Amherst County Public Schools



Articulation/Phonological Disorders and ApraxiaChildren with difficulty producing speech sounds can receive services based on whether their errors are developmental or not. Speech-language pathologists evaluate children to determine if the sounds the child is making are acceptable for their age. We use information based on research to determine at which age a child should have certain sounds. If the child is not producing a sound by a particular age, and their is no structural reason for the difference, we will usually treat the child by engaging in activities that will improve their perception of the error sound. Articulation disorders can be the result of many different factors. Sometimes the cause of the disorder is relatively clear and straightforward, but most of the time speech-language pathologists develop hypotheses based on the child's history, the evaluation and clinical observations. Speech sounds are the product of the coordination of multiple articulators. On a physical level, in order to produce any speech sound, a person must coordinate breathing with the movement of sound through the larynx and into the mouth or the nose (m, n, ng sounds). Once the sound is in the mouth it is further shaped by the movement of the tongue, teeth and lips.Apraxia is a motor disorder in which volitional or voluntary movement is impaired without muscle weakness. The ability to select and sequence movements is impaired. Oral apraxia affects one ability to move the muscles of the mouth for non-speech purposes. Someone with oral apraxia would have trouble coughing, swallowing, wiggling their tongue or blowing a kiss when asked to do so. Verbal apraxia, or apraxia of speech is an impairment in the sequencing of speech sounds. Apraxia is different from dysarthria in that there is no muscle weakness. The errors heard in dysarthric speech and usually consistent and predictable, while errors in apraxic speech are unpredictable. Apraxic speakers "grope" for the correct word; they may make several attempts at a word before they get it right.Developmental apraxia of speech (DAS) is not well understood. This is a disorder that occurs in children and is present from birth. There are no specific lesion sites in the brain in cases of developmental apraxia; acquired apraxia can be linked to specific lesion sites. When children do not develop speech normally and are unable to produce consonant sounds, they may be apraxic. It is difficult to diagnose as expressive language impairment may cloud the issue. Young children only use a few words at at time and it has been argued that delays in language expression can disrupt a child's ability to gain voluntary motor control over their speech muscles. Some children with DAS have generalized incoordination.Voice Therapy and AssessmentMost changes in the voice result from a medical disorder. Failure to seek a physician’s care (ENT-Ear, nose and throat doctor) can lead to hoarseness and more serious problems. They include:Laryngitis Vocal cord lesions Gastroesophageal reflux disease and laryngopharyngeal reflux disease Poor speaking technique Vocal cord paralysis Throat cancer Therapy provided by an SLP for voice disorders includes the following:Providing the patient with specific information on the type of problem or vocal instrument abnormality present, and the most likely causal factors. Providing the patient with specific information on how the above is/are interfering with normal voice production. Describing the interactive function of the breathing and speech systems to produce normal voice. Assigning the patient out-of-clinic activities designed to make them aware of their daily vocal use. Identifying daily vocal abuse patterns and working on strategies to eliminate them. Implementing strategies to establish more appropriate daily vocal hygiene and vocal health. Specific work on elimination of vocal muscle tension. Specific work on establishing appropriate breath support and speech breathing patterns.Language Therapy and AssessmentA language disorder is an impairment in the ability to understand and/or use words in context, both verbally and nonverbally. Some characteristics of language disorders include improper use of words and their meanings, inability to express ideas, inappropriate grammatical patterns, reduced vocabulary and inability to follow directions. One or a combination of these characteristics may occur in children who are affected by language learning disabilities or developmental language delay. Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate. Speech-language pathologists assist children who have communication disorders in various ways. They provide individual therapy for the child; consult with the child's teacher about the most effective ways to facilitate the child's communication in the class setting; and work closely with the family to develop goals and techniques for effective therapy in class and at home. Technology can help children whose physical conditions make communication difficult. The use of electronic communication systems allow nonspeaking people and people with severe physical disabilities to engage in the give and take of shared thought.Auditory Processing and Comprehension DeficitsAuditory processing is a term used to describe what happens 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. APD goes by many other names. Sometimes it is referred to as central auditory processing disorder (CAPD).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.What are the symptoms of possible auditory processing difficulty?