FREQUENTLY ASKED QUESTIONS

Speech-Language Pathologists (SLPs) specialize in evaluating and treating a variety of speech-language disorders, cognitive, voice, and feeding-swallowing problems. SLPs work with the full range of human communication and its disorders in individuals of all ages, from infants to the elderly.

Prior to the speech evaluation, a formal audiological evaluation (hearing test) is required, to rule out hearing deficits impacting speech-language development.  After hearing test results are received and reviewed, parents complete a questionnaire regarding their concerns and the child’s medical, developmental, and educational history.  We will request medical information from the child’s pediatrician, and may also request information from other medical or educational professionals who have evaluated and/or treated your child.

Your child’s medical, developmental, and educational histories are carefully reviewed. Parents are interviewed regarding their concerns and the child’s history. This information helps the Speech-Language Pathologist identify areas to evaluate more closely.  A variety of methods, including formal and informal tests, observation, parent/caregiver interview, and play-based activities will be used to evaluate your child’s speech, language, cognition, and voice. Selection of testing methods is based on your child’s individual needs. 

Following the speech evaluation, initial results of the evaluation and recommendations are reviewed with parent/s (and your child if appropriate). Parent/s and child’s physician will be provided with a written report detailing evaluation results.

A speech therapy treatment plan is an individualized plan created by the Speech-Language Pathologist to address your child’s speech, language, cognitive, and/or voice needs.  The plan may include:

• Recommendations for therapy or re-screening/re-evaluation at a later time.
• Initial goals to address during therapy, and suggestions for parents/caregivers.
• Referrals to other professionals (i.e. occupational/physical therapist, medical specialists, etc).
• Referral to other community services.

Speech therapy sessions are usually from 30-45 minutes (as tolerated) for young children, and 60 minutes for older children and adults.  The duration (length of therapy) is dependent on individual needs, severity of the deficit areas, and prognosis for improvement.

If you are concerned about your child’s communication skills, please call to find out if your child should be seen for a speech-language evaluation. The early months of your child’s life are of great importance for developing speech and language, social skills, emotional growth, and intelligence.

Speech-Language Pathologists (SLPs) specialize in evaluating and treating a variety of speech-language disorders, cognitive, voice, and feeding-swallowing problems. SLPs work with the full range of human communication and its disorders in individuals of all ages, from infants to the elderly.

Refer to Milestones for Speech and Language Development.

Receptive Language involves the ability to understand language. Receptive Language Disorders are difficulties in the ability to attend to, process, comprehend, and/or retain spoken language. A Receptive Language Disorder means the child has difficulties with understanding what is said to him or her. The symptoms vary between individuals but, generally, problems with language comprehension usually begin before the age of four years. Other names for Receptive Language Disorder include Central Auditory Processing Disorder and Comprehension Deficit. In most cases, the child also has an Expressive Language Disorder, which means they have trouble using spoken language.

The main components of language include:

• Phonology– The manipulation of sound according to the rules of the language.
• Morphology– The understanding and use of the minimal units of meaning.
• Syntax– The grammar rules for constructing sentences in language.
• Semantics– The interpretation of meaning from the signs or symbols of communication.
• Pragmatics– The social aspects of communication.

Some early signs and symptoms of a Receptive Language Disorder include:

• Difficulty following directions.
• Repeating back words or phrases either immediately or at a later time (echolalia).
• Difficulty with answering questions appropriately.
• Use of jargon while talking.
• Difficulty attending to spoken language.
• High activity level.
• Inappropriate and/or off topic responses to questions.

Understanding spoken language is a complicated process. The child may have problems with one or more of the following skills:

• Hearing– A hearing loss may be the cause of language problems.
• Vision– Understanding language involves visual cues, such as the facial expressions and gestures used by others. A child with impaired vision will not have these additional cues, and may experience language problems.
• Attention– The child may have difficulty paying attention or concentrating on what’s being said.
• Speech sounds– There may be problems distinguishing between similar speech sounds.
• Memory– The brain has to remember all the words in a sentence in order to make sense of what was said. The child may have difficulty with remembering the string of sounds that make up a sentence.
• Word and grammar knowledge – The child may not understand the meaning of words or sentence structure.
• Word processing– The child may have problems with processing or understanding what was said to him or her.

