Speech and Language Studies

(4FHE1049)
CASE STUDY:
SPEECH AND LANGUAGE
IMPAIRMENT
NOR AFRAH BINTI ROSSAM
PLPPIP2011/107/KIC
930429016058
A4
PUAN HAZINA ZAKARIA

INTRODUCTION & HISTORY

Speech and language disorders are among the most common developmental
problems in childhood. Severe difficulties may restrict the child from social
participation and academic achievement and lead to a permanent dysfunction in
adulthood (Conti-Ramdsen et al., 2001, Young et al., 2002, Snowling et al., 2006).
Children with language disorders have been variously referred to as language
disordered, language impaired, language delayed, or as having a specific language
impairment. Clinicians tend to use the first three terms; specific language impairment
is the preferred term in research publications. A language disorder can be defined as
a significant delay in the use and/or understanding of spoken or written language.
The disorder may involve the form of language (phonology, syntax, and morphology),
its content or meaning (semantics), or its use (pragmatics), in any combination
(American Speech-Language-Hearing Association 1993).
Phonology is the aspect of language concerned with the rules that govern the
structure, distribution, and sequencing of speech sounds. Syntax is the rule system
that governs how words are combined into larger meaningful units of phrases,
clauses, and sentences. Morphology is the aspect of a language that governs word
structure and includes grammatical word inflections that carry tense. Semantics is
the aspect of language that governs the meaning of words and word combinations.
Pragmatics is concerned with the social use of language. Difficulties with any aspect
of language must be in a person's first language in order for language disorder to be
considered.
Some cases of speech sound disorders, for example, may involve difficulties
articulating speech sounds. Educating a child on the appropriate ways to produce a
speech sound and encouraging the child to practice this articulation over time may
produce natural speech, Speech sound disorder. Likewise, stuttering does not have
a single, known cause, but has been shown to be effectively reduced or eliminated
by fluency shaping (based on behavioural principles) and stuttering modification
techniques.

BACKGROUND OF THE RESEARCH

Aims
This research attempts to explore the development of speech and language in
children and explore strategies to meet the needs of learners with speech and
language difficulties. Further, understand the role of adults in childrens speech and
language development and also understand the educational implications of speech
and language difficulties or challenges.

Definition & Concepts

Language refers to the cognitive set-up of the sounds of a language, the rules
for their combination into words and sentences and the meaning behind them.
Speech refers to the articulated utterances and the motor act and ability to perform
them. Speech and language are mainly used for communication and this term also
incorporates the use and understanding of social context and meaning. Language is
usually described as consisting of phonology, which means the set-up of sounds and
the rules for their combinations into words. It also consists of lexicon, meaning the
vocabulary of a language and the meaning of words, which is also referred to as
semantics. Additionally it consists of grammar, which refers to the combination of
words into sentences, and pragmatics, which means the social use of language, or
communication.
Children with specific speech and language disorders are those whose nonverbal ability is in the average band or higher and whose skill in understanding or
expressing themselves through the medium of spoken language is severely
impaired. Their disability is not attributable, however, to factors such as defective
hearing, emotional or behavioural disorders or a physical condition. The disorders
may involve difficulty with one or more of the main components of communication
through spoken language, receptive and/or expressive, such as patterning and
production of speech sounds, the message content, the syntax and grammar, or the
use of speech in interacting with other people.

Speech and language disorders refer to problems in communication and

related areas such as oral motor function. These delays and disorders range from
simple sound substitutions to the inability to understand or use language or use the
oral-motor mechanism for functional speech and feeding. Some causes of speech
and language disorders include hearing loss, neurological disorders, brain injury,
mental retardation, drug abuse, physical impairments such as cleft lip or palate, and
vocal abuse or misuse. Frequently, however, the cause is unknown.

