Preschool Sessions

Speech, Language, Fluency, and Voice Services

Speech-Language Sessions with Young Children

At Language & Learning, when working with young children, you will often see our therapists on the floor because we integrate our therapy with play! Although we may select specific toys, books, crafts, or activities to use during a session, we follow the child’s lead, using their interests to help reinforce the skills we are teaching. After all, aren’t we all more likely to do something when it is fun? Additionally, play is such an important part of a child’s development that we wouldn’t dream of leaving it out! Play allows for natural, positive reinforcement for behaviors and language as well as ample opportunities for naturalistic learning. After therapy sessions, we provide insight to what went well and how the family can implement this at home.

 

Below are different areas that speech-language therapy may target with this age group.

Articulation and Phonological Disorders

A child may substitute, distort, delete, or add speech sounds, making their speech difficult to interpret. A speech sound disorder occurs when a child consistently incorrectly produces certain speech sounds beyond the age at which it is developmentally appropriate. Whether or not a speech sound error is developmentally appropriate depends on the error being made as well as the child’s age and gender. Follow this link to a chart of speech sound development milestones to determine whether your child may require intervention.

A child with a phonological disorder produces speech errors that can be classified as a particular error pattern. Phonological processes are typical as a part of development for children age 5 and under. For example, deleting weak syllables (e.g., saying teffone for telephone) is a typical pattern for children of a certain age. However, various phonological processes are unexpected, or may persist longer than expected, at which point a diagnosis may be warranted. Follow this link to a chart of phonological process milestones to determine whether your child may require intervention.

What may my child be working to develop in therapy?
A speech-language pathologist at Language & Learning will assess speech sound errors and oral-motor skills. If diagnosis of a speech sound disorder (articulation disorder or phonological disorder) is warranted, the speech-language pathologist will develop a treatment plan to correct errored speech sounds or patterns. This will typically include direct, multisensory instruction for production of sounds, auditory discrimination of correct productions, and structured rehearsal of correct production in increasingly difficult contexts all while incorporating play and fun activities!

Motor Speech Disorders

Motor speech disorders involve the inability to plan and coordinate the motor movements required for speech due to disrupted neurological signals.

Childhood apraxia of speech (CAS) is a motor disorder that is present from birth. Despite knowing the word they would like to say, children with apraxia of speech are unable to coordinate the motor movements necessary to sequence the sounds and syllables within words. This often results in erroneous sounds and movements as they attempt to produce the word. Typically, individuals with CAS will have difficulty with lengthy and/or complex words. They also have inconsistent speech errors, meaning their errors may vary instance-to-instance or day-to-day. In isolation, CAS does not impact the ability to understand language; therefore, individuals with apraxia of speech may understand others at a much higher level than they are able to express themselves. As a result, they may experience a high level of frustration due to their inability to motorically produce their intended message.

What may my child be working to develop in therapy?
If apraxia of speech is suspected, a speech-language pathologist at Language & Learning will examine oral-motor skills, including the ability to: produce a variety of nonverbal and verbal motor movements, sequence and vary sound/syllables/words, vary intonation (pitch and volume) when speaking, and produce speech sounds. This evaluation will allow the speech-language pathologist to determine whether or not a diagnosis is warranted, and if so, its nature and severity. Following diagnosis of apraxia of speech, a speech-language pathologist will target planning, sequencing, and coordination of oral-motor movements. Similar to the “muscle memory” required in other activities such as sports training, repetitive practice with areas of difficulty for the client (ranging from individual sounds to multisyllabic words within contextual language) can help teach the necessary coordinated movements required for speech. Additionally, strategies such as pacing, over-articulation, and visual/tactile cueing are explored and implemented depending on their effectiveness and necessity for the individual client.

Expressive and Receptive Language

Expressive language refers to one’s ability to communicate information to others. Receptive language refers to one’s ability to understand language. These skills are necessary to understand information in the world around you as well as express thoughts and information. As a result, receptive and expressive language play an integral role in our daily lives. As children progress in life and school, expressive and receptive demands increase and build upon each other; therefore, impacts of weaknesses evident at a young age may increase as a child grows.

Weaknesses in expressive or receptive language may involve any combination of various language areas. These include semantics (word meaning and use), morphology (using word parts to build words), or syntax (how words go together in phrases or sentences).

For children who need support in expressive and/or receptive language, a speech-language pathologist at Language & Learning will investigate specific areas of need. As the areas are identified, repetitive, targeted practice through play, songs, and movement-oriented activities will be used to reinforce these language skills.

What may my child be working to develop in therapy?
For toddlers, therapy in expressive language may include goals involving shifting from pointing and grunting communication to more symbolic language, such as signs and/or sounds, while always working toward the goal of word production and then the combination of words.

Receptive language therapy with toddlers may include goals such as following simple directions, identifying objects after hearing its name, and exploring cause and effect.

Preschool children receiving therapy for expressive language may involve goals such as increasing their vocabulary, using age-appropriate grammatical forms, or starting to structure narratives.

Receptive language therapy with preschool children may include goals such as following directions, grouping items into categories, identifying parts of a narrative (characters, problem), and understanding increasingly difficult vocabulary.

