, MA: Harvard University Press.
Chomsky, N. (1968). Language and mind. New
York: Harcourt Brace Jovanovich.
deBoysson-Bardies, B., Sagart, L., and Bacri, C.
(1981). Phonetic analysis of late babbling: A
case study of a French child. Journal of Child
Language, 8, 5 11524.

REFERENCES

Eilers, R., and Oiler, D. (1994). Infant vocalizations

and the early diagnosis of severe hearing impairment. Journal of Pediatrics, 80(2).
Emerick, L., and Haynes, W. (1986). Diagnosis and
evaluation in speech pathology (3rd ed.). Englewood Cliffs, NJ: Prentice Hall.

Golinkhoff, R. (Ed.). (1983). The transition from

prelinguistic to linguistic communication. Hillsdale, NJ: Lawarence Erlbaum.
Hoffman, P., Schuckers, G., and Daniloff, R. (1985).
Children's phonetic disorders. Boston: College
Hill Press.

Lester, B., and Zachariah, C. (1985). Infant crying:

Theoretical and research perspectives. New York:

Plenum.
Levitt, A., and Utman, J. (1992). From babbling towards the sound systems of English and French:
A longitudinal two-case study. Journal of Child
Language, 19, 1949.
Lund, N., and Duchan, J. (1993). Assessing children's language in naturalistic contexts (3rd
ed.). Englewood Cliffs, NJ: Prentice Hall.
Meltzoff, A., and Moore, M. (1977). Imitation of
facial and manual gestures by neonates. Science,
198, 7578.

Moon, C., Bever, T., and Fifer, W. (1992). Canonical and non-canonical syllable discrimination by
two-day-old infants. Journal of Child Language,
19, 117.

Mowrer, 0. (1950). On the psychology of 'talking

birds': A contribution to language and personality theory. In Learning theory and personality
dynamics. New York: Ronald Press.
Nelson, N. (1993). Childhood language disorders in
context. Englewood Cliffs, NJ: Prentice Hall.
Oiler, D., and Eilers, R. (1982). Similarity of babbling in Spanish and English learning babies.
Journal of Child Language, 9, 565577.
Petrovich-Bartell, N., Cowan, N., and Morse, P.
(1982). Mothers' perceptions of infant distress

101

vocalizations. Journal of Speech and Hearing

Research, 25, 371376.

Pinker, S. (1994). The language instinct: How the

mind creates language. New York: William Mor
row and Co.
Reich, P. (1986). Language development. Eng1ewoo
Cliffs, NJ: Prentice Hall.
Roug, L., Landberg, I., and Lundberg, L. (1989).
Phonetic development in early infancy: A study
of four Swedish children during the first eighteen months of life. Journal of Child Language
16, 1940.

Sander, E. (1972). When are speech sounds learned

Journal of Speech and Hearing Disorders, 37,
5463.

Stoel-Gammon, C., and Dunn, C. (1985). Normal

and disordered phonology in children. Baltimore:
University Park Press.

Stoel-Gammon, C., and Otomo, K. (1986). Babbling development of hearing impaired and
normally hearing subjects. Journal of Speech an
Hearing Disorders, 51, 3341.

Vihman, M., and McCune, L. (1994). When is a

word a word? Journal of Child Language, 21,
517542.

Wanska, S., and Bedrosian, J. (1985). Conversational structure and topic performance in
mother-child interactions. Journal of Speech an
Hearing Research, 28, 579584.
Wood, B. (1981). Children and communication
(2nd ed.). Englewood Cliffs, NJ: Prentice Hall
Yavas, M. (ed.). (1991). Phonological disorders in
children. New York, NY: Routledge, Chapman
and Hall.
Zeskind, P., and Lester, B. (1981). Analysis of cry
features in newborns with differential fetal
growth. Child Development, 52, 207212.

C
a

Speech Disorders

CHAPTER 4 SPEECH DISORDERS

In the first chapter we providcd a few glimpses of some speech disorders. In this one, we provide basic information that will help us identify
all of the major ones.

DEFINITION
Our first diagnostic task, however, is to make sure that the person's speech
is impaired. To accomplish this, we need a definition and the best one we
have found is this &eech is impaired when it deviates so far from the speech
of other people that it (1) calls attention to itself (2) interferes with communication, or (3) provokes distress in the speaker or the listene)
Let us consider each of the three parts of this definition in turn. The
first part indicates that the speech is so different from that of other speakers that it is conspicuous. It varies too far from the prevailing and relevant
norm. For example, a three-year-old child who says "wabbit" for "rabbit"
would not be viewed as having a speech disorder because most three-yearolds make such mistakes, but an adult who said the word that way would

be speaking in an abnormal way. A somewhat nasal voice in one geographic region might not be conspicuous; the same voice in another region could result in the speaker being urged to seek help from a speech
clinician. All of us repeat and hesitate, but we are not all considered to be
stuttering. Clearly, some speech differences fall into the range of normal
variation and are not speech disorders.
Second, a person's speech tends to be diagnosed as impaired if it is
difficult to understand. The main purpose of speaking is to snd and receive messages and, when these messages are difficult to comprehend, we
feel the speaker must have some kind of speech problem. We once heard
and eighteen-year-old client of ours say" "Poh ko an tebbuh yee adoh ow
pojpadduh baw poh upah did kawinaw a nu naytuh." What was he saying?
He was reciting the first part of the Gettysburg address. Speech must be
intelligible; if it is not, then it is abnormal.
Part three of our definition stresses that when the speech behavior is
Fluency.
Unhesitant speech.
Stuttering,
Disrupted speech,
characterized by
prolongations.
hesitations, and
blockages,

unpleasant to either or both the speaker and listener, it tends to b diagnosed as. being abnormal enough to require the services of a speech
pathologist. You will read about clutterers who speak so fast and have so
many slurred words or fluency breaks that their listeners just won't tolerate their efforts to communicate. Clutterers do not find their speech
unpleasant but others do. Clergymen have come to us because their congregations complained about the harshness of their voices. Most of us find

that listening to severe stuttering is both frustrating and unpleasant.

The person who stutters may be no less distressed than the listener,
of course, nor is stuttering the only speech pr6blem that can cause frustration and emotional stress in the speaker. As we shall see in Chapter 5,

DISORDER CLASSIFICATION

there are individuals whose communicative handicaps are due more to

their emotional reactions than to the speaking disability itself.

In summary, our first task is to ascertain if the speech is conspicuous,
unintelligible, or unpleasant enough to be diagnosed as impaired.

DISORDER CLASSIFICATION
It is not enough merely to decide that the person's speech is impaired. We

must also determine the way(s) in which it is impaired. The speechlanguage pathologist immediately begins scanning to determine if the deviancy lies more in the person's articulation, voice, fluency, or language.

This fourfold classification, it should be understood, refers to the outstanding aspect of the observed behavior. The person with aphasia, for ex-

ample, may show articulation errors, broken rhythm, and difficulty

producing voice; but the outstanding feature of aphasia is disability in handling symbolic meanings and language. Therefore, while describing and

analyzing all problem areas, we would place aphasia under disorders of

symbolization or language. Other individuals, such as the child with a cleft
palate, also may have difficulty in more than one areasometimes to the
extent that one may not clearly be more outstanding than another.

FIGURE

4.1

The range of speech disorders

VOICE

Quality
disorders

ARTICULATION
Alaryngeal
voice
Phonological
disorders

Phonetic
disorders

LANGUAGE
Dysarthria

Dyspraxia

Pitch
disorders
Intensity
disorders

Aphasia
Deviant

ILUENCY

Cluttering

Delayed

Stuttering

III

CHAPTER 4

SPEECH DISORDERS

Each of these four aspects of human speech has its own criteria of normality, and each has a range of acceptable differences. The s sound in Sue
is not the same sound as it is in the word see; it is lower in pitch, but this
variation is within normal limits. But when that s is too slushy as in a person with a lateral lisp we would diagnose abnormality. A difference to be a
difference must make a difference. If it calls attention to itself; interferes
with the receiving of the message, or is unpleasant to the speaker or his
listener, we then have a speech problem.
One of the common mistakes made by beginners in this field is the
failure to scan all these four features of the speech of a person who obviously has some communicative abnormality.
I learned another lesson today and I don't know why it took me so long.
I have been working with a junior high school boy whose speech is full
of distorted speech sounds due to the fact that he keeps his tongue flat
in his mouth. Often he is unintelligible. Yet he could make every sound
perfectly in isolation and often in single words if I said them first. Well,
I began therapy by working to mobilize the lifting of the tongue tip and

to disassociate it from any jaw movement and by stimulating him

strongly with the sounds on which the distortions occurred. He was immediately successful in anything I asked him to do yet there was no transfer into real communication. Then just by chance I happened to overhear

him talking to a girl in the hall and saw him have a severe stuttering
block, so of course we discussed this at our next session. Come to find
out, he doesn't have any articulation problem at all. He just uses this kind
of speech as a way to keep from stuttering. Says he's only been using it
for a few months and that though it helped at first because it was so novel
and distracting, it was beginning to lose its effectiveness. After he told

me this I realized that I had noticed many hesitations and gaps in his
speech but had ignored them. The abnormal articulation had just been
too conspicuous. Anyway, now we can begin to tackle the real problem.

Experienced speech pathologists do not make this mistake. Their

diagnostic computers do not stop until they have scanned enough speech
samples for deviancy not only in articulation but in voice, fluency, and language. They know the normal ranges of variation for each, and bells ring
in their heads when they discover speaking behaviors that go beyond these
boundaries.
Educators, counselors, health service providers, and other professionals who interact with individuals who may have communication disorders
also must be alert to the necessity for recognizing the multiple aspects of
speech that can show deviancy. The patient with Parkinson's disease who
has difficulty with articulation often will be experiencing significant voicing problems as well. A child who is deaf, deafened, or severely hearing
impaired will show not only articulatory errors, inappropriate vocal inflections, or a monotonous voice; he also often may have a language disability or the rhythm of his fluency will be broken by pauses in the wrong

ARTICULATION DISORDERS

parts of a sentence. Similarly, the person with cerebral palsy may show de-

viancy in all four features. So may the child with mental retardation. The
emotionally disturbed child may present the picture of a strange voice

quality along with infantile kinds of articulatory errors. Although the

speech of a child with a cleft palate is often conspicuously nasal, he will
also tend to show speech sound errors, one of which may be the use of
the glottal stop (similar to a tiny cough) for his k sounds. It is not enough
merely to recognize that a person does not speak normally. We must know
what features of the speech are abnormal.
Moreover, it is not enough merely to recognize that the deviancy exists in articulation, voice, fluency, or language. We must be able to analyze
that deviancy so as to identify exactly what makes the speech conspicuous,
hard to understand, or unpleasant. If a person has an articulation problem, we must know what sounds are produced incorrectly, for all of them
are not defective. If the voice is abnormal, the speech pathologist will survey the pitch, loudness, and vocal quality aspects of that voice before ze-

roing in on the targets for therapy. It is not enough just to say that the
person stutters, for there are literally thousands of different stuttering behaviors, though certain ones are demonstrated most frequently. If a person is aphasic (dysphasic is the more precise word), the language disability
must be carefully analyzed if it is to be remedied.
In this chapter we present only the salient symptoms of the four major
disorder categories. A more complete discussion of tile various disorders
will be found in subsequent chapters.

ARTICULATION DISORDERS
How does one learn to do diagnostic analyzing? The answer lies in training and experience. A speech clinician must acquire habits of careful listening and systematic observation. We begin your training by providing
some brief word pictures of individuals with disorders of articulation.
When we first heard Lori's rapid unintelligible chatter, we suspected for
a moment that she might be speaking a foreign language. At the end of
a torrent of strange staccato syllables, all accompanied by seemingly appropriate gestures and vocal inflections, she looked at us expectantly for

a response. When we just scrutinized her quizzically, she frowned

slightly, sighed, and repeated her message in a slower but still incomprehensible manner. Showing the first-grader some pictures, we asked her
to name them one at a time. Recording her responses, we then asked Lori
to repeat words and short phrases and describe objects in the room. Later

analysis showed that she produced all the vowel sounds correctly but
substituted t, d, and n for all other consonants except the h. An interview
with Lori's mother revealed that the youngster had been chronically ill

113

CHAPTER 4 SPEECH DISORDERS

with respiratory ailments during her first three years. Also, she was
overindulged by older siblings who had learned to interpret the child's
defective speech. We enrolled Lori in the clinic, enlisted the aid of her
parents and older sisters, and gave her intense daily speech therapy. By
the end of the school year, she was using all speech sounds correctly
but still inconsistentlyexcept s, r, and 1.

When Craig came to the speech clinic, he was hurt and angry. A sophomore majoring in broadcasting, he had been dispatched posthaste to the
clinic by the director of the university radio station. During his radio au-

dition, Craig's strident s sound caromed the sensitive VU meter into

overload. As far as we could discern, no one had confronted him about
his sharp sibilants before his audition. This seemed astounding since we
found it difficult not to wince when working with him in a small treatment room. A glib, fluent speaker, he had decided while still in junior
high school to pursue a career in radio. Now he found his path blocked
and he was bewildered and hostile. After utilizing the first few sessions
for emotional ventilation (catharsis), we showed Craig how to make the
s sound while anchoring his tongue tip below his lower teeth. When he
combined this new articulatory placement with a more relaxed posture
of his lower jaw, the strident s disappeared. Once he was able to make the
new sound and compare it with his old sharp whistle, Craig's motivation
zoomed. He practiced incessantly, and when he returned for a second audition at the end of the semester, he passed easily.

