What We Do

If you feel your child's speech is difficult to understand, it may be related to an articulation disorder. Articulation refers to the manner in which an individual produces a sound and the placement of the tongue, lips, and teeth. An articulation disorder is the atypical production of a specific speech sound that may interfere with speech intelligibility (how much is understood). It is a deficiency in an ability to produce sounds motorically, considered a motor-based error. The sound can be difficult to produce in syllables, words, phrases, sentences, or in conversation. There is no pattern related to the error. Many speech sound disorders occur without a known cause. Some can result from physical problems, developmental disorders, genetic syndromes, hearing loss, illness, or a neurological disorder. Children who experience frequent ear infections could also be at a higher risk for an articulation disorder. Sounds occur in a developmental hierarchy. Some sounds develop prior to other sounds. All sounds should be mastered by the age of seven.

Phonology refers to the sound system of language. A phonological disorder is the difficulty in acquiring a phonological system; involving organizing the pattern of sounds in the brain and the output. For example, substituting all sounds made in the back of the mouth "k" and "g" for those in the front of the mouth like "t" and "d" (e.g., "car" for "tar"). This is known as the process of "fronting". Children who have a phonological disorder are often very difficult to understand. If the disorder persists into school age, children may have difficulty in reading and writing, as well. Phonological patterns or "processes" are considered normal unless they persist beyond a certain age when most typically developing children have stopped using them. For example, if a 5 year old is saying "bu" for "bus", this process is known as final consonant deletion and should disappear by the age of three.

Language is a form of social behavior shaped and maintained by a verbal community. A language disorder occurs when there is a significant deficiency, not consistent with a student's chronological age. When looking at language, we assess in two parts - receptive and expressive language.

Typically, an individual’s receptive language develops prior to their expressive language. For a child to learn, they need to comprehend spoken language. Children will understand more words than they are able to say, this refers to their receptive vocabulary. A child with a receptive language disorder often has difficulty understanding and processing what is said to them. A parent may notice they have difficulty following directions or the child may appear to not be listening.

An individual with an expressive language disorder understands language better than he/she is able to communicate it. An expressive language disorder is characterized by having a limited vocabulary and grasp of grammar. An expressive language disorder could occur in a child of typical intelligence or it could be a component of a condition affecting mental functioning more broadly (e.g., intellectual disability, autism).

Social skills are the skills we use to communicate and interact with each other, verbally and non-verbally. This can be done through gestures, body language, and our personal space. A social communication disorder is characterized by difficulty with the use of verbal and nonverbal language for social purposes. A person may have difficulty in social settings, developing peer relationships, achieving academic success, and performing successfully in a job. A social communication disorder may co-occur with other conditions, most often seen in an individual with autism.

A cognitive communication disorder is defined as difficulty with any aspect of communication that is affected by disruption of cognition. Some examples of cognitive processes include attention, memory, organization, problem solving/reasoning, and executive functioning. The disorder varies in severity depending on where the neurological deficit occurs. A cognitive disorder can result from a stroke, traumatic brain injury, brain tumor, degenerative diseases, or dementia. The disorder can also co-occur with dysarthria, apraxia, or aphasia.

Dysphagia is the disorder of swallowing. Swallowing occurs in 3 phases: oral, pharyngeal, and esophageal. Feeding and swallowing difficulties can occur in one or more than one phase. Some signs of feeding and swallowing disorders include but are not limited to: cries/fusses when feeding, falls asleep when feeding, difficulty breathing, refusal, eats only certain textures, takes a long time, spits/throws up, or not gaining weight. Various causes of feeding and swallowing disorders include nervous system disorders, reflux, heart disease, breathing problems, autism, head/neck problems, muscle weakness in the face and neck, medications, sensory issues, and behavior problems.

Fluency refers to the continuity, smoothness, rate, and effort of speech production. Stuttering is the most common fluency disorder, typically occurring in childhood. Some examples of atypical disfluencies include part-word or sound/syllable repetitions (e.g., “I l-l-l-love you”), prolongations (e.g., “Do you ssssssee”), and blocks (audible or inaudible). In addition to stutter-like disfluencies, a person may exhibit physical tension in the face or body. All speakers produce disfluencies; however the disorder is diagnosed when a high number of atypical disfluencies occur, creating great difficulty with speech production.

A voice disorder occurs when vocal quality, pitch, and loudness differ or are inappropriate for an individual’s age, gender, cultural background, or geographic location. A voice disorder can be of physical (e.g. vocal nodules) or neurogenic (e.g. vocal cord paralysis) nature.

Augmentative and alternative communication (AAC) is an area of clinical practice that addresses the needs of individuals with significant and complex communication disorders characterized by impairments in speech-language production and/or comprehension, including spoken and written modes of communication. An AAC evaluation determines the accurate mode of communication an individual may require including: picture communication boards, line drawings, speech-generating devices (SGDs), tangible objects, manual signs, gestures, and fingerspelling to help the individual express thought, wants and needs, feelings, and ideas. AAC is augmentative when used to supplement existing speech and alternative when used in place of speech that is absent or not functional.