SPEECH-LANGUAGE THERAPY

 

Some children have difficulty pronouncing sounds; others have difficulty understanding the words they hear. Since 1987, SPS has been helping children do both— that is, helping them communicate more effectively.

Others have difficulty properly using vocabulary and grammar to clearly express ideas. For many children and adolescents, following oral directions, understanding questions, and learning new words and concepts are a challenge. Early intervention during a child’s formative stages can be critical to his or her success in communication.

SPS works from a family-centered model and routinely involves the parents as partners. We do that not only through such programs as Toddler Talk, but also through continuous and scheduled communication with the family and with medical and educational professionals involved in the child’s life.

Early Speech and Language Milestones

By ten to 13 months of age, a child should say his first words.

By 18 months, he should have a vocabulary of ten to 20 words and be able to name many common objects, as well as follow one-step directions and play “pretend.”

By 24 months, children should have a vocabulary of 50 to 100 words and be able to combine them into short phrases. They also begin to identify body parts.

At 36 months, a child should have a vocabulary of 500 words and be able to speak in sentences. Children also should be interested in using words and sentences to interact with their peers, and do so successfully.

Those who do not meet these guidelines or lack interest in communicating are at significant risk for future learning difficulties; early intervention is key to decreasing that risk.

Toddler Talk is a unique, SPS-developed program designed to teach parents how to facilitate language development in 12- to 36-month-old children.Talking does not just happen. For some children, chronic ear infections, illnesses, and complications during or after birth may slow down the process of speech and language development. For others, the reasons for delayed communication are difficult to determine. In any case, researchers have found that most late talkers do not simply outgrow their communication problems.

During Toddler Talk, parents learn specific play techniques to use with their child. The Speech-Language Pathologist “coaches” parents so that they can help expand their child’s communication skills during everyday living. Children learn to use new words and create “conversations,” commenting upon actions, objects, and events. For all children, communication is the first step to learning.

Each week, a new language technique is introduced and parents and toddlers engage in specifically designed activities to foster communications. Parents also share their ideas and experiences. Toddler Talk is designed to be a fun, rewarding, and educational experience for the entire family.

Articulation & Apraxia

Children with Articulation and/or Phonological Disorders benefit from traditional methods of treatment to teach them how to correctly produce specific sounds. They may mispronounce just a few sounds, or they may have difficulty being understood in general.

Oral, verbal, and motor apraxia may present differently from child to child. Children can also present with a combination of oral-motor difficulties, articulation difficulties, and Apraxia. It is important to have an experienced Speech-Language Pathologist and/or Occupational Therapist help to determine the cause(s) of your child’s difficulty.

Signs of Articulation/Phonological Disorders

  • Errors are predictable and follow patterns
  • Difficult sounds are substituted with simpler sounds (e.g., /s/ for /sh/)
  • May produce a variety of sounds, with errors that make speech sound “immature”
  • Errors are typically consistent as length of utterance increases
  • Minimal vowel distortions
  • No difference is how speech is produced based on situation (e.g., automatic speech vs. on demand)
  • Rate, rythym, and stress are typically not affected
  • Omissions are more likely to happen in the final position than initial position

Signs of Childhood Apraxia of Speech

  • First words produced after delay, but these words are missing sounds
  • Only produces a few sounds
  • Inconsistent sound errors
  • Language comprehension better than production
  • Difficulty imitating speech of others or does not imitate
  • Difficulty positioning mouth movements when attemtping to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
  • More difficulty saying longer phrases than shorter ones
  • Well-rehearsed, “automatic speech” is easiest to produce, errors occur with “on demand” speech (e.g., answering a direct question)
  • Rate, rythym, and stress of speech are affected, causing reduced inflection
  • Omissions tend to happen in the initial and final positions

Other Indicators of Childhood Apraxia of Speech

Clumsiness
More cautious to try new motor activities
Finds it difficult to jump, hop, and/or skip
Has trouble throwing a ball
Is slower to learn to ride a bike
Has difficulty playing sports with peers

We at SPS have developed innovative models to address dyspraxia. After we pinpoint the root causes of your child’s difficulty, we work with you to design the most effective, efficient therapeutic program. Intervention for the child diagnosed with developmental Apraxia of speech often focuses on improving the planning, sequencing, and coordination of motor movements for speech production. The speech-language pathologist uses tactile, auditory, and visual feedback to help the brain tell the speech muscles what to do. With this feedback, the child repeats syllables, words, sentences, and longer utterances to improve muscle coordination and sequencing for speech.

