Stuttering

Today I am going to discuss the communication disorder known as stuttering. According to The Stuttering Foundation, “Stuttering is a communication disorder in which the flow of speech is broken by repetitions (li-li-like this), prolongations (lllllike this), or abnormal stoppages (no sound) of sounds and syllables”. In American alone there are about 3 million people who stutter. Of those 3 million people approximately 70% are children. 5% of all children will experience stuttering at some point in their lives, but most cases of stuttering last only 6-12 months. Stuttering affects boys four times more than it affects girls and can be the result of genetics, neurophysiology, family dynamics, and/or child development (The Stuttering Foundation). Stuttering can negatively affect children’s abilities to effectively communicate, their self-esteem and confidence, and the development of social relationships. Family members of children who stutter are also affected by the disorder as they feel pressure to correct their child’s stuttering and sometimes feel that they are the cause of their child’s stuttering. This can add stress to the family in the form of guilt, frustration, strained relationships, etc., as some parents find it hard to listen to their child when s/he is stuttering. It has been found that stuttering is not an emotional or psychological problem and is not caused by parents or family members (The Stuttering Foundation).

To help a child who stutters early intervention and support is key. Parents should not correct their child while she/he is speaking, as this only draws attention to the inaccurate fact that something is wrong with the child or the way he/she speaks. Parents should be good listeners, talk slowly and concisely so children can imitate this speech, and make time for each child. Speech Language Pathology is especially helpful in teaching children how to manage their stuttering and develop more fluency in their speech. For additional information on stuttering and tips, videos, and resources on how parents can help their children who stutter visit:   http://www.stutteringhelp.org/Default.aspx?tabid=151,  http://www.stutteringhelp.org/Default.aspx?tabid=4, or http://www.mnsu.edu/comdis/kuster/Parents/childwhostutters.htmlm.

In the last post I discussed resources and services available to families with children who have communication disorders. Family members play a very important role in the therapy and development of children with communication disorders. Parents and family members can extend speech therapy at home by encouraging and helping the child practice his/her language, sounds, and oral-motor movements for a few minutes each day. For example, family members can model sounds and mouth movements for the child, engage the child in conversations that use the target sounds, read books with the target sounds, play games that encourage the use of the sounds or words, engage children in social scenarios and authentic language experiences to enhance their social skills, etc. Doing tongue twisters, blowing bubbles, and other exercises can help children develop and strengthen muscles necessary for speech and swallowing. Even a simple reminders such as "use your good sounds", "lips together", "tongue up" can be very helpful. The more children with communication disorders talk and experience speech, the more they benefit. Being supportive, talking to and with your child, and practicing the sounds and oral-motor movements frequently at home is the best thing that family members can do. Often times SLP's encourage families to participate in the therapy sessions and suggest specific activities to do at home as well. For an article on additional ways to help children overcome speech disorders visit:  http://voices.yahoo.com/how-help-child-overcome-speech-disorder-3519661.html

      A child does not grow up in isolation. Each child affects and is affected by many aspects of their environment.  Families, schools, churches, culture, etc., all impact a child’s development and his/her beliefs and values. For this reason, a childhood communication disorder affects the entire family.    
         Once getting a diagnosis of a speech/language disorder, families might feel a sense of grief, fear, anger, helplessness, etc. Raising a child with any type of disability is associated with successes and joys, but also with specific challenges and stressors.  Challenges and stressors that families with children with communication disorders face include, but are not limited to: an inability to communicate with your loved one, an inability for your loved one to express his/her needs, feeling the need to always speak for your child or family member, locating resources and services for your family member, the feeling that your family member is not listening or complying with rules, and seeing your child or family member struggle to read, understand, interact, and develop important social skills and relationships on a daily basis. Communication disorders can also add additional emotional and financial strains.            
         The most important thing families of children with communication disorders can do is get informed and educated about your child’s specific communication disorder. There are great online and print resources about almost every communication disorder, as well as support groups, and pamphlets at local hospitals and schools. Understanding the disorder and its symptoms can not only help families cope, but it can also help families create realistic goals and be effective advocates for their family members. It is also very helpful to get in touch with local service providers, speech language pathologists, and schools to create individualized plans of care. Because early intervention is so crucial, Help Me Grow, Child Focus, and Head Start Preschools are great resources for families of infants, toddlers, and young children with communication disorders. Once in an elementary school, children with communication disorders are entitled to an IEP (Individualized Education Plan) and services from the school-based SLP. Local hospitals, such as Children’s Hospital, also have great speech language pathologists that work with and address the needs of children and their families in respectful and caring manners. Parents and families have every right to participate in the formation of IEP’s, goals for their children, and the actual therapy itself. Parental/family involvement and support is highly encouraged and very beneficial to the children with the communication disorders.