Types of Speech and Language Disorders

a) Speech disorders
A speech disorder affects the ability to produce normal speech. Speech
disorders may affect articulation (phonetic or phonological disorders); fluency
(stuttering or cluttering); and/or voice (tone, pitch, volume, or rate). Speech
disorders may have their roots in oral-motor difficulties, although some involve
language processing problems. Diagnosis is made through speech/language
assessment that is performed by a licensed speech/language pathologist.
Treatment is by speech therapy.
b) Articulation
Aphasia is condition characterized by either partial or total loss of the ability to
communicate verbally or using written words. A person with aphasia may have
difficulty speaking, reading, writing, recognizing the names of objects, or
understanding what other people have said. Aphasia is caused by a brain
injury, as may occur during a traumatic accident or when the brain is deprived
of oxygen during a stroke. It may also be caused by a brain tumour, a disease
such as Alzheimer's, or an infection, like encephalitis. Aphasia may be
temporary or permanent. Aphasia does not include speech impediments
caused by loss of muscle control.
c) Fluency
Speech impairments where a childs flow of speech is disrupted by sounds,
syllables and words that are repeated, prolonged or avoided and where there
may be silent blocks or inappropriate inhalation, exhalation or phonation
patterns. A fluency disorder, or stuttering, is when speech shows
an abnormal number of repetitions, hesitations, prolongations, or disturbances

in this rhythm or flow. Tension may also be seen in the face, neck, shoulders,
or fists. There are many theories about why children stutter. Most experts
agree that certain environmental reactions to normal disfluency can result in
stuttering.
d) Voice
Occur when children have difficulty with pitch, intensity, vocal quality, or
resonance. For example, a child might not be speaking in a voice that ever
exceeds a whisper. The voice is produced as air from the lungs moves up
through and vibrates the vocal cords. This is called phonation. The voice is
then changed as it travels up through the different-shaped spaces of the
throat, nose, and mouth. This is called resonance. Voice disorders include
both phonation and resonance disorders.
e) Language
Language impairments are where the child has problems expressing needs,
ideas, or information, and or in understanding what others say.
f) Apraxia
The difficulty planning and coordinating the movements needed to make
speech sounds.

Characteristics of Speech or Language Impairments

Speech or language impairment is a problem in communication and can refer
to a childs language development being significantly below age level. A childs
communication is considered delayed when the child is noticeably behind peers in
the development of speech or language skills such as stuttering, impaired
articulation, language impairment, or a voice impairment, that adversely affects a
childs educational performance. The characteristics of speech or language
impairments will vary depending upon the type of impairment involved. There may
also be a combination of several problems. When a child has an articulation disorder,
he or she has difficulty making certain sounds. These sounds may be left off, added,
changed, or distorted, which makes it hard for people to understand the child.
Leaving out or changing certain sounds is common when young children are
learning to talk, of course. A good example of this is saying wabbit for rabbit. The
incorrect articulation is not necessarily a cause for concern unless it continues past

the age where children are expected to produce such sounds correctly. Fluency
refers to the flow of speech. A fluency disorder means that something is disrupting
the rhythmic and forward flow of speech, usually a stutter. As a result, the childs
speech contains an abnormal number of repetitions, hesitations, prolongations, or
disturbances. Tension may also be seen in the face, neck, shoulders or fist.
Voice is the sound that is produced when air from the lungs pushes through
the voice box in the throat (also called the larynx), making the vocal folds within
vibrate. From there, the sound generated travels up through the spaces of the throat,
nose, and mouth, and emerges as our voice. A voice disorder involves problems
with the pitch, loudness, resonance, or quality of the voice. The voice may be
hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if
they are stuffed up. People with voice problems often notice changes in pitch, loss
of voice, loss of endurance, and sometimes a sharp or dull pain associated with
voice use. Some characteristics of speech disorders are noticeably behind other
students in speech and/or language skills development, trouble forming sounds
(called articulation or phonological disorders), difficulties with the pitch, volume, or
quality of the voice, may display stuttering (dysfluency), an interruption in the flow of
speech, omits or substitutes sounds when pronouncing words, sounds nasal and
voice may have a "whining" quality and has abnormal rhythm or rate of speech.

