Background: Speech-language pathologists/Otolaryngologists recognize high prevalence of speech and

language disorder among children. The aim of the study is to find out the epidemiological profile of speech

and language disorder in north central Nigeria. Method: A five year retrospective review of all referral to

speech and language therapy unit ENT Department between January 2005 and December 2009. Information

retrieved and analysed included bio-data, clinical presentation and diagnosis of the patients.Descriptive

analysis of these data were done. Results: A total of 146 patients were seen out of which 89 (61%) were under

five, 32 (21.9%) were between 5-10 years, 20 (13.7%) in the range of 11-20 yrs and 2 (1.4%) were between

21-34 yrs. None was observed in the elderly. Male preponderance was noted with male to female ratio of

1.9:1.0. The commonest diagnosis was deaf-mutism in 84 (57.5%) followed by delayed speech development in

31(21.2%) patients. The least diagnosis was aphasia in 2 (1.4%) patients. Conclusion: Speech and language

disorder was commonest among the under five’s with non in the elderly, There was a higher prevalence

amongst males and deaf-mutism was the commonest observed

Afolabi, Olushola A.

Alabi, Biodun S.

Aremu, Shuaib K.

Elemunkan, Isiah O.

PubMed

Afe Babalola University Repository

See	discussions,	stats,	and	author	profiles	for	this	publication	at:	https://www.researchgate.net/publication/236910015Epidemilogical	Profile	of	Speech	and	LanguageDisorder	in	North	Central	NigeriaArticle	·	December	2011Source:	PubMedCITATIONS3READS1204	authors,	including:Some	of	the	authors	of	this	publication	are	also	working	on	these	related	projects:Retropharyngeal	Abscess	in	Diabetics:A	Challenge	View	projectShuaib	Kayode	Aremu23	PUBLICATIONS			64	CITATIONS			SEE	PROFILEOlushola	AfolabiUniversity	of	Ilorin57	PUBLICATIONS			296	CITATIONS			SEE	PROFILESulyman	AlabiUniversity	of	Ilorin56	PUBLICATIONS			145	CITATIONS			SEE	PROFILEAll	content	following	this	page	was	uploaded	by	Olushola	Afolabi	on	06	May	2017.The	user	has	requested	enhancement	of	the	downloaded	file.	All	in-text	references	underlined	in	blue	are	added	to	the	original	documentand	are	linked	to	publications	on	ResearchGate,	letting	you	access	and	read	them	immediately.December  2011    Vol. 7  No. 4    Int  J  Biomed  Sci    www.ijbs.org 268InternatIonal  journal of  BIomedIcal  scIenceEpidemilogical Profile of Speech and Language Disorder in North Central NigeriaShuaib K. Aremu (FWACS), Olushola A. Afolabi (FWACS), Biodun S. Alabi (FWACS), Isiah O. Elemunkan (PhD. Speech therapist)University of Ilorin Teaching Hospital, Ilorin, NigeriaAbstrActbackground: speech-language pathologists/Otolaryngologists recognize high prevalence of speech and language disorder among children. The aim of the study is to find out the epidemiological profile of speech and language disorder in north central Nigeria. Method: A five year retrospective review of all referral to speech and language therapy unit ENT Department between January 2005 and December 2009. Informa-tion retrieved and analysed included bio-data, clinical presentation and diagnosis of the patients.Descriptive analysis of these data were done. Results: A total of 146 patients were seen out of which 89 (61%) were under five, 32 (21.9%) were between 5-10 years, 20 (13.7%) in the range of 11-20 yrs and 2 (1.4%) were between 21-34 yrs. None was observed in the elderly. Male preponderance was noted with male to female ratio of 1.9:1.0. The commonest diagnosis was deaf-mutism in 84 (57.5%) followed by delayed speech development in 31(21.2%) patients. The least diagnosis was aphasia in 2 (1.4%) patients. Conclusion: Speech and language disorder was commonest among the under five’s with non in the elderly, There was a higher prevalence amongst males and deaf-mutism was the commonest observed. (Int J Biomed Sci 2011; 7 (4): 268-272)Keywords: speech disorder; language disorder; deaf-mutismCorresponding author: Shuaib K. Aremu, Department of ORL, Uni-versity of Ilorin Teaching Hospital, Ilorin, Nigeria. E-mail: shuaib.aremu@gmail.com.      Received Feburary 16, 2011; Accepted March 25, 2011  Copyright: © 2011 Shuaib K. Aremu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Li-cense (http://creativecommons.org/licenses/by/2.5/), which permits unre-stricted use, distribution, and reproduction in any medium, provided the original author and source are credited.INTRODUCTIONSpeech-language pathologist/Otorhinolaryngologist recognizes that substantial segments of the adult popula-tion as well as younger groups have serious speech, lan-guage, and voice defects. Some researchers have reported prevalence as high as 10% for some groups of children (1). Most of these difficulties in children involve function-al articulation disorders; faulty language formulation and dysfluency (stuttering) comprise the remainder. In addi-tion, many neurogenic speech and language disorders, un-like stuttering and many articulatory disorders, develop in adulthood (1).Speech and language disorders can be divided into three major