MEd -Speech and language impairment-communication disorder

Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.

A speech impairment is characterized by difficulty in articulation of words. Examples include stuttering or problems producing particular sounds. Articulation refers to the sounds, syllables, and phonology produced by the individual. Voice, however, may refer to the characteristics of the sounds produced—specifically, the pitch, quality, and intensity of the sound. Often, fluency will also be considered a category under speech, encompassing the characteristics of rhythm, rate, and emphasis of the sound produced 

A language impairment is a specific impairment in understanding and sharing thoughts and ideas, i.e. a disorder that involves the processing of linguistic information. Problems that may be experienced can involve the form of language, including grammar, morphology, syntax; and the functional aspects of language, including semantics and pragmatics

An individual can have one or both types of impairment. These impairments / disorders are identified by a speech and language pathologist.The Following are brief definitions of several of the more prominent speech disorders:

Apraxia of speech

Main article: Apraxia of speech

Apraxia of speech is the acquired form of motor speech disorder caused by brain injury, stroke or dementia.

Developmental verbal dyspraxia

Main article: Developmental verbal dyspraxia

Developmental verbal dyspraxia refers specifically to a motor speech disorder. This is a neurological disorder. Individuals suffering from developmental verbal apraxia encounter difficulty saying sounds, syllables, and words. The difficulties are not due to weakness of muscles, but rather on coordination between the brain and the specific parts of the body. Apraxia of speech is the acquired form of this disorder caused by brain injury, stroke or dementia.

Interventions are more effective when they occur individually at first, and between three to five times per week. With improvements, children with apraxia may be transitioned into group therapy settings. Therapeutic exercises must focus on planning, sequencing, and coordinating the muscle movements involved in speech production. Children with developmental verbal dyspraxia must practice the strategies and techniques that they learn in order to improve. In addition to practice, feedback can be helpful to improve apraxia of speech. Tactile feedback (touch), visual feedback (watching self in mirror), and verbal feedback are all important additions. Biofeedback has also been cited as a possible therapy. Functional training involves placing the individual in more speech situations, while providing him/her with a speech model, such as the SLP. Because the cause is neurological, however, some patients do not progress. In these cases, AAC may be more appropriate.

Dysarthria

Main article: Dysarthria

Dysarthria is a motor speech disorder that results from a neurological injury. Some stem from central damage, while other stem from peripheral nerve damage. Difficulties may be encountered in respiratory problems, vocal fold function, or velopharyngeal closure, for example.

Orofacial myofunctional disorders

Main article: Orofacial myological disorders

Orofacial myofunctional disorders refers to problems encountered when the tongue thrusts forward inappropriately during speech. While this is typical in infants, most children outgrow this. Children that continue to exaggerate the tongue movement may incorrectly produce speech sounds, such as /s/, /z/, “sh”, “ch”, and “j”. For example, the word, “some,” might be pronounced as “thumb”.

The treatment of OMD will be based upon the professional’s evaluation. Each child will present a unique oral posture that must be corrected. Thus, the individual interventions will vary. Some examples include:

increasing awareness of muscles around the mouth

increasing awareness of oral postures

improving muscle strength and coordination

improving speech sound productions

improving swallowing patterns

Speech sound disorder[edit]

Main article: Speech sound disorder

Speech sound disorders may be of two varieties: articulation (the production of sounds) or phonological processes (sound patterns). An articulation disorder may take the form of substitution, omission, addition, or distortion of normal speech sounds. Phonological process disorders may involve more systematic difficulties with the production of particular types of sounds, such as those made in the back of the mouth, like “k” and “g”.

Naturally, abnormalities in speech mechanisms would need to be ruled out by a medical professional. Therapies for articulation problems must be individualized to fit the individual case. The placement approach—instructing the individual on the location in which the tongue should be and how to blow air correctly—could be helpful in difficulties with certain speech sounds. Another individual might benefit more from developing auditory discrimination skills, since he/she has not learned to identify error sounds in his/her speech. Generalization of these learned speech techniques will need to be generalized to everyday situations. Phonological process treatment, on the other hand, can involve making syntactical errors, such as omissions in words. In cases such as these, explicit teaching of the linguistic rules may be sufficient.

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 behavioral principles) and stuttering modification techniques.

Stuttering

Main article: Stuttering

Stuttering is a disruption in the fluency of an individual’s speech, which begins in childhood and may persist over a lifetime. Stuttering is a form of disfluency; disfluency becomes a problem insofar as it impedes successful communication between two parties. Disfluencies may be due to unwanted repetitions of sounds, or extension of speech sounds, syllables, or words. Disfluencies also incorporate unintentional pauses in speech, in which the individual is unable to produce speech sounds

While the effectiveness is debated, most treatment programs for stuttering are behavioral. In such cases, the individual learns skills that improve oral communication abilities, such as controlling and monitoring the rate of speech. SLPs may also help these individuals to speak more slowly and to manage the physical tension involved in the communication process. Fluency may be developed by selecting a slow rate of speech, and making use of short phrases and sentences. With success, the speed may be increased until a natural rate of smooth speech is achieved. Additionally, punishment for incorrect speech production should be eliminated, and a permissive speaking environment encouraged. Electronic fluency devices, which alter the auditory input and provide modified auditory feedback to the individual, have shown mixed results in research reviews.

Because stuttering is such a common phenomenon, and because it is not entirely understood, various opposing schools of thought emerge to describe its etiology. The Breakdown theories maintain that stuttering is the result of a weakening or breakdown in physical systems that are necessary for smooth speech production. Cerebral dominance theories (in the stutterer, no cerebral hemisphere takes the neurological lead) and theories of perseveration (neurological “skipping record” of sorts) are both Breakdown theories. Auditory Monitoring theories suggest that stutters hear themselves differently from how other people hear them. Since speakers adjust their communication based upon the auditory feedback they hear (their own speech), this creates conflict between the input and the output process. Psychoneurotic theories posit repressed needs as the source of stuttering. Lastly, Learning theories are straightforward—children learn to stutter. It should be clear that each etiological position would suggest a different intervention, leading to controversy with the field.

