Speech and Languge Disorders

    Sensory Strategies to Calm and Engage Children with Autism Spectrum Disorder - Estrategias sensoriales para calmar e involucrar a niños con trastorno del espectro autista

    Though there is great variability in ASD-related behaviors, occasionally clinicians encounter behaviors so challenging that they interfere with treatment. Some research indicates a relationship between several characteristics—lower nonverbal IQ, lower levels of expressive language, more severe social deficits and more repetitive behaviors—and the incidence of aggression, self-injurious behaviors and tantrums in children with ASD. When confronting such behaviors, clinicians may struggle to keep children on task. They may spend more time managing and addressing behaviors and less time providing treatment, thus limiting progress. OTs frequently work with children with ASD to address their sensory-processing differences. They use a variety of interventions, including sensory integration and sensory-based strategies, to help children organize environmental input and perform daily activities. Such strategies may include jumping, swinging and weight-bearing activities. SLPs are among the other professionals OTs commonly work with—in addition to teachers and parents—in providing sensory strategies to help children attend, participate and communicate.
    Si bien existe una gran variabilidad en los comportamientos relacionados con la TEA, en ocasiones los médicos encuentran comportamientos tan desafiantes que interfieren con el tratamiento. Algunas investigaciones indican una relación entre varias características (menor coeficiente intelectual no verbal, niveles más bajos de lenguaje expresivo, déficits sociales más graves y conductas más repetitivas) y la incidencia de agresión, conductas autolesivas y berrinches en niños con TEA. Al confrontar tales comportamientos, los clínicos pueden tener dificultades para mantener a los niños en la tarea. Pueden pasar más tiempo administrando y abordando los comportamientos y menos tiempo brindando tratamiento, lo que limita el progreso. Los OT con frecuencia trabajan con niños con TEA para abordar sus diferencias en el procesamiento sensorial. Usan una variedad de intervenciones, que incluyen integración sensorial y estrategias basadas en la información sensorial, para ayudar a los niños a organizar información ambiental y realizar actividades diarias. Tales estrategias pueden incluir saltos, balanceos y actividades de carga de peso. Los SLP se encuentran entre los otros profesionales con los que los OT suelen trabajar, además de los maestros y los padres, para proporcionar estrategias sensoriales que ayuden a los niños a asistir, participar y comunicarse.
    Click this link to read the pdf of the story.
    Haga clic en este enlace para leer el pdf de la historia. en English. No hay versión en español disponible.

    Assistive Technology Solutions for Employees with Speech Impairments

    "Have you ever wondered how a person who hears but doesn’t speak uses the phone? Of course there are TTY and speech-to-speech relay services, but what if relay methods don’t meet the employee’s needs? What if the nature of the work requires a more direct and confidential method of communicating? There are devices for phone and face-to-face communication that are designed for individuals who do not speak at all or who find speaking very challenging called AAC (Alternative and Augmentative Communication). AAC devices, also called speech-generating devices, are an example of a type of technology that can be used by individuals who have difficulty speaking. JAN has general information about AAC devices as well as information about AAC with telephone access."
    Click this go to the page.

    Apraxia/Childhood Apraxia of Speech

    Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.
    Click this link to read about Childhood apraxia.

      Girl with Apraxia learning to speak

      "They say talk is cheap. Not for 7-year-old MacKenzie Winn who works hard for every word. She practiced for 2 1/2 years just to learn to say her name. Bright and loving, MacKenzie never babbled like most babies do. Her parents, who live in Magna, noticed something was wrong at 14 months, and speech therapists diagnosed her at age 2. She has childhood apraxia of speech, or CAS. It's the most severe neurological speech disorder there is, doctors say.
      Click this link to listen to the podcast.

      Interview with Nancy Kaufman on Apraxia

      In this episode of the Speech and Language Kids podcast, Carrie Clark interviews speech-language pathologist Nancy Kaufman about speech therapy for Childhood Apraxia of Speech.
      Click this link to listen to the podcast.

      What is Apraxia and Why you should Care

      A helpful blog post explaining Apraxia.
      Click this link to read the post.

