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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
- Substitution of sounds (i.e. t for k, f for th,,
- Still unable to produce certain sounds at the age of 6
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.
Auditory Processing Disorders (APD)
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:
- 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
- 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
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.
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
- 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.
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 required with speech. 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. PediaSpeech therapists use a variety of treatment strategies to address CAS. See our Programs page for details.
Children with CAS typically exhibit the following characteristics:
- Understand more than they can express
- Will imitate gross vocalization (though that could be difficult in some cases)
- Difficulty combining sounds
- May show pauses between some sounds
- Use some spontaneous ‘pop outs’ more complicated words they have learned but cannot on demand
- May appear to be groping when attempting to produce sounds or coordinate the lips, tongue, and jaw for purposeful movement
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. The child’s food refusal is usually significant enough that it will cause significant disruption to family-life, especially at mealtimes. Feeding disorders can be caused by food allergies, by difficulty with the movement of the mouth or tongue (oral motor), sensory-based issues or a possible behavioral disorder. Feeding problems often occur in infant and children who are tube fed for extended periods of time due to some other illness or disability.
Characteristics of children with feeding disorders could include:
- Dysphagia, a real or imagined difficulty in swallowing
- Food refusal
- Taking too long to eat
- Choking, gagging, or vomiting when eating
- Inappropriate mealtime behavior
- Picky eating according to food type and texture
Cleft Lip and Palate
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.
Reading and Writing Disorders
Children who struggle with specific written language disorders typically have strong cognitive skills (IQ) but have trouble achieving grade-level expectations with their reading and writing skills. Many of these children have Dyslexia, a significant and statistical difference between their IQ and reading achievement. These children do not learn how to read as easily as their peers and often get frustrated at school or at home when required to read. Many of these children also demonstrate difficulty writing both grammatically and using appropriate vocabulary and semantically appropriate sentences and paragraphs. Most of our therapists use a combination of approaches to address these issues including Orton-Gillingham and Lindamood Bell.
Some characteristics of children with written language disorders include:
- Appears bright, highly intelligent, and articulate but unable to read, write, or spell at grade level.
- Labelled lazy, dumb, careless, immature, "not trying hard enough," or "behavior problem."
- Isn't "behind enough" or "bad enough" to be helped in the school setting.
- High in IQ, yet may not test well academically; tests well orally, but not written.
- Feels dumb; has poor self-esteem; hides or covers up weaknesses with ingenious compensatory strategies; easily frustrated and emotional about school reading or testing.
- Talented in art, drama, music, sports, mechanics, story-telling, sales, business, designing, building, or engineering.
- Seems to "Zone out" or daydream often; gets lost easily or loses track of time.
- Difficulty sustaining attention; seems "hyper" or "daydreamer."
- Learns best through hands-on experience, demonstrations, experimentation, observation, and visual
An oral-motor disorder is the difficulty of using the oral mechanism for functional speech, eating, blowing or making specific sounds. It is a muscle-based difficulty that impacts the children’s range of motion and strength of their lips, cheeks and/or tongue. One program that PediaSpeech clinicians use to remediate this disorder is Debra Beckman.
Characteristics of children with oral motor disorders include:
- Low Muscle tone in the face (i.e. “droopy face”)
- Open mouth posture/trouble keeping lips closed
- Tongue hangs forward
- 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 at our Atlanta location 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.
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.
For information about some of the approaches we use for these and other disorders, see our Speech Programs page.