Screenings

We offer free consultations and speech-language screenings. Screenings generally take 15-20 minutes and look at speech sound production, following directions, answering questions, sentence repetition and categorization. Screenings are customized based upon specific speech-language concerns. Screenings are provided by a licensed and certified Speech-Language Pathologist. They can be conducted in any private space of your choosing (office, home, etc.). Parents will receive a copy of the screening results once the screening is complete.

Evaluations

An evaluation may be recommended based upon the results of the speech-language screening. They are often recommended by a teacher, pediatrician or parent. Evaluations are provided by a licensed and certified Speech-Language Pathologist and typically take 1-5 hours depending on need. The assessment may include observations, language sample, case history and standardized testing. They can be conducted in any private space of your choosing (office, home, etc.). Parents will receive a written evaluation report detailing the assessment results once the assessment is complete.

Therapy

Therapy plans are formulated based upon the assessment results. The therapy plan includes measurable short and long term goals targeting your child’s specific communication needs. Quite often, parents seek out additional therapy to supplement their child’s school services. If that is the case, an evaluation is often not required and we will assess their current IEP and formulate a therapy plan.

Therapy services can be conducted in any private space of your choosing (office, home, etc.) and are provided by a licensed and certified Speech-Language Pathologist. Services are provided one on one targeting your child’s specific communication needs. Data is collected at every session to assist in measuring progress toward goal mastery.

Schools

Help your families to identify potential problems early. We provide speech-language screenings to schools.

• Screenings are conducted by a certified and licensed Speech Language Pathologist.
• We provide screenings to programs of any size.
• Written screening results and recommendations are provided to the school and family.
• Families are provided with all necessary information regarding the screening process, including speech-language screening consent forms to be completed before the screening.
• We provide the school with a brief in-service (upon request) describing the screening process.
• We provide In-Services to schools on a variety of topics geared towards families and staff. Common topics include developmental speech-language milestones, early childhood enrichment, social language and literacy.

Telepractice

Telepractice is the use of telecommunications technology to provide speech-language pathology services at a distance by linking a Speech-Language Pathologist to a client. Use of telepractice must be equivalent to the quality of services provided in person and consistent with adherence to the Code of Ethics (ASHA, 2016a), Scope of Practice in Speech-Language Pathology (ASHA, 2016b), state and federal laws (e.g., licensure, HIPPA…), and ASHA policy. Telepractice may not be appropriate for all clients and should be assessed prior to initiating services.

Considerations:

• Pro: Therapy sessions are convenient and can be conducted from the comfort of your own home.
• Pro: Therapy sessions can be easier to fit into your busy schedule.
• Pro: Minimizes the spread of illness and infectious diseases.
• Pro: Children who live in rural areas now have access to services.
• Pro: Live computer interactions customized to meet the child’s needs.
• Pro: Therapy sessions can be recorded for future use, such as self critique, parent review, feedback.
• Con: Technology troubleshooting.
• Con: Some therapies benefit from a hands on approach.
• Con: Some children might not benefit from video style interactions.

Speech Sound Disorders: Articulation and Phonological Processes

A speech sound disorder is characterized by difficulties with articulation (the inability to produce individual speech sounds clearly and correctly) and phonological processes (patterns of sound errors), after a certain age. At some point, all children make mistakes as they learn to pronounce new words. All sounds have an age range of when they are required. Speech sounds may be incorrectly substituted (tun for sun), omitted (ool for school), or distorted (shlun for sun).

When to refer:

• Doesn’t use consonant sounds/ uses mostly vowel sounds and gestures to communicate.
• Omits/Substitutes /Distorts sounds in words.
• Speech is difficult to understand/ unintelligible.
• Not using one or more of the sounds expected at their age.
  • Consonants p, b, m, d, t, k, g, f, w, n, y and vowels should be well established by age 4-5.
  • Consonants p, b, m, d, t, k, g, f, w, n, y, ng, h and vowels should be well established by age 5-6.
  • Speech should be intelligible yet some sounds may not yet be mastered: s, z, l, r, ch, sh, dj, v, zh, voiced and voiceless th.

Receptive and Expressive Language Disorders

Language is made up of socially shared rules that include word meanings, making new words, putting words together and using word combinations appropriately in specific situations. A language disorder is characterized by difficulty understanding language or following directions (receptive), or the inability to choose appropriate words and combine them correctly for sentences (expressive). The individual lacks age appropriate language comprehension and expressive abilities.

