Frequently Asked Questions

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Health insurance may sometimes cover speech and language therapy. There are variations in coverage based on carriers, individual’s policy and diagnosis. Be aware of  restrictions, deductibles and co-payments.

There is definitely the possibility that impairment in the speech and language areas can have a detrimental effect on academics and social interactions. It is also known to have a very negative impact on self-esteem. These are all factors that can be addressed with treatment.

M.A. is an abbreviation for master of arts. M.S. is an abbreviation for master of sciences. Both graduate degrees have been used for students of Communication Disorders depending on the university attended and the year.

C.C.C. is an abbreviation for Certificate of Clinical Competence. Speech pathologists that have passed a national exam and did a clinical fellowship year with proper accreditation from the American Speech Language and Hearing Association will have those letters after their name.

S.L.P is an abbreviation for Speech-Language Pathologist, a certification awarded by the Americah Speech-Language-Hearing Association (ASHA)

 

Speech therapy can vary from a short duration for something like an isolated tongue thrust or reverse swallow to a lengthy period of time for people that are deaf or have Down syndrome, autism, or cerebral palsy. Each case needs to be looked at individually and discussed with the professionals and family members within the context of the remediation process.

Motor speech disorders can make it very difficult for individuals to clearly and effectively express themselves, which can be very frustrating. People with motor speech disorders know what they want to say, but cannot get it out. The two types of motor speech disorders are:

  • Dysarthria:  This is when the muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all. Sometimes people refer to dysarthric speech as “slurred” speech.
  • Apraxia:  People with apraxia of speech have trouble sequencing the sounds in syllables and words. Sometimes a person cannot say a word, and then later they can say the same word without any difficulty. People with apraxia have problems imitating words but often can produce “automatic speech” without any problem (for example, saying “hello”, “I’m fine”, “OK”, etc.)

Aphasia

Aphasia is a language disorder, usually caused by damage to the left side of the brain. There are different types of aphasia that affect people in various ways. Aphasia can make it difficult for a person to understand spoken or written information. It can also affect a person’s ability to speak or write. Sometimes an individual can 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.

Evaluation

The Speech-language pathologist will obtain medical history, perform an oral motor examination, and have the patient perform various speech tasks. The Speech-language pathologist may ask the patient to follow commands, respond to questions, name objects, repeat words and sentences, or perform reading and writing tasks. All of the information obtained during the evaluation will be used to establish a treatment plan to meet the patient’s individual needs.

Treatment

Treatment and therapy varies greatly depending on the specific disorder. For example, if someone has problems speaking clearly because of weak muscles, they may perform oral exercises and be taught speech strategies to speak more clearly. If a patient has a type of aphasia that causes them to have difficulty understanding what others are saying; therapy may target comprehension activities. The Speech-language pathologist will establish what the patient’s individual needs are and will develop a specific treatment plan that will be most beneficial for the patient.

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 Laryngo-Pharyngeal 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: breathiness, raspiness, harshness
  • 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 low or too loud
  • Vocal fatigue (decreased stamina, increased hoarseness following speaking)
  • Effortful voice use (having to use too much effort to speak)

Evaluation of Voice Disorders

Voice evaluations are conducted by Speech-language pathologists who are experts in the area of voice. Evaluations include non-instrumental assessment and instrumental assessment. These assessments allow the Speech-language pathologist to measure the voice objectively, determine patterns that suggest how the larynx is functioning physically, and determine whether there is a hyper functional or hypo functional component present. Voice disorders are complex and this type of evaluation helps determine whether behavioral voice therapy, surgery or a combination of approaches would best serve the patient.

Treatment Options

Types of voice treatment 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 during voice therapy sessions and 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 healthy return to voice use following surgery. Patients can expect 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 Phase – sucking, chewing, and moving food or liquid into the throat
  • Pharyngeal Phase – starting the swallowing reflex, squeezing food down the throat, and closing off the airwayto prevent choking
  • Esophageal phase – squeezing food through the esophagus into the stomach

Some patients have limited awareness of their dysphagia, so lack of the symptom does not exclude an underlying disease. When dysphagia goes undiagnosed or untreated, patients are at a high risk of pulmonary aspiration and subsequent aspiration pneumonia secondary to food or liquids going the wrong way into the lungs. Some people present with “silent aspiration” and do not cough or show outward signs of aspiration. Undiagnosed dysphagia can also result in dehydration, malnutrition, and renal 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, frequent pneumonia, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and dysphagia (patient complaint of swallowing difficulty). When asked where the food is getting stuck, patients will often point to the cervical (neck) region as the site of the obstruction. The actual site of obstruction is always at or below the level at which the level of obstruction is perceived.

