speech

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.

 

 

Speech Sound Disorders: Articulation vs. Phonological

Laura LeBlanc MA, CCC/SLPLeave a comment

Parents often asked me about the difference between an articulation disorder and a phonological disorder.  Here is the difference:

Articulation (Phonetic) Disorder:

Articulation is the process by which sounds, syllables, and words are formed when your tongue, jaw, teeth, lips, and palate alter the air stream coming from the vocal folds. When an individual cannot produce or distorts an age-expected sound, it affects the ability of the person to be understood.  With an articulation disorder, the child has difficulty saying certain sounds or consonants- for example “wake” for “rake” or as seen with a lisp. Articulation disorders are motor errors than can occur among people of any age; however, they are most common in children whose articulators have not fully developed properly.

Phonological Process Disorder:

A phonological disorder is a simplification of the sound system that also affects intelligibility. Children with phonological processes have difficulty in acquiring a phonological system; involving organizing the patterns of sounds in the brained the output.; not necessarily in the motor production of the sounds like articulation errors.  For example, “fronting” is when sounds that should be produced  by the tongue moving up in the back of the throat are replaced with front sounds -“cake” becomes “take” or “gold” becomes “dold”.  This is typically seen in children whose speech would be considered unintelligible, but can also be seen in children through kindergarten that are developing normally.  Other examples of phonological processes include initial and final consonant deletion, cluster reduction, stopping, backing, gliding, syllable reduction, and consonant harmony.

Both articulation and phonological disorders put a child at risk for difficulties in school, both academically, as well as socially.  If you feel that your child may have a speech disorder, be sure to have his/her speech evaluated by a licensed speech-language pathologist.

 

 

 

What is a Lisp?

Laura LeBlanc MA, CCC/SLPLeave a comment

You’ve heard of a lisp-but what exactly is it? A lisp is an articulation disorder where a child is having difficulty correctly producing the “s” and “z” sounds. Sometimes the “sh”, “ch” and “j” sounds may also be in error.  There are 4 main types of lisps:

  • Interdental/frontal lisp: This type of lisp is characterized by a protrusion of the tongue out through the teeth- for example, saying “thwim” instead of “swim” or “thoup” for  “soup”.
  • Dentalized lisp:  A dentalized lips happens when the tongue pushes up against the top teeth during production of  “s” and “z” sounds, cutting off the airflow.

Both interdental/frontal and dentalized lisps are considered developmental in nature and are typically seen in normal speech development.  In other words, the child will most likely “grow out” of it.  It is perfectly normal development for a child to produce an interdental or dentalized lisp until they are about 4.5 years old.

  • Lateral lisp: This type of lisp results in a “slushy” or “spitty” sound.  A lateral lisp occurs when the tongue tip is in a similar position as when making the “l” sound but the air flow escapes out the sides of the sides of the tongue, instead of directly forward and out of the oral cavity.
  • Palatal lisp: A palatal lisp occurs when the mid section of the tongue comes in contact with the soft palate.  The sound of a person with a palatal lisp attempting to produce the “s” and “z” sounds will closely mimic the production of an “h” and a “y”.

Both lateral and palatal lisps are never normal in development and most likely will require speech therapy intervention to correct.  If you feel your child is in need of a speech evaluation, be sure to contact an ASHA certified speech-language pathologist.

 

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

Could Your Child’s Phonological Disorder Really Be Apraxia of Speech?

Laura LeBlanc MA, CCC/SLPLeave a comment

According to Edith Strand, the leading expert in child apraxia, “childhood apraxia of speech (CAS) typically occurs alongside other language delays or phonological impairments.  This can make diagnosing it a major challenge.”

