By Pam Marshalla
Q: Your book, Apraxia Uncovered, describes seven stages of vocal development. If my son can only do 80% of Stage One, should I proceed with Stage Two? Or do I wait for him to be able to do 100% of Stage One before moving on to Stage Two, even though he is able to do some of the items already in Stage Two? The stages overlap. Many children learn a little bit of this and that from each stage without…
By Pam Marshalla
Q: What ICD-9 code would be appropriate to use for oral motor dysfunction? As far as I know, there is no ICD-9 diagnostic code for oral motor. Use appropriate codes for apraxia, dysarthria, dysphagia, orofacial myofunctional, etc..
By Pam Marshalla
Q: I am a preschool teacher and am wondering how to teach the “K” sound to one of my students. Let’s broaden your question to: How does one teach a child to say a new phoneme? This is what I would tell a preschool teacher: Show her how to make the sound: Ask her to watch and listen to you say the sound. Pause slightly before you say it. Make the sound stand out by saying it a little louder, by…
By Pam Marshalla
Q: I am looking for oral motor exercises that will teach and promote chewing. My client prefers a diet of soft foods that he can form into a bolus with his tongue against the roof of his mouth and swallow whole without moving the food to his molars and cheeks. The best book on the topic is: Morris, S. E., & Klein, M. D. (2000). Pre-feeding skills: A comprehensive resource for mealtime development, 2nd edition. Austin, TX: Therapy Skill Builders (Harcourt…
By Pam Marshalla
What is the first most important goal of speech-language therapy? This question came up at a workshop recently. One seminar member answered, “Build the child’s self esteem.” This is not correct. The first most important goal of therapy is to establish rapport with the client. All the old-time speech-language textbooks taught this. Establish a trusting relationship between yourself and the child early in therapy, and continue to build this relationship as therapy progresses. If the child doesn’t trust or like…
By Pam Marshalla
Q: How often should a young child (2-4 years of age) with apraxia or dysarthria receive speech-language therapy services? I have a baseline that all my clients with motor speech disorders have to meet. They must attend once per week for one hour at a minimum. Twice per week is very nice. Three times per week is a complete luxury. More than that is unnecessary because these children do not change very fast. Children with motor speech disorders take a…
By Pam Marshalla
Q: Is it wise to talk to a preschool child with childhood apraxia about their disorder? I never tell little kids that they have a disorder. I let them know that they are speaking very well, that they are still learning, and that I am thrilled that they are speaking as well as they are. Often I imitate back to the child what he said and how he said it, then I model for him how to say it better….
By Pam Marshalla
Q: Our son is three and was non-verbal. Our SLP seems really good at helping him learn to talk. But he is very hard to understand. What can we do? The essence of speech therapy for little children is to learn about words and sounds. We need to focus on both when working with young children. Many of today’s younger therapists put all their focus on building vocabulary, and they spend very little time focused on the actual production of…
By Pam Marshalla
Q: Is it necessary to get a diagnosis of apraxia with a young child who does not talk, or can we just proceed with therapy? The answer to that depends upon the rules and regulations of your treatment center or school, and whether or not insurance providers are involved. But in my opinion, as far as the actual therapy is concerned, you do not need a diagnosis to start. Just start. Time in treatment will tell you increasingly more about…
By Pam Marshalla
Q: I was listening to your audio tape called Apraxia Uncovered and heard you say that voice-activated toys are great for getting children to vocalize. Where can I find these? I know of no speech company that is selling these toys now, but I searched online and found many for sale at various venues. Some are overpriced, but if you take the time to look around online, I am sure you will find at least one at a reasonable price….
