Uno de las alteraciones más comunes por los que los alumnos de infantil y primaria acuden a terapia de logopedia es debido a TSH (Trastorno de los sonidos del habla).

El TSH se define como un trastorno de articulación donde los niños no pronuncian correctamente palabras de acuerdo a su edad cronológica.

In some cases these difficulties are due to a malfunction of the organs involved in speech, especially due to incorrect lip or tongue positions, poor breathing, poor mobility of the lips, tongue, palate...

If these articulatory patterns persist, they can become automated and therefore more difficult to correct. Therefore, early intervention is very important.

For the speech and language therapist, language delay is defined as a significant delay (relative to what would be expected for a child of the same chronological age) in the emergence or onset of expressive language that is not due to a neurological factor, hearing impairment or deficit, or a pervasive developmental disorder.

There may also be a comprehension gap, although this is usually to a lesser extent. They are able to produce sounds and groups of sounds, but are unable to order and differentiate them within words.

Significant features that may lead us to suspect that our child has a language delay are:

• Difficulties in language development at phonological, semantic and morphosyntactic levels.
• Functional language impairment.
• Learning difficulties and school area.
• Alteration of comprehension.
• Alteration of communicative intent.

The children's speech therapist identifies dyslexia as a disorder of learning to read and write, the origin of which seems to derive from a neurodevelopmental disorder. They have difficulties in naming letters and in analysing or classifying sounds.

In addition, reading is characterised by omissions, substitutions, distortions, inversions or addictions, slowness, hesitations, visual tracking problems and comprehension deficits. They put so much effort into reading and writing tasks that they tend to become fatigued, lose concentration, become distracted and reject such tasks.

They are also often accompanied by problems of comprehension, short-term memory, lexical access, confusion between right and left, difficulties in spatial-temporal notions...

Atypical swallowing is one of the most deforming habits of the mouth and one of the most common in children. It can manifest itself with labial and lingual interposition.

Dental and facial deformity is in most cases not due to pathological processes, but to a distortion of normal development. They are usually the result of an interaction of several factors. 

Habits are patterns of muscular contraction of a complex nature which are learned and which, when repeated, become unconscious.

They can be beneficial when they serve as a stimulus for normal growth of the mouth such as proper chewing or detrimental when they interfere with regular facial growth leading to dental anomalies.

These include sucking on any of the fingers, prolonged sucking on a dummy, interposition of the tongue at rest and during swallowing, and mouth breathing.

Atypical swallowing is characterised by:

• At the beginning of the swallowing phase, the tongue is positioned between the incisors, in contact with the lower lip.
• During swallowing there is a forward movement of the tongue with the jaw open.
• When there is a large opening between the jaws, the lower lip is also involved in swallowing, being positioned between the upper and lower incisors in order to close the oral cavity on the anterior side, together with a contraction of the chin muscle.
• This is followed by the swallowing movement with a forced movement of the lower lip.

Different circumstances in the nervous system can cause disturbances in speech fluency.

Stuttering

Acquired stuttering starts from a brain injury or disease in a person who previously had normal fluent speech.

Psychogenic stuttering begins in adults, without neurological cause, with little emotional impact. It is a very rare disorder, caused by a stressful event.

Dysphemia

Dysphemia begins in infancy, usually between 2 and 4 years of age.

Coincides when the child moves from using single-word utterances to combining several words to form the first sentences.

In cases of children with developmental language delay or Down's Syndrome, stuttering starts later.

What is the most striking feature?

Difficulty in articulating a word, mostly at the beginning of a sentence.

It gives rise to repetitions of part of a syllable, silent or sonorous prolongations of sounds).

The person knows what he/she wants to say and how to say it, with increased muscle tension and effortful speech behaviours.

When the disorder persists for more than two years after onset, it becomes chronic.

