Speech Therapists evaluate, diagnose and administer treatment for children and adults with various types of speech-language, cognitive, voice, and feeding/swallowing disorders.

Speech and language disorders may affect children in the way they speak, understand, analyze and/or process information. Speech disorders encompass issues in the clarity, voice quality, and fluency of one’s spoken words, while language disorders include children’s capability in holding meaningful conversations, understanding others, problem solving, reading comprehension, as well as expressing their thoughts through the spoken and/or written word.

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. There are specific speech sound errors that are age appropriate. Mastering specific speech sounds may take 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.

Signs & Symptoms:

• Drooling, feeding concerns
• Omits medial and final sounds
• Is difficult to understand
• Stops many consonants, little use of continuing consonants such as /w, s, n, f/
• Limited variety of speech sounds
• Omits initial consonants
• Asymmetrical tongue or jaw movement
• Tongue between teeth for many sounds
• Omissions/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, which are appropriate.
• Model correct pronunciation at natural times during the day. Do not correct your child. For example, if your child says, ” I see a tat”, you could say, “Yes, you see a cat”. You may want to emphasize the target sound.
• Play sounds games if your child is interested. This will increase his overall awareness and discrimination of sounds. You might play with magnetic letters, read rhyming books such as Dr. Seuss, 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 has said. Let him know that you will listen and try to understand. Have him gesture or show you what he is talking about if needed. Explain to him that sometimes you may not understand what he says and that you know this must be frustrating for him. Let him know you understand how he feels.

The first few years of life are an exciting time of development for children. Below are important milestones for your child’s speech, language, and communication:

Speech:

• “Coo” and make vowel sounds (“eeee” “oooo”) at 4-6 months
• Make a single sound (“ba” or “ma”) at 5 months
• Repeat a single sound (“mamama”) at 7-9 months
• Babble and mix sounds (“mabagama”) at 10-12 months

Language:

• First word at 12 months
• Use approximately 20 words at 18-20 months
• Use 50 words and two-word phrases (“me go,” “mommy up”) at 2 years

Communication:

• Smile between 4-6 weeks
• Localize to voices at 4 months
• Pay attention to caregivers and reach to be picked up at 6-7 months
• “Take turns” making sounds (cooing) and wave at 8-9 months
• Point at objects (toys or lights) at 11 months and shake their head “no” at 13 months

Please click on the attached link to view a developmental chart from ASHA outlining the milestones you should be looking for in children 0-5 years old. http://www.asha.org/public/speech/development/chart

Expressive language includes the skills involved in communicating one’s thoughts and feelings to others. An expressive language disorder concerns difficultly with verbal expression.

Signs & Symptoms:

• Omitting word endings, difficulty acquiring forms such as plurals, past tense verbs, complex verb forms, or other grammar forms
• 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

Receptive language includes the skills involved in understanding language. Receptive language disorders are difficulties in the ability to attend to, process, comprehend, and/or retain spoken language.

Signs & Symptoms:

• Difficulty following directions
• Repeating 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

Children with social pragmatic difficulties demonstrate deficits in social cognitive functioning. Diagnostic terms include: Asperger Syndrome, hyperlexia, High Functioning Autism, Semantic-Pragmatic Disorder, Pervasive Developmental Disorders-Not Otherwise Specified and Non-Verbal Learning Disabilities. Individuals with social-pragmatic deficits have significant difficulties in their ability to effectively communicate and problem solve.

Signs & Symptoms:

• Difficulties with personal problem solving
• 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

Making language the focus of everyday life is crucial in a child’s development. Encouraging language at home should be natural and not forced.

• Spend as much time as you can with your child
• Try to be at your child’s eye level and follow the child’s lead
• Use facial expressions
• Talk about what your child is playing with (ex: “You have a pretty doll, she is sitting in the carriage.”)
• Repeat what your child says and then add additional details to their utterance (ex: child says, “toy fall” you can say, “yes the toy fell down on the floor)

Here are additional resources to help you encourage language with your child: http://www.speechaccentsolutions.com/language_facilitation_techniques.html

Non-fluent speech is typical between the ages of 2-6 years old. It is typical for non-fluent speech to last up to six months, improve and 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.