The most common symptom of esophageal dysphagia is the inability to swallow solid food, which the patient will describe as ‘becoming stuck’ or ‘held up’ before it either passes into the stomach or is regurgitated.

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, for example, talking on the telephone or talking 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 (circumlocution), 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 can be affected by how the person and others react to the disorder.

Signs and Symptoms of Stuttering

Stuttered speech often includes repetitions of words or parts of words, as well as prolongations of speech sounds. 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. Blocked is when 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.)
  • SSSS ave 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.)

One common speech problem that adults can have is apraxia or motor speech disorder. This condition is caused by damage to the speech-related areas of the brain.

Patients with apraxia have difficulty putting the sounds of syllables together to make words. Therapists engage patients in an activity that slows down the pace of speech and practices sounds over and over. The patient reads a list of simple sentences while a metronome taps out a slow pattern of speech. The patient repeats the first sentence over and over to the beat of the metronome. When the first sentence is mastered, he moves on the next sentence.

Dysarthria is a condition where muscle weakness in the jaw and mouth area cause problems with speaking. Dysarthria is often the result of a disease like cerebral palsey, multiple sclerosis, Lou Gehrig’s Disease or a stroke or accident causing damage to the brain.

One way to improve the muscle movements is an activity that uses oral motor therapy. The instructor asks the patient to pretend he is a mirror. The patient is to mimic the movements the instructor makes. These movements include making silly faces, smiling and frowning, blowing kisses and using the tongue to lick all the way around the lips. This is a fun activity that exercises necessary mouth muscles to improve speech function.

Although often considered treatment for childhood speech and language issues, speech therapy is sometimes recommended for adults. Adult speech therapy is a part of recovery programs for many illnesses, and may be used to help manage conditions that affect speech, language, eating or swallowing. When choosing an adult speech therapist, a variety of different settings and treatment options exist depending on the diagnosis.

Adult speech therapy helps people gain greater control over speaking and language skills. For many adults, a medical issue such as stroke, or onset of motor-skill affecting conditions like Parkinson’s Disease or Multiple Sclerosis. Brain injury and accidents that cause damage to the throat, jaw, or facial structure can also impair speaking ability. Other people may require adult speech therapy due to mental difficulties which affect comprehension of language or the ability to speak intelligibly.

Diagnosis of a speech or language disability is done through a variety of tests, both mental and physical. If the problem is not physical in nature, the patient may be assessed for language comprehension and retention skills. Once the specific underlying cause is identified, treatment programs to help the patient can begin.

Treatment done in adult speech therapy may be done in many different ways, as best fits the need of the patient. Some people receiving adult speech therapy have group classes focusing on comprehension and pronunciation, similar to those taken when learning a foreign language. Depending on the nature of the condition, exercises for muscular improvement and homework may also become a part of the program.

While adult speech therapy may not be able to cure all speech or language disabilities, it can go a long way to giving adults confidence and focused training. Some patients may see a great improvement and even full recovery of all skills, while others may have to work hard to achieve every bit of increased ability. Struggling to communicate clearly can be greatly frustrating, yet some people may find speech therapy embarrassing or even shameful. A trained speech pathologist should soon be able to put worries to rest, and help to improve the quality of language, and life, for many patients.

Developmental expressive language disorder is a condition in which a child has lower than normal ability in vocabulary, producing complex sentences, and remembering words. However, children with this disorder may have the normal language skills needed to understand verbal or written communication.

Some common expressive language disorder symptoms  include:

  • 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

If you are concerned about a child’s language development, have them tested.

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
  • Referrals to other professionals (i.e., audiologist, medical specialist, occupational/physical therapist, etc…)
  • Referral to other community services, such as an early intervention program
  • Suggestions for parents/caregivers and educators

 

Prior to the speech evaluation

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 the child.

During the speech evaluation

Your child’s medical, developmental, and educational history is 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. Parents are encouraged to observe during the evaluation.

Following the speech evaluation

Initial results of the evaluation and recommendations are reviewed with you (and your child if age appropriate). A written report detailing evaluation results will be mailed to your home and to your child’s physician (if requested).

Improving pronunciation in children begins at home.

