Frequently asked questions

Speech-language therapy refers to treating children, adolescents, and adults with articulation; dysfluency; oral-motor, speech, voice, receptive and expressive language disorders. Speech and language therapy includes:

• Language intervention activities: In these exercises the phoniatrician or speech and language therapist (pathologist)  interacts with the child by playing and talking. The therapist may use pictures, books, objects, or ongoing events to stimulate language development. The therapist may also model correct pronunciation and use repetition exercises to build speech and language skills.
• Articulation therapy: Articulation, or sound production, exercises involve having the therapist models correct sounds and syllables for a child. The level of play is age-appropriate and related to the child's specific needs. The phoniatrician or speech and language therapist (pathologist) physically shows the child how to make certain sounds, such as the "r" sound, and may demonstrate how to move the tongue and oral organs in a certain way to produce specific sounds.

• A child might need speech-language therapy for a variety of reasons, including:

  • Cognitive (intellectual; thinking) or other developmental delay
  • Hearing impairment & central auditory processing disorder
  • Weak oral muscles
  • Birth defects such as cleft lip or cleft palate
  • Oral motor planning problems & apraxia of speech
  • Autism Spectrum Disorders
  • Difficulty paying attention
  • Reduced speech clarity
  • Sucking difficulties, frequent salivation, and swallowing disorders
  • Traumatic brain injury
  • Chromosomal aberrations associated with speech ad / or language defects
  • language based learning difficulties
  • Social communication disorder (irrelevant use of language with poor narrative & conversational skills)

• Therapy should begin as soon as possible. Children enrolled in therapy early in their development (younger than 3 years) tend to have better outcomes than those who begin therapy later.
• This does not mean that older children can't make progress in therapy; they may progress but, sometimes, at a slower rate because they often have learned patterns that need to be changed.

These false concepts and beliefs can have a great negative influence on the child’s language development. Leaving your child with no intervention can widen the gap between his chronological age and the language age he is functioning at. This can , in turn, has a great negative influence on his social interactions, self-esteem, and later, academic achievement and even career placement in the future.

The ability of a child to overcome his language difficulties depend on several factors among which are the age of diagnosis, child's intellectual abilities and compliance as well as severity of the condition, comorbid difficulties, regularity and intensity of proper intervention. Many children can overcome their language difficulties by time. However, others may start to develop some academic difficulties at the age of school entry and/or continue to sturggle with high language skills such as listening comprehension, narrative skills, understanding and properly following complex multi-seuqntial instructions, etc..

Bilingualism, especially in children with language difficulties, has always been an area of interest for several researchers and a source of debate; some view it as a hindering factor to the child's normal language development whereas others view it as a language enhancing opportunity. That's why some prefer to use the approach of "One person-One language", others recommend the "One Setting, One Language" approach, whereas others recommend using the family “natural code switching” commonly used at home, as much as possible while dealing with the child.

The approach of  Age of Language Competence  and bilingualism can be also considered and it is the one mostly used at  SLC: Therapy is initially introduced in the child’s first language which is the child’s stronger language and the language that he is mostly exposed to in his daily life interactions. We regularly monitor progress achieved with therapy, till the child is able to verbally express himself independently in 3-4 word sentences and is able to follow 2-3 sequential commands (i.e. he is starting to function at a 3-year level; language-wise) i.e. he has reached the age of language competence. Afterwards, we start to add few sessions to foster the development of second language, while still continuing to provide sessions in the first language i.e. trying to make the child’s bilingualism an additive; not subtractive one so as to avoid the development of the second language at the expense of the child’s first language.

Lack of eye contact, limited social interactions, lack of emotional reciprocity, ritual activities, and repetitive movements can be all among signs of autism. If you notice these signs in your child, then you have to seek professional consultation. However the characteristics of Autism Spectrum Disorders are many and they discrepantly vary from one child to the other. Even if you see some autistic features in your child, does not mean that he has an Autism Spectrum Disorder. There are many medical conditions that have the same warning signs  and it can take a number of qualified medical specialists to diagnose  Autism. Thus, it is highly recommended that you quickly seek professional consultation in order to receive proper diagnosis and intervention plan, if needed.

A speech disorder refers to a problem with the actual production of sounds, whereas a language disorder refers to  difficulty in understanding or putting words together to communicate ideas.

SPEECH DISORDERS INCLUDE:

• Articulation disorders which include difficulties with producing sounds in syllables or saying words incorrectly to the point that other people can't understand what is being said by the child.
• Fluency disorders include problems such as stuttering, the condition in which the flow of speech is interrupted by abnormal stoppages, repetitions (st-st-stuttering), or prolonging sounds and syllables (ssssstuttering).
• Resonance disorders eg.(nasal tone of speech.

LANGUAGE DISORDERS INCLUDE:

• Receptive disorders refer to difficulties understanding or processing language.
• Expressive disorders include difficulty putting words together and/ or limited vocabulary.
• Pragmatic disorders which include difficulties with appropriate use of eye contact, facial expressions, and relevant use of language in social contexts.

• Most children start to develop stuttering at the preschool age-; a condition often referred to as habitual childhood dysfluency / physiological dysfluency. The condition usually resolves by time provided that the adults starts dealing with the child in a way that would enhance rather than inhibit his speech fluency. To get acquainted with the proper way of dealing with this condition, parents need to receive professional consultation and recommendations.
• Dealing with your child’s physiological dysfluency in an unintentionally wrong way can further deteriorate his speech fluency; thereby leading to the development of true stuttering. Fortunately, there are some red flags that can warn you that your child’s speech dysfluency is turning into stuttering.