We do not wish to leave the impression that disorders of articulation

present little difficulty to the clinician. Some of them have been our
toughest cases. Somehow we remember our failures much more vividly
than we do our successes. They haunt us. What did we do wrong or what
did we fail to do? One of them was Joe.
Joe was in the fifth grade when we first worked with him. Only one of
his sounds was defectivethe vowel r sound as in fur. He was able to
make the consonantal r perfectly, articulating it correctly whenever it occurred as the initial consonant of a syllable. He could say "run," "radio,"

or any other word beginning with r without error. Even the consonant
blends, pr, t, gr, and so on were uttered normally. But when the r occurred as a vowel as in church, he said "chutch." He said "theatuh,"
"mothuh," "guhl." When the r was part of a diphthong as in ar, or, ir,
not only was the r distorted but the preceding vowel was often misartic-

ulated. Instead of "far," he said "foah," and in these distorted diphthongs we heard sounds that we had never heard before. We worked hard

with Joe and initially felt that the prognosis was good, that we could
probably effect a transition from the consonantal to the vowel r with
ease. We failed completely. He tried and we tried with all our might. We
used every technique known to us. We vainly explored every possible reason for the persistence of the errors. We tried different clinicians. They
failed. When Joe was a senior in high school we tried again with the same
result. We still wonder what else we might have done.

ARTICULATION DISORDERS

115

As we have seen from our scrutiny of the preceding examples, the

basic problem shown by a person with a disorder of articulation is that he

has failed to master the speech sounds of his language. Each of these three
persons could be characterized as having a phonological (articulatory) disorder rather than one of voice or of fluency or of symbolization. Although

they differed one from the other in the pattern of their errors, they all
showed one or more of the following types: (1) a substitution of one standard English phoneme for another (2) a distortion of a standard sound,

(3) an omission of a sound that should be present. Some authorities

include additions (the intrusion of an unwanted sound) as another type
of articulatory disorder; in our experience, additions are generally the
result of emphasis ("p uhlease close that door!") or idiosyncratic pronunciation ("I need some filum to take photographs of the athuhletes by the
elum tree.").
Most young children during the course of their speech development
show all these articulatory disorders at one time or another, but some children persist in their usage, having failed to perceive the contrasting features of the correct sound as compared with the defective one, or having
been unable to achieve its correct production.
While we defer our discussion of the causes of articulation disorders
until later (Chapter 6), there are two basic categories or types of impairments we should mention immediately: phonetic disorders and phonological disorders.

In the case of phonetic disorders, the individuals are unable to produce certain speech sounds correctly because of structural, motor, or sen-

sory impairments; they have organic abnormalities that limit their

speaking capabilities. In our present clinic caseload we have two clients
with phonetic errors:
Seven-year-old Cindy has a rare hereditary skin disorder that is atrophying her lips, tongue, and soft palate. Almost all speech sounds are difficult for her to produce, but she has particular difficulty with s, 1, r, and
sb and ch, k, and g. Her clinician is attempting to teach the child to slow
her rate of speech and use compensatory oral movements to articulate
the defective sounds.

By the time the physicians diagnosed his chronic and progressive muscular weakness as myasthenia gravis, Cliff Harris had to retire early from
his position as high school English teacher and debate coach. He tires

easily, talks in a soft nasal voice, and misarticulates most tongue-tip

sounds. Mr. Harris is trying to learn to speak in short phrases, pause, and
then continue. When he does this his speech is more intelligible,

Many children have phonological disorders of articulation (formerly

termed functional, dyslalic, or habit errors). They misarticulate for no apparent organic reason. Although most of these youngsters can produce all
the sounds of English speech, they seem to simplify the adult pattern or

Omission.
One of the four types
of articulatory errors.
The standard sound is
replaced usually by a
slight pause equal in
duration to the sound
omitted.

Atro h
A withering; a shrinking
.

in size and decline in

fi.inction of some bodily
or organ

Myasthenia gravis.
Chronic neuromuscular
disorder characterized
by progressive
weakening of
musculature without
atrophy.

CHAPTER 4 SPEECH DISORDERS

it with a contrived system of their own. They use phonemes differently. Interestingly, however, a careful analysis of their sound errors
generally reveals an underlying system or set of rules by which they organize their repertoire of phonemes. Here is a portion of a student clinician's
report on an eight-year-old child that illustrates a developmental disorder
of articulation:
replace

Lance has inconsistent errors on 1, r, s, sh, j v, th, k, and g. He can produce each of the phonemes correctly by imitating the examiner's model.

In spontaneous speech, however, he omits or substitutes other sounds

for the phonemes listed in a seemingly random fashion. But he does appear to use a system for organizing his complement of speech sounds.
His use of the s sound is typical of his misarticulation. When s begins a
word, Lance substitutes the tsound ("toup" for "soup"); in words such
as "basket," where s is in the medial position, he replaces it with the th
("bathkit"); for plurals, he omits the s. Interestingly, he substitutes s for
sh when the latter sound occurs in the initial position.

Children with phonological disorders do not have "broken-down"

patterns of sound production. On the contrary, they appear to have coherent strategies that guide their use of speech sounds; quite often these
strategies evolve from the simplification techniques used by very young
children who are learning to speak.
At this point we must remind ourselves that cultural and linguistic diversities abound in our nation. Standard American English is by no means

the only dialect encountered by the speech-language clinician; and, although users of other dialects may elect to work on altering their speech
patterns, the original pattern is not viewed as a disorder. The individual's
background must be taken into account in the assessment of phonology.

Medial.
The occurrence of a
sound within a word

but not initiating or

ending .
Nasal emission.
Airflow through the
nose, especially during
production of oraJ
consonants.

For example, if members of a child's speech community consist of individuals who are bilingual Spanish and English and the variety of English
spoken in the child's community is Black English Vernacular (BEV), then
the child will most likely speak. . . English which (is) influenced by BEV
and Spanish. . . . Information on the characteristics of particular languages and dialects, together with information on normal phonological
development can provide information for.. . differentiating children
with dialectal differences from those with phonological disorders (Iglesias and Anderson, 1993, p. 147).
.

Even though we have described phonetic and phonological disorders

as distinctly different types of articulation disorders, there can be a great

deal of overlapping. A child born with a cleft palate may be unable to produce certain phonemes correctly because air leaks through his nose (nasal
emission) when substantial oral air pressure is required. The same child
may have other phonemic errors that are unrelated to the cleft. The key
feature of all articulatory disorders is the presence of defective and incorrect
sounds.

ARTICULATION DISORDERS

Most people with articulation disorders have more than one error
sound and are not always consistent in their substitutions, omissions, or
distortions. This is not always the case, however. Thum lingual lithperth
merely thubthitute a th for the eth thound. Othersh shkwirt the airshtream
over the shide of the tongue and are shed to have a lateral lishp. Others
thnort the thnound (nasal lisp). Many children have been known to buy
an "ites tream toda" or an all-day "tucker."
People sometimes tend to regard articulatory errors as being cute and
relatively unimportant. This view is unlikely to be shared by those who
have such disorders, particularly if the problem is severe, as they seek to
cope with even the simpler demands of modern life. We knew a woman
who could not produce the s, 1, and r sounds and yet who had to buy a
railroad ticket to Robeline, Louisiana. She did it with a pencil and paper.
A man with the same difficulty became a farmer's hired hand after he
graduated from college rather than suffer the penalties of a more verbal
existence. Many children are said to outgrow their defective consonant

sounds. Actually, they overcame them through blundering methods

of self-help, and far too many of them never manage the feat. One man,
aged sixty-five, asked us bitterly when we thought he would outgrow his
baby-talk.
Misarticulations can cause a great deal of difficulty in communicating. Mothers cannot understand their own children. Teachers and classmates fail to comprehend speech when it is too full of phonemic errors.
Try to translate these familiar nursery rhymes:
Ha ta buh, Ha ta buh,
Wuhnuh peh, two uh peh,
Ha ta buh.
Tippo Tymuh meh a pyemuh,
Doh too peh,
Ted Tippo Tymuh to duh pyemuh
Yeh me tee oo weh.
("Hot Cross Buns" and "Simple Simon.")

Many children who are severely handicapped by unintelligible speech

also find it very difficult to express their emotions except by screaming or
acting out their conflicts. Most of us relieve ourselves of our emotional
evils by using others as our verbal handkerchiefs or wastebaskets. We talk
it out. But when a child runs to his mother crying "Wobbuh toh ma tietihtoh" and she cannot understand that Robert stole his tricycle, all he can
do is fling himself into a tantrum. The same frustration results from his
inability to use speech for self-exhibition. Often penalized or frustrated
when he tries to talk, he soon finds it better to keep quiet, to use gestures,
or to get attention in other ways. Some of the most handicapped people
we have ever known were those who could not speak clearly enough to be
understood.

Ill

CHAPTER 4 SPEECH DISORDERS

FLUENCY DISORDERS
While all of us hesitate and bobble at times, someone whose speech habitually shows abnormal interruptions in the form of hesitations, repetitions, or prolongations may be diagnosed as having a fluency disorder.
About two million persons in this country suffer from disorders of fluency,
primarily from the disorder called stuttering. Severe stuttering may be very
conspicuous, and certainly it can be very distressing. 'When the flow of
speech is excessively fractured, its meaning is hard to grasp. The contortions and struggling, the backing up and starting again, the prolongations
of sounds, the compulsive repetition of syllables, and the difficulty in initiating utterances bother both the speaker and the listener alike.

Stuttering
It is difficult to find "typical" illustrations of this disorder since it is characterized by a high degree of variability. Nevertheless, some examples may
be informative.

By the time Cohn's parents brought him to the speech clinic, the
frequency of the child's speech interruptions exceeded the limits of
normalcy for three-year-old children. The upsurge of disfluency began,
according to his parents, three months before, on an extended family
trip to attend a fi.rneral and to settle a rancorous probate dispute. Prior

to that time, Cohn had been considered a normal, even a superior

speaker. In fact, the child talked so well and was so skilled at echoing

adult speech, his parents had often amused relatives and guests by
having the child repeat polysyllabic words. Although the speech breaks
seemed to come and go in waves, in the past few weeks Cohn's disfluency had become more chronic. Our examination revealed that Cohn
was repeating whole words and syllables, and that these speech bobbles

occurred more than fifty times in a thousand words. Most of the

repetitions took place at the beginning of an utterance. For example,
he uttered the word "I" (he was asking for a toy) with ten repetitions;
the tempo of the iterations was irregular. We noted also that the child
seemed to prepare himself to speak by uttering two or three "urns";
sometimes this preparatory set (utterance) was accompanied by several tiny inhaled gasps. Cohn prolonged sounds. Once he said "mmmmmmc" and held on to the m for about 2 seconds. We detected a slight
upward shift in pitch on one of his prolongations. We recommended
that the child be accepted for therapy and that his parents receive counseling.

Preparatory set.
An anticipatory
readiness to perform an

. .

Shawn was referred to the clinic by a public school speech clinician. Here

is a portion of the clinician's report: "This nine-year-old child is having

real troubles in her third-grade classroom. She has a severe fluency problem. Her stuttering is characterized by long silent blocks (as long as 10
seconds) and audible prohongations of sounds. During the longest of her

FLUENCY DISORDERS

119

blocks, there is a tremor of the lower lip and chin. To terminate a fixa-

tion, she first clicks her tongue and then blurts out the word with a sudden surge of force. During the utterance she also blinks her eyes. She
speaks and reads aloud very slowlyless than forty words per minute.

When I talk with her, her most common response is 'I don't know.'
When I do press her for a reply to my question, she lowers her head, fixes

her eyes on the floor, and begins to cry. She is very quiet in the classroom, but her teacher says she does well on written work. Some of the
children have teased and mocked her in the halls and during recess. She
prefers to spend recess and lunch hour with the teacher. Shawn's mother
reports that the child spends a great deal of time alone in her room talking with her dolls. Apparently she is fluent in this situation."
Barry, a high school senior, was one of the most severe stutterers we have

seen. His speech was filled with rapid, explosive repetitions of sounds
and syllables; the speech interruptions were accompanied by head jerks
and a violent backward thrust of his upper body. He refused to give up
a speech attempt. In a highly compulsive manner he would repeat a
sound or syllable over and over until finally a fractured, grotesque version of the word emerged. For example, Barry attempted to say the word
"Friday" in the following manner: the word was broken into four syllables, "fruh-high-un-day"; we counted forty-six repetitions of the first
three syllables ("fruh-high-un), and it took him 27 seconds and three
complete breath cycles to add to the last syllable. Almost immediately he
plunged back into the word with a somewhat shorter but similar result.
Barry's conversational speech was judged to be unintelligible. The only
avoidance he seems to use is the phrase "Let's see," which he employs to
start an utterance. He displayed open hostility toward the listener and on
several occasions has been involved in fights at school and in his neighborhood.

In considering this disorder of fluency, let us observe its various aspects. Stuttering shows breaks in the usual time sequence of utterance.
The usual flow is interrupted. There are conspicuous oscillations and fixations, repetitions, and prolongations of sounds and syllables. There are
gaps of silence that call attention to themselves. If you ask a question, the
answer may not be forthcoming at the proper time. Stuttered speech
sometimes seems to have holes in it. Some sounds are held too long. Syllables seem to echo themselves repeatedly and compulsively. Odd contortions and struggles occur that interfere with communication and the
person who stutters may show marked signs of fear or embarrassment.
Stuttering fits our definition because this behavior deviates from the
speech of other people in such a way that it attracts attention. All of us
hesitate and repeat ourselves, but the person who stutters hesitates and repeats differently from us, and more often.
One of the interesting features of stuttering is that it seems to be a disorder more of communication than of speech. Most people who stutter can
sing without difficulty. Most of them speak perfectly when alone. Usually,
it is only when they are talking to a listener that the difficulty becomes ap-

Tremor
The rapid tremulous
vibraxion of a muscle

group
FixatIon.
In stuttering, the
prolongation of a
speech posture.

