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Speech Matters July 2011

A Speech Language Pathologist can help children with autism

Speech Matters

by Cheryl D. Lindsay M.S. S-LP

The Autism Society of Canada website provides the following definition: “Autism Spectrum Disorder, also referred to as autism, is a neurological disorder which causes developmental disability. Autism affects the way the brain functions, resulting in difficulties with communication and social interaction, and unusual patterns of behaviour, activities and interests.”

Autism affects boys four times more often than girls and usually appears in the first three years of life.

In the term Autism Spectrum Disorder, (ASD), the word spectrum is used to show the uniqueness of each child with autism. There are milder forms of the disorder, sometimes called “higher functioning” autism, diagnosed using the term Aspergers. The other end of the spectrum includes children exhibiting more severe characteristics.

It is so important to realize that each child diagnosed with ASD has individual strengths and weaknesses. Children with autism find it difficult to interpret and then respond to information in their environment.

Some of the more common characteristics that are seen in children with autism include: 

1. Communication:

-may be verbal or nonverbal

-pronunciation variable; speech may be telegraphic, or robotic,

 with a high pitched voice

-echolalic speech i.e. repeating what they have heard

-use of “canned phrases” or learned responses

-may be able to repeat entire scripts from movies but unable to answer simple questions.

-rely more on gestural communication, such as hand leading to

 request

2. Motor Abilities:

-fine motor deficits  

-poor coordination

-depth perception deficit

3. Social Interaction:

-poor pragmatics or social language – i.e. may not show interest in

 others

-poor processing of semantics or meaning- i.e. may take you  

 literally

-may resist or be overly affectionate

-lpoor eye contact

4. Behaviours:

–flapping, spinning

-lining up toys

-inappropriate play with toys i.e. focused on a moving part vs. the

 whole

5. Sensory:

-may be overly sensitive to or seek stimuli such as noise, light,

 texture

-may be overly sensitive to or seek stimuli such as deep pressure

6. Safety issues:

-not aware of harmful situations, may self-injure

7. Health issues:

-Gastro-intestinal sensitivities and sleep disturbances

The cause of ASD is still unknown but research is flourishing. Early intervention is crucial. Your doctor, early intervention professionals and speech-language pathologist can be excellent resources.

ASD must be diagnosed by a developmental pediatrician. When parents bring their child to see an SLP because of a delay in speaking, the SLP may use an inventory or checklist to help in ruling out autism. An SLP also provides help with an individually tailored treatment plan, which may include elicitation of verbal responses, teaching gestures and sign language, a picture exchange communication system, (PECS) or other augmentative or alternative communication, (AAC). Building routines during interaction can be helpful when teaching language and new forms of communication.

Some children with autism benefit from IBI (intensive behaviour intervention). This is highly structured behaviour, cognitive and social skills therapy provided by specifically trained individuals.

Autism not only impacts the child, but their parents, family members, caregivers and professionals providing help. It may be overwhelming for families who must familiarize themselves with the many different disciplines and resources associated with supporting their child.  Knowledge and awareness are crucial to understanding ASD and getting help.

References: www.autismsocietycanada.ca, www.autismcanada.org/pdfs/PhysicianHandbook.pdf

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Newsletter January 2011

Speech Matters June 2011

Taking Care of Your Voice

Speech Matters

by Cheryl D. Lindsay M.S., S-LP

Have you ever felt like you had “a frog in your throat?” The belief behind this old story was that if you drank pond water, containing frog eggs, a frog would grow in your throat, obstructing your airway, and the result would be a “croaky” sounding voice.  A “croaky” sounding voice is not a normal voice.

In order to understand how to take care of your voice, it helps to understand, in simple terms, how your “normal” voice is produced.  As you breathe out, air flows over your vocal folds, (also called voice box or larynx), causing them to vibrate. The air then flows through the resonance chamber, (mouth, and sometimes nose) and then out. To “feel” your voice, put your hand on your throat and say /v/. Then try /f/ and you should not be able to feel the vibrations.

The size and shape of your mouth and the size and condition of your vocal folds, changes the way sounds are produced and gives each of us our unique sounding voice.  The larynx, located at the top of your windpipe, is made up of muscles covered in a mucous lining. If your larynx is damaged in any way, by a growth or disease, (pathology), then your voice will be affected.

There are professionals that help train your voice for singing, but that voice training is not usually in the scope of practice of a speech-language pathologist, (SLP).  An SLP can help to retrain your voice after vocal fold damage.

