Speech Articulation Speech articulation disorders are very common in children. In fact, children go through different stages during development in which they are expected; in fact, many sounds are not usually mastered until age 8 or 9. Speech articulation disorders are diagnosed when the child or adult continues to make articulation errors when we would expect them to stop. At this point, a referral to a speech-language pathologist (SLP) is common.

SLPs do a number of tests and observations to determine the best route for therapy – not one option fits all. Often times, an SLP needs to help the client practice making specific sounds. Sounds are made in different places and using different manners. You can find more information about the ways sounds are produced here.

Speech articulation therapy can take varying amounts of time for successful completion – but the client can always improve faster by practicing at home. The SLP will send materials or practices home after a session.

Language Language disorders are in a different category from speech disorders.

Speech and articulation refers to:

·       the motor movements of the mouth when making specific sounds

Language refers to:

·       the comprehension and use of the spoken, written, or signed language

Language disorders may impact any part of language. Language is split into two categories, receptive and expressive language.

Receptive language refers to understanding words and gestures in the language. A child with a receptive language disorder may have difficulties:

·       understanding words or gestures

·       interpreting input as questions, statements, or instructions

·       understanding grammatical concepts

Receptive language is learned before expressive language, and delayed receptive language typically results in delayed expressive language.

Expressive language refers to the ability to communicate thoughts, wants, and needs. Expressive language can include labeling objects, putting words into an understandable sentence, describing actions, answering questions, and making requests. Children’s expressive language begins in infancy, when a baby coos upon hearing a familiar voice. This slowly develops into the ability to talk. Expressive language disorders may include:

·       speaking in ‘jargon,’ (like they have their own language)

·       limited vocabulary

·       improper pronoun and tense use

·       behavioral outbursts as a result of frustration from the inability to communicate

There are many activities that can support a child in language therapy – focus on creating a language-rich environment. Read aloud to the child, and have conversations with them about the events and objects around them. When having a conversation, make sure to leave spaces for the child to respond, even if they do not have discernable words yet.

Reading and Writing Literacy is a very important skill for children to learn, and beginning literacy intervention at an early age facilitates future success in both school and life. Language and literacy are closely tied – children with delayed language skills are more likely to struggle with reading and writing, as children need sound/letter awareness and a wide vocabulary to perform these tasks. SLPs are uniquely suited to early detection of literacy challenges, and can develop a program designed to address the child’s target areas.

To learn more about literacy and struggling readers, visit the website for Reading Rockets.

Social Thinking Children struggle with social appropriateness, but often ‘get the hang of it’ by the time they are in elementary school. Social skills can be thought of as how a person behaves in a specific social context. If the behaviors demonstrated are expected, they are considered to have “good” social skills. If they are demonstrating unexpected behaviors, they are considered to have “poor” social skills.

There are many complex rules in our society that are followed in social situations, and some children and adults may have a hard time learning or retaining these rules. This is especially the case if they are overwhelmed by input, whether sensory or social.

There are many benefits to pursuing Social Thinking Therapy:

·       help clients consider the thoughts, beliefs, intentions, and emotions of themselves and others

·       decrease difficult, unexpected behaviors

·       increase positive, expected behaviors

Parents are indispensable when doing Social Thinking, as they can continue to reinforce new concepts even outside of the clinic.

Myofunctional Therapy Orofacial Myofunctional disorders can have many effects on the dental alignment of the teeth and posturing of the mouth. Myofunctional therapy is recommended when improper tongue and lip positions cause problems with the dental bite, such as overbites and open bites, when a space is present between the top and bottom front teeth when the jaw is shut. Treatment is recommended for both children and adults. The following behaviors may be addressed with Myofunctional therapy:

·       thumb or finger sucking

·       open-mouth breathing

·       tongue forward thrust when speaking or swallowing

·       teeth grinding or cheek biting

Myofunctional therapy can take a lot of work, but it’s very important. Practicing the activities given to you by the SLP is the best way to hasten treatment.

Voice Voicing disorders can be presented as hoarseness, or “losing” your voice. Sometimes voicing problems can begin in childhood, and continue through adulthood until diagnosed.   Voicing problems may be traced to weak or uneven respiration, which can cause irritation, nodules, or polyps on the vocal cords. Some voice disorders stem from acquired paralysis or spasms of the vocal folds. The vocal folds vibrate as air passes through them, creating voiced sound. This sound is changed into recognizable words when it resonates through the throat, mouth, and nose. This can also be the source of voicing disorders.
Stuttering People who stutter can feel alone – however, 3 million people in the US and 68 million people worldwide are affected by stuttering. Many adults who stutter reported feeling like stuttering has kept them from pursuing certain goals or career paths. Stuttering, or disfluency, is treatable. The core types of disfluency are:

·       blocks (stops before or between words without sound)

·       repetitions (repeating a whole or part of a word)

·       prolongations (stretching a single sound)

Therapy for stutterers can include:

·       modification (treating the stuttering to be more fluent and less severe)

·       fluency shaping (training clients to use breathing, vocal, and articulation techniques to speak with more fluency)

You can find more information about stuttering at I Have A Voice. There is also an excellent documentary made and narrated by a stutterer, The Way We Talk.

