Parents know their children better than any other person in the world; so, when a parent is concerned that there may be a problem they are typically correct. But, sometimes what we, as parents, see as a problem may turn out to be normal development. If there is doubt about how your child functions, an evaluation will help diagnose, or rule out, potential issues. ‘The sooner the better’ applies in this case and is a common belief among professionals. The sooner your child begins working on problematic areas the easier it will be for them to change learned habits. Imagine someone telling you that its time to change the manner you've learned to speak! Habits are really tough to break especially when you’ve been practicing and refining the habit for several years.
It’s easy to get started. Simply call or email us to discuss the situation with a trained professional. If it is determined that your child would benefit from an evaluation then an appointment can be made for a time convenient to the schedules of all involved. During an evaluation, the therapist will collect a background case history and other relevant data to aid with diagnosis or help rule out problems. Evaluation procedures include formal testing, observation, and the collection of a speech and language sample if warranted. The evaluation can usually be done in one session (which usually takes approximately one to one and a half hours), however, keep in mind that all children are individuals and some may need more than one session to truly collect enough information to make a thorough diagnosis. After completing the evaluation, the clinician will discuss treatment options and make any necessary referrals.
A speech disorder can be considered anything that makes a child unintelligible to a non-familiar person. Many parents can interpret for their children... but can everyone understand them? Most children are able to acquire enough conversational skill to produce understandable speech by approximately 30 months of age. While it is not uncommon for some speech sounds to remain un-mastered until six or seven years of age, typically a child four years of age should be completely understandable to an untrained listener.
We have all heard children babble. Moving from babbling to the level of competent speaking requires the mastery of many highly complex skills. Children are typically able to learn speech through constant observation and interaction with their environment. In order to be a capable speaker children must be able to make judgments, based on their ability to understand what the listener is saying, and give feedback on what he or she has heard. They innately learn how to pair, group, and practice speech sounds that share similar qualities (for example, /p/ and /b/ are paired because they are produced when the lips close and produce an explosion of air...the only difference is that one sound require no voice /p/ and one does /b/...If a child can learn one then it follows that he/she should be able to learn the other). Children then learn to make combinations by adding those practiced sounds with other learned consonants and vowels to make patterns and words.
There are many reasons why a child may not be speaking as perfectly as he/she could. Apraxia of speech is a motor planning disorder that is often confused with speech delay. The condition of apraxia affects the child’s ability to plan, sequence, and perform purposefully movements necessary for speech. Proprioceptive difficulties may also affect speech production. Proprioceptive difficulties make it difficult for a child to receive enough sensory feedback regarding the appropriate placement of the articulators for speech production. This sample is not exhaustive. Again, there are numerous possibilities for a speech delay/disorder.
Throughout the world, regardless of the language spoken, acquisition of speech sounds occurs the same way. As a child develops, he/she can be compared to predicted developmental features (for example, 80-90% of all children aged 2+ will have mastered the sound /m/). In some cases, the process of developing speech is slowed, or even halted. While there are many possible reasons for this, when a predicted feature is not met by a certain age, the appearance of a speech disorder/delay must be considered. A speech and language evaluation can be administered to determine the presence or absence of a speech delay or disorder.
Language development is similar to speech development, that is, it develops on a timetable. Many professionals have indicated that Language helps shape the way cognitive skills develop as well. In a sense, their development is tied together. For example when an adult names an object (ball) the child sees everything that is round as a ball. However as cognition and language continue to develop other modalities ( taste, smell, touch, hearing, etc.) play a role in naming an object. Now each ball that the child sees has its’ own qualities, ie: big, small, soft, hard, smooth, rough ball. Vocabulary continues to develop based on how much information the child takes in through the various modalities. Soon all of these new vocabulary words are then combined to create utterances and certain rules have to be followed. The rules are called syntax and grammar. As the child learns these rules and learns to combine words appropriately he or she is also learning the social customs of language. In-other-words, how I communicatively interact with my peers and adults as well as acting appropriately in varied social situations. These social rules are learned and internalized and are called pragmatic rules.
