Voice Quality

Is your child using an odd sounding voice?

Is your child:

  • Sounding hoarse?
  • Using a gruff voice?
  • Sounding like he has the voice of someone older?
  • Always clearing his throat?
  • Complaining that his throat hurts?
  • Sounding strained or tired?
  • Seeming like he has laryngitis all the time?
  • Being described as having a wobbly voice or a scratchy voice? 

LET'S TALK ABOUT IT

If your child’s voice sounds funny, there could be three primary issues.

First, your child may use an odd pitch and tone. Perhaps, your child sounds like he is singing a song when he is telling a story about his day. Or, your child may unintentionally sound like a robot. This symptom may be a sign of a neurodevelopmental disability.

Another possibility is that your child’s voice sounds raspy or throaty. Sometimes, kids have acid reflux or allergies that can affect voice and make them sound like they have a gruff sounding voice. Your child might sound tired even when he is not.

Allergy season might bring more complaints of throat pain, or you may notice more phlegm production and throat clearing, which can affect the tone of voice. If you notice your child is frequently clearing his or her throat and is complaining of burning in the throat, voice issues may be a concern.

The third possibility is that your child’s voice sounds ‘hard’ and loud, almost like he or she is yelling all the time. The beginnings of sentences may sound harsh. Voice disorders 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 loudly.

These loud and intense sounds force the vocal chords 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. Your child might have voice issues if you notice your child has a raspy voice or rough voice when compared to others her age.

CLINICAL DESCRIPTION

Voice problems can vary in origin and can show up in a variety of symptoms. Assessing the cause of voice problems is difficult because a condition might not be observable or seen easily.

Major symptoms and signs of voice problems can include the following:

  • hoarseness
  • fatigue
  • breathiness
  • reduced phonation or ability to “sing all notes”
  • absence of voice
  • pitch breaks or an unusually high pitch
  • strained/struggled voice
  • tremor or wobbly/shaky voice

In kids, usually you will observe hoarseness or absence of voice, which can be caused by abusing the voice with frequent and aggressive yelling. The four most common voice problems in children are listed below.

Odd Pitch-Tone: If our child’s voice sounds different due to pitch and tone, this may be a sign of autism or a neurodevelopmental disability. Children with Autism Spectrum Disorder may exhibit voice issues, such as difficulty controlling their pitch (too high or too low pitch) and prosody (odd rhythm). A child may speak with a larger or smaller range of pitch and prosody than is heard in same-aged children without the disorder.

Children with these issues might speak or read in a very high pitch and could be unaware they are doing it. They may sound ‘sing songy’ when speaking with others during social interactions, or they may mimic and copy others. A child with autism may also sound very monotone. When your child uses big words, he may say it without realizing the meaning or how it may come across.

A child with voice issues may use the wrong intonation. For example, he may talk about a friend’s dog dying and use a high-pitched, happy sounding voice, and he may not realize this pitch appears insensitive. These voice differences can complicate communication with others. Your child may have a hard time knowing when to raise or lower his or her voice so that the message is understood and the loudness is appropriate to the situation.

Hoarse – Raspy: Allergies or acid reflux can affect 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 chords; 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 be a sign of a voice problem. If voice problems persist in the absence of sickness or allergies, it is worthwhile to talk to your child’s doctor. Another potential problem could be glottal attacks. Glottal attacks are when your child’s loud vocalizations force the glottis or vocal chords to slam together to make a sound. If the bad vocal behaviors such as yelling and hard glottal attacks continue persistently, your child’s voice will sound this way on a normal basis; however, if behaviors are monitored and changed, his voice will improve.

Harsh – Loud: Another sign of voice issues can be overuse of the vocal chords. You might observe that your son starts his sentences with very forceful beginnings, which can cause his vocal chords to slam against each other and can cause nodules or bumps on the chords that over time result in his hoarse voice.

