Definitions

What on earth is...

• Articulation – the way speech sounds are made by the mouth
• Auditory Processing – paying attention to, analysing and organising information we hear
• Dysfluency (stuttering) – sounds, syllables or words may be repeated or “stuck”
• Dyspraxia – difficulty planning and co-ordinating mouth movements for clear speech
• Expressive Language – use of vocabulary, grammar, explanations and story-telling
• Phonology – the way speech sounds are organised in our brain so the right sound is used in the right place.
• Phonological Awareness – abilities such as breaking words into syllables and sounds, and combining sounds to make words (necessary for literacy development)
• Pragmatics – social skills, ability to use language appropriately
• Pre-language Skills – skills such as eye-contact, attention and turn-taking
• Receptive Language – understanding of questions, concepts, instructions and conversation

Speech

Speech is the actual sound of spoken language. Speech difficulties include:

• Phonological Delays & Disorders
• Articulation Delays & Disorders
• Stuttering or general fluency
• Dyspraxia (speech coordination)
• Voice (nasal, husky, irregular pitch or volume)

Articulation

An Articulation Delay is likely if:

• Others cannot understand your child
• There is difficulty with coordinating speech
• Parts of words are omitted eg, the endings or the beginnings
• They are having difficulty saying sounds expected for their age

Stuttering

Stuttering is a speech motor disorder characterised by one or more of the following:

• Repeating sounds, words or phrases: d-d-d-dad / dad-dad- dad / I can-I can-run
• Prolonging sounds: c-c-c-c-can
• Blocking before the sound begins …………can
• Facial grimaces, twitching or irregular breathing

Stuttering is not a psychological or emotional disorder. Whilst some children spontaneously stop stuttering, most children require therapy. If stuttering is left untreated, the pattern can become established which makes it more difficult to treat. If your child is stuttering, it is recommended that they receive an assessment by a Speech Pathologist to determine the severity and if or when to commence treatment.

Childhood Apraxia of Speech (CAS)

Childhood Apraxia of Speech refers to a difficulty in organising the oral muscles to make voluntary movements in order to produce speech sounds.

You may also have heard it referred to as:

• Apraxia of Speech
• Verbal Apraxia
• Developmental Apraxia of Speech
• Developmental Verbal Dyspraxia

Characteristics of dyspraxia may include:

• Increased difficulty saying target sounds when pressure is applied (ie, when they are told to do so)
• Difficulty sequencing sounds (often will use metathesis eg, hospital → hopstible or animal → aminal)
• Increased difficulty with longer words or sentences
• Inappropriate prosody (stresses on parts of words)
• Searching movements with the mouth when trying to make speech sounds (referred to as ‘groping’)
• Inconsistency in repeating sounds and words
• Slow progress with learning speech sounds
• A child with dyspraxia may show frustration when they are not understood, and they may use their own system of gestures to communicate
  

CAS is difficult to diagnose as it often has similar characteristics to other speech disorders and has a changing nature (Stackhouse 1992). More symptoms may appear as a child gets older and has increased demands. Therefore it is often gradually diagnosed, and rarely diagnosed until after a child is about 3 years of age. Children with CAS can be ‘at risk’ of persistent problems in speech, expressive language and phonological awareness. This is not always the case. Therapy for children with CAS should be individual, frequent and intense.

Voice

Poor voice quality – a voice that sounds:

• Husky
• Hoarse
• Raspy
• Strained
• Breathy

Nasality – a voice that sounds:

• Hyponasal = sounds like the person has a cold all the time, even when they are perfectly healthy
• Hypernasal = sounds like the voice is coming out of the nose (can be a little snorting sound)

Pitch – a voice that sounds:

• Too high or too low for the persons age and sex

Volume – a voice that sounds:

• Too loud
• Too weak/soft

Language

Language is the system of spoken and written words, grammar, vocabulary and gestures. Language has two areas: Receptive and Expressive Language. Receptive language refers to understanding the meaning of language. Expressive language refers to the way in which we produce our ideas and thoughts and put them into words or sentences. This includes structured sentences, word endings and vocabulary.

