So…What does a Speech-Language Therapist do? What is the difference between Speech and Language?

Speech: Also known as Articulation, speech skills require strength, coordination and adequate range of movement of all the parts of the mouth and oral cavity to produce individual sounds and sound combinations (words!).  The oral cavity is complex, made up of many muscles, ligaments, and articulators.  Typically, a Speech-Language Therapist will assess your child’s tongue, lips, palate, jaw, and cheeks to make sure they are all strong enough, and able to work together, to produce accurate sounds.  Keep in mind, each sound in the English language requires different parts of the mouth, moving in different ways, together…phew!  For example, if a child has difficulty lifting the tip of their tongue, they might have difficulty with the sounds /t/, /d/, /n/, /s/, and /l/.

Language:  Language skills are broken into two areas…Receptive and Expressive Language.  Receptive Language is the ability to process and understand language, while Expressive Language is the ability to use all the components of language at a developmentally appropriate level to express oneself.  When working on Language skills, a Speech-Language Therapist might work on grammar, vocabulary, syntax or word order, pragmatics (social language), content such as spatial/temporal/qualitative/quantitative concepts, and following directions of increasing complexity.  A comprehensive evaluation, utilizing standardized testing, as well as informal testing, is important in identifying a child’s true language skills.

The second best part of being a Speech-Language Pathologist (second only to a child’s excitement after achieving a particularly challenging goal) is the games!!  Speech-Language Pathologists L-O-V-E their games and can turn almost any toy, game, book, or household item into a therapy tool.  No, we are not magicians…but we do pride ourselves on our unparalleled creativity and imagination skills.

Many parents ask me how I manage to get their child engaged, and keep them engaged, throughout long Speech-Language Therapy sessions.  Parents want to know how they can do the same, while working on their child’s Speech-Language Therapy goals at home.  After thinking long and hard about what makes a good “game,” I have come up with a short list of MUSTS.  Here they are:

• A toy/game/activity does not have to be age appropriate, but more importantly, developmentally appropriate.
• A toy/game/activity should be engaging and FUN for your child.  They should forget that they are “working.”
• A toy/game/activity should help you target your child’s Speech-Language Therapy goals and help your child overcome a challenge.
• A toy/game/activity should be able to be altered, manipulated, or played in a variety of different ways (children are easily bored with playing the same game, the same way, all the time!)
• A toy/game/activity should elicit a variety of vocabulary (colors, shapes, categories, actions, etc) and concepts (under, behind, first, after, next, one, some, all, etc).
• A toy/game/activity should be one tiny step above your child’s abilities.  With your help, they can be successful in that activity and learn to master it on their own.
• A toy/game/activity should elicit many, many, many repetitions of your goal.  The more times your child practices their goal, the faster your child will master it!  For example, if your goal is the /F/ sound in initial position, the perfect game would be a “fishing” game.  (some words that may come up during the game: Fish, Fishing, First, Found, Front, Frog, Finger, Finally…).
• Finally, the #1 most important thing to remember when “working” with your child on their Speech-Language Therapy goals: Be present, Keep the Specific Goal in Mind, and Have Fun!

Happy Playing…

Phonological Processes or patterns do occur in typically developing children.  While it is common to see difficulties with sounds and sound patterns in development, it is not typical for a child to continue having difficulty with sound patterns beyond a certain age.  The chart below details common Phonological Processes and the age at which children typically stop using those processes:

Gone by age 3:

1. Pre-vocalic voicing (“big” for “pig”)
2. Word-final de-voicing (“pick” for “pig”)
3. Unstressed Syllable Deletion (“nana” for “banana” or “tato” for “potato”)
4. Reduplication (syllable is repeated twice, e.g., “baba” for “bottle”)
5. Fronting (sounds made in the front of the mouth are substituted for sounds that should be made in the back of the mouth, e.g., “take” for “cake” or “see” for “she”)
6. Final consonant deletion (“hou” for “house)
7. Assimilation (one consonant in the word influences another, e.g. “mime” for “mine”)
8. Stopping (fricative or “long” sounds are replaced by stopped sounds, e.g., “toup” for “soup” or “dop” for “shop”)

Gone by age 4:

1. Cluster Reduction (leaving off one consonant in a cluster, e.g., “top” for “stop” or “lace” for “place”)

Gone by age 5:

1. Gliding (substituting the /w/ or /y/ sound for /r/ or /l/ sounds, e.g., “yeg” for “leg” for “won” for “run”)

Persistent Processes that should be gone by age 7:

1. Epenthasis (inserting an extra vowel into a word, e.g., “balack” for “black”)

Source: American Speech-Language-Hearing Association (ASHA.org)

Some children seem to understand information, but then have difficulty accurately carrying out a task or following directions.  Other children are successful in getting the “gist” of what they are hearing, but then have difficulties with their expressive language.

