Pam Marshalla, Author at Marshalla Speech & Language

Author: Pam Marshalla

Starting Over in Apraxia Research

By Pam Marshalla

Q: I have heard you complain about research in the area of apraxia. Why do you think it is so poor? Think about this: APRAXIA occurs in the ABSENCE of neuromuscular disorder while DYSARTHRIA occurs in the PRESENCE of neuromuscular disorder. Now think about this: ALL the research in speech that has been done on apraxic kids since the beginning of time has been done without any assessment of their muscle tone. Researchers have just been assuming that tone is…

Differentiating Between Apraxia and Dysarthria

By Pam Marshalla

Q: What would to do in an evaluation to differentiate between CAS and dysarthia? Specifically would you rule out muscle weakness? The definitions of apraxia and dysarthria speak for themselves–– APRAXIA is a motor speech disorder that occurs in the ABSENCE of neuromuscular problems. It is a problem in the perception of movement, and therefore it causes problems in planning movement. The result is severe articulation and phonological deficit. DYSARTHRIA is a motor speech disorder that occurs in the PRESENCE…

Thumb Sucking With Asperger’s Syndrome

By Pam Marshalla

Q: I have a 9-year-old male client with Asperger’s who sucks him thumb. I read your book How to Stop Thumbsucking and have had success with other children, but not this one. Advice? I have never faced this but I think this all boils down to what makes sense for him. It seems that the only things that get through to these clients are the things they can plug into their own logic. If you can figure out what makes…

Low Tone and Speech Therapy

By Pam Marshalla

Q: My client has low tone and many deviant phonological processes. Is this common? Does this mean he has dysarthria? How should my treatment look different from traditional articulation or phonological therapy? Yes! If the child has hypotonia then this is dysarthria. Whenever you have muscle tone problems of a global nature, then dysarthria is the diagnosis. Dysarthria is a speech movement problem that is the result of muscle tone disturbance. (See definitions below) It is common for children with…

The Schwa… Then What?

By Pam Marshalla

Q: My client can produce only the schwa––“Uh.” He is 3-years-old and pretty smart. But he cannot imitate any consonants or vowels at all. What can I do? This is what I would be thinking about––– Teach him to prolong the sound he has––the schwa. And teach him to tolerate your hands on his jaw. Once he can prolong his schwa and tolerate your hands, move his jaw up-and-down while he is vocalizing. If he can prolong his sound while you…

Question re: Eyedropper Technique and Drooling

By Pam Marshalla

Q: I am using your eyedropper method for a non-verbal 5-year-old girl in the trainable cognitive level. She also has a neuromuscular disorder. We do it for 15 minutes and then she gets bored. Do you have advice? This is not the type of activity that you do for 15 minutes. Weave it in-and-out of other SL activities you are doing. Use the dropper procedure every 90 seconds while she is otherwise engaged. You want to stimulate her to swallow…

Starting Carryover with Young Kids

By Pam Marshalla

Q: Is there an age constraint for starting self-awareness techniques for carryover? My son is 6 years old. Carryover ideas should start right from the first day of therapy, no matter the client’s age. That means that you are planning for and thinking about and stimulating for carryover from the first day, and you are dropping in ideas here and there. For example, let’s say your child is learning to keep his tongue in his mouth. He can work on…

Mobius Syndrome and Articulation Therapy

By Pam Marshalla

Q: What type of articulation therapy should be provided for children with Mobius Syndrome? I have only seen a few children with Mobius Syndrome, and those were seen for diagnosis only. As I understand it, facial paralysis is the main problem and the paralysis can involve some or all of the facial muscles, particularly the upper lip in most cases. The breadth and scope of the paralysis will guide speech involvement. One client I saw had paralysis only in the…

Push-In vs. Pull-out

By Pam Marshalla

Q: What is your opinion about push-in vs. pull-out therapy? Is anyone doing research on this? As far as I know, no one is doing research on in-class versus pull-out therapy for articulation. I cannot address this question as it concerns language. In my opinion, in-class stimulation is good for the following: Building general vocabulary and concepts Establishing general communication routines Encouraging basic syntactic structures Stimulating phonological awareness Engaging in articulation carryover activities Teaching elocution Teaching early-developing phonemes—P, B, M…

Is a Frontal Lisp Outgrown?

By Pam Marshalla

Q: My 4-year-old son has a frontal lisp. The school is refusing services and says he will outgrow it. Is this true in all cases? No one that I know of is researching this area any more and there are big questions like this one that are going un-answered. There seem to be two types of frontal lisps. The first is an immature speech pattern that will go away with time––by 7-9 years of age. The second is the result…