Some children do not follow the timetable of language development the way an average child does. When there is a significant lag in language acquisition a delay must be considered. A child with a language delay may not use the language commensurate with his or her peers. There may be a delay in learning the correct vocabulary for his/her age. The child may have difficulty learning the proper rules of syntax and grammar or they may not develop the correct pragmatic skills necessary to engage in play and communication with their peers or adults. We often do not know or understand why these delays occur. A complete medical history is often needed to attempt to learn what the etiology of the delay might be. Sometimes recurrent ear infections early in life can cause speech and language delays. It is important to have the child evaluated as soon as a delay is noticed. Like speech disorders, a language disorder can sometimes appear to be a problem when in actuality it isn’t. It may simply be a part of the normal developmental sequence. However a wait and see attitude can be harmful. Other problems can manifest themselves from a language disorder. Difficulties in reading, learning phonetics, spelling, mathematics, and written language difficulties can often be the result of speech and language delays.
Again, as with speech disorders, there are many possible reasons for these delays in language development. When one or more of the areas of language are delayed, it is advisable to seek help and advisement. A speech and language evaluation can be administered to determine the presence or absence of a language disorder.
We judge a normal voice according to pitch, loudness, and quality and determine whether or not it is adequate for communication and whether its suits a particular person. People use pitches that are too high, too low or deep, hoarse, breathy, or nasal. Sometimes a vocal quality can be inappropriate for a particular person, such as a man having a high pitched voice.
A teenager has a voice change and boys usually have high pitched voices for a few years. This is normal change and will typically normalize by itself. Once the individual moves through the adolescent period his voice should normalize. If it doesn’t then consult your physician or a speech pathologist. "Voice is a problem when the pitch, loudness, or quality calls attention to itself and not to what the speaker is saying." (Asha.org.)
Hyperfunctional Voice Disorders:
Contact Ulcers: A small ulceration that develops on the arytenoids cartilages, and typically develop due to vocal misuse. Primarily seen in men who speak aggressively, excessive throat clearing due to allergies, or reflux. Typically the speaker will exhibit a breathy voice with some hoarseness sometimes accompanied by discomfort or pain.
Vocal Nodules: Benign growths on the vocal folds usually brought on by vocal abuse. People with vocal nodules usually speak loudly, and excessively, and experience soreness or pain in the neck, hoarseness, and breathiness.
Vocal Polyps: Soft bulges filled with fluid located in the front area of the vocal folds. In almost all cases they come from vocal abuse. People usually exhibit hoarseness, shortness of breath and vocal inhalation.
Psychogenic Voice Disorders:
Functional Aphonia: By definition this means “no voice”. Again it can be caused by stress or abuse to the vocal folds or it can be diseased in nature.
Spasmodic Dysphonia: This disorder is a rare disorder that is both functional and organic in nature. There is usually a neurological basis for this disorder. Symptoms include a effortful amount of strain to speak with a jerky, hoarse vocal quality.
There are many other types of voice disorders not mentioned here. For more detailed information go to the ASHA website.
The following is a list of symptoms to watch for:
1. Monotonous voice, with low pitch
2. Complaints of vocal fatigue
3. Reduced volume, and restricted phonation range.
4. Too much or too little nasality.
5. Strained voice, tremors, or loss of voice while speaking.
6. Monopitch, or monoloudness.
7. Excessive coughing that lasts for more then 10 days.
If any of these symptoms are noticed and prolonged for more then two weeks, you should contact a physician or a speech pathologist right away for an evaluation. If you are unsure what to do, contact Herman & Associates and someone will assist you.
As Speech and Language Pathologists we frequently treat children with Autism regardless of our setting. (Clinic, hospital, school, etc.) It is a prevalent disorder in our office that we treat daily, and the diagnosis of Autism nationally is on the rise. Autism is a disorder that, while it dramatically affects the quality of life the child may have, completely changes the life of a parent. The issues that are present while raising a child with autism are life consuming and life altering. Many of our parents have frustration and stress levels that are at their highest due to the unknown factors that come from raising a child with a disorder. "When will my child talk," they say? "Will my child be able to tie his shoes," they ask? The prognosis of children with autism varies dramatically depending on severity level. But, there is a silver lining! A Speech Pathologist can help give your child a way to communicate. An Occupational Therapist aids in self help skills and overall sensory issues. A physical therapist can help make sure your child has the strength to crawl, sit, walk, run, or play. So, while there is no cure for autism as yet, the symptoms of autism are treatable!! Early diagnosis and intervention are vital to the future development of the child.