Voice disorders

Voice disorders range from aphonia (loss of phonation) to dysphonia, which may be phonatory and/or resonance disorders. Phonatory characteristics could include breathiness, hoarseness, harshness, intermittency, pitch, etc. Resonance characteristics refer to overuse or underuse of the resonance chambers resulting in hypernasality or hyponasality. Several examples of voice problems are vocal chord nodules or polyps, vocal chord paralysis, paradoxical vocal fold movement, and spasmodic dysphonia. Vocal chord nodules and polyps are different phenomena, but both may be caused by vocal abuse, and both may take the form of growths, bumps, or swelling on the vocal chords. Vocal fold paralysis is the inability to move one or both of the vocal chords, which results in difficulties with voice and perhaps swallowing. Paradoxical vocal fold movement occurs when the vocal chords close when they should actually be open. Spasmodic dysphonia is caused by strained vocal chord movement, which results in awkward voice problems, such as jerkiness or quavering.

If nodules or polyps are present, and are large, surgery may be the appropriate choice for removal. Surgery is not recommended for children, however. Other medical treatment may suffice for slighter problems, such as those induced by gastroesophageal reflux disease, allergies, or thyroid problems. Outside of medical and surgical interventions, professional behavioral interventions can be useful in teaching good vocal habits and minimizing abuse of vocal cords. This voice therapy may instruct in attention to pitch, loudness, and breathing exercises. Additionally, the individual may be instructed on the optimal position to produce the maximum vocal quality. Bilateral paralysis is another disorder that may require medical or surgical interventions to return vocal cords to normalcy; unilateral paralysis may be treated medically or behaviorally.

Paradoxical vocal fold movement (PVFM) is also treated medically and behaviorally. Behavioral interventions will focus on voice exercises, relaxation strategies, and techniques that can be used to support breath. More generally, however, PVFM interventions focus on helping an individual to understand what triggers the episode, and how to deal with it when it does occur.

While there is no cure for spasmodic dysphonia, medical and psychological interventions can alleviate some of the symptoms. Medical interventions involve repeated injections of Botox into one or both of the vocal cords. This weakens the laryngeal muscles, and results in a smoother voice.

Language Disorders

Main article: Language disorder

A language disorder is an impairment in the ability to understand and/or use words in context, both verbally and nonverbally. Some characteristics of language disorders include improper use of words and their meanings, inability to express ideas, inappropriate grammatical patterns, reduced vocabulary and inability to follow directions. One or a combination of these characteristics may occur in children who are affected by language learning disabilities or developmental language delay. Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate.

Specific language impairment

Main article: Specific language impairment

Interventions for specific language impairment will be based upon the individual difficulties in which the impairment manifests. For example, if the child is incapable of separating individual morphemes, or units of sound, in speech, then the interventions may take the form of rhyming, or of tapping on each syllable. If comprehension is the trouble, the intervention may focus on developing metacognitive strategies to evaluate his/her knowledge while reading, and after reading is complete. It is important that whatever intervention is employed, it must be generalized to the general education classroom.

Selective mutism

Main article: Selective mutism

Selective mutism is a disorder that manifests as a child that does not speak in at least one social setting, despite being able to speak in other situations. Selective mutism is normally discovered when the child first starts school.

Behavioral treatment plans can be effective in bringing about the desired communication across settings. Stimulus fading involves a gradual desensitization, in which the individual is placed in a comfortable situation and the environment is gradually modified to increase the stress levels without creating a large change in stress level. Shaping relies on behavioral modification techniques, in which successive attempts to produce speech is reinforced. Self-modeling techniques may also be helpful; for example, self-modeling video tapes, in which the child watches a video of him/herself performing the desired action, can be useful.

If additional confounding speech problems exist, a SLP may work with the student to identify what factors are complicating speech production and what factors might be increasing the mute behaviors. Additionally, he/she might work with the individual to become more comfortable with social situations, and with the qualities of their own voice. If voice training is required, they might offer this as well.

Aphasia

Main article: Aphasia

Aphasia refers to a family of language disorders that usually stem from injury, lesion, or atrophy to the left side of the brain that result in reception, perception, and recall of language; in addition, language formation and expressive capacities may be inhibited.

Language-based learning disabilities

Language-based learning disabilities, which refer to difficulties with reading, spelling, and/or writing that are evidenced in a significant lag behind the individual’s same-age peers. Most children with these disabilities are at least of average intelligence, ruling out intellectual impairments as the causal factor.

Diagnostic criteria

The DSM-5 and the ICD-10 are both used to make specific diagnostic decisions. Speech and language disorders commonly include communication issues, but also extend into various areas such as oral-motor function—sucking, swallowing, drinking, or eating. In some cases, a child's communication is delayed considerably behind his/her same-aged peers. The effects of these disorders can range from basic difficulties in the production of certain letter sounds to more comprehensive inabilities to generate (expressive) or understand (receptive) language. In most cases, the causal factors that create these speech and language difficulties are unknown. There are a wide variety of biological and environmental causal factors that can create them, ranging from drug abuse to neurological issues. For more information on causal hypotheses, refer to the section on models.

Developmental disorders

Developmental disorders tend to have a genetic origin, such as mutations of FOXP2, which has been linked to Developmental verbal dyspraxia and Specific language impairment. Some of these impairments are caused by genetics. Interestingly, case histories often reveal a positive family history of communication disorders. Between 28% and 60% of children with a speech and language deficit have a sibling and/or parent who is also affected.Down syndrome is another example of a genetic causal factor that may result in speech and/or language impairments. Stuttering is a disorder that is hypothesized to have a strong genetic component as well.

Some speech and language impairments have environmental causes. A specific language impairment, for example, may be caused by insufficient language stimulation in the environment. If a child does not have access to an adequate role model, or is not spoken to with much frequency, the child may not develop strong language skills. Furthermore, if a child has little stimulating experiences, or is not encouraged to develop speech, that child may have little incentive to speak at all and may not develop speech and language skills at an average pace.

Developmental disabilities such as autism and neurological disorders such as cerebral palsy may also result in impaired communicative abilities. Similarly, malformation or malfunctioning of the respiratory system or speech mechanisms may result in speech impairments. For example, a cleft palate will allow too much air to pass through the nasal cavity and a cleft lip will not allow the individual to correctly form sounds that require the upper lip.The development of vocal fold nodules represents another issue of biological causation. In some cases of biological origin, medical interventions such as surgery or medication may be required. Other cases may require speech therapy or behavioral training.

Acquired disorders

Acquired disorders result from brain injury, stroke or atrophy, many of these issues are included under the Aphasia umbrella. Brain damage, for example, may result in various forms of aphasia if critical areas of the brain such as Broca’s or Wernicke's area are damaged by lesions or atrophy as part of a dementia

Speech and language assessment

Main article: Speech and language assessment

What follows are a list of frequently used measures of speech and language skills, and the age-ranges for which they are appropriate.