Normal changes in your voice occur throughout your life. The most notable changes in children occur between a very young age, (higher pitched), and early teen years, (lower pitched, especially in boys when they reach puberty). Your voice also changes with your emotions. There are further changes in older adults when their voice typically becomes weaker.

The other characteristics of voice besides loudness and pitch are nasality, i.e. the amount of air flowing through the nasal cavity, and quality, i.e. breathiness, hoarseness, strain, pitch breaks, tremors, or arrests.

The most common voice problem in children is vocal nodules, which form on the vocal folds as a result of vocal misuse or abuse. There may also be more serious problems such as vocal polyps, laryngeal cancer, contact ulcers, vocal fold paralysis, or infections, which can cause laryngitis.

Another common voice problem is linked to gastroesophageal reflux, (GERD), a burning sensation in the throat. It is caused by stomach acid backing up into the throat and damaging the vocal folds.

Other voice disorders can be related to psychological problems.

An Ear, Nose and Throat specialist, (ENT), can use endoscopy, which is a photo or video of your larynx, to identify the problem. Sometimes surgery is recommended.

An SLP can help you take care of your voice by recommending voice therapy and proper vocal hygiene.

The following tips will help you keep a healthy voice.

– Stay hydrated by drinking plenty of water.

– Get plenty of rest, including vocal rest.

– Practice good posture and relaxation exercises.

– Use a humidifier in dry winter months.

– Avoid caffeine, alcohol, certain lozenges, (peppermint and menthol), and smoking.

– Don’t strain your voice i.e. no loud talking, yelling, screaming or making loud, non-speech noises.

– Practice a softer voice, but not whispering, as it can dry your vocal folds.

– Avoid excessive throat clearing.

(Next Month: How Speech Language Pathologists can help individuals with autism)

Speech Matters May 2011

Speak Well, Hear Well, Live Well”:  May is Speech and Hearing Month

 

Speech Matters

by Cheryl D. Lindsay M.S. S-LP

The month of May has been designated by the Canadian Association of Speech-Language Pathologists and Audiologists, (CASLPA), as Speech and Hearing Awareness Month.

“One out of ten Canadians lives with a serious communication disorder.” (Source: www.caslpa.ca )

The goal for speech-language pathologists and audiologists is to enhance one’s quality of life by improving communication skills.

It is important that speech and hearing problems be identified as early as possible. In the past few years, and again this year, free speech and hearing screenings are being offered at the Early Years Centre, in Hanover, (ph. 519-376-8088).

A speech-language pathologist, (S-LP), is able to help assess, diagnose and treat many aspects of disordered communication. These include:

  • Voice:  clarity, volume, pitch, hoarseness
  • Articulation, or, how sounds are produced
  • Receptive language, or, understanding
  • Expressive language, or speaking
  • Swallowing
  • Dysfluency or stuttering
  • Respiration
  • Apraxia or motor planning
  • Phonological processing

An SLP, as part of a health care team, is also able to help people who have communication challenges as part of, or, in conjunction with, other diagnoses such as:  

  • Autism Spectrum Disorder, (ASD)
  • Attention Deficit Hyperactive Disorder (ADHD)
  •  Down syndrome
  •  Pierre-Robin Syndrome
  • Acquired Brain Injury, (ABI)
  • Central Auditory Processing Disorder
  • Cleft palate
  • Cerebral Palsy

Communication delays or disorders that affect children in infancy to preschool years, may have consequences that affect success in school, both socially and academically. Early identification and treatment can be critical to a child’s success.

If you are concerned about any aspect of your, or a family member’s communication, speech language pathologists and audiologists are here to help. To find a qualified professional in your area, visit www.caslpa.ca.

(Next Month: Taking care of your voice)

Speech Matters April 2011

Fluency Disorders – Not Just The King’s Speech

Speech Matters

By Cheryl D. Lindsay M.S., S-LP

Fluency disorders are more commonly referred to as stuttering. In England, during the time of King George VI, stuttering was, and is still called, stammering.

Fluent speech is the smooth, rhythmic flow of sounds syllables and words. It occurs “automatically” and without effort. Around the age of two years, when children begin to put words together, they may go through a period of normal dysfluency. These periods of dysfluency may last until school entry. At times, adults may also speak less fluently, especially under conditions of stress.  When periods of dysfluency persist, a speech-language pathologist, (SLP) can help to determine whether the child is truly stuttering.