Sometimes individual Speech-Language Therapy and/or Occupational Therapy (if the child has motor dyspraxia) is most successful. However, other intervention models such as Speech-Language and Occupational Co-Treatment is the preferred approach to yield the most success. Ultimately, we want your child to have fun and enjoy the success of developing new skills.

Often, it’s the ‘right’ combination of therapy and support programming at the ‘right’ time that is most effective. As your child grows and increases her skills, we at SPS, adjust our therapeutic programming to provide the ‘right’ challenge for continued success.

Auditory Processing and Language

In order to learn, we must first understand and use language.  Language learning starts at the sound level. That is, we must first be able  to process the individual sounds that form words before we can apply meaning to the words in our language, understand the language we hear, and use language to express our needs, thoughts, and ideas. Speaking, reading, writing, and facial expressions/gestures are all forms of language.

About 1 in every 20 children experiences difficulty with langauge. Language difficulties are not always obvious, and often go untreated. Children may have global attention deficits (e.g., ADHD) that result in an auditory processing deficit, or may have an auditory processing deficit that has been misinterpreted as ADD/ADHD. Often, language disorders can stem from underlying auditory processing deficits that go untreated. As you will see below, the characteristics of both auditory processing deficits and language deficits are very similar. Whatever the underlying cause of this language-learning difficulty,  these children are often mislabeled as “lazy,” “not applying himself,” “late bloomer,” or “doesn’t listen.”

A child of normal or above average intelligence may not be able to understand and use language at their expected age levels. Some children acquire langauge normally, and some may have “gaps” in their language acquistion, which affects their ability to reach their full learning potential. At SPS, we can help find the underlying causes of the language-learning deficits, and work to permanently remediate these imperative functions  and skills.

Signs of Auditory Processing Difficulties
  • Slow acquisition of vocabulary and concepts
  • Often distracted or inattentive
  • Difficulty following spoken directions
  • Difficulty understanding and answering questions
  • Requests that information be repeated
  • Seems to have poor listening skills
  • Difficulty listening in noisy environments
  • Confusion over similar sounding words
  • Poor phonological awareness skills
  • Gives slow or delayed responses
  • Inconsistency in learning
  • Difficulty learning to read spell or write
Signs of Language Difficulties
  • Slow acquisition of vocabulary & concepts
  • Difficulty remembering/ following spoken directions
  • Difficulty summarizing verbally presented information and/or recalling details
  • Difficulty learning and retaining new words and concepts
  • Requires extensive overview of previously-learned material
  • Spoken language is “simpler” than peers- uses immature vocabulary
  • Word retrieval difficulty, overuse of fillers (e.g., “um”)
  • Difficulty “finding” the right words
  • Difficulty describing with salient information- uses few descriptive words in speaking and writing
  • Difficulty with grammar and/or sentence structure
  • Difficulty relating sequential events
  • Needs requent redirection
  • Difficulty with math word problems
  • Uses comments that are off-topic or inappropriate for the conversation
  • Social difficulty – reluctant to engage in conversation
  • Difficulty understanding and using jokes or sarcasm
  • Inconsistency in learning 
  • Difficulty learning to read, spell, and write 

Social Communication

Social communication is a complex process that begins in infancy when a child begins to babble back and forth with others or make eye contact. Children of all ages can have difficulty learning and applying the unspoken rules of communication. These children may appear too shy, anxious, or even too friendly with others. Children must first process language effectively in order to be a competent social communicator, which involves:

  • Social interaction (e.g., speech style and context; linguistic rules)
  • Social cognition (e.g., emotional competence, understanding emotions)
  • Pragmatics (e.g., communicative intentions, conversational management, body language, eye contact)

Receptive and expressive language processing (Adams, 2005)

Social communication difficulties present differently from child to child. The Speech-Language Pathologists at SPS Atlanta are trained to diagnose and treat all presentations of social language deficits. We are trained in the most effective techniques for helping children learn to succeed in their social environments. Therapists at SPS teach specific skills in a comfortable environment and help children learn to interact with others and become more comfortable in their own skin.

