Finally, reinforce his efforts at speaking.
Even before he has real words you can engage him in a babble dialogue, repeating what he
says and modifying it a bit for him to imitate. Even after doing all of this, if you are
still unsure about your child's speech and language development, call to have him screened
when he is about three. This is a free service at most centers and it will give you peace
of mind.
QUESTION: My 7 year old child has some articulation problems. He will say
"w" for "r" like "wabbit" for "rabbit" and
"f" for "th" like "fink " for "think". We are
usually able to figure out what he is saying. However, what bothers us now is that
he is starting to spell and write words the way he says them. Is this
something to worry about?
ANSWER: It is true that words that
are misarticulated tend to be misspelled more frequently than words that are pronounced
correctly. At times there may also be accompanying language and/or learning
difficulties. Speech therapy focusing on correcting misarticulations and emphasizing
speech - sound discrimination may significantly improve written spelling
performance. Contact a speech pathologist for a further evaluation of this problem.
QUESTION: My three-year-old was
recently screened at her daycare center and the speech therapist reported that she has an
articulation problem. Isn't she too young to benefit from therapy?
ANSWER: Your child is at a very good age to benefit from speech therapy. We know that at three years about 80% of what the child says should be intelligible to a stranger. We also know that children of this age should have mastered the following sounds: p, b, m, w, n, t, d, k, g, h. Many of the other more difficult sounds are emerging, such as: r, l, s, z. If a child shows a pattern of speech that does not contain these sounds, she is probably very difficult to understand. Usually just a short period of therapy (three to six months) is needed to help the child learn to discriminate and produce the speech sounds that are missing. If therapy is not undertaken until the child is older, often it takes a much longer period of time to correct the errors. This is because speech becomes a habit, and the longer a habit is practiced, the stronger it becomes.
Do make sure that the speech therapist who
works with your child has had a lot of experience with preschoolers. Therapy should
be fun and the therapist should use a variety of toys when working with your child. At
Cary Speech Services we see lots of preschoolers, some as young as 18 months.
QUESTION: My child's speech is difficult to understand by most people except family
members. I know some children are able to use pictures or computers with speech to
help them communicate. I'm afraid that my child will stop using speech if he uses
these things and will lose his motivation to talk. Is this true?
ANSWER: First of all, it is important to consider whether the child has been given an opportunity to improve his speech through more traditional forms of speech therapy. If this has been attempted unsuccessfully, the most important thing to keep in mind is successful communication. Most of us don't realize it, but 72% of everything we communicate is NOT communicated through words, but rather through non-verbal means; this includes facial expression, body posture, proximity to other speakers etc. Try turning the sound down on your television and see how much you can understand without hearing a word!! This is particularly true for your favorite programs because you are familiar with the characters and setting.
Communication is the essence of our
interaction with the world. And, as such, it includes not only words but
also nonverbal strategies. Children who do not speak intelligibly often become
frustrated. This is a danger signal that it is time to try some other strategies.
Research tells us that by using these "augmentative" strategies to support
speech, not replace it, children become more effective communicators and can
participate in all aspects of life more independently and confidently. They may
develop normal speech. If these strategies are not adopted to augment the
communication, children may have delays in reading and writing in addition to being
ineffective communicators. "Augmentative" strategies can help get these kids on
track without replacing speech, but instead emphasizing speech as a part of the larger
whole--communication.
QUESTION: A friend of mine is signing with her baby. If the baby is able to
get what he wants without using words, won't he learn that he doesn't have to talk?
ANSWER: No, not at all! Babies have an inborn desire to communicate and will use speech when they are physically ready. But sign language is an easier form of communication that younger babies can learn and it helps them to communicate their needs and interests. Contrary to what some people think, signs do not inhibit a baby's motivation to communicate. Rather, it makes them even more eager to master words that will enable them to expand their social network.
Your friend may be using a book called BABY
SIGNS, which was written by Linda Acredolo and Susan Goodwyn, and is available in many of
the local bookstores. Here at Cary Speech Services we teach parents the techniques
described in the book. This is an especially useful strategy to use with
toddlers who are a bit slow at acquiring speech and consequently somewhat frustrated
when they cannot get you to understand them.
QUESTION: Can chronic middle ear infections cause a delay in my
preschooler's speech and language development?
ANSWER: Chronic otitis media, or middle ear infections, are very common in preschool children, and occur most frequently during the first three years of life. The incidence peaks between six and eighteen months, which is also a critical period for onset of the first words.