Speech patterns and behaviors that might signal that a child is at risk of stuttering include:

• Within-word or part-word repetitions
• Prolonged sounds
• Avoiding speaking situations or saying “I can't say it”
• Looking upset
• Speaking with tension in the face or neck muscles or voice
• Speaking with unexpected rises in pitch or loudness
• Boys are 4 times more likely than girls to develop a stutter

Speech problems, including stuttering, seem to have a genetic component for some people. Many of the people who stutter report a history of stuttering in their family. Some studies have shown that recovery in young children might be related to family history so if a child has no family history of stuttering, or a positive history where the affected family member has recovered, it is more likely that the child will also recover.

The phonemes/speech sounds are not mastered at the same age. Therefore, it is essential that you have your child examined by a qualified phoniatricain in order to determine whether his speech errors are developmental in nature or are secondary to some organic or neuro-motor problems.

• Children who show great difficulties with vocabulary, sentence length, understanding language, following classroom instructions, listening comprehension and / or storytelling.
• Children who have mispronunciations, stuttering, nasality, voice problems or difficulties with social use of language.
• Children whose cognitive assessment has revealed difficulties with those areas related to language (low scores for Verbal Intelligent Quotient).
• Children who have academic difficulties that are suspected to be secondary to language problems.

• Starting from the age of 6 months (especially for children with hearing impairment or ones with previously diagnosed syndromes / chromosomal aberrations), language can be assessed.
• For children less than 18-24 or 30 months, the child's language level can be determined through parent checklists and / or informal observations and screenings.
• The older the child -after 2;06-3 years old- the more he/she gets able to participate with structured or standardized tests.
• At the Speech and Language Clinic, speech and language assessments are available for children and students from the early months of life up to 21 years old or older.

A screening is a brief procedure that helps determine whether a child will need to undergo further more detailed assessment. Children who pass screening procedures are -preliminarily- judged to have normal language skills in the areas screened and thus do not usually need a lengthy assessment.

Assessment (evaluation) refers to the process of arriving at a diagnosis whereas diagnosis is an understanding of the problem, or the identification of a disorder by analyzing assessment findings, along with interpretation of symptoms presented and, in some cases, according to their underlying causes as well.

• For professionals to reach a diagnosis, they need to optimally use structured  assessment procedures and/ or a combination of structured  and child/ student-specific measures that are culturally and linguistically appropriate for each student.
• In case of structured, reliable as well as valid assessment tools, the assessor uses the obtained scores to compare the child's performance with that of children at his age (scaled/ standard scores) whereas in case of informal tests, the assessor mainly leans on qualitative interpretation of the child's performance and its comparison to what would be normally expected of his/her peers based on published norms and developmental milestones.
• Based on the assessor's analysis, the child's areas of need and strength can be identified and, according to this analysis, appropriate language intervention programs can be properly and relevantly planned.

• Assessment is not carried out solely to obtain a diagnosis but also, and more important, to determine the student's areas of need and strength especially that children with language difficulties constitute a heterogeneous group; differing enormously with regards what they need and what they have already acquired. It would be a waste of time for the child if therapy objectives involve skills that the child already has.
• Based on the assessment results, long-term goals and short-term objectives can be decided upon.
• Through assessment, a pre-therapy baseline of the child's performance can be established, against which later follow up post -therapy screening can be compared to monitor the gain achieved through therapy.

• Receptive Language Skills: refer to one's ability to understand language. Receptive skills involve: vocabulary one understands, ability to understand orally presented sentences, following instructions, and listening comprehension, etc.
• Expressive Language Skills: refer to one's ability to express himself/herself using language. Expressive skills involve: vocabulary one uses, sentence length, sentence structure, grammar, narrative skills, and storytelling.
• Speech and language assessment also includes:
  • Analysis of a sample of spontaneous speech
  • Pragmatics / social use of language: facial expressions, conversational skills, eye contact, etc.
  • Articulation / speech sound production: correct or incorrect & types of speech sound errors
  • Prosody: Rate, stress, and melody or intonation of speech; appropriate or inappropriate
  • Speech clarity / intelligibility: how well the speech of the child is clear to his / her listeners.
  • Speech fluency: normal or there is a fluency disorder e.g. stuttering
  • Voice: there is change of voice (dysphonia) or the child's voice is appropriate for his/her age and gender
  • Oral-peripheral examination: examination of the oral and facial structures to evaluate their structural and functional integrity form the standpoint of speech production.
  • Oro-motor power screening: to exclude the need for further in-depth oro-motor assessment particularly if the child has associated swallowing difficulties or drooling (salivation). etc.

The native / primary language has to be assessed. The second language is assessed if:

• It is the language of instruction at school and the child is facing academic problems due to it.
• Parents consider changing schools.
• Parents are not quite sure which language is the primary language for their bilingual child.

Usually one setting is sufficient unless the child has low attention span, is easily distractible, too shy, uncooperative, or has low frustration tolerance. Intra-setting breaks can be tried but if these fail, the rest of the assessment will need to be postponed and another setting will be needed.

Parents can receive a detailed report, including:

• Numerical / quantitative results (standard / scaled scores) in case of structured normalized tests
• Qualitative analysis of the child's level and performance during the assessment
• Areas of need and strength with regards speech and language skills
• List of recommendations needed

Will the school / nursery receive the report?

Based on the assessment, the following is made:

• Further assessment / investigation recommendations
• Therapy recommendations: type, frequency, language, and duration
• Nursery / classroom recommendations (if applicable)
• Daily life / home recommendations (whenever needed)