Clinical Evaluation of Language Fundamentals – Preschool (3–6 years)

Clinical Evaluation of Language Fundamentals (6–21 years)

MacArthur Communicative Development Inventories (0–12 months)

The Rossetti Infant-Toddler Language Scale (0–36 months)

Preschool Language Scale (0–6 years)

Expressive One-word Picture Vocabulary Test (2–15 years)

Bankson-Bernthal Phonological Process Survey Test (2–16 years)

Goldman-Fristoe Test of Articulation 2 (2–21 years)

Peabody Picture Vocabulary Test (2.5–40 years)

In the United States of America

Under the Individuals with Disabilities Education Act (IDEA) 2004, the federal government has defined a speech or language impairment as "a communication disorder such as stuttering, impaired articulation, a language impairment, or a voice impairment, which adversely affects a child's learning." In order to qualify in the educational system as having a speech or language impairment, the child's speech must be either unintelligible much of the time or he/she must have been professionally diagnosed as having either a speech impairment or language delay which requires intervention. Additionally, IDEA 2004 contains an exclusionary clause that stipulates that a speech or language impairment may not be either cultural, ethnic, bilingual, or dialectical differences in language, temporary disorders (such as those induced by dental problems), or delayed abilities in producing the most difficult linguistic sounds in a child's age range.

Management

Speech-Language Pathologists (SLPs) offer many services to children with speech or language disabilities.

Speech-Language Pathology

Main article: Speech-language patho

Speech-Language Pathologists (SLPs) may provide individual therapy for the child to assist with speech production problems such as stuttering. They may consult with the child's teacher about ways in which the child might be accommodated in the classroom, or modifications that might be made in instruction or environment. The SLP can also make crucial connections with the family, and help them to establish goals and techniques to be used in the home. Other service providers, such as counselors or vocational instructors may also be included in the development of goals as the child transitions into adulthood.

The individual services that the child receives will depend upon the needs of that child. Simpler problems of speech, such as hoarseness or vocal fatigue (voicing problems) may be solved with basic instruction on how to modulate one's voice. Articulation problems could be remediated by simple practice in sound pronunciation. Fluency problems may be remediated with coaching and practice under the guidance of trained professionals, and may disappear with age. However, more complicated problems, such as those accompanying autism or strokes, may require many years of one-on-one therapy with a variety of service providers. In most cases, it is imperative that the families be included in the treatment plans since they can help to implement the treatment plans. The educators are also a critical link in the implementation of the child's treatment plan.

For children with language disorders, professionals often relate the treatment plans to classroom content, such as classroom textbooks or presentation assignments. The professional teaches various strategies to the child, and the child works to apply them effectively in the classroom. For success in the educational environment, it is imperative that the SLP or other speech-language professional have a strong, positive rapport with the teacher(s).

Speech-language pathologists create plans that cater to the individual needs of the patient. If speech is not practical for a patient, the SLP will work with the patient to decide upon an augmentative and alternative communication (AAC) method or device to facilitate communication. They may work with other patients to help them make sounds, improve voices, or teach general communication strategies. They also work with individuals who have difficulties swallowing. In addition to offering these types of communication training services, SLPs also keep records of evaluation, progress, and eventual discharge of patients, and work with families to overcome and cope with communication impairments (Bureau of Labor Statistics, 2009).

In many cases, SLPs provide direct clinical services to individuals with communication or swallowing disorders. SLPs work with physicians, psychologists, and social workers to provide services in the medical domain, and collaborate with educational professionals to offer additional services for students to facilitate the educational process. Thus, speech-language services may be found in schools, hospitals, outpatient clinics, and nursing homes, among other settings.

The setting in which therapy is provided to the individual depends upon the age, type, and severity of the individual's impairment. An infant/toddler may engage in an early intervention program, in which services are delivered in a naturalistic environment in which the child is most comfortable—probably his/her home. If the child is school-aged, he/she may receive speech-language services at an outpatient clinic, or even at his/her home school as part of a weekly program. The type of setting in which therapy is offered depends largely upon characteristics of the individual and his/her disability.

As with any professional practice that is informed by ongoing research, controversies exist in the fields that deal with speech and language disorders. One such current debate relates to the efficacy of oral motor exercises and the expectations surrounding them. According to Lof, non-speech oral motor exercises (NS-OME) includes “any technique that does not require the child to produce a speech sound but is used to influence the development of speaking abilities.” These sorts of exercises would include blowing, tongue push-ups, pucker-smile, tongue wags, big smile, tongue-to-nose-to-chin, cheek puffing, blowing kisses, and tongue curling, among others. Lof continues, indicating that 85% of SLPs are currently using NS-OME. Additionally, these exercises are used for dysarthria, apraxia, late talkers, structural anomalies, phonological impairments, hearing impairments, and other disorders. Practitioners assume that these exercises will strengthen articulatory structures and generalize to speech acts. Lof reviews 10 studies, and concludes that only one of the studies shows benefits to these exercises (it also suffered serious methodological flaws). Lof ultimately concludes that the exercises employ the same structures, but are used for different functions. The NS-OME position is not without its supporters, however, and the proponents are numerous.

Interventions

Intervention services will be guided by the strengths and needs determined by the speech and language evaluation. The areas of need may be addressed individually until each one is functional; alternatively, multiple needs may be addressed simultaneously through the intervention techniques. If possible, all interventions will be geared towards the goal of developing typical communicative interaction. To this end, interventions typically follow either a preventive, remedial, or compensatory model. The preventive service model is common as an early intervention technique, especially for children whose other disorders place them at a higher risk for developing later communication problems. This model works to lessen the probability or severity of the issues that could later emerge. The remedial model is used when an individual already has a speech or language impairment that he/she wishes to have corrected. Compensatory models would be used if a professional determines that it is best for the child to bypass the communication limitation; often, this relies on AAC.

Language intervention activities are used in some therapy sessions. In these exercises, an SLP or other trained professional will interact with a child by working with the child through play and other forms of interaction to talk to the child and model language use. The professional will make use of various stimuli, such as books, objects, or simple pictures to stimulate the emerging language. In these activities, the professional will model correct pronunciation, and will encourage the child to practice these skills. Articulation therapy may be used during play therapy as well, but involves modeling specific aspects of language—the production of sound. The specific sounds will be modeled for the child by the professional (often the SLP), and the specific processes involved in creating those sounds will be taught as well. For example, the professional might instruct the child in the placement of the tongue or lips in order to produce certain consonant sounds.