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CHAPTER 4

SPEECH DISORDERS

parent. Stuttering varies with emotional stress and increases in situations

invested with fear or shame. When very secure and relaxed, they often are
very fluent. In extreme cases even the thinking processes seem to be affectedbut only when they are thinking aloud, and again in the presence
of a listener. The intermittent nature of the disorder is not only extremely
unsettling for the speaker, it is also astonishing for family and friends.
Stuttering takes many forms; it presents many faces. The only consistent behavior is the repetition and prolongation of syllables, sounds, or speech
postures. It changes as it develops, for stuttering usually grows and gets
worse if untreated.
At the outset, generally around two and a half to four years of age,
the child's speech is broken by an excessive amount of repetitions of syllables and sounds or, less frequently, by the prolongation of sound. He
does not seem to be aware of his difficulty. He does not struggle or avoid
speaking. He does not seem to be embarrassed at all. Indeed he seems al-

most totally unconscious of his repetitive utterance. He just bubbles

along, trying his best to communicate. In many instances, it appears as if
the child's need to talk exceeds his maturational capacity to coordinate
thoughts and motor speech skills. An excerpt from a parent's letter may
illustrate this early stuttering.
I would appreciate some advice about my daughter. She is almost three
years old and has always been precocious in speech. Four weeks ago she
recovered from a severe attack of whooping cough, and it was immediately after that when she began to show some trouble with her speech.
One morning she came downstairs and asked for orange juice, and it
sounded like this: "Wh-wh-wh-where's my orange juice?" Since then,
she has repeated often, and sometimes eight or nine times. It doesn't
seem to bother her, but I'm worried about it as it gets a lot worse when
she asks questions or when she is tired, and I'm afraid other children will
start laughing at her. One of her playmates has already imitated her several times. No one else in our family has any trouble talking. What do
you think we should do? Up to now we have just been ignoring it and
hoping it will go away.

In some instances it does go away; apparently many children do seem

to outgrow stuttering. Unfortunately, other youngsters, however, neither

outgrow the problem nor does the stuttering remain so effortless. The
child begins to react to his broken communication by surprise and then
frustration. The former effortless repetitions and prolongations become
irregular, faster, and more tense. As the child becomes aware of his stuttering and is frustrated by it he begins to struggle. Finally, he becomes
afraid of certain speaking situations and of certain words and sounds.

Once this occurs, stuttering tends to become self-penetrating, selfperpetuating, self-reinforcing. The more he fears, the more he stutters,
and the more he stutters, the more he fears. He becomes caught in a
vicious circle.

FLUENCY DISORDERS

121

In the older person, stuttering occurs in many forms, since different

individuals react to their speech interruptions in different ways. One German authority carefully described ninety-nine different varieties of stuttering (each christened with beautiful Greek and Latin verbiage), and we
are sure that there must be many more. Individuals who stutter have been
known to grunt or spit or pound themselves or protrude their tongues or
speak on inhalation or waltz or jump or merely stare glassily when in the
throes of what they call a "spasm" or a "block." Some of the imitations of
stuttering heard in the movies and on radio may seem grotesque, yet the
reality may be even more unusual.
Some develop an almost complete inability to make a direct speech attempt upon a feared word. They approach it, back away, say "a-a-a-a" or
"um-um-um," go back to the beginning of the sentence and try again and
again, until finally they give up communication altogether. Many become
so adept at substituting synonyms for their difficult words, and disguising
the interruptions that do occur, that they are able to pose as normal speakers. They have preached and taught school and become successful traveling salesmen without ever betraying their infirmity, but they are not happy
individuals. The nervous strain and vigilance necessary to avoid and disguise their symptoms often create stresses so severe as to produce profound emotional breakdowns.
This general picture of stuttering gives you an overview of the disorder, but it does not show you how a speech pathologist would analyze the
problem of a specific client. First she would ask the question, "What behaviors does this person show that are unlike those of a normal speaker?"
She would be interested in the overt, visible, and audible manifestations
of the problem such as repetitions, prolongations, tremors, inappropriate
mouth postures, or abnormal foci of tension. She would note how the
stutterer avoids or postpones the speech attempt. She would try to determine how the person seeks to release himself from the verbal oscillations
and fixations that break up the flow of speech. Through interview and ob-

servation the speech clinician would probe the stutterer's inner world.
What speaking situations are most feared? What words and sounds are
viewed as difficult? How much frustration does he feel? How much shame
and embarrassment? Is the disorder getting worse? How fluent can he be

in certain situations? These and a host of other questions and scannings

provide the diagnostic information needed to plan appropriate therapy.

Cluttering
Cluttering is a fluency disorder that is often confused with stuttering, but
there are some major differences. People who clutter also have breaks in
fluency, but they repeat words rather than syllables or sounds. They show
few prolongations, few tremors, and rarely any of the tension and struggle that characterizes stuttering. Also they have no fears of words, sounds,

Cluttering.

A disorder of time or
rhythm characterized
by unorganized, hasty
spurts of speech often
accompanied by slurrec
articulation and breaks
in fluency.

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CHAPTER 4

SPEECH DISORDERS

or speaking situations, and indeed have little awareness that their speech
is disrupted. Most striking, however, is the very rapid rate of their utterances (tachylalia). They speak in torrents, their words stumbling over
each other so that listeners just cannot understand much of.what they are
trying to say. Perhaps because of this excessive speed, speech sounds and
entire syllables are often omitted or distorted, a feature that again affects
intelligibility. Speech occurs in spurts rather than continuously, and sentence structure may be disorganized. Nevertheless, and curiously, individuals who clutter typically seem unaware of and largely indifferent to, their
speech. Very few refer themselves to the speech pathologist because of
cluttering, but their teachers and employers certainly do and treatment is
often difficult.
Ralph was referred to us as a stutterer by his industrial education supervisor during his semester of student teaching. When we examined him,
he revealed no fears or avoidances, exhibited only a few part-word repetitions, and had no fixations; he said he enjoyed talking, did a lot of it,
and that he was asked frequently to repeat himself, "especially when I
talk fast." Ralph's difficulty seemed to take place on the phrase or sentence level; his interruptions broke the integrity of a thought rather than
a word. In addition, he frequently omitted syllables and transposed words
and phrases: he said "plobably," "posed," and "pacific" for "probably,"
"supposed," and "specific." Ralph's speech was sprinkled with spoonerisms (he said "beta dase" for "data base") and malaproprisms (he said he
was under the "antiseptic" for two hours in a recent operation and that

the students had made him so angry it got his "dandruff" up). His
speech was swift and jumbled; it emerged in rapid torrents until he
jammed up and then he surged on again in another staccato outburst. In
spontaneous talking, his message was characterized by disorganized sentences and poor phrasing. He gave the impression of being in great haste.
When we asked him to slow down and speak careftilly, there was a dramatic improvement, but he soon forgot our admonishment and reverted
to the hurried, disorganized style. Ralph was an impatient, impulsive
young man, always on the go. His college coursework was characteristically done in a rush; he had difficulty reading and his handwriting was a
scrawl.

Many clinicians suspect that cluttering may be one symptom of a central

language disturbance or learning disability, citing the difficulties their clients

often have with reading, writing, spelling, and other language-dependent

skills. Cluttering also tends to run in families, suggesting a possible genetic
basis for the disorder. Pointing to the occurrence of mixed laterality, brainwave irregularities, and deficits in auditory functioning, some authorities
speculate that minimal but diffuse brain dysfunction may be involved.

Although our understanding of the cause of cluttering is limited,

Tachylaha
Extremely rapid speech

we can offer a rather comprehensive description of the disorder The most

salient feature is, of course, pell mell, sputtered speech We include here a
comprehensive list of symptoms associated with the disorder. The items

VOICE DISORDERS

indicated with an asterisk are the essential features for a diagnosis of clut-

tering; the remaining symptoms may or may not be present.

* 1. No seeming awareneSs of the excessive speed or garbled utterance;

no fears or avoidance.
2. Speech characterized by
*_rapid and irregular rate
*_disorganized sentence structure
*_articulatory imprecision or slurring
*_repetitions of whole words and phrases
scoping (compressing two or more words into a holistic utterance, e.g., "she's expecting" becomes "shezezptn")
spoonerism (transposition of sounds of two words, e.g., "darn
bore" for "barn door")
malapropism (incorrect use of words, e.g., "sales will rise for a
while and then reach a platitude")
restricted vocabulary, redundant utterances, use of clichs
limited inflection, sometimes monotone voice
3. Reading problems (letter reversals, word emission)
4. Writing and spelling problems (both content and legibility)
5. Difficulty sustaining attention (some clients need to plan aloud,
repeating instructions to themselves several times)
6. Difficulty imitating musical notes or simple melody patterns; some
clients dislike or are indifferent to music
7. Personal characteristics: impulsive, careless, untidy, suggestible
8. Poor motor coordination
9. Case history revealing delayed speech and language development
10. Intelligence skewed toward arithmetical functions and skills requiring precision in nonverbal, concrete tasks

Since they are generally deficient in self-monitoring, persons who

clutter are difficult to treat. They are surprised when others cannot understand them. They can speak perfectly when they speak slowly, but it is
almost impossible for them to do so except for short periods.
The treatment of cluttering in school-age children requires the coordinated efforts of classroom teachers, learning disability specialists, and
speech-language clinicians. Early intervention is important because some
clutterers also become stutterers, although most do not.

VOICE DISORDERS
Except for instances in which the voice problem is sufficiently great to actually interfere with a speaker's intelligibility (or in which, for example, an
individual's larynx has been surgically removed, or when an individual for

I 23

CHAPTER 4 SPEECH DISORDERS

Falsetto.
The upper, highpitched register of
voice; produced with
stretched, thinned vocal
folds; also known as

other reason is not producing phonation at all), voice disorders are

not necessarily easily identified or defined. The voice that "calls attention
to itself" is not always perceived as a problem by either the speaker or the
listener. On the other hand, a voice that is perceived by the typical listener
as a relatively pleasant voice can be causing legitimate distress for its owner.
Diagnostic and treatment decisions relating to voice are even further
confounded by many other considerations that we will begin to explore in
Chapter 9. For now, we will simply note that the range of variation regarded as "normal" tends to be greater for vocal characteristics than for
articulatory, fluency, or linguistic features of speech.
When speech pathologists become convinced that the speech impairment does involve voice (other than the voice loss associated with laryngectomy, which necessitates the utilization of some form of alaryngeal
speech), they carefully scrutinize the client's voice for deviancy in pitch,
loudness, or quality. They recognize that this simple three-dimensional
analysis merely begins to scratch the surface and that a voice evaluation involves many other types of observations. We will need to know, for example, if the voice disorder (dysphonia) has some organic or neurologic
cause and if medical or surgical treatment is warranted, or if the disorder
seems instead to be a functional problem.
Nevertheless, one or more of these three basic features can show significant differences from the normal range of variation, and it is impor-

loft register.

tant to describe and define such differences as clearly as possible.

Inflection
Upward or downward
change in pitch of the
voice during a
continuous phonation.

Moreover, pitch, loudness, and quality, plus alaryngeal speech, afford us a

useful framework for our first glance at voice disorders.

some

Alaryngeal speech.
Speech in which a
sound source other
than the larynx is used
in place of normal
voicing

Monopitch.
Speaking in a very
narrow pitch range,
usually of one to four,
semitones.

Pitch break
Sudden abnormal shifi
of pitch during speech.
Diplophonia.
Voice in which two
separate tones are
present simultaneously;
associated with
laryngeal pathology,

Deviations of Pitch
The normal range of pitch vanations depends upon sex, age, and several
other factors. The voices of men are generally lower in average pitch than
are those of women. A deep-voiced male would have no voice disorder; the
women who speaks with a bass voice is conspicuous. A six-year-old boy
with a high-pitched treble voice would incur no penalty from society; a
thirty-year-old man would find raised eyebrows if he began to speak in
such tones. Under conditions of great excitement, many of us have voices
that crack or show pitch breaks. But when an adult shows pitch breaks upward into the falsetto register when he orders a hamburger or says goodbye, we suspect the abnormal. There are times when it is appropriate to
speak with a minimum of inflection, but a person who consistently talks on
a monopitch will find his listener either irritated or asleep. In deciding
whether a person has a pitch disorder we must always use the normal yardstick.

This discussion has anticipated our listing of the pitch disorders. They
are as follows: too-high pitch, too-low pitch, monotone or monopitch, pitch
breaks, stereotyped inflections, and diplophonia.

VOICE DISORDERS

125

The following description was uttered by a 200-pound football player

in his high, piping, shrill, child's voice:
Yes, I was one of those boy sopranos and my music teacher loved me. I
soloed in all the cantatas and programs and sang in the choir and glee
clubs, and they never let my voice change. I socked a guy the other day
who wisecracked about it, but I'm still a boy soprano at twenty-two. I'm

getting so I'm afraid to open my mouth. Strangers start looking for a

Charlie McCarthy somewhere. I got to get over it, and quick. Why, I
can't even swear but some guy who's been saying the same words looks
shocked.

The falsetto register used by this tortured young man involves more

than simply a high pitch. Falsetto voice is produced with laryngeal

adjustments that are different from the adjustments of the modal register in which we typically speak. In falsetto, our vocal folds are stretched
long and thinly, and they vibrate in a fashion that differs markedly from
the vibrations seen in modal register. When heard in the adult male, the
high pitch of falsetto voice turns the heads of anyone within earshot.
Some of our more troubled voice clients have been postadolescent males
who told us that their voices never changed at puberty. Very rarely is
there any physical cause, however, and therapy basically requires that we
show them how to find the correct laryngeal adjustment for producing
their true and mature voices. A high-pitched voice in th male, falsetto
or otherwise, can definitely be a handicapcommunicative, economic,
and social.
An excessively low pitch in the male voice also can be problematic,
particularly when it is used forcefully to convey the "voice of authority,"
although initially it may only damage the tissue of the larynx and contribute to the possible development of a contact ulcer.
Another interesting pitch issue that sometimes is seen in the clinic
today is that of the transsexual person who is undergoing the process of
gender reassignment. Pitch modification is only one of several aspects of
speech that can help a former male sound more feminine (or vice versa),
but it usually is a major concern for these individuals.
. .
A woman's high-pitched voice (even, unfortunately, when it is an optimal pitch for her larynx) also is viewed too often as detrimental. A re-

Manner of adjustment
of the larynx for voice
production (e.g.,
falsetto register, modal
or chest register).

cent "how to succeed" article in a women's magazine irresponsibly

advised its readers that the typical woman, to command respect, must

Contact ulcer.

"lower the pitch of her speaking voice by one full octave." And we have
had more than one female broadcaster request therapy to lower an already
quite appropriate speaking pitch. Small wonder, then, that some women

may abuse their voices while tryingeither consciously or subconsciouslyto alter their pitch levels toward a stereotypical, unrealistic vocal

"standard."
At the other extreme, if the female voice has been forced to an excessively low pitch level, or if her pitch level is unusually low due to physical

Register.

