Dysarthria: the child knows the word but cannot pronounce it

Dysarthria is a disorder of pronunciation caused by the muscles of the speech apparatus not obeying properly. The word is there in the head, the child knows what they want to say, but the tongue, lips, palate and breathing do not carry out the command precisely. Hence the effect every parent recognises: sounds only half identifiable, the pace of speech stumbling, the voice muffled or nasal.

The signs it is recognised by

Dysarthria shows up in more than speech. It usually comes with a whole set of everyday signs that parents rarely pay attention to:

• speech is slurred, "as if something were in the way", especially towards the end of a phrase;
• drooling and a half-open mouth after the age of three;
• the child chews poorly, gags on solid food, holds food in the cheek for a long time, prefers purees;
• the tongue cannot hold a position: it trembles, slides to one side, cannot reach the upper lip;
• the voice is quiet, monotone or nasal;
• breathing is short — the child does not make it to the end of a phrase and snatches a breath in the middle;
• sounds put in place by a speech therapist come out right in the session and disappear in ordinary speech.

The forms, and why telling them apart matters

Form	What is happening	How the speech sounds
Mild	Minimal impairment of the precision of movement. The most common form in children with no obvious neurology.	Broadly understandable but indistinct; sibilants and the "r"/"l" sounds never settle.
Pseudobulbar	The tone of the articulatory muscles is raised and movement is constrained. Often linked to perinatal brain damage.	Tense, slowed, with a nasal quality; marked drooling.
Bulbar	The muscles are flaccid, tone is reduced, some movements drop out.	Quiet, "blurred", the voice weak, swallowing difficult.
Subcortical	Tone is unstable and involuntary movements appear.	Speech comes in bursts, pace and volume jump about, sometimes speech "gets stuck".
Cerebellar	The coordination of speech movements is impaired.	Scanning speech, syllable by syllable, with uneven volume.

Where it comes from

At the root there is almost always damage to, or immaturity of, the parts of the nervous system that control the speech muscles. The typical sources:

• hypoxia and asphyxia during birth, cord entanglement, precipitate or prolonged labour;
• prematurity and low birth weight;
• intrauterine infections, rhesus conflict, severe newborn jaundice;
• cerebral palsy — dysarthria is present in almost every case;
• neuroinfections and head injuries that have been through.

How dysarthria is treated in our centers

The logic is simple: the muscle first, the sound second. Putting a sound in place on a tongue that cannot hold a position is pointless — it will fall apart the moment the child leaves the room. So the work goes in this order:

1. Assessment of oral praxis at the consultation — what exactly cannot be done: holding a position, switching, strength, coordination.
2. The Z-Vibe massager — daily oral motor massage at home. The vibration gives the muscles and receptors the stimulation that used to require courses of massage with a speech therapist. Short daily sessions work better than ten procedures once every six months.
3. Micropolarization — stimulation of the areas of the cortex responsible for speech motor control, following a scheme drawn up for that particular child.
4. SpeechLeader — putting sounds in place and automating them, work on phonemic hearing and reading aloud, for ages 3 to 12.
5. High-Frequency Therapy — where dysarthria comes with general speech underdevelopment or developmental delay.
6. The vibrophone — strengthens perception of the child's own speech through the tactile channel and helps them hear the difference between their version and the correct one.

What to do at home every day

• Let them chew. Carrot, apple, dry crust, meat in pieces. Chewing is the main natural exercise for the articulatory muscles, and purees cancel it.
• Train the out-breath. A whistle, soap bubbles, blowing on a feather, a straw in a glass of water. Speech is built on the out-breath.
• Drink through a straw. A simple and unobtrusive way of bringing the lips and cheeks into play.
• Do not hurry them. "Speak faster and more clearly" makes dysarthric speech worse: tension increases the disturbance of tone.
• Watch how they sit. Feet supported and a straight back at the table — the tongue works more precisely when the body is stable.

Frequently asked questions

How does dysarthria differ from a simple articulation disorder?

In a simple articulation disorder one or two sounds are affected while the rest of the speech apparatus works normally — those sounds are put in place in a few sessions. In dysarthria the control of the muscles itself is impaired: a whole group of sounds suffers, the voice, the breathing and the pace of speech change, and there is often drooling and difficulty chewing. That is a different amount of work and a different timescale.

What is mild dysarthria?

It is the light form, in which there is no obvious paralysis but the precision of tongue and lip movements is reduced. The child seems to speak understandably, yet the sounds drift, speech sounds indistinct, and sounds put in place by a speech therapist do not stick in ordinary speech. Mild dysarthria is exactly what is most often taken for an ordinary articulation disorder — and sounds are then drilled for years without result.

Is oral motor massage essential?

In dysarthria, almost always, because the work has to be with the muscle that produces the sound, not with the sound. The other question is how: classic massage means travelling to a specialist and is not always tolerated by the child. At home it is replaced by the Z-Vibe massager, which parents use daily and briefly.

Does dysarthria go away completely?

In mild and light forms, as a rule yes — speech becomes clear. In marked forms linked to cerebral palsy or severe brain damage the task is different: to make speech intelligible and functional. The outlook depends not on the name of the diagnosis but on what exactly is damaged and how much.

Is drooling at four years old dysarthria?

In itself it is not a diagnosis, but it is a reason for an examination. A permanently half-open mouth, drooling, refusing solid food and "lazy" chewing at that age point to weakness in the very muscles responsible for articulation.

See also

• Alalia: when speech does not start at all
• General speech underdevelopment: the levels
• Cerebral palsy: why speech is almost always affected
• The Z-Vibe massager: oral motor massage at home
• SpeechLeader: working on pronunciation

This material was prepared by the specialists of the Vlada Tarasenko Speech Restoration Centers. This material is for information only and does not replace an in-person consultation with a doctor or a speech pathologist. Only a doctor can make a diagnosis.