Technology is another avenue of intervention, and can help children whose physical conditions make communication difficult. The use of electronic communication systems allow nonspeaking people and people with severe physical disabilities to engage in the give and take of shared thought.

Adaptability and limitations

While some speech problems, such s certain voice problems, require medical interventions, many speech problems can be alleviated through effective behavioral interventions and practice. In these cases, instruction in speech techniques or speaking strategies, coupled with regular practice, can help the individual to overcome his/her speaking difficulties. In other, more severe cases, the individual with speech problems may compensate with AAC devices.

Speech impairments can seriously limit the manner in which an individual interacts with others in work, school, social, and even home environments. Inability to correctly form speech sounds might create stress, embarrassment, and frustration in both the speaker and the listener. Over time, this could create aggressive responses on the part of the listener for being misunderstood, or out of embarrassment. Alternatively, it could generate an avoidance of social situations that create these stressful situations. Language impairments create similar difficulties in communicating with others, but may also include difficulties in understanding what others are trying to say (receptive language). Because of the pervasive nature of language impairments, communicating, reading, writing, and academic success may all be compromised in these students. Similar to individuals with speech impairments, individuals with language impairments may encounter long-term difficulties associated with work, school, social, and home environments.

Assistive technology

Augmentative and alternative communication (AAC) includes all forms of communication other than oral communication that an individual might employ to make known his/her thoughts. AAC work to compensate for impairments that an individual might have with expressive language abilities. Each system works to maintain a natural and functional level of communication. There is no one best type of AAC for all individuals; rather, the best type of AAC will be determined by the strengths and weaknesses of a specific individual. While there are a large amount of types of AAC, there are fundamentally two categories: aided and unaided.

Unaided systems of communication are those that require both communication parties to be physically present in the same location. Examples of unaided systems include gestures, body language, sign language, and communication boards. Communication boards are devices upon which letters, words, or pictorial symbols might be displayed; the individual may interface with the communication board to express him/herself to the other individual.

Aided systems of communication do not require both individuals to be physically present in the same location, though they might be. Aided systems are often electronic devices, and they may or may not provide some form of voice output. If a device does create a voice output, it is referred to as a speech generating device. While the message may take the form of speech output, it may also be printed as a visual display of speech. Many of these devices can be connected to a computer, and in some cases, they may even be adapted to produce a variety of different languages

Inclusion vs. exclusion

Students identified with a speech and language disability often qualify for an Individualized Education Plan as well as particular services. These include one-on-one services with a speech and language pathologist. Examples used in a session include reading vocabulary words, identifying particular vowel sounds and then changing the context, noting the difference. School districts in the United States often have speech and language pathologists within a special education staff to work with students. Additionally, school districts can place students with speech and language disabilities in a resource room for individualized instruction. A combination of early intervention and individualized support has shown promise increasing long-term academic achievement with students with this disability.

Students might work individually with a specialist, or with a specialist in a group setting. In some cases, the services provided to these individuals may even be provided in the regular education classroom. Regardless of where these services are provided, most of these students spend small amounts of time in therapy and the large majority of their time in the regular education classroom with their typically developing peers.

Therapy often occurs in small groups of three or four students with similar needs. Meeting either in the office of the speech-language pathologist or in the classroom, sessions may take from 30 minutes to one hour. They may occur several times per week. After introductory conversations, the session is focused on a particular therapeutic activity, such as coordination and strengthening exercises of speech muscles or improving fluency through breathing techniques. These activities may take the form of games, songs, skits, and other activities that deliver the needed therapy. Aids, such as mirrors, tape recorders, and tongue depressors may be utilized to help the children to become aware of their speech sounds and to work toward more natural speech production.

Prevalence

In 2006, the U.S. Department of Education indicated that more than 1.4 million students were served in the public schools’ special education programs under the speech or language impairment category of IDEA 2004. This estimate does not include children who have speech/language problems secondary to other conditions such as deafness; this means that if all cases of speech or language impairments were included in the estimates, this category of impairment would be the largest. Another source has estimated that communication disorders—a larger category, which also includes hearing disorders—affect one of every 10 people in the United States.

ASHA has cited that 24.1% of children in school in the fall of 2003 received services for speech or language disorders—this amounts to a total of 1,460,583 children between 3 –21 years of age.Again, this estimate does not include children who have speech/language problems secondary to other conditions. Additional ASHA prevalence figures have suggested the following:

Stuttering affects approximately 4% to 5% of children between the ages of 2 and 4.

ASHA has indicated that in 2006:

Almost 69% of SLPs served individuals with fluency problems.

Almost 29% of SLPs served individuals with voice or resonance disorders.

Approximately 61% of speech-language pathologists in schools indicated that they served individuals with SLI

Almost 91% of SLPs in schools indicated that they servedindividuals with phonological/articulation disorder

Estimates for language difficulty in preschool children range from 2% to 19%.

Specific Language Impairment (SLI) is extremely common in children, and affects about 7% of the childhood population.

Discrimination

While more common in childhood, speech impairments can result in a child being bullied. Bullying is a harmful activity that often takes place at school, though may be present in adult life. Bullying involves the consistent and intentional harassment of another individual, and may be physical or verbal in nature.

Speech impairments (e.g., stuttering) and language impairments (e.g., dyslexia, auditory processing disorder) may also result in discrimination in the workplace. For example, an employer would be discriminatory if he/she chose to not make reasonable accommodations for the affected individual, such as allowing the individual to miss work for medical appointments or not making onsite-accommodations needed because of the speech impairment. In addition to making such appropriate accommodations, the Americans with Disabilities Act (1990) protects against discrimination in “job application procedures, hiring, advancement, discharge, compensation, job training, and other terms, conditions, and privileges of employment”.

Terminology

Smith  offers the following definitions of major terms that are important in the world of speech and language disorders.

Alternative and augmentative communication (AAC): Assistive technology that helps individuals to communicate; may be low-tech or high-tech

Articulation disorder: Atypical generation of speech sounds

Cleft lip: Upper lip is not connected, resulting in abnormal speech

Cleft palate: An opening in the roof of the mouth that allows too much air to pass through nasal cavity, resulting in abnormal speech

Communication: Transfer of knowledge, ideas, opinions, and feelings

Communication board: Low-tech AAC device that displays pictures or words to which an individual points to communicate

Communication disorder: Disorders in speech, language, hearing, or listening that create difficulties in effective communication

Disfluency: Interruptions in the flow of an individual’s speech

Expressive language: Ability to express one’s thoughts, feelings, or information

Language: Rule-based method used for communication

Language delays: Slowed development of language skills

Language disorder: Difficulty/inability to comprehend/make use of the various rules of language

Loudness: A characteristic of voice; refers to intensity of sound

Morphology: Rules that determine structure and form of words

Otitis media: Middle ear infection that can interrupt normal language development

Pitch: A characteristic of voice; usually either high or low

Phonological awareness: Understanding, identifying, and applying the relationships between sound and symbol

Phonology: Rules of a language that determine how speech sounds work together to create words and sentences

Pragmatics: Appropriate use of language in context

Receptive language: Ability to comprehend information that is received

Semantics: System of language that determines content, intent, and meaning of language

Speech: Vocal production of language

Speech impairment: Abnormal speech is unintelligible, unpleasant, or creates an ineffective communication process

Speech/language pathologist: Professionals who help individuals to maximize their communication skills.