categories. The first and most common are the articulation disorders (2). These problems involve the pro-duction of defective speech sounds and sound combina-tions that may be distorted, omitted, substituted, or added as accessory sounds. Sometimes articulatory disorders are the result of neurogenic disorders and dysarthrias (2). A second type of disorder is the impairment of speech fluen-cy, called stuttering or stammering. Repetition of sounds, syllables, words, or phrases; sound prolongations; atypical pauses (hesitations); word substitution; and use of word fillers characterize dysfluent behavior. A third category is variously labeled language impairment, linguistic disabil-ORIGINAL ARTICLEspeech and language dIsorderwww.ijbs.org    Int  J  Biomed  Sci    Vol. 7  No. 4    December  2011 269ity, or faulty symbolization, which refers to disorders in both expression of thought through verbal language and its comprehension. This category includes various disor-ders, ranging from delayed/deviant language development to neurogenic disorders known as aphasia (2). The normal acquisition of speech depends on the process of matura-tion. A “speech readiness period” extends from birth to the fifth year of life, when the child acquires the ability to develop speech as a method of communication which represents the cumulative learning of many bits and pieces of language that begin within the first few weeks of life (3). In the first few months of life, infants are capable of per-ceptually differentiating a wide variety of speech sound contrasts, giving children the capability of learning any of the languages of the world (4, 5). But, by 6 months of age, children have already begun to lose some of the capability of perceptually differentiating among sound contrasts that are not used by talkers within their immediate language environment (6). Also, by 6 months of age, infants show an enhanced ability to distinguish perceptually those sounds used by talkers within their native language environment (7). Infants and young children are typically “bathed in language” by their caregivers during the first months of life. Such stimulation, often called mothers, serves to nur-ture proper language development (8). This study aims to find out the epidemiological profile of speech and lan-guage disorder in north central Nigeria as there is paucity of data on this subject in this part of the world.MEtHODOLOGYThis was a retrospective study of all patient referred to the speech therapy unit of the department of Ear, Nose and Throat of the university of Ilorin teaching hospital over a five year period through January 2005 to December 2009. Using the patients’ registers and individual case-notes, the data retrieved included the age of the patients, the sex, occupation and the diagnosis. All these were entered into an SPSS version 11.0 computer software and analysed de-scriptively.RESULTSOne hundred and fifty one patients were found to have one form of speech pathology or the other.However five patients were excluded on the basis of inadequate data or misplaced record at the health records department of the hospital, thus one hundred and forty-six patients in these form the basis for this write up. Age grouping showed that 89 (61%) were under five, 32 (21.9%) were between 5-10 years, 20 (13.7%) in the range of 11-20 yrs and non was observed in the elderly (Table 1). There was male prepon-derance with 96 males and 50 females (Table 3); This gives a male to female ratio of 1.9:1.0.More than half 84 (57.5%) of the patients had a diagnosis of deaf-mutism, about one third 31 (21.2%) had delayed speech development. 6 (4.1%) Table 1. Age DistributionAge Frequency Percentage (%)0-5 yrs 89 616-10 yrs 32 21.911-20 yrs 20 13.721-34 yrs 2 1.435-64 yrs 3 2.0Total 146 100Table 2. DiagnosisDiagnosis Frequency Percentage (%)Deaf-Mutism 84 57.5Delayed speech 31 21.2Slurred speech 6 4.1Impaired speech 19 13.0Stuttering/Stammering 4 2.7Aphasia 2 1.4Total 146 100Table 3. Relationship of Sex with diagnosis of patientDiagnosis Deaf-Mutism Delayed slurred Impaired stuttered Aphais totalSexMale 58 21 3 11 3 0 96Female 26 10 3 8 1 2 50Total 84 31 6 19 4 2 146speech and language dIsorderDecember  2011    Vol. 7  No. 4    Int  J  Biomed  Sci    www.ijbs.org 270had slurred speech pathology, 19 (13.0%) had impaired speech, 4 (2.7%) had stammering or stuttering as the di-agnosis and only 2 (1.4%) had a aphasia (Table 2). Most of the diagnosis made were commoner in males more than the females except in slurred speech where there is equal prevalence in both sexes and aphasia where females are more prevalent. The diagnosis of deaf mutism was most common among the under fives as seen in (Table 4) below and almost non existent above fifteen years age groups. This was found to apply to all the problems of speech and language disorders, except for slurred speech noticed in two patients in the fourth to fifth decades of life.DISCUSSIONPrevalence of communication disorders in children is high, with a gradual decline through adolescence. At least 5% of school-age children (up to age 17) have