stuttering

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.

Stuttering

Laura LeBlanc MA, CCC/SLPLeave a comment

What is stuttering?

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.

What are 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.)

  • How is stuttering diagnosed?

    Identifying stuttering in an individual’s speech would seem like an easy task. Disfluencies often “stand out” and disrupt a person’s communication. Listeners can usually detect when a person is stuttering. At the same time, however, stuttering can affect more than just a person’s observable speech. Some characteristics of stuttered speech are not as easy for listeners to detect. As a result, diagnosing stuttering requires the skills of a certified speech-language pathologist (SLP).

    During an evaluation, an SLP will note the number and types of speech disfluencies a person produces in various situations. The SLP will also assess the ways in which the person reacts to and copes with disfluencies. The SLP may also gather information about factors such as teasing that may make the problem worse. A variety of other assessments (e.g., speech rate, language skills) may be completed as well, depending upon the person’s age and history. Information about the person is then analyzed to determine whether a fluency disorder exists. If so, the extent to which it affects the ability to perform and participate in daily activities is determined.

    For young children, it is important to predict whether the stuttering is likely to continue. An evaluation consists of a series of tests, observations, and interviews designed to estimate the child’s risk for continuing to stutter. Although there is some disagreement among SLPs about which risk factors are most important to consider, factors that are noted by many specialists include the following:

    • a family history of stuttering
    • stuttering that has continued for 6 months or longer
    • presence of other speech or language disorders
    • strong fears or concerns about stuttering on the part of the child or the family

    No single factor can be used to predict whether a child will continue to stutter. The combination of these factors can help SLPs determine whether treatment is indicated.

    For older children and adults, the question of whether stuttering is likely to continue is somewhat less important, because the stuttering has continued at least long enough for it to become a problem in the person’s daily life. For these individuals, an evaluation consists of tests, observations, and interviews that are designed to assess the overall severity of the disorder. In addition, the impact the disorder has on the person’s ability to communicate and participate appropriately in daily activities is evaluated. Information from the evaluation is then used to develop a specific treatment program, one that is designed to:

    • help the individual speak more fluently,
    • communicate more effectively, and
    • participate more fully in life activities.

    What treatments are available for stuttering?

    Most treatment programs for people who stutter are “behavioral.” They are designed to teach the person specific skills or behaviors that lead to improved oral communication. For instance, many SLPs teach people who stutter to control and/or monitor the rate at which they speak. In addition, people may learn to start saying words in a slightly slower and less physically tense manner. They may also learn to control or monitor their breathing. When learning to control speech rate, people often begin by practicing smooth, fluent speech at rates that are much slower than typical speech, using short phrases and sentences. Over time, people learn to produce smooth speech at faster rates, in longer sentences, and in more challenging situations until speech sounds both fluent and natural. “Follow-up” or “maintenance” sessions are often necessary after completion of formal intervention to prevent relapse.

    What can I do to communicate better with people who stutter?

    Often, people are unsure about how to respond when talking to people who stutter. This uncertainty can cause listeners to do things like look away during moments of stuttering, interrupt the person, fill in words, or simply not talk to people who stutter. None of these reactions is particularly helpful, though. In general, people who stutter want to be treated just like anybody else. They are very aware that their speech is different and that it takes them longer to say things. Unfortunately, though, this sometimes leads the person to feel pressure to speak quickly. Under such conditions, people who stutter often have even more difficultly saying what they want to say in a smooth, timely manner. Therefore, listeners who appear impatient or annoyed may actually make it harder for people who stutter to speak.

    When talking with people who stutter, the best thing to do is give them the time they need to say what they want to say. Try not to finish sentences or fill in words for them. Doing so only increases the person’s sense of time pressure. Also, suggestions like “slow down,” “relax,” or “take a deep breath” can make the person feel even more uncomfortable because these comments suggest that stuttering should be simple to overcome, but it’s not!

    Of course, different people who stutter will have different ways of handling their speaking difficulties. Some will be comfortable talking about it with you, while others will not. In general, however, it can be quite helpful to simply ask the person what would be the most helpful way to respond to his or her stuttering. You might say something like, “I noticed that you stutter. Can you tell me how you prefer for people to respond when you stutter?” Often, people will appreciate your interest. You certainly don’t want to talk down to them or treat them differently just because they stutter. However, you can still try to find a matter-of-fact, supportive way to let them know that you are interested in what they are saying, rather than how they’re saying it. This can go a long way toward reducing awkwardness, uncertainty, or tension in the situation and make it easier for both parties to communicate effectively.

     

    Source: ASHA.org

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.

 

 

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.