Speech therapy treatment is usually combined with psychological therapy, using various procedures:

• Teaching the mechanics of speech.
• Observation of speaking behaviour.
• Fluency techniques.
• Muscle relaxation techniques and vocal control.
• Stuttering correction techniques.
• Social skills training.
• Behavioural and attitude modification psychotherapy, and reduction of speech-related anxiety and defence reactions.
• Modification of the patient's environment to eliminate the conditioning factors that aggravate or maintain stuttering.

Aphasia is a disorder caused by lesions in the regions of the brain that control language. It can impair or hinder reading, writing and expressive language.

Causes are usually stroke, brain tumours, infections, injuries and dementia.

The severity and type of alterations that the affected person presents will depend on the part of the brain that suffered the damage and the magnitude of the damage.

There are four main types:

• Expressive: the patient knows what he/she wants to say, but has difficulty saying it or writing it down.
• Receptive: you hear the voice or can read a printout, but do not make sense of what you read or hear.
• Anomic: has difficulty using the right words to describe objects, places or events.
• Global: the patient cannot speak, understand what is said, read or write.

Most need speech therapy as soon as possible.

Many people have voice problems such as no voice at all or voice changes at a certain time of the year. These disturbances are caused by a variety of reasons. The treatment depends on the cause of the disorder, but always includes voice therapy in the hands of a speech therapist or qualified professional.

The larynx is made up of cartilage, muscle and mucous membranes located at the top of the windpipe and the base of the tongue. Sound is created when the vocal cords vibrate. This vibration comes from air moving in the larynx. If the vocal cords become inflamed, develop growths or become paralysed, they cannot function properly and you may develop a voice disorder. Some common voice disorders are:

• Neurological voice disorders.
• Laryngitis.
• Polyps, nodules or cysts on the vocal cords.
• Weakness or paralysis of one or both vocal cords.
• Cancerous lesions.

There are risk factors to take into account when suffering from a voice alteration. Many of them can be controlled and we can take better care of our throat and, as a consequence, our voice. These factors are for example the consumption of alcoholic or caffeinated drinks, allergies, smoking, gastro-oesophageal reflux, inadequate use of the voice for a prolonged period of time, colds, low water consumption, ageing and neurological disorders.

Children with Specific Language Disorder (SLD) have marked deficits in language acquisition.

What are the signs?

Difficulties in comprehension and/or production in semantic, phonological, syntactic, morphological and pragmatic aspects.
Inappropriate verbal behaviour

How is it evaluated?

Using standardised tests of language, intelligence and general cognitive functioning. Communication skills, hearing screening or assessment, and medical assessment data to rule out organic disorders or hearing problems.

How does it work?

We intervene with children with SLI from a multidisciplinary point of view. We consider non-verbal cognitive skills and the level of cognitive functioning.

Sessions will be conducted on an individual basis, based on the nature of the child's specific needs and learning style.

What are the characteristics of children with ASD (Asperger's and Autism).

• Present disorders characterised by specific behavioural disturbances
• Qualitative impairment of cognitive development, communication skills and social interaction.

They develop in the first years of life and are often associated with maturational delay in both lines.

Following the DSM-V criteria we made a clinical diagnosis based on impairments in social interaction, problems in social communication and the presence of a restricted repertoire of activities and interests.

Treatment will be individualised, intensive and continuous with long-term results, tailored to the child's levels of functioning, abilities and potential.

It will include the collaboration of the family, school or centre.

People communicate mainly through words, but this is not the only way we communicate. Communication in children begins with gestures, vocalisations and finally speech, which encompasses the ability to master all the above possibilities.

There are people who never achieve a sufficient command of language to make themselves understood. These are people of all ages for whom we must find the best possible way in which they can express themselves and communicate through the skills that are most useful to them.

Augmentative and Alternative Communication Systems (AACS) are part of communication and language that studies and organises these elements with which people become able to communicate.

Alternative and augmentative communication (AAC) is defined as a structured set of non-vocal codes, whether or not they need physical support, which serve to carry out acts of communication (functional, spontaneous and generalisable) on their own, or in conjunction with or as partial support for vocal codes".