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: My client is 7;0 and is being denied SL services because he has cognitive impairment and apraxia. The insurance company is saying that there is no evidence to demonstrate that he will improve because of his cognitive problems. Will he improve? Is there supportive research on this? Have you seen these kids improve? Children or adults with cognitive impairment bring unique challenges to the work of speech-language pathology. When reviewing the research in this area recently I found very…
By Pam Marshalla
Q: I am an SLP who works with preschoolers, and my own daughter has a slight problem at age 18 months. I am getting frantic about this and need advice. She uses more than 50 words, is beginning to put two-word combinations together, and she has consonant phonemes from each manner group (a few stops, glides, nasals, and fricated sounds). She has all her vowels except those that require lip rounding, and I cannot seem to get her to round…
By Pam Marshalla
Q: My 19-month-old cannot produce O. She is smart and has no other speech or developmental problems, but it interferes with intelligibility. My guess is that your daughter will learn to round her lips within a few weeks or months all on her own without any help. She is only one year old and has lots of time to gain this simple skill. If you were to come to my office about this, and this was the only problem, I…
By Pam Marshalla
Q: I have an elementary age male client that was attaining an adequate R, but then we had scheduling problems and he lost it. I cannot get it anywhere now. Help! When I have a client like this, I start from scratch. I assume they can do nothing that I worked on with them, and I re-visit all we have done before. Slow way down. Do not assume any generalization. Review, review, review what he could already do and solidify…
By Pam Marshalla
Q: Do you have a list of diagnostic indicators for young children with CAS? The best I have found has been from a seminar I attended by Dr. Barbara Davis in 2010. This is what I put together from her handout: Characteristics of Apraxia Barbara Davis does research in the area of childhood apraxia of speech and she presented a summary of research in this area at a recent seminar (Davis, 2010). She reported that the incidence of apraxia is…
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
A professor wrote me several years ago. She said she taught articulation and phonology, she had tenure, she did research in phonology, she supervised students, and she had published many articles. She said that she could not “see” the oral-motor problems I was talking about in my writing. She wanted to know what I had to say about that. I wrote back and said that she could not “see” the OM problems I was talking about because she could not…
By Pam Marshalla
Q: Can phonemes like R and S be taught to adults? I have received an unusual number of questions recently about the effectiveness of articulation therapy with adults. Where is this notion that articulation therapy cannot be done with adults coming from? Articulation therapy is EASIER with adults because they can understand what you are talking about and they usually are highly motivated to change. The only time this is not the case is when the adult client has a significant…
By Pam Marshalla
Q: I am helping with policy development in my district and we’re facing significant budget cuts. We have to cut mild artic kids from the caseload. Do you have any advice about this? I am wondering if they are considering cutting services for very low functioning kids too. Kids with very low communication skills tend to be seen quite often these days, often 2-3 times per week. On the other hand, high-functioning artic kids are being seen less and less…