Fluid can persist behind the eardrums for several weeks and up to three months after each incidence of otitis. In other words, during the period that fluid is in the ears, the child is hearing sounds muffled, the way you hear if you plug up your ears with your fingers.
Some children find it difficult to learn certain speech sounds because they are not hearing clearly. Other children become confused when hearing fluctuates between muffled sounds and clear speech and they may "tune out" much of the spoken world or not attempt to talk.
If your child seems to be slow in learning
speech and language skills and has had a history of repeated episodes of ear infections,
it would be worthwhile to request a speech/language and hearing screening.
QUESTION: My two-year old has had recurrent ear infections since infancy. Now
he seems to have trouble speaking clearly. Do you think these are related?
ANSWER: Chronic ear infections during the early speech learning period can indeed affect your child's speech. When a child develops an ear infection, fluid builds up behind the ear drum. This produces a mild hearing loss, similar to the way you hear if you plug up your ears with your fingers. Sounds appear muffled. The child may learn to speak the way he hears the world, leaving off word endings, omitting or distorting high frequency sounds like "s" and "f" and substituting the more visible sounds like "t" and "d" for the back of the mouth sounds like "k" and "g".
The first step is to seek prompt medical
treatment for the ear infections. The second step is to have your child screened by
a pediatric speech language pathologist to determine if the speech is delayed or if
there is an articulation problem developing. Often the speech specialist can give
parents information to help the speech and language develop normally during this
period. The good news is that most children outgrow their ear infections by age
three.
QUESTION: My three year old son has been stuttering for the past several
weeks. Should I be concerned?
ANSWER: The majority of preschoolers go through a period of dysfluency, usually between their second and third birthdays. They may repeat entire words, the first sound of a word, or the first syllable. Sometimes they interject "uhs" and "ums" or revise their sentence halfway through. Usually this occurs when the child is very excited, fatigued, or perceives that he does not have the listener's attention.
There are many reasons for children's dysfluencies. They seem to coincide with periods of rapid language growth when the child is learning new grammatical forms, such as how to ask a question or use the past tense. Since he lacks much experience in these grammatical structures, he may hesitate, back up, revise what he is saying or stumble on a word.
Most children will outgrow this in three to
six months. If the stuttering behavior gets worse where the child is struggling to
speak and obviously very frustrated, or if the parents feel very anxious about the speech,
I would recommend seeking a professional opinion from a licensed speech-language
pathologist.
QUESTION: What are central auditory processing problems in children?
ANSWER: A child who has difficulty
following the teacher's directions, listening in the presence of background noise,
appearing not to pay attention, and who is easily distracted or not motivated in school,
may be experiencing difficulties in processing verbal language. Some children may
hear the sound but have problems processing or understanding what is said by others,
particularly when the language used is complex, lengthy, spoken rapidly, or presented when
there is a lot to look at and lots of competing noise. The inability to understand
spoken language in a meaningful way in the absence of what is commonly considered a
hearing loss is called " a central auditory processing problem".
Evaluation by both an audiologist and speech-language pathologist provides important
information about the child's processing abilities in order to develop treatment
strategies and recommendations for improving the listening environments at home and school
and thereby helping a child reach his or her academic potential.
QUESTION: I have
struggled with stuttering most of my life and now my 3-year old son is stuttering,
too. How can I get help for him and is it too late to get help for my own stuttering
problem?
ANSWER: It is never too late, or too early, to improve fluent speech under guidance of a qualified speech and language pathologist. There are over three million Americans who stutter and many go on to lead successful lives which are not defined by their stuttering. Stuttering can be treated successfully, although there is no quick "cure". If your child has been stuttering for six months or if you or your child are becoming frustrated due to the stuttering, it is time to have your child evaluated. Stuttering can be demonstrated in the form of part-word repetitions, hesitations, prolongations of a word, or a rise in pitch or loudness. More severe signs of stuttering include accompanying body tension, facial grimaces, or detracting bodily movements during the stuttering.
Family-focused intervention is key to
learning and generalizing positive speaking skills. The entire family is involved in
learning "slow and smooth" speech modeling in order to facilitate fluency, as
well as establishing consistent turn-taking routines, and decreasing time pressures when
possible. The child re-learns positive speaking behaviors and the entire family
benefits as well.
