language

Five Common Speech Disorders in Children

Laura LeBlanc MA, CCC/SLPLeave a comment

Speech Disorders

You have determined that your child has more than just a speech delay, now what? How do you determine what kind of speech disorder your child has and more importantly, what do you do about it? Here are five common speech disorders in children. Of course, we always recommend a visit to your pediatrician if you feel your child has any of these symptoms, and an appointment with an SLP may be necessary to begin an effective speech therapy treatment plan.

Articulation Disorder: An articulation disorder is a speech sound disorder in which a child has difficulty making certain sounds correctly.  Sounds may be omitted or improperly altered during the course of speech. A child may substitute sounds (“wabbit” instead of “rabbit”) or add sounds improperly to words. Young children will typically display articulation issues as they learn to speak, but they are expected to “grow out of it” by a certain age.  If the errors persist past a standard developmental age, which varies based on the sound, then that child has an articulation disorder.

The most common articulation disorders are in the form of a “lisp” – when a child does not pronounce the S sound correctly – or when a child cannot pronounce the R sound correctly. He may say “wabbit” instead of “rabbit” or “buhd” or instead of “bird.”

Apraxia of Speech is a communication disorder affecting the motor programming system for speech production.  Speech production is difficult – specifically with sequencing and forming sounds. The person may know what he wants to say, but there is a disruption in the part of the brain that sends the signal to the muscle for the movement necessary to produce the sound.  That leads to problems with articulation as well as intonation and speaking stress and rhythm errors. Apraxia of Speech can be discovered in childhood (CAS), or might be acquired (AOS) resulting from a brain injury or illness in both children and adults.

Fragile X Syndrome (FXS) is an inherited genetic disorder that is the most common cause of inherited intellectual disabilities in boys as well as autism (about 30% of children with FXS will have autism). It also affects girls, though their symptoms tend to be milder. It is greatly under-recognized and second only to Down syndrome in causing intellectual impairment.

FXS occurs when there is a mutation of FMRI gene and is an inherited disorder.  If a child received a pre-mutated X chromosome from one of his parents (as a carrier), then he is at greater risk of developing FXS.  Diagnosing Fragile X Syndrome is not easy for parents and doctors at the beginning of a child’s life.  Few outward signs are noticeable within the first 9 months. These signs may include an elongated face and protruding eyes.

Intellectual disabilities, speech and language problems, and social anxiety occur most frequently in children with Fragile X. Speech symptoms include repetition of words and phrases, cluttered speech and difficulties with the pragmatics of speech. All of FXS’s symptoms can range from mild to very severe.

Stuttering occurs when speech is disrupted by involuntary repetitions, prolonging of sounds and hesitation or pausing before speech. Stuttering can be developmental, meaning it begins during early speech acquisition, or acquired due to brain trauma. No one knows the exact causes of stuttering in a child.  It is considered to have a genetic basis, but the direct link has not yet been found. Children with relatives who stutter are 3 times as likely to develop stuttering. Stuttering is also more typical in children who have congenital disorders like cerebral palsy.

A child who stutters is typically not struggling with the actual production of the sounds—stress and a nervousness trigger many cases of stuttering. Stuttering is variable, meaning if the speaker does not feel anxious when speaking, the stuttering may not affect their speech.

Language disorders can be classified in three different ways: Expressive Language Disorder (ELD), Receptive Language Disorder (RLD) or Expressive-Receptive Language Disorder (ERLD).  Children with Expressive Language Disorder do not have problems producing sounds or words, but have an inability to retrieve the right words and formulate proper sentences. Children with Receptive Language Disorder have difficulties comprehending spoken and written language. Finally, children with Expressive-Receptive Language Disorder will exhibit both kinds of symptoms. Grammar is a hard concept for them to understand and they may not use of articles (a, the), prepositions (of, with) and plurals. An early symptom is delay in the early stages of language, so if your child takes longer to formulate words or starting to babble, it can be a sign of ELD.

Children with Receptive Language Disorder may act like they are ignoring you or just repeat words that you say; this is known as “echolalia.” Even when repeating the words you say, they may not understand.  An example of this is if you say, “Do you want to go to the park?” and they respond with the exact phrase and do not answer the question. They may not understand you or the fact that you asked them to do something.

Children with Expressive-Receptive Language Disorder can have a mix of these symptoms

These are some of the most common speech disorders in children. No child is the same and you know your child best. If you feel that your child has a speech or language disorder, contact an ASHA Certified speech-language pathologist for an evaluation.

