		Auditory Processing/ Reading Disorders		Feeding Disorders
		Sensory Processing Disorders		Augmentative Communication
		Feeding & Oral Motor Disorders		Learning Disabilities
		Articulation Disorders		Physical Disabilities
		Language Disorders		Apraxia
		Oral Motor Disorders		Autism
		Cleft Lip & Palate

A child with an articulation (speech sound) disorder has difficulty producing individual speech sounds or producing sounds correctly in words. There may be incorrect placement of the lips, teeth, tongue, or even soft palate during speech. This often affects the clarity of speech.

Speech sounds develop gradually over time, but most sounds should be correctly produced by the age of 3, and all sounds should be correctly produced by the age of 6. Below are common symptoms of an articulation disorder.

Early feeding problems
Lack of cooing with vowels at 2 to 3 months of age
Lack of babbling using consonant sounds (particularly /b/,/m/,/d/,/n/) by 6 to 7 months
Use of mostly vowel sounds and gestures for communication after the age of 18 months
Unclear speech at the age of 3
Omission of consonants in words at the age of 3
Still unable to produce certain sounds at the age of 6

The following speech sound (articulation) errors can occur:

Sounds in words and sentences are completely omitted: "I go o coo o the bu" for "I go to school on the bus."
An incorrect (usually easier) sound is substituted for the correct one: "I saw a wittle wamb" instead of "I saw a little lamb."
Sounds are distorted: a slushy sound occurs on /s/ sounds.
Extra sounds or syllables are added to a word: "animamal" for "animal."
There is slow, slurred speech.

Children are diagnosed with a language disorder when they have ongoing difficulty with the meaning of words or sentences (semantics), with word order or grammar (syntax), or with the social rules of language and conversation (pragmatics).

A language disorder can be characterized by any of the following:

Poor eye contact or attention to the speech of others by 4 months
Absence of gestures at the age of 6 to 8 months
Difficulty understanding the speech of others or following simple directions at the age of 12 months
Absence of words or limited vocabulary at 16-18 months
Absence of two-word combinations by 24-26 months
Echoing words or phrases at age 3
Use of incomplete sentences by age 3
Inability to retell stories or talk about past events at age 3 to 4
Difficulty with attention, memorization of facts, learning, or reading at age 6 to 7.

The term "feeding disorder" refers to a condition in which an infant or child is unable or refuses to eat, or has difficulty eating, which can result in frequent illnesses, failure to grow normally, and even death. Feeding disorders should not be confused with eating disorders, such as anorexia, which are more common in adolescence and adulthood. Some common types of feeding disorders in children include:

Dysphagia, a real or imagined difficulty in swallowing
Food refusal
Inability to self-feed
Taking too long to eat
Choking, gagging, or vomiting when eating
Inappropriate mealtime behavior
Picky eating according to food type and texture

Approximately 25% of all children experience feeding disorders. However, they are most common in children with developmental disabilities. There are many medical conditions that can cause feeding problems. Feeding problems often occur in infant and children who are tube fed for extended periods of time due to some other illness or disability. In premature infants, the underdeveloped sphincter muscle, between the stomach and esophagus, can cause the infant to spit up frequently during feedings. Because this is uncomfortable for the child, he or she may not want to eat. Feeding disorders can be caused by food allergies, by difficulty with the movement of the mouth or tongue (oromotor), or may be a cry for attention by a neglected child or a child with a behavioral disorder.

A feeding disorder is diagnosed when an infant's or child's continuing failure to eat causes inadequate weight gain or significant weight loss over at least a one-month period and there is no known medical condition or withholding of food that would cause the failure to eat.

An Oral-Motor Disorder is an inability to use the oral mechanism for functional speech or feeding, including chewing, blowing, or making specific sounds.

Oral-motor disorders are diagnosed by the SLP directly observing the child, doing what is called an "Oral-Motor Exam". In this exam, the therapist asks the child to do a variety of tasks (such as pursing lips, blowing, elevating tongue, etc), looks inside the child's mouth, observes the child eating and listens to the child talk. The therapist will also listen for the child's ability to produce rapid oral movements. The SLP will determine how "intelligible" the child is (how much of what the child says can other people understand?), and may complete a formal speech test.

Some children with oral-motor disorders are considered to be orally hyper-sensitive or to have tactile defensiveness. These children tend to have very rigid lips, and appear to be tight around their mouths. They may hate having their teeth brushed, dislike many foods, and get upset when their mouths are touched. Other children are hypo-sensitive. These children may drool, because they have weak lip muscles. They may also stuff food in their mouths until they gag or choke; these kids don't have normal sensation in their mouths and it takes a lot of food before they realize their mouth is full. These type of children need to develop more normal sensitivity. A SLP can work with these children, using a variety of exercises designed to normalize sensitivity. These can include deep touch (for the hypo-sensitive child), chewing exercises, blowing a variety of whistles, working with straws, and more. Talk Tools Oral Motor Program developed by Sarah Rosenfeld- Johnson, is one of the methods used at PediaSpeech Services. If these children have multiple speech production errors, the SLP includes oral-motor exercises in every therapy session, and match the oral-motor exercise to the sound being targeted. For example, if the child has weak lip closure (tapping on the upper lip, drinking from a straw, blowing a whistle), then immediately working on words starting with [p],[b],or [m]. This way the exercise directly relates to the speech sound.