Modal register.

The manner of
laryngeal adjustment
and vocal fold vibration
used to produce voice
in normal speech;
sometimes referred to
as chest register in
singing

Small lesion on the

posterior medial edge
of the vocal fold; may
be caused by reflux of
stomach acids or
abusive use of the
voice.

126

CHAPTER 4

SPEECH DISORDERS

conditions such as hormonal imbalance, she also may express concern.

And we may agree that she has reason for concern.

When a woman's voice is pitched very low and carries a certain type
of male inflection, it certainly calls attention to itself and causes maladjustment. The following sentence, spoken by a casual acquaintance and
overheard by the girl to whom it referred, practically wrecked her entire
feelings of security: "Every time I hear her talk I look around to see if it's
the bearded lady of the circus."
The use of an excessively low pitch level in speaking, whether by a
woman, man, or child, often is accompanied by frequent lapses into the
vocal fry register of phonation. Vocal fry (sometimes called "glottal fry"

or "dichrotic dysphonia" or "pulse register") is the very low-pitched,

crackly, ratchet-like sound that can contribute to our perception of roughness, harshness, or hoarseness in a voice. Often it reflects simply a functional misuse or abuse of the voice, and it can help us identify habitual use
of a pitch level that is too low for the individual even if it is not exceptionally low relative to group averages. But its presence also can be one
sign of a potentially serious health condition such as hypothyroidism.
On every campus some professor possesses that enemy of education,
a monotonous voice. A true monotone is comparatively rare, yet it dominates any conversation by its difference. To hear a person laugh on a single note is enough to stir the scalp. Questions asked in a true monotone

seem curiously devoid of life. Fortunately, most cases of monotonous

voice are not so extreme. Many of them could be described as the "poker
voice"even as a face without expression is termed a "poker face." Inflections are present, but they are reduced to a minimum.
By stereotyped inflections we refer to the voice that calls attention to
itself through its pitch patterning. The sing-song voice, the voice that ends

Glottal ,
A low-pitched tickerlike
continuous clicking

sound produced by the

vocal folds; also known
as voca.I ty and
pulse register.
Hypothyroidism.
Insufficient production
of hormone by thyroid
gland; can produce
fatigue and other
symptoms; may cause
voice problems,
especially in women.

every phrase or sentence with the same rising or falling inflection, the

"schoolma'am's voice" with its emphatic dogmatic inflections, are all

types of variation that, when extreme, may be considered speech defects.
Pitch breaks may be upward and downward, usually the former. The

adolescent boy, learning to use his adult voice, sometimes experiences

them. Often they can be very traumatizing. To have your voice suddenly
flip-flop upward into a falsetto or child's voice is to lose control of the self.
When you want to speak you don't wish to yodel. Often individuals who
fear this experience use a monopitch or too low or too high a pitch level

to keep the flip-flopping from occurring. Pitch breaks can define the
speaker as one who cannot control himself or who is very emotional. They
often interfere with the person's ability to think on his feet, since he must
forever be monitoring his voice. They may sound funny to others, but we
have not found them so.
A curious pitch disorder, usually but not always organic, is found in
diplophonia. The person uses two pitches at the same time, producing a
voice that is very noticeable. We wish we could play for you a tape that

VOICE DISORDERS

I 21

would demonstrate it. One of our clients developed diplophonia as the resuit of having discovered that she could speak in a deep bass by adjusting
her larynx in a certain way. She played with this deep voice, shocked her

roommates in the shower or bedroom, and generally used it for kicks.

Then she found that she could use both her normal voice and the deep
voice at the same time, even being able to sing tunes in harmony with herself. About the time that she had decided to use it to go into show busi-

ness, she found that she could no longer shift back and forth at will

between the two voices but instead had the double voice, the diplophonia, all the time. Terrified, she came to us for help.

Loudness Deviations
Most of us, if we have abused our voices by excessive shouting or yelling,
or have suffered from a severe cold or allergy, have experienced temporary
dysphonia. For a time we cannot talk loudly or can speak only in a breathy
whisper. In the latter case, we can be said to have had aphonia, the complete loss of voice. In either case, our voices usually have recovered rela-

tively quickly, especially if we avoided placing heavy demands on an

unhealthy larynx.
Loudness deviations come in other forms as well. The basic loudness
level can be inadequate, as above, but a voice also can be too loud. The
voice can be lacking in loudness variability, making it seem as monotonous
as the voice that lacks appropriate pitch variability. Aphonia might occur
during only some portion of an utterance (for example, as a breath phrase
ends), but it also can occur rapidly and intermittently, virtually in spasms,
even within the confines of a single syllable.
When a client is chronically dysphonic in these or other ways, the job
of the speech pathologist can be quite challenging but also intriguing. The
skilled clinician will try to identify the causes of the dysphonia through in-

terviewing the client and try to sort out the predisposing from the precipitating causes, as well as identify the factors that may be maintaining
the disorder. Is there a long history of vocal abuse, of regularly having to
speak in an environment with high noise levels, of having to communicate

too often with a family member who has become deafened? Does the
client herself have any hearing impairments? Does the client have a long
history of chronic laryngitis? Is she a college cheerleader? How many cigarettes does she smoke each day? Has there been a history of previous loss
of voice and under what conditions? Speech pathology involves a lot of
detective work, and these questions are only a few of those that are helpful in understanding the nature of the problem.
Associated behavior also interests us. How does this person with dysphonia attempt the production of voice? We may observe his thyroid car-

tilage, (his "Adam's apple"), to see if it assumes the position for

swallowing at the moment he begins to phonate. We note any evidences

Breathiness.
Air wastage during
phonation; voice qualit
heard when the vocal
folds do not ifilly

approximate during thE

vibratory cycle.

CHAPTER 4 SPEECH DISORDERS

of excessive tension in the area of the throat. We look for the mistiming
of the breath pulse or for other breathing irregularities. And, knowing that
dysphonia may be one of the first signs of organic abnormalities, such as

growths on the vocal cords, benign or cancerous, or the reflection of

paralysis, the speech pathologist perhaps may save a life by insisting that
his client be seen by a laryngologist.
Many dysphonias, however, do not have such an organic pathology.
Our voices are the barometers or our emotional states. They reflect our feelings of anxiety, guilt, or hostility. When these acids begin to eat their human
containers too often, voice disorders may ensue. Here is an illustration:
For nine years since graduating from high school, Sgt. Maynard Gooch
enjoyed a tranquil life in the U.S. Air Force. He had had it made, he told
us in a strained whisper, as a clerk in the quartermaster's office. He relished the redundancy of the work and the secure certainty of military life.
It all changed drastically when Sgt. Gooch was awarded another stripe
for his sleeve and put in charge of twelve clerk-typist recruits. His new
job was to train and supervise the men. Apprehensive about the responsibility at the outset, the client's fears were soon realized when the recruits showed no respect for him or the work; and they simply did not
listen to Sgt. Gooch's patient pleading.
Several days later, the client woke up and discovered his voice was gone.
VVhen we examined him, he seemed strangely unconcerned, even serene.
"It's too bad," he whispered with a sad-sweet smile, "Now they will have

to put me back on my old job." Instead of being a problem, the client's

aphonia was a solution to a problem. It was easy to demonstrate that his
vocal folds were not impaired: When we asked him to cough and clear his

Laryngologist.
Physician specializing in
diseases and pathology
of the larynx; typically
an otorhinola,yngologist

'ENT

Functional.
Refers to a disorder that

has no organic cause;

may or may not be

'psychogenic"
Organic.
In the sense of
causation, refers to an
anatomic or physiologic
etiology,

throat, he produced a normal baritone voice. Clearly, his sudden loss of

voice had no physical basis, as reports from the Air Force medical officer
and psychiatrist confirmed. The psychiatrist requested that we restore the
client's phonation to facilitate individual and group psychotherapy. Using
throat-clearing, sighing, and humming, combined with strong positive
suggestion, we convinced Sgt. Gooch over several sessions that his larynx
was again ftinctioning normally. When we checked several weeks later, we

learned that the client had made small gains in psychotherapy, that he cxperienced no relapse or transfer of symptoms, and that he was happily employed as a private secretary to the chaplain.
.

Speech pathologists, as well as physicians, may use certain adjectives

before the term aphonia to indicate the presumed cause of the disorder.

In our preceding illustration, Sgt. Gooch might be said to have the hysterical type of aphonia because of its evident neurotic nature. Someone
whose loss of voice seemed to be due to vocal abuse and strain would have
a functional aphonia, but not a hysterical one. On the other hand, when

the loss of voice is due to paralysis or growths upon the vocal folds,
it would be called an organic aphonia or dysphonia, depending upon
whether the loss was complete or incomplete.

VOICE DISORDERS

129

Although clearly more than a "loudness deviation," we mention here

an unusual voice disorder that for many years bewildered physicians, psychologists, speech pathologists, and researchers, and that can severely disable the person who experiences it. Formerly known as spastic dysphonia
(and, by some early observers, as "laryngeal stuttering"), it is more often
called spasmodic dysphonia today. A person (somewhat more often fe-

male than male) with this problem may begin an utterance with a good
voice, then the laryngeal and throat muscles tense so tightly that the voice
comes out only spasmodically in small bursts of squeezed, strangled
sound, with intermittent total blockages of airflow. Or, in a variation of
this pattern, laryngeal muscles may slacken in spasms to the point that
voicing is intermittently absent with only whispered airflow being present.
Like stuttering, spasmodic dysphonia can vary in severity with cornmunicative stress. Persons with spasmodic dysphonia may briefly show
normal voicing in, for example, the quick, automatic utterance of an expletive, and there may be little or no interruption of phonation when they
sustain a vowel sound, especially at a high pitch level. Some can sing with
relative ease; others find the singing and speaking voice equally impaired.
Long regarded by many authorities as the reflection of a deep-seated
emotional disturbance, spasmodic dysphonia had been resistant to almost
any form of treatment until very recent years. It now appearsthat there
a probable neurological basis for most cases of spasmodic dysphonia,and

laryngeal dystonia is the term often applied. Now, through medical intervention combined with voice therapy (more about this in Chapter 9),
many with this disorder are able to be helped, although not cured.
Another voice problem, ventricular dysphonia, will be mentioned in
this section because the phonation can fade in loudness enough to impair
comprehension. With ventricular dysphonia, voicing is produced by vibration of the false or ventricular folds, which are located just above the
level of the true vocal folds. The sound often seems strangled and harsh,
and you may have unknowingly produced it yourself when straining and
grunting on the toilet or when lifting a heavy object. The experienced
speech clinician is cautious in accepting a quick diagnosis of ventricular
phonation, however, because it can be a misdiagnosis which arises when
a client's voice is badly dysphonic and, because of tense overcompression
of the false folds, the faulty action of the true vocal folds beneath them
simply has not been seen. In any event, ventricular dysphonia is fortunately very rarely encountered.

Voice Quality Deviations

Vocal quality or timbre varies a great deal from person to person. There
are about as many characteristic voice qualities as there are faces, which is
why it usually is so easy to identify a speaker by hearing the voice. It is ex-

ceptionally difficult, on the other hand, to describe voice qualities in

Spastic dysphonia.
Generally synonymous
with spasmodic
dysphonia, associated
with great strain and
effort in producing
voice; has been
referred to in the past
as 'laryngeal stuttering."

Spasmodic dysphonia
SD

spasmodic closures
(adductor SD) or
openings (abductor SD)
of the glottis during
phonation, causing

voice interruption; now

believed usually to
reflect the presence of
a focal laryngeal
dystonia.
Dystonia.
Abnormal muscle
tonicity due to
neurologic causes; may
cause spasms or
writhing movements.

Ventricular phonation.
Voice produced by the
vibration of the false
VOC
al f0IdS.

CHAPTER 4

SPEECH DISORDERS

words. Novelists have called voices thick, thin, reedy, shrill, sweet, rich,

brilliant, grating, and even metallic, but such adjectives are rarely used by
speech pathologists. Yet even the terms used by professionals are imprecise. Only a few of them are descriptive enough to have gained very wide
acceptance.
One of the exceptions is the voice quality termed hypernisality. The
lay person would say that a speaker with such a disorder seems to be talking through his nose too much. When most of the vowels or the voiced

continuant sounds (other than the nasal sounds, /m/, /n/, and /rj/)

Continuant.

A speech sound that

can be prolonged
without distortion, e.g.,
/5/ or /1/ or/u/.

Adenoids
Growths of lymphoid
tissue on the back wall

of the throat; also called

pharyngeal tonsils.

Harshness.
Voice quality usually
associated with
excessive laryngeal
tension.

have so much nasal resonance in them that the voice is conspicuously unpleasant, most speech pathologists would agree on the diagnosis of hypernasality. No one should have to whine when he passionately says "I love
you." Not all hypernasality gives the impression of whining, however. To
whine, you also usually show the upward inflection patterns of complaint
combined with the excessive nasality. And some of our clients, the more
neurotic ones who bathe constantly in self-pity, show this combination of
pitch and quality deviations. But there are others, as we have said, who do
not whine, yet show too much nasality.
In certain sections of this country there are dialectal ways of speaking
that show more nasality than we find generally. Providing the Hoosier
who speaks this way stays on his Indiana farm, he certainly would not possess any voice disorder at all, but he would have to reduce that nasality
were he to become an actor or radio announcer in some other part of our
land. (Again, we find the need always to define abnormality with reference to an individual's "speech community.") Persons from certain rural
parts of New England are also said to have a nasal twang that we would
hate to classify as abnormal. Indeed, most of this dialectal hypernasality
seems to be due to what is termed assimilation nasality, which refers to
the nasalization of only those sounds which precede or follow the /m/,
/n/, or /rj/. Most of us show some slight assimilation nasality in saying
such words as name, man, or mangle, the vowels being mildly nasalized.
Hypernasality is a quality commonly heard, too, in the voices of children born with cleft palates or with other impairments that make it diffi-

cult to shut the nasal cavity off from the rest of the vocal tract. Some
hypernasality normally may be heard for a few weeks following the surgical removal of adenoids; but if the nasal resonance is great and if it does
not subside, the surgery may be found to have "unmasked" a previously
unrecognized palatal insufficiency.
The onset of persistent hypernasality in adulthood should be investigated with great care, we must note, for it can be an early sign of neurological disease. At the same time, of course, we would not want to unduly
alarm anyone.
Another voice quality disorder that is fairly easily recognized is the
harsh or strident voice. People would describe it as raspingly unpleasant,

as "grating upon the ear." There is tension in it, an abrupt beginning of

VOICE DISORDERS

131 I

phonation, an unevenness rather than smoothness, and bits of that

scratchy noise called the vocal fry. Try speaking aloud very harshly to see

how well this description fits.