According to the Autism Society of America, autism is a severely incapacitating lifelong developmental disability that typically appears during the first three years of life. It occurs in approximately 62 out of every 10,000 births and is four times more common in boys than girls. It has been found throughout the world in families of all racial, ethnic and social backgrounds. No known factors in the psychological environment of a child have been shown to cause autism but symptoms are caused by physical disorders of the brain.
Autism occurs by itself or in association with other disorders, which affect the function of the brain such as viral infections, metabolic disturbances, and epilepsy. It is important to distinguish autism from retardation or mental disorders since diagnostic confusion may result in referral to inappropriate and ineffective treatment techniques. The severe form of the syndrome may include extreme self-injurious, repetitive, highly unusual and aggressive behavior. Special educational programs using behavioral methods have proven to be the most helpful treatment.
The good news is that parents are not alone. There are many resources to help parents and their children navigate the autism spectrum so talk to your local therapist and find out how they can help. It’s easy...just call us and we’ll take it from there!
(Some of the information for this section was taken from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV), The Autism Society of America, and the Dan Marino sponsored website Childnett.tv).
A dictionary describes stuttering as “hesitation or stumbling in uttering words,” but a speech and language pathologist feels this definition is incomplete. Stutterers typically do not have any discernible characteristics or mental abnormalities. They typically experience fears and anxieties in relation to speaking, and are almost always aware that their speech is unusual. They frequently show signs of struggling to speak as well.
All children develop normal hesitancies and it is very important that all professionals and parents recognize the differences between these normal hesitancies and beginning stuttering.
Let’s look at some behaviors that are typically normal especially around the age of 28 – 36 months.
1. The child begins to show marked and obvious speech hesitancies;
2. The child avoids verbal contacts and or becomes shy in certain speaking situations. These situations may be ones that he/she formally had no difficulty with.
3. An effortful attempt to speak is noticed and there is a clear struggle to express himself.
4. The drawing out of sounds (prolongations) are noticed and or sounds are repeated.
Frequently with a little patience and understanding these behaviors can be modified and often the stuttering will disappear in a few months.
It is not always easy to distinguish the difference between normal dysfluency and real stuttering. A rule of thumb to follow is: If the problem doesn’t go away on its own after a few months seek help. This is especially true if the child appears helpless and unable to speak and express their thoughts. Often times the child will attempt to start again many times, or stop and try to say the same thing in a different way. Not all-repetitive speech is alarming. If the hesitancies are the result of a child searching for a word, then it is of little importance. If the child simply seems to be hunting out a thought then again, this is not of much importance. Such hesitancies are normal. To reiterate this thought: There are many possible reasons for stuttering and when it is felt that a true disorder is continuing for more than a few months an evaluation by a speech and language pathologist is recommended.
The Hanen Centre is a charitable organization founded in 1975. Originally from Canada, the mission of the Hanen Centre is to “provide the important people in a young child’s life with the knowledge and training they need to help the child develop the best possible language, social, and literacy skills” (www.hanen.org). They do this by creating programs that teach parents and other caregivers how to promote a child’s language development during everyday activities. Alicia Sperrazza, a long time associate of Herman & Associates, is a Speech-Language Pathologist, Diagnostician, and certified provider of the Hanen Program for Parents. We are currently able to offer the following two Hanen Programs: It Takes Two to Talk and More Than Words.
It Takes Two to Talk® — The Hanen Program® for Parents (IT4) is a well-known model of family-focused early language intervention for young children with expressive and/or receptive language delays. The goal of It Takes Two to Talkis to enable parents to become their child’s primary language facilitator, thereby maximizing the child’s opportunities for communication development in everyday situations. It Takes Two to Talk is designed for toddlers and preschool-age children with specific language impairment, as well as for children with cognitive and developmental delays under age five. The program consists of eight two-hour training lectures and three one-hour video feedback (VFB) sessions spanning eight consecutive weeks.