The most important thing to remember about speech production disorders is that therapy can, in most cases, make a huge difference. The earlier and more intensive the intervention, the more successful the therapy.

Signs and Symptoms

Low muscle tone in the face (i.e. "droopy face")
Open mouth posture/Trouble keeping lips closed
Tongue hangs forward
Drooling
Speech sounds are unclear/Makes speech sound errors
Leaves food in cheeks after eating or does not chew it up well
Teeth grinding
Oral defensiveness (i.e. Will not let you touch their face or doesn't like food on it)
Oral Hyposensitivity (i.e. crave sensory input so will mouth non-edible objects such as toys and clothes etc, to increase awareness in the mouth)
Difficulty moving tongue side to side, up and down, or point it outside of the mouth
Head does no move independently of the tongue (i.e. when move tongue side to side the head goes with it)
Bites on fork/spoon/straw when eating/may bite on a horn while blowing
Feeding problems

We have AAC specialists offering evaluation and consultative services to parents and therapists of children needing high and low-tech devices. Specific device demonstrations available in conjunction with DynaVox Electronics and Dunamis AAC Products.

Augmentative and alternative communication (AAC) refers to ways (other than speech) that are used to send a message from one person to another. We all use augmentative communication techniques, such as facial expressions, gestures, and writing, as part of our daily lives. In difficult listening situations (noisy rooms, for example), we tend to augment our words with even more gestures and exaggerated facial expressions.

People with severe speech or language problems must rely quite heavily on these standard techniques as well as on special augmentative techniques that have been specifically developed for them. Some of these techniques involve the use of specialized gestures, sign language, or Morse code. Other techniques use communication aids, such as charts, bracelets and language boards. On aids such as these, objects may be represented by pictures, drawings, letters, words, sentences, special symbols, or any combination thereof.

Electronic devices are available that can speak in response to entries on a keyboard or other methods of input. Input can come from any number of different switches that are controlled with motions as simple as a push of a button, a puff of air, or the wrinkle of an eyebrow. The possibilities increase virtually every day! Augmentative communication users don't stop using speech! When speech is used with standard and special augmentative communication, not only does communication increase, but so do social interactions, school performance, feelings of self-worth, and job opportunities.

A child with an auditory processing disorder (APD) has difficulty processing or interpreting auditory information. This is a common disorder in children, even in those children with normal hearing abilities and normal intelligence.

A child with an auditory processing disorder may have difficulty understanding speech in the presence of background noise, such as a noisy classroom. The child may be unable to understand and follow spoken directions. The child may have difficulty discriminating and identifying individual speech sounds.

Some symptoms of APD are as follows:

Behaving as if a hearing loss is present, even though hearing sensitivity is known to be normal
Requiring frequent repetitions - saying "what?" or "huh?" or "I didn't hear you"
Having difficulty paying attention to auditory tasks and/or being easily distracted by background noise
Having difficulty following complex or multi-step directions; having difficulty being able to localize sound
Having difficulty with phonics or speech sounds
Possessing poor reading, listening, or spelling skills
Turning in a below-average academic performance despite normal I.Q. scores
Showing a speech and language delay that is not improving despite therapy
Having a short attention span
Showing delayed responses to auditory information

Treating Language-Based Reading Disorders

Speech Pathologists are uniquely qualified as sound and language specialists to train written language skills. Our Speech-Language Pathologists (SLPs) are trained using a combination of skills derived from Orton-Gillingham instruction, and Lindamood-Bell Training, cogitative retraining, and behavioral intervention.

We believe in a team approach to curing reading disorders. We believe in including child, parents, teachers, other therapists, and physicians. We go to many locations in the Atlanta area to help children where they need it most - in the academic setting.

Orton-Gillingham Instruction

Orton-Gillingham is a phonetically based, structured approach effective in teaching reading, spelling, and writing of dyslexic students. Sound systems are taught employing all of the learning pathways--auditory, visual, activity based, and tactile.

The Orton-Gillingham curriculum teaches, at appropriate developmental times, phonograms for decoding and encoding spelling rules and generalizations, writing, and syllable types.

Lindamood-Bell Training

Individuals become aware of the mouth actions which produce speech sounds. This awareness becomes the means of verifying sounds within words and enables individuals to become self-correcting in reading and spelling, and speech.

It is common for individuals to gain several grade levels in decoding ability in four weeks to six weeks of intensive instruction, or to make further gains in speech-language after hitting a plateau under traditional speech therapy.

Childhood Apraxia of Speech (CAS) is a motor speech disorder. Children with CAS have great difficulty planning and producing the precise, highly refined and specific series of movements of the speech mechanism.