A third disorder of voice quality is the breathy voice. Hot Breath Harriet had one and used it as a Maine guide uses a birchbark horn to bring
a lovelorn moose to the gun. In our culture, for some esoteric reason, a
low-pitched husky voice in a woman sounds sexy to the vulnerable male,
even though it may merely be the result of asthma or a paralyzed vocal
cord or a postnasal drip. It certainly can call attention to itself and impair
intelligibility in a noisy environment.
These three, the hypernasal, the harsh, and the breathy voice, can be
labelled with some precision. But how about the hoarse voice? This quality has been defined as one that combines harshness and breathiness, and
therein may lie a source of some confusion. In producing harshness we introduce substantial laryngeal hypertension; in trying to make our voices
breathy, we must reduce tension sufficiently that the vocal folds will not
completely meet during the vibratory cycle. This will appear less contra:
dictory, though, if we remember that hoarseness can encompass a wide
spectrum of possible perceptual features and that it seldom occurs in the
absence of some vocal fold abnormality which alters the normal vibratory
pattern. The hoarse voice can be predominantly breathy with only mild
harshness, or the opposite can be true, as can any combination between

the two extremes. At any rate, you should know that when a person Voi fry
doesn't have the flu or a cold or allergy and yet has been hoarse for a
month, he or she should be referred immediately to a laryngologist because growths may be forming on the vocal folds or some other unpleasant consequences may lie in wait. Even when the hoarse voice is suspected
tobe the result of obvious vocal abuse and strain, it is a signal that something should be done.
Finally, we have the disorder of denasality, another one that is difficult to describe or define. Sometimes called the adenoidal voice because
it is characterized by a lack of nasality (hyponasality), when you hear it
you want to swallow or clear your throat and are impelled to get out of
range of suspected cold germs. Denasality has also been classified among

the articulation disorders because the /m/, /n/, and /ij/ lose some of
their nasality and turn into /b/, /d/, and /g/, respectively. And, of
course, assimilation nasality will be absent from this voice. If you will pretend that you have a very bad cold and say this sentence, you will proba-

bly show the picture of denasality: "My mother made me come home."
Chronically enlarged adenoids can be the cause of denasality (as well as
the cause of habitual mouth breathing), as can any other condition (nasal
polyps, for example) that blocks the nasal cavity from being opened posteriorly to the mouth and throat portions of the respiratory and vocal
tract. Denasality virtually always has a physical cause, however temporary
and fleeting it may be.

Low-pitched
continuous clicking
sound produced by the
vocal folds; also knowr
as glottal fly and as
pulse register
Denasality.
A lack of, or reduced,
nasality.

Hyponasality
Lack of sufficient
nasality, as in the
denasal or adenoidal
voice

Polyp.
Tissue mass that may
form on a vocal fold
following abuse of the
voice.

CHAPTER 4 SPEECH DISORDERS

The speech pathologist soon comes to recognize that few voice

quality disorders are free from deviances in pitch or intensity and that

their abnormality is increased when these other vocal features differ from
the norm. For example, an excessively harsh and also excessively loud

voice is more noticeable and more unpleasant than one that is not as
loud. When we find a voice that is both hypernasal and too high in its
pitch level, we can sometimes bring it closer to normality by lowering
the pitch. In spastic dysphonia we hear harshness, aphonia, and breathmess combined. Again, we find deviant voices wherein several vocal
quality deviations are apparent, as in the harsh nasal voice. In helping
our students to sort out and to remember all these features of voice, we
ask them to try to produce them before applying the diagnostic labels.
Why don't you try, too?

Alaryngeal Speech
Alaryngeal speech is a term often used in reference to the speaker who, typically because of cancer, has undergone surgical removal of the larynx. The

surgery is known as a laryngectomy and the laryngectomized person is

sometimes referred to as a laryngectomee. The restoration of speech, not
just ofvoice, is needed after surgery, for air now enters and leaves the lungs

through a surgically created opening (tracheostoma) in the neck rather

than via the mouth and nose.
The laryngectomized individual is not able even to whisper his name
or to articulate speech sounds in the manner to which we all are accustomed. Clearly, speech rehabilitation can pose a substantial challenge for
this client as well as for the clinician. Happily, success in the endeavor also
is especially rewarding for both. In this chapter we acquaint you briefly
Alaryngeal.
Without a larynx.

Afic.J
Electronic or pneumatic
vibrator used by a
laryngectomee to
produce a voice-like
sound for speech.

Electrolarynx.
Battery-operated device
used by laryngectomees
to produce sound as a
replacement for lost
voice,

with three main approaches to acquiring a new voice, alaryngeal voice,

when the larynx has been totally amputated.
One form of alaryngeal voicing is known as esophageal voice. As its
name implies, the user of esophageal voice has learned to inject a small
quantity of orally captured air into the upper part of the esophagus and
then to release this "air charge" in a way that creates a rapidly vibrating
sound source near the juncture of the pharynx and the esophagus. When
speech articulation gestures are skillfully superimposed on this voice, with

practice the esophageal speaker can become quite fluent and easy to
understand.
Aj-iother approach, one that often is used while the client is learning
esophageal voice (and one that many laryngectomees elect to continue on
a permanent basis), involves the use of an artificial larynx. Many such
devices are marketed, the most common of which is the electrolarynx.
With an electrolarynx the client learns to place a small electrically driven
vibrating diaphragm against his neck in a manner that allows the device's
sound to be carried through body tissue into the oral cavity where it can

LANGUAGE DISORDERS

133

"shaped" into speech. Alternatively, an oral adapter can be used to

carry this sound to the mouth via a flexible tube that attaches over the vibe

brator. In either case, good intelligibility depends upon, among other

things, skillful and precise articulation. The pneumatic artificial larynx,
although utilized much less frequently than its electronic counterpart,
produces a sound that more closely resembles the human voice. With this

device the client's own lung air is exhaled from the stoma opening
through a hand-held reed-like vibrator and thence to the mouth through
a second tube. As in traditional esophageal speech, the accurate production of certain consonant sounds while using any artificial larynx usually
requires considerable practice either with a speech pathologist or, in some
circumstances, with another experienced laryngectomee.
There have been many attempts over the past decades to develop surgical solutions for the surgical loss of voice (even including one known,
but failed, transplantation of a donor larynx). Several procedures that initially seemed to hold promise have later been abandoned, often because
of associated problems in maintaining a viable airway. One procedure involving very minor surgery, however, has come to enjoy wide success and
popularity. In the "t-e (tracheal-esophageal) puncture" approach, a small
opening is created between the back wall of the trachea and the front wall
of the esophagus at the level of the stoma, just below the junction of the
pharynx and the esophagus. When a very small one-way valve (voice prosthesis) is inserted, the patient can direct lung air into the esophagus while
yet avoiding the risk of saliva and other material entering the airway. In
essence, this enables the client to produce esophageal soundwithout the
necessity of injecting oral air for that purpose. Speech with the voice prosthesis can be exceptionally good: fluent, naturally phrased, and easily un-

derstood. Surgeon and speech pathologist teams around the world now
work closely together to implement this technique for laryngectomee
speech rehabilitation.

LANGUAGE DISORDERS
One of the chief fascinations about the field of speec_pathology is the
opportunity it presents for exploration and discovery(Iumans, like the
bear, must go over the mountain to see what they can see. The baby discovers her toes and babbles with delight, the child roams the fringes of his

neighborhood, the adult walks gingerly on the moon At this very mo Som%
ment all over the world there are people testing the boundaries of
known in astronomy, physics, chemistry, biology, and a hundred other sci

ences In speech pathology, because it is a relatively new field, the un

known is very near Every speech disorder has its puzzles, unanswered
questions, and problems to be solved.

the Oeigfttbe *ieck

Mu4the

CHAPTER 4

SPEECH DISORDERS

Of all the disorders of communication, those of language disability

most urgently need exploration. Although humans have been talking for
thousands of years, language itself still holds many mysteries, and the disorders of language have many more. Language disorders are perhaps the
most devastating of all communication impairments because the very
substance of messagesthe code or symbol systemis disturbed. All
language-dependent behaviorsspeech, comprehension, reading, writing, problem solvingare involved. There are two major language disrders: aphasia (dysphasia) and delayed or deviant language develop

Dysphasia
The term aphasia if used precisely would refer to the complete inability to

comprehend or use language symbols, a condition that fortunately is

rarely found, while dysphasia refers to a lesser degree of disability. Most
working speech clinicians tend to use the terms interchangeably and so
shall we. It is impossible to give you a "typical" description of an individual with aphasia because the disorder appears in many forms and levels
of severity. He might show impairment in comprehending or formulating
his messages or in finding ways to express them. His disability may be
shown in reading, writing, or silent gesturing as well as in speaking. His
speech may be so garbled as to be incomprehensible to others, or merely

broken by a search for words that momentarily he cannot find. She

may say "bread" when she wants to ask for "butter" or "jugga" for soup.
She may nod her head affirmatively when she wants to say no. He may
hold a pencil in his hand and yet not be able to copy the triangle placed
before him. Dysphasia as a disorder has a thousand faces and the speech
pathologist's first job is to analyze the features of the disability presented

by the client. So let us here confine ourselves to brief symptomatic

pictures.
One of our colleagues, a professor of biology, suffered a mild stroke and
dysphasia. When he recovered, he told us what it was like during the initial stages of the disorder: "I could pick out words here and there when
people talked to me, I could sense the flow of a message, but the meaning was lost. It sounded as if the nurses, my doctor, even my wife, were

speaking a foreign language, or a jumble of strange sounds. It was so

frustrating and caused me so much anxiety that I refused to listen when
people talked to me. That's when I became very depressed and felt so
isolated."
Ned Labonte, a sixty-four-year-old farmer, presented a similar albeit less

severe problem in understanding spoken words. When we asked him

to define the word "money" he responded: "Money, money, ah,

money. . how did you say that again?" We repeated the word. "Money,
let's see, money, ah, you mean like you get 5 or 10. . . and put it in your
pocket?"

LANGUAGE DISORDERS

Some of our clients have told us that when trying to read, they see "a
line of meaningless squiggles or scribbles" and haven't the slightest idea
as to what they mean. Some of them cannot even recognize snapshots of
their own faces or those of their friends.
In these examples, we see the receptive problems of aphasia, the difficulties in comprehending language symbols whether they are spoken or
written. More dramatically visible is the impairment that may be shown in
speech. Here is what one of our clients wrote in her autobiography after
she had made a good recovery.

When I tried to say a few things the words wouldn't come out. I got so
upset! All I could say was, "Shit!" And I always detested that word.
There were strange things I would say like, "I died," as if I had come
back to life. As I sat at the dinner table, my family would encourage me
to name foods, but I called everything "catsup" or "fish." But I thought
I was talking normally.

The expressive loss often extends to writing as the same client noted
in her autobiography.
One time soon after my second operation, my sister-in-law visited me. I

was trying to say something but the words would not come out, so I
thought, "I know what, I will write it." So I picked up pencil and paper
and expected to write, but I looked at her and said, "I can't write!" We
both laughed; it wasn't funny, but we both laughed.

In treating the patient who has dysphasia, the speech pathologist ideally is just one member of a closely coordinated rehabilitation team that
includes at least the physician, an occupational therapist, a physical therapist, and perhaps a psychologist or social worker. Even so, the speechlanguage professional often is the person who works most closely with the
family of the stroke victim, helping them to understand the client's communication difficulties and ensuring that they help rather than hinder the
process of rehabilitation. Perhaps no work in speech pathology is more
challenging than helping the person with aphasia become able to communicate effectively again and to regain a sense of human dignity.

Language Development Problems

Problems of language development are encountered often by every
worker in the field of special education as well as by the speech pathologist. A child who, for one reason or another (and there may be many reasons), does not understand what others say to him or who does not know
the basic rules by which our language is structured is truly handicapped,
for he cannot send or receive the messages that are essential in a society
that demands constant communication. There is little doubt that language
is the most important acquisition a child will ever make. Most, if not all,

135

CHAPTER 4 SPEECH DISORDERS

skills or knowledge are learned through language. Relationships with oth-

ers are mediated through the exchange of messages. But language is more
than a vehicle for learning and relating; it is also an instrument that shapes
the way in which the user perceives and conceptualizes the world. The

child with delayed or deviant language is pretty helpless in a world of

words.
Especially during the past two decades, speech pathologists increasingly have responded to the challenge that these youngsters present. Surveys show that over one-half of the caseload of public school speech
pathologists now consists of children with language disabilities. As a matter of fact, the parent organization of speech pathologists, the American
Speech and Hearing Association changed its name in 1977 to the American Speech-Language-Hearing Association. The worker in speech pathology began to be referred to as the "speech and language clinician" at that
same time.
A language problem may be defined as a disturbance in, or impoverishment of, the symbol processing systemthe child's supply of concepts
and use of linguistic rules is either severely limited or is significantiy different from the conventional usage of his peers (see semantics). These disor-

ders range from a very mild disturbance to profound or almost total

absence of language. Many diagnosticians find it useful to distinguish be-

tween two broad categories of language problems: delayed or deviant.

Children with delayed language exhibit symbolic functioning that would
be considered normal at an earlier age; their verbal skills are, in other
words, underdeveloped relative to what is expected at a given chronological age. On the other hand, some children use deviant language when they
invent idiosyncratic (their own unique) rules for processing information.

