Over the past few weeks we have been developing an understanding of the components of a mental state exam. So far we have discussed how a young persons appearance and behaviour can provide indicators as to their mental state. Today we look at how a young persons speech can provide insight into their current mental health.
A young persons speech is assessed by observing their spontaneous speech, and also by using structured tests of specific language functions. during this time we are focussed on the production of speech rather than the content of speech, which we will address under thought form and thought content in weeks to come. When observing the young persons spontaneous speech, a youth worker should note and comment on paralinguistic features such as the loudness, rhythm, prosody, intonation, pitch, phonation, articulation, quantity, rate, spontaneity and latency of speech.
A structured assessment by a qualified speech pathologist is a great tool for diagnosing serious difficulties in speech however a basic screening can be performed by an aware youth worker. An assessment of speech includes an assessment of expressive language by asking the young persons to name objects, repeat short sentences, or produce as many words as possible from a certain category in a set time. Simple language tests form part of the mini-mental state examination. In practice, the structured assessment of receptive and expressive language is often reported under cognition which we will discuss in a coming cast.
Language assessment will allow you to recognise young people presenting with aphonia or dysarthria, neurological conditions such as stroke or dementia presenting with aphasia, and specific language disorders such as stuttering, cluttering or mutism. People with autism or Asperger syndrome may have abnormalities in paralinguistic and pragmatic aspects of their speech. Echolalia (repetition of another person’s words) and palilalia (repetition of the subject’s own words) can be heard by young people with autism, schizophrenia or Alzheimer’s disease. A young person with schizophrenia might use neologisms, which are made-up words which have a specific meaning to the person using them.
Speech assessment also contributes to assessment of mood, for example people with mania or anxiety may have rapid, loud and pressured speech; on the other hand depressed patients will typically have a prolonged speech latency and speak in a slow, quiet and hesitant manner.
If you know a speech pathologist or have the opportunity to do some training with one, do it! Aside from appearance speech is one of the most observable ways to notice a persons mental state.
Stay tuned next week for part four: Mood and Affect.