Free Praxis Speech-Language Pathology (5331) Study Guide

The First Two Years

Prelinguistic development is everything a baby does to communicate before true words appear, and it follows a predictable sequence organized by age band.

• Cooing (about 2 to 4 months): vowel-like sounds that signal a comfortable, responsive baby.
• Canonical (reduplicated) babbling (about 6 to 8 months): consonant-vowel strings such as "bababa." Babbling that does not appear by 9 to 10 months is an early warning sign, especially for hearing loss.
• Jargon and gestures (about 9 to 12 months): babble that carries adult intonation, plus pointing, showing, and waving. Joint attention is firmly online here.
• First true words (about 12 months): consistent word forms tied to meaning.
• Vocabulary spurt and word combinations (about 18 to 24 months): roughly a 50-word expressive vocabulary by 18 months, then two-word combinations ("more milk") by about 24 months.

When Sounds and Processes Come Online

Children acquire consonants in a rough order, and they also use predictable phonological processes, which are systematic sound-simplification patterns that a typical child outgrows on a schedule.

• Early sounds: /p, b, m, n, w, h, d/ are usually mastered by about age 3.
• Later sounds: /s, z, r, l/ and both "th" sounds are the last to stabilize, often not fully mastered until age 7 to 8. A 6-year-old who still distorts /r/ is within the late-normal window.
• Processes gone by age 3: reduplication, final consonant deletion, and unstressed-syllable deletion.
• Processes that persist to about 5 to 7: cluster reduction, gliding of liquids (/r, l/ become /w/), and stopping of later fricatives.

⚠ COMMON TRAP: Do not confuse intelligibility norms with sound-mastery norms. A child should be approximately 50% intelligible to unfamiliar listeners by age 2, 75% by age 3, and nearly 100% by age 4, even though individual late sounds such as /r/ are still developing. An item may present a fully intelligible 4-year-old who still distorts /r/; this is typical and does not constitute a disorder.

From Sentences to Literate Language

Language has five domains: phonology (the sound system), morphology (word structure and grammatical markers), syntax (sentence structure), semantics (meaning and vocabulary), and pragmatics (social use of language). Development continues well past the early years.

• Preschool (3 to 5): grammatical morphemes emerge in a predictable order (Brown's morphemes: present progressive -ing, plurals, possessives, articles, past tense), and sentences grow in length and complexity, tracked by mean length of utterance, the average number of morphemes per utterance.
• School-age (6 to 12): the gains shift to literacy, complex syntax, figurative language, and metalinguistic awareness, the ability to think about and manipulate language itself (rhyming, defining words, judging grammaticality).
• Adolescence: refined narrative and expository discourse, advanced vocabulary, and flexible pragmatic skills for varied social and academic settings.

Typical Versus Pathological Aging

Communication is stable through most of adulthood. In healthy older adults you expect mild, normal changes that should not be mistaken for disease.

• Typical aging: slower word retrieval and more "tip of the tongue" moments, mild high-frequency hearing decline (presbycusis), and a slightly weaker, breathier voice (presbyphonia). Vocabulary and everyday communication stay strong.
• Not typical aging: progressive memory loss that disrupts daily function, frank word-finding failure in conversation, or a sudden change in speech or swallowing. These point to dementia, stroke, or other pathology, not normal aging.

The Four Phases and the Feeding Timeline

A normal swallow moves through four phases you must be able to name in order:

1. Oral preparatory phase: food is chewed and formed into a cohesive bolus.
2. Oral (transit) phase: the tongue propels the bolus back toward the pharynx.
3. Pharyngeal phase: the swallow reflex triggers, the airway closes (the larynx elevates and the epiglottis inverts), and the bolus passes the pharynx. This is the phase where airway protection matters most.
4. Esophageal phase: peristalsis carries the bolus to the stomach.

The feeding timeline is just as testable: newborns rely on the suck-swallow-breathe pattern and reflexes (rooting, suckling); pureed spoon-feeding begins around 6 months; cup drinking and soft table foods emerge around 12 months; chewing matures as molars erupt across the second and third years.

Physical and Health-Related Factors

• Hearing status: even mild or fluctuating hearing loss (think chronic otitis media with effusion in toddlers) degrades the speech input a child needs and delays speech and language.
• Cognition and neurological status: intellectual disability, autism, cerebral palsy, stroke, and traumatic brain injury all shape what communication and swallowing are possible.
• Structural and craniofacial factors: cleft lip and palate, velopharyngeal insufficiency, and dental or jaw anomalies affect resonance, articulation, and feeding.
• Prematurity and medical history: low birth weight, prolonged intubation, and complex medical conditions raise the risk for feeding and communication problems.
• Genetic and syndromic conditions: Down syndrome, fragile X, and similar conditions carry characteristic communication and feeding profiles.