Most children who are diagnosed with CAS have receptive (or understanding) skills within normal limits. These children perform much better when asked to repeat simpler motor sounds, such as vowels or consonants in isolation. When asked to repeat a succession of vowels and consonants, many children with CAS have difficulty. more

Approaches to Treating Apraxia

Our therapists at PediaSpeech are trained using multiple methods for treating apraxia including P.R.O.M.P.T. (Prompts for Restructuring Oral Motor Phonetic Targets) and the Kaufman Speech Praxis Treatment Technique.

All of the techniques used at PediaSpeech include a motor hierarchy that builds on the individual child's skill level. This method allows the child to build confidence in their speech and therefore, they want to learn more.

Autism is a complex developmental disability that typically appears during the first three years of life. The result of a neurological disorder that affects the functioning of the brain, autism impacts the normal development of the brain in the areas of social interaction and communication skills. Children and adults with autism typically have difficulties in verbal
and non-verbal communication, social interactions, and leisure or play activities.

Autism is a spectrum disorder. The symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe. Although autism is defined by a certain set of behaviors, children and adults can exhibit any combination of the behaviors in any degree of severity. Two children, both with the same diagnosis, can act very differently from one another and have varying skills.

People with autism process and respond to information in unique ways. In some cases, aggressive and/or self-injurious behavior may be present. Persons with autism may also exhibit some of the following traits.

Insistence on sameness; resistance to change
Difficulty in expressing needs; uses gestures or pointing instead of words
Repeating words or phrases in place of normal, responsive language
Laughing, crying, showing distress for reasons not apparent to others
Prefers to be alone; aloof manner
Tantrums
Difficulty in mixing with others
May not want to cuddle or be cuddled
Little or no eye contact
Unresponsive to normal teaching methods
Sustained odd play
Spins objects
Inappropriate attachments to objects
Apparent over-sensitivity or under-sensitivity to pain
No real fears of danger
Noticeable physical over-activity or extreme under-activity
Uneven gross/fine motor skills
Not responsive to verbal cues; acts as if deaf although hearing tests in normal range.

There are many myths and misconceptions about autism. Contrary to popular belief, many autistic children do make eye contact; it just may be less or different from a non-autistic child. Many children with autism can develop good functional language and others can develop some type of communication skills, such as sign language or use of pictures. Children do not "outgrow" autism but symptoms may lessen as the child develops and receives treatment.

Learning Disabilities affect the brain’s ability to receive, process, analyze, and store information. This type of disability can make it difficult for a child to learn as quickly as someone who is unaffected by a learning disability.

There are many different types of learning disabilities. Most types fall into two categories: verbal and nonverbal. Children with verbal learning disabilities may have trouble with words, both spoken and written. Our Speech Therapists would be able to help treat and remediate verbal learning disabilities. Children with nonverbal learning disabilities may have difficulty processing what they see. Our Occupational Therapist can help your child improve nonverbal learning disabilities.

Learning disabilities are diagnosed by a physician at the M.D. or Ph.D. level and are treated by therapists. Speech therapy and Occupational therapy can aid children with learning disabilities and teach strategies that will help accomplish their goals and dreams.

Physical disabilities include a wide range of disabilities and health issues. They can be either congenital or acquired. Physical disabilities interfere with a child’s ability to attain the same developmental milestones as other children his or her age.

If appropriate, our Occupational Therapist can assist in addressing many of these issues and teach strategies that will help children with physical disabilities accomplish their goals and dreams.

Sensory Processing (sometimes called “Sensory Integration”) refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses.

A child with SPD finds it difficult to process and act upon information received through the senses. This can create everyday problems such as: motor clumsiness, behavioral problems, anxiety, depression, school failure, and other impacts if not treated effectively.

A referral for an occupational therapy evaluation may be necessary if your child has difficulties in several of the areas listed below or major functional problems in one area.

Unusually fussy, easily startled, or difficult to console as an infant
Slow to achieve motor milestones, such as rolling over, creeping, sitting, standing, or walking
Strongly dislikes and protests baths, hair washing, haircutting, or nail cutting
Uses inappropriate amounts of force when handling objects, coloring, writing, or interacting with friends, sibling, or animals
Leans on people, slumps when sitting, tires/fatigues easily, has poor muscle tone
Falls frequently, bumps into furniture or people, is clumsy, or has difficulty judging position of his/her body in relation to space

Cleft lip and palate are the most common birth defects in the United States with one out of every 600 newborns being affected.

Speech pathology services are frequently necessary before and after surgery and/or prosthetic management to help children learn to use oral pressure sounds and to remediate maladaptive and/or compensatory misarticulations that may arise.

It is important that children with clefts and other craniofacial disorders are followed by therapists trained in working with the specialized techniques related to treatment of this population in order to maximize progress in a timely manner.

Our Speech-Language Pathologists are trained to work with clefts and other craniofacial disorders.

PediaSpeech offers the Fast ForWord programs, a research-based computer program that develops brain processing efficiency through intensive, adaptive software exercises.