The Arizona Literacy and Learning Center provides remediation for the following:
Articulation refers to the movement of speech articulators (tongue, lips, larynx, teeth, hard palate, soft palate, jaw, nose, and mouth) to produce speech sounds correctly. An articulation disorder occurs when a child produces age-appropriate sounds incorrectly because his or her speech articulators are not working correctly.
For example, a child who is unable to produce /r/ may substitute “w” instead, such that he or she produces “wabbit” for “rabbit” and “wain” for “rain.” Many of these errors are typical at younger ages and are not considered disordered unless the child continues to mispronounce these sounds at an age when most of his/her same age peers have begun to produce these sounds correctly.
Speech/language pathologists often refer to developmental data to determine whether a child’s errors are developmentally appropriate or inappropriate for his/her age. Articulation disorders are treated by teaching the child to produce the specific error sounds and to practice forming the sounds until he or she is able to produce these sounds in natural conversation.
Phonological disorders are broader in scope than articulation disorders. Rather than producing individual sounds incorrectly, children with phonological disorders produce entire classes of sounds incorrectly in an effort to simplify adult speech. All children use these processes to simplify adult speech as their speech and language skills begin to develop. Common phonological processes include final consonant deletion (“daw” for “dog), cluster reduction (“poon” for “spoon”), syllable reduction (“puter” for “computer”), gliding (“wabbit” for “rabbit), fronting (“tar” for “car”), stopping (“bone” for “phone”) , and prevocalic voicing (“zoo” for “Sue.”) As children get older, they stop using these simplifications and their speech becomes more intelligible and adult-like. By age five, most children have stopped using these all of these processes.
Phonological disorders occur when children continue to use these simplifications at a time when their same-age peers have stopped using these simplifications. Speech/language pathologists often refer to developmental data regarding different classes of simplification to determine whether a child’s use of simplifications is age-appropriate. Children with phonological disorders present with reduced speech intelligibility. Therapy focuses on decreasing patterns of errors and increasing overall speech intelligibility.
Childhood Apraxia of Speech
Childhood Apraxia of Speech (CAS) is a motor speech disorder characterized by difficulty planning and consistently producing sequences of speech sounds using lips, tongue, jaw, and palate. This results in significantly reduced speech intelligibility. CAS may be due to neurological impairments or may accompany developmental disabilities. CAS is not due to muscle weakness or paralysis.
A child with CAS knows what he or she wants to say but is unable to coordinate the muscle movements necessary to say these words. In young children, CAS is marked by lack of babbling, late first words, problems combining sounds, restricted use of vowels and consonants, and word simplifications consisting of use of easier words or deletion of difficult sounds. In older children, CAS is marked by inconsistent errors, difficulty imitating speech, groping when attempting to produce sounds, and choppy or monotonous speech.
Remediation of CAS requires frequent therapy with repeated practice for sounds, sequences, and movement patterns until the child is able to produce these independently. Sometimes, CAS is accompanied by delayed language development, expressive language problems, difficulties with fine motor/coordination, difficulty reading, spelling, and writing, and hypo/hypersensitivity in their mouths.
Dysarthria is a motor speech disorder in which the muscles involved in speech (for example, mouth, face, respiratory system) may become weak, move slowly, or not move at all following a brain injury or illness. Symptoms of dysarthria include slurred speech, quiet voice, decreased rate of speech, limited movement of muscles involved in speech, abnormal intonation, drooling, and feeding/swallowing difficulties.
Causes of dysarthria include stroke, head injury, cerebral palsy, and muscular dystrophy. Possible goals of treatment include normalizing the rate of speech, improving breath support for to increase volume of voice, strengthening the muscles involved in speech, and improving articulation of speech sounds affected by the dysarthria. Resource link.
Fluency disorders are often referred to as “stuttering.” Stuttering begins in childhood and often persists into adulthood. It is characterized by disruptions in the production of speech sounds including repetition of words (“where where where are you going?”), repetitions of phrases (“Where are where are you going?”) or repetitions of parts of words (“w-w-w-w where are you going?”) Stuttering may also be characterized by prolongation of speech sounds (“SSSSSS save me a seat”) and insertion of interjections (“I’ll meet you um um um um um at six o’clock”).