An Expressive Language Disorder involves difficultly with sharing one’s thoughts, ideas, and feelings. An Expressive Language Disorder affects academics/schooling in many ways. It is usually addressed through speech therapy, and usually cannot be expected to go away on its own.

Is my child showing signs of an Expressive Language Disorder?

Some common Expressive Language Disorder symptoms include:

• Omitting word endings, difficulty acquiring forms such as plurals, past tense verbs, complex verb forms, or other forms of grammar.
• Limited vocabulary.
• Repetition of words or syllables.
• Difficulty understanding words that describe position, time, quality or quantity.
• Word retrieval difficulties.
• Substituting one word for another or misnaming items.
• Relying on non-verbal or limited means of communicating.

If you are concerned about a child’s language development, contact The Clinic.

The signs and symptoms of Autism Spectrum Disorder (ASD) may be detected earlier than 12 months of age. Symptoms of ASD can occur in isolation or in combination with other conditions. Some early indicators of Autism Spectrum Disorder may include:

• Delayed development of the ability to draw the attention of parents and others to objects and events.
• Little or no use of pointing to encourage another person to look at what (s)he sees (i.e., “joint attention”).
• Little or no attempt to gain attention by bringing or showing toys/objects to others.
• Little or no eye contact.
• Participates in repetitive patterns of activities.
• Aloofness and indifference to other people.
• Lack of understanding that language is a tool for conveying information.
• Tendency to select for enjoyment, trivial aspects of things in the environment (e.g., attending to a wheel on a toy car and not the whole car for imaginative play).
• Odd responses to sensory stimuli, such as hypersensitivity to sound, fascination with visual stimuli, dislike of gentle touch but enjoyment of firm pressure.
• Uses senses of taste and smell rather than hearing and vision.
• Poor coordination including clumsiness, odd gait and posture.
• Over or under activity.
• Abnormalities of mood, such as excitement, misery.
• Abnormalities of eating, drinking, and sleeping.

More Obvious Signs of Autism Spectrum Disorder

• Flicking fingers, objects, pieces of string
• Watching things that spin.
• Tapping and scratching on surfaces.
• Inspecting, walking along and tracing lines and angles.
• Feeling special textures.
• Rocking, especially standing up and jumping from back of foot to front of foot.
• Tapping, scratching, or otherwise manipulating parts of the body.
• Repetitive head banging or self-injury.
• Teeth grinding.
• Repetitive grunting, screaming or other noises.
• Arranging objects in a line.
• Intense attachment to particular objects for no apparent reason.
• A fascination with regular repeated patterns of objects, sounds.

Red Flag Statements Often Heard by Caregivers

• “His speech is delayed, he’s not talking. He doesn’t respond to his name, could he be deaf?”
• “She’s not interested in playing with toys.”
• “At the playgroup he won’t have anything to do with the other children.”
• “She hits other children if they get in her way.”
• “He’s not very affectionate, he doesn’t like being touched and cuddled.”
• “She clings to me all the time and won’t let me out of her sight.”
• “He insists on the same routine and is very upset if this is changed.”
• “She seems very different from other children her own age.”
• “At school he says nothing and gives no problems. At home he just won’t fit in with family.”
• “He seems to have no idea of how to follow the social rules.”

Compiled from: The National Autistic Society

Children with a social pragmatic language disorder demonstrate deficits in social cognitive functioning.  Children have particular trouble understanding the meaning of what others are saying, and they are challenged in using language appropriately to get their needs met and with interacting with others. 