Characteristics that are often present, but not discriminative, in childhood apraxia include:

  • Limited consonant and vowel repertoire
  • Use of simple syllable shapes and frequent omission of sounds
  • Numerous errors-poor standard scores on articulation tests
  • Poor intelligibility

More “discriminative” characteristics of apraxia of speech include:

  • Difficulty moving from one articulatory movement to another  (ie saying the word “pancake” at a fast rate)
  • Groping and/or trial and error behavior
  • Vowel distortions
  • Prosodic errors (putting stress on the wrong syllable)
  • Inconsistent voicing errors (“teck” for “deck” or “van” for “fan”)

Distinguishing CAS from Phonological Impairment

The primary characteristics of  childhood apraxia of speech (CAS) are vowel distortions, segmentation and/or equal stress, awkward movement transitions and error behavior in words and phrases. On the other hand, children with only phonological impairment may make substitution errors of exhibit phonological processes that are fairly consistent.  The movements for those incorrect sounds will be accurate though, and rate and prosody are typically good.  For more information on this topic, see the March 2017 issue of The ASHA Leader “Appraising Apraxia”.

If you are concerned about your child’s speech or language be sure to contact an ASHA certified speech-language pathologist 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.

10 Signs Your Child May Have Asperger’s Syndrome

Laura LeBlanc MA, CCC/SLPLeave a comment

Asperger’s syndrome is a neurological disorder which falls under the category of autism spectrum disorders- a group of disorders characterized by impaired communication and social interaction. About 1 percent of the world’s population is affected by this disorder. Although exact symptoms may vary from child to child, there are many behaviors that may be signs of Asperger’s syndrome.  Here are the most common:

1. Unusual Body Language

Your child may make unusual facial expressions or stare at others a lot.  More likely, however, a child will avoid making eye contact all together.

2. Fixation on One Activity

Many children with Asperger’s are preoccupied with a single or few interests for hours on end and do not engage in play with other children.

3. Overly “Formal” Speech

Children with Asperger’s have advanced verbal skills and tend to speak more formally than expected for their age or prefer talking with adults.

4. Difficulty Reading Social Cues

Social difficulties is one of the most “obvious” of the Asperger’s symptoms.  Reading body language may be hard, as well as turn-taking or accepting others point of view and sticking to a topic of conversation.  A child may talk incessantly without giving others a chance to speak, or notice that others are becoming bored with the conversation.

5. Lack of Empathy 

Many child with Asperger’s have a lack of empathy for others and have no idea that others have feelings or wants.

6. Delayed motor development

From fine motor (ie writing) to gross motor (ie riding a bike), poor or delayed motor skills could be a sign of Asperger’s syndrome.

7. Sensory Sensitivities 

It’s possible for a child with Asperger’s to have heightened sensory sensitivity.  Things such as loud noises, strong lights, or even certain textures can cause them to become overstimulated and overwhelmed.

8. Can’t Understand Speech Subtleties

Some people with Asperger’s have a hard time understanding speech tone, pitch, and accent.  They may take words very literally and not comprehend humor or jokes.

9. Strong Need for Routine 

Many people with Asperger’s prefer to adhere to a strict routine for everything from bedtime to meals and showers.  Having structure is very important, otherwise they may feel unsettled or confused.

10. Emotional Meltdowns

When a child with Asperger’s becomes overwhelmed they often have a meltdown.  This is a common result of routines or plans not going as expected.

Stuttering in Children-What you need to know

Laura LeBlanc MA, CCC/SLPLeave a comment

If your child has difficulty speaking and tends to hestitate on or repeat syllables, words, or phrases- he may have a stuttering problem.  However, he may also be going through periods of “normal” dysfluency that most children experience as they learn to speak.  Dysfluencies occur most often between 1.5 and 5 years of age and they tend to come and go.  Signs of an actual fluency disorder include the following:

  • Dysfluencies are accompanied by tension and struggle behavior (ie facial grimaces or eye blinking).
  • The pitch of the voice may rise or the child will experience silent “blocks” (no sound comes out.)
  • Dysfluencies may still come and go but are more present than absent.
  • Your child is repeating words more than twice (ie “what..what..what”)

What you can do:

  • Try and model slow and relaxed speech when speaking with your child.
  • When your child asks you a question, try to pause a second or so before you answer. This will help your child to be less hurried and more relaxed when speaking.
  • Try not to be upset or annoyed when stuttering occurs.
  • If your child is frustrated or upset when stuttering occurs, reassure him.  Some children respond well to hearing “I know it’s hard to talk at times…but lots of people get stuck on words.  It’s ok.”

 

If you are concerned about  your child’s stuttering and would like assistance, be sure to contact an ASHA Certified speech-language pathologist (www.ASHA.org) for an evaluation.