By Pam Marshalla
Q: My toddler-age clients sometimes fuss and cry, even scream. I know this is normal behavior for a little kid, but I am a young therapist with no children of my own yet, and I simply do not know how to handle it. Do you have advice for me? Sometimes it is the language we use that causes stubborn and uncooperative behavior. Changing our language can improve some of these situations. Let me illustrate with a story. 🙂 I was…
By Pam Marshalla
Q: Do you think that clients really can improve when parents never attend therapy as is common in the public schools? The notion that children only can improve when parents are involved is a modern idea that runs counter to the way therapy has been practiced throughout the past century. In 38 years I rarely have involved parents all the time. I have parents watch parts of therapy when they are around, and I give them encouraging information about how…
By Pam Marshalla
I was recently reminded of a client I worked with decades ago who taught me a very important lesson about therapy when I was a young therapist. I wanted to share his story. David David was 6;0 and non-verbal. He was a big clunky kid with fine and gross motor problems who was basically untestable, and everyone thought he had very low IQ. I was using Bliss Symbols with him (it was 1976) to develop a home-made communication board (before…
By Pam Marshalla
Q: My son just turned 5. He has been having difficulties with his articulation for several years especially with D, T, TH, S, Z, N and H. also he has difficulties in putting letters together such as D-O-G. He is able say things correctly only when we go really slow and draw out each sound. He also sucks in when trying to make the S sound. How can my husband and I help him with this? The severity of what…
By Pam Marshalla
Q: I work in a school and I have an autistic student 4;0 with limited verbalizations. She also sees a private therapist who keeps telling the parents that my methodology isn’t right, and that is why the girl isn’t making progress. She says that apraxia therapy has to be done a certain way. The child actually is making progress but limited, and the parents are saying that the progress is due to the child’s own development and not because of…
By Pam Marshalla
Q: Have you tried the SmartPalate? I am considering trying it with a few clients who have stubborn sound errors. I would like some input from people who used it first. The SmartPalate is a clinical electropalatometry tool and I have not used it. I have read all about it, however, and I am sure it will be very useful for some clients, but there are ways to do this without the expense. The SmartPalate provide visual feedback about place of articulation,…
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…
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…