QUESTION: My child was recently
assessed for a speech problem. The speech therapist asked questions about oral
habits like thumbsucking and whether my child had any eating problems. What does
this have to do with his speech?
ANSWER: Many children with articulation disorders have oral-sensorimotor problems. Some of these children are very sensitive to stimuli around the mouth and reject foods of certain tastes or textures. They may also choke easily on certain foods or liquids. They do not easily tolerate face washing and tooth brushing. Other children crave oral stimulation and eat even non-food items; they frequently mouthe fingers and toys. Some children drool well past the stage of cutting teeth.
Information about the child's oral habits and unusual food preferences tell us about the tone of the muscles in the face and mouth and give us a clue to what might he wrong with the underlying speech structures that are resulting in an inability to make certain sounds. When these muscles are strengthened through specific exercises the child will be able to more easily produce clear speech.
QUESTION: I noticed that
you advertise free screenings. What is a screening and how does that differ from an
evaluation?
ANSWER: We do free screenings on children, especially preschoolers. Often the parent or pediatrician notices that the child has some difficulty with his speech, but is unsure whether this is significant for the child's age. A screening is a short session (about 15 to 20 minutes) that answers the question "Does the child have normal speech for his age or is there a significant speech problem?" Screenings involve playing with the child and listening to how he communicates. Older preschoolers are given abbreviated tests for language and articulation as well as a hearing screening.
An evaluation follows if the child failed
the screening. There is a charge for an evaluation based on the amount of time
needed to test the child and generate a report. The evaluation tries to answer the
question, "What specifically is wrong with the speech, and with help, how easily can
the child correct it?" At the end of the evaluation the therapist should also
have an estimate of the number of therapy sessions needed to correct the problem.
QUESTION: My 2-year-old son just started to stutter. The pediatrician
said that this is just a phase and he will out-grow it. Should I be concerned?
ANSWER: Many little boys go through a "stuttering-like" phase between the ages of two and three. The majority of them do out-grow it. I would be more concerned if your child did this for more than six months, it got more severe over time, he became frustrated while speaking, or he did not want to talk.
As a parent it is important to give him plenty of time to speak so he does not have to rush. Keep good eye contact with him and let him know that you are interested in what he has to say. It is generally felt that this "stuttering phase" is due to the child's rapid growth in language and ideas and it is almost as if he does not know how to organize his thoughts and say what he wants. In other words, his mouth just cannot keep up with his mind.
If your child continues to experience
fluency problems for over six months or his stuttering becomes progressively worse, it
would be advisable to get him screened by a speech-language pathologist. This service is
usually free in most practices.
QUESTION: Can chronic middle ear infections cause a delay in my
preschooler's speech and language development?
ANSWER: Chronic otitis media, or middle ear infections, are very common in preschool children and occur most frequently during the first three years of life. The incidence peaks between six and eighteen months, which is also a critical period for onset of the first words.
Fluid can persist behind the eardrums for several weeks and up to three months after each incidence of otitis. In other words, during the period that fluid is in the ears, the child is hearing sounds muffled, the way you hear if you plug up your ears with your fingers.
Some children find it difficult to learn certain speech sounds because they are not hearing clearly. Other children become confused when hearing fluctuates between muffled sounds and clear speech and they may "tune out" much of the spoken world or not attempt to talk.
If your child seems to be slow in learning
speech and language skills and has had a history of repeated episodes of ear infections,
it would be worthwhile to request a speech/language and hearing screening.
QUESTION: My 22 month old
son has only three words in his vocabulary: mama, dada, and ball. I'm concerned that
he is delayed and needs help, but my husband feels that he will be fine if we just do
nothing. What is your opinion?
ANSWER: Your baby is certainly slower than the average. At 18 months most babies have between 3 and 20 words in their vocabulary; at 24 months the average is 50 words. So I can appreciate your concern about your son's slow speech development.
Sometimes boys are a bit slower in
acquiring speech and there is a good chance that he will catch up and be fine.
However, if he hasn't acquired any new words recently and you and he are getting
frustrated communicating, it would be worthwhile having him seen by a pediatric
speech-language pathologist. You and your husband will be shown techniques to use
with your son to get the communication going again. The therapist will use toys and
play techniques that you can implement at home. Remember, speech language therapy
can never hurt a child--and in fact, it's fun!
QUESTION: My four year old was recently screened at his preschool and the
speech pathologist said that he has a lisp and would benefit from therapy. I thought
a lisp was normal at this age. Won't he outgrow it?