Some signs and symptoms may include:

• Delayed language development.
• Difficulty understanding questions.
• Difficulty understanding choices and making decisions.
• Difficulty following conversations or stories. Conversations are “off topic” or “one sided.”
• Difficulty extracting the key points from a conversation or story; they tend to get lost in the details.
• Stuttering or cluttering speech.
• Repeating words or phrases.
• Difficulty with verb tenses.
• Difficulty with pronouns.
• Difficulty explaining or describing an event.
• Reduced personal problem solving skills.
• Literal/concrete understanding of language.
• Difficulty engaging in conversational exchange.
• Difficulty with active listening, including participating through observation of the context and making logical connections.
• Aggressive language.
• Decreased interest in other children.
• Difficulty with abstract and inferential language.
• Lack of eye contact.
• Difficulty interpreting nonverbal language.
• Difficulty with adequately expressing feelings.

Non-fluent speech and stuttering in children is typical between the ages of two and six years. It is typical for non-fluent speech to last up to six months, improve then return.  A speech-language evaluation may be in order if your child exhibits any other speech and language difficulties or was a late talker. Any child who is demonstrating any “struggle behaviors” (e.g., facial/bodily tension, breathing disruptions, blocks, grimacing) should be referred to a Speech-Language Pathologist immediately.

Correcting disfluency in children can begin at home with just a few simple concepts:

• Slow down your own speech to a slow normal rate; slow down your own actions and adopt a more relaxed, non-hurried atmosphere for your child. Build in more time for getting ready for activities and changing activities.
• Make sure your child has adequate rest and is healthy. Attend to any allergies.
• Chart your child’s “stuttering” to see if a pattern can be determined. Videotape or audiotape your child once a month to obtain an objective assessment of disfluencies.
• Encourage conversation on a “good day.” On a day when your child shows many disfluencies, ask more “yes/no” questions which require shorter answers and direct your child to “quiet” activities if your child prefers not to talk.
• Listen patiently to your child and encourage other family members to refrain from interrupting.
• Do what works to encourage fluent speech. Don’t be afraid of the stuttering. Your attitude will be conveyed to your child. Contrary to popular belief, many things parents say naturally (e.g., slow down, start again) help their children. Sensitivity and patience is the best approach.

Articulation is the production of speech sounds. An articulation disorder is when a child does not make speech sounds correctly, due to incorrect placement or movement of the lips, tongue, velum, and/or pharynx. An articulation disorder involves problems making sounds. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand your child.

Young children often make speech errors. For instance, many young children sound like they are making a “w” sound for an “r” sound (e.g., “wabbit” for “rabbit”) or may leave sounds out of words, such as “nana” for “banana.” The child may have an articulation disorder if these errors continue past the expected age. It is important to recognize that there are differences in the age at which children produce specific speech sounds in all words and phrases. Mastering specific speech sounds may take place over several years.

Phonology refers to the speech sound system of language. A phonological disorder is when a child is not using speech sound patterns appropriately. A child whose sound structures are different from the speech typical for their stage of development, or who produce unusual simplifications of sound combinations may be demonstrating a phonological disorder.  Commonly, children with this disorder have:

• Problems with words that begin with two consonants. “Friend” becomes “fiend” and “spoon” becomes “poon.”
• Problems with words that have a certain sound, such as words with “k,” “g,” or “r.” The child may either leave out these sounds, not pronounce them clearly, or use a different sound in their place.  Examples include: “boo” for “book,” “wabbit” for “rabbit,” “nana” for “banana,” “wed” for “red,” and making the “s” sound with a whistle.

Milder forms of this disorder may disappear on their own by around age 6.  Speech therapy may be helpful for more severe symptoms or speech problems that do not get better. Therapy may help the child create the sound, for example, by showing where to place the tongue or how to form the lips when making a sound.