      Winners of the 2014 National Apraxia Awareness Day Video Contest

      The Three winning videos for National Apraxia Awareness Day (May 14th, 2014)
      2014 Apraxia Awareness Day Video Contest Winner - Emily Purdy

      2014 Apraxia Awareness Day Video Contest Winner - Jennifer Helm

      2014 Apraxia Awareness Day Video Contest Winner - The Miesners

      A helpful and heartfelt video on Childhood Apraxia of Speech

      "Danny Keefe is a 6-year-old optimist with a speech disorder. And he doesn't care what other people think. In fact, this spunky kindergartner wears a suit, tie, and fedora to school every day. He's also the water coach for the Bridgewater Badgers, a pee wee football team comprised of a band of boys who have rallied around Danny in the hopes to make his life better.

      Awareness Needed for childhood Apraxia

      Apraxia is a speech disorder that seriously interferes with an individual's ability to develop clear speech. Apraxia makes is difficult or at times almost impossible for an individual to plan the movements of the lips, facial muscles, tongue, and jaw to produce speech.
      Click this link to read Childhood apraxia.

    Auditory Processing Disorder

    Auditory Processing Disorder, alternatively known as Central Auditory Processing Disorder (CAPD) is a disorder impacting an individuals' ability to process auditory information. When someone hears speech, the sound is transformed through the ear to neural impulses that travel through the brain to the speech and language processing centers of the brain. Individuals can have difficulty with each or all of the three steps of this process. If a problem exists within the ear, the individual will present with a hearing impairment or in some cases with deafness. If a problem exists in the speech or language processing centers of the brain, the individual will present with a speech and language impairment. Some individuals present with difficulties that occur as the auditory signal is sent from the ear to the language centers of the brain. This would present as an Auditory Processing Disorder. The analogy, I use is that a mother and father are talking to each other on cell phones. They are speaking clearly and have no problem with hearing, but there is static on the cell phone. This static is constantly changing (as if you were on a cell phone in a car) so that the message is at times clear and at other time is distorted or lost. If an individual presents with these difficulties, there are a number of things that can be done to try to train the brain to process in the information more clearly, to modify the environment, and/or to provide tools to amplify the important sound signals over distracting sounds in the environment.

    An excellent resource on Auditory Processing Disorders is the book "Like Sound Through Water." by Karen Foli. The compelling book provides one mother's story of the process of trying to sort out what is wrong with her son, and of pursuing treatment for him.

      Differently Wired - Auditory Processing Disorder

      Auditory Processing Disorders are often a hidden disability, literally hidden, because you can not see them. At DeMarle INC we screen for APDs and then refer to Audiologists who can diagnose the Disorder if it is present. This is important because these disorders can be successfully addressed in a school or work setting.
      Click this link to read more about the article.

      Information on Auditory Processing Disorders: What does it mean to have APD?

      Auditory Processing Disorder is a neurological condition that impacts the way the brain is able to process what is heard. Somewhere between the sounds that are heard and how the brain remembers or understands those sounds, the information is jumbled or even lost. Hearing is not usually affected in people with APD. Learn how APD can be so frustrating in the video below.

      Information on APD

      Confronting 5 common myths around Auditory Processing Disorders.
      Click this link to read the article.

      Journey of Sound to the Brain

      Learn how sounds make their way from the source to your brain.
      To learn more about how we hear, visit the National Institute on Deafness and Other Communication Disorders .

    Mixed Receptive-Expressive Language Disorder

      Information on Mixed Receptive-Expressive Language Disorder

      Children with mixed receptive-expressive language disorder is when an individual displays problems with speaking and understanding others.
      Click this link to read more about the disorder.


      Stuttering Myths, Beliefs and Straight Talk for Teens - Tartamudeando mitos, creencias y conversaciones directas para adolescentes

      One of the most frustrating aspects about stuttering is that it is a variable disorder. In other words, sometimes you may stutter quite a bit and other times you may not. Because it is so variable and complex, stuttering is often misunderstood. This leads many people to believe myths about stuttering. This brochure discusses some common myths and "debunks" them with straight talk about stuttering.
      Uno de los aspectos más frustrantes del tartamudeo es que es un trastorno variable. En otras palabras, a veces puedes tartamudear un poco y otras veces no. Debido a que es tan variable y complejo, la tartamudez es a menudo mal entendida. Esto lleva a muchas personas a creer en mitos sobre el tartamudeo. Este folleto discute algunos mitos comunes y los "difunde" con una charla directa sobre el tartamudeo.
      Click this link to go to the site.
      Haga clic en este enlace para ir al sitio.

