Speech and Language
Speech and Language treatment at the ICF is centered upon the unique needs and challenges of the child. Our philosophy involves improving speech, language and communication skills while promoting the child’s self esteem and confidence. The developmental level of the child is central to our treatment plan. Parent involvement and understanding is also essential to our Speech/Language/Communication program.
At the ICF, therapy is provided for a variety of Speech/Language Challenges & Disorders. These include:
Articulation Delays and Disorders
Childhood Apraxia of Speech
Language Processing Challenges and Disorders
Receptive Language Delay and Disorders
Expressive Language Delay and Disorders
Pragmatic Language Impairment
Language Challenges associated with Autism Spectrum Disorders
Language Difficulties associated with Asperger Syndrome
Programs that are offered at the ICF include:
Hanen Communication Programs (hanen.org)
Feuerstein Instrumental Enrichment (irinc.us) (newhorizons.org)
Fast Forword (scientificlearning.com)
DIR (Developmental, Individual Difference Relationship Based) (floortime.org)
Visualizing and Verbalizing (lindamoodbell.com)
Details regarding these programs can be found on their websites. The programs provide excellent tools to help attain our overall Speech/Language/ Communication goals. The above programs are offered individually and in groups. Parent children communicative interaction groups are also offered.
Speech/Language/Communication Disorders
Articulation Disorder or Delay
Articulation Disorder or Delay exists when a child does not develop speech sounds or the ability to sequence speech sounds as expected for their chronological age. In some instances, children can be simply assisted to use their articulators (lips, tongue, jaw, teeth, tongue, hard and soft palate) correctly to produce the target sounds. Repetition tasks then reinforce the new target sounds. At times, these difficulties may be due to dysarthria, which is a generalized oral/facial muscle weakness. Oral motor exercises to strengthen and tone articulators assist with this difficulty.
Childhood Apraxia of Speech
Childhood Apraxia of Speech is a Motor Speech Disorder. It results in difficulty planning, executing or sequencing movements needed for speech production. Mild to severe disorders are documented. It can range in difficulty from reduced ability to produce accurate oral motor imitation, to difficulty with consonant-vowel production as well as difficulty sequencing complex sounds. Sequenced motor, syllable and specific phrase imitative tasks are highly successful in helping children overcome Apraxia of Speech. An intensive program is necessary for the repetition required. Parent involvement is also essential. Difficulty motorically sequencing complex sequenced speech is often referred to as Oral Verbal Dyspraxic Speech.
Language Processing Disorders
Language Processing involves conceptualizing the auditory message to a meaningful level. In a severe form, Language Processing Disorders present with children having difficulty associating meaning at the word level. In a moderate form, children have difficulty processing complex directions or stories read to them. Children with difficulty taking in auditory messages are often helped by visual cues and highlights. The length of the auditory message greatly affects the ability to retain the information. In later school years, language processing can result in difficulty in note taking during lectures. Language processing difficulties may also include word retrieval difficulties and decreased vocabulary development. It is important that children presenting with these difficulties have a complete Speech & Language Assessment as well as an Audiological Assessment to rule out a Central Auditory Processing Disorder (asha.org)
Expressive and Receptive Language Disorders
Language is a system of symbols people use to communicate. Expression involves “output” (speaking, gestures, signs, facilitated communication, writing) and receptive language involves “input” or the comprehension and understanding of language. Children with delayed or disordered language development do not exhibit symbolic skills as expected of their age norms. A complete language assessment including informal and formal diagnostic test measures determines the degree of language delay or disorder. At the ICF, the language treatment program is then developed based on the overall developmental level and needs of the child and family.
Expressive Language differences include:
Reduced sentence structure
Difficulty telling a story in sequenced order
Delayed vocabulary development
Word Retrieval difficulties
Difficulties with Topic Maintenance
Grammatical reduction or errors
Receptive Language differences include:
Difficulty following and retaining directions
Difficulty with concept development
Working memory difficulties
Word retrieval difficulties
Difficulty responding appropriately to yes/no, where, what,
what doing, who, why and when questioning
Reduced Story Comprehension
Communication and Language Challenges
as Associated with Autism Spectrum Disorder
For children experiencing the Social and Communicative difficulties associated with the diagnostic label under the umbrella of ASD, we provide a treatment program based on the developmental, emotional and language needs of the child and family.
Areas where we can offer improvement and achievement include:
Improving Eye Contact
Improving Speech prosody
Enhancing Joint attention
Decreasing Echolalia
Improving Accurate Pronoun Use
Promoting Symbolic Play Routines
Increasing Turn taking abilities in conversation
Promoting Verbal reasoning
Noting the verbal and nonverbal cues of language
Understanding of Abstract Language
Understanding the Language of Emotions
Pragmatic Language Impairment
Social Language and Understanding are the main areas of focus for children displaying a Pragmatic Language Impairment. Pragmatic language includes the ability to use language to accomplish a wide variety of social purposes (e.g. requesting, greeting, commenting, protesting, refusals, questioning). Eye contact, inflection and tone of voice are areas that also come under this category. In general, the social rules of verbal and non verbal language are not adequately understood for reciprocal social discourse.
