Cary Speech Services – Services Provided

Don’t Hesitate to get a Screening

Parents are often hesitant to make an appointment to have their child evaluated for fear that speech may be normal and a big bill will follow. The purpose of the free screening is to determine whether the child is developing speech and language at a normal rate or whether something is wrong. This is especially useful for preschoolers.

A screening is about 15 to 20 minutes in length. It involves playing with the child and listening to the way the child speaks and communicates. With older preschoolers ages 4 to 5 and young elementary age children we give abbreviated language and articulation screening tests.

If a child fails the screening, an evaluation should follow. There is a charge for an evaluation based on the time needed to test the child and generate a report. Because of its briefness, a screening can never take the place of an evaluation. Try to think of a screening this way: the screening answers the question, “Is the child’s speech normal for his age or is there a speech-language problem?” The evaluation is based on the idea that there is a speech-language problem present. We need to answer the question, “What specifically is wrong with the speech or language and how easily can it be corrected?”

We work successfully with stuttering

Stuttering, or a fluency disorder, presents as whole or part-word repetitions, silent blocks, prolongation of sounds. Often there is obvious tension in the face and neck. Children with fluency problems have the most difficulty at the beginning of sentences. Children with a stuttering problem generally are shy and hesitant to speak aloud in class. Thus, sometimes they have difficulty making friends.

Many children with a fluency problem have a history of speech difficulties that began in the early preschool years, usually between ages 2 and 5. In addition to the stuttering, as preschoolers they may also have had a phonological disorder or a language delay. Sometimes it is difficult to discern whether a young child is indeed stuttering or just going through a normal period of dysfluency. If the dysfluency persists over six months, becomes progressively worse, or the child appears frustrated, a speech-language pathologist will be the next step. The good news is that many children diagnosed with a fluency disorder in the preschool years can achieve normal fluency with treatment. The longer stuttering is left untreated, the harder it is to achieve and maintain normal fluency in later years.

Speech and language therapy is individualized.

Cary Speech Services provides individualized speech and language therapy to meet the needs of each child. Generally, speech therapy session are 30 minutes in length. Most children visit once per week; however, those with disorders that are severe in nature may visit two or three times per week. After completion of the formal evaluation, your therapist can determine appropriate scheduling.

Our philosophy of therapy is to involve parents in the treatment process.  Parents will sit in on at least some, if not all, of the therapy sessions. The therapist will teach the parents how to implement the treatment at home and parents take home the materials necessary to do this. Parents should make a commitment to spend at least 30 minutes a day working on the assigned exercises.

Our therapists do thorough speech and language evaluations.

During the speech and language evaluation the therapist tries to answer the following questions:

What types of speech problems are detected? How is articulation, or the ability to produce the vowels and consonants of our language? How intelligible is the speech? Must the parent interpret what the child is saying? Does the child speak too fast? Is there a stuttering problem? How is the child’s voice (does it sound hoarse or raspy)? In the adolescent, is the pitch appropriate for age and sex?

Are there problems with language? How appropriate is vocabulary and sentence structure for age? Is the child able to clearly relate stories and events that are of interest to her? How does she respond to questions? Does she seem to have difficulty understanding what is said to her? Can she follow directions; how many? Are there problems with use or comprehension of pronouns?

How well can the child control the muscles of speech? Is there a good range of motion with the tongue, lips, and jaw? Are there any feeding problems? Does the child choke a lot when eating or drinking? Can she imitate the therapist’s movements to produce individual speech sounds or a string of varied speech sounds? Are oral habits such as thumb-sucking or a pacifier present? Is she able to drink from a glass or with a straw?

Your therapist writes a speech and language evaluation in report form and a copy may be sent to the insurance company if filing with them for coverage. With your permission, we also like to send the pediatrician a second copy so that he can be aware of all aspects of your child’s health. We also give you a copy of the report for your personal files.

We work successfully with auditory processing problems.

A central auditory processing disorder (CAPD) is a term used to describe children who have normal peripheral hearing but who have difficulty processing or generating meaning from spoken communication.

