By Pam Marshalla
Q: My 2-year-old daughter has to get her four front teeth extracted because of decay. The doctor told me that there could be speech disorders. She doesn’t speak as much as other kids of her age and she started walking a little late. After these teeth are extracted I am worried that she is going to stop trying to talk and become even more timid. What can I do? You have two things going on that have different impacts on…
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: 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 client misarticulates all the lingua-alveolar consonants–– T, D, N, L, S, Z. Can you give me some advice for how to fix them? Designing methods to “fix” a phoneme all depends upon what is wrong with it. Therefore in order to recommend methods to address these lingua-alveolars, one would need to know–– Are they completely absent from the client’s repertoire? Are they backed? Are they lateralized? Are they interdentalized? Are they nasalized? Is there a lack of plosiveness…
By Pam Marshalla
Q: My 5-year-old son has average intelligence but speaks in 3-5 word utterances. He had hearing problems earlier. The SLP at school wants to put him into a group. Can he be affected by the modeling of the other students who also have poor articulation? Isn’t a 1-to-1 setting better? I work in private practice because I always prefer the 1:1 situation, but a group can be useful for many reasons. Group work can be more motivating and fun. Language…
By Pam Marshalla
Q: Everyone seems to say that kids with Down Syndrome have apraxia. Is this right? Shouldn’t it be dysarthria? Any client with a speech problem and neuromuscular disorder has dysarthria. Period. That is the very definition of dysarthria. Dysarthria is a non-linguistic, neuromuscular disorder of expressive speech, characterized by impaired capacity to execute speech movements. Dysarthria defines a group of motor speech disorders that includes clients with muscle tone disturbance–– Low tone, high tone, mixed tone, fluctuating tone; It includes…
By Pam Marshalla
Q: I just started working with toddlers and preschool children and my colleague says that you can’t do an oral-peripheral exam on these little guys. What do you say? Do you do it and if so how? An examination of the oral mechanism’s structure certainly can be done on little kids. Come on people! Let’s get creative! I do oral exams on all clients regardless of age. With infants I just poke around in there and prop the mouth open…
By Pam Marshalla
Q: My elementary-age client injured her tongue-tip. It has been a few weeks post the accident and her speech is moderately distorted and she still complains of pain. Her doctor says she is just trying to get attention. Do you have experience with this? I have worked with a few patients who had injury to the tongue-tip. In my experience it can take up to a year to fully recover from it. If some of the nerves were damaged,…