Speech synthesizer: Assistive technology that creates voice

Stuttering: Hesitation or repetition contributes to dysfluent speech

Syntax: Rules that determine word endings and word orders

Voice problem: Abnormal oral speech, often including atypical pitch, loudness, or quality

History

In the mid 19th century, the scientific endeavors of such individuals as Charles Darwin gave rise to more systematic and scientific consideration of physical phenomenon, and the work of others, such as Paul Broca and Carl Wernicke, also lent scientific rigor to the study of speech and language disorders. The late 19th century saw an increase in “pre-professionals,” those who offered speech and language services based upon personal experiences or insights. Several trends were exhibited even in the 19th century, some have indicated the importance of elocution training in the early 19th century, through which individuals would seek out those with training to improve their vocal qualities. By 1925 in the USA interest in these trends lead to the forming of the organization that would become American Speech-Language-Hearing Association (ASHA) and the birth of speech-language pathology.

The twentieth century has been proposed to be composed of four major periods: Formative Years, Processing Period, Linguistic Era, and Pragmatics Revolution. The Formative Years, which began around 1900 and ended around WWII, was a time during which the scientific rigor extended and professionalism entered the picture. During this period, the first school-based program began in the U.S. (1910). The Processing Period, from roughly 1945-1965, further developed the assessment and interventions available for general communication disorders; much of these focused on the internal, psychological transactions involved in the communication process. During the Linguistic Era, from about 1965-1975, professionals began to separate language deficits from speech deficits, which had major implications for diagnosis and treatment of these communication disorders. Lastly, the Pragmatics Revolution has continued to shape the professional practice by considering major ecological factors, such as culture, in relation to speech and language impairments. It was during this period that IDEA was passed, and this allowed professionals to begin working with a greater scope and to increase the diversity of problems with which they concerned themselves

What is Shyness ?

Shyness (also called diffidence) is the feeling of apprehension, lack of comfort, or awkwardness especially when a person is in proximity to other people. This commonly occurs in new situations or with unfamiliar people. Shyness can be a characteristic of people who have low self-esteem. Stronger forms of shyness are usually referred to as social anxiety or social phobia.

The primary defining characteristic of shyness is a largely ego-driven fear of what other people will think of a person's behavior. This results in a person becoming scared of doing or saying what he or she wants to out of fear of negative reactions, being laughed at or humiliated, criticism, and/or rejection. A shy person may simply opt to avoid social situations instead.

One important aspect of shyness is social skills development. Schools and parents may implicitly assume children are fully capable of effective social interaction. Social skills training is not given any priority (unlike reading and writing) and as a result, shy students are not given an opportunity to develop their ability to participate in class and interact with peers. Teachers can model social skills and ask questions in a less direct and intimidating manner in order to gently encourage shy students to speak up in class, and make friends with other children.

The initial cause of shyness varies. Scientists believe that they have located genetic data supporting the hypothesis that shyness is, at least, partially genetic. However, there is also evidence that suggests the environment in which a person is raised can also be responsible for his or her shyness. This includes child abuse, particularly emotional abuse such as ridicule. Shyness can originate after a person has experienced a physical anxiety reaction; at other times, shyness seems to develop first and then later causes physical symptoms of anxiety. Shyness differs from social anxiety, which is a broader, often depression-related psychological condition including the experience of fear, apprehension or worrying about being evaluated by others in social situations to the extent of inducing panic.

Shyness may come from genetic traits, the environment in which a person is raised and personal experiences. Shyness may merely be a personality trait or can occur at certain stages of development in children.

Genetics and heredity

Shyness is often seen as a hindrance on people and their development. The cause of shyness is often disputed but it is found that fear is positively related to shyness,[3] suggesting that fearful children are much more likely to develop being shy as opposed to less fearful children. Shyness can also be seen on a biological level as a result of an excess of cortisol. When cortisol is present in greater quantities it is known to suppress an individual’s immune system, making them more susceptible to illness and disease.The genetics of shyness is a relatively small area of research that has been receiving an even smaller amount of attention, although papers on the biological bases of shyness date back to 1988. Some research has indicated that shyness and aggression are related—through long and short forms of the gene DRD4, though considerably more research on this is needed. Further, it has been suggested that shyness and social phobia (the distinction between the two is becoming ever more blurred) are related to obsessive-compulsive disorder. As with other studies of behavioral genetics, the study of shyness is complicated by the number of genes involved in, and the confusion in defining, the phenotype. Naming the phenotype – and translation of terms between genetics and psychology — also causes problems.

Several genetic links to shyness are current areas of research. One is the serotonin transporter promoter region polymorphism (5-HTTLPR), the long form of which has been shown to be modestly correlated with shyness in grade school children. Previous studies had shown a connection between this form of the gene and both obsessive-compulsive disorder and autism. Mouse models have also been used, to derive genes suitable for further study in humans; one such gene, the glutamic acid decarboxylase gene (which encodes an enzyme that functions in GABA synthesis), has so far been shown to have some association with behavioral inhibition.

Another gene, the dopamine D4 receptor gene (DRD4) exon III polymorphism, had been the subject of studies in both shyness and aggression, and is currently the subject of studies on the "novelty seeking" trait. A 1996 study of anxiety-related traits (shyness being one of these) remarked that, "Although twin studies have indicated that individual variation in measures of anxiety-related personality traits is 40-60% heritable, none of the relevant genes has yet been identified," and that "10 to 15 genes might be predicted to be involved" in the anxiety trait. Progress has been made since then, especially in identifying other potential genes involved in personality traits, but there has been little progress made towards confirming these relationships. The long version of the 5-HTT gene-linked polymorphic region (5-HTTLPR) is now postulated to be correlated with shyness, but in the 1996 study, the short version was shown to be related to anxiety-based traits.

