Articulation refers to how a person sounds when they speak. An articulation disorder or a speech sound disorder might mean a person is distorting a specific sound when they are talking, replacing a sound with a different sound, or leaving out certain sounds altogether. Clear articulation also requires correct placement within the oral cavity while speaking. Our teeth, tongue, lips, palate, and jaw all play a role in helping to us produce sounds clearly. Poor articulation skills may be evident in a child who experiences the following:

• People ask “what?” frequently when he or she is speaking

• The family understands the child, but unfamiliar listeners do not

• The child becomes frustrated when trying to communicate but is unsuccessful

• You notice the child’s mouth is always open or his or her tongue is always out/visible

• Specific sounds are absent or unclear in the child’s speech

Receptive language is a measurement of how we understand spoken or written language. Impaired receptive language skills can mean poor language comprehension and can negatively affect how a person follows along in conversation, answers questions, follows directions, or understands descriptive concepts such as location, time, and quantity. Having strong receptive language skills can help the development of expressive language skills. Poor receptive language skills may be evident if the following occurs:

• Difficulty following simple and/or complex directions (e.g. “get the red socks from the second drawer”)

• There seems to be two different conversations occurring

• Directions and questions need to be repeated or rephrased several times

• Visual aids are required to follow verbal communication

• Requests and/or questions are answered incorrectly or are not answered at all

Expressive language is a broad term for how we use words to communicate our needs, wants, thoughts, and ideas. This includes our use of different vocabulary words, grammar skills, word order, combination of words into expanded sentences, and story-telling skills. Language can be expressed verbally or non-verbally and is a skill we continue developing throughout our lives. Poor expressive language skills may be evident if the following occurs:

• Difficulty describing familiar objects with different vocabulary

• Use of short sentences or phrases, or not combining words into longer phrases

• Verb tenses and/or pronouns not matching the intended message, such as “she running to see his mom”

• Difficulty telling stories in a clear and organized way

• Not describing recent events accurately or clearly

• Brief responses to questions and responses lacking detail

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When we hear someone speaking, we use auditory processing skills to interpret the message correctly. This is a neurological function that requires attention and coordination between our ears (where we receive the sound) and our brains (where we interpret the sound). If auditory processing speeds are too slow or impaired, the auditory signal that we are receiving (e.g. someone speaking) won’t be interpreted correctly and it may be difficult to understand what someone is saying. An Auditory Processing Disorder (APD), also known as a Central Auditory Processing Disorder (CAPD), may be appear worse in places with noisy backgrounds such as sports events, playgrounds, or parties. The following may be indicative of poor auditory processing skills:

• Easily distracted and/or difficulty focusing

• Directions need to be broken down into small parts or repeated several times

• Not remembering number sequences correctly, like phone numbers

• Difficulty following along conversation, especially in loud or noisy places

• Difficulty recalling details from conversations or read-aloud stories

Pragmatic skills include how we use and interpret body language, figurative language, and verbal communication appropriately in different settings and with different people. These skills begin developing during year one of life when babies smile at their parents to relate and communicate using learned emotions. They continue to develop throughout our lives as we face new situations that require social awareness, like interviewing for a job. Poor pragmatic skills may interfere with academic performance and forming relationships. Pragmatic skill weaknesses may be evident if the following occurs:

• Not using or responding to “typical” greetings on their own, such as “hello” and “how are you?”

• Difficulty following a peer’s play scheme or including others in their own play scheme

• Poor understanding and use of figurative language, such as idioms and sarcasm

• Difficulty seeing other perspectives and understanding others’ feelings

Not changing communication style for different contexts/environments

Difficulty making inferences and drawing conclusions

Fluency refers to how “fluently” a person speaks without stuttering or cluttering interruptions in their speech. Stuttering occurs when disfluencies disrupt the forward flow of speech. It typically begins during childhood and commonly occurs between the ages of 2-5 while a child’s language development is rapid. This type of stuttering may be developmental, and children can “grow” out of it. In other instances, stuttering may continue into adulthood. Some people have secondary characteristics that accompany their stutter, such as eye blinking, jaw tension, and head movements. Cluttering occurs when a person’s speech is rapid and unclear, lacking appropriate pauses between words. This makes understanding difficult for listeners. A fluency disorder may be present if:

• Sounds are repeated, like “m-m-m-mommy”

• Words and/or parts of words are repeated, like “do-do-do you want to play?”