Signs of difficulty with social communication/pragmatics:

  • Fidgety or tense in social environments
  • Clings to adults and has poor self-confidence around peers
  • Avoids starting social interactions with others
  • Trouble keeping up the flow of a normal conversation
  • Experiences frustration when trying to get ideas across in conversation
  • Sometimes is “awkward” in turn-taking interactions with peers
  • Has difficulty making friends, even when trying hard to do so
  • Takes things too literally and doesn’t understand the real meaning of a conversation
  • Difficulty interpreting the facial expressions of others
  • Facial expressions don’t always match what he/she is saying
  • Unaware of how his/her actions/comments affect others
  • Doesn’t always play appropriatetly with peers- difficulty following rules of games
  • May act too silly or laugh inappropriately
  • Difficulty answering questions directly- will talk around a subject

Getting it Together for Executive Functions

Getting it Together at SPS combines iLs programming and Interactive Metronome programming that is designed to target attention and concentration with specific training in executive function skills.
Our curriculum helps students plan, initiate, organize and complete tasks, as well as know when to “put on the brakes” and think before they act! Depending on each unique learner’s needs, we individualize each student’s program to address the specific areas that will help him navigate the educational and social arenas with success.

Getting it Together targets the following cognitive and behavioral skills:

  • Attention
  • Impulse control
  • Working memory
  • Time management
  • Planning & organization
  • Emotional control
  • Self-talk
  • Self-monitoring
  • Setting goals & self-evaluating
  • Listening awareness
  • Flexible thinking

Tongue Thrust

What is a Tongue Thrust?
Tongue thrust is the process of pushing the tongue forward against or between the teeth when swallowing.  Constant pressure of the tongue against the teeth can move teeth, thus causing malocclusion.  We at SPS work closely with dentists and orthodontists in diagnosing and treating tongue thrust in children and adults.

What are the Affects of Tongue Thrust 

  • Sounds such as “s,””z,””sh,””ch,” and “j” may sound distorted
  • Weak jaw and lips
  • Slowing of orthodontic correction or possible orthodontic relapse
  • Periodental problems
  • Difficulty wearing dentures or dental appliances
  • Temporomandibular joint problems (TMJ)
  • An unusual, perhaps unpleasant, appearance when chewing and eating

What Causes a Tongue Thrust?

  • Allergies
  • Enlarged adenoids
  • Thumb or finger sucking
  • Tongue that is “anchored” to the floor of the mouth
  • Heredity, neurological, and/or muscular problems may be contributing factors as well.

Tongue Thrust Therapy
The purpose of therapy is to replace behaviors that appear harmful to the teeth and/or appearance with alternative ones that are neutral or beneficial in their effects. Treatment is based on principles of teaching new oral-motor patterns. Generally, it is difficult to correct articulatory errors (if caused by tongue thrust) without addressing the tongue thrust pattern.

Oral Motor Skills

Oral motor skills are imperative for speech production, feeding, and swallowing. Children may present with weak oral musculature that affects intelligibility of speech in a number of ways.

Children and adults who persist in using a “lax” sounding “r,” a lisp, or tongue thrust may have specific weakness of the tongue that contributes to their articulation difficulty.

Treatment at SPS consists of training, strengthening, and maintaining muscle patterns. Various exercises are prescribed based on specific needs. SPS therapists are experienced in Beckman Oral Motor Protocol and various other oral-motor treatment tecniques to achieve improved muscle tone and fuction for more intelligible speech and/or acquisition of age-appropriate feeding skills.

When Should Treatment Begin?
Oral Motor Therapy can begin at early feeding stages to strengthen the muscles and patterns required for feeding and swallowing. Children as young as 2 years old begin oral-motor therapy to improve feeding, decrease drooling, and improve muscle tone for articulation.

Results of Treatment
Changing habits requires commitment, discipline, and effort.  Within a few months, new oral muscular patterns can be developed.  With consistent practice, long lasting results can be achieved.