More Than Words®- The Hanen Program® for Parents (MTW)is a family-focused program that gives parents of children with Autism Spectrum Disorder (ASD) and related social communication difficulties, practical tools to help their children communicate. The More Than Words program is geared towards non-verbal communicators. Itemphasizes the child’s everyday activities as the context for learning to communicate. The program consists of eight two-hour training lectures and three one-hour video feedback (VFB) sessions spanning eight consecutive weeks.
Benefits of Training with the Hanen Program for Parents:
* Programs are per family not per child. Parents, grandparents, and caregivers are encouraged to attend the lectures...any person that frequently communicates with your child.
* Parents learn exactly what their child does in therapy...no more, "What can I do at home to help?"
* The program allows for much more parent contact time than typical therapies. It also holds parents accountable for change within the child.
* Parent/caregiver training leads to easier carryover of skills at home since the parent becomes the therapist.
* Lectures are offered in the evenings to accommodate work schedules and encourage both parents to attend.
* The entire program costs one flat rate...no authorization periods, no denial of services from your insurance. Parents are billed for an 8-week block of training. Does this mean your child will not need individual services after the program? No. Remember, this is parent training. Will the parent need more than 8 weeks of training? Probably not.
* The program is more affordable per session and per hour than typical therapies.
* Therapy/training is provided in finite blocks of time...no more, "How long will my child have to be in therapy?"
* There are two program options to fit varying budgets.
* Options are provided for ongoing counsel and treatment.
* There are two program types each with beginner and intermediate levels. This offers an option to continue treatment throughout the year by attending successive programs.
Program Costs and Payment Options:
Hanen Programs are not currently covered by insurance pay sources, but provide an affordable short-term alternative to traditional therapy and out-of-pocket treatment expenses. For children under the age of three please consider contacting Early Steps and the Developmental Center for Infants and Children at the Howard Phillips Center for Children and Families, a part of Arnold Palmer Hospital for Children at (407) 317-7430. They have trained professionals to help provide funding and services for children in need under the age of three and may be able to refer you to the program.
Hanen Program Costs
Parents commit to attend 1 orientation, 8 lectures, and 3 VFB Sessions
$500 for 12 Sessions. 8 Weeks of Training | $40 Per Session | 19hrs of Training at $25/hr
Social groups focus on the skills needed to effectively communicate in a group setting. The set of rules that dictates how language is used within different social and communicative contexts is called pragmatics. Knowledge and use of pragmatics is needed for effective social communication. The social groups develop these pragmatic skills.
In the social groups, strategies that facilitate successful communication are taught. This involves skills of topic management. First a topic must be selected. Group members learn how to select a topic based on what other members are interested in order to increase the quality and quantity of interaction. The topic must then be initiated to begin the interaction. Topic maintenance is the ability to listen and respond appropriately to keep the conversation going. Group members practice questioning techniques to assist in topic maintenance. An important skill for topic maintenance is turn-taking. For turn-taking to be successful, the individual needs to be able to take on the role of the listener and the speaker sequentially, and know when to switch roles. Group members learn to consider the perspective of their conversational partners. When communication breakdowns occur, and strategies for repair are needed. Topic changes require smooth transitions. Throughout the social group experience, opportunities are provided for guided practice of topic management skills.
Nonverbal aspects of language are also important in conveying the desired message within the communicative context. Nonverbal communication includes physical proximity, body posturing, gestures, facial expressions, and eye contact. Within the social groups, instruction is given regarding the use of appropriate nonverbal communication.
The social groups are designed to provide multiple opportunities to engage in peer conversational interaction. Direct instruction is given to provide skills and techniques for successful conversation as needed; however, the primary delivery method is through peer conversation. Each group is tailored to meet the needs of its members based on age, interest, and family input.
If you are in need of further assistance or information, please call Herman & Associates, Pediatric Specialists, at (407) 898-5060 and someone will be happy to assist you.
Early Intervention applies to all children from birth through school age where it has been determined that they have or may be at risk of developing a handicapping condition that could affect their development. Caution must prevail however. Children develop differently. One baby may walk earlier, while another might speak first. Frequently the differences seen in development even out, but some will need extra help.