      Stuttering Foundation - Fundación Americana de la Tartamudez

      The Stuttering Foundation a great resource for parents, teachers, and individuals with fluency issues.
      La Fundación Americana de la Tartamudez ofrece información, servicios y apoyo a las personas que tartamudean y sus familiares, a la vez que ayuda a financiar investigaciones sobre las causas de la tartamudez.
      Click this link to go to the site.
      Haga clic en este enlace para ir al sitio.

      Stuttering Foundation Podcasts - Fundación Poderosos Tartamudez

      Listen in to some of the Stuttering Foundation's past podcasts! What is your favorite podcast?
      Escucha algunos de los podcasts anteriores de la Fundación Stuttering. ¿Cuál es tu podcast favorito?
      Click this link to see the podcasts.
      Haga clic en este enlace para ver los podcasts - los podcasts No disponible en español.

      Stuttering Video: Sttuering For Kids, By Kids

      Meet Swish and his young friends! They talk about stuttering, dealing with teasing, what helps, and how to teach others about stuttering. Cartoon animation and real children come together to help other kids who stutter in this lively and engaging 12-minute film.

      Stuttering analogy

      People who don't stutter have great difficulty truly understanding what stuttering is like. This is helpful.
      Click this link to read the article.

      Megan Washington: The Thing Is, I Stutter: TEDxSydney 2014

      Megan Washington is sort of like Katy Perry in Australia. She also has a stutter.

      Special Education Law and Children who Stutter

      A helpful pamphlet on special education law as it applies to students who stutter
      Click this link to download a pdf of the pamphlet.

      Stuttering Notes to the Teacher on Students with Stuttering

      Helpful information for teachers, teaching students with stuttering or oral fluency issues. Back-to-school: Here's a great resource to share with your teacher today!
      Click this link to download a pdf of the pamphlet.

      APA from Stuttering to Fluency

      The role of counseling in helping stutters is explored in this article from the American Psychological Association.
      Click this link to read the article.

      Stuttering Information explained in a short animation film

      Short Animation Film about stuttering: what is stuttering, how does it start, what can you do about it, how do you react to it....

      Myths about stuttering brochure

      A helpful brochure highlighting 5 myths about stuttering.
      Click this link to download the pdf of the brochure.

      Speech/Language Therapy: A guide to some of what a Speech/Language Therapist Does

        By Jane Iannacconi
        In March 2004 Jane Iannacconi began teaching Exceptional Students at JFK Middle School in North Miami Beach, FL. While at JFK, she taught ESE for grades 6-8: Social Studies and Inclusion Math. As a Homeroom teacher for the Emotionally Handicapped population, she began to learn how to understand, and teach children who were Learning Disabled with Varying Exceptionalities on all levels. For the last three years Jane Iannacconi has taught Special Education for the Jersey City Public School System. Working with these children has been a blessing to Jane. She truly enjoys the diversification of knowledge they provide her, as well as what she has gained personally by teaching them.
        It is most important to first understand the complexity of speech. Speech is a means of communicating through spoken language, and therefore using proper speech by way of language (sounds) we can establish intelligent receptive and expressive communication with others.
        Errors in receptive and expressive language abilities occur when the production of sounds (articulation), and a misappropriation of the system of rules for organizing those sounds are made, hence Phonological disorders will occur.
        Speech sound production errors are classified into three types:
        1) Substitutions: when one sound is substituted for another
        2) Distortions: when a child attempts the appropriate phoneme but fails to produce it accurately
        3) Omissions: signify when a phoneme is omitted and nothing is produced in its place

        There are certain errors in speech, which affect specific sounds or classes of sounds that are given a precise name. The following are examples of specific names with the most common being, a lisp. A lisp affects sibilant sounds. A sibilant sound in phonetics is a fricative consonant sound in which the tip or blade of the tongue is brought near the roof of the mouth, and air is pushed past the tongue to make a hissing sound. There are two common types of lisps:
        1) Central lisp: this lisp occurs when the speaker produces the sibilant sound with their tongue between their teeth resulting in a th-like sound
        2) Lateral lisp: this lisp occurs when air is directed laterally around the sides of the tongue rather that down the middle. This results in air leakage between the tongue and the molars producing a slushy s or sh sounds.