ANSWER: A lisp is not normal at age four. A lisp is caused by an abnormal tongue posture. The normal posture is for the tongue to rest on the roof of the mouth when the child is not speaking. With a lisp the tongue is held on the floor of the mouth with the tip resting on or between the teeth. When the child tries to make the "s" or "z" sounds he protrudes the tongue between his teeth. Some children also produce "sh", "ch" and "j" this way as well.
If a child is lisping at age four it is doubtful that he will outgrow it. The older the child is, the more ingrained the habit of lisping becomes. Generally preschool children progress faster in therapy than school- age children. The majority of preschoolers who have only a lisp to correct can he taught to use a standard "s" in about ten therapy sessions. Older children usually average twenty sessions.
QUESTION: What is the advantage of getting my child's speech problem
corrected before she starts public school?
ANSWER: There are several reasons for getting speech and language problems corrected prior to enrollment in kindergarten. First of all, a child with articulation problems will have difficulty with phonics. For example, a child who substitutes "w" for "I" or "r" will have difficulty sounding out words in reading; spelling will also be affected.
Children with expressive language problems (for example, verbally expressing what they want, what happened or asking a question) will also have difficulty with literacy skills. Being able to express oneself in complete sentences using correct pronouns, regular plurals, possessives, and verb tenses is important in learning how to read.
Children of five or six years are also aware of their communication problems and may feel self-conscious and anxious in speaking situations. They may be hesitant to share in "Show and Tell" and avoid answering the teacher's questions. Teasing on the playground can also occur.
Finally, speech and language problems can
often be corrected in a shorter length of time during the preschool years than later
on. So if you feel your preschooler has a problem, make an appointment to have him
screened.
QUESTION: Most strangers have trouble understanding my three year old.
Should I be concerned?
ANSWER: By 36 months of age approximately 80% of what a child says should be understood by people outside of the immediate family. As a child becomes older he/she learns to master the more complex sounds of our language. There is a general sequence of sound acquisition. The sounds that are made at the front of the mouth with the lips, such as "p", "b" and "m" are usually the first ones that the baby learns; they are usually followed by "t", "d", "n", "w" and "h" before the third birthday. The more difficult sounds of our language ("th", "sh", "ch", "v" and "j"), as well as the blends, are usually not present consistently in the speech of younger children. Beyond these generalizations, decisions regarding the adequacy of a preschooler's speech is based on the number of correctly produced sounds, the types of sound substitutions, and the overall intelligibility of the speech.
Anytime parents feel that their child's
speech is not developing normally, I recommend that they seek a professional
opinion. Speech problems are easier to correct in the preschool years before the
articulation develops into an established habit.
QUESTION: My neighbor's child was recently diagnosed with
"developmental verbal dyspraxia". What is that?
ANSWER: Developmental verbal dyspraxia is a problem with the motor planning needed to produce speech. In the preschool years children with this diagnosis often are late in speaking and when they do start to talk, they usually have difficulty with articulation. The muscles of the mouth are working fine, but the problem seems to be in the motor speech areas of the brain. What is frustrating for both the child and those around him is that he may be able to say a work or phrase very clearly on one occasion, but be totally unable to repeat it the next time. It is as if he has forgotten the motor sequence needed to move his lips, tongue and jaw to produce the same verbal output.
Generally the younger the child is when the diagnosis is made, the more positive the prognosis for complete recovery. Therapy involves teaching the child the motor movements needed to produce all 44 of the sounds of our language. Then he/she must learn how to sequence those individual sounds to make words, phrases and finally sentences. In addition, the child is usually given oral motor exercises to gain better control of the lips, tongue and jaw and these are tailored to meet that child's specific needs.
QUESTION: My child is almost three and still not talking much. Should I be
concerned?
ANSWER: Most children say their first word around 12 months, although some children start to speak as early as 9 months and others as late as 18 months. By the child's second birthday, he or she will usually have about fifty recognizable words and will be making two-word phrases such as "Daddy car." By two and a half years most children have a vocabulary of about 200 words and use sentences averaging three words. Generally, if a child is not saying much by his second birthday we start to become concerned and ask some questions. Some children are late in talking because they may have had a lot of middle ear infections. Other children are late in talking because they have older siblings who either interpret what they want or don't let them "get a word in edgewise." There are also some children who have developed such a good non-verbal communication system, like pointing and gesturing, that they are understood by their parents and have no need to speak. If any of these scenarios seem familiar, then you may have found why your child is still not yet communicating verbally and you may be able to make some changes. There are a very small percentage of children who have more serious problems that cause their delay in speaking, and these children need to be seen by a speech language pathologist who is experienced in working with preschoolers.