As symptom of mercury poisoning

Excessive shyness, embarrassment, self-consciousness and timidity, social-phobia and lack of self-confidence are also components of erethism, which is a symptom complex that appears in cases of mercury poisoning. Mercury poisoning was common among hat makers in England in the 18th and 19th centuries, who used mercury to stabilize wool into felt fabric.

Prenatal development

The prevalence of shyness in some children can be linked to day length during pregnancy, particularly during the midpoint of prenatal development. An analysis of longitudinal data from children living at specific latitudes in the United States and New Zealand revealed a significant relationship between hours of day length during the midpoint of pregnancy and the prevalence of shyness in children. "The odds of being classified as shy were 1.52 times greater for children exposed to shorter compared to longer daylengths during gestation." In their analysis, scientists assigned conception dates to the children relative to their known birth dates, which allowed them to obtain random samples from children who had a mid-gestation point during the longest hours of the year and the shortest hours of the year (June and December, depending on whether the cohorts were in the United States or New Zealand).

The longitudinal survey data included measurements of shyness on a five-point scale based on interviews with the families being surveyed, and children in the top 25th percentile of shyness scores were identified. The data revealed a significant co-variance between the children who presented as being consistently shy over a two-year period, and shorter day length during their mid-prenatal development period. "Taken together, these estimates indicate that about one out of five cases of extreme shyness in children can be associated with gestation during months of limited daylength."

Low birth weights

In recent years correlations between birth weight and shyness have been studied. Findings suggest that those born at low birth weights are more likely to be shy, risk-aversive and cautious compared to those born at normal birth weights. These results do not however imply a cause-and-effect relationship.

Personality trait

Shyness is most likely to occur during unfamiliar situations, though in severe cases it may hinder an individual in his or her most familiar situations and relationships as well. Shy people avoid the objects of their apprehension in order to keep from feeling uncomfortable and inept; thus, the situations remain unfamiliar and the shyness perpetuates itself. Shyness may fade with time; e.g., a child who is shy towards strangers may eventually lose this trait when older and become more socially adept. This often occurs by adolescence or young adulthood (generally around the age of 13). In some cases, though, it may become an integrated, lifelong character trait. Longitudinal data suggests that the three different personality types evident in infancy easy, slow-to-warm-up, and difficult tend to change as children mature. Extreme traits become less pronounced, and personalities evolve in predictable patterns over time. What has been proven to remain constant is the tendency to internalize or externalize problems. This relates to individuals with shy personalities because they tend to internalize their problems, or dwell on their problems internally instead of expressing their concerns, which leads to disorders like depression and anxiety. Humans experience shyness to different degrees and in different areas.

Shyness can also be seen as an academic determinant. It has been determined that there is a negative relationship between shyness and classroom performance. As the shyness of an individual increased, classroom performance was seen to decrease.

Shyness may involve the discomfort of difficulty in knowing what to say in social situations, or may include crippling physical manifestations of uneasiness. Shyness usually involves a combination of both symptoms, and may be quite devastating for the sufferer, in many cases leading them to feel that they are boring, or exhibit bizarre behavior in an attempt to create interest, alienating them further. Behavioral traits in social situations such as smiling, easily producing suitable conversational topics, assuming a relaxed posture and making good eye contact, may not be second nature for a shy person. Such people might only affect such traits by great difficulty, or they may even be impossible to display.

Those who are shy are perceived more negatively, in cultures that value sociability, because of the way they act towards others Shy individuals are often distant during conversations, which can result in others to forming poor impressions of them. People who are not shy may be up-front, aggressive, or critical towards shy people in an attempt "to get them out of their shell." This can actually make a shy person feel worse, as it draws attention to them, making them more self-conscious and uncomfortable.

Shyness vs. introversion

The term shyness may be implemented as a lay blanket-term for a family of related and partially overlapping afflictions, including timidity (apprehension in meeting new people), bashfulness and diffidence (reluctance in asserting oneself), apprehension and anticipation (general fear of potential interaction), or intimidation (relating to the object of fear rather than one's low confidence).Apparent shyness, as perceived by others, may simply be the manifestation of reservation or introversion, character traits which cause an individual to voluntarily avoid excessive social contact or be terse in communication, but are not motivated or accompanied by discomfort, apprehension, or lack of confidence.

Rather, according to professor of psychology Bernardo J. Carducci, introverts choose to avoid social situations because they derive no reward from them or may find surplus sensory input overwhelming, whereas shy people may fear such situations. Research using the statistical techniques of factor analysis and correlation have found shyness overlaps mildly with both introversion and neuroticism (i.e., negative emotionality). Low societal acceptance of shyness or introversion may reinforce a shy or introverted individual's low self-confidence.

Both shyness and introversion can outwardly manifest with socially withdrawn behaviors, such as tendencies to avoid social situations, especially when they are unfamiliar. A variety of research suggests that shyness and introversion possess clearly distinct motivational forces and lead to uniquely different personal and peer reactions and therefore cannot be described as theoretically the same, with Susan Cain's Quiet (2012) further discerning introversion as involving being differently social (preferring one-on-one or small group interactions) rather than being anti-social altogether.

Research suggests that no unique physiological response, such as an increased heart beat, accompanies socially withdrawn behavior in familiar compared with unfamiliar social situations. But unsociability leads to decreased exposure to unfamiliar social situations and shyness causes a lack of response in such situations, suggesting that shyness and unsociability affect two different aspects of sociability and are distinct personality traits. In addition, different cultures perceive unsociability and shyness in different ways, leading to either positive or negative individual feelings of self-esteem. Collectivist cultures view shyness as a more positive trait related to compliance with group ideals and self-control, while perceiving chosen isolation (introverted behavior) negatively as a threat to group harmony; and because collectivist society accepts shyness and rejects unsociability, shy individuals develop higher self-esteem than introverted individuals. On the other hand, individualistic cultures perceive shyness as a weakness and a character flaw, while unsociable personality traits (preference to spend time alone) are accepted because they uphold the value of autonomy; accordingly, shy individuals tend to develop low self-esteem in Western cultures while unsociable individuals develop high self-esteem.

Shyness vs. social phobia

An extreme case of shyness is identified as a psychiatric illness, which made its debut as social phobia in DSM-III in 1980, but was then described as rare. By 1994, however, when DSM-IV was published, it was given a second, alternative name in parentheses (social anxiety disorder) and was now said to be relatively common, affecting between 3 and 13% of the population at some point during their lifetime.Studies examining shy adolescents and university students found that between 12 and 18% of shy individuals meet criteria for social anxiety disorder.

