Professional Therapy Providers

Articulation Disorders
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.

• 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.

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Language Disorders
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.
• Absence of gestures.
• Difficulty understanding the speech of others or following simple directions.
• Absence of words or limited vocabulary.
• Absence of two-word combinations.
• Echoing words or phrases.
• Use of incomplete sentences.
• Inability to retell stories or talk about past events.
• Difficulty with attention, memorization of facts, learning, or reading.
• Poor topic maintainence

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Oral Motor Disorders
An Oral-Motor Disorder is an inability to use the oral mechanism for functional speech. Oral-motor disorders are diagnosed by the Speech and Language Pathologist 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 Speech and Language Pathologist 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 Speech and Language Pathologist 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. If these children have multiple speech production errors, the Speech and Language Pathologist 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).

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Learning Disabilities
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.

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Autism
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.

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Apraxia
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. All of the techniques used at Professional Therapy Providers 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.

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Disfluency
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, they successfully complete the word.
• "SSSS ave me a seat." Sound prolongation: The person is having difficulty moving from the "s" in "save" to the remaining sounds in the word. They continue to say the "s" sound until they are 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, they produce several interjections until they are able to say the word "around" smoothly.

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