Signs of a possible Articulation and Phonological Disorder in a preschool child may include:

• Drooling, feeding concerns.
• Omission of initial, medial, or final sounds.
• Speech is difficult to understand.
• Stops many consonants, little use of continuing consonants such as /w, s, n, f/.
• Limited variety of speech sounds.
• Asymmetrical tongue or jaw movement.
• Tongue between teeth for many sounds.

Signs of Articulation and Phonological disorders in a school age child may include:

• Omissions and substitutions of speech sounds.
• Difficulty with consonant blends.
• Frontal and/or lateral lisps.
• Difficulty producing consonant /s, r, l, th/.

• Speak clearly and at a slow conversational rate.
• Know which sounds are expected to be pronounced correctly at your child’s age – encourage only the speech sounds that are appropriate for his/her age.
• Model correct pronunciation at natural times during the day. Do not correct your child. For example, if your child says, ” I got a pish,” you could say, “Yes, you have a fish.” You may want to emphasize the target sound slightly.
• Play sound games if your child is interested. This will increase his or her overall awareness and discrimination of sounds. You might play with magnetic letters, read rhyming books such as Dr. Seuss, or say nursery rhymes, or sing songs slowly. Many songs can encourage awareness of sounds through their words (Old MacDonald, Bingo, etc.)
• Tell your child when you don’t understand what he/she says. Let him/her know that you will listen and try to understand. Have him/her gesture or show you what he/she is talking about if needed. Explain that sometimes you may not understand what is said, and that you know this must be frustrating. Let him/her know you understand how he/she feels.

Speech and language delays/disorders impact academics and social interactions, as well as have a negative impact on a child’s self-esteem. These are all factors that can be addressed with treatment.

For many adults, a medical condition such as a Stroke, Traumatic Brain Injury, Parkinson’s Disease, Guillain-Barre Syndrome, and other diseases affecting motor skills may impact overall speech, language, and swallowing function. Speech Therapy helps adults improve speaking and language skills, comprehension of language, cognitive (thinking) skills such as attention, memory, reasoning, problem solving, executive functioning, as well as improve feeding skills, and swallowing function. 

The Speech-Language Pathologist will obtain medical history information from the patient and/or family member/caregiver, perform an oral-motor examination, followed by a Speech-Language Evaluation. The evaluation includes such tasks as following commands, responding to questions, naming objects, repeating words and sentences, and performing reading and writing tasks. An assessment of swallowing function may also be performed if needed. All of the information obtained during the evaluation will be used to establish a treatment plan to meet the patient’s individual needs.

Treatment is dependent on the specific disorder and its severity, prognosis for improvement, results of the evaluation, patient’s individual needs, and patient’s and/or family’s goals.  Depending on the nature of the condition, exercises for muscular improvement and a home exercise program may also become a part of the treatment regimen.

While Speech Therapy may not be able to “cure” all Speech or Language deficits, it can go a long way to giving adults confidence and focused training. Some patients may see a great deal of improvement and even achieve full recovery of all skills, while others may have to work harder to improve skills. Struggling to communicate clearly is frustrating and at times embarrassing, however Speech Therapy helps to improve the quality of life for many people.

Motor-speech disorders are disorders resulting from neurological damage. The term “neurological” refers to the brain, spine, and the nerves that connect them. Neurological damage or disorders may affect the motor control of speech muscles or motor programming of speech movements. Motor speech disorders can make it very difficult for individuals to clearly and effectively express themselves. Often times, those affected by motor speech disorders know what they want to say, but have difficulty getting the words out. The most common motor speech disorders are:

• Dysarthria is a condition in which a person has difficulty controlling or coordinating the muscles used for speaking. The muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all after a stroke or brain injury. Common causes of dysarthria include nervous system (neurological) disorders such as brain tumors, cerebral palsy, muscular dystrophy, and conditions that cause facial paralysis or tongue or throat muscle weakness. Dysarthria may also be caused by certain medications. Both children and adults can have dysarthria. Dysarthria is often characterized by slurred or slow speech that may be difficult to understand.
• Apraxia of speech is caused by damage to the parts of the brain related to speaking. Other terms include  acquired apraxia of speech, verbal apraxia, and dyspraxia. People with apraxia of speech have trouble sequencing the sounds in syllables and words. The severity depends on the nature of the brain damage. Sometimes a person cannot say a word, then is later able to spontaneously say the same word without any difficulty. People with apraxia of speech have problems imitating words but can often produce “automatic speech” without any problem (for example, saying “hello”, “I’m fine”, “OK”, etc).

