This article was written with contributions from Vinita Kokatnur-Lemercier CCC-SLP. She is a Pediatric Speech and Language Pathologist.
What is Voice Quality in Childhood?
Voice quality in childhood is the quality of the sound air makes when it is forced out of a child’s lungs and passes over their vocal cords.
Voice quality in childhood is noteworthy when a child has an unusual pitch, tone, volume, or rhythm of speech. When a child has good hearing and no medical issues around the throat or vocal cords, their voice tends to present typically and cause no notice or concern from the listener.
Voice is measured by hearing a child speak. A child with a remarkable voice will sound different than expected, with words coming across high or low in pitch or soft in volume. We may first notice these differences in the preschool years when meaningful speech develops and children have more to say.
On rare occasions, a listener may hear an accent, such as a British accent (when the child or parents have not lived abroad or the child does not have reason to have an accent).
Psychologists care about voice quality because it can indicate that the clinician should look more closely at developmental or genetic causes. The most common association here is with Autism Spectrum Disorders (ASD).
Certainly, not everyone on the Spectrum has a remarkable voice quality, but it is commonly noticed in clinical settings. Children with autism often sound stilted or robotic or have a tone of voice that lacks prosody or talk in a very soft or loud voice.
When we need to turn off the fan, air conditioning, and sound machine to hear what a child or teen is articulating OR when we need to warn office mates in connecting suites that the noise may carry, we are noting a difference in voice quality.
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Symptoms of Voice Quality Concerns in Childhood
You may have voice quality concerns in childhood if your child has the following symptoms.
- Mature voice: your child’s voice sounds like an adult
- Strained or tired voice: your child’s voice sounds scratchy or as if they had laryngitis
- Sore throat: your child is constantly yelling so much that their throat hurts
- “Sing-songy” voice: your child sounds like they are singing a song when telling you about their day
- Wobbly voice: your child’s voice is tremors or shaky
- Robotic sounding voice: your child unintentionally sounds very stilted when talking
- Not able to musically sing notes: your child has reduced phonation
- Monotone voice: your child speaks in a very even unchanging tone of voice that is very neutral
- Unusual voice: your child’s voice is way too loud or too soft for the setting. For example, a voice that is too loud or soft to have a casual conversation
Causes of Odd Sounding Voice in Childhood
- Voice disorders: if your child has a problem with pitch, volume, tone, or other quality of voice that is different from typically developing peers
- Vocal abuse or constant yelling: can be common in young children or school-aged children due to vocal abuse or frequent yelling. This symptom is most commonly seen in little boys who use aggressive-sounding voice tactics, such as yelling loudlyThese loud and intense sounds force the vocal cords to slam together and create “hard voicing.” Hard voicing occurs when the child coughs, bears down for a bowel movement, yells, or starts speaking with force. If you notice your child has a rough or raspy voice, your child might have voice issues compared to others their age.
- Allergies or reflux: Allergies or acid reflux can cause a hoarse or raspy sound that affects a child’s voice. Your child may complain of burning in the throat or an itchy throat with mild coughing, especially during allergy season. Allergies, such as inhalation of pollen, can irritate the vocal cords; a post-nasal drip, or inflamed nose, can alter your child’s voice. You can visit your pediatrician to see if allergy testing is recommended. This testing can rule out seasonal symptoms that may not have anything to do with your child’s vocal habits.Any hoarseness or roughness that persists after two weeks following a cured cold or flu may signify a voice problem. If voice problems continue in the absence of sickness or allergies, it is worthwhile to talk to your child’s doctor.
- Glottal attacks: Loud vocalizations that force the glottis or vocal cords to slam together to make a sound are called glottal attacks. If bad vocal behaviors such as yelling and hard glottal attacks continue persistently, your child’s voice will sound this way every day. However, their voice will improve if behaviors are monitored and changed.
- Overuse: Another sign of voice issues can be overuse of the vocal cords causing a harsh or loud sound. You might observe that your child starts their sentences with very forceful beginnings, which can cause their vocal cords to slam against each other. Over time, the vocal cords can develop nodules or bumps that result in a hoarse voice. Your child may have a hard time changing their behavior and may complain that their throat hurts. They may cry very loudly, which is also abusive to the vocal cords. It is normal for a child’s voice to change with maturation due to the changing size of the vocal cords. However, if symptoms persist or your child is experiencing throat pain regularly, it is important to consult with your doctor.
- Autism Spectrum Disorder: As noted above, some children, teens, and adults on the Autism Spectrum have a remarkable voice. ASD can cause social difficulties that have an impact on language skills. These individuals may speak at a high or low volume because it is hard to understand the way their communication is coming across to others. Social perspective-taking can contribute to how loudly one speaks and what kind of personal space or nonverbal communication accompanies speech. Children with autism can have trouble with body space, social communication, perspective-taking, rigid language, to name a few things. Often practice can help with these challenges. Want to know if your child's challenges are a sign of Autism Spectrum Disorder? Cadey courses are taught by licensed psychologists and walk you through the symptoms of autism and how they may present in your child. Sign up today.
