Speech and Language Pathology

Parents and caregivers with children needing speech, language, feeding or swallowing therapy are bound to have a variety of questions about the child’s diagnosis, the evaluation process and what to expect once therapy begins. The answers to the questions below should not take the place of specific instructions or information provided by the child’s therapists or physician.

How can I get my child speech, language, feeding or swallowing therapy?

If a caregiver suspects his or her child may have a speech, language, feeding or swallowing delay or disorder, it is important to discuss those concerns with the child’s pediatrician as soon as possible and request an evaluation. The physician can write a prescription for an evaluation. Once insurance authorization for the evaluation is obtained, the child will be scheduled for an evaluation at CHOC’s outpatient rehabilitation center.

What should I expect during a speech evaluation?

A comprehensive speech and language evaluation can take from one to two hours. The evaluating therapist will ask the caregiver questions regarding the child’s medical history as well as when their developmental milestones were achieved. If your child is in the care of other rehabilitation professionals or physicians, notes from their last visit or assessment may be helpful. Then, from the history information a therapist will conduct an assessment to identify the presence and severity of a child’s speech and language disorder.

The therapist may use a variety of standardized tests or norm referenced assessment measures. The therapist may ask the caregiver to interact with the child in play and through that observation can assess the child’s speech and language in a naturalistic environment. Following the assessment procedures, the therapist will present preliminary findings and recommendations for follow up. The therapist may provide a home program of activities to encourage improved development of speech and language skills while awaiting a therapy appointment.

What should I expect during a feeding evaluation?

A comprehensive feeding and or swallowing evaluation will begin with a medical history interview. This interview may include your child’s typical feeding schedule (oral or gastrostomy tube) as well as your child’s general daily schedule (wake and bed times, naps, school schedule, etc). The evaluating therapist will work with the parent to determine the best positioning for the child during the assessment. Then, the therapist may observe the parent feeding the child a typical oral meal (if appropriate). The parent and therapist will discuss some therapeutic meal time strategies and if appropriate, the therapist may demonstrate them with the child. Preliminary findings of the assessment will be discussed as will recommendations. A home program of activities may be provided to help the parent encourage development of the child’s feeding and swallowing skills while a therapy date is arranged.

What is an articulation disorder?

Articulation disorders occur when a child has difficulties pronouncing certain consonants or vowels correctly (such as the letters “s” and “r”). Children with these disorders leave out, replace or distort the sounds of vowels or consonants that they have difficulty pronouncing. A common type of articulation disorder is a lisp. In many cases, the cause for articulation disorders is unknown and are often not a cause for concern. These disorders are common in young children and most are able to pronounce words correctly by the age of five. Caregivers who note an articulation disorder in a child older than age five should speak with the child’s doctor.

Sometimes articulation disorders are caused by brain damage or brain disorders. They may also be caused by physical handicaps, such as a cleft palate, hearing loss, or cerebral palsy. In other cases, the condition may be caused by poor coordination of muscles in the mouth or dental problems.

What is a phonological disorder?

Children with a phonological disorder are unable to use age-appropriate speech sounds or omission of sounds. They typically struggle with sound patterns or consistently omit sounds from words, especially consonant blends like “br” or “sp” at the beginning of words. These types of struggles with sound patterns are normal in young children learning to speak but can become very problematic once a child becomes school-aged and can lead to difficulties learning to read and write.

What should I expect when my child learns more than one language?

Every bilingual child is unique. Developing skills in two languages depends on the quality and amount of experience the child has using both languages. Like other children, most bilingual children speak their first words by the time they are 1 year old (e.g., “mama” or “dada”). By age 2, most bilingual children can use two-word phrases (e.g., “my ball” or “no juice”). These are the same language developmental milestones seen in children who learn only one language. From time to time, children may mix grammar rules, or they might use words from both languages in the same sentence. This is a normal part of bilingual language development. When a second language is introduced, some children may not talk much for a while. This “silent period” can sometimes last several weeks.

When it comes to speech and language therapy for bilingual children, children should be evaluated and treated in their dominant language. During the assessment that the therapist will determine whether the child’s language appears delayed or disordered and will check to see if the child is mixing grammar rules.