METHODOLOGY
This research was took place during my School Based Experience (SBE) 3 in
Kedah. First, I asked the teacher about the students who have speech and language
disorders. The teacher told me that particular student is 8 years old and her name is

Nur Husnina Alya binti Nafil. She has four siblings and her father works as a labor
while her mother as a housewife. Her academic performance was not good because
she has difficulties to communicate with the teacher or even their friends. The
teacher has to teach personally to Husninas and use variety of teaching materials
according to her ability. Then, I gave the questionnaire to the teacher to fill in
regarding about the student behaviour in classrooms. After that, I followed the
teacher to enter the Husninas classroom. Then, the teacher introduced Husnina to
me. In the classroom, I observed Husninas behaviour. She was really passive in the
classroom and did not give co-operation in the learning activities. Besides that, she
cannot give full attention in the teaching and learning process because she did not
has interest in the subject that has been taught. Then, she likes to move around a lot
and did not stay still. After the class ended, I interviewed the student and asked her
about her hobby and ambition. Husnina has difficulty to pronounce the words and
stutter. When I asked Husnina some questions, she was slow to respond because
she did not know the meaning of the questions given to her. Moreover, she
occasionally spoke in complete sentences. Then, I asked Husnina to invite her
parents to come to the school if they have their free time. The next day, her parents
came to the school. Then, I took this opportunity to discuss and interview about her
daughter behaviour at home. Her parents stated that Husnina was really taciturn and
did not socialize with her siblings. She likes to play alone and always remain silent.
After that, I gave the questionnaire to the Husninas parents to be filled in. Her
parents gave full commitment and co-operation when we discussed about this
problems.

FINDINGS
Inside the Classroom

This section has been divided into three sections which are before, during and after.
Before the class begun, the student did not talk with the peers and she always
moves around a lot and do not stay still. Besides that, she did not make noises or
being too loud. She stayed inside the classroom even though the teaching and
learning process did not occur. Then, she did not prepare before class such as takes
out books and stationary. During the teaching and learning process, she always
fiddles and fidgets while listening and need breaks and distractions from the task in
classroom. She is very passive in the classroom and seldom asks questions to the
teacher. Then, she always uses body or hand gestures while explaining and also
uses small notes when asking or answering peers. She always gives up when trying
explaining something. Besides that, she has a bland facial expression while listening
to others. She did not talk too loud or high pitch voice and always talks with low voice
or very quietly. She did not use harsh words when answering the questions and did
not has the effort in order to ask for help from others if does not understand the task
given. After the classroom, she greets the teacher properly and arrange her
belongings appropriately. She did not change her mood suddenly after class is
finished and did not continue playing with peers.

Husnina's rate of voice inside the classroom

Too loud

Slow voice

High pitch

15% 5%
5%

75%

Outside the Classroom

Moderate

Husnina appears frustrated or gives up when struck on words and frequently loses
her voices. She did not consistent harsh or hoarse vocal quality. She also has nasal
quality when speaking and did not always sounds like having a cold. She tends to
speak in short and simple sentences and always interact in passive ways with peers.
Besides that, Husnina always seem fidgety and restless and did not always being
hyperactive. Then, she always uses body or hand gestures while explaining instead
of speaking. Further, she did not always have a bland facial expression while
listening to others. She always stutters while speaking or explaining to peers all the
time. Moreover, she did not ask help from peers to speak on her behalf and whispers
to peers instead of speaking. Then, she acts very shy when meeting unfamiliar
person and did not avoids conversation with unfamiliar person. Husnina usually nods
or shakes head when implying yes or no as an answer.