What to Do about Voice Concerns in Childhood
DO consider a psychological evaluation for unique prosody, volume, pitch, or tone: If your child’s voice sounds robotic, stilted, or like they are singing a song while telling a story, they may have autism. Ruling this in or out can lead your child to social communication therapies as needed.
DO talk with your pediatrician if you suspect your child has a voice disorder: If you suspect your child may have a voice disorder, talk to your pediatrician and get a consultation to see an Ear, Nose, and Throat (ENT) doctor. An ENT doctor will make recommendations and can refer you to a speech pathologist specializing in vocal rehabilitation.
Voice rehabilitation focuses on reducing or eliminating abusive vocal behavior, such as yelling and consumption of irritants. Clinicians working in vocal rehabilitation will help your child with relaxation, timing, rate, rhythm change, pitch, and loudness monitoring.
Treatment can include decreasing abusive behaviors, performing vocal cord exercises, treating allergies, avoiding allergens, treating reflux, and treating vocal nodules if they exist on the vocal cords by following a regimen created by a speech pathologist and ENT doctor. Voice rest is an important treatment for some of these harsh vocal behaviors.
DO talk with your child’s teacher while they are in treatment: While your child is in treatment, it is a good idea to talk to your child’s teacher about their behaviors in class and on the playground to keep track of vocal abuse.
DO keep a chart at home to monitor your child’s symptoms: At home, keep a chart to monitor yelling, aggressive vocal behaviors, and observation of symptoms consistent with allergies or reflux.
DO encourage your child to stop yelling: You can even use a bell or other method to encourage your child to get your attention at home instead of yelling, for example. Consistent compliance with exercises and regular checkups with the ENT doctor will help to improve a child’s voice issues.
The monitoring of symptoms will, with time, show improved voice quality. Regular adherence to a treatment plan of this nature can decrease any roughness of voice and can improve overall communication skills.
DO consider if your child has general voice differences: If there is nothing physically going on with your child, simply practicing tone and volume of speech depending on the setting and social context can be helpful. It is possible to take video or audio recordings and evaluate voice to help improve social communication. You and your child can practice speaking more slowly, quietly, clearly, or anything else impairing communication.
DO consider working with a speech therapist: You may decide that a speech therapist could be helpful if you and your child are working together and finding this process difficult. Suppose your child’s voice is unique but easily intelligible. Then, no need to worry unless your child wants to address it. It may be best, in this case, to be sure your child has support for any other challenges around social interaction or anxiety if you notice any of these differences.
When to Seek Help for Voice Quality Issues
Voice issues are important because they are often related to other social symptoms like autism and other developmental disorders or language disorders. Seeking help from a psychologist or speech therapist can help with these challenges. A psychologist can rule in or out the presence of autism. Understanding whether your child has this diagnosis will allow you to pursue support in social skills and communication areas should they benefit your child. Every child can benefit from some individualized attention and support, so there is no harm in asking if you think your child might need help.
Further Resources on Voice Quality Concerns in Childhood
If your child is struggling with this symptom to the point that it is getting in the way of their learning, relationships, or happiness, the following professionals could help. They may offer diagnosis, treatment, or both.
- Speech-language pathologists: specializing in voice or voice therapists
- Pediatrician: for a referral to speech or motor therapy or to diagnose medical issues
- Psychologist: a neuropsychologist, clinical psychologist, or licensed (school) psychologist can conduct a thorough assessment of social and communication as well as other areas of development and help guide you and your family to the right kind of help
- Developmental pediatrician: also assesses for autism or other genetic differences or medical causes
Professionals to consider for vocal issues that may be due to a medical condition
- ENT or otolaryngologist
- Voice Specialist
Similar Conditions to Voice Quality Concerns in Childhood
- Social communication challenges: some children with significant voice issues may have impacted social skills
- Articulation: some children with articulation issues also have voice problems
- Tantrums: some children who scream and yell will have voice problems
- Aggression: some children who are often angry and aggressive may yell and have voice issues as a result
- Hoarseness or throat pain: some children may have voice issues that are due to allergies, reflux, or a medical issue
Resources on Voice Quality in Childhood
American Speech-Language-Hearing Association. http://www.asha.org/
Colton, Raymond H. & Casper, Janina K. (2011). Understanding Voice Problems: A Physiological Perspective for Diagnosis and Treatment (Understanding Voice Problems: Phys Persp/ Diag & Treatment).
Tomblin, Bruce J. & Morris, Hughlett L. (Eds) (1999). Diagnosis in Speech -Language Pathology.
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