A person who stutters may also experience blockages, in which his or her mouth is positioned to produce a sound but he or she is not able to make the sound come out. A person who stutters may appear to be out of breath or tense. In order to prevent or to lessen stuttering, a person who stutters may show associated physical characteristics including eye blinks, tics, tremors, head jerking, and fist clenching. People who stutter often use avoidance behaviors to decrease stuttering. For example, they may substitute easier words for harder words, avoid eye contact, refuse to speak, or produce speech with abnormal patterns including whispering, using a monotone voice, or using an accent. Factors that contribute to stuttering include genetics, speech and language problems or developmental delays, neurophysiological processes, and family dynamics. Although there is no “cure” for stuttering, people who stutter can be taught strategies to decrease stuttering and to increase fluent speech. Many children go through a normal phase in development in which they stutter and then “outgrow” the stuttering without intervention.
Receptive Language Impairment
Receptive language refers to understanding language (words as well as gestures). Children who have impairments in receptive language often have difficulty understanding gestures, following directions, answering questions, identifying objects and pictures, and taking turns when talking with others. They may have difficulty understanding basic concepts such as “in” and “on” and may have difficulty understanding a variety of grammatical forms. For example, a child with a receptive language impairment may have difficulty understanding that the phrase “The boy was kicked by the girl” means that the girl kicked the boy.
Children with impairments in receptive language may have difficulty listening and attending to conversation, understanding stories, and understanding vocabulary.
Delayed receptive language skills often result in delays in expressive language. Children who have receptive language delays without any coexisting conditions may be diagnosed as having Specific Language Impairment. In diagnosing receptive language impairment, speech/language pathologists often refer to guidelines on receptive language development in children.
Expressive Language Disorder
Expressive language refers to the sharing of thoughts, ideas, and feelings. Children with expressive language delays may have difficulty asking questions, naming objects, using gestures, putting words together into sentences, learning songs and rhymes, using correct grammar including pronouns and verbs, using correct vocabulary, and knowing how to initiate and maintain a conversation. Difficulty using verbs correctly is one of the most common characteristics of expressive language disorder. For example, a child may omit helping verbs such is “is” (“the boy walking” instead of “the boy is walking”) and omit the –ed to mark past tense (“the boy play” instead of “the boy played”).
A child with an expressive language disorder often has difficulty interpreting gestures in addition to verbal speech. It is often difficult to determine what factors contribute to expressive language disorders.
Children who have expressive language delays without any coexisting conditions may be diagnosed as having Specific Language Impairment. Specific Language Impairment often negatively impacts a child’s reading and writing. In diagnosing expressive language disorders, speech/language pathologists often refer to guidelines on expressive language development in children.
Receptive/Expressive Language Disorder
A child with receptive/language disorder displays difficulties in both receptive and expressive language (please refer to descriptions of Receptive Language Disorder and Expressive Language Disorder.)
Children with Specific Language Impairment (SLI) often have difficulty learning to read and to write. SLI is one of the most common learning disabilities, affecting approximately 8% of all children.
Language-Based Learning Disabilities
Language-based learning disabilities are characterized by difficulties with age-appropriate reading, spelling, and/or writing. Language based learning disabilities refer to the relationship between spoken and written language. Many children who have difficulty reading often have difficulty with spoken language. Children with language-based learning disabilities may have difficulty expressing ideas clearly, learning new vocabulary, understanding questions and following directions that are spoken, recalling numbers in sequence, comprehending what is read, learning words to songs and rhymes, learning the alphabet, and identifying sound/letter associations. A child with a language-based learning disability may have difficulty manipulating sounds in words. Children with language-based learning disabilities are often diagnosed with dyslexia.
Pragmatic Language Disorders
Pragmatic language/social language refers to using language appropriately in social situations. Social language includes physical difficulties, verbal difficulties, and thinking difficulties. Physical difficulties include poor eye contact, inability to maintain appropriate personal space, and inability to match one’s body language with what is being spoken. Verbal difficulties include interrupting, difficulty with turn-taking, and inability to initiate, maintain, and terminate conversation appropriately. Thinking difficulties include inability to consider someone else’s perspective, difficulty understanding age-appropriate humor and slang, and inability to analyze how a speaker’s words may may impact someone else’s feelings. Children who have difficulty with social language may need specific instruction in how to use language for different purposes (greeting, informing, demanding, promising, requesting), change language according to situations and speakers (talking differently to adults than to babies, giving background information, etc) and follow rules for conversations and storytelling (turn-taking, using nonverbal language, staying on topic, etc.).
Remediation of pragmatic language disorders often requires extensive role-playing and practice in a variety of social situations. For example, an individual with a pragmatic language disorder may be asked to role-play appropriate responses to situations such as “Someone has given you a gift that you do not like. What do you do?” When addressing these difficulties, speech/language pathologists often utilize peer modeling and create real life situations in which children are given opportunities to practice newly taught social language skills