QUESTION: Sometimes I have a hard time understanding my child's speech. We
both get frustrated because he knows what he's saying but I can't understand him.
What should I do?
ANSWER: Start by asking him to give you some "clues". This should not only make it less frustrating, but should also provide him with a good learning experience. You can start by asking questions like, "What color is it?" "Is it big or little?" "Is it outside or inside?" The most frustrating experiences often result from parents attempting to guess what is being said without narrowing down the range of possible answers. If what the child is attempting to say to you is in the immediate environment, they can obviously show you. However, if the event or item is out of this environment it will be more important to use this type of stragegy. The questions that you ask help the child to begin to develop descriptive language skills. Even if your child has no difficulty speaking, these kinds of activities can be fun when you are travelling in the car and have more time to sit and talk . What's more is that they are educational!
If your child or another individual you know is experiencing frustration attempting to communicate, it is advisable to call a speech-language pathologist and ask whether an evaluation may be appropriate.
QUESTION: My preschooler has recently been diagnosed with a speech and language disorder. Is there a relationship between early speech and language disorders and later learning and academic problems?
ANSWER: First I commend you for identifying your child's speech and language problems early and not waiting until school to see if it will "clear up". Developmental speech and language problems left untreated can many times be related to later reading, writing, and spelling problems as well as the more obvious problems in oral expression. To learn how to read and write, children must auditorily learn to develop explicit phonological or sound awareness of the consonants and vowels in the English language. Early examples of phonological awareness include knowledge that words rhyme, begin and end with same/different sounds, and that words have a certain number of syllables. This early sound awareness is one of the better predictors of early reading ability. Conversely, if a child has numerous articulation errors and problems with spoken language, it is highly likely that he will have difficulty with printed letters and words. Other problems beyond word recognition include poor processing and decoding necessary for reading comprehension and fluent oral reading skills as well as poor short-term verbal memory skills.
The speech-language pathologist plays an important role in early identification of potential language-based learning problems. Early remediation is the key to reading readiness and later academic success. Parents can also be good speech models and promote reading and sound awareness at home by reading nursery rhymes, Dr. Seuss books, and doing sound play and syllable-sound blending games.
QUESTION: My eight-year old child has difficulty making the "s" sound. His tongue protrudes between his teeth. I also have concerns about a gap between his upper and lower teeth. The orthodontist recommends braces; he is concerned about the tongue thrusting and continuously pushing on his teeth.
ANSWER: Dental malocclusions and the "lisp" that you describe often are the result of a "tongue thrust" or reverse swallow pattern. This is characterized by the tongue coming forward in the mouth to obtain the liquids, rather than moving upward and backward when swallowing. Other sounds beside "s" may also be affected; "n", "t", "d" and "l" are often produced between or on the front teeth, rather than behind the teeth on the upper gum ridge. A combination of oral motor exercises to increase tongue strength and agility and speech therapy to correct the lisp and placement of other phonemes is beneficial for children with this problem.
QUESTION: My child had a lot of ear infections up to the age of three. He no longer has any, but his speech is not as intelligible as that of other chidren in his preschool class. Could his difficulty making certain sounds be related to his early history of ear infections? Will his develop clearer speech on his own?
ANSWER: Ear infections during the critical early speech development period may affect your child's speech. When he was experiencing the ear infections he may not have heard sounds accurately due to the fluid build-up behind the ear drum. Consequently he may have learned to produce sounds incorrectly or even omit them.
Since he is no longer having ear infections and his hearing is now within normal limits, he may benefit from a period of speech therapy to learn the sounds that he has been omitting or distorting. A speech screening will initially determine whether your child would need and benefit from therapy.
QUESTION: My eight year old child seems to "misread" social situations. At times he doesn't understand that a person may be joking or being sarcastic. Other times he does not seem to catch facial expressions that give clues that the speaker is angry or sad. Idoms such as "You're killing me" really puzzle him. What can we do?