  • 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 got a pish”, you could say, “Yes, you have a fish”. You may want to emphasize the target sound slightly.
  • 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 she has said. Let her know that you will listen and try to understand. Have her gesture or show you what she is talking about if needed. Explain to her that sometimes you may not understand what she says and that you know this must be frustrating for her. Let her know you understand how she feels.

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

  • 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

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

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

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 “soon.”
  • 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.

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 you.

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.

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 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 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. Fluent speech is like any other sill to be learned and can be encouraged. 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.
  • Come in for a consultation if you are very worried or upset.

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.

Persons with social pragmatic language disorder have significant difficulties in their ability to effectively communicate and problem solve. Some signs and symptoms may include:

  • 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.

Children with social pragmatic language disorder demonstrate deficits in social cognitive functioning.

Individuals with SLD 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 interact with others. Children with the disorder often exhibit:

  • 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
  • tendency to be concrete or prefer facts to stories
  • have difficulty understanding satire or jokes
  • have difficulty understanding contextual cues
  • difficulty in reading comprehension
  • difficulty with reading body language and reading/using nonverbal communication
  • Problems with nonverbal cues such as personal space between others
  • Difficulty with writing
  • difficulty in making and maintaining friendships and relationships because of delayed language development
  • difficulty in distinguishing offensive remarks
  • difficulty with organizational skills
  • difficuly telling left from right

Autism signs and symptoms may begin to be detected as early as 12 months of age. Symptoms of autism 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 foot to front 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 of her 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

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

Expressive language disorder affects work and schooling in many ways. It is usually treated by specific speech therapy, and usually cannot be expected to go away on its own.

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 can be the cause of language problems.
  • Vision – understanding language involves visual cues, such as facial expression and gestures. A child with vision loss won’t have these additional cues, and may experience language problems.
  • Attention – the child’s ability to pay attention and concentrate on what’s being said may be impaired.
  • 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 has been said. The child may have difficulties 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 has been said to them.

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.

Receptive language disorder means the child has difficulties with understanding what is said to them. 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.

Here are some of the common warning signs of a communication disorder by age range.

Birth to Six Months

  • Developmental or medical problems
  • Lack of response to sound
  • Lack of interest in speech
  • Limited eye contact
  • Feeding problems
  • Very limited vocalizations
  • Difficulties with attachment
  • Lack of interest in socializing

Six to Twelve Months

  • Limited sound production, lack of variety or amount.
  • Groping movements when attempting to make or imitate sounds.
  • Oral-motor problems such as excessive drooling, trouble with solid foods, intolerance to touch in and around the mouth.
  • Lack of interest in sounds-making toys, radios, T.V., music, voices.
  • Developmental or medical problems
  • Lack of response to sound
  • Lack of interest in speech
  • Limited eye contact
  • Feeding problems
  • Very limited vocalizations
  • Difficulties with attachment
  • Lack of interest in socializing

Twelve to Eighteen Months

  • Easily distractible.
  • Does not understand any words or directions.
  • Limited sound production, lack of variety or amount.
  • Groping movements when attempting to make or imitate sounds.
  • Oral-motor problems such as excessive drooling, trouble with solid foods, intolerance to touch in and around the mouth.
  • Lack of interest in sounds-making toys, radios, T.V., music, voices.

Eighteen to Twenty-four Months

  • Not using words some of the time to communicate.
  • No interest in imitation.
  • Won’t play games.
  • No jargon.
  • Grunting and pointing as primary means of communication.
  • Easily distractible.
  • Does not understand any words or directions.
  • Limited sound production, lack of variety or amount.
  • Groping movements when attempting to make or imitate sounds.
  • Oral-motor problems such as excessive drooling, trouble with solid foods, intolerance to touch in and around the mouth.
  • Lack of interest in sounds-making toys, radios, T.V., music, voices.

Two to Three Year Olds

  • Not combining words
  • Must be told and retold to carry out simple directions (not just non-compliance)
  • Using only nouns
  • Poor eye contact
  • No rapid increase in number of words understood and used
  • Does not tolerate sitting for listening activity/looking at books, etc.

Three to Four Year Olds

  • Not speaking in full sentences (not necessarily correct grammar, but nice variety of word types
  • Not using “I” to refer to self
  • Cannot relate experiences, even in simple telegraph sentences

There are differences in the age at which each child understands or uses specific language skills. The following list outlines the general speech and language development. If your child is not doing 1 -2 of the skills in a particular age range, your child may have delayed hearing, speech, and language development. If your child is not doing 3 or more of the skills listed in a particular age range, please take action and contact a Speech-Language Pathologist and/or Audiologist to find out if an evaluation or consultation is necessary.

