FREQUENTLY ASKED QUESTIONS ABOUT PEDIATRIC SPEECH LANGUAGE PATHOLOGY
1. What is a Speech-Language Pathologist and is it different from a Speech Therapist?
A Speech-Language Pathologist has received his or her Certificate of Clinical Competence (CCC) as a Speech Language Pathologist (SLP). A Speech-Language-Pathologist provides services to individuals with a variety of communication challenges These areas of service can be broken down into categories: speech disorders, feeding and swallowing disorders, language based disorders, pragmatic communication disorders, voice disorders, and fluency disorders. Speech Language Pathologist work in a variety of settings, including; yet not inclusive to schools, hospitals, homes, private practices, long-term care facilities, and outside social settings. The terms Speech-Pathologist and Speech Therapist are often utilized to refer to a Speech-Language-Pathologist. In schools many a time children will refer to their therapist as a Speech Therapist; however, the official title is Speech-Language-Pathologist.
2. Is my child too young to begin treatment? How will they learn all of this - being so young? I would also like some developmental norms and how I can help my child.
Pediatric Speech and Language Pathologists assist children with communication challenges from infancy through teen years. Most younger children are truly like sponges. They love to learn and to play and by combining these two actively together in therapy, your child should not only have fun, they will also be engaging in new language learning experiences. In addition, your child will likely be looking forward to going back to therapy. Depending on your child’s needs, a certain age time frame may be appropriate. First, you may want to look at some developmental norms and discuss your child’s candidacy for treatment with your pediatrician if it is suggested.
Click here to view the developmental norms from the “How Does Your Child Hear and Talk?” chart from the American Speech Language Hearing Association.
3. My son is stuttering all of the time. He is five. Is this okay?
When a child is demonstrating dysfluent speech between the ages of two and six years it may be typical. In addition, dysfluencies may heighten and be episodic during periods of verbal growth or challenges with verbal organization. If these types of fluencies exist you may want to discuss it with your pediatrician or a Speech Language Pathologist for monitoring. However, if a child is demonstrating verbal dysfluencies along with any facial or body tension, blocks, grimacing, breathing disruptions, or other secondary behaviors it is advised that you meet with a Speech Language Pathologist on a more immediate basis.
4. What does expressive language disorder mean?
An expressive language disorder involves one’s abilities to express his or her thoughts through spoken or written words, including the ability to organize, to retrieve, to generate, and to produce fluent expressive language.
5. What does receptive language disorder mean?
Receptive language involves all of the skills related to understanding language. A child with a receptive language disorder may have challenges with the ability to attend to, to process, to comprehend, to interpret, or to retain spoken language.
6. My child was diagnosed with a Pragmatic Disorder, what do I do next? Is this a really long term problem? How worried should I be?
Children may speak quite eloquently and utilize expansive sentence structures; yet they may still have a communication challenge. When a child does not master the rules of social language, they may have a pragmatic language disorder. For example, your child may have challenges with utilizing language for specific purposes such as when greeting others, when informing others, or when making requests. It is also possible that a child may struggle with language flexibility in relationship to changes with communicative partners, listening contexts, and in different social/home/academic environments. In addition, there are also many rules to follow in conversations, when storytelling, and recounting events. Children need to learn how to take turns verbally and they need to gain experience with initiating topics and with maintaining and varying appropriate topics. They also need to understand nonverbal language cues and to utilize these cues in changing environments. Some children need extra practice with learning how to navigate their own facial expressions and nonverbal responses to others.
“It is not unusual for children to have pragmatic problems in only a few situations. However, if problems in social language use occur often and seem inappropriate considering the child's age, a pragmatic disorder may exist. Pragmatic disorders often coexist with other language problems such as vocabulary development or grammar. Pragmatic problems can lower social acceptance. Peers may avoid having conversations with an individual with a pragmatic disorder.” (www.ASHA.org)
Dear Parent - By taking the first step of having your child undergo an assessment of his or her language skills and by receiving this diagnosis, you have already worked towards assisting your child with improving upon his social language development. Yes, sometimes pragmatic communication difficulties can be considered longer terms challenges; however, this very much depends on your child’s current diagnosis and their current levels of communication challenges and or other impairments. In addition, one must take into consideration the level of desire that the individual child has towards improving their skills as well as their likely emerging skills regarding perspective taking. By providing your child with services appropriate to their needs in what may be an “at first more intensive basis”, it is likely that your child will be more successful in the future. A variety of therapists and professionals may work with your child on these skills. For example if your child is having more trouble with self-regulation or sensory challenges, they may work with an Occupational Therapist in addition to a Speech and Language Pathologist. Sometimes psychological services or behavioral services are recommended as a core treatment. Many families attempt to find the best of both worlds by working with a Speech and Language Pathologist in individual or small group settings along with another specialist to conquer both communication, social, and emotional overlaps. With these supports, the children will likely gain the ‘social give and take’ that they need to become more confident and more related in their communication endeavors.
HERE ARE A FEW “PRAGMATIC LANGUAGE TIPS” TAKEN FROM THE AMERICAN SPEECH LANGUAGE HEARING ASSOCIATION’S WEBSITE WWW.ASHA.ORG:
Parents, caregivers, families, and teachers can help individuals use language appropriately in social situations ( pragmatics ). Some general suggestions to help develop skills in three major pragmatic areas are listed below.
USING LANGUAGE FOR DIFFERENT PURPOSES
Ask questions or make suggestions to use language for different purposes:
Comment: "What did you do?" ,"Tell me about..."
Request: "Tell your friend...", "What do you want?"
