By Pam Marshalla
Q: I have a new referral for a 4-year-old client who has had several cleft repairs and prior therapy. Per his last report his only speech error is a lisp but I also saw in his mom’s referral info that he has some feeding problems and is sensitive to certain food temperatures and consistencies. Could his atypical sensory and chewing issues be factors in his interdental error pattern? Do you have suggestions for evaluating and treating this child? His mom…
By Pam Marshalla
Q: What do you think of the “no-child-left-behind” perspective so pervasive in the schools today? How is it possible that a teacher or therapist could guarantee to leave no child behind? There always have been and there always will be people left behind. That’s is how life is, and no matter what ideal pie-in-the-sky philosophy one has, one cannot leave the facts of life out of the equation. For example, when it comes to hard sciences like chemistry and physics,…
By Pam Marshalla
Q: “Do you think feeding problems cause speech problems? My professor says no.” I believe you’re approaching the question from the wrong direction. My experience is that feeding problems do not cause speech problems, and speech problems do not cause feeding problems, because — My experience is that both feeding and speech problems are the result of mouth movement problems. This is easy to understand if you step away from our field and consider other movement skills.
By Pam Marshalla
Q: I have a five-year-old male client who slurs and I think this is mild dysarthria. Do you tell parents the diagnosis? Do you tell them that this is a lifelong problem? I usually don’t bring up dysarthria with a little guy who only slurs unless I need to assign a code for insurance, if the parents are pushing for a label, or if the parents already are bringing up apraxia or some other label as a possibility. Mild dysarthria…
By Pam Marshalla
Q: Sometimes parents fight and argue with me when I mention dismissing their child who no longer needs speech services. Where in the ASHA guidelines does it say that it is unethical to provide services for an individual who does not need it? This is in ASHA’s Code of Ethics although it’s phrased funny and therefore somewhat buried… It is letter I under Principle of Ethics 1 – Rules of Ethics. The important part of the guideline here is where it…
By Pam Marshalla
Q: My male client is five years of age. He has developmental artic errors and slurred speech. He also add a schwa at the ends of words: “Baby” is “baby-uh” and “Sand” is “Sand-uh.” What would account for this and how would you address this kind of speech sound error? Developmental errors are normal in a five year old but slurred speech is not. Something is going on. This sounds like mild dysarthria. I see the addition of the schwa…
By Pam Marshalla
Q: I work with a 6th grade student who has myotonic dystrophy. This is my 5th year working with this student. We have been working on P, B, and M for all of that time. At this time he can say these sounds correctly much of the time in therapy but has a horrible time with carry-over and self monitoring. He refuses to use video or voice recording or a mirror to help with this. Any thoughts on how I…
By Pam Marshalla
Q: My 5-year-old has been in speech therapy since he was 2. After many years of therapy, he pronounces a word right during speech and at home speech activities and he uses them in a sentence, however he’s not carrying over with conversational speech. His SLP tells me to correct him when he says a word wrong, but I’m correcting nearly every word he says which makes him get frustrated and not even want to talk to me. I don’t…
By Pam Marshalla
Q: I recently started working with a student with a right side unilateral lisp caused by jaw and tongue instability. He also has a midline bulge. Right now we are working on maintaining a stable jaw. Do I focus on tongue position as well? It sounds like he is shifting both his jaw and his tongue to one side. If so, stabilize the jaw first and use a straw to analyze what is going on with the airstream with the…
By Pam Marshalla
Q: I have a 5-year-old child with PDD, NOS (autism spectrum disorder). Her language comprehension is very good. She makes sounds and she babbles, but she produces no words. She is social and definitely has communicative interest and intent. Based on your experience, would the techniques in your book and CD called Apraxia Uncovered be of potential benefit to my daughter to help her speak words (even though she does not carry a diagnosis of Apraxia, per se). Thank you…