Five Tips for Getting Insurance to Pay for Therapy

Laura LeBlanc MA, CCC/SLPLeave a comment

Did you know that you may be entitled to coverage or reimbursements for services for your child who has a disability or special need.

The Affordable Care Act created new mandates for “essential benefits” (but it left it up to the states to define which benefits insurance companies must provide — so don’t forget, these benefits vary from state to state).  For example, you may receive coverage for applied behavior analysis services for your child with autism.

Here are five tips that can you you get your child’s therapy covered by insurance.

1. Understand the Requirements & Be Persistent

Whenever one is attempting to get health insurance to pay for certain treatments, it pays to be persistent and to understand exactly what is needed in order to get the company to approve the coverage. Speech therapy is an example of one of these areas, where several steps may be required to obtain coverage.

2. Obtain a Medical Diagnosis

A crucial first step in obtaining coverage for speech therapy is to obtain a medical diagnosis indicating that the need for therapy is medical rather than developmental. For instance, verbal apraxia is a speech disorder that results in a delay when speaking, and it is a diagnosis that qualifies for coverage with many health plans. If your child has such a diagnosis, then it may be necessary to obtain a letter from your doctor stating that speech therapy is a medical necessity, and that the disorder is neurologic rather than developmental. Read your insurance policy’s exclusions carefully and make sure that doctors and therapists try to avoid such language in their reports.

3. Include a Personal Letter

An additional step that you may take is for you as a parent to add your own letter emphasizing the medical nature of your child’s condition.

4. Denials of Coverage

It is common to receive a denial of coverage from insurance companies, but this is often not their final answer. You should understand that you may need to be persistent. If you receive an initial denial, be sure to check the denial letter or other insurance documents for the diagnostic code that was used and make sure that it is a neurological code rather than one indicating a developmental delay. Your speech therapist may be able to help. If there is a discrepancy between your child’s actual diagnosis and the one used to deny coverage, this can be the basis for an appeal of the decision.

5. The Appeals Process

If you believe an initial denial of coverage was in error, then the next step is to ask about the company’s appeals process and be prepared to go through it. This will vary according to your insurance company’s policy, but regardless of the details of the process, you will need to submit everything in writing, keep a careful record of communication with the company, and be persistent. To appeal the decision, you must examine the insurance company’s specific reason for denial. You will want to obtain a copy of the insurance company’s master policy and any exclusions, and carefully compare these to the medical evidence you submitted, to make the best argument that your child’s therapy should be covered.

Preparation and persistence are key to obtaining health insurance coverage for special needs therapy.

Conquering the High Cost of Speech-Language Therapy

Laura LeBlanc MA, CCC/SLPLeave a comment

Families with a speech disordered child often face a financial burden due to the high cost of speech therapy and other needed treatments. In fact, a survey published in Public Health Reports found that 40% of American families with children with special needs report feeling the strain of the financial toll that those healthcare needs cause. The survey further reported that children with disabilities are more likely to grow up in single-parent households, and that those parents often hold lower-paying jobs. As pricey as speech therapy is, you may be able to reduce the high cost of speech therapy with these tips:

Insurance

If you’re not sure if your insurance will cover the cost of speech therapy, talk to your employer’s human resources representative. If you’re uninsured or underinsured, contact the appropriate department in your state for information on insurance programs.

Flexible Spending Accounts

Ask your employer if he offers a flexible spending account (FSA). An FSA allows you to designate a portion of your income for qualifying medical and childcare expenses. The income is not subject to payroll taxes, which can save you a nice chunk of change.

Sliding Scale

Many hospitals, clinics, and early childhood centers offer services based on a sliding scale. It’s always worth asking your child’s speech therapist if she offers a reduced fee or sliding scale program based on your income.

The Gardiner Scholarship (For Home-Schooled Children)

The Gardiner scholarship is for Florida students 3 years old through 12th grade or age 22, whichever comes first, with one of the following disabilities: Autism spectrum disorder, Muscular dystrophy, Cerebral palsy, Down syndrome, Phelan McDermid syndrome, Prader-Willi syndrome, Spina bifida, Williams syndrome, Intellectual disability (severe cognitive impairment), rare diseases as defined by the National Organization for Rare Disorders, anaphylaxis, deaf, visually impaired, dual sensory impaired, traumatic brain injured, hospital or homebound as defined by the rules of the State Board of Education and evidenced by reports from local school districts, or three, four or five year-olds who are deemed high-risk due to developmental delays.

The term “hospital or homebound” includes a student who has a medically diagnosed physical or psychiatric condition or illness, as defined by the state board in rule, and who is confined to the home or hospital for more than 6 months.