Dysfluent speech is diagnosed by an SLP who measures the following characteristics:

  • Repetitions of sounds, syllables, phrases or words  i.e. “c-c-c-c-cat”, “ban-ban-ban-bandaid”, “I want – I want – I want”, “I I I I want to go”.
  • Restarts/Revisions i.e. “ I want, I mean can we … ?”
  • Prolongations i.e. “sssssssand”
  • Interjections, or fillers, such as “um” and “er”
  • Hesitations, or long pauses before speaking
  • Blocks or “silent struggles” described as words getting “stuck” or the words “won’t come out”
  • Secondary characteristics or avoidance behaviours such as eye blinking, tension or shoulder shrugs

True stuttering is a rare disorder affecting only 0.5 – 1 % of the general population. It tends to run in families, is more common in males than females, and is less common in preschool aged children. There is no known cause or cure but there is help in the form of therapy.

Before the age of school entry, normal dysfluency, or developmental dysfluency, may present with word or phrase repetitions. The child is usually unaware, there is no tension in his speech and the episodes of dysfluent speech may start and stop over a long period of time.

People, who are aware that they stutter, often experience feelings of frustration, anxiety, and fear of certain speaking situations.  It is important to note that these feelings are not the cause of stuttering but rather reactions to the speech disorder.

By being good listeners, there are things we can all do to help a person who stutters;

  • Do not interrupt or try to finish sentences.
  • Do not suggest they slow down or start over.
  • Try to create a relaxed atmosphere and model a clear, concise, slower rate of speech.
  •  Encourage turn taking which reduces competition for speaking time.
  •  Maintain eye contact.

The old school of thought regarding dysfluency said that, if you drew attention to the stuttering, it would get worse. As Caroline Bowen suggests, this thinking leaves the child “confused and wondering why her struggle to speak fluently is an unmentionable subject.” The more current view says that ignoring the issue does not necessarily best serve your child.

Bowen, C. (2001). Stuttering:  What can be done about it? Retrieved on Apr. 13, 2011 from www.speech-language-therapy.com/stuttering.htm

www.caslpa.ca  (Stuttering Factsheet)

 www.istar.ualberta.ca/content/pdf/info_4_parents.pdf

www.stutteringhelp.org  

(Next Month:  May is Speech and Hearing Month! )

Speech Matters March 2011

What is Childhood Apraxia of Speech?

Speech Matters

By Cheryl D. Lindsay MS, S-LP

The term Childhood Apraxia of Speech, (CAS) may not sound familiar to you. Occurring in only 3 – 5 % of speech impaired preschoolers, it is not a very common condition, nor is it easily diagnosed.

CAS can be described as a motor speech disorder affecting the ability to organize, plan and execute proper movement of the speech muscles necessary for accurate speech. CAS is not related to any muscle weakness, slowness, or paralysis of the face or mouth.

CAS can affect a child’s intelligibility, or clear speech, and ranges from mild to severe. You may recall the speech model from last month’s column on phonological disorders. Before a sound output is produced, the brain plans the appropriate placement and movement of the articulators.

One way to explain what happens with apraxia is by using a simple analogy. Think of the brain as a computer keyboard. When attempting to produce the sound, /m/, you hit the correct key but somewhere between selecting /m/ and the output, the result is not /m/ on the screen. Similarly, a child with apraxia may know that she wants to say, /m/, but cannot coordinate her articulators to do so, despite sending the correct message.

Although the preferred terminology is Childhood Apraxia of Speech, it may also be known as verbal apraxia, developmental apraxia of speech, or verbal dyspraxia.   The root word “praxis” means planned movement.  The “a” in apraxia means “absence”:  which together, means “absence of planned movement.”

Some common characteristics of CAS are:

1. The child produces errors inconsistently in repeated productions. For example, the child may be observed to say “ma ma da ba” spontaneously, but when requested to “say mama”, is unable to do so.

2. The child’s speech is relatively clear in single words but unintelligible in longer sentences.

3. The child struggles to use correct placement of their articulators, primarily lips and tongue. Trial and error or “groping” behaviours of the articulators are observed.

4. The child understands more language than they are able to use; meaning that their receptive language ability is better than their expressive language ability.

5. The child has a limited consonant and vowel inventory.

6. The child has an overall slow rate of speech, perhaps monotone and choppy.

7. The child uses unusual speech error patterns.

8. The child will likely have difficulty with phonological awareness skills, reading, writing, and spelling if the apraxia persists, or is left untreated.

