Pediatric services- Making The Mind/ Communication Connection

 

Articulation

 

Children are actually developing precursor articulation skills within their first six months.  During that time, they are listening to sounds and words around them, and playing with their own mouths to see what happens when they use various parts of their speech mechanism.

 

Later, children begin to learn how to use their tongue, jaw, lips, 'teeth' and voice box to intentionally reproduce sounds they hear from parents, sibs, and peers.  You'll remember your toddler making 'silly' sounds with peals of laughter.

 

Sometimes children have difficulty making movements with their articulators to reproduce sounds of their language. If you know anyone who cannot make their mouth (lips, jaw, tongue, soft palate) whistle particular notes of a song, it is a similar issue. Articulation issues can result from auditory (listening) issues or from muscle (movement) issues.

 

At GLSA we identify the best approach to help children produce sounds alone, in words, phrases and then sentences.  With older students it is a direct approach; with younger children a series of approximations toward consistent movements for vowels and consonants. Dr. Lybolt has developed articulation treatments for older clients that focus on building muscle awareness and motor memory for speech sounds.  With these techniques, clients often produce correct sounds within the first session; then treatment can focus on solidifying monitoring, transferring and self-correction skills. 

 

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Language Issues

 

The process of speaking in sentences is so complex it is a wonder that any of us can speak.  In addition to making speech sounds (typically at a rate of about 10 per second even when speaking slowly), children must learn to understand the meaning of words just by listening.  They listen to learn that words have different meanings depending on the context in which they are spoken. “Now!” (Dad is running out the door…) does not mean the same as “nooow” (when you've given permission to eat the marshmallow.) They learn (not by memorizing!!) by listening how words are assembled grammatically and meaningfully to form phrases and sentences.  They learn to watch listeners and situations to be able to say the …. right idea, in the right format, at the right moment... to be a speaking partner. 

Sometimes children have difficulty learning purely by listening...interpreting, choosing, and sequencing words in phrases.  Parents, with the speech/language pathologist, and use toys, books, play and role-play to isolate areas of difficulty, practice language and speaking skills together, and get reinforcement that shapes specific areas of difficulty.

Initial sessions evaluate what is difficult for the child, what skills are present, which need specific support, and what reinforcers will support a child's development. Then, with parents, a treatment plan is outlined; parents participate in sessions and learn how to practice at home, and learn particular areas that they can readily reinforce with books, conversations, and play.

 

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Fluency

 

Research has still not provided a specific reason for the appearance of stuttering in children. There is a great deal that is known about what can ease or aggravate stuttering for different children.  Time pressures, complexity of language, normal social pressures, having a close relative who has difficulty with stuttering....all these may contribute to fluency issues. 

 

When parents are concerned about repetitions or blocks in their child's speech an initial evaluation can help determine

1. Whether the frequency of dysfluency
2. The quality (type) of dysfluency
3. The overall interference in communication are an issue

 

Three general approaches are available:

1. Observe the child and provide parents strategies to ease dysfluent episodes
2. Provide a series of parent sessions to teach parents strategies specific to change situations that provoke dysfluency
3. More direct treatment sessions with child and parents to address specific stuttering behaviors

 

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Myofunctional Swallowing Disorders

(Tongue thrust)

 

Orthodontists often refer some clients as part of their treatment process.  Some clients push their tongue against or between their incisors when they swallow.  When this swallowing pattern continues after completion of dental arch realignment, your orthodontist may determine that the tongue pressure will force teeth out of their new alignment.  Our Myofunctional treatment includes an initial assessment to determine the extent of the problem and suitability/timing for treatment.  The treatment process lasts from 8 to 10 weekly sessions (depending on the consistency of client practice between visits.  After the final session, follow-up visits are scheduled from one to three months apart to ensure continuity.

 

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Effective Teen Communication

(Presentations and Interviews)

 

High school students often have difficulty pulling together the skills they need for effective presentations, interviews and self-advocacy. There may be concerns about..... effectively listening to their conversational partner, answering a question completely, providing sufficient (but not too much) detail, speaking with tone, projection, and engaging so that their message is heard and processed by classmates, teachers, or adults. 

 

We teach students to communicate using speech goals (easy to remember cues for clarity). They learn to listen for the key word or idea in their partner's question to frame their answer.  Students learn that speaking with tone, body language and phrasing do make a positive impact on their listener.    

 

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Vocal Cord Sports Breathing Dysfunction (VCD)

 

Vocal cord dysfunction is a condition in which athletes have difficulty breathing, with spasm-like behaviors that affect their performance.  Typically, we see clients after asthma or other disease processes have been ruled out. Athletes who 'put-their-all into performing, at any level of skill, may develop this debilitating condition.  Our referrals from athletic trainers, pulmonologists, or allergists are evaluated with respect to breathing; specific strategies for managing laryngeal spasms typical for this condition are taught to clients, resulting in an ability to anticipate, manage and reduce laryngeal spasms during athletic competition.

 

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Cleft Palate Articulation Treatment

 

Children with a cleft palate frequently have difficulty with articulation due to soft palate insufficiency, dental configuration, fistulas in the hard palate, mandible/maxilla displacement, and structural issues.  Surgeries that begin close to birth can approximate normalized structures; if there is a habituated pattern of misarticulation developed before surgery, speech therapy may be necessary.  Speech therapy to teach compensatory techniques for the current structural configuration is possible.  Effective speech therapy maps goals to current structures and does not attempt to teach what a child's structures cannot support.