Shyness affects people mildly in unfamiliar social situations where one feels anxiety about interacting with new people. Social anxiety disorder, on the other hand, is a strong irrational fear of interacting with people, or being in situations which may involve public scrutiny, because one feels overly concerned about being criticized if one embarrasses oneself. Physical symptoms of social phobia can include shortness of breath, trembling, increased heart rate, and sweating; in some cases, these symptoms are intense enough and numerous enough to constitute a panic attack. Shyness, on the other hand, may incorporate many of these symptoms, but at a lower intensity, infrequently, and does not interfere tremendously with normal living.

Social inhibition vs. behavioral inhibition

Those considered shy are also said to be socially inhibited. Social inhibition is the conscious or unconscious constraint by a person of behavior of a social nature. In other words, social inhibition is holding back for social reasons. There are different levels of social inhibition, from mild to severe. Being socially inhibited is good when preventing one from harming another and bad when causing one to refrain from participating in class discussions.

Behavioral inhibition is a temperament or personality style that predisposes a person to become fearful, distressed and withdrawn in novel situations. This personality style is associated with the development of anxiety disorders in adulthood, particularly social anxiety disorder.

Misconceptions and negative aspects

Many misconceptions/stereotypes about shy individuals exist in western culture and negative peer reactions to "shy" behavior abound. This takes place because individualistic cultures place less value on quietness and meekness in social situations, and more often reward outgoing behaviors. Some misconceptions include viewing introversion and social phobia synonymous with shyness, and believing that shy people are less intelligent.

Intelligence

No correlation (positive or negative) exists between intelligence and shyness. Research indicates that shy children have a harder time expressing their knowledge in social situations (which most modern curricula utilize) and because they do not engage actively in discussions, teachers view them as less intelligent. In line with social learning theory, an unwillingness to engage with classmates and teachers makes it more difficult for shy students to learn. Test scores, however, indicate that shyness is unrelated to actual academic knowledge, and therefore only academic engagement. Depending on the level of a teacher's own shyness, more indirect (vs. socially oriented) strategies are used with shy individuals to assess knowledge in the classroom, and accommodations are made. Observed peer evaluations of shy people during initial meeting and social interactions thereafter found that peers evaluate shy individuals as less intelligent during the first encounter. During subsequent interactions, however, peers perceived shy individuals' intelligence more positively.

MEd -What is Intellectual giftedness ?

Intellectual giftedness is an intellectual ability significantly higher than average. It is a characteristic of children, variously defined, that motivates differences in school programming. It is thought to persist as a trait into adult life, with various consequences studied in longitudinal studies of giftedness over the last century. There is no generally agreed definition of giftedness for either children or adults, but most school placement decisions and most longitudinal studies over the course of individual lives have been based on IQ in the top 2 percent of the population, that is above IQ 130.

The various definitions of intellectual giftedness include either general high ability or specific abilities. For example, by some definitions an intellectually gifted person may have a striking talent for mathematics without equally strong language skills. In particular, the relationship between artistic ability or musical ability and the high academic ability usually associated with high IQ scores is still being explored, with some authors referring to all of those forms of high ability as "giftedness," while other authors distinguish "giftedness" from "talent." There is still much controversy and much research on the topic of how adult performance unfolds from trait differences in childhood, and what educational and other supports best help the development of adult giftedness.

The formal identification of giftedness first emerged after the development of IQ tests for school placement. It has since become an important issue for schools, as the instruction of gifted students often presents special challenges. During the twentieth century, gifted children were often classified via IQ tests; other identification procedures have been proposed but are only used in a minority of cases in most public schools in the English-speaking world. Developing useful identification procedures for students who could benefit from a more challenging school curriculum is an ongoing problem in school administration.

Because of the key role that gifted education programs in schools play in the identification of gifted individuals, both children and adults, it is worthwhile to examine how schools define the term "gifted".

Definitions

For many years, psychometricians and psychologists, following in the footsteps of Lewis Terman in 1916, equated giftedness with high IQ. This "legacy" survives to the present day, in that giftedness and high IQ continue to be equated in some conceptions of giftedness. Since that early time, however, other researchers (e.g., Raymond Cattell, J. P. Guilford, and Louis Leon Thurstone) have argued that intellect cannot be expressed in such a unitary manner, and have suggested more multifaceted approaches to intelligence.

Research conducted in the 1980s and 1990s has provided data which support notions of multiple components to intelligence. This is particularly evident in the reexamination of "giftedness" by Sternberg and Davidson in their collection of articles Conceptions of Giftedness. The many different conceptions of giftedness presented, although distinct, are interrelated in several ways. Most of the investigators define giftedness in terms of multiple qualities, not all of which are intellectual. IQ scores are often viewed as inadequate measures of giftedness. Motivation, high self-concept, and creativity are key qualities in many of these broadened conceptions of giftedness.

Joseph Renzulli's (1978) "three ring" definition of giftedness is one frequently mentioned conceptualization of giftedness. Renzulli's definition, which defines gifted behaviors rather than gifted individuals, is composed of three components as follows: Gifted behavior consists of behaviors that reflect an interaction among three basic clusters of human traits—above average ability, high levels of task commitment, and high levels of creativity.Individuals capable of developing gifted behavior are those possessing or capable of developing this composite set of traits and applying them to any potentially valuable area of human performance. Persons who manifest or are capable of developing an interaction among the three clusters require a wide variety of educational opportunities and services that are not ordinarily provided through regular instructional programs.

In Identifying Gifted Children: A Practical Guide, Susan K. Johnsen explains that gifted children all exhibit the potential for high performance in the areas included in the United States' federal definition of gifted and talented students:

There is a federal government statutory definition of gifted and talented students in the United States.

The term "gifted and talented" when used in respect to students, children, or youth means students, children, or youth who give evidence of high performance capability in areas such as intellectual, creative, artistic, or leadership capacity, or in specific academic fields, and who require services or activities not ordinarily provided by the school in order to fully develop such capabilities." (P.L. 103–382, Title XIV, p. 388)

This definition has been adopted partially or completely by the majority of the individual states in the United States (which have the main responsibility for education policy as compared to the federal government). Most states have a definition similar to that used in the State of Texas:

"gifted and talented student" means a child or youth who performs at or shows the potential for performing at a remarkably high level of accomplishment when compared to others of the same age, experience, or environment, and who

exhibits high performance capability in an intellectual, creative, or artistic area;

possesses an unusual capacity for leadership; or

excels in a specific academic field." (74th legislature of the State of Texas, Chapter 29, Subchapter D, Section 29.121)

The major characteristics of these definitions are (a) the diversity of areas in which performance may be exhibited (e.g., intellectual, creativity, artistic, leadership, academically), (b) the comparison with other groups (e.g., those in general education classrooms or of the same age, experience, or environment), and (c) the use of terms that imply a need for development of the gift (e.g., capability and potential).