Pre-literacy & Literacy Skills

Pre-literacy skills are important because they form the foundation on which your child must build if they are to become competent readers and writers. Some children acquire literacy skills with ease - others need extra help with skills built gradually and cumulatively. Phonological Awareness Skills are the awareness of sounds and the ability to manipulate sounds in words. Phonological Awareness Skills are essential for literacy development. They include:

• rhyme awareness
• syllable awareness
  
• identifying blends in words
  
• identifying phonemes (sounds) in initial and final positions
  
• breaking words into sounds
  

Leaps & Bounds Speech & Language Pathologists have undertaken many further post-graduate studies and training in literacy. Speech Pathologists who are specially trained are one of the best professionals to help your child if they have any literacy difficulties. Literacy is language based and we use an explicit method of decoding. We can assess and help your child in the areas of:

• Phonological Awareness
• Reading Decoding
  
• Reading Comprehension
  
• Vocabulary Development
  
• Spelling
  
• Written Language
  

Literacy includes all the above areas such as spelling, phonological awareness, reading (both decoding and comprehension), vocabulary development and writing skills. Reading starts with ‘phonemic awareness’, which is the ability to notice, think about and manipulate the individual sounds in words or ‘phonemes’. Phonemes are the smallest units of sound in our language that can make a difference in the meaning of a word (eg, hat vs cat). Recent studies have shown that the largest gains for reading comprehension are shown in children who are taught using the oral-language approach. Researchers found these gains to be entirely explained by an increase in their knowledge of vocabulary words and ability to understand them when spoken. This study also showed that vocabulary training did not simply help children with ‘taught’ words, but also with ‘untaught’ words. The children appeared to be developing ‘some enhanced meta-cognitive skills” that enabled them to become more engaged with learning language.

Children with any sort of speech production deficit are at higher risk for difficulty with phonological awareness, which itself is a “critical element of literacy development” (Justice & Schuele, 2004).

If your child is struggling in any of the areas of literacy mentioned (reading is only one part of literacy), call us to have a literacy assessment and we can organise therapy that is specifically suited to your child.

Auditory Processing Skills

Auditory Processing is a term used to describe what happens when your brain recognises and interprets the sounds around you. "Auditory Processing Disorder" or "Central Auditory Processing Disorder" means that something is adversely affecting the processing or interpretation of information.

Only an audiologist can properly diagnose a (Central) Auditory Processing Disorder. Due to maturation of the auditory system, no child should be diagnosed with such a disorder before the age of seven. If your child has been diagnosed with APD by anyone other than a qualified audiologist, this diagnosis may not be accurate. Some 'screening' tests (tests used for screening and not diagnosis) that are being used are not classified as best practice, according to current research. This is partly due to the fact that some of the screeners are language based and this may interfere with accurate results in children with language impairments.

Leaps & Bounds no longer conducts assessments specifically for (C)APD due to best practice policies. However, a thorough evaluation of receptive and expressive language skills forms a vital part of the puzzle when reaching diagnosis of (C)APD, and a full language assessment is recommended for all children with suspected (C)APD and/or literacy difficulties.

Many children are referred to us due to suspected (C)APD, often because they have identified difficulties with literacy, and more specifically, difficulties with sequencing sounds for spelling and reading (i.e. phonological awareness). In these cases, the referrer's use of the term (C)APD actually seems to indicate a concern about phonological awareness skills. The diagnosis of (C)APD is a complex process, involving the expertise of several health professionals, and it is suggested that anticipatory use of the label (C)APD may actually lead some clients to request assessments which are not the most relevant.

When Leaps & Bounds Speech Pathologists have concerns regarding auditory processing skills, based on analysing the results of language and literacy assessments and looking at those sub-tests which relied most heavily on auditory input, we will refer to an Audiology clinic which specialises in assessment of specific auditory processing skills. They will test speech in noise, gap detection, hi/low discrimination and use nothing word-based. Assessment of memory and cognition by a Psychologist may also be warranted.

A Speech Pathologist is the person best qualified to help remediate and provide therapy for Auditory Processing Disorder. We can also provide strategies and techniques to assist in the classroom. Leaps & Bounds continues to offer high quality therapy intervention for those who have been properly diagnosed with (C)APD.