Be aware of signs that identify the need for Early Intervention. Early help does make a difference. Early Intervention may focus on your child alone, or it may involve the whole family working with the child. Early Intervention can be home based, center based, or it could be a combination of both to these. Early Intervention may begin at anytime during birth and school age, however the earlier it is begun the more success the child can achieve prior to his entering formal school.
Child development research has established that development and learning is the most rapid during the preschool years. Children develop and learn in sequential stages and the most teachable moments during these stages must be taken advantage of. The success of each stage is dependent upon the success of each subsequent stage. If a child is not successful at each stage of development then a child may have difficulty learning a particular skill at a later time. Connolly, Morgan, Russell, and Fulliton, (1993) have noted that “Early Intervention for children with developmental delays was significant for children to develop to their fullest potential.”
Early Intervention services also play an important role on the whole family. There is a significant impact on the parents and siblings of an exceptional child. The family quite often feels helpless and isolated socially. These feelings of stress may affect the family in a negative way and also interfere with the development of the handicapped child. There have been many studies that have demonstrated that families of handicapped children are found to have increased instances of divorce and child abuse. Early Intervention can have positive family outcomes as well. Professionals are able to help families cope with the stress of having a handicapped child and parents typically have improved attitudes about themselves and their child. Many parents feel guilty about having caused the handicap, which is rarely the case.
There are social benefits as well. As children increase in their development and make better educational gains their dependency upon social institutions decreases, and their eligibility for employment increases as well.
This question is asked by many parents, and professionals. Early Intervention research has been intensive for over 50 years. Based on both quantitative and qualitative research, early intervention increases both educational and developmental gains in children. It has also been shown to improve family functioning, and increases the child’s ability to be of benefit to society. In many cases early intervention has such a great impact on the development of a child that by school age the child is indistinguishable from the nonhandicapped child, demonstrates less of a need for special education and has fewer retentions. There have been other research studies to indicate higher achievement scores on reading, math and language achievements test at all grade levels, less high school dropouts and less delinquent behaviors. (Berrueta-Clement, Schweinhart, Barnett, Epstein, Weikart, 1984).
The following is a check list for growing children. Remember this is just a guide and that all children development differently. However if you see that there are mulitple things on the list that your child is not doing then it is better to be safe then sorry and you should seek professional advice.
By 3 months most babies will:
___ turn their heads toward bright colors and lights
___ move both eyes in the same direction together (visual tracking or scanning)
___ recognize a bottle or breast
___ respond to familiar voices
___ make cooing sounds
___ bring their hands together
___ wiggle and kick with their arms and legs
___ lift head when on stomach
___ become quiet in response to sound, primarily to speech
By 6 months most babies will:
___ follow moving objects with their eyes
___ turn toward the source of normal sound (localize sound)
___ reach for objects and pick them up
___ switch objects from one hand to another
___ play with their toes
___ help hold the bottle during feeding
___ recognize familiar faces
___ imitate speech sounds
___ roll over
By 12 months most babies will:
___ sit up
___ pull to standing position
___ crawl (usually cross lateral / left arm – right leg/ right arm-left leg)
___ stand briefly without support
___ put objects in a container
___ say at least one word
___ imitate adult movements such as drinking with a cup or clapping
___ play peek a boo
___ wave bye bye
___ say “ma ma or “da da”
By 1 1/2 years most babies will:
___ push and pull objects
___ take off clothing (socks, shoes)
___ feed themselves finger foods
___ follow simple directions
___ say at least 6 words
___ walk without help for a few steps
___ make marks on paper with crayon or pencil
___ point to pictures in a book
___ say “no” with their heads or push things aways
___ walk backwards
By 2 years most babies will:
___ say about 50 or more words
___ kick a ball forward
___ use 2-3 word phrases
___ identify some body parts (eyes, nose, ears, hair, mouth, by pointing)
___ turn the pages of a book
___ feed themselves with a spoon ___ demand attention
___ imitate parental or sibling behaviors
___ build a tower of four blocks
___ show affection
By 3 years of age most children will:
___ ride a tricycle
___ open the door
___ play with other children
___ repeat common phrases or nursery rhymes
___ put on their shoes
___ throw a ball
___ use 3-5 word sentences
___ name at least one color and some letters
all any professional (speech pathologist, occupational or physical therapist, psychologist or consult with your family physician. You can also call us (Herman & Associates at (407) 898-5060) We will be happy to answer any questions for you and help in anyway we can. You can also email Dr. Herman directly with questions at firstname.lastname@example.org
If you live in Central Florida call (407) 317-7430. This will put you in touch with The Developmental Center for Infants & Children early steps program. These services are free of charge and they offer everything your child will need to achieve his maximum potential.