Many schools use a variety of assessments of students' capability and potential when identifying gifted children. These may include portfolios of student work, classroom observations, achievement tests, and IQ test scores. Most educational professionals accept that no single criterion can be used in isolation to accurately identify a gifted child.

One of the criteria used in identification may be an IQ test score. Until the late 1960s, when “giftedness” was defined by an IQ score, a school district simply set an arbitrary score (usually in the 130 range) and a student either did or did not “make the cut”. It is no longer accepted today in academic circles; however, it's still used by many school districts because it is simple and not entirely without merit. Although a high IQ score is not the sole indicator of giftedness, usually if a student has a very high IQ, that is a significant indicator of high academic potential. Because of this consideration, if a student scores highly on an IQ test, but performs at an average or below average level academically, school officials may think that this issue warrants further investigation as an example of underachievement.However, scholars of educational testing point out that a test-taker's scores on any two tests may vary, so a lower score on an achievement test than on an IQ test neither necessarily indicates that the test-taker is underachieving nor necessarily that the school curriculum is underchallenging.

IQ classification varies from one publisher to another. IQ tests do not have validity for determining test-takers' rank order at higher IQ levels, and are perhaps only effective at determining whether a student is gifted rather than distinguishing among levels of giftedness. The Wechsler tests have a standard score ceiling of 160. Today, the Wechsler child and adult IQ tests are by far the most commonly used IQ tests in hospitals, schools, and private psychological practice.Older versions of the Stanford-Binet test, now obsolete, and the Cattell IQ test purport to yield IQ scores of 180 or higher, but those scores are not comparable to scores on currently normed tests. The Stanford-Binet Third Revision (Form L-M) yields consistently higher numerical scores for the same test-taker than scores obtained on current tests. This has prompted some authors on identification of gifted children to promote the Stanford-Binet form L-M, which has long been obsolete, as the only test with a sufficient ceiling to identify the exceptionally and profoundly gifted, despite the Stanford-Binet L-M never having been normed on a representative national sample.[20] Because the instrument is outdated, current results derived from the Stanford-Binet L-M generate inflated and inaccurate scores. The IQ assessment of younger children remains debated.

While many people believe giftedness is a strictly quantitative difference, measurable by IQ tests, some authors on the experience of bring have described giftedness as a fundamentally different way of perceiving the world, which in turn affects every experience had by the gifted individual. This view is doubted by some scholars who have closely studied gifted children longitudinally.

Dyslexia - reading disorder

Dyslexia, also known as reading disorder, is a learning disability characterized by trouble reading despite normal intelligence. Different people are affected to varying degrees. Problems may include sounding out words, spelling words, reading quickly, writing words, pronouncing words when reading aloud, and understanding what was read. Often these difficulties are first noticed at school. When someone who previously knew how to read loses the ability, it is known as alexia. The difficulties are not voluntary and people with this disorder have a normal desire to learn.

The cause of dyslexia is believed to involve both genetic and environmental factors. Some cases run in families.It occurs more often in people with attention deficit hyperactivity disorder (ADHD) and is associated with problems with mathematics. When the condition begins in adults it may be the result of a traumatic brain injury, stroke, or dementia. The underlying mechanism involves problems with the brain's processing of language. Diagnosis is by a series of tests of a person's memory, spelling, ability to see, and reading skills. It is separate from reading difficulties due to poor teaching, or hearing or vision problems.

Treatment usually involves adjusting teaching methods to meet the person's needs.While this does not cure the underlying problem, difficulties can be ameliorated. Treatments aimed at vision are not effective. Dyslexia is the most common learning disability, affecting 3 to 7 percent of people.While it is diagnosed more often in males,some believe it actually affects males and females equally. Up to 20 percent of the population may have some degree of symptoms.Dyslexia occurs in all areas of the world.

Dyslexia is thought to have two kinds of causes, one related to language processing and another to visual processing. It is considered a cognitive disorder, not a problem with intelligence, and there are often emotional problems that arise because of it. There are many published definitions which are purely descriptive or involve proposed causes that encompass a variety of reading skills, deficits, and difficulties with distinct causes rather than a single condition. The National Institute of Neurological Disorders and Stroke definition describes dyslexia as "difficulty with spelling, phonological processing (the manipulation of sounds), or rapid visual-verbal responding."The British Dyslexia Association definition describes dyslexia as "a learning difficulty that primarily affects the skills involved in accurate and fluent word reading and spelling" and characterized by "difficulties in phonological awareness, verbal memory and verbal processing speed."

Acquired dyslexia or alexia may be caused by brain damage due to a stroke or atrophy.Forms of alexia include pure alexia, surface dyslexia, semantic dyslexia, phonological dyslexia, and deep dyslexia

In early childhood, symptoms that correlate with a later diagnosis of dyslexia include delayed onset of speech, difficulty distinguishing left from right, difficulty with direction, as well as being easily distracted by background noise. While they do occur in people with dyslexia, reversal of letters or words, or mirror writing, is not included in the definition of dyslexia,and its relationship with dyslexia is controversial.

Dyslexia and attention deficit hyperactivity disorder (ADHD) commonly occur together; about 15 percent of people with dyslexia also have ADHD and 35 percent of those with ADHD have dyslexia.

School-age dyslexic children may exhibit signs of difficulty identifying or generating rhyming words, or when counting syllables in words – both of which depend on phonological awareness. They may also show difficulty when segmenting words into individual sounds or may blend sounds when producing words – indicating reduced phonemic awareness. Difficulties with word retrieval or when naming things also feature in dyslexia.:647 Dyslexics are commonly poor spellers, a feature sometimes called dysorthographia or dysgraphia, which depends on orthographic coding.

Problems persist into adolescence and adulthood and may accompany difficulties with summarizing stories, memorization, reading aloud, or learning foreign languages. Adult dyslexics can often read with good comprehension, although they tend to read more slowly than non-dyslexics and perform worse in tests of spelling or when reading nonsense words – a measure of phonological awareness.

A common myth about dyslexia is that its defining feature is reading or writing letters or words backwards; however, this is true of many children as they learn to read and write.