Specific Areas of Speech and Language Development (continued)

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• Expressive vocabulary. which refers to the number and type of words a child has acquired;
• Word and sentence formation:
• Pragmatic development, which includes the ability to use language socially (to interact and accomplish an objective). (Bloom & Lahey, 1978)

All of these parts working together constitute expressive language. Many children who have a language delay or language disorder exhibit a large discrepancy between their receptive and expressive language skills (Nelson, 199 I).

Articulation Skills

Articulation is the production of speech sounds. This means using muscles and other body structures to shape sounds from exhaled air. Children might be able to understand and produce language without being able to speak clearly. When articulation is assessed, the therapist evaluates:

• Whether a child uses the oral structures (muscles, teeth, or tongue) to produce sounds correctly;
• How a child uses sounds to create meaning.

For children with severe articulation disorders, assessment is complex and detailed. Some basic elements that are evaluated include how individual sounds are produced in words and continuous speech, the child's overall speech intelligibility (clarity), and the child's ability to imitate sounds correctly that the child often produces incorrectly when speaking. An ability to imitate sounds indicates that these sounds are more likely to be corrected without direct treatment (Mannix, 1987). Certain error patterns (e.g., difficulty clearly pronouncing "s" or "th" sounds) are normal in development and must be considered in the context of a child's age and language level.

Oral-Motor Skills

Oral-motor skills involve the development of the mouth and surrounding area in terms of its structure and functional ability. Weaknesses in this area often affect articulation development. An important part of assessing oral-motor skills is determining if a child has any problem with eating, drinking, or swallowing. The speech and language pathologist often works on oral-motor and feeding skills in conjunction with other professionals such as the occupational therapist (Mannix, 1987).

Voice

The physical health of the voice, as well as how it is used to communicate, is within the realm of speech and language pathology. Some aspects of the voice that are assessed formally and informally are the pitch (high or low voice), volume (loud or soft), and quality (such as hoarseness or extreme nasality) (Moore, 1986). The speech pathologist will recommend that a child be evaluated by an ear, nose, and throat doctor (ENT) if any aspect of the voice suggests a possible physical problem. This evaluation should be done before providing voice therapy (Lindfors, 1987).

Fluency

Fluency problems, often called stuttering or dysfluency, refer to interruptions in the flow of speech. Dysfluency consists of pauses, prolonged sounds, or repetition of sounds and words. In severe dysfluency secondary characteristics such as jerking motions or blinking often are present. It is important to note that a certain amount of mild dysfluency is normal for many young children. Children whose level of dysfluency interferes with their ability to communicate or the willingness of others to interact with them often require speech therapy services. The speech and language professional assesses dysfluency to determine whether it is a developmental stage or a true disorder (Owens, 1991).