Delayed Language Development, Although the child with delayed

language development usually shows many articulation errors (sometimes
to the point of unintelligibility), his major difficulties often lie in vocabu-

lary deficits that restrict his speech output, in grammatical deficits that
prevent him from expressing himself according to the hidden rules of
communication (appropriate plurals, tense, subject-predicate, etc.), or in
his inability to handle transformations, such as being able to know the difference between a statement and a question or to be able to express himself in both ways.
Anyone who wants to help a child with such a language disability must
not only determine that his language competence and performance are inferior to other children of his chronological, mental, or physical age levels; he must also analyze the child's specific difficulties in encoding and
decoding.
For illustrative purposes, we include a brief portion of a speech and
language clinician's presentation of her diagnostic findings on a languagedelayed child at a staffing conference.

LANGUAGE DISORDERS

Carol Dilworth is a five-year, one-month-old language-delayed child discovered by our preschool screening program. At that time we administered several screening tests, took a language sample, and conducted an
extensive parent interview. The screening test results are as follows:
(1) Gross and fine motor skills are delayed; Carol completed items up to
the three-year-old level. (2) Personal and social skills are also performed
at the three-year-old level. (3) With regard to language skills, the child is
performing at a level one year behind her chronological age on all recognition and auditory comprehension items; verbal expressive skills are
more severely delayedCarol successfully completed task items up to
but not beyond the normative level for twenty-four-month-old children.
(4) An assessment of her syntax shows that she is still using simple twoword utterances ("Carol play?" "Want Mommy.") characteristic of children between the ages of eighteen to thirty months.
The language sample was taken in the Dilworth home. We showed the
child twenty-five items (pictures, objects) and asked her to tell us about
them. Carol's mean (average) length of response was 1.8; typically, she
responded with two-word utterances. Once again, this level of language
usage is appropriate for children about two years of age. A youngster of
five should have a mean length of response of about 5.7 words per stimulus item.
The parent interview revealed a general slowness in Carol's development.

For example, she sat up at eleven months, walked at nineteen months, and
was toilet trained at three years, six months. Mrs. Dilworth noted very little babbling or vocal play when Carol was an infant. Reportedly, the child
did not use her first word meaningfully until almost two years old.

Deviant Language. Children with deviant language not only do not

show the linguistic patterns generally found in normally developing
younger children, they also use atypical or eccentric forms instead of simplifying the symbolic code. They tend to have a limited repertoire of utterances and may even have difficulty repeating simple messages after the
diagnostician. They devise a strange language of their own. Let us listen
in on a parent interview with the mother of identical twin boys who show
signs of deviant language. A college graduate in anthropology, Mrs. Mannion kept careful records on the development of her six-year-old sons:
Clinician:

You said that Otis and Lotis had a bizarre form of communication. Could you describe what you mean?

Mrs. Mannion: Well, almost right from the start, they seemed to be
tuned into each other, perhaps through some type of
nonverbal clues. Even now they can finish each other's

sentencesone will start to say something and the

other will complete the message.
Did they have special words they shared?
Clinician:
Mrs. Mannion: Yes, they had several wordsthey called it "werry talk."
When I tried to learn the meanings of their words, they

131

CHAPTER 4 SPEECH DISORDERS

would just laugh and look at each other like conspira-

tors. Let's see, they called the fireplace "rapabeef,"

shoe was "di" at first, and then they named their feet
"moppy" and "pedo." My husband and I found that
we were using some of the children's words: One time
I gave someone directions by telling him to go downtown and turn "pedo"!

Clinician:

Did they have any other unusual language forms?

Mrs. Mannion: Yes, Otis and Lotis made up their own rules for singu-

lar and plural nouns. For example, I remember that

they used "do" as singular for "clothes." And, by the
way, they still do not use the word "why"they say
"what-cause" instead.

We do not have the space here to include a complete inventory of the

twins' speech, but the sample we provided does illustrate atypical or deviant language development. In addition to the novel use of plurals and
wh words and the contrived vocabulary, the children also showed unusual
syntax and articulation. They had created their own special language.

These, then, are the disorders of communication with which the

speech pathologist must cope. If at the moment you feel a bit overwhelmed by their number and variety, be reassured. We shall discuss them
one at a time in later chapters. Our purpose here is merely to acquaint you
with the scope of speech pathology.
Before ending this presentation of the classification of speech disor-

ders, let us offer one warning: We must avoid the tendency to slip into
"label language." Remember, a communication disorder does not transform a person to a state of being less than human; we treat children and
adults, not lispers, cleft palates, and spastic dysphonics. The proper focus
of speech pathology is the whole person.

STUDY QUESTIONS

L What three questions must be answered in order to determine

whether a person's speech is impaired?
2. Into what four major classifications do we categorize speech communication disorders?
3. What types of problems might we expect to find in the speech of a
child who has been severely hearing impaired since birth?
4. How would you begin to describe the basic features of stuttering
to someone who never has heard or seen stuttering? And what
would you point out as major differences between stuttering and
cluttering?

SUPPLEMENTARY READINGS

139

5. What advice or suggestions would you give to the mother and fa-

ther who are concerned that their three-year-old child "may be beginning to stutter"?
6. Why may voice problems be more difficult to categorize as disorders than are other types of speech problems?
7. In the speech of a person with a voice disorder we may expect to
hear deviations from "normalcy" in one or more of what three basic
vocal features?

8. What is meant by "esophageal voice," and for what reason may an

individual need to use this form of phonation?
9. What typically causes dysphasia in the adult, and why is it important
that the speech pathologist not work with dysphasic clients in isolation from other members of a rehabilitation team?
10. What difference(s) might help you to distinguish delayed from
deviant language deve.lopment in children?

REFERENCES

Iglesias, A., and Anderson, N. (1993). Dialectal

variations. In J. Bernthal and N. Bankson.
Articulation and phonological disorders, 3d ed.
Englewood Cliffs, NJ: Prentice Hall.

SUPPLEMENTARY READINGS
Battle, D. (1993). Communication disorders in multicultural populations. Stoneham, MA: Butterworth-Heinemann.
Maistrom, P., and Silva, M. (1986). "Twin talk: Manifestations of twin status in
the speech of toddlers." Journal of Child Language, 13: 29 3304.

OUTLINE

Emotional

Aspects of
Communication
Disorders

CHAPTER S EMOTIONAL ASPECTS OF COMMUNICATION DISORDERS

In the previous chapter we have focused on the outward symptoms of

various speech disorders, but it is important to remember that each of the
people who possesses them is a unique individual with a past history that
may be laden with hurt. Brief examples of such emotional. factors were
seen in some of the clients mentioned in Chapter 1, where it was evident
that current emotional reactions also can be a significant part of the problem. And the person who does not hear normally, as we will see again in
Chapter 13, may be burdened as much by social and emotional consequences as by the loss of hearing. Nor is it just the individual alone who
may be affected. Impaired communication, whether in a child or an adult,
can impact significantly on the emotions of family members and of the
family constellation itself. Our primary emphasis for now, however, will be
on speech and the speaker.
To ignore the individual's history, feelings, and attitudes and merely to
treat the outward behaviors is folly. If we are to hope that the behavioral
changes we may help our clients achieve will persist, we must know their
needs and feelings. Often we find that our clients have incorporated their
abnormalities of communication into their self-concepts, and, unless we
help them make essential changes in the way they perceive themselves, all
of our efforts may be in vain. This is not to say that the speech pathologist
or audiologist must assume the role of the professional psychotherapist.
When a client's emotional problems are severe we, of course, make the necessary referrals.' Nevertheless, those who seek to serve persons with communicative disorders need to have some background in counseling, and
they need to understand the emotional aspect of impaired communication.
It is hard for normal speakers to comprehend how difficult it is to live
in a culture such as ours without possessing the ability to speak in an acceptable fashion. Perhaps a glimpse into the inner world of RK. may help
us begin to understand.
When I really take a look at things I have doneand still dobecause I
stutter, it makes me want to vomit with revulsion. Stuttering has dominated my whole life. Using the telephone, especially to call girls, was a
nightmare. Since I could talk fine when all alone, I once made a tape
recording with which I planned to call a particular young lady. I used all
the appropriate social gesture language and tried to time the pauses for
her responses. It backfired: her father answered the phone! I don't go in
certain restaurants, like fast-food places, because of the time pressure; I

write a note with my name and phone number when I take clothes to
the cleaners; and in fill-service gas stations, I still sing, "Fill it up to the
brim" when the attendant comes to the car window. I even picked a shy,
introverted woman for a wife so I wouldn't be dragged off to parties
where I might have to talk. Which reminds me, I had so much trouble
talking during the wedding rehearsal, the minister suggested that I just
"think" the vows during the actual ceremony. When Cindy and I have
an argument, I tell her that I wasn't really thinking about "I will" when

COMPONENTS OF THE EMOTIONAL FRACTION

we were married. Being a stutterer is not really funny, though. I often

feel like I have a large scarlet letter "S" on my forehead.

This may seem exaggerated and distorted. Unfortunately, it is not. We

have heard literally thousands of similar tales in one form or another.

These people have been hurt deeply and repeatedly because they did not
and could not conform to the speech standards of our society. The tragedy
lies in the fact that they could not. They were not responsible for their de-

fective speech, but those who hurt them acted as though they were, as
though they had a choice. This assumption is the core of the problem not
only of the person with impaired speech or hearing but also of the poor,
the person with mental illness, the person who has epilepsy, those who
have learning disabilities, and most of the other kinds of deviancy.

Once, on Fiji in the the South Pacific, we found a whole family of

stutterers. As our guide and translator phrased it, "Mama kaka; papa kaka;
and kaka, kaka, kaka, kaka." All six persons in that family showed marked
repetitions and prolongations in their speech, but they were happy peopie, not at all troubled by their stuttering. It was just the way they talked.

No hurry, no frustrations, no stigma, indeed very little awareness. We

could not help but contrast their attitudes and the simplicity of their stuttering with those that would have been shown by a similar family in our
own land, where the pace of living is so much faster, where defective com-

munication is rejected, where stutterers get penalized all their lives. To

possess a marked speech disorder in our society is almost as handicapping
as to be a physical cripple in a nomadic tribe that exists by hunting. Western society does not suffer the speech-handicapped gladly, and the persons
with whom we work come to us with a special kind of human misery.

COMPONENTS OF THE
EMOTIONAL FRACTION
The pollution of human misery comes from many wells, but its composition is the same: PFAGH. This strange word is an acronym, a coined as-

semblage of letters each of which represents another word. The P

represents penalty; the F frustration; the A anxiety, the G guilt, and the H
hostility (Figure 5-1). We invent this word to help you realize and remember the major components of the emotional fraction of a communication
disorder.
Impaired speech is no asset to anyone. It invites penalty from any

society that prizes the ability to communicate effectively. Speech is

the membership card that signifies that its owner belongs to the human

race. Those who do not possess normal speech are penalized and

143

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CHAPTER 5

EMOTIONAL ASPECTS OF COMMUNICATION DISORDERS

p
F

FIGURE 5-I PFAGH:

The emotional fraction

of a communication handicap

rejected. Even the struggling speaker himself often feels this rejection is
justified.
Moreover, the inability to communicate, to get the rewards our society offers to those who can do so effectively, results in great frustration.
To be unable to say the word when he desires to do so, as in the case of
the stutterer; to say "think" when he means "sink," as in lisping; not to
be able to produce a voice at all, as in the laryngectomee; to try to say
something meaningful only to find that gibberish emerges, as in the aphasicall these are profoundly frustrating. So, too, is it frustrating to mis-

hear spoken directions, or to be unable to hear whispered words of

endearment, or to answer a teacher's question only to discover from reactions of classmates that a quite different question apparently had been
asked. Anxiety, guilt, and hostility are the natural reactions to penalty and
frustration. You, too, have known these three miseries transiently when
you have been punished or met frustrations, but many individuals with
communication disabilities spend their lives immersed in these emotions.

COMPONENTS OF THE EMOTIONAL FRACTION

Penalties
Let us look at some illustrative penalties culled from the autobiographies
of clients with whom we have worked.
I hate to stutter in restaurants because the waitress ignores me and then
talks to my companions. I feel like a nonperson. And when they do talk
to me, they speak too loudly, slowly, and in a patronizing manner; and
they never, ever look at me.

In junior high school I got a lot of teasing about the scar on my lip and
the way I talked through my nose. Once someone put a set of glasses and
a big nose like persons wear on Halloween on my desk and all the kids
laughed when I came into class. Even the teacher was grinning behind
her workbook.
It was quite a shock when I came to college from the small hometown
where everyone knew me. My articulation is so garbled that I have to
show people my name tag when I introduce myself. The worst part is the
stares I get in stores. Speech is so public, so self-revealing, and I'm sure
people think I'm either drunk or retarded.
A hearing loss really isolates you, even from your own loved ones. They
try not to show it, but they get so annoyed when I ask them to repeat.
That's why I stay at home a lot.

These are but a few of the many penalties and rejections that any
individual with an unpleasant difference is likely to experience. Imitative
behavior, curiosity, nicknaming, humorous response, embarrassed withdrawal, brutal attack, impatience, quick rejection or exclusion, overprotection, pity, misinterpretation, and condescension are some of the other
common penalties.
The amount and kind of penalty inflicted depend on four factors:
(1) the vividness or peculiarity of the difference; (2) the person's own attitude toward the difference; (3) the sensitivities, maladjustments, or preconceived attitudes of the people who penalize; and (4) the presence of
other personality assets.
First, in general, the more frequent or bizarre a speech peculiarity, the
more frequently and sternly it is penalized. Thus a child with only one
sound substitution or one that occurs only intermittently will be penalized
less than one with almost unintelligible speech, and mild stuttering will be
penalized less than severe. Second, the speaker's own attitude often de-

termines what the attitude of the auditor will be. If he considers it a

shameful abnormality, his listeners can hardly be expected to contradict
him. Empathic response is a powerful agent in the creation of attitudes.
Third, the worst penalties will come from those individuals who are sensitive about some difference of their own. Since some of them have parents or siblings with similar speech differences, they are often penalized
very early in life by those persons.