When to refer:

• Difficulty answering and asking questions.
• Difficulty following simple and multi-step directions; comprehension of basic concepts.
• Difficulty retelling a story or talking about an event.
• Difficulty remembering information presented verbally.
• Difficulty expressing ideas with a variety of complete and grammatically correct sentences.
• Difficulty with vocabulary naming and classification.
• Difficulty listening and drawing conclusions; making inferences; summarizing main points during learning activities.
• Difficulty with problem solving.

Word Retrieval

Word retrieval or word finding difficulty can be described as having knowledge of a word but being unable to retrieve the known word. The feeling can be described as the word “being on the tip of my tongue.”

When to refer:

• Difficulty telling a story, relating an event, participating in conversation.
• Substitutes related words for the target word such as sweeper for broom.
• Gestures for the word (using hand to pretend to write for the word pencil) or out of frustration.
• Silence or long delay when trying to retrieve a word.
• Extra verbalizations to help describe the word (it starts with the p sound).
• Adding fillers such as “um”, “uh”.

Fluency Disorders

A fluency disorder is characterized by an abnormal amount of involuntary repetitions, hesitations, prolongations, blocks or disruptions in the natural flow of rate and rhythm of speech.

When to refer:

• Student physically struggles to initiate and complete utterances.
• Student has an abnormal number of repetitions (repeat sounds, syllables, words, phrases), hesitations, prolongations, blocks (can’t get words out) or disruptions in natural flow of speech.
• Student exhibits tension or abnormal movements during speech.
• Student avoids speaking due to fear of stuttering or is embarrassed by his/her speech.
• Student’s rate of speech is too fast making him/her difficult to understand.

Voice Disorders

A voice disorder is characterized by abnormal vocal pitch, loudness, quality, or resonance. Voice is the use of vocal folds and breathing to produce a sound.

When to refer:

• Voice is chronically hoarse, harsh, breathy or of poor quality.
• Voice is always too loud or soft.
• Pitch is inappropriate for the student’s age or sex or has frequent pitch breaks.
• Voice is hyponasal (absence of nasal resonance in the voice) or hypernasal (sounds like “too much nose” in the voice).

Social Language/Pragmatic Disorders

Pragmatics refers to the appropriate use of language in social situations. For example, knowing what to say, how to say it, when to say it and generally how to “act” around other people during conversation. There are many children who have large vocabularies and are able to speak in full sentences that are clearly articulated, however, they may still have difficulty using language in various social situations.

When to refer:

• Difficulty following a simple conversation; participating appropriately in a conversation; starting a conversation; opening and closing a conversation.
• Difficulty participating appropriately in conversation.
• Difficulty initiating and maintaining topic.
• Difficulty taking turns during conversation.
• Difficulty maintaining eye contact.
• Difficulty understanding other people’s perspectives.
• Difficulty understanding humor and sarcasm.

Phonological Awareness /Phonemic Awareness

Phonological awareness is the ability to identify and work with sounds in spoken language and is the foundation for learning to read. Typically these skills are developed gradually and sequentially during the preschool and kindergarten years through exposure and direct instruction. Some examples of phonological awareness include awareness of sounds in language, rhymes (recognize and produce rhymes), sound manipulation (break words into syllables i.e. cow/boy) and understanding the relationship between spoken and written language.

Phonemic awareness is the ability to hear, identify, and manipulate individual sounds-phonemes–in spoken words. Phonemic awareness is a subset of phonological awareness skills. Before children learn to read print, they need to become more aware of how the sounds in words work. Children must understand that words are made up of speech sounds, or phonemes (the smallest parts of sound in a spoken word that make a difference in a word’s meaning). Some examples of phonemic awareness tasks include: identifying sounds in a word (what is the first sound in the word /bat/, blending sounds to make a word /b-a-t/, adding sounds to a word /b-a-t-s/ or deleting sounds from a word to form a new word /-a-t/, and substituting sounds to make a new word /m-a-t/.

When to refer:

• Difficulty learning nursery rhymes.
• Dislike of listening to rhymes.
• Difficulty producing rhymes.
• Difficulty counting syllables in words.
• Difficulty identifying beginning or ending sounds in words.
• Difficulty blending individual sounds into words.

Speech and Language Development Delay in Toddlers

Children develop at different rates but are usually able to meet speech and language milestones by a certain age. Please contact us to set up a free screening or consultation, if you have any concerns.
Communication delays in toddlers are very common and often temporary once early intervention is received. However, it is possible the delays are related to something more serious such as a hearing loss or delays in other areas. Consulting with your pediatrician is also recommended when your baby is not meeting developmental milestones.