Additional information and resources for parents and teachers of children with communication disorders can be found at: http://www.voicenation.com/resources/article-library/a-childhood-language-and-communication-disorder-guide-for-parents-and-teachers.shtml.

  

While researching more about apraxia of speech, I came across an interesting article about Childhood Apraxia of Speech (CAS). It is written from a parent's point of view and gives insights that only a parent of a child with a speech disorder could have. The article gives great information about CAS, as well as some parental accounts of when they suspected that their children might have a speech/language disorder. The article can be found at: http://www.curiousparents.com/Parenting/xq/asp/article.408special/qx/parenting_article.htm

The term “communication disorder” covers a broad range of disorders that affect speech and language. A communication disorder can be categorized as: an articulation disorder, a fluency disorder, a voice disorder, a language disorder, and/or a phonological disorder. Communication disorders can occur alone or can be a result of another condition, such as autism, brain damage due to birth defects, etc. The link below provides some facts and figures about these types of communication disorders: http://www.rhsc.org/files/communication-disorders.pdf. 

            Today I am going to discuss the communication disorder known as Childhood Apraxia of Speech (CAS). “Childhood Apraxia of Speech is an oral-motor disorder (mouth-movement problem) that causes the child’s speech to be hard to understand. It is usually detected after two years of age, when speech development is noted to be delayed” (Cincinnati Children’s). According to http://testyyettrying.blogspot.com/2011/04/what-is-childhood-apraxia-of-speech-and.html, CAS is “a relatively uncommon neurological disorder caused by problems with motor planning and programming of the movements necessary to produce speech. Children with Childhood Apraxia of Speech do not have a problem with the actual structures and muscles involved in speech production. There is no evidence of weakness in the muscles of the face, jaw, lips, or tongue. Children with CAS also generally do not have problems knowing what they want to say. They can formulate the message in their mind and the muscles are capable of producing speech. The message just doesn't travel from the brain to the mouth properly.”         

            Ultimately, apraxia of speech in the inability to say or “get out” what you want to say, even though you have the ability to form a clear message in your mind and the physical strength and structures to produce sounds/words (lips, tongue, palate, etc.). Usually children with CAS are late talkers who babble infrequently and use one or two sounds for everything, often relying on grunting and pointing for communication. Some characteristics of CAS that SLP’s and families can look for are:  “child makes more errors when attempting to produce longer words or phrases (multi-syllable words or multi-word sentences), child has abnormal prosody (unusual stress patterns, intonation, volume control, and rate issues), errors are inconsistent, if the child says the same multi-syllable word three times it will come out differently each time, child has a reduced number of vowels and demonstrates vowel errors, child has significant difficulty imitating words and phrases, child uses predominantly simple syllable shapes (they substitute shorter, simpler words for longer, more complicated ones)”.

            I can only imagine how frustrating CAS would be for the child and for the family members. Luckily, CAS can be addressed with speech therapy. Some interventions/methods of therapy for CAS include helping children learn new motor skills (movements for speech sounds and words), frequent practice of sounds, and rebuilding of connections from the brain to the mouth. It is important that parents practice these sounds and movements at home with their children as well. Articulation picture cards for one and two syllable words, games, forming and ordering words into sentences, mirror work, and message boards are all things that SLP’s and parents might use to address CAS. 