Husnina's rate of interaction outside the classroom

Peers

Teachers

Unfamiliar person

30%
50%
10%
10%

Interview and Questionnaire

No interaction

Student
The student that I have interviewed is Nur Husnina Alya binti Nafil who is study at
Sekolah Kebangsaan Seri Gedong, Sungai Petani, Kedah. She is 8 years old and
her first language is Malay. She has 4 siblings and she is the younger ones. She did
not always communicate with her family and she find it is hard to communicate with
friends and teachers. She claimed that her friends always respond to her when she
tries to communicate with them. She also find it is hard to use appropriate words to
express the ideas. Besides that, she did not always respond to instruction correctly.
Further, she often takes time in understanding certain instructions or conversations.
She also ever thinks of giving up in learning due to her speech and language
disorders. Her parents did help her with the homework at home. Then, her parents
always support and encourage her in communication. She did not prefer to speak or
express her feeling rather than keep it to herself. Husnina always think that she need
someone to help her to understand better and at the same time she always think that
she need someone to improve her conversations. The things that she usually talk
about with her siblings is about herself regarding her problems in speech and
language. She also seldom shares her experience at school with her siblings
because she likes to remain silent. The next is she did have a problem to complete
the sentences during expressing her ideas and sharing her thoughts. Sometimes she
also quarrels with her siblings and pinches them without use bad words. Her parents
always try to correct the mistake that she have done during her speech. Further, her
parents also encourage her to speak more but she prefers to listen to others rather
than to speak. She feels comfortable when speak with her family members and feel
fearful when speak with a group of friends. Besides that, she will feel anxious when
communicate with one friend. The speaking situation that she will avoid is when her
family or friends ask about the subject that has been taught. The strategy that she
will use to get through a disfluent moment is by avoiding the situations and plays
alone.

Teacher

The teacher that I have interviewed is Puan Azura binti Marzuki. She is 33 years old
and has the qualification under graduated from Universiti Malaya. Her major subject
is English. Her works experience in Sekolah Kebangsaan Seri Gedong for almost 9
years. She is the classroom teacher of 2 Dedikasi which is Husninas class and she
has been observed about Husninas behaviour for almost 1 years. She is the teacher
who is in charged for enrichment class. The hardest thing to teach Husnina is she
always has a difficult time following spoken directions. According to Puan Azura,
Husninas voice is usually soft and frequently stutters when speaking. Further, she
claimed that Husnina has problems with her voice like hoarseness, nasal and
breathy. Husnina also like to use excessively um, uh, you know and a when
speaking. During Puan Mazura an observation regarding Husninas interaction,
Husnina is seldom interacts with peers. However, the other students react nicely to
Husninas speech. Besides that, Husnina is not sensitive than most children but she
will getting upset easily if she cannot do something well. Husnina never use dirty
words when she upset and she will avoid talking in a group, making oral reports and
answering questions in class. Puan Azura stated that Husnina will not always excited
while doing activities and she did not expressed concern about her speech errors.
Puan Azura also said that Husnina has spelling problems due to articulation
problems and her voice cannot be heard clearly. According to Puan Azura, she
needs to make special preparation before class according to Husninas learning
styles and abilities in order to make the teaching and learning process become
meaningful and not bored. Puan Azura also give strategies to overcome the students
who have speech and language difficulty which are used step by step symbol or
picture cards, clear verbal explanations and break down tasks and instruction into
manageable. Puan Azura also clarified that there is obstacles that she had faced
while dealing with this particular students which are lack of interest to study and
cannot give full attention and co-operation the teaching and learning process. Puan
Azura also made an adaptations to her lesson plan to fulfil the needs of students with
speech difficulty by providing different kinds of teaching materials according to the
students ability, interest and learning styles such as picture books and flash cards.

Parents

The heir of the student that I had interviewed is Husninas father, Nafil bin Kassim.
He is 48 years old and works as a labor. Her father was stopped by at the school
when I said to Husnina that I would like to meet her personally. Her fathers
academic level is SPM level and he is from a poor family background. His wife did
not work so he has to bear the cost for his family all alone. From his observations, he
said that Husnina enjoy going to school. He also always keeps in touch with the
teachers at school regarding her daughters behaviour and academic performance.
According to Encik Nafil, his daughter achievement at school is moderate. Husnina
never have friends at school that she always talks about. Encik Nafil did encourage
her to socialize with people around her. Then, she did not have closed relationships
with other siblings and did not share her problems with the siblings. Encik Nafil also
said that Husnina always quarrel with the others when they are gathering at home.
However, Husninas other siblings always help her to teach or to help her to
communicate her needs. The problem that she usually shares with Encik Nafil is
about her. Encik Nafil also always repeats the words during giving instructions to
Husnina and it do really take a lot of time to communicate with her. Further, Encik
Nafil said that he realised that his daughter has speech disorder and there is other
family members has the same disorder as Husnina. He also clarified that he did not
know any specialist to be referred regarding this disorder. Encik Nafil will allocate his
time to interact with his daughter. During the process of communication withing the
family, Encik Nafil noticed that Husnina take part passively and in order to overcome
this problem, Encik Nafil will ask Husnina some questions that will catch her attention
such as about giving the suggestion for having a picnic. Besides, Encik Nafil stated
that Husnina do have strong interest in drawing. Encik Nafil also detected that
Husnina will get frustrated when she fails to communicate her needs.