When to refer:

• An infant is not responding to sound or who isn’t vocalizing.
• A child between 12 -24 months: isn’t using gestures such as pointing by 12 months, prefers gestures
  over vocalizations to communicate at 18 months, has trouble imitating sounds by 18 months , has
  difficulty understanding simple verbal requests.
• A child over 2 years: can only imitate speech or gestures and does not produce spontaneous language,
  cannot follow simple directions, has limited sounds/words and has difficulty communicating immediate
  needs, is more difficult to understand than expected for age (parents should understand at least half
  of child’s speech at age 2/three quarters by age 3 and by age 4 the child should be understood by all).

Auditory Processing Disorder

Auditory Processing Disorder (APD) refers to how the central nervous system uses auditory information and is an auditory deficit that is not the result of other higher order cognitive, language or related disorder. For example, children with Attention Deficit/Hyperactivity Disorder (ADHD) may have poor listening skills and have difficulty understanding spoken language however their neural processing of auditory information is intact. To diagnose APD, an audiologist will administer a series of tests in a sound treated room which requires the listener to attend to a variety of signals and respond. Most of the tests require the child to be at least 7 years old. There are many types of auditory processing deficits. Once diagnosed, a treatment plan will be created to address the child’s specific areas of difficulty. Treatment generally focuses on three primary areas: adapting the learning environment (modifications to improve access to auditory information), compensatory strategies (active listening and problem solving techniques), and direct speech-language treatment (intervention to address specific auditory deficits). Auditory processing deficits commonly affect the areas of communication, academics and social skills.

Deficit areas:
Auditory Discrimination: The ability to notice, compare and distinguish between distinct and separate sounds. For example, the sounds /p/ and /b/ are produced in the same manner but one has voice and one is voiceless or the words /pear/ and /bear/.

Auditory figure-ground discrimination: The ability to focus on the important sounds in a noisy setting. For example, a child might miss important teacher instructions in the noisy gym, if they cannot filter the background noise and focus on what is important.

Auditory memory: The ability to recall what you have heard after a period of time. For example, a child may not be able recall a story or follow directions.

Auditory sequencing: The ability to understand and recall the order of sounds and words. For example, a child might say ‘aminal’ for ‘animal’.

When to refer:

• Asks speakers to repeat what they have said or says “huh”.
• Finds it hard to follow spoken multi-step directions (difficulty remembering information presented orally).
• Doesn’t like being read to (struggles to process what they hear).
• Easily distracted by background noise or hates loud noises (sensitive to sounds and have trouble tuning out background noise).
• Gets tripped up by words such as mispronouncing or confusing similar sounding words (speech delay).
• Won’t read out loud (difficulty understanding how different sounds work together to form words).
• Won’t read or has poor reading comprehension (difficulty decoding words).
• Seems to hear but doesn’t listen, doesn’t remember people’s names, forgets basic facts or won’t follow instructions/ directions (difficulty remembering information when presented orally).
• Difficulty expressing emotions, answering questions (difficulty with oral communication).

Childhood Apraxia of Speech

Childhood apraxia of speech is a motor speech disorder (speech coordination). The child knows what they want to say, but their brain has difficulty coordinating the muscle movements necessary to say those words.

When to refer:

• (Young Child)
  • Does not coo or babble as an infant.
  • First words are late and may be missing sounds.
  • Only have a few different consonant and vowel sounds.
  • Difficulty combining sounds.

(Older Child)

• Makes inconsistent sound errors.
• Can understand language better than can express language.
• Difficulty imitating speech, but initiated speech is clearer than spontaneous speech.
• May appear to be groping when attempting to produce sounds or coordinate the lips/tongue/jaw for purposeful movement.

Literacy

Reading and writing are secondary forms of speaking and listening. Strong speaking and listening skills are critical for reading and writing development.
Speech-Language Pathologists help to assure children develop strong speaking and listening skills.
Some of the skills that speech language pathologists emphasize in therapy that help improve reading and writing include: comprehension, phonological awareness, alphabet knowledge and concepts about print.
Direct links to children’s eventual success in reading include: alphabet knowledge, environmental print, invented spelling, listening comprehension, oral Language and vocabulary, phonemic awareness and phonological short term memory, and visual memory and visual perceptual skills.

Early Language Characteristics Related to Reading Disability-The Speech/Language/Reading Connection:

• Speech Delays: Phonology, Semantics, Grammatical Structure, Pragmatics
• Difficulties in articulation.
• Rhyming difficulties.
• Child may substitute a similar word, using words like “stuff” or “things” to cover up retrieval difficulties.
• Difficulty in learning alphabet, both name and sound.