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Speech Articulation Speech articulation disorders are diagnosed when the child is making phonological processes or errors beyond the expected age of suppression. Typically, the best way to determine if a child or adult needs speech articulation therapy is by noticing the client’s intelligibility. If the client is older than three and unintelligible by a stranger, they are usually a candidate for treatment. The speech-language pathologist (SLP) will use these methods for assessment:

·       oral mechanism exam

·       client/parent interview

·       medical history

·       speech sound assessment (including taking a speech sample)

·       language testing

The assessment may include a literacy assessment or hearing screening.

There are a number of standardized tests used for assessment, but scores may not be standardized if the client is not within the range determined by test criteria. ASHA’s website contains more information about speech assessment here.

Language Language disorders are common; 5 percent of school-age children have language disorders. This percentage drastically increases in the special education field – about 18 percent of children with disability diagnosis have language disorder comorbidity. Children and adults with language disorder often have speech articulation errors as well.

Language disorders can include receptive (heard or read) or expressive (spoken or written) language.

Clients may have disorders in the following areas:

·       phonological (sound/letter inventory)

·       morphological (grammatical units)

·       syntactic (sentence structure)

·       semantic (word meanings)

·       pragmatic (social appropriateness)

Clients with language disorders may struggle socially, academically, or behaviorally. Clients may be referred to an SLP for assessment if they are not reaching specific developmental milestones on time, such as:

·       following simple directions

·       responding to yes or no questions

·       understanding action words

·       limited vocabulary

·       poor sentence construction

·       incorrect tenses and pronouns

There are a number of standardized and unstandardized language tests, including bilingual options. A client may take a standardized test during assessment without being in the desired range of the test, in which case the scores are not applicable, but still give us qualitative data.

Reading and Writing SLPs are a good resource to identify children at risk for delayed literacy. Literacy and Language share many core skills, and children with language disorders are very likely to experience problems when it comes to reading and writing. ASHA has a website detailing what SLPs can do to assess and treat children for delayed literacy.
Social Thinking Social Thinking therapy can decrease unwanted social behaviors, and increase desired behaviors. Children who could benefit from Social Thinking therapy often have other diagnoses – such as Autism Spectrum Disorder, Language Disorder, or Intellectual Disorder. The SLP will assess the client and begin treatment with a number of interventions, such as modeling, prompting, or using peer training. Some children benefit from very rigid, structured intervention, like Applied Behavioral Analysis (ABA). This may be teaching specific phrases or behaviors to use in specific situations, almost like a behavior manual. This can make the child seem very scripted. Social Thinking focuses on the thoughts that the child has when in certain situations, and how to adapt behavior to different circumstances. It is more flexible and encourages social problem solving, rather than a set scenario=reaction formula.
Myofunctional Therapy Myofunctional therapy differs from dental or orthodontic treatment by using a functional approach to orofacial motor movement and patterns. Myofunctional therapy is generally used when client behavior results in an open dental bite; this can include tongue thrust when speaking or swallowing, thumb and finger sucking, and a slack resting position of the mouth. Speech-language pathologists establish better rest positions for the lips and tongue, and can often assist with dental malocclusion and physical appearance and posturing of the face. Myofunctional therapy can also hasten orthodontic goals.
Voice Voicing disorders can originate in the respiration, phonation, or resonating system. Determining the source of the voicing disorder is the first step to therapy, whether it is a medical cause or a patient behavior. Diagnosis of voice disorders includes an oral motor examination, patient interview, and medical history. Laryngoscopy or stroboscopy can also be performed to examine the vocal fold vibration and closure. Once referred and diagnosed, the client may begin voice therapy, which uses a client-specific plan to guide change in vocal behaviors.
Stuttering Stuttering, also called disfluency, often begins in childhood, and continues into adulthood if not treated. The core types of disfluency are:

·       blocks (stops before or between words without sound)

·       repetitions (repeating a whole or part of a word)

·       prolongations (stretching a single sound)

Therapy for stutterers can include:

·       modification (treating the stuttering to be more fluent and less severe)

·       fluency shaping (training clients to use breathing, vocal, and articulation techniques to speak with more fluency)

Disfluency is not necessarily a problem, but can affect a client’s communication and confidence. Children commonly stutter as a part of typical development. An evaluation by a licensed SLP can determine if the stuttering is likely to continue – if a parent interview indicates a family history of stuttering, or it has continued for more than 6 months, the child may be a candidate for therapy.

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