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CHAPTER 5 EMOTIONAL ASPECTS OF COMMUNICATION DISORDERS

You ask why I slap Jerry every time he stutters? I do it for his own good.

If my mother had slapped me every time I did it I could have broken my-

self of this habit. It's horrible going through life stuttering every time
you open you mouth, and my boy isn't going to have to do it.

Moreover, many individuals have such preconceived notions or attitudes concerning the causes or the unpleasantness of speech handicaps that
they react in a more or less stereotyped fashion to such differences, no mat-

ter how well adjusted the speaker himself may be. Finally, as we have
pointed out, the speaker may possess other abilities or personal assets that
so overshadow her speech difference that she is penalized very little.

Even though some children with a speech disorder are fortunate

enough to be brought up in a family and an environment where they meet
little punishment for their difference, eventually they will meet the rejection that society reserves for the person who has an unacceptable difference. Indeed, some of these protected children are more vulnerable than
those whose lives have been full of penalty.
A second-grade boy had been receiving speech therapy for over a year
and had made excellent progress in mastering many of the defective
sounds. In the third grade he met a teacher who was old and uncontrolled, who had had to return to teaching after her husband had died,
and who hated the whole business. She used the boy as a scapegoat for
her own frustrations. Under the guise of helping him, she ridiculed his
errors and held him up to scorn before his fellows. Shortly after the fall

term began, this boy's speech began to get worse, and within a few
months it had lapsed to its former unintelligible jargon.

Oddly enough, penalties also can be feltand may have devastating effectsbecause of improvement. This can occur especially if the clinician has
not prepared a client for the possibility of adverse reactions. It is one of the
reasons we often advise the person with a resolving voice problem to "try
out the new voice" first with strangers, later with acquaintances and family.
Charles, age 15, had come to us only three weeks ago, referred by a
school clinician because his persistent falsetto voice was not yielding to
therapy. In the new and unfamiliar setting of our clinic, however, he had
quickly learned to use his natural (and pleasantly low-pitched baritone)
modal register voice at will. In spite of his delight with this newfound
confirmation of his masculinity, Charles was encouraged to wait and not
to use the new voice until we had done more to stabilize it in therapy.

He did not come to therapy in the fourth week, nor did we hear from
him or his family. When he failed to show up the following week, we tele-

phoned the school clinician to inquire about him. As it happened, she

had just talked with Charles. Fighting to hold back tears, and in his highpitched falsetto, he told her of having used his new voice to surprise his
family at the dinner table a week earlier. He noticed a smile on his
mother's face, and he was not unpleased that his younger sister seemed
shocked. He was not at all prepared for his father's reaction: "What

COMPONENTS OF THE EMOTIONAL FRACTION

makes you think you're a man?" It was only after several counseling ses-

sions with his parents that Charles was allowed to return to therapy, and

even then it was a long time before he was able to risk using his new
voice, even with us.

Fortunately, experiences of the type Charles had are not terribly common, and we were able to counter it successfully. Unfortunately, Ted's experience may be more common and less easily remedied.
We had been working for three years with Ted, an eight-year-old youngster. His cleft palate had been repaired surgically; but it remained a bit
difficult to close off the rear opening to the nasal passages with speed.
He had improved greatly, however, and only a few bits of nasal snorting
or excessive nasality remained when he talked carefully. Then one day his
associates on the playground, led by the inevitable bully, began to call

him "Nosey-Nosey." Within one week his speech disintegrated into a

honking, unintelligible jargon, and he refused to come to the clinic for
any more therapy.

Covert Penalties. Not all the penalties bestowed upon the person who
talks differently are so obvious. Perhaps the worst ones are those that are
hidden, the covert kind. One of our clients who stuttered wrote this:
When I stutter at home the silence is deafening. No matter how much I
struggle, no one acknowledges that I am having trouble talking. My
mother freezes like an arctic hare and my father hides behind the Wall
StreetJournal. I feel like a family pariah. My problem is unmentionable,
unspeakable. The emperor has no stuttering problem. Maybe I should
walk around ringing a bell and chanting "Unclean, unclean!"

Most of the more obvious penalties are felt by children. After a

speech-handicapped person becomes an adult, few people mock him,
laugh at him, or show disgust. Instead, he now finds that they shun him.
Their distant politeness may hurt worse than the epithets he knew when
he was young. One of our cases, a girl with a paralyzed tongue and very
slurred speech who was desperately in need of work so she could eat and
have a place to sleep, contacted forty-nine different prospective employers before she found one who would give her a chance to exist. "Not one
of them ever said anything about my speech," she told us. "Some were

extra kind, some were impatient, some were rude, but all of them had
some other reason besides my speech for saying no. I could tell right away
by seeing how they changed the moment I began to talk. Like I was unclean or something."
Why do such things happen? Why do we punish the person who is different? Why must he punish himself? Surely Americans are some of the
kindest people who have ever lived on this earth. We show our concern
for the unfortunate every day. No nation has ever known so many agencies, campaigns, foundations, and private charities. One drive for funds

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CHAPTER 5

EMOTIONAL ASPECTS OF COMMUNICATION DISORDERS

follows another. Muscular Dystrophy, the Red Cross, the United Fund,

the Heart Association, Seeing Eye dogs, the coin bottle in the drugstore,
the pleading on radio and television. Surely all of these activities seem to
show that we help rather than punish our handicapped, but perhaps we
find it easier to give our money than ourselves.
Cultural anthropologists have regarded this altruism with more than
academic interest. They point out that our culture is one that features the
setting up of a constant series of material goals and possessions that are
highly advertised. Prestige and status seem often to be based upon winning these possessions and positions in a highly competitive struggle. We
fight for security and approval, but in the process we trample underfoot
the security of others. Some psychologists have felt that our need to help
the handicapped is a product of the guilt feelings we possess from this
trampling. Others attribute our concern for the underprivileged to fear
lest someday we too will be the losers in the battle for life. They claim that
we tend to say to ourselves, "There, but for the grace of God, go I," when
we meet someone who has failed to find a place for himself in the world
for reasons beyond his control. These organized charities do much good,
but they cannot fulfill the needs of the handicapped for personal caring.
Perhaps legislation such as the Americans with Disabilities Act will help in
some ways.

Aggressive or Protest Behavior as a Reaction to Penalty. Penalty and

rejection may lead individuals to react aggressively by attack, protest, or
some form of rebellion. They may employ the mechanism of projection
and blame parents, teachers, or playmates. They may display toward the
weaknesses of others in the group the same intolerant attitude manifested
toward their own. In this way they not only temporarily minimize the importance of their own handicap, but also enjoy the revenge of recogniz-

ing weaknesses in others. They may attempt to shift the blame for
rejection. "They didn't keep me out because I stutterthey just didn't
think I had as nice clothes as the rest of them wore." In this way they will
exaggerate the unfairness of the group evaluation and ignore the actual

cause. Another attack reaction may be to refuse to cooperate with the

group in any way, belittle its importance openly, andrefuse to consider it
in their scheme of existence. Finally, they may react by direct outward attack. A child, or an adult with an easily provoked temper, may indulge in
actual physical conflict with members of the nonaccepting group.
Kevin's speech was marred by several articulation errors that made him
sound considerably younger than his nine years. But his left hook was
worthy of a prizefighter twice his age. No one teased Kevin about his
speech disorder, not even older children in the elementary school. If anyone did refer to his speech, he flew into a towering rage that ended only
when the offender was bloody and bowed. The youngster refused to read
aloud or recite in class. When an unknowing substitute teacher insisted

COMPONENTS OF THE EMOTIONAL FRACTION

answer a question one day, Kevin broke seven windows in the school
that evening. 'When he was selected to go to speech therapy, he cursed
the other children in his group, tore up the clinical materials, and sat sullenly in a chair. Instead of responding directly to his obvious anger, the
clinician separated Kevin from the group and, without making any demands for him to talk, enlisted his assistance in assembling a large model
of a sailing ship. Gradually, and it took several months, she was able to
gain his confidence and eventually Kevin could tolerate direct speech
therapy for his several articulation errors.
he

A rejected individual may spread pointed criticism of the group in a

resentful manner. In any of these methods, the object of the rejection does
not retreat from realityhe reacts antagonistically and attacks those who
made his reality unpleasant. The more the person attacks the group, the
more it penalizes him. Often such reactions interfere with treatment, for
many of these persons resent any proffered aid. They attack the speech
pathologist and sabotage his assignments. The inevitable result of these attack reactions is to push them even farther from normal speech and adequate adjustment.

Frustration
Frustration is always experienced when human potential is blocked from
fulfillment. It is the ache of the giant in chains. All lives are filled with
frustrations. We cannot live together without inhibiting some of our impulses and desires. Circumstances always place barriers in the paths we desire to take. But for some persons, the cup of frustration is filled to the
brim and more is added every day. Frustration breeds anger and aggres-

sion, and these corrupt everything they touch. Those who cannot talk
normally are constantly thwarted. Consider, then how a person must feel
if unable to talk intelligibly. Others have difficulty in understanding the
messages of the stutterer, the jargon-talking child, or the person who has
lost his voice due to cancer. Others listen, but they do not, they cannot,
understand. The aphasic tries to ask for a cigarette and says, "Come me a
bummadee. A bummadee! A bummadee!" This is frustration.
Communication is the lifeblood of a society. When it cannot flow, the
pressure builds up explosively. The worst of all legal punishments short of
death is solitary confinement where no one can talk to the prisoner, nor
can the prisoner talk to anyone else. There are such prisoners walking
about among us, sentenced by their speech and hearing disorders to lives
of deprivation and frustration.
One young client diagnosed his own problem for us. His speech was full
of irregular and forced repetitions. He hesitated. He seldom was able to
utter even a short sentence without having wide gaps in it. One day, after
he had just beaten up our plastic-clown punching bag he confided in us.
"Y-y-y-you know. . . y-y-you know whuh-whuh-what's wrrrrrong with

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EMOTIONAL ASPECTS OF COMMUNICATION DISORDERS

the Illillittlest . . . child." He was. He was the runt of the

litter, the weakest, smallest, most unattractive of the eight children in
that family. The others were an aggressive bunch, yelling, fighting, arme? I-I-I-I-I'm

guing, talking. His mouth never had an ear to hear it. When his sentences
were finished, it was some brother's or sister's mouth that finished them.
He was constantly interrupted or ignored. He had learned a broken English, a hesitant speech.

The good things of life must be asked for, must be earned by the
mouth as well as the hands. The fun of companionship, the satisfaction
of earning a good living, the winning of a mate, the pride of self-respect

and appreciation, these things come hard to the person who cannot
talk. Often she must settle for less than her potential might provide,
were it not for her tangled tongue. Speech is the "Open Sesame," the
magical power. When it is distorted, there is small magic in itand much
frustration.
We need safety valves for emotion. When we can express the angry

evils within us, they subside; when we can verbalize our grief, it decreases. A fear coded into words and shared by a companion seems less
distressing. A guilt confessed brings absolution. But what of those who
find speaking hard, who find it difficult even to ask for bread? This wonderful function of speech is denied them. The evil acids cannot be emptied; they remain within, eating their container. For many of us it comes
hard to verbalize our unpleasant emotions, even though we know that

in their expression we find relief. How much more frustrating it must

be for those who feel that they have only the choice of being stillor
being abnormal.
Perhaps most frustrating of all is the inability to use speech as the expression of self. One of the hardest words for the average stutterer to say
is his own name. Most of us talk about ourselves most of the time. We talk
so people will notice us, so we can feel important. This egocentric speech
is highly important in the development of the personality. Until the child
begins to use it, he has little concept of selthood, according to Piaget, the
famous French psychologist. If you will listen to the people about you or
to yourself, you will discover how large a portion of your talking consists
of this cock-a-doodle-dooing. When we speak this way we reassure ourselves that all is well, that we are not alone, that we exist and belong. The
person with a severe speech defect finds no such reassurance when he
speaks. He exposes himself as little as he can. In this self-denial, too, lies
much frustration.

Egocentnc
Self centered
pertaining to the self
and its display

For years almost a decade now I took a backseat because of my hearing

loss Conversation with more than two persons was impossible I felt like
such a fool when I missed the point of a story or laughed at the wrong
time Listening is so hard when you only get fragments The whole busi
ness of talking with people took too much time and energy Eventually
I just gave up and didn't even go to church.

COMPONENTS OF THE EMOTIONAL FRACTION

One very severe frustration is the deprivation from social interaction

which persons with speech disorders experience. It is not hard to understand why this occurs. Speech is the vital prerequisite for human interaction. It is the bond that unites us. When it is impaired, that bonding is
disrupted. Long ago the senior author spent a week in a school for the
deaf where all the students used sign language and did very little lipreading. He felt isolated, rejected, excluded from the miniature society; and it
was with relief that he re-entered a speaking world. Those who cannot talk
feel much the same way. They are rejected from membership. They find
it hard to belong. The worse they talk the more isolated they become.
Here again we find in speech pathology a miniature model of a basic evil
that pollutes humanity, the same rejecting exclusion that plagues the physically disabled, the poor, the elderly, and minority groups.

