By Pam Marshalla
Q: I have heard you say that although most school districts seem to have excellent entrance criteria for therapy, they tend to have very poor exit criteria. Could you speak to this in regard to a client’s willingness to participate and in regard to cognitive level? Because I have been in private practice for 25 years, I have not had to agree with anyone on exit criteria, and therefore I have taken it on a case-by-case basis. In all honesty,…
By Pam Marshalla
Q: I am working with a 7-year-old in first grade. He has received services since 3-years of age privately and at school. He is making very slow progress in speech, and is having great difficulty comprehending and completing first grade work. His speech is characterized mostly by jargon with a few intelligible words, so some meaning may be derived. He is able to produce two-syllable words but falls apart with more complexity. He occasionally produces three-word intelligible utterances such as…
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
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: I have heard you say that you have a real problem with Evidence-Based Practice (EBP). Why would you be opposed to something that so clearly will help and protect our clients? I am not against using EBP. I am for EBP. However, I am concerned about several recent results of the EBP philosophy. I am especially opposed to three new ideas: I am against throwing out everything we have learned through a century of trial-and-error speech-language therapy just because we…
By Pam Marshalla
Q: How can I find out about orofacial myofuctional therapy? Go to the website for the International Association of Orofacial Myology. According to their website, “The IAOM provides information about Orofacial Myological disorders including: tongue thrust, improper mouth posture and incorrect swallowing patterns.”
By Pam Marshalla
Q: Do you recommend therapy breaks for preschoolers with phonological delay? For example, summer off after the year of early childhood in a public school? I have usually found that a break from therapy (especially in the summer) is a fruitful experience for kids. Most often they come back to therapy having made considerable progress on their own. It always seemed to me that all that sunshine, gross motor activity, and new experiences helped them move along. Plus, they are…
By Pam Marshalla
Q: Our son is 28 months old and just starting to talk. He may be apraxic and he sucks a pacifier all day and night. He seems to be very bright. What is your opinion about the pacifier? I have seen otherwise normally-developing two-year-olds who do not talk at all become completely verbal within a few weeks after their pacifier is tossed out. I always recommend elimination of the pacifier in cases of speech delay, except in those rare cases…
By Pam Marshalla
Q: How can we teach our five-year-old child on the autism spectrum to spit out his toothpaste after brushing? Perhaps you could start with a solid object, like a rubber ball. SAFETY TIP: Use a ball large enough to fit in his mouth but not too small that he might swallow it. Also make sure it doesn’t taste bad. Some rubber objects taste really bad. Have him learn to put the ball in his mouth and then “spit” it out…
By Pam Marshalla
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