  • Students need an IEP written in accordance with the rules of the State Board of Education or with the rules of another state OR the diagnosis of a Florida physician or psychologist or a physician who holds an active license issued by another state or territory of the United States, the District of Columbia or the Commonwealth of Puerto Rico.
  • Students must be at least 3 or 4 on or before Sept 1. Students entering kindergarten must be 5 on or before Sept 1. Students entering first grade must be 6 on or before Sept 1.
  • Students can participate in the Gardiner Scholarship program as part of home education. However, they cannot be enrolled in a public school or receive any other state-sponsored scholarship (McKay Scholarship or the Florida Tax Credit Scholarship).

As always, if you feel that your child is in need of speech-language services, be sure to contact an ASHA Certified provider.

 

 

Predicting First Words in Infants

Laura LeBlanc MA, CCC/SLPLeave a comment

According to new research from Indiana University, children’s visual experiences could influence their first words.   The research team, led by Linda Smith (a professor in IU Bloomington’s Dept. of Psychological and Brain Science) found that infants may link objects they most frequently see with words they most often hear.  This new theory of language has been coined “pervasiveness hypothesis”.  Smith went on to add that “visual memory may be the initial key to getting words stuck on objects-familiar objects like table, shirt, bottle, or spoon. It’s an aggregated experience, those very first words may be learned-slowly and incrementally-for a few visually pervasive objects. This may be how infants break into language before their first birthday.”

The results of the study may help inform future interventions for children with language disorders; difficulty learning words could be caused by visual-processing problems.  For more information on this topic, see the March 2017 issue of The ASHA Leader.

If you are concerned about your child’s speech and or language development or skills, be sure to contact an ASHA certified SLP for an evaluation.  A list of providers can be found at http://www.ASHA.org

Dispelling the 3 Most Common Myths About Speech Language Development in Children

Laura LeBlanc MA, CCC/SLPLeave a comment

There are many myths about most things in life, one being speech and language development in children.  Read on to find out what the biggest misconceptions are.

1-No words by the age of 1= RED FLAG

Truth: Most children say their first words between the ages of 12 and 18 mths.  Often these words are still unintelligible.  Causes for concern, however, are if your child has yet to speak a single word by 18 mths and 2 years,  or  if your child had been speaking then suddenly stops, or his language skills no longer expand.

2-The Use of “Baby Talk” Slows Down Language Development

Truth: The use of “Motherese”,  or “baby talk” has been shunned for years with many recommending using “adult style” speech to newborns.  The truth is this-any type of engagement with young children is beneficial.  Some studies even show that babies actually react well to baby talk from parents.

3- Sign Language “Speeds Up” Language Development

Truth: Using sign language does not translate to accelerated language acquisition for children.  According to a study from the University of Hertfordshire, Dr Liz Kirk found “Although babies learn the gestures and used them to communicate long before they started talking, they did not learn the associated words any quicker than the non-gesturing babies, nor did they show enhanced language development.”

If you have questions  or concerns regarding your child’s speech or language, contact an ASHA Certified Speech Language Pathologist in your area.

Articulation in Children Top 5 Speech Questions

Laura LeBlanc MA, CCC/SLPLeave a comment

What is articulation?

Articulation is the ability to make speech sounds clearly. Children learn correct sound production by listening and imitating appropriate speech role models. Articulation develops gradually over a period of 8 years.

When should I be concerned about my child’s articulation?

Under the age of 3, it is common for children to make quite a few sound errors and substitutions.  By age 3, a child should be using at least 200 words, using 3-5 word phrases and be understood at least 80% of the time.  By age 4, a child should be 100% intelligible even if they continue to have some articulation errors.  Sounds which are “later developing” include “sh”, “ch” “j” and “th”.  Sometimes the “s” and “r” sounds are more difficult to remediate and require more speech therapy.

What sounds do children learn to produce first and in what order?

Most children are able to produce the “bilabial” sounds (made with the lips) of “b”, “p” “m”and “w”. They may also produce sounds such as “d”, “t”, and “n” early on as well.  Child acquire sounds developmentally and by age 8 should have mastered all of the sounds.

What causes an articulation disorder?

Although the cause is often unknown, the following are may cause an articulation disorder:

  • Hearing loss
  • Illness
  • Developmental Disorder (ie Autism)
  • Neurological Disorder (ie Cerebral Palsy)
  • Genetic Disorder (ie Down Syndrome)

How do you treat an articulation disorder?

If you feel that your child is in need a speech evaluation, it is vital to seek treatment from an ASHA (American Speech Hearing Association) Certified provider who will conduct a comprehensive evaluation and provide services as needed.