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 What treatments are available for auditory processing difficulty?Much research is still needed to understand APD problems, related disorders, and the best intervention for each child or adult. Several strategies are available to help children with auditory processing difficulties. Some of these are commercially available, but have not been fully studied. Any strategy selected should be used under the guidance of a team of professionals, and the effectiveness of the strategy needs to be evaluated. Researchers are currently studying a variety of approaches to treatment. Several strategies you may hear about include:Auditory trainers are electronic devices that allow a person to focus attention on a speaker and reduce the interference of background noise. They are often used in classrooms, where the teacher wears a microphone to transmit sound and the child wears a headset to receive the sound. Children who wear hearing aids can use them in addition to the auditory trainer. Environmental modifications such as classroom acoustics, placement, and seating may help. An audiologist may suggest ways to improve the listening environment, and he or she will be able to monitor any changes in hearing status. Exercises to improve language-building skills can increase the ability to learn new words and increase a child's language base. Auditory memory enhancement, a procedure that reduces detailed information to a more basic representation, may help. Also, informal auditory training techniques can be used by teachers and therapists to address specific difficulties. Auditory integration training may be promoted by practitioners as a way to retrain the auditory system and decrease hearing distortion. However, current research has not proven the benefits of this treatment. Pragmatic Language DisordersPragmatics is the area of language function that embraces the use of language in social contexts (knowing what to say, how to say it, and when to say it - and how to "be" with other people). Children with pragmatic difficulties have great trouble using language socially in ways that are appropriate or typical of children of their age. They often do not understand that we take turns to talk, and they will "talk over the top of you" at times, or, at other times respond to what you say with inappropriate silences, or in a voice that is too quiet. They may interrupt excessively and talk irrelevantly or about things the listener shows no interest in. Their communicative behaviour often appears rude and inconsiderate.Pragmatics skills include:Knowing that you have to answer when a question has been asked; Being able to participate in a conversation by taking it in turns with the other speaker; The ability to notice and respond to the non-verbal aspects of language (reacting appropriately to the other person's body language and 'mood', as well as their words);Awareness that you have to introduce a topic of conversation in order for the listener to fully understand; Knowing which words or what sort of sentence-type to use when initiating a conversation or responding to something someone has said; The ability to maintain a topic (or change topic appropriately, or 'interrupt' politely); The ability to maintain appropriate eye-contact (not too much staring, and not too much looking away) during a conversation; and The ability to distinguish how to talk and behave towards different communicative partners (formal with some, informal with others).Hearing ImpairmentsThere are a few different types of hearing loss: conductive, sensory, mixed (conductive and sensory combined), and neural.Conductive hearing loss: This happens when there is a problem with a part of the outer or middle ear. Most kids with conductive hearing loss have a mild hearing loss and it is usually temporary because in most cases medical treatment can help.Sensory hearing loss: This happens when the cochlea is not working correctly because the tiny hair cells are damaged or destroyed. Depending on the loss, a kid may be able to hear most sounds (although they would be muffled); only some sounds; or no sounds at all. Sensory hearing impairment is almost always permanent and a kid's ability to talk normally may be affected.Neural hearing loss: This happens when there is a problem with the connection from the cochlea to the brain. Neural means related to nerve, so neural hearing loss means the nerve that carries the messages from the cochlea to the brain is damaged.Children with hearing loss may attend a special school, special classes within a regular school, or may be part of a regular classroom. Depending on how severe their hearing loss is, some kids may work with audiologists or speech-language pathologists to help them develop their hearing and speaking skills. Some people with hearing loss may need to use special techniques like these to communicate:Speechreading: Involves looking closely at a person's lips, facial expressions, and gestures to help figure out spoken words. American Sign Language, or ASL: Language of hand movements that allows deaf people to communicate with one another without speaking. Auditory Verbal Therapy: Auditory-Verbal therapy is a specialized type of therapy designed to teach a child to use the hearing provided by a hearing aid or a cochlear implant for understanding speech and learning to talk. The child is taught to develop hearing as an active sense so that listening becomes automatic and the child seeks out sounds in life. Hearing and active listening become an integral part of communication, recreation, socialization, education and work. For more information, visit the following website . SLP’s also screen hearing, check hearing aids and other hearing devices (FM systems) and work with others to develop strategies to maximize the hearing impaired child’s performance. Oral-Motor DisordersWeaknesses in the tongue, lips and or jaw can decrease the clarity of speech. SLP’s often employ oral activities such as blowing bubbles and whistles, using straws and chewing gum to strengthen these muscles. Children may also demonstrate difficulties in coordination of movements and range of motion of structures in the mouth during speech. These difficulties are often associated with apraxia. Structural deficits (teeth, tongue, palate) should be addressed by a doctor first before speech therapy begins. Myofunctional DisordersChildren with myofunctional disorders typically demonstrate a tongue thrust when eating and a lisp when producing sounds such as “s”. Myofunctional problems are characterized by a flat, weak tongue that always pushes against the front teeth. Therapy focuses on reducing the tongue thrust which also reduces difficulties with speech. LINKS TO SITES FOR SPEECH AND LANGUAGEARTICULATION ................
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