9. The child is easily frustrated: they appear to know what they want to say, but have difficulty saying the word(s).

A speech-language pathologist can help to diagnose CAS in children, typically between the ages of three and four years. Those between the ages of 2 and 3 may be “suspected” of having CAS, but a diagnosis at this young age is more difficult. As well, some children with severe apraxia may be nonverbal and therefore, challenging to diagnose.

Some of the key principles of therapy for apraxia are:

  • Frequent practice and repetition of motor placement for sounds and sound sequences so that they eventually become automatic
  • Sensory cueing including touch cues and verbal cues
  • Slower rate of speech, modeled first
  • Focus on speech movements versus individual sounds
  • One on one, more frequent therapy, with typically slower progression
  • Augment with sign language, and picture books always pairing verbal cues with gestures or visuals

(Information for this article was obtained from: www.apraxia-kids.org )  

(Next Month: Fluency (Stuttering) Disorders)

Speech Matters February 2011

Talking About Phonological Disorders

Speech Matters

by Cheryl D. Lindsay, M.S., S-LP

Explaining phonological disorders is not an easy task! Hold on to your hat (and your brain!). In order to define this term, it helps to understand what happens when we speak. The following model includes three simplified steps of speech production and includes the key terms phonological representation and articulation.

Step # 1. Phonological representation is the abstract representation, or “the picture” of the speech sounds, that are stored in the child’s mind: 

e.g. /m/ /a/ /m/ /a/

Step # 2. Using this representation or “picture”, specific systems in the brain generate a rough plan. This plan or “blueprint” sends instructions in syllable chunks, to the muscle groups involved in saying the target word:

e.g. /ma/ /ma/

Step # 3. Articulation is the speech output, or when articulators produce the sounds, in sequence, to form “the spoken word”:

e.g. /mama/

(Adapted from Model of speech production. Laura M. Justice, 2010)

Articulation then, is the correct movement of all parts of the speech sound system, (tongue, lips, larynx, teeth, hard palate, velum, jaw, nose and mouth) to produce intelligible speech (Step # 3, “the spoken word”).

Phonology, however, refers to the rules that govern the sound system to create language. These rules oversee speech sound combinations and their productions, generating intelligible speech. (Step # 1, “the picture”).

When these rules are “broken”, we see error patterns (also called phonological processes, as discussed in last month’s column). An example of one error pattern occurs when sounds made in the back of the mouth, like /k/ and /g/, are replaced by sounds that are made in the front of the mouth, or as /t/, /d/. The words /car/ and /go/ are instead produced as /tar/ and /doe/. This process is referred to as “velar fronting”.

A phonological delay is different than a phonological disorder. If these error patterns persist beyond normal developmental milestones, this may signal a phonological disorder and be cause for concern.

“Developmental Phonological Disorders (also called “phonological impairments” or “phonological disorders”) are a group of language disorders that affect children’s ability to develop easily understood speech by the time they are four years old, and, in some cases, their ability to learn to read and spell. 

Phonological disorders involve difficulty in learning and organizing all the sounds needed for clear speech, reading and spelling. They are disorders that tend to run in families. 

Developmental phonological disorders may occur in conjunction with other communication disorders such as stuttering, specific language impairment, or childhood apraxia of speech.”
Bowen, C. (1998). Developmental phonological disorders: Information for families. Retrieved from http://www.speech-language-therapy.com/parentinfo.html  

Children with Phonological disorders typically:

        1. use a small number of sounds

        2. use more than one phonological process or type of error

            ex: velar fronting and final consonant deletion

        3. use one phoneme to represent a category

            eg. /t/ for all fricatives /th/, /f/, sh/ and /s/

        4. use atypical processes eg. instead of the usual             

            “tain”  for “train”, the child uses “rain” for “train”

            (Laura M. Justice, 2010)

A speech language pathologist can help to identify phonological delays and disorders.

Isn’t it a miracle, and still somewhat a mystery, that we learn to say what we think?

(Next Month: Childhood Apraxia of Speech)

Speech Matters January 2011

Phonological Processes – A child’s normal patterns for simplifying adult speech – Speech Matters – January 2011

By Cheryl D. Lindsay MS S-LP

 At about the time that children are beginning to use more words and words in combination, (approximately 18 – 24 months), they also begin to use “phonological processes”.

The term, phonological processes, refers to the normal, predictable, patterns (errors) that children, between the ages of 18 months and five years, typically use to simplify adult speech. Some sounds are harder to produce because a child’s sound system has not developed enough to be able to fully coordinate the movements required for accurate speech.  These ‘errors’ are thought to be part of our genetic pre-programming. (Source: www. speech-therapy-information-and-resources.com/phonological-processes.html).  If more than one ‘error’ pattern is used, the child’s intelligibility can be greatly reduced.  As children grow out of using these phonological processes, their speech becomes easier to understand, and they gradually sound more like adults.

