Areas of Practice
Social concepts are the foundation for receptive and expressive language development. It encompasses shared attention, communicative intention, and shared meaning. Shared attention