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 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: 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: 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…
By Pam Marshalla
Q: My client is 4;0 with a frontal lisp with a very small mandible (underbite) and chronic upper respiratory problems––congestion, nasal drip, mouth breathing, snoring, etc. He cannot breath through his nose. Do you think he is capable of learning to keep his tongue in for the sibilants given his underbite? Yours is a very common question for which we have no clear answers. In all likelihood both the under-bite and the upper respiratory problems are contributing to his speech…
By Pam Marshalla
Q: I am faced with cutting my caseload down considerably due to budget cuts. We will see the more severe kids a max of one time per week, and that’s fine. However, we are being asked to cut the mild kids more, and even eliminate them from our caseloads. Do you have any ideas? Many therapists are facing this today. Here is a brainstorm I had that may get you thinking outside the box. The idea is to use four…
By Pam Marshalla
Q: A pediatrician recommended that a 4-year-old child receive speech therapy for R distortion. When do you recommend starting therapy for R? In my seminars I always say that a preschool child CAN be helped with R, but most therapists don’t feel it is necessary that young. School-based therapists almost never see these kids that young, but therapists in private practice often do. Therapists in private practice do so not because they feel it is absolutely necessary but because the…
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: 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…