sig-nificant speech impairment, although most professionals consider this estimate extremely conservative (1). Some researchers have reported prevalence as high as 10% for certain samples of children (1). However from our study the prevalence was found to be 8.6%. The majority of re-ferrals were between 3 months and 5 years old with more boys than girls. The socio-economic status matched that of the local population, similar to findings by Broomfield and Dodd (9). This could be associated with the significant improvements in context of normal speech development, accuracy of production of words of increasing length with increasing age (10). Stuttering is used to describe a child’s speech when it is marked by effortless repetitions or prolongations of words, phrases, or syllables without awareness on the child’s part that these mannerisms are different or abnormal. This can be primary or secondary (2), Johnson stated that “practi-cally all stutterers are originally diagnosed (regarded as “stutterers,” “not talking right,” or “having difficulty say-ing words,” and so forth) by their parents, more often than not the mother being the first to become concerned (11).” From our studies only three were found and it constituted 2.7% of speech disorders, however when parents have had a background of experience with stuttering, they appear to react to the speech imperfections of their children dif-ferently.Our studies have shown that male stutterers outnum-ber female stutterers by about 3 to 1 similar to finding in the literature and this could be from physical standpoint (2). According to Shames, the family is a critical factor in dealing with the young child stuttering because “the family can either reinforce or counteract the efforts of the speech-language pathologist (12).” An advanced, or secondary, stutterer should seek the assistance of a qualified speech-language pathologist. Clinical management of stuttering involves changing the stutterer’s attitude, method of talk-ing, and/or environment. Delayed language development is common and has serious sequelae into adulthood in terms of educational, social and emotional development (13).From our report there is high percentage of deaf-mut-ism constituting more than half of the patients seen and this is found to be commoner among male more than the Table 4. Age of patients with diagnosis of patientAge groupDiagnosistotalDeaf-mutism Delay slurr Impair stutt Aphas0-5 yrs 51 20 3 13 1 1 896-10 yrs 18 8 1 4 - 1 3211-15 yrs 12 3 - 1 2 - 1816-20 yrs 1 - - - - - 121-25 yrs - - - - - - 026-30 yrs 1 - - - 1 - 231-35 yrs - - - - - - 036-40 yrs 1 - - 1 - - 241-45 yrs - - - - - - 046-50 yrs - - 2 - - - 2Total 84 31 6 19 4 2 146speech and language dIsorderwww.ijbs.org    Int  J  Biomed  Sci    Vol. 7  No. 4    December  2011 271female this is not surprising as the study was conducted in Ilorin which is one of the major Islamic town and also belongs to the northern part of the country and favours consanguineous marriage which has been implicated as a risk factor in the development of deaf-mutism from previ-ous studies (14-16). Deaf-Mutism is defines as congenital deafness that re-sults in inability to speak (17). This is usually a childhood problem however from our studies some patient present at adult thus the prognosis for this is poor compared to those detected early and started on speech training. The basis of mutism is usually family psychopathology. Mutism most especially in this group could be an elective type in which there is willingness to speak in a limited number of situa-tions but refusal to speak in others (18). A substantial mi-nority of children with elective mutism have a history of speech delay or articulation problems. It is common for elective mutism to be associated with social anxiety, ex-cessive sensitivity to the reactions of others and stubborn-ness based on fearfulness (14-16). Elective mutism most frequently appears in early child-hood and occurs with approximately the same frequency in both sexes (14) while some found it to be commoner among females than males (18), however this is at variance with our study that found more males than females (14-16). Delayed language may be mild or severe, once the child's language does appear, it usually develops normally in sequence and pattern (13, 19). Whilst early delay may resolve itself, it may turn out to be a long-term delay or disorder (19). It is the second commonest disorder from our series the degree of which was not determined by the study it may probably be associated with hearing impair-ment. Some studies have shown that children with conduc-tive hearing loss associated with middle ear fluid during the first few years of life are at risk for speech delay (20, 21). However, not all studies find this association (22). This was not established by our study. The condition is more common in boys, and a family history of "late bloomers" is often present from previous studies (23). The prognosis for these children is excellent, however; study have shown that they usually have normal speech development by the age of school