Pediatric Feeding and Swallowing

Meal times should be happy times! Eating should be a pleasurable activity during which important emotional, social, and communicative foundations are established. For most infants and young children, eating and swallowing occurs with ease, with little conscious thought given to the process. However, for some children, eating is difficult, even frightening. What appears to be a simple process is actually complex. As more than 26 muscles and 7 cranial nerves are involved in eating and swallowing, multiple factors may play a role in your child’s eating and swallowing problems.

Our Multidisciplined Approach
With our specialized training in the identification and treatment of dysphagia, oral motor dysfunction, and sensory processing disorders, our expert team of Speech-Language Pathologists and Occupational Therapists provides a well–rounded sensory–motor approach to feeding therapy. After our comprehensive evaluation, therapeutic goals are carefully designed and tailored to meet the unique needs of your child. At SPS, we work closely with your child and you to address the multiple factors that contribute to mealtime difficulties.

Specially Designed
Our programming is designed specifically for infants, toddlers, and adolescents who have a variety of feeding and swallowing difficulties, including: dysphagia, failure–to–thrive, feeding tube dependency, oral-motor difficulties, food / oral aversion, inadequate use of utensils, and significant behavior problems during mealtime.

 Treatment Protocols
Given our extensive experience and knowledge of leading medical research, your child’s treatment may include some of the following:

  • Increasing volume of foods eaten
  • Cup drinking
  • Tolerating an oral diet
  • Chewing Foods
  • Self–Feeding
  • Eating a variety of textures and tastes
  • Gaining weight
  • Managing or discontinuing tube feedings
  • Regulating Sensory Processing
  • Decreasing oral and facial hypersensitivities
  • Decreasing avoidance and disruptive behaviors at mealtime
  • Generalizing eating habits to home and community endeavors
  • Improving vocal function due to GERD and LPR
  • Increasing variety of foods eaten

We welcome the opportunity to discuss our programming with you. Please contact us at 404–459–9192 to schedule a meeting at your earliest convenience.

Voice & Fluency

Voice disorders are often overlooked. Speech-Language Pathologists are trained to diagnose and treat these disorders and make appropriate recommendations to other professionals if vocal pathology is suspected. Voice disorders can be caused by neuromuscular diseases (e.g., Parkinson’s Disease), vocal over-use, acid-reflux disease, and physical pathologies of the vocal folds.  Abnormal sounding voice can also be due to problems with  resonance of the voice (e.g., hyper/hypo nasality) through the vocal tract. Some clients need to develop an understanding of how to coordinate their breathing and vocal muscles in order to produce their best quality of voice and increase awareness of vocal production.

Signs of voice abnormalities

  • Voice that is too loud or too soft
  • Hoarse, harsh, and/or breath quality of voice
  • Pitch that is too high or too low
  • Voice that sounds too “nasal” or too “muffled”
  • Increased effort required to produce voice

SPS therapists are trained to teach vocial hygienge (e.g., preserving your voice), vocal awareness (e.g., awareness of reduced loudness or high pitch), increase vocal efficiency (e.g., improve coordination of  breathing and vocal production), and help improve overall function of voice and resonance in the daily living environment.

Fluency
Children and adults alike experience dysfluency, or what is commonly known as “stuttering.” The Speech-Language Pathologists at SPS understand that many people have undergone years of therapy for stuttering with little to no improvement. Our therapy programming is designed for the individual. Our treatment is not based on any one theory of stuttering, but on how to help the invidual take control of his or her speech fluency with the combination of brain-plasticity programming, experience, and research-based therapeutic techniques.

Signs of fluency difficulties in children and adults

  • Repeats whole words or parts of words (e.g., initial sounds)
  • Prolongs or stretches sounds within words
  • Physically struggles to produce speech
  • Feeling of not being able to “get words out”

Teletherapy

Telepractice is the application of telecommunications technology to the delivery of Speech-Language Pathology professional services at a distance by linking clinician to client or clinician to clinician
for assessment, intervention, and/or consultation (ASHA 2012).

SPS services available via teletherapy:
Speech-Language Therapy

Occupational Therapy
iLs home programming
Interactive Metronome Home Programming
Parent and Professional Consultations

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750 Hammond Drive
Building 4, Suite 100
Atlanta, Georgia 30328
404-459-9192
frontoffice@sps-atlanta.com