ANSWER: Your child seems to be having difficulty with pragmatic language. Most children develop pragmatic language in a routine and progressive way without being taught intentionally. However some children with language learning disabilites, attention deficit disorders, and autism spectrum disorders may need to have direct teaching of pragmatics. These children need to learn to watch speakers' faces and body language for clues about emotions. They also need to be taught to listen for the speaker's pitch and intonation patterns for additional clues. These children benefit from role playing situations that bewilder them. The meaning of common idioms will also need to be directly taught as well. This type of problem responds well to language therapy.
QUESTION: My six year old talks freely; however, he is often difficult to understand. Most of the sounds he makes seem to be correct. I'm having difficulty determining why he seems unintelligible at times.
ANSWER: Children often speak at an increased rate when they are excited or have something important they want to share. Often incorrect production of "f", "th", "s" and vowelized "r" (such as in bird, sweater, car, more) can make speech difficult to understand since they occur often in our language. It would be helpful to have your child evaluated by a speech-languge pathologist.
QUESTION: My child uses limited sounds, omits some sounds, and has lots of sound substitutions, such as "w" for "l" and "r" and "er"; some of his vowels are not very clear either. Needless to say, the longer the sentences, the less we understand. Do you have any suggestions about how I can help my child develop better speech?
ANSWER: Your child sounds like he needs the professional services of a speech-language pathologist. She will give you exercises and material to work on with your child every day that will address his speech errors in a systematic fashion. Many children with similar problems acquire age-appropriate speech in just six months of once-a-week speech therapy.
QUESTION: What is
"tongue thrusting"?
ANSWER: Tongue thrusting is an immature way of swallowing; the tongue pushes against the front teeth or between the upper and lower teeth. Almost all infants swallow this way, but by age four most children have automatically switched to a normal swallow. During a normal, or mature swallow, the tongue pushes against the palate (roof of the mouth) and moves up and backward toward the throat.
Tongue thrusting can be the result of thumb or finger sucking; enlarged tonsils and adenoids or allergies that make mouth-breathing necessary; poor muscle control; or a high, narrow palate. Children who tongue thrust usually keep their tongue in a low and forward position in the mouth when not speaking, rather than up on the palate.
Children with tongue thrust usually have
dental malocclusions due to the repeated force of the tongue pushing forward on the front
teeth. They may also have a lisp in which speech sounds like "s" and
"z" are made with the tongue between or on the front teeth. These children
require a period of myofunctional therapy to retrain the swallow before any speech errors
can be corrected.
Question: How can I help my
child to learn to speak clearly?
Answer: Parents play an important role in teaching their children to speak. The most
important thing that you can do is to model good speech. Speak to your child slowly and
clearly. Set aside a special time each day- when you are not rushed and encourage your
child to talk about his day. Ask questions and show that you are interested in what he
does. Some families find the dinner table a good time for talking about what everyone has
done during the day. It is important that everyone have a turn talking and that no one is
interrupted.
When your child makes errors in his speech, repeat his message correctly, but don't ask
him to repeat after you. If he hears the correct way to say a word, he is more likely to
say it right the next time.
Children enjoy having stories read aloud to them. Make this part of the bedtime ritual.
All children develop favorite books. Sometimes let them help you read a familiar story by
finishing a sentence or telling what they think is going to happen on the next page.
If you make speaking fun and give your child plenty of opportunities to talk, he is more
likely to develop into a good, clear speaker.
QUESTION: I have had my child
screened and she needs speech therapy. How can I get my health plan to cover it?
ANSWER: You may have a health plan that has
coverage for evaluation and treatment of a communication disorder. First read your policy
or review your benefits booklet provided by your insurance company or HMO. If it seems
unclear, talk with your employee benefits manager or phone your insurer. Many insurance
companies will pay for the initial evaluation and base their decision on coverage of
therapy according to what the diagnosis and/or prognosis is. Some companies require that
the child's pediatrician write a "letter of medical necessity" or call them for
an authorization number prior to the evaluation.
If your insurance company or HMO denies coverage for services, you can appeal it. All
companies have an appeals process that you must follow within a specified time frame.
Sometimes this requires that your physician send applicable notes about illnesses or
conditions that might be related to the communication disorder, such as chronic ear
infections.
If your insurance company continues to deny coverage, talk with the speech-language
pathologist who screened your child. He or she may refer you to a program in the schools
or in the community that does not require insurance monies. Let your employer know that
you want coverage for speech therapy for your child and they may be able to negotiate for
this benefit when renewing insurance coverage in the future.
