While reading one of my classmate’s blogs, I came across the communication disorder known as Selective Mutism (SM). SM is when a child has full capability to talk, but refuses to speak in certain situations, such as at school. According to ASHA, “A child with selective mutism does not speak in certain situations, like at school, but speaks at other times, like at home or with friends. Selective mutism often starts before a child is 5 years old. It is usually first noticed when the child starts school”. The child’s decision to be selectively mute is often linked to intense anxiety in social situations. ASHA lists treatments for this behavioral disorder as well things teachers can do to support and encourage speech. These suggestions can be found at http://www.asha.org/public/speech/disorders/selectivemutism.htm and include:

·         Stimulus fading: involve the child in a relaxed situation with someone they talk to freely, and then very gradually introduce a new person into the room

§  Shaping: use a structured approach to reinforce all efforts by the child to communicate, (e.g., gestures, mouthing or whispering) until audible speech is achieved

§  Self-modeling technique: have child watch videotapes of himself or herself performing the desired behavior (e.g., communicating effectively at home) to facilitate self-confidence and carry over this behavior into the classroom or setting where mutism occurs

If specific speech and language problems exist, the SLP will:

§  target problems that are making the mute behavior worse;

§  use role-play activities to help the child to gain confidence speaking to different listeners in a variety of settings; and

§  help those children who do not speak because they feel their voice "sounds funny".

Work with the child's teachers includes:

§  encouraging communication and lessening anxiety about speaking;

§  forming small, cooperative groups that are less intimidating to the child;

§  helping the child communicate with peers in a group by first using non-verbal methods (e.g., signals or cards) and gradually adding goals that lead to speech; and

§  working with the child, family, and teachers to generalize learned communication behaviors into other speaking situations.

Parents play a critical role in helping children with SM as well. SLP’s often have to rely on parents and family members to give them information about the child, such as if any other problems (schizophrenia, PDD, etc.) exist, the environmental factors in the household, child’s symptoms, child’s amount of verbal expression and where this verbal expression does and does not occur, family history, and the child’s speech and language development. SLP’s also review a child’s educational history, do a hearing screening, and an oral-motor examination before creating a therapy plan for each child with SM.

Only about 10% of Selective Mutism children appear to have a language, learning or speech articulation problem. Because SM seems like more of a behavioral issue than a true communication disorder, I would like to look into the amount of children with SM that also have other behavioral issues, such as anxiety disorder.   

While researching communication disorders and resources for families of children with communication disorders/delays I realized that not all people will have access to the internet. For this reason, I decided to look for additional resources that might be more readily available to all families. I was able to find many books written on the topic that might serve as sources of information and support to families. These books include:  The Parent’s Guide to Speech and Language Problems by Debbie Feit, More Than Words: Helping Parents Promote Communication and Social Skills in Children with Autism Spectrum Disorder by Fern Sussman, It Takes Two To Talk: A Practical Guide For Parents of Children With Language Delays by Jan Pepper, The Late Talker: What to Do If Your Child Isn't Talking Yet by Marilym Agin, and Childhood Speech, Language, and Listening Problems by Patricia McAleer Hamaguchi. I was happy to find a great short book about stuttering that was written for children (Sometimes I Just Stutter by Eelco de Geus). This book discusses stuttering in an open and encouraging way and includes letters from many people who stutter. I was also able to find activity books and videos that promote speech and language development, such as Let's Talk Together - Home Activities for Early Speech & Language Development by Cory Polland and Baby Babble DVDs.

All of these resources are written by experts, SLP’s, and/or parents who have experienced raising a child with a communication disorder. I found all of these books and DVD’s at my local library, which is a great free resource that all families can use.

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/