Occupational Therapy is based on engagement in meaningful activities of daily life, especially to enable or encourage participation in such activities in spite of impairments or limitations in physical or mental functions.
Sensory Integration International, Inc. states., when we think of “the senses”, we can easily call to mind taste, smell, sight, and sound, The senses of touch, movement, force of gravity, and body position are so natural to most people that we assume our way of dealing with incoming information is similar for all people. However, it isn’t. Our tactile sense (touch) allows us to identify a multitude of sensations from gentle pleasure to forceful defense. Our vestibular sense (sense of movement) responds to the bodily movement through space. It can identify even the slightest changes in head movement. It is absolutely essential in maintaining muscle tone, coordinating the two sides of the body, and holding the head upright and aligned against gravity. Proprioception, (the sense of body position in space) is the sense that enables us to move different parts of our bodies smoothly without having to see the action. An example of proprioception is adjusting ourselves to prevent from falling out of bed, or the ability to manipulate objects such as pencils, spoons, forks, knives, etc.
The relationship between the senses, and the way they organize themselves is termed sensory integration. The tactile, proprioceptive, and vestibular senses are particularly important in providing the individual with knowledge about motor planning which is essentially having the idea of what to do, planning the action, and finally performing it.
Most children develop sensory integration through normal play activities during childhood. Motor planning is the natural outcome as is the ability to respond appropriately to incoming sensation. Unfortunately for some children, sensory integration (SI) does not develop as normally as it should. When this normal process is interrupted, ie: lack of appropriate stimulation, or the inability to move for a long time, specific problems occur. These problems may be in learning, development, or behavior. If there is over sensitivity to incoming sensory input, an individual may have a negative reaction to physical contact, have a fear of movement, or avoid normal routines such as: combing hair, brushing teeth, bathing, etc. If there is under sensitivity to incoming sensory input, an individual they may require excessive movement, especially hard movements such as: throwing themselves to the floor, or crashing into a wall. Pain tolerances are typically very high and the individual may appear not to get hurt during these types of harsh physical movements. Sometimes you may see fluctuations between very high and low activity levels. There are no specific patterns of behavior. Frequently an person might exhibit difficulties with coordination, balance (dynamic and static) and various types of movement since (SI) acts negatively on motor planning. The ability to regulate one’s arousal and attention level is also impaired. Again (SI) difficulties can cause problems in learning, understanding and expressing ones ideas and feelings, and interaction with peers.
Occupational Therapists at Herman & Associates are trained to address difficulties that individuals have with sensory integration. The therapists will use the child’s strengths to help motivate him/her to participate in activities that help organize sensory input.
Pediatric physical therapy is a form of therapy that deals with many types of diagnoses that affect normal development between the ages of 0 to 21 years of age. Look under Herman & Associates (services) for specific diagnoses.
The primary role of the physical therapist depends on the diagnosis, severity of the disability, and age of your child. As always, our primary role, regardless of what therapy is required, is to be an advocate for you and your child.
Pediatric physical therapists help to ensure that your child reaches his or her fullest potential and maximum performance during every day activities. Our therapists rely on their expert knowledge of the neurological, musculoskeletal, cardiopulmonary, and integumentary (skin) systems to help your child in the following areas:
- Achieve age-appropriate developmental milestones.
- Reach age-appropriate gross motor skills and participate in school activities with peers.
- Improve range of motion, strength, mobility, posture, balance, endurance for independent function.
- Improve your child’s independence in mobility, so that they may move through their environment in a more efficient manner.
- Become an active and functional member of society.
Contact the doctor and he’ll get back to you as soon as possible.