Speech and Language in Children

+ What are some signs of a speech disorder?

An articulation disorder involves problems making sounds. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand you. Young children often make speech errors. For instance, many young children sound like they are making a "w" sound for an "r" sound (e.g., "wabbit" for "rabbit") or may leave sounds out of words, such as "nana" for "banana." The child may have an articulation disorder if these errors continue past the expected age.

+ How do I know if my child's language is delayed?

A language delay is a delay in acquisition of language skills compared to one’s chronological and cognitive/ intellectual age peers. A young child with a language delay may exhibit a slower onset of usage of a language skill, rate of progression through the acquisition process, sequence in which the language skills are learned, or all of the above. Generally, early language delay (late talking) may be characterized by less than 50 words at 24 months, few word combinations at 30 months, limited use of gestures and sounds to communicate, limited symbolic play, limited understanding of word meaning and inability to follow verbal instructions.

+ My child was diagnosed with a phonological disorder. What is this?

A phonological process disorder involves patterns of sound errors. For example, substituting all sounds made in the back of the mouth like "k" and "g" for those in the front of the mouth like "t" and "d" (e.g., saying "tup" for "cup" or "das" for "gas"). Another rule of speech is that some words start with two consonants, such as broken or spoon. When children don't follow this rule and say only one of the sounds ("boken" for broken or "poon" for spoon), it is more difficult for the listener to understand the child. While it is common for young children learning speech to leave one of the sounds out of the word, it is not expected as a child gets older. If a child continues to demonstrate such cluster reduction, he or she may have a phonological process disorder.

+ What is a Receptive Language Disorder?

Receptive language is the comprehension of spoken language. Children with a receptive language disorder have difficulty understanding and processing what is said to them. Receptive language includes understanding figurative language, as well as literal language. Characteristics of a receptive language disorder may include not appearing to listen, difficulty following verbal directions, limited vocabulary, difficulty understanding complex sentences or responding appropriately to questions, parroting words or phrases, and demonstrating lack of interest when storybooks are read to them.

+ What is an Expressive Language Disorder?

A child with an expressive language disorder may have lower than normal ability in vocabulary, producing complex sentences, and remembering words. However, a child with this disorder may have the normal language skills needed to understand verbal or written communication.

+ How do I know if my child’s stuttering is typical?

Disfluency is an interruption within normal fluency of speech. Commonly, people associate stuttering with “getting stuck on a sound or a word.” All speakers demonstrate a natural level of disfluency in their speech, and children can display higher levels of “normal” disfluency as they are learning to talk and their language skills are emerging. The types of stuttering and frequency of the disfluencies dictate how “fluent” a person’s speech is perceived to be. Some types of disfluencies are typical in preschoolers as language emerges. Others, such as part­word repetitions (“Sat­sat­Saturday”) or prolongations (“sssssssssaturday”) are not.

+ What is Childhood Apraxia of Speech?

Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words. Childhood apraxia of speech (CAS) is an uncommon speech disorder in which a child has difficulty making accurate movements when speaking. It's important to know that CAS is just a label for a speech disorder.

 Sensory and Motor Development

+ What can Occupational Therapy do for pediatric patients?

Occupational therapy helps children to develop the underlying skills necessary for learning and performing specific tasks, but it also addresses social and behavioral skills. It can help with the child’s self-concept and confidence. Pediatric occupational therapy helps children develop the basic sensory awareness and motor skills needed for motor development, learning and healthy behavior.

+ What is an Occupational Therapy evaluation?

An occupational therapy evaluation will assess a child's gross motor, fine motor, visual motor, visual perceptual, handwriting, daily living and sensory processing skills. The use of standardized assessment tools, non-standardized assessment tools, parent interview and clinical observations will be used to assess the child's performance.

Occupational therapy treatment encompasses several areas of performance. All treatment plans and therapy goals are created and implemented based on the child's individual needs.

+ What areas are addressed in Occupational Therapy treatment?

  • Fine Motor Skills: Pertaining to movement and dexterity of the small muscles in the hands and fingers.
  • Gross Motor Skills: Pertaining to movement of the large muscles in the arms, legs and trunk.
  • Visual Motor Skills: Referring to a child's movement based on the perception of visual information.
  • Oral Motor Skills: Pertaining to movement of muscles in the mouth, lips, tongue and jaw, including sucking, biting, crunching, chewing and licking.
  • Self-Care Skills: Pertaining to daily dressing, feeding and toileting tasks.
  • Sensory Integration: The ability to take in, sort out and respond to the information we receive from the world.
  • Motor Planning Skills: The ability to plan, implement and sequence motor tasks.
  • Neuromotor Skills: Pertaining to the underlying building blocks of muscle

+ What is sensory processing?

Sensory processing is the ability to organize sensations from the environment for purposeful use. Children diagnosed with autism spectrum disorder (ASD) often have difficulty organizing and interpreting information from their senses. Difficulties adequately processing sensory input can affect a child’s motor skills, attention span, behavior, learning, play skills, and self-care skills. The role of an occupational therapist is to address the child’s sensory systems so that learning and skill development are not adversely affected. The sensory systems include: • Sight • Hearing • Vestibular, movement • Proprioception, body awareness • Touch • Taste • Smellstrength, muscle tonicity, postural mechanisms and reflex integration.


+ What are the symptoms of a feeding disorder?

The symptoms of a feeding disorder can vary and not all children will exhibit all symptoms. Some parents may find that they must force feed their child by using distractions or dragging out meals over a long period of time in order to get the child to eat. While many children, especially toddlers and preschoolers, can be picky eaters, some children with feeding disorders are often very picky and are only willing to eat a very limited amount (types) of foods—sometimes as few as 10 foods or less. Children with a feeding disorder may also exhibit some or all of the following symptoms:

  • Persistent difficulty with feeding.
  • Refusal to eat food (refusal behaviors).
  • Difficulty with age-appropriate foods or textures.
  • Pain or distress with feeding.
  • Poor weight gain (failure to thrive).
  • Bottle feeding only while the child is asleep.
  • Family history of feeding disorders.
  • Child can only eat small amounts.

+ How do I know if my child has a feeding disorder or if he is just a picky eater?

Problem feeders have the following behaviors: Young infants who refuse bottle or breast, or drink a small amount then refuse. This results in a decreased overall volume consumed, and eventually weight loss and dehydration; Toddlers and children who eat less than 20 foods; Kids who “lose” foods that they once ate, and do not resume eating them even after a few weeks break. Eventually they may be down to 5­10 foods; Kids who refuse certain textures altogether; Kids who scream, cry, and panic over touching, smelling, or tasting new food; Kids who are unwilling to try almost any new food even after 10+ exposures.

+ What does feeding therapy look like?

During feeding therapy, therapists work with children to provide them with the skills they need to make mealtime more enjoyable and nutritious. The skills taught to each child are determined based on the patient’s needs and may differ based on the child’s specific issues. Children in feeding therapy are taught oral skills, are introduced to new foods and textures and taught to enjoy eating, especially if the child has developed negative feelings toward mealtime.