Question: "Ask me"
Respond to the intended message rather than correcting the pronunciation or grammar. Be sure to provide an appropriate model in your own speech. For example, if an individual says, "That's how it doesn't go," respond, "You're right. That's not how it goes."
Take advantage of naturally occurring situations. For example, practice greetings at the beginning of a day, or have the individual ask peers what they want to eat for dinner or request necessary materials to complete an project.
CHANGING LANGUAGE FOR DIFFERENT LISTENERS OR SITUATIONS
Role-play conversations. Pretend to talk to different people in different situations. For example, set up a situation (or use one that occurs during the course of a day) in which the individual has to explain the same thing to different people, such as teaching the rules of a game, or how to make a cake. Model how the person should talk to a child versus an adult, or a family member versus a friend of the family.
Encourage the use of persuasion. For example, ask the person what he or she would say to convince family members or loved ones to let him or her do something. Discuss different ways to present a message:
Polite ("Please may I go to the party?") versus impolite ("You better let me go")
Indirect ("That music is loud") versus direct ("Turn off the radio")
Discuss why some requests would be more persuasive than others
CONVERSATION AND STORYTELLING SKILLS
Comment on the topic of conversation before introducing a new topic. Add related information to encourage talking more about a particular topic.
Provide visual cues such as pictures, objects, or a story outline to help tell a story in sequence.
Encourage rephrasing or revising an unclear word or sentence. Provide an appropriate revision by asking, "Did you mean .... ?"
Show how nonverbal signals are important to communication. For example, talk about what happens when a facial expression does not match the emotion expressed in a verbal message (e.g., using angry words while smiling).
7. My pediatrician would like for my child, age 3, to be evaluated by a specialist to see if he has an Autism Spectrum Disorder. What would I be seeing as a parent if this were true?
As a parent you can look at your child’s current skills and you may also want to note your child’s language, play, sensory, motor, and learning histories. Here are some frames for you to consider:
Early on (12 months-18 months) your child may show signs of inattention and with the abilities to develop joint attention. For example, you may observe that your child utilizes a minimum amount of pointing to attain the attention of another. Eye contact is typically a big concern as well as the ability to maintain or track objects or people. Sometimes, patterns of repetition with activities or vocal repetitions are common early on. In addition, parents report a good deal of hypersensitivity to noises, smell, and touch. Visual stimulus is often most attractive to children with autism.
As children get a bit older (2-3 years of age) you may notice more challenges with clumsiness, fine motor abilities, or coordination in general (these skills may stand out more at this point). Rocking, tapping, hitting, scratching, or flicking may become more noticeable. You may also observe more verbal repetitions and specific repetitions related to favorite TV shows, videos, songs, or favorite sayings. Social concerns may begin to take its place in terms of your child’s ability to verbally and nonverbally interact with peers. In addition, you may notice that your child is increasingly sensitive in general.. crying often, screaming, and in general having less control over his/her emotions.
National Autistic Society
8. How long will therapy take?
This is probably one of the first questions every new parent asks and it is also one of the trickiest to answer. As we know, there are many variables that lead to therapy progress. Here are just a few things that help make therapy more successful:
positive energy and attention from the child
eagerness to learn and/or to play
having a therapist that matches your child’s energy levels and understands your child’s unique needs
families willing to practice and carryover new techniques on a frequent basis
known diagnosis and set treatment plan
acceptance of challenges with older children and abilities to self-monitor
acceptance of diagnosis and challenges from the parent’s perspective
After a diagnosis, what we like to do at Speech Therapy Networks is work with a child for approximately a month and then determine how the child is carrying over their newly learned skills. We also observe how the family is working together to help their child develop their skills and what impacts are causing the greatest successes versus the greatest challenges. In addition, we work to collaborate with other teachers and professionals that may be working with your child. After that point, a timeline can be discussed based on shorter and longer term objectives.
9. My daughter speaks Mandarin and English. Her nanny speaks Spanish and has broken English. Should we stop all languages except for English in the house??
In this practice we are recently seeing more children who have bilingual or trilingual language influences. Typically, these children continue to develop speech quite normally. However, learning two languages (or three) can often take a longer time. Still, early milestones such as speaking first words at approximately 12 months and using two word phrases before the age of two are expected. As children get older (4-6 years of age) we have sometimes observed that their comprehension falls above their abilities to express themselves equally between the two languages (this is only within this practice). At the same time therapists familiar with this practice have also discussed that as these children grow and become more comfortable with their communications, that they seem to catch up to their peers around the age of 7. Sometimes grammatical changes, particularly within question forms and with question responses can continue to be a bit of a challenge depending on what languages are spoken; yet these are often milder challenges and again, develop well typically.
To answer the last part of your question. No, please do not stop speaking your natural languages within your home. The suggestions are for you to speak your natural languages in an interchangeable manner. If your nanny speaks Spanish well; yet has "broken" English I would encourage her to speak her fluent Spanish; yet to utilize familiar English terms and sentences with your daughter.
10. Our youngest daughter who is 12 months keeps getting ear infections. Will this affect her ability to speak?
It is very difficult to have a child endure an ear infection and even worse for them to have to suffer through a few within a relatively short period of time. Yes, ear infections are common in children from birth to three years of age and the children are more inclined to getting ear infections. It is also true that your daughter is at a very influential age in relationship to speech production and sound discrimination and therefore it will be important to continue to discuss any fluid build up or hearing loss with your child’s pediatrician. Also an ear, nose, and throat specialist can be a ‘welcome ear’ to make sure that you are doing all of the things you need to be doing to prevent any further occurrences and to make your child more comfortable during an ear infection. This physician may also be able to better monitor your child’s needs to determine if tubes or other treatments are necessary.