Parkinson’s Disease is a neurodegenerative disorder that predominately affects dopamine-producing neurons (nerve cells) in a specific area of the brain called the substantia nigra. These neurons break down and no longer produce chemical “messengers” called dopamine.  Dopamine sends signals to other nerve cells and help with, for example, initiating speech and movement.  Many people with Parkinson’s Disease suffer from disorders of speech and voice. Cognitive skills and memory may also be impaired. These disorders are typically characterized by speech and voice that are monotonous, quiet, hoarse, and breathy. People with Parkinson’s Disease also tend to give fewer non-verbal cues, such as facial expressions and hand gestures. These disabilities increase as the disease progresses and may lead to serious problems with communication and swallowing.

Treatment 

Individuals with Parkinson’s Disease are referred for speech and language therapy to improve the intelligibility (clarity) of their speech, and primarily receive treatment for dysarthria (a speech disorder due to muscle weakness), articulation, voice, and resonance problems. They may need swallowing treatment. Specific treatment to address cognitive and memory skills may also be needed. Intensive voice treatment protocols continue to be effective in this population (Sapir, Ramig & Fox, 2011). LSVT LOUD is the gold standard of treatment for individuals with Parkinson’s Disease.  The clinician rendering treatment must be certified in LSVT LOUD.

Aphasia is a language disorder, usually caused by damage to the parts of the brain that contain language. Aphasia causes problems with any or all of the following: speaking, listening, reading, and writing. Sometimes an individual may have impairments in all of these areas to some degree. The different types of aphasia are known as global, Broca’s, transcortical motor, conduction, anomic, transcortical sensory and Wernicke’s aphasia.

Stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts throughout life. The disorder is characterized by disruptions in the production of speech sounds, also called “disfluencies.” Most people produce brief disfluencies from time to time. For instance, some words are repeated and others are preceded by “um” or “uh.” Disfluencies are not necessarily a problem; however, they can impede communication when a person produces too many of them.

In most cases, stuttering has an impact on at least some daily activities. The specific activities that a person finds challenging to perform vary across individuals. For some people, communication difficulties only happen during specific activities, such as speaking on the telephone or before large groups. For most others, however, communication difficulties occur across a number of activities at home, school, or work.

Some people may limit their participation in certain activities. Such “participation restrictions” often occur because the person is concerned about how others might react to disfluent speech. Other people may try to hide their disfluent speech from others by rearranging the words in their sentence, pretending to forget what they wanted to say, or declining to speak. Other people may find that they are excluded from participating in certain activities because of stuttering. Clearly, the impact of stuttering on daily life may be affected by how the person and others react to the disorder.

Repetitions of words or parts of words, as well as prolongations of speech sounds are present. These disfluencies occur more often in persons who stutter than they do in the general population. Some people who stutter appear very tense or “out of breath” when talking. Speech may become completely stopped or blocked, meaning the mouth is positioned to say a sound, sometimes for several seconds, with little or no sound forthcoming. After some effort, the person may complete the word. Interjections such as “um” or “like” can occur, as well, particularly when they contain repeated (“u- um- um”) or prolonged (“uuuum”) speech sounds or when they are used intentionally to delay the initiation of a word the speaker expects to “get stuck on.”