There are many types of auditory processing deficits and each type manifests itself in different ways. At Cary Speech Services, we can screen for the perception stage of auditory processing, which is pre-cognitive (doesn’t require understanding), using an instrument called the SCAN-C. The SCAN-C is an imitative test for children between the ages of five and eleven years. It requires that the child repeat stimulus words or sentences in four different listening environments: filtered words; auditory figure-ground; competing words; and competing sentences. The results can help to identify how a child’s pattern of auditory skills compares to a national sample of same age peers. This information can help to rule out the presence of an auditory processing problem. We can also test for receptive language difficulties, including auditory memory and sequencing.

With a central auditory processing disorder (by a multi-disciplinary team), our therapists may be able to design and implement a treatment program that addresses some of the child’s weaknesses, such as strengthening auditory memory and language skills. This may also include suggestions to the classroom teacher to improve the listening environment.

We work successfully with various language disorders.

Expressive language refers to the vocabulary and grammar that the child is using. Language develops in a rather orderly fashion: between 9 and 12 months most children begin to use real words, such as “mama” or “bye-bye”. Around 18 months there is an explosion of speech and the baby acquires a vocabulary of words, mainly nouns, that reflect his interest and. By 24 months the average baby has a vocabulary of about 50 words and is starting to make “sentences”. Between 24 and 36 months the toddler’s speech continues to develop. Not only does he acquire nouns, but now he also begins to get more verbs, adverbs, and adjectives so that sentences have a more mature format of: agent + action, action + object, agent + object, etc.

Receptive language refers to the child’s comprehension of what he hears. Before 12 months the baby understands routines and comes to expect certain things to happen in a specific order. Babies understand frequent words closer to 12 months. During the baby’s second year there is an increase in his understanding of short sentences. Babies generally understand more than they can say. By 24 months most babies can point to familiar objects in the house or in a picture book when told.

Children with delayed speech and language development are slow in achieving the above language milestones. The causes for these delays are many and varied. Some of the causes are hearing losses, mental retardation, cleft lip and palate, Down’s syndrome, cerebral palsy, attention deficit hyperactivity disorder, dyspraxia, and learning disabilities. In many instances, we are unable to find a reason for the delayed onset of language, or we find it in retrospect several years later.

Voice therapy involves the whole family.

A misuse of the voice causes a voice disorder. Screaming and whispers over time can result in nodules or polyps on the vocal cords. In voice therapy the child will learn the reasons for his hoarse voice and will learn how to use the voice properly without straining the vocal cords. When a child is misusing his voice, the entire family can help child identify this; a reward system will reinforce him when he uses his voice properly. The child can use non-speech methods as a substitute for yelling, such as a whistle to get attention.

Children with cleft lip and palate may also have voice disorders. Generally, children with clefts have hyper nasal speech or nasal air emission. Some children with repaired clefts have hypo nasal speech (unable to produce “m”, “n” and “ng” as nasal consonants). Children with dyspraxia and cerebral palsy may also have problems with nasal resonance. These children benefit from a period of voice therapy.

We work with ‘common’ and less-common speech disorders.

The most common speech disorder is an articulation defect. This can be as simple as an inability to produce one speech sound, or phoneme, such as an “r” or “l”. A common disorder that everyone is familiar with is the lisp, where the tongue protrudes between the teeth and a “th” sound is used in place of the “s”. A child can also have problems saying multiple phonemes and sometimes these children are unintelligible to everyone (except maybe their parents). We refer to these children as having a phonological disorder.

The condition called dysarthria is common in children with neurological impairments like cerebral palsy. Slurred or indistinct words indicates this; the child may have difficulty speaking loudly because he cannot control his respiration; there may be drooling; rate of speech may be laboriously slow and intonation pattern may be monotonous.

Individuals born with a cleft lip and /or palate will often have articulation problems as well as hyper nasality. They may have air escaping through their noses during speech resulting in nasal snorts and distortion of many of the plosive sounds like “p”, “t”, and “k” and the strident like “s” and “ch”.