Additional information and resources for parents can be found at: http://testyyettrying.blogspot.com/p/childhood-apraxia-of-speech-resource.html

http://www.asha.org/public/speech/disorders/childhoodapraxia.htm

www.cincinnatichildrens.org/health/v/verbal-apraxia/

A speech language pathologist (SLP) works with a wide range of diverse children. As an SLP in a school, inpatient, or outpatient setting, you work with children with communication disorders and their entire families.  A disorder or disability can impact the entire family, both positively and negatively. It is the SLP’s job to address the patient’s needs, but also to provide information, resources, and counseling to the family members of their patients. When first getting a diagnosis of a disorder/disability, families encounter many emotions: fear, sadness, anger, uncertainty, grief, etc. According to Mary Friehe, “When a child is diagnosed with a communication disorder, family members often are confused and in shock. They are not prepared for the challenges associated with a long-term communication disorder, and family-focused resources are not readily accessible. The sense of loss related to the diagnosis may provoke a grief reaction, which, if not resolved, could lead to depression and other problems for the family and the child”.

Speech language pathologists are committed to working with families to best meet their patients’ needs. Parents and families play integral roles in their children’s therapy and development, are often the children’s strongest advocates, and can provide SLP’s with critical information about their child’s development, culture, etc. “As part of the team of specialists who work with a family throughout the phases of diagnosis and intervention, speech-language pathologists (SLPs) need to understand the impact on the family of a sense of loss that may accompany a communication disorder diagnosis and how best to assist with coping strategies” (Stone, 1992). The SLP functions as a counselor and educator whose role is to help the family adapt (American Speech-Language-Hearing Association [ASHA], 1999).

SLP’s play an important role in helping children communicate effectively, but in order to provide the most effective interventions and therapies, a collaborative relationship must be established with the young patients’ families. Not only is it important to understand the role that families play in overcoming communication disorders, it is also important to understand that there are numerous communication disorders, all with their own implications, affecting children and families in different ways and requiring individualized therapies and interventions. With each patient, an SLP must create a plan of care that is tailored to the patient and his/her family. As I explore communication disorders more, my goal is to discuss one disorder at a time, how that disorder can affect children and their families, and what specific interventions and resources are available to them.  

      I have been looking into communication disorders that affect children and found a great website that explains what a communication disorder is, characteristics of children with communication disorders, and how communication disorders affect learning/education. The site is: http://www.cec.sped.org/AM/Template.cfm?Section=Communicative_Disorders&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=37&ContentID=5626. According to this site, "Children with communication disorders have deficits in their ability to exchange information with others. A communication disorder may occur in language, speech, and/or hearing. Language difficulties include spoken language, reading and/or writing difficulties. Speech encompasses such areas as articulation and phonology (the ability to speak clearly and be intelligible), fluency (stuttering), and voice. Hearing difficulties may also encompass speech problems (e.g., articulation or voice) and/or language problems. Hearing impairments include deafness and hearing loss."
      Communication disorders can be incredibly frustrating both to the individual with the disorder and his/her family members. The site above goes on to explain that children with communication disorders may have difficulty: following directions, initiating and attending to a conversation, pronouncing words, perceiving what is said, expressing oneself, and/or being understood. Can you image how frustrating it would be to not be able to express your wants or needs, for others to not understand what you are saying, or for you to not understand what others are saying to you? Communication disorders affect family members too. It can be extremely challenging and isolating to not be able to effectively communicate with your own family member. Your child or brother or sister not being able to talk to you, not following your directions, and not initiating any type of conversation, even a simple "Hi" or "I love you" can be very stressful and can affect bonding and the type of care and support children receive. Luckily, there are resources and therapies available to help children and families learn to communicate effectively, such as SLP's, speech therapy, and augmentative and alternative communication. In later blogs I hope to discuss in more depth how communication disorders affect families (positively and negatively), specific communication disorders, and resources that are available to help these children and their families.