By Pam Marshalla
I get questions all the time about children with global delays and severe speech-language impairment. The current trend is to call these children “apraxic” and to treat them like other children with motor speech disorders. But this is an incorrect approach that results in confusion over the purpose and direction of therapy. For example, here is a letter I received lately: I started working with a boy (who is now 3 yrs.) about a year ago. He has delays “across…
By Pam Marshalla
Q: I am serving a student with moderate acquired dysarthria impacting speech intelligibility due to impaired respiration, phonation, coordination, speech rate and articulatory precision. She is six-years old and her accident was 2 years ago. She can follow directions well and is aware that she sounds different than her peers. The most obvious speech quality is the slow rate, pausing, and unnatural phrasing. Her peers tend to ignore her when she is speaking because these qualities make her sound so…
By Pam Marshalla
Q: What articulation developmental norms do you use? I don’t use any specific developmental norms because of the following: Lieberman (1980) found that a rudimentary vowel quadrilateral is set in infant vocal productions by 5 months of age. According to a recent chapter by Vihman (2004), research demonstrates that average children acquire basically all the consonant phonemes by 3 years of age. All studies that have been done since Templin in 1957 have demonstrated that all the consonants reach adult…
By Pam Marshalla
Q: I have a 3-year-old male client with apraxia. We are working on initial F. After two unsuccessful sessions where he completely shut down and did not want to speak, I took the pressure off, bombarded him with the sound, and rewarded him for placement. He ended up with a few good productions of the sound by the end of the session. The problem is that he came back to therapy today overgeneralizing the F. I was wondering if this…
By Pam Marshalla
Q: My preschool client says words, but they only occur at the end of long jargoned gibberish. How do I get rid of that unintelligible part? I would not take the jargon away because jargon is a natural part of speech development. Van Riper called it pretend speech. I call the type you described Word Jargon. It is jargon embedded with real words. Kids without speech-language impairment do this all the time, as they are moving toward 2-3 word phrases….
By Pam Marshalla
Q: I am an SLP with a two-year-old son who has developed a lateral lisp on Sh and Ch. I really don’t want these lateral sounds to get worse and I am tired of hearing that I am over-reacting. Help! Oh you poor thing! Being an SLP and having a child of your own with an artic problem is one of the worst situations to be in! You are NOT over-reacting because you know that some of these so-called minor…
By Pam Marshalla
Q: I am working with a two-year-old who uses a guttural back sound for initial T in words. He can say initial D correctly. Do I need to be worried about this T? Yes and no. When I work with kids under three years of age, I do not concern myself with how they produce individual phonemes within individual words. So I don’t find it important that the child can say “two” with a correct T, for example. But I…
By Pam Marshalla
Q: I am working with toddlers for the first time after a 10-year career with elementary school children. They are different! Can you guide me? This is what I would tell a graduate student–– With a toddler, the most important thing to change from therapy with older children is that you have to STOP trying to get him to do what you want him to, and you have to START doing what he is doing. In other words, stop saying,…
By Pam Marshalla
Q: I received a referral for a 15-month-old diagnosed by a private SLP with apraxia. The child has excellent receptive language and produces 10-15 words. I was told that the child was an “automatic qualifier” coming in with the diagnosis of apraxia. I have huge reservations with this and do not feel as if the diagnosis was made appropriately in just in one session and not over time. There are no indications of motor difficulties elsewhere. Am I out in…
By Pam Marshalla
Q: My 5-year-old daughter has below average intelligence and she can say Bah, Mah, S, Da, and Nnn, but no real words. She has had speech therapy for two years. Could you suggest an oral appliance that can help her to improve oral muscles and tongue movement awareness? I am going to be very blunt here, and probably more straight forward than I would in a real therapy session in which I would gently lead you toward this idea over…