 Outlined below are some examples of common patterns children use, and at what age they usually disappear.  The names of the error types may sound daunting, but the examples should sound more familiar.

 * Word final devoicing – e.g. “bet” for “bed”

gone by 3 years

 * Context sensitive voicing – e.g. “gup” for “cup”

gone by 3 years

In the patterns above, it is helpful to understand the terms voiced and voiceless, by placing your fingers on your larynx, (voice box), while saying the sound.  With voiced sounds, e.g. /g/, /b/, /d/, you can feel your vocal folds vibrating. With unvoiced sounds, e.g. /k/, /p/, /t/, no vibrations are felt.

 * Final consonant deletion – e.g. “ca” for “cat”

 -gone by 3 years, 3 months

 * Velar fronting – e.g.  “tey” for “key”

-gone by 3 years, 6 months

In the pattern shown above, the child is substituting /t/, a sound made at the front of the mouth for /k/, a sound made at the back of the mouth.

 * Weak syllable deletion – e.g. “nana” for “banana”

-gone by age 4

In this pattern, the weaker, unstressed syllable is left out.

 * Cluster Reduction – e.g. “poon” for “spoon”

-gone by age 4

A cluster is two consonants together e.g. /sp/, /cl/, /tr/

 More examples of phonological processes and the ages at which they typically disappear can be found on Caroline Bowen’s website listed below.

 (Source:  Bowen, C. (1998). Speech and language development in infants and young children. Retrieved on (January 11, 2011) from http://www.speech-language-therapy.com/devel1.htm)

 If children continue to use these patterns beyond the age of four, there may be a concern.  Persistent errors may also put the development of reading and writing at risk; after all, you must be able to say it first, followed by being able to read it, then write it!  If you have concerns, a speech-language pathologist can help to determine if a child may be using phonological processes.

 (Next Month: Phonological Disorders)

Speech Matters November 2010

What is a Late Talker? – Speech Matters – November 2010

By Cheryl D. Lindsay MS., S-LP

 ‘Late talker’ is “a term used to describe children 18 to 20 months old, who have fewer than 10 words or those 21 to 30 months old, who have fewer than 50 words and no two-word combinations. Typically, these children have no other problems.” (Source:  Contemporary Pediatrics. “The ‘late talker’ – when silence isn’t golden”, by Marilyn C. Agin, MD, 2004)

 Speech and language developmental milestones have been presented here in previous columns. As speech is developing, it is important to recognize that a child will follow a certain order through the stages, but may be delayed at reaching the milestones. The stages begin with reflexive sounds; cooing, (first using vowels); babbling, (reduplicated e.g., “mama” and then variegated e.g., “baba beee-ummm gubba dum-goo-ee?”); vocal play; jargon; first words and then putting two-words together. When the order of development is not typical, or where there is regression in some areas, there may be reason for concern. A speech-language pathologist can help by assessing your child’s speech and language development.

 Although most late talkers do eventually “catch up” and speak normally, it is wise to be aware of warning signs that may indicate a disorder rather than a delay.

Sometimes talking late may be a symptom of another condition such as a hearing loss, cognitive impairment, speech disorder, (dysarthria, apraxia, phonological disorder), language disorder, autism spectrum disorder, or another syndrome. These conditions would be diagnosed by the appropriate medical professional. If late talking is not just delayed but a symptom of another condition, it will not resolve itself, therefore, early diagnosis and early intervention are necessary.

 Receptive language, which is comprehension or understanding, develops before expressive language. An example of this would be asking your child to put on their winter coat and they do so because they understand the request, but are unable to use vocalizations to express themselves. If a child’s receptive language is delayed, this would be cause for concern.

 Children can still communicate without words or nonverbally, by using eye-contact, gestures, body language, facial expression, shaking or nodding their head for yes or no, or hand leading.  Ultimately though, encouraging vocalizations with these initial nonverbal skills should lead to using true words and more verbal communication.

 Late talking may result in the experience of frustration for the child and the caregiver. It is important to stay positive and encourage good self-esteem. Think of your child as ‘learning to talk’ rather than ‘being expected to talk’ and celebrate every small step!

 (Next Month:  Phonological Processes – A child’s normal patterns for simplifying adult speech)

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