• Slow down your own speech to a slow normal rate; slow down your 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.
• Encourage conversation on a “good day”. On a day when your child shows many dysfluencies, 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. Fluent speech is like any other skill to be learned and can be encouraged. Sensitivity and patience is the best approach.

Signs & Symptoms:

• Refusal of different textured foods
• Prolonged feeding times
• Excess drooling or spilling of food and liquids from the mouth
• Frequent spitting up
• Wet, gurgly voice or breathing
• Coughing or gagging during meals
• Recurrent pneumonia and/or respiratory infections
• Slow weight gain
• Younger children may demonstrate stiffening of body, irritability, and/or lack of alertness during feeding

Occupational therapists use assessment and treatment to develop, recover, or maintain the daily living and work skills of individuals with a physical, mental, or cognitive disorder. Occupational therapists also focus much of their work on identifying and eliminating environmental barriers to independence and participation in daily activities.

Signs & Symptoms:

• Poor motor coordination (client falls a lot, is clumsy, cannot perform typical motor skills at an age appropriate level, or seems off balance compared to others)
• Difficulty completing age appropriate self care tasks such as buttoning clothes or tying shoes
• Poor postural control leading to slouching, slumping, or sitting with legs in a ‘w’ shape thus avoiding prolonged use of weak trunk muscles
• Over-reaction (or under-reaction) to sensory input such as loud sounds, bright lights, textures, or smells
• Physical fatigue in excess of what might be expected after performing a task for a short time
• Difficulty receiving, organizing and using sensory information
• Difficulty with fine motor skills as evident by difficulty playing with small objects or coloring with an efficient grasp.
• Visual perceptual difficulties as evident by having a hard time coloring within the lines, writing on a line with proper spacing, putting a puzzle together, or location an object in a busy scene.
• Difficulty with balance or gross motor coordination activities including riding a bike, skipping, climbing on a playground, or getting dressed.
• Sensitive to sensory stimulation including touch, textures, sounds, movement, taste, or light. (aversion to certain types of clothing or foods and over-or-under responsiveness to pain or injury)
• Difficulty visually attending to a task or tracking with isolated eye movements, which may be seen in tasks such as writing, reading, and catching a ball (immature drawing or handwriting skills for age level)

Classroom Setting:

• Poor handwriting
• Difficulty copying from the board
• Poor fine motor skills
• Attention difficulties and/or hyperactivity
• Poor postural control
• Difficulty recognizing, forming or distinguishing shapes, letters or numbers
• Social interaction difficulties

Daily Living:

• Self care skills such as dressing, brushing teeth or hair, tying shoes, and using eating utensils
• Eating difficulties such as gagging or difficulty swallowing
• Difficulty integrating all sensory information
• Fine or gross motor coordination difficulties
• Poor awareness of where the body is in space or poor balance

Occupational therapy uses purposeful activities to enhance and encourage skill development. Guided by the client’s interests, the therapist provides fun and motivating activities that aim to provide a “just-right challenge” so that the client will develop the underlying skills needed to effectively complete functional tasks. The goal of occupational therapy treatment is to use meaningful activities to assist the client in achieving functional skills needed for daily living. When skill and strength cannot be developed or improved, occupational therapy offers creative solutions and alternatives for carrying out daily activities.

When evaluating a client for occupational therapy needs, the occupational therapist will assess many skills necessary for all domains of daily functioning. Parents/caregivers or teachers may be asked to complete rating scales in order to provide the therapist with specific information about the client’s level of functioning at home and school. Depending on the concerns expressed prior to the evaluation, the therapist may evaluate any or all of the following:

• Gross motor skills such as muscle strength, muscle stamina, coordination, and ambulation skills
• Fine motor skills such as buttoning, stringing beads, or picking up and manipulating small objects
• Ease and range of motion in joints, muscle flexibility and muscle tone
• Hand-eye coordination for skills such as catching a ball
• Visual-motor integration skills that are important for skills like copying
• Sensory integration ability
• Balance and posture
• Self care skills
• Social interaction skill such as maintaining eye contact and engaging in conversation with another person
• Visual skills such as tracking moving objects and discriminating between similar objects etc.
• Hand use skills such as finger strength and dexterity, manipulation ability, handwriting skills, and bimanual functions such as cutting with scissors and catching a large ball
• Tactile discrimination skills
• Motor planning ability