        Speech sound production errors can occur in three positions of a word.
        The initial position, which is the first sound of the word. The final position which would be at the end of the word or the medial position which would be anything between the initial and the final position of the word.

        Causes of Phonological disorders:
        1) Organic: are disorders that occur as a result form a structural, physiological, sensory or neurological deficit. Some speech sound production errors may be made by:
        a) Malocclussion: the misalignment of the teeth or improper alignment of the upper and lower teeth
        b) Macroglosia: an enlargement of the tongue
        c) Microglosia: a tongue that is smaller than normal developmental size
        d) Ankyloglossia: a condition in which the lingual frenum (a small flap of tissue that holds the tongue to the floor of the mouth) is too short or attached too far forward.
        Other organic conditions such as tongue thrust, hearing impairments, dysarthria, and developmental apraxia of speech (DAS) all contribute to the development and/or ability for proper phonological language.
        2) Functional: are disorders that are not associated with organic conditions; which make it nearly impossible to determine a child with a phonological disorder. Case studies, and research have been made on such conditions where organic elements are ruled out as being a source or error.

        Assessments for Phonological Disorders:
        In our school setting, it is safe to say that all children in kindergarten level will show some problem in their language skills. This does not necessarily mean they do have a phonological disorder, just that further screening and testing should be considered. It is critical to decipher at this age exactly what the problem is. This is usually done by a Speech Language Pathologist (SLP) during an assessment period. In addition to screenings, a teacher's referral to an SLP is another important way to distinguish children with phonology problems. Once the SLP has determined that the child may have a phonological disorder, permission from the parents must be obtained in order for the child to be given a diagnostic evaluation. Some of the objectives of a diagnostic evaluation would include: determining if there's a problem, determining the nature and extent of the disorder, and suggesting methods to remediate the disorder.

        Depending on the child's speech pattern, an SLP may administer the following assessments.
        Speech sound inventory: will test each phoneme in the context of a word. Picture naming is most preferable due to the age of the child and their inability to read yet. Here each consonant and consonant cluster is tested. At times, depending on need the SLP may choose to test vowel inventories, as well. Some of the most common speech sound inventory tests include the Goldman-Fristoe Test of Articulation, Photo Articulation Test and the Arizona Articulation proficiency Scale. Contextual tests: using a picture containing an error sound in the initial position is preceded by a series of 30 pictures ending with a different sound. For each picture pair the student is instructed to say the two words together, so to sound like one big word. This test is referred to as the deep-type tests after the Deep Test of Articulation, (McDonald, 1964). This test will give the SLP a clear sample of error sound as it is preceded and followed by many different phonemes. It will also identify one or more contexts in which the error sound is correctly produced.
        Pattern Analysis: is used to determine the presence of patterns that may underlie multiple sound errors. This is an effective way the SLP can identify a number of phonemes as opposed to concentrating on single phoneme errors. Frequently used tests are the Hodson Assessment of Phonological Patterns (Hodson, 2004), and the Kahn-Lewis Phonological Analysis-2 (Kahn & Lewis, 2002).
        Each of these tests are rapid and easy to administer; which makes it popular with most SLP's with large caseloads, and minimal time available to them for testing. Teachers can be an integral part of the evaluation stage by observation and documentation of their student's communicative behavior. After the screening and the evaluation a treatment plan is put in place for a child with a phonological disorder. In most schools an SLP will see a child twice a week as a pullout for thirty minutes each visit. As a teacher, working closely with an SLP and Administration on a child's progress plan can make a positive impact on the student's needs and remediation.

        As we have determined, there are on two levels in which a child may have a phonology problem. The first being a motor level and the second on a cognitive level. After the assessment and determining the level of cause a recommendation to the eligibility committee will be made. If given permission to receive services through the district a treatment plan will be put in place for the child. This will then be worked out between the SLP and the teacher. It is also noted that it may be determined that a child could have both motor based and cognitive-linguistic problems.

