This is not seen as often in the schools, but it can be a factor.
This is when the vocal cords or other structure are not able to work as they should to create an appropriate voice.
Too high in pitch
Too low in pitch
A vocal production where sound has stopped in the middle of a production.
Yes we all may have a harsh voice when we have a cold or other such virus, but something ongoing can be an issue.
Vocal abuse is an issue when we mistreat our voice by yelling too often or exposing it to chemicals such as those found when smoking.