Contextual and Linguistic Influences

• Language exposure and environment: the quantity and quality of language input, caregiver responsiveness, and access to books and conversation shape development.
• Socioeconomic and health-access factors: nutrition, access to care, and environmental stress can influence outcomes, though they do not by themselves equal a disorder.
• Cultural and linguistic background: bilingualism, dialect, and culturally based communication styles are normal variation. A bilingual child is not language-disordered for mixing languages, and a dialect speaker is not articulation-disordered for using the features of that dialect.

⚠ COMMON TRAP: A second language influencing speech and grammar is a normal feature of bilingual development, not evidence of disorder. The clinical question is whether the difficulty appears across both languages. A true disorder is present in the child's first language as well, not in the newly learned one alone.

Distinguishing the Two Terms

Incidence is the number of new cases of a disorder that arise in a population over a defined period of time. Prevalence is the total number of existing cases (new and ongoing) in a population at a given point in time.

• Stuttering is the classic illustration: lifetime incidence is high (roughly 5 to 8 percent of children stutter at some point), but prevalence is much lower (about 1 percent) because most children recover.
• Prevalence is driven by both how often a disorder starts and how long it lasts.

The Sound and Production Disorders

• Speech sound disorders: an articulation disorder is trouble physically producing specific sounds (a distorted /s/ or /r/), while a phonological disorder is a rule-based pattern affecting whole sound classes (deleting all final consonants). Most common in young children.
• Fluency disorders: stuttering features part-word repetitions, prolongations, and blocks, with typical onset between ages 2 and 4, more common in males. Cluttering is a related rapid, disorganized speech pattern.
• Voice disorders: changes in pitch, loudness, or quality. Vocal nodules are bilateral, callus-like growths caused by vocal abuse or misuse and are common in children and heavy voice users; expect hoarseness and breathiness.
• Resonance disorders: hypernasality (too much nasal resonance, often from velopharyngeal insufficiency or cleft palate) and hyponasality (too little, as when the nose is blocked).

Developmental and Acquired Language Disorders

• Developmental language disorder (DLD): a persistent language impairment without an obvious cause such as hearing loss or intellectual disability, affecting roughly 7 percent of children. It involves receptive and/or expressive deficits in grammar, vocabulary, and discourse.
• Aphasia: an ACQUIRED language disorder, most often from left-hemisphere stroke. Know the major types: Broca's (nonfluent) aphasia features effortful, agrammatic speech with relatively preserved comprehension; Wernicke's (fluent) aphasia features fluent but empty speech with paraphasias and poor comprehension; global aphasia impairs both severely.

Motor and Cognitive Bases of Communication Disorders

• Dysarthria: a group of motor speech disorders from weakness, slowness, or incoordination of the speech muscles (the EXECUTION of movement). Speech sounds slurred, and errors are consistent. Causes include stroke, Parkinson's disease, and ALS.
• Apraxia of speech: a disorder of motor PLANNING and programming, not muscle weakness. Errors are inconsistent, the speaker gropes for articulatory positions, and speech worsens with longer or more complex words.
• Cognitive-communication disorders: communication problems driven by deficits in attention, memory, and executive function, seen after traumatic brain injury, right-hemisphere damage, and in dementia.

⚠ COMMON TRAP: Aphasia is a LANGUAGE disorder, while dysarthria and apraxia are SPEECH (motor) disorders. A client can present with aphasia and apraxia simultaneously after a stroke. Do not select "aphasia" solely because the client had a stroke; determine whether the breakdown is in language (words, grammar, comprehension) or in speech motor output.

Characteristics and Risks

Dysphagia is difficulty swallowing, and it can affect any phase of the swallow. Its most dangerous consequence is aspiration, the entry of food or liquid below the vocal folds into the airway, which can lead to aspiration pneumonia.

• Common causes: stroke, Parkinson's disease and other progressive neurological disease, dementia, head and neck cancer, and traumatic brain injury. In infants and children, prematurity and neurological conditions are frequent causes.
• Warning signs: coughing or choking during meals, a wet or gurgly vocal quality after swallowing, and recurrent pneumonia. Silent aspiration produces no cough and is especially dangerous because it is easy to miss.