These areas need to be assisted concretely, cognitively, symbolically and playfully with patience and reciprocal rehearsal.
Floor Time techniques are excellent ways to enhance pragmatic language skills. Through the DIR, The Developmental, Individual Difference, Relationship Based model, children master the building blocks of relating, communicating and thinking. The give and take of relationships, turn taking and social reciprocity are emphasized through six stages of development. (floortime.org)
Techniques offered by James MacDonald in his book Communicating Partners also provides excellent strategies to assist parents in helping their children become more social and communicative. The five strategies include sensitive responding, balancing, matching, sharing control, and responding in a emotionally playful manner. Dr. MacDonald emphasizes the importance of early parent/child/play relationships.
(jamesmacdonald.org)
Older children displaying a Pragmatic Language Impairment may evidence additional difficulties. Some specific difficulties include inferring information during conversation, difficulty understanding metaphors and idioms, difficulty with social discourse as well as understanding humor. The student may tend towards literal interpretations.
Each of these areas can be assisted with treatment. At the ICF, individual therapy as well as social skills groups aid the ability to improve pragmatic/social language.
Asperger Syndrome
Not everything that steps out of line, and thus abnormal, must be necessarily “inferior”. (Hans Asperger–1930)
According to The Gillberg diagnostic criteria for Asperser’s Syndrome (Gillberg 1991) a diagnosis includes the following:
1) Social Impairment (Extreme Egocentricity), at least two of the following
A) Difficulties interacting with peers
B) Indifference to peer contacts
C) Difficulties interpreting social cues
D) Socially and emotionally inappropriate behavior
2) Narrow Interest, at least one of the following
A) Exclusion of other activities
B) Repetitive adherence
C) More rote than meaning
3) Compulsive Need for Introducing Routines and Interests
A) Which affects the individual’s every aspect of every day life
B) Which affect others
4) Speech & Language Peculiarities, at least three of the following
A) Delayed Speech Development
B) Superficially perfect Expressive Language
C) Formal pedantic language
D) Odd prosody, peculiar voice characteristics
E) Impaired of comprehension including misinterpretations of literal/implied meanings
5) Non-verbal Communication Problems
A) Limited use of gestures
B) Clumsy/gauche body language
C) Limited facial expression
D) Inappropriate facial expression
E) Peculiar, stiff gaze
6) Motor Clumsiness
A) Poor performance in neurodevelopment test
Symptoms of Asperger’s Syndrome that we at the ICF may be helpful with:
Social immaturity and delayed reasoning skills
Impairment in verbal and nonverbal communication
Impairment in the conversational rules of language
Intellectualizing feelings
Literal interpretation of Empathy
Specific Topic Adherence/Interest
Social skills groups offer assistance in social routines and with the verbal and nonverbal rules of language. Individual treatment offers the opportunity to develop a program for the unique developmental and social needs of the student.
Speech and Language Developmental Milestones
Provided by American Speech-Language Hearing Association, www.asha.org
Expression
Birth–3 Months
Makes pleasure sounds including cooing and babbling
Cries differently based on different needs and quiets if crying
4–6 Months
Babbling sounds more speech-like, including simple consonant productions such as p, b, m
Vocalizes excitement and pleasure with cooing and babbling
7 Months–1 Year
Babbling includes repeated syllables
Uses speech sounds to gain attention
Begins to imitate different speech sounds
First words emerge (bye-bye, mama, dada)
Hearing and Understanding
Birth–3 Months
Startles at loud sounds
Seems to recognize parent’s voice
4–6 months
Moves eyes in direction of sounds
Responds to changes in vocal tone
Responds to changes in vocal tone
7 Months–1 Year
Enjoys peek-a-boo & Pat-a-cake
Localizes to the direction of sound
Recognizes words—common items
Begins to respond to simple requests
Expression
1–2 Years
Produces more words each month
Begins to use two words together (“more cookie”)
Begins to use 1–2 word questions (“where cookie?”)
Produces many different sounds at the beginning of words
2–3 Years
Produces two-three word phrases
Has a vocabulary of 50–300 words
Refers to objects by their name
Majority of speech is understood by familiar listeners
Hearing and Understanding
1-2 Years
Understands simple requests
Listens to simple songs and rhymes
Listens to simple stories
Points to pictures named
2–3 Years
Follows two step directions
Word recognition expanding
Expression
3–4 Years
Talks about various activities
Sentence production includes 4 + words
Asks and begins to answer “why” questions
Non family understand speech production
4–5 Years
Able to maintain topic when telling a story
Grammar increasing in accuracy, with detailed sentences
Communicates with both children and adults
Majority of speech sounds are used correctly (except a few such as l, r, s, z, th)
Hearing and Understanding
3–4 Years
Comprehends simple “Who, What, Where, Why” questions
4–5 Years
Answers questions about stories
Able to engage in conversation
Understands most language at home and at school