entry (24).Limitation of this study is that it is a retrospective study thus the inability to assess the degree of mutism, the rela-tionship between hearing loss and speech and language disorders also the relationship between consanguinity and deaf mutism. Future studies will want to assess relation-ship between their academic performance and speech and language disorders.CONCLUSIONDeaf-mutism is still the commonest speech disorder in our environment common among males more than females and the least common is aphasia, thus the need early hear-ing screening for early detection of speech disorders and rehabilitation of this group of patients as early detection and rehabilitation gives a better prognosis. Although this study does not find out the nature of marriages but observed a high rate of consanguineous marriages in the community. This is a risk factor to development of speech and language disorders from previous studies and literatures and the need to discourage it so as to reduce the prevalence of speech and language disorders in our environments.rEFErENcE1. Boone D. Human communication and its disorders. Englewood Cliffs (NJ): Prentice-Hall. 1987.2. Fred D. Minifie. Disorders of Voice, Speech, and Language in Bal-lenger’s Otorhinolaryngology Head and Neck Surgery, Sixteenth Edi-tion. James B. Snow Jr, John Jacob. Ballenger. 2011; 49: 1135-1146.3. Eimas PD, Siqueland ER, Jusczyk P, Vigorito J. Speech perception in infants. Science. 1971; 171: 303-306.4. Kuhl PK. Speech perception. In: Minifie FD, editor. Introduction to Communication sciences and disorders. San Diego (CA): Singular Publishing Group. 1994; 77-148.5. Gopnik A, Meltzoff AN, Kuhl PK. The scientist in the crib: minds, brains, and how children learn. New York: William Morrow. 1999.6. Werker JF, Tees RC. Cross-language speech perception: evidence for Perceptual reorganization during the first year of life. Infant Behav Dev. 1984; 7: 49-63.7. Kuhl PK, Williams KA, Lacerda F, et al. Linguistic experience alters phonetic perception in infants by 6 months of age. Science. 1992; 255: 606-608.8. Greiser DL, Kuhl PK. Maternal speech to infants in a tonal language: support for universal prosodic features in motherese. Dev Psychol. 1988; 24: 14.9. Broomfield J, Dodd B. Children with speech and language disability: caseload characteristics. International Journal of Language & Com-munication Disorders. 2004; 39 (3): 303-324.10. Vance M, Stackhouse J, Wells B. Speech-production skills in children age 3-7 years. International Journal of Language & Communication Disorders. 2005; 40 (1): 29-48.11. Johnson W. People in quandaries. New York: Harper and Row. 1946.12. Shames G. Disorders and fluency. In: Shames G, Wiig E, editors. Human communication disorders. 3rd ed. Columbus (OH): Charles E. Merrill. 1990.13. Ward S. An investigation into the effectiveness of an early intervention method for delayed language development in young children. Inter-national Journal of Language & Communication Disorders. 1999; 34 (3): 243-264 (22).14. Bittles AH, Sullivan SG, Zhivotovsky LA. Consaguinity, Caste and Deaf-Mutism in the Punjab. 1921.15. Bittles AH, Neel JV. The costs of human in breeding and their implica-tions for variations at the genome level. Nature Genetics. 1994; 8117-8121.16. Bennett R, et al. Genetic counseling and screening of consanguineous speech and language dIsorderDecember  2011    Vol. 7  No. 4    Int  J  Biomed  Sci    www.ijbs.org 272couples and their offspring: Recommendations of the National Soci-ety of Genetic Counselors. Journal of Genetic Counseling. 2002; 11: 97-119.17. Encyclopædia Britannica. Encyclopædia Britannica Online. http://www.britannica.com/EBchecked/topic/154320/deaf-mutism. 2010.18. Bishop DV. Developmental disorders of speech and language. In: Rutter M, Taylor E, Hersov L, eds. Child and adolescent psychiatry. Oxford: Blackwell Science. 1994; 546-568.19. Ansel BM, Landa RM, Stark-Selz RE. Development and disorders of speech and language. In: Oski FA, DeAngelis CD, eds. Principles and practice of pediatrics. Philadelphia: Lippincott. 1994; 686-700.20. Shonkoff JP. Language delay: late talking to communication disorder. In: Rudolph AM, Hoffman JI, Rudolph CD, eds. Rudolph's pediatrics. London: Prentice-Hall. 1996; 124-128.21. Schlieper A, Kisilevsky H, Mattingly S, Yorke L. Mild conductive hearing loss and language development: a one year follow-up study. J. Dev. Behav. Pediatr. 1985; 6: 65-68.22. Allen DV, Robinson DO. Middle ear status and language development in preschool children. ASHA. 1984; 26: 33-37. 23. Whitman RL, Schwartz ER. The pediatrician's approach to the pre-school child with language delay. Clin. Pediatr. 1985; 24: 26-31.24. McRae KM, Vickar E. Simple developmental speech delay: a follow-up study. Dev. Med. Child Neurol. 1991; 33: 868-874.View publication stats

Epidemilogical Profile of Speech and Language

Disorder in North Central Nigeria

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Epidemilogical Profile of Speech and Language Disorder in North Central Nigeria

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