Expressive language difficulties can manifest in one or all areas of language, including semantics (vocabulary), syntax (word order), morphology (grammar), phonology (the sound system), or pragmatics (social skills).  For example, a child might have difficulty finding the right word, or may use non-specific words, such as “that thing” when trying to communicate.  Other children may have difficulty putting words in the correct order when talking, or using grammatical endings, such as the past tense (e.g., jumped).

How will a Speech-Language Therapist work on my child’s Language Processing skills? In general, the best way to improve a child’s ability to process language is through a systematic and intensive course of Speech-Language Therapy.  A Speech-Language Pathologist will evaluate your child’s language and processing skills, and implement activities that help move your child from relying on visual cues to utilizing their auditory skills more effectively.

In addition, your Speech-Language Pathologist will assess which cues are most helpful for your child and use those to help your child reach their potential.  Some compensatory cues might include; additional time, stimulus repetition, prompting them with questions (What sound does it start with? What does it look like?), giving them additional information, and lastly naming the target item for them.  Ultimately, your child will learn to use few, if any, cues to help them process what is heard.

A Speech-Language Therapist might begin their therapy protocol with simple activities that encourage your child to label common items, and progress up to teaching your child to express an items function and category, as well as begin to make associations between items.  These activities are designed to help your child re-organize their knowledge and make recalling information, learning new information, and expressing themselves an easy, efficient, and concise task.

There are over 20 variations of the English /r/ sound (would you ever have guessed that??).  The English /r/ sounds begins to emerge in a child’s speech sound repertoire around age 3, but can take up to age 6 or 7 to develop fully.  A child who is highly unintelligible as a result of their difficulty producing speech sounds should see a Speech-Language Pathologist as soon as possible.  If a child is 5-6 years old, and showing no progress towards correct /r/ sounds, a visit to a Speech-Language Pathologist may be warranted.

My favorite article on evaluating and treating the /r/ sound(s) can be found here: http://www.sayitright.org/article.html.  The “Say It Right” program is a fan favorite in my Speech Therapy “bag of tricks,” and often helps parents to understand just how difficult the /r/ sound is, in comparison to other speech sounds.

It is incredibly important for your Speech-Language Therapist to evaluate all variations of /r/ when assessing your child’s Speech skills.  Keep in mind a few tips to ask your Speech Therapist about:

• Only variations of /r/ that are incorrectly articulated should be addressed in Speech Therapy.
• Start with the most “visual” /r/ variants and work towards the least “visual” ones.  This helps your child to use their other sensory systems to see, mimic and master /r/ sounds systematically.
• Work on only 1 or 2 /r/ variants until your child has mastered that variant at 80% accuracy.
• Practice at home!!  Ask your Speech Therapist to provide at home practice materials, such a word lists or tips.  This will allow your child to generalize their new skills from the Speech Therapy room to a more natural environment, such as a conversation at home!

The short answer is NO.  However, it is important to identify how your child is attempting to say the /s/ sound.  There are a variety of substitutions children use for this sound; some typical and some atypical.  If your child is utilizing an atypical substitution, it is important to seek out the help of a Speech-Language Pathologist to determine whether their /s/ sound will normalize without intervention.

The many /s/’s of speech sound development:

• Using a /d/ for an /s/: This process is called “stopping” and is typical in children under age 3 (???).  After age 3, however, your child should begin to use a typical /s/ sound.
• Using a /th/ for an /s/:  This is called a frontal lisp, and is the most common reason a parent will seek Speech Therapy for their child.  While this is a commonly seen substitution, it may indicate a weakness in your child’s tongue muscles.  Early intervention is important to determine the nature and extent of your child’s difficulty.
• “Slushy” /s/: This is called a lateral lisp, where air is escaping from the sides of your child’s mouth.  This /s/ is never typical and should be corrected as soon as possible.  A lateral lisp may be caused by a weakness in your child’s tongue and jaw muscles.

My child is 5 years old and still doesn’t use a correct /S/ sound.  I was told to wait a few months and see if it corrects itself.  Should I see a Speech-Language Pathologist?

The short answer is YES!  As a child ages, it becomes more difficult to correct their sounds.  “Their” way of saying /s/ is quickly becoming ingrained.  Taking a “wait and see” approach is never recommended, as it may simply delay your child receiving much need intervention.

Apraxia is a motor speech disorder that goes by many names; Apraxia, Apraxia of Speech (AOS), Childhood Apraxia of Speech (CAS)…but for a child with Apraxia, it means only one thing.

• A child with Apraxia often knows what they want to say, but has difficulty carrying out the motor movement to say it.
• For a child with Apraxia, being understood by others is often difficult, and talking can become frustrating.
• A child with Apraxia typically uses many vowels in their speech, but has trouble incorporating appropriate consonants and consonant-vowel combinations into their speech.  They might say “ee aunt ore” instead of “me want more.”
• A child with Apraxia may not respond to traditional Speech Therapy, and may need a more systematic and repetitive approach designed to train their motor system to simply do what they want it to do!!
• A child with Apraxia can get the intervention they need by a Speech-Language Pathologist and can become intelligible and successful communicators!