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Individuals with hearing impairments are likely to omit consonants in the final and initial positions. It is thought that speech programming in the brain is impaired in individuals with apraxia of speech. Some children who have difficulty producing speech sounds may have apraxia of speech and possible neurological involvement. Like adults with apraxia of speech, children with childhood apraxia of speech may show signs of trial-and-error grouping while trying to say certain words. The children can produce the movements necessary to make a speech sound but have difficulty making them in the context of speech production. The variety of speech sound disorders is called childhood apraxia of speech. Some children who have difficulty producing speech sounds may be apraxia of speech and possible neurological involvement. Another speech disorder of neurological origin that includes speech sound errors is called apraxia of speech. Central or peripheral nerve damage causes a group of speech disorders called dysarthria. When the parts of the brain or various nerves that control speech muscles are damaged, speech production is affected. Various diseases and accidents can damage portions of the central nervous system concerned with speech production. However, communicative problems resulting from neural damage are different from functional speech sound disorders seen in most children. Although most children with speech sound disorders do not show gross neurological problems, neural damage of various kinds tends to cause those disorders, along with other communicative problems. The upper incisors are important in the production of some speech sounds. However, if the lingual frenum, which attaches the tongue to the base of the mouth, is too short, the range of the tongue-tip movement is reduced. However, if the lingual frenum, which attaches the tongue to the base of the moth, is too short, the range of the tongue-tip movement is reduced. Severe hearing loss makes it difficult not only to hear other people's speech but also to monitor one's own speech production. Individuals who are born with deafness have the greatest difficulty in articulating speech sounds. Various kinds of articulation problems are frequently seen in children and adults with moderate to severe hearing loss. Hearing loss causes a variety of oral speech and verbal language problems. People who do not learn compensatory responses show problems of speech sound production. In essence, the child will have learned unusual ways of producing the target sounds. When an organic problem that could affect articulation exists, but its effects are not observed, the clinician usually concludes that the child has learned a compensatory response. Many people with diagnosed malocclusion do not exhibit problems of speech sound disorders. Studies do not suggest that speech sound production and dental malocclusions are strongly related. Malocclusion is a problem of misaligned upper and lower dental arches. The effects of malocclusion of the dental arches on speech sound production has been a topic of several studies. Although some children have difficulty producing the target sounds, other do not. Nevertheless, missing incisors may or may not cause problems in target phoneme production. Although most children who misarticulate do not show gross organic defects, such defects, when present, are associated with speech sound disorders.
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