QUESTION: My neighbor's 2 1/2 year old son was recently diagnosed with autism. What is that?
ANSWER: Autism is thought to be a neurological disorder that the child manifests from birth. It becomes more evident around 18 to 30 months when we expect speech and social interaction with others. Autism pervades all aspects of life.
Many autistic children have some, but not necessarily all, of these characteristics:
1. Late onset of speech; echoing of others speech; inappropriate speech or lack of speech; screaming
2. Lack of interest in social interactions with others; lack of eye contact
3. Odd play; unusual attachments to objects; enjoys being left alone to play or engage in sensory stimulation
4. May have strange reactions to sensory stimuli (sounds, smells; etc.)
5. May have strange gait; toe walking; may spin or flap hands, may injury self when frustrated (band head; bite hands, etc. )
6. May have a very limited diet
7. Sleep difficulties
For further information contact the Autism Society of America at 1-800-3-AUTISM
QUESTION: My five year old has had a hoarse voice for several months. Sometimes at the end of the day it is very hard to understand what he is saying. Should I be concerned?
ANSWER: Children who do a lot of shouting and yelling generally have hoarse voices. They develop nodules on their vocal cords; this will only get worse with time unless they are taught the proper use of their voice. I am sure that by the end of a day your child's vocal cords are red and inflamed so that he gets intermittent voicing when speaking, thus resulting in your inability to understand him.
First, have his vocal cords checked out by a medical doctor to make sure that it is only inflammation and nodules that are causing the hoarseness. Then seek help from a pediatric speech pathologist who will work with you and your child on learning vocal hygiene. You will probably keep a chart posted in a prominent area and reward your child for using his "indoor voice" while playing. The speech pathologist will also teach your child how to use a noise-maker, like a whistle, to get friends attention while outside instead of shouting.
QUESTION: My four year old seems to be delayed in language development. His sentences are much shorter than those of his friends and he does not speak as clearly as they do. Are there any software programs I can use to help him speak better?
ANSWER: First of all, it would be wise to have him screened by a licensed speech language pathologist to determine if indeed he is delayed for his age. Preschool age boys generally develop speech a bit slower than girls; girls usually talk earlier and have larger vocabularies than boys, but by kindergarten age the boys catch up. So if we compare boys to girls at age four, we do see some real differences. However, your son may still be well within the normal range for his age and sex. This is why it is so crucial to have a professional with experience in pediatric speech and language development observe your child.
If your child does have delayed speech and language development the therapist will give you specific exercises to do with him on a daily basis. These exercises are fun and you will see real changes from week to week. There are also wonderful software programs that you can mount on your computer; these are geared to young children and reinforce the new skills that they are learning in therapy. Your therapist will help you select software that is appropriate for your child. We have a variety of programs that are appropriate for children of different ages with a variety of speech and language disorders.
QUESTION: The little fellow next door stutters quite a bit when I talk to him. Is there anything I can do to help him?
ANSWER: There are several things that you can do to make him feel more comfortable. First of all, do maintain eye contact when he is blocking; some people mistakenly look away, but this gives the message that you are embarrassed or uncomfortable with his speech. Secondly, do not finish his words for him, even if you think you know what he wants to say. And thirdly, give him ample time to speak; do not act as if you need him to hurry up. If you can make conversations a pleasant experience, you will probably find that he is more comfortable and therefore more fluent when speaking with you. Good luck!
QUESTION: My child is scheduled for a speech screening next week. How do you suggest I prepare him for this?
ANSWER: Most preschoolers have had the experience of being in either preschool or Sunday school, so we suggest that you use this analogy. Tell your child that he/she will be going with you to visit a teacher. The teacher will have lots of toys. She will let you play with the toys and talk to you about them.
We do not engage in any formal screening testing with children below the age of three. But we do watch how they engage with toys and other people. We try to determine how well they comprehend simple commands, e.g. "Put the monkey in the tree" or "Give the car to mommy". We are also listening for clarity of speech, vocabulary and sentence structure. We also try to determine whether voice and fluency are appropriate for age.
For children over the age of three we will give a short screening test to determine whether articulation and language skills are age-appropriate. This is also done with toys as the stimuli. If the child is cooperative enough we will also try to screen hearing. Screenings take about 20 minutes and are FREE. Call and set up an appointment for your child if you have any concerns about his or her communication skills.