• There are pauses or blocks during speech, like “I think we--------need more”

• Sounds are prolonged, like “mmmmove over”

• Speaking situations are avoided or cause anxiety

• Sentences are spoken rapidly

Tongue thrust is the incorrect movement of the tongue against or in between the front teeth while speaking and/or swallowing. This oral motor pattern can negatively affect articulation and the clarity of certain speech sounds, such as “t, d, l, n, s, z” and can also affect the oral motor movements used while swallowing foods/liquids. This is a type of orofacial myofunctional disorder and requires treatment to prevent speech problems and possible dental problems. Tongue thrust may be evident if the following is observed:

• Frequent thumb sucking

• Prolonged use of a pacifier/bottle/sippy cup

• An “open-mouth” breathing pattern

• An interdental lisp (e.g., saying “I thee” instead of “I see”)

Oral motor skills are required for speech and swallowing tasks. Oral motor weakness may occur as a result of a neurological difference, such as dysarthria, stroke, cerebral palsy, Down syndrome, and other disorders that can affect muscle strength. If an individual has oral motor weakness, it is likely that his or her speech-sound clarity and precision will be impacted. It is also possible that a person’s ability to chew and swallow foods of all textures will be impacted, resulting in dysphagia. His or her ability to make different facial expressions can also be impacted. The muscles around the lips, cheeks, tongue, palate, and jaw all contribute to oral motor movements. Oral motor weakness may be present if the following is observed:

• Drooling

• Low tone

• Slow chewing or avoidance of certain foods due to difficulty chewing/swallowing

• Food frequently falling out of the mouth while eating

• Difficulty using a straw, puckering lips, or blowing bubbles

Apraxia of speech (AOS) is a motor speech planning disorder that can occur in childhood or as a result of a neurological injury. It is also known as acquired apraxia of speech, verbal apraxia, or Childhood Apraxia of Speech (CAS). Individuals with apraxia have difficulty achieving the correct oral motor movements needed to communicate their intended verbal message. Even though the person may know exactly what her or she wants to say, the motor planning system experiences a breakdown, and he or she is unable to plan and sequence the sounds to produce a clear verbal message. Though the person is unable to move his or her tongue, jaw, and lips in the correct way, it is not because of weakness. Apraxia may be present if:

• Longer words containing multiple syllables are difficult to say

• The person mostly produces only vowels, while consonants often omitted from words

• Sound production and sound errors are inconsistent

• Difficulty imitating words

• Groping for sounds is observed, which may look like a person trying to say sounds/words without producing any

• Prosody and intonation patterns may sound unusual

*Our clinicians are trained in PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets)

A voice disorder refers to inappropriate vocal quality, pitch, and/or volume as the result of a structural change to the larynx, a problem within the nervous system, or improper use of the vocal mechanism. Voicing is the result of several parts working together, including respiration in the lungs, vibration at the vocal folds, and sound shaping in the vocal tract. A voice disorder may be a result of any of these parts malfunctioning and, if present, can negatively affect how a person is able to participate in functional communication and preferred activities. A voice disorder may present with the following symptoms:

• Vocal hoarseness or roughness

• Muscle tension

• Vocal strain

• Pain when speaking

• Complete or partial voice loss

• Fatigue when speaking

• Frequent throat clearing or coughing

A cognitive impairment refers to difficulty with skills including memory, attention, organization, processing speed, judgment and reasoning, and problem-solving skills. Many of the skills impacted by cognitive impairments are considered “executive functioning” skills that work together for daily activities. Tasks that require critical thinking, logical reasoning, and language functions may be more difficult for people with cognitive impairments. A cognitive impairment may be present if the following is observed:

• Difficulty staying on topic in conversation

• Poor memory

• Disorganization of personal belongings, information, and scheduling

• Poor time management

• Difficulty with task initiation and completion

• Making inappropriate comments

• Poor self-awareness

Reading and written-language skills require the ability to recognize and identify letter sounds to decode words fluently. This allows energy to be spent on reading comprehension instead of spending energy on constantly sounding out words. The skills required for reading fluently are related to spoken-language skills such as phonology, morphology, syntax, semantics and pragmatics. There are pre-literacy skills that aid fluent reading, including syllable counting, rhyming, and awareness of sounds in words. Written language relies on oral language skills as well, such as story organization, grammatical knowledge, and a strong vocabulary. Difficulties with reading and writing may be evident by the following:

• Difficulty with completing rhymes or generating rhymes

• Difficulty identifying the first/last sound in words

• Difficulty recognizing letters and their corresponding sounds

• Poor sight-word recognition

• Poor knowledge of story structures and story components

• Difficulty with letter formation and spelling

*Our clinicians are certified in the Orton-Gillingham based Wilson Reading System

Augmentative and Alternative Communication (AAC) refers to the use of non-verbal speech to communicate. This may include everyday un-aided actions like using facial expressions and gestures, or more skilled modes communication that include the use of high-tech devices and software. An aided system can be comprised of touching picture symbols to communicate messages, or it may include the use of a speech generating device (SGD) to create messages that can be read or spoken aloud. Individuals with significant speech sound disorders, voice disorders, or neurological differences, such as Autism Spectrum Disorder, may benefit from the use of AAC to help them communicate effectively in different environments.