Treatment and Evaluation for:

Articulation Disorder 


Involves problems making sounds. Sounds can be substituted, left off, added or changed. These errors may make it hard for a person’s speech to be understood. Most children make some mistakes as they learn to say new words. A speech sound disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should make the sound correctly. If your child has problems with speech articulation, his/her speech may be difficult to understand. Specific speech sound errors may include making a “w” sound for an “r” sound (e.g., “wabbit” for “rabbit”), an “f” for a “th” (e.g., “fum” for “thumb”), leaving sounds out of words (e.g., “nana” for “banana), or having a lisp.


Phonological Processes Disorder


Involves patterns of sound errors. For example, substituting all sounds made in the back of the mouth like “k” and “g” for those in the front of the mouth like “t” and “d” (e.g., saying “tup” for “cup” or “das” for “gas”). Another rule of speech is that some words start with two consonants, such as “school” or “spoon”. When children don’t follow this rule and say only one of the sounds (e.g, “cool” for “school” or “poon” for spoon), it is more difficult for the listener to understand the child. While it is common for young children learning speech to leave one of the sounds out of the word, it is not expected as a child gets older. If a child continues to demonstrate such speech error patterns, he or she may have a phonological process disorder.


Apraxia and Motor Speech Disorders


Children with apraxia of speech or other motor planning challenges have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis but because the brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.


For a younger child, some signs of motor planning challenges include: Does not coo or babble as an infant; First words are late, and they may be missing sounds; only a few different consonant and vowel sounds; Problems combining sounds; may show long pauses between sounds; Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often); May have problems eating.


For an older child some signs of motor planning challenges include: Makes inconsistent sound errors that are not the result of immaturity; Can understand language much better than he or she can talk; Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech; May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement; Has more difficulty saying longer words or phrases clearly than shorter ones; Appears to have more difficulty when he or she is anxious; Is hard to understand, especially for an unfamiliar listener; Sounds choppy, monotonous, or stresses the wrong syllable or word.


One of the most important things for the family to remember is that treatment of apraxia of speech takes time and commitment. Children with apraxia of speech need a supportive environment that helps them feel successful with communication.


Orofacial Myofunctional Disorder (OMDs)


OMDs are disorders of the muscles and functions of the face and mouth. OMDs may affect, directly and/or indirectly, breastfeeding, facial skeletal growth and development, chewing, swallowing, speech, occlusion, temporomandibular joint movement, oral hygiene, stability of orthodontic treatment, and more.


Signs of an Orofacial Myofunctional Disorder

  • Thumb sucking, Finger sucking, and Other Negative Oral Habits such as prolonged nail biting, pacifier use, nail biting 
  • Open bite or front teeth that stick out 
  • Mouth Breathing and Open Lips/Mouth Posture
  • Tongue Thrust for Speech and Speech Articulation Issues especially lisps and /r/
  • Tongue Thrust for Chewing and Swallowing
  • Incorrect Tongue Positioning at Rest
  • Atypical tongue placement/tongue protrusion
  • Drooling
  • Chewing and Eating Difficulties
  • Chewing with lips open
  • Sleep-Related Breathing Issues (including snoring and sleep apnea)
  • Bruxism (Clenching and Grinding)
  • Misaligned teeth
  • TMJ Dysfunction
  • Mouth, Face, and Jaw Muscle Problems and Pain
  • Orthodontic cases (including orthodontic relapse)
  • Neck/Shoulder tension and pain
  • Headaches 


Voice Disorders


Occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual’s age, gender, cultural background, or geographic location (Aronson & Bless, 2009; Boone et al., 2010; Lee et al., 2004). A healthy voice is clear, strong, and age/gender appropriate. A voice that sounds different may be a hoarse voice, nasal voice, lack of nasality (sounding like the person has a cold), or an overly loud voice. Voice differences can be due to reflux, structure abnormalities such as enlarged tonsils or adenoids, or poor habits/misuse of the voice.


Selective Mutism (SM)


An anxiety disorder whereby people are consistently unable to speak in specific situations (APA, Citation2013). It is when the child does not to speak in at least one social setting. However, the child can speak in other situations. Selective mutism typically occurs before a child is 5 years old and is usually first noticed when the child starts school. Failure to speak is not due to a lack of knowledge of, or comfort, with the spoken language required in the social situation and not due to a communication disorder.


Symptoms of selective mutism are as follows: 

  • Consistent failure to speak in specific social situations (in which there is an expectation for speaking, such as at school) despite speaking in other situations. 
  • May exhibit anxiety disorder (e.g., social phobia); excessive shyness; fear of social embarrassment; and social isolation and withdrawal.


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. 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.; “SSSSave 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.) In childhood, there are risk factors to predict whether stuttering may continue on its own.


Auditory Processing


Is when your brain recognizes and interprets the sounds around you. Humans hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. The “disorder” part of auditory processing disorder means that something is adversely affecting the processing or interpretation of the information. Children with APD often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example, the request “Tell me how a chair and a couch are alike” may sound to a child with APD like “Tell me how a couch and a chair are alike.” It can even be understood by the child as “Tell me how a cow and a hair are alike.” These kinds of problems are more likely to occur when a person with APD is in a noisy environment or when he or she is listening to complex information. Children with auditory processing difficulty typically have normal hearing and intelligence. However, they have also been observed to: Have trouble paying attention to and remembering information presented orally; Have problems carrying out multistep directions; Have poor listening skills; Need more time to process information; Have low academic performance; Have behavior problems; Have language difficulty (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language); Have difficulty with reading, comprehension, spelling, and vocabulary.


Expressive Language Disorder


Affects a child’s ability to express him/herself using spoken or written language. People with expressive language disorders may understand what is said to them or written in passages, but they have substantial difficulty communicating. They may have challenges using correct grammar/syntax, organizing their thoughts, sequencing information, telling stories, and explaining information. They have difficulty with language processing and the connection between words and ideas they represent. Some people may also have problems with pronunciation of words. People with Expressive Language Disorder may appear less capable than they really are because they cannot effectively express themselves.


Receptive Language Disorder



Is a type of learning disability affecting the ability to understand spoken, and sometimes written, language. Students with receptive language disorders often have difficulty with speech and organizing their thoughts, which creates problems in communicating verbally with others and in organizing their thoughts on paper. People with receptive language disorder may have difficulty understanding spoken language, responding appropriately, or both. Problems may including difficulty following directions, remembering the sequence of information, understanding stories and general listening skills.