Some examples of stuttering include:

• “W- W- W-Where are you going?” Part-word repetition: The person is having difficulty moving from the “w” in “where” to the remaining sounds in the word. On the fourth attempt, he successfully completes the word.
• “SSSSave me a seat.” Sound prolongation: The person is having difficulty moving from the “s” in “save” to the remaining sounds in the word. He continues to say the “s” sound until he is able to complete the word.
• “I’ll meet you – um um you know like– around six o’clock.” A series of interjections: The person expects to have difficulty smoothly joining the word “you” with the word “around.” In response to the anticipated difficulty, he produces several interjections until he is able to say the word “around” smoothly.

Voice is the sound produced by vibration of the vocal cords (vocal folds) in the larynx (voice box). A voice disorder occurs when the vocal folds do not vibrate effectively to produce a clear sound.

Common Causes

Causes of voice disorders can include abuse or misuse of the voice, such as yelling, excessive throat clearing, or speaking too loudly. These types of behaviors result in excessive hard closure of the vocal folds causing blister-like bruises that can harden into callous-like lesions called vocal fold nodules. Other causes of voice disorders can include laryngopharyngeal reflux (excessive stomach acid backing into the larynx), vocal fold polyps, vocal fold paralysis, vocal fold cysts, etc.

Symptoms of Voice Disorders

• Voice quality disturbance: breathy, raspy, or harsh voice.
• Voice pitch disturbance: pitch too high for age and gender, pitch too low for age and gender, pitch fluctuates excessively, pitch is monotone.
• Voice volume is too soft or too loud.
• Vocal fatigue (decreased stamina, increased hoarseness following speaking).
• Effortful voice use (having to use too much effort to speak).

Treatment Options

Types of voice treatment following a voice evaluation may include:

• Vocal strengthening – Exercises that can improve voice quality and stamina and can also reduce symptoms of vocal effort and fatigue. Examples of exercises are repetitions of high speech sounds, pitch glides, or glottal closure. These exercises are often used with singers.
• Reduction of vocally abusive behaviors – During the evaluation and interview, vocally abusive behaviors are often identified. Some examples include:  talking in competition with background noise, yelling, throat clearing, loud cell phone use, not using a microphone, etc. In the treatment session, goals can be made to improve or eliminate these behaviors and provide strategies for care of the voice.
• Improvement in vocal technique – improving respiratory support for proper voice use, reducing hard glottal attack, and improving vocal resonance. Goals are created after the voice evaluation and modified as needed during therapy.   Home exercises are provided for continued practice. Carryover of these techniques into everyday situations is also expected.
• Pre and Post surgical  treatment – Counseling of proper voice care before and/or after vocal fold surgery can significantly improve surgical outcomes and assist patients in a healthy and gradual return to voice use following surgery.

Dysphagia is the medical term for the symptom of difficulty in swallowing. Dysphagia can occur at different stages (oral preparatory phase, oral phase, pharyngeal phase, esophageal phase). 

Oral Preparatory Phase:  Preparing the food or liquid in the oral cavity (mouth) to form a bolus (ball).  This phase includes sucking liquids, manipulating soft foods, and chewing solid foods.

Oral Transit Phase:  Moving or propelling the bolus posteriorly through the oral cavity.

Pharyngeal Phase:  Initiating the swallow; moving the bolus through the pharynx.

Esophageal Phase:  Moving the bolus through the cervical and thoracic esophagus and into the stomach via esophageal peristalsis (Logemann, 1998).

Some people have limited awareness of their dysphagia, so lack of the symptom does not exclude an underlying disease. When dysphagia goes undiagnosed or untreated, there is a high risk of pulmonary aspiration and subsequent aspiration pneumonia, due to food or liquids getting into the lungs, instead of going into the stomach. Some people present with “silent aspiration” and do not cough or show outward signs of aspiration. Undiagnosed dysphagia may also result in dehydration, malnutrition, and renal (kidney) failure.

Some signs and symptoms of oropharyngeal dysphagia include difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating a swallow, coughing, choking, and frequent bouts of pneumonia. There may be unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and complaints of swallowing difficulty.