SUGGESTIONS

Teachers
A speech disorder refers to a problem with the actual production of sounds, whereas
a language disorder refers to a difficulty understanding or putting words together to
communicate ideas. The teacher should know the ways to overcome speech
impairment and how it affects the students communication abilities. The strategies
for teaching and learning for speech impairment is first by teach an understanding of
words and concepts through the use of actual objects and progress from the
concrete to the abstract. The teacher also can use a slower speech rate if necessary
as this facilitates the processing of information. However, it is important that the
speech rate is not so slow as to lose the continuity of the message. Then, use
pictures or photographs to reinforce and review the vocabulary that has been taught
and use role play as a regular feature of language learning as this helps alternate
speaker roles. Further, the teacher also has to variety the teaching materials by
conduct activities such as conversations, discussions, radio or television broadcasts,
puppetry, telephoning, reporting, interviewing, telling riddles, book reports and role
playing can be used to develop oral language activities.

Parents
Learn the specifics of their childs speech or language impairment. Parents can read
the same story book again and again before the bedtime or any leisure time. This is
because the repetition will help the child to learn language. Besides that, always
keep in touch with the childs teachers. Always up to date on the child development
in school. Moreover, use simple sentences and instructions when speak with the
child as it will reinforce key words. Be well informed about the speech-language
therapy of their son or daughter is receiving. Talk with the specialist, find out how to
augment and enrich the therapy at home and in other environments. Then, listen to
the child. Dont rush to fill gaps or make corrections. Conversely, dont force the child
to speak. He/she may feel demotivated. Lastly, try to give the child chores. Chores
build confidence and ability.

CONCLUSION

Speech and language impairments include a variety of conditions that interfere with
communication. Many of these disabilities are relatively rare or subtle in appearance,
and the individuals lack of any visible abnormalities may further disguise speech and
language impairments. The field of speech-language pathology is diverse and
complex. Only a speech-language pathologist can accurately and thoroughly
diagnose and treat speech and language impairments. These professionals are
available in the public schools, hospitals, university clinics, or private practice clinics.
A child with this problem should be help as soon as possible with an appropriate
style and ways. In this circumstance, parents and teachers play a very important role
as they the closest person to the child. Parents should be more aware of their
children problem and spend a quality time with them. As a teacher, he or she need to
variety the teaching materials in order to make the teaching and learning process
become more meaningful and grab the child attention to learn.

REFFERENCES

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Chicagospeechtherapy.com, (2014). Speech Therapy Tips: What Should Parents of
Children with Auditory Processing Disorder Do? | Chicago Speech Therapy, LLC.
[online] Available at: http://www.chicagospeechtherapy.com/speech-therapy-tipswhat-should-parents-of-children-with-auditory-processing-disorder-do/ [Accessed 9
Apr. 2014].
Kidshealth.org, (2014). Speech-Language Therapy. [online] Available at:
http://kidshealth.org/parent/system/ill/speech_therapy.html [Accessed 9 Apr. 2014].
Med.umich.edu, (2014). Speech and Language Delay and Disorder: Your Child:
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of

Michigan

Health

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[online]

Available

at:

https://www.med.umich.edu/yourchild/topics/speech.htm [Accessed 9 Apr. 2014]

Nichcy.org, (2014). Speech and Language Impairments in Your Classroom: 8 Tips
for Teachers National Dissemination Center for Children with Disabilities. [online]
Available at: http://nichcy.org/s-l-i-8-tips-for-teachers [Accessed 9 Apr. 2014].
Speech And Language Difficulties (Sp&LD) | Speech And Language Difficulties
(Sp&LD) | Sensory Difficulties | The Good Schools Guide [online] Available at:
http://www.goodschoolsguide.co.uk/help-and-advice/special-needs-advice/types-ofsen/sensory-difficulties/206/speech-and-language-difficulties-sp-ld [Accessed 9 Apr.
2014].

APPENDIXES