Anxiety
It should not be difficult to understand why people who meet rejection,
pity, or mockery would experience anxiety. When one is punished for a
certain behavior, and the behavior occurs again, fear and anxiety raise their
ugly heads. If penalty is the parent of fear, then we might speak of anxiety as the grandchild of penalty, for the two are not synonymous. The stutterer may fear the classmate who bedevils him, or he may fear to answer

the telephone since fear is the expectation of approaching evils that are
known and defined. But anxiety is the dread of the unknown, of defeats
and helplessness to come. In its milder form, we speak of "worrying."
There is a vague nagging anticipation that something dangerous is approaching. To observe a person in an acute anxiety attack is profoundly
disturbing. Often she can find no reason for her anxiety, but it is there just
the same. At times it fades, only to have its red flare return when least expected. Few of us can hope to escape it completely in our lifetimes, but
there are those for whom anxiety is a way of life. It is not good to see a
little child bearing such a burden.
One of the evil features of anxiety is that it is contagious. When parents begin to worry about a child's speech, the child is almost bound to
reflect and share their feelings. "Will he ever be able to go to school, to
learn to read, to earn a living, to get married? Who will hurt him? Will he
ever learn to talk like others?" Such thoughts may never leave the parents'
lips, but somehow they are transmitted to the child, perhaps by tiny gestures or facial expressions or even the holding of the breath. Once the
seeds of anxiety are planted, they sprout and grow with incredible speed.
Another of the evils of anxiety is that it usually is destructive. It does
not aid learning or speech therapy. It distracts; it negates. It undermines
the self-esteem. The person seeks to contain it, to explain it. Sometimes
she invents a symptom or magnifies one already there. When speech becomes contaminated with anxiety, the way of the speech pathologist is

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CHAPTER 5 EMOTIONAL ASPECTS OF COMMUNICATION DISORDERS

hard. One of the first things a student must learn is to create a permissive

atmosphere in which speaking is not painful, over which no threat hangs

darkly. The speech therapy room must be a welcoming, pleasant place. All
of us need a harbor once in a while; these children need a haven often, one
where for once they can feel free from penalty and frustration, where impaired speech is viewed as a problem instead of a curse. In the presence of
an accepting, understanding clinician, they can touch the untouchable,
speak the unspeakable. There they can learn. Anxiety does not help in
learning or relearning.
Reactions to Anxiety. Anxiety is invisible, but it has many faces. By this
we mean that it shows itself in different ways.
Edward had undergone many operations for his cleft palate, but the scars
on his face and the speech that came from his mouth bore testimony of
his difference. Throughout his elementary and secondary school years,

he had appeared a carefree, laughing, mischievous child. He was the

happy clown, and by his behavior, he had managed to gain much acceptance. When other people laughed at him, he laughed with them. His
grades were poor, although he was bright. Then suddenly, in the final
semester of his senior year in high school, he underwent a marked personality change. He laughed no longer; he became apathetic, quiet, and
morose. Formerly very much the extrovert, he now withdrew from contacts with others. He daydreamed. He walked alone. Our intensive study
of this boy revealed that he had always lived with anxiety, that his cheerful behavior was adaptive but spurious. Underneath he had always ached.
The compensatory pose had brought him rewards, but it had not allayed
the anxiety. When faced with the necessity for leaving school and earn-

ing a living, the anxiety flared up too strongly to be hidden, and the
change of personality took place. Not until we were able to provide some
hope through the fitting of a prosthesis (a false palate) and some information about the possibility of plastic surgery, did the anxiety decrease
sufficiently to enable us to improve his speech.

Prosthesis.
An appliance used to
compensate for a
messing or paralyzed
structure.

One of the common methods used to ease anxiety is the search for
other pleasures. By gratifying other urges we seem to be able temporarily
to diminish anxiety's nagging. Some of the people with whom we have
worked are compulsive eaters of sweets; they grow fat and gross. And then
they worry about their weight. Others relieve their anxiety by sexual indulgences. There are others who find a precarious and temporary peace
by regressing to infantile modes of behavior, trying to return to the penod of their lives when they did not need to worry about speaking. We
also find a few sufferers who attach themselves to a stronger person like
leeches, hoping for the security of dependency. Yes, they are many ways of
reducing anxiety; but unless the spring from which it flows is stopped, it
always returns. That is why people with communication impairments need
speech pathologists and audiologists.

COMPONENTS OF THE EMOTIONAL FRACTION

I 53

When the anxiety clusters about speaking, one way of reducing it is

to stop talking. Some persons with speech disorders merely become taci-

turn; some lose their voices; other contract what is called voluntary
mutism and do not make an attempt to communicate except through gestures. We knew a night watchman once who claimed that he averaged only
two or three spoken sentences every twenty-four hours. "It's easier on me
than stuttering."
There is also a curious mechanism called displacement, which most of
us use occasionally to reduce our anxiety. We start worrying about something else besides the real problem that is causing us such distress. The
shift of focus seems to bring some relief, much as a hot-water bottle on
the cheek can ease a toothache. The scream of a little child in the night
may reflect such a displacement, but perhaps a better example can be
found in Andy.
Andy stuttered very severely when he came to us at the age of seven. He
blinked his eyes, jerked and screwed up his mouth, and sometimes cried

with frustration when he was unable to begin a sentence. At times he

spoke very well. But what struck us most about Andy was his furrowed
brow. Whether he stuttered or not, he seemed to be constantly worried.
His face always had an anxious expression. Finally we were able to get
him to tell us what he was worrying about. Surprisingly, it was not about
his stuttering or his parents' very evident concern about his speech.
Andy said he was worrying about the moon hitting the sun. He said that
if this happened, everything would blow up. He said that on those

nights when there wasn't any moon, and both sun and moon were
under there someplace, that they might crash together. Andy said he
could never sleep on those nights. His mother and father had told him
this couldn't happen, but Andy said they had lied about Santa Claus,
and how did they know, anyway, that it wouldn't happen? It took a lot
of play therapy, speech therapy, and parent counseling before Andy was
able to surrender his solar phobia and express his real anxiety, which
concerned his speech.

But there are some fortunate persons with speech disorders who are
lucky in their associates and ability to resist stress, who seem to manage to
get along with a minimum of anxiety. They may find themselves loved and

accepted. They may possess philosophies or compensating assets that

make the speech problem minor in importance.
To illustrate our point, we quote now from the laboriously written
diary of an adult aphasic. (We have omitted the many errors.)
I remember the feeling of being a "mummy" when I could barely speak.

In spite of all the troubles of the past, I am happy that I m capable of

doing so many things now. I m learning more every day and continually strive to improve my reading and writing. Above all, my numbers
are coming back to me. A person has to be happy in their heart and
soul. To relax and forget the past. There is always tomorrow. We get

splacement

ofemotton

CHAPTER 5

EMOTIONAL ASPECTS OF COMMUNICATION DISORDERS

too impatient. To me, that is the secret of it all. I can live gracefully as
an aphasic. Lately, I have been busy and I have accomplished many
things.
Right now I am happy and content. It has been five years since my stroke
and in the last three weeks, I feel it has been worth it. I shall be a more
graceful, middle-aged woman from now on.

So let us state our caution again. If there is excessive anxiety, recognize its face where you find it, no matter how it is disguised; but do not
invent or imagine its presence if it is not there!
We wish to conclude this section with a caution. Let us remember that
some people with impaired speech have no more anxiety than those who
speak normally. All of us have some anxiety and probably need some. A
bit of anxiety in the pot of life is like a bit of salt in a stew. It makes it
tastier. But too much salt and too much anxiety ruin both. We have had
to describe the anxiety fraction of a speech handicap so that you will not
add to it, perhaps so that you may relieve it. Those of us who come in contact with children or adults with disabilities may unwittingly make their
burdens heavier if we do not understand.

Guilt
Like anxiety, guilt also contributes a part of the invisible handicap that
often accompanies abnormal speech. We have long been taught that the
guilty are those who are punished. Intellectually we can understand that
the converse of this proposition need not be true, that those who are punished are not always those who are guilty. But let affliction beset us, and
we find ourselves in the ashes with Job of the Old Testament. "What have
I done to deserve this evil?" We have known many persons deeply troubled by speech disorders and other ills, and most of them have asked this
ancient question. Parents have asked it; little children have searched their
souls for an answer. Here's an excerpt from an autobiography.
Even when I was a little girl I remember being ashamed of my speech.
And every time I opened my mouth, I shamed my mother. I can't tell
you how awful I felt. If I talked, I did wrong. It was that simple. I kept
thinking I must be awful bad to have to talk like that. I remember praying to God and asking him to forgive me for whatever it was I must have

done. I remember trying hard to remember what it was and not being
able to find it.

It seems to be the fashion now to blame parents for many of the troubles of their offspring, for juvenile delinquency, for emotional conflicts, for

speech difficulties. We can blame the school if Johnny cannot read, but
few parents of a child who comes to school with unintelligible speech have
escaped the blame of their neighbors. The father of a child with a cleft
palate often feels an urge to accuse the mother, and the mother the father,

COMPONENTS OF THE EMOTIONAL FRACTION

for something that is the fault of neither. When guilt enters a house, a
home is in danger. Children who grow up in such an atmosphere of open
or hidden recrimination are prone to blame themselves. Thus the emotional fraction of a speech disorder may grow.
Reactions to Guilt Feelings. Guilt is another evil that eats its container.
In its milder forms of regret or embarrassment, most people can handle it
with various degrees of discomfort. However, when shame and guilt are
strong, they can become almost unbearable. The person may react with
behavior that produces more penalty or more guilt. We have seen children
deliberately soil themselves, throw temper tantrums, break things, steal
things, even set fires so that they could get the punishment they felt their
guilt deserved. After the punishment comes a little peace!
Sometimes people punish themselves. We have seen people who stutter use their stuttering to hurt themselves, using it in much the same way
as the flagellants of the Middle Ages flogged and tortured their bodies for
their sins. We have known children with repaired cleft lips and palates who
could not bear to watch themselves in a mirror even to observe the action
of the tongue or soft palate. We have heard children cry and strike themselves when they heard their speech played back from a tape recorder. We
must always be alert to this need for punishment lest they place the whip
in our hands.
Here is what one adult with cerebral palsy painfully typed for us.
Sometimes when I lie in bed pretty relaxed I almost feel normal. In the
quiet and the darkness I don't even feel myself twitching. I pretend I'm
just like everybody else. But then in the morning I have to get up and
face the monster in the mirror when I shave. I see what other people see,
and I'm ashamed. I see the grey hairs on my mother's head and know I
put them there. I eat but I know it isn't bread I can earn. Oh there are
times when I get interested in something and forget what I am, but not
when I talk. When I talk to someone, he doesn't have a face. He has a
mirror for a face, and I see the monster again.

We who must help these people must also expect at times to find apathy and depression as reactions to the feelings of guilt. It is possible to
ease the distress of guilt a little by becoming numb, by giving up, by refusing to try. Again, we may find individuals who escape some of their
guilt by denying the reality of their crooked mouths or tangled tongues.
They resist our efforts to help them because they refuse to accept the fact
of abnormal speech. Somehow they feel that the moment they admit the
existence of abnormality they become responsible. And with responsibility comes the guilt they cannot bear. So they resist our efforts to help
them. Finally, we meet persons who absolve themselves from guilt by projection, by blaming others for their affliction, by converting their guilt
into hostility or anxiety. But this brings us to the next section.

I 55

I 56

CHAPTER 5 EMOTIONAL ASPECTS OF COMMUNICATION DISORDERS

Hostility
Both penalty and frustration generate anger and aggression. We who are
hurt, hate. We who are frustrated, rage. Here is an example to help you
understand.
One of our former clients, a university professor, had always been a
quiet, self-effacing man. Interviews revealed that no one, not even
members of his family, ever heard him swear or raise his voice in anger

until he suffered a massive stroke. He awoke in the hospital to find

himself incontinent, aphasic, dysarthric, and paralyzed on his right
side. Since he found it so difficult to chew and swallow, chopped
and strained foods were prescribed. He endured all the indignities that
had befallen him with stoic detachment until a nurse's aide brought
his lunch tray containing three containers of baby food with the labels
still on the small jars. The mild-mannered professor threw the tray at
the aide and soundly cursed his wife and the patient in the adjoining
bed.

Reactions to Hostility. Hostility, like anxiety and guilt, ranges along

a continuum all the way from momentary irritation through anger to
intense hatred. A few of our clients have had such a huge reservoir of
anger that they mistrust the motives of anyone who tries to befriend
them. A young man with Gilles de Ia Tourette syndrome, a neuropsychiatric disorder involving involuntary movements and explosive, often
obscene speech, described his distorted relationship with young women
this way.
This mixture of conflicting emotions became even stronger when I
began dating. I wanted to go out with girls, to socialize, and to conduct a normal relationship. On the other hand, whenever a girl did accept a date with me, especially more than once, I invariably began
wondering what was wrong with herwhy would she want to go out
with me?

Resentment, or remembered anger, is perhaps the worst form of hostility. As long as we are resentful of another person for some past hurt,
ironically our lives are in part controlled by that person.
Some individuals with severe speech problems show little hostility;
yet we have known some with mild and minor disorders to show much.
One may have much anxiety or guilt but little hostility; another may
reveal quite an opposite state of affairs. Some people just seem to roll

with the punches and the frustrations and manage to get along with
a minimum of emotional response. But often hostility and aggression
are found, and so we must understand them. The experienced clinician knows that she may become the target for pent-up emotions
and she does not react personally to a client's expressions of anger and
resentment.

ROLE OF THE SPEECH-LANGUAGE PATHOLOGIST

ROLE OF THE SPEECH-

LANGUAGE PATHOLOGIST
Fortunately, most of the emotional conflicts shown by persons with
impaired speech are not deep-seated problems such as those treated by
psychiatrists, psychologists or psychiatric social workers. They are not pho-

bias, obsessions, or compulsions. They are not neuroses or psychoses.

Instead, they are related directly to the speech disorder and the ways in
which others and the person himself have reacted to it. When the person
gains acceptable speech most of the negative emotions disappear, though
their scars may remain.
This is not to say that the speech clinician can ignore the hidden emotional handicap of the person who comes to her. Indeed, she must become
highly aware of the client's history of penalty, frustration, anxiety, guilt,
and hostility because any of them untreated may interfere with successful
speech therapy.
The major task of the clinician in dealing with these emotional prob-

lems is to provide understanding and an opportunity for the client to

ventilate feelings, feelings rarely confided to anyone. Once shared, they
seem to lose their force. Let us describe some of the ways that this is
accomplished.

Evoking the Expression of a Negative Emotion

It has long been known that anxiety, guilt, and hostility, when repressed
or blocked from expression, tend to maintain themselves or even to increase in intensity. They thereby create other problems and certainly interfere with therapy. The healing that comes from the confession of guilt,
the relief achieved by verbalizing fear or anger is well known. However,
when the speech clinician is confronted by a hostile, fearful client or one
who feels great embarrassment or shame, the verbal expression of these
feelings is often constrained by the speech disorder itself. How can the
stroke patient with aphasia verbalize his emotions when he has no language? How can a laryngectomized p