Pre-Literacy

Pre-literacy skills refer to the skills acquired before school that support reading and writing development. Basically, during this stage, children learn about print and sound.

Print awareness includes knowing which way to turn pages, that some symbols have universal meaning (the red octagon sign means that the car has to stop), that letters hold meaning, and that letters represent sounds. A lot of children learn the latter through learning the first letter in their name and/or their friends’ names.

The ability to identify and play with word parts (phonological awareness) is another crucial pre-reading skill. This includes skills such as rhyming, identifying words that start with the same sound, and breaking words into syllables.

Vocabulary development (semantics) and understanding narrative structure are also important pre-literacy skills, which are discussed in Expressive/Receptive language.

What may my child be working to develop in therapy?
For toddlers, we will coach parents on how to incorporate pre-literacy activities into their daily routines and during reading times. These skills may also be more directly targeted during therapy sessions for children who are working on articulation or phonology goals.

With preschoolers who are building pre-literacy skills during therapy, activities such as rhyming production and identification, word manipulation, and initial sound hunts may be incorporated into play and activities. Additionally, narrative structure may begin to be taught explicitly.

Social Skills/Pragmatics

Social skills may also be referred to as pragmatics or social pragmatics. Social skills come from an underlying, somewhat unspoken, set of rules about what behaviors are expected and unexpected in various situations. For toddlers and preschoolers, these skills are constantly growing and can later impact relationships that they form.

What may my child be working to develop in therapy?
Areas addressed with toddlers and preschoolers include (note that expected skills will vary by the child’s age):

  • Using communication skills socially (e.g., greetings, closings, politeness markers)
  • Taking turns in a conversation
  • Maintaining conversational topics appropriately
  • Understanding and using nonverbal communication (e.g., eye contact, following eye gaze, body positioning, facial expressions)
  • Modifying their communication depending on the listener or environment

When addressing social skills with young children, our therapists like to explicitly label what we are working on in child-friendly words. The rationale is that the child has not “picked up” the implicit social rules, so explicit labeling helps make the expectation less abstract. However, as with most of our therapy with young children, sessions that target social skills will revolve around play, with the child learning and practicing specific skills to help them demonstrate pragmatics.

Fluency Disorders

Stuttering is the most common fluency disorder; it impacts a child’s ability to produce continual, even speech with minimal effort. Stuttering typically involves effort or tension by the speaker, and dysfluencies for young children may consist of:

  • Repetitions and revisions of anything ranging from sounds to entire phrases
  • Prolongation of sounds
  • Blocking (silent or filled pauses while the speaker attempts to produce the sound)
  • Secondary, struggle behaviors such as such as twitching and shaking of the face or body.

Most children go through a phase of typical dysfluency while their language develops. However, it is atypical for these dysfluencies to last for more than 4-6 months or to be paired with struggle behaviors (such as hard blinking or tic-like movements). Additionally, if there is a family history of stuttering, further investigation is recommended. Some children outgrow their dysfluencies, others do not.

What may my child be working to develop in therapy?
If a fluency disorder is suspected with a young child, a speech-language pathologist at Language & Learning will consult with and interview the family and interact with the child. Treatment of fluency disorders with young children involves parent education and coaching to help encourage fluency and to help the child through dysfluent moments. Depending on the child’s age and maturity, direct stuttering treatment may involve any combination of:

  • Child-friendly speech production/mechanism education
  • Speech modification (i.e., fluency shaping) techniques to avoid stuttering moments (e.g., easy onset, light articulatory contact)
  • Stuttering modification techniques that require the child to identify and modify stuttering moments (e.g., pull-out, cancellation)

Voice Disorders

A change in the structure or function of any aspect of the vocal mechanism may lead to voice problems or a voice disorder. Vocal abuse and/or inadequate vocal hygiene habits may be the underlying cause of voice disorders characterized by a hoarse, raspy vocal quality with low volume. Extended abuse of the vocal mechanism may cause vocal nodules or vocal polyps. These growths on the vocal folds are similar to a callus or blister respectively. These growths not only impact the quality of your voice, but can also make it difficult to talk, requiring the speaker to strain to produce speech. This increased strain can make it difficult for the growth to then heal.

If a voice disorder is suspected, the first step is to visit an otolaryngologist (also known as an ENT), which is a doctor specializing in ear, nose, and throat disorders. This doctor can perform an examination to determine if there are structural or functional problems with the vocal mechanism. Following this appointment, the doctor may make a referral to a speech-language pathologist.

What may my child be working to develop in therapy?
A speech-language pathologist at Language & Learning will evaluate the vocal problem, taking into consideration the results of the otolaryngological evaluation and the family’s concerns. With young children, therapy will include child-friendly education of how the voice is made, vocal hygiene practices (practices to help promote voice health), and increasing their awareness of their voice and vocal use. Additionally, the family will be educated on vocal hygiene and how to encourage healthy voice use at home.

If appropriate to the child’s age and maturity, therapeutic techniques to help safely enhance vocal quality will be taught and practiced, such as diaphragmatic breathing, breathy onset, and techniques to decrease strain while talking.