Birth – 3 Months:

  • Startles to loud sounds.
  • Quiets or smiles when spoken to.
  • Seems to recognize your voice and quiets if crying.
  • Increases or decreases sucking behavior in response to sound.
  • Makes pleasure sounds (cooing, gooing)
  • Cries differently for different needs.
  • Smiles when sees you.

4 – 6 Months

  • Moves eyes in direction of sounds.
  • Responds to changes in tone of your voice.
  • Notices toys that make sounds
  • Pays attention to music.
  • Babbling sounds more speech-like with many different sounds, including, p, b, and m.
  • Vocalizes excitement and displeasure.
  • Makes gurgling sounds when left alone and when playing with you.

7 Months – 12 Months

  • Enjoys games like peek-a-boo and pat-a-cake.
  • Turns and looks in direction of sounds.
  • Listens when spoken to.
  • Recognizes words for common items like “cup”, “shoe,” “juice.”
  • Begins to responds to requests (“Come here,” “Want more?”).
  • Babbling has both long and short groups of sounds such as “tataupup bibibibibi.”
  • Uses speech or non-crying sounds to get and keep attention.
  • Imitates different speech sounds.
  • Has 1 or 2 words.

12 Months

  • Responds to their name
  • Understands simple directions with gestures
  • Uses a variety of sounds
  • Plays social games like peek a boo

15 Months

  • Uses a variety of sounds and gestures to communicate
  • Uses some simple words to communicate
  • Plays with different toys
  • Understands simple directions

18 Months

  • Understands several body parts
  • Attempts to imitate words you say
  • Uses at least 10 – 20 words
  • Uses pretend play

24 Months

  • Uses at least 50 words
  • Recognizes pictures in books and listens to simple stories
  • Begins to combine two words
  • Uses many different sounds at the beginning of words.

2 to 3 Years

  • Speech is understood by familiar listeners most of the time.
  • Understands differences in meaning (go-stop, in-on, big-little, up-down)
  • Follows two requests (“Get the book and put it on the table.”)
  • Combines three or more words into sentences
  • Understands simple questions
  • Recognizes at least two colors
  • Understands descriptive concepts

3 to 4 Years

  • Uses sentences with 4 or more words.
  • Talks about activities at school or at friends’ homes.
  • People outside family usually understand child’s speech.
  • Identifies colors
  • Compares objects
  • Answers questions logically
  • Tells how objects are used

4 to 5 Years

  • Answers simple questions about a story
  • Voice sounds clear
  • Tells stories that stay on topic.
  • Communicates with other children and adults.
  • Says most sounds correctly
  • Can define some words
  • Uses prepositions
  • Answers why questions
  • Understands more complex directions

Compiled from www.asha.org, “How Does Your Child Hear and Talk?”

Our Speech-Language Pathologists work with children from infancy to adolescence. If you are concerned about your child’s communication skills, please call to find out if your child should be seen for a communication evaluation and/or consultation. The early months of your baby’s life are of great importance for good social skills, emotional growth, and intelligence!

Speech and language disorders in children can affect the way they talk, understand, analyze or process information. Four major areas in which these impairments occur include:

[checklist]

  • Articulation | speech impairments where the child produces sounds incorrectly (e.g., lisp, difficulty articulating certain sounds, such as “l” or “r”);
  • Fluency | speech impairments where a child’s flow of speech is disrupted by sounds, syllables, and words that are repeated, prolonged, or avoided and where there may be silent blocks or inappropriate inhalation, exhalation, or phonation patterns;
  • Voice | speech impairments where the child’s voice has an abnormal quality to its pitch, resonance, or loudness; and
  • Language | language impairments where the child has problems expressing needs, ideas, or information, and/or in understanding what others say.

[/checklist]

 

Language disorders include a child’s ability to hold meaningful conversations, understand others, problem solve, read and comprehend, and express thoughts through spoken or written words.

Speech-Language Pathologists specialize in treating a variety of speech-language, cognitive, voice, and feeding-swallowing problems.

Working with the full range of human communication and its disorders, speech-language pathologists:

  • Evaluate and diagnose speech, language, cognitive-communication and swallowing disorders.
  • Treat speech, language, cognitive-communication and swallowing disorders in individuals of all ages, from infants to the elderly.

The main components of speech production include: phonation, the process of sound production; resonanceintonation, the variation of pitch; and voice, including aeromechanical components of respiration.

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.