        Direct Treatment of Phonological Disorders
        Motor based treatment: suggests that most articulation-phonology treatment programs can be divided into three major stages
        1) Establishment- during this phase, a child will be taught to produce a single phoneme either in isolation or in a syllable. This may include ear-training, auditory stimulation, phonetic placement and/or successive approximation.
        2) Generalization- usually referred to as the carry over phase. The goal of this phase is to enable the child to use the behavior learned in the establishment phase in all words and speaking situations. Here we will se Positive generalization, Context generalization, Linguistic unit generalization, sound and feature generalization and Situation generalization.
        3) Maintenance- the goal here is for the newly acquired sound or pattern to be incorporated as a natural part of a child's everyday speech. Some SLPs use negative practice during the maintenance phase. During negative practice, a child would be asked to intentionally produce the error sound or sound pattern in order to sharpen the contrast between the 'old' and the 'new' productions.

        It is most critical that teachers and parents alike support active participation in the remediation of a child's progress. Simple strategic means such as a speech notebook could aide in the goals; activities, progress charts, instructions and comments can assist in the child's remediation. A teacher should always know the goals of the student's treatment program. They should be aware of any progress toward those goals, and most importantly the teacher needs to know how he/she can help their student in achieving such goals.

        Indirect Treatment of Phonological Disorders
        Whole-class language experience- in this approach the SLP will design procedures that will enrich the entire classroom of children, but yet target specific skills for students with phonological disorders. Using this procedure, a child is seen twice a week, once as a pullout, and the second session as a whole class language experience. Specific skills are targeted during the first session. These same skills are then addressed in the second whole class experience. Here again, it is critical for the teacher to be on board with the goals, progress and skills that are being implemented by the SLP to ensure their students' success.
        Communication Centered Instruction (CCI)
        CCI consists of practicing speech sounds in pro-social communicative activities in which correct responses are reinforced by natural consequences (Low et al., 1989, p.27)
        This practice is ideal for group settings The goal of using this method is that the target sounds are always in words that are part of longer meaningful and relevant utterance.
        Click this link to read more about this topic.

Speech and Language Disorder Resources

ASHA: Answers to Your DSM-5 Questions

Guidance on the changes from DSM-IV to DSM-V, and answers to questions for Speech and Language Therapists working in the field.
Click this link to read the article
Click this link to download a pdf on ASHA's position on the changes in DSM-V.

NICHCY Speech and Language Disorders Fact Sheet

National Dissemination Center for Children with Disabilities (NICHCY) Speech and Language Disorders Fact Sheet.
Click this link to read go to the NICHCY page.
Click this link to download a pdf of the Fact Sheet.

Latest Speech and Language Research

Language Ability of Students with Emotional Disturbance: Discrepancies Between Teacher Ratings and Direct Assessment

In performing evaluations on children and adults, it is vital to get multiple data sources. It is very easy to jump to conclusions based on one data source or report. In this interesting article, Chow and Hollo found that when teachers were asked to rate the language ability of students with emotional disorders their ratings varied considerably from the true language ability of those children as identified on a formalized language assessment. The teachers rated the children as being more competent then they actually were. This means that the language needs of those students, that may have been in part driving that behavior, were not identified. At DeMarle INC we use, whenever possible, multiple sources of data when Dr. DeMarle evaluates a child or adult.
Click this link to read about the studies

Scientists Have Found That Lost Languages Leave A Lasting Mark On The Brain

New study in the Proceedings of the National Academy of Sciences indicates that babies adopted across international borders may not remember the language they heard in their first days, but the words leave a lasting mark on their minds.
Click this link to read about the article.

Dramatic increase in the number of children presenting with Speech and Language and Hearing Problems

A recently published study in the journal Pediatrics reported a 63 percent increase in disability associated with speech problems from 2001-02 to 2010-11 among U.S. children, plus a 15 percent increase in disability associated with hearing problems.
Click this link to read the abstract.

Poor Early Language Skills linked to later behavior and attention problems

Young children use language--specifically self-directed talk--as a tool to control and guide their behavior, especially in difficult situations. New findings from NICHD-supported researchers at Indiana University suggest that poor language skills limit young children's ability to control behavior. These limitations could lead to behavior problems, including disorders of inattention and hyperactivity.
Click this link to read about the study
Click this link to read the abstract.

© Copyright, all rights reserved Daniel J. DeMarle, Ph.D. 2014