Your child may have a hard time changing the behaviors, which can continue for years. He might complain that his throat hurts often.  He may cry very loudly, which is also abusive to the vocal chords. It is normal for a child’s voice to change with maturation due to the size change of the vocal chords. However, if symptoms persist, or if your child is experiencing throat pain regularly, it is important to consult your doctor.

WHAT TO DO

If your child has an odd prosody, pitch or tone, it might be necessary to consider a psychological evaluation. If your child’s voice sounds like a robot or like he is singing a song while telling a story, autism should be a consideration.

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 vocal abusive 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.

Treatent can include decreasing abusive behaviors, performing vocal chord exercises, treating allergies, avoiding allergens, treating reflux, and treating vocal nodules if they exist on the vocal chords by following a regimen created by a speech pathologist and ENT doctor.

While in treatment, it is a good idea to talk to your child’s teacher about his behaviors in class and on the playground to keep track of vocal abuse. At home, keep a chart to monitor yelling, aggressive vocal behaviors, and observation of symptoms consistent with allergies or reflux.

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.

SIMILAR SYMPTOMS

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

  • Social challenges (Socializing): significant voice issues may impact 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 angry and aggressive often may yell and have voice issues as a result
  • Hoarseness or throat pain: may be due to allergies, reflux, or a medical issue

POTENTIAL DISABILITIES

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

  • Autism Spectrum Disorder (ASD): some children with ASD have issues with voice quality, prosody, pitch and tone
  • Trauma and Attachment Related Disorders: some children who have been mistreated or have a significant trauma history may have issues with voice
  • Behavior Disorders: some children who yell and scream a lot due to poor behavior or aggression may have voice problems
  • Allergies (seasonal and environmental): children with allergies can have voice issues
  • Reflux: some children with reflux may have voice issues
  • Organic disease of vocal chords: children with medical problems in the vocal chords will have voice problems

WHERE TO GO FOR HELP

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

  • CLEAR Child Psychology: to obtain a customized profile of concerns for your child or to consult ‘live’ with a psychologist or speech therapist
  • Speech Language Pathologists: specializing in voice or voice therapists
  • Pediatrician: for a referral to speech or motor therapy or to diagnose medical issues

For vocal issues that may be due to a medical condition:

  • ENT or otolaryngologist
  • Allergist
  • Otolaryngologist
  • Laryngologist
  • Voice Specialist

These professionals may recommend the following tests for this symptom:

  • Imaging tests such as radiology
  • Evaluation by Ear, Nose & Throat (ENT) Doctor
  • Evaluation by Speech/Language Pathologist
  • Mirror examination, rigid and flexible laryngoscopy, and videostroboscopy. An ENT would place a mirror in the back of the throat and view the vocal folds and voice box or larynx for a mirror examination. During a rigid laryngoscopy, a scope is placed in the larynx or voice box. During a flexible laryngoscopy, a scope is placed through the nose into the back of the throat into the voice box or larynx. Videostroboscopy uses either the rigid or flexible laryngoscopy with strobe lights to see the movement of the vocal folds.

LEARN MORE

[1] American Speech-Language Hearing Association. http://www.asha.org/

[2] Colton, Raymond H. & Casper, Janina K. (2011). Understanding Voice Problems: A Physiological Perspective for Diagnosis and Treatment (Understanding Voice Problems: Phys Persp/ Diag & Treatment).

Amazon: https://www.amazon.com/Understanding-Voice-Problems-Physiological-Perspective/dp/1609138740/

[3] Tomblin, Bruce J. & Morris, Hughlett L. (Eds) (1999). Diagnosis in Speech -Language Pathology .

Amazon: https://www.amazon.com/Diagnosis-Speech-Language-Pathology-Bruce-Tomblin/dp/0769300502/

Image Credit:
Description: Kid shouting through megaphone
Image ID# 178170946 (iStock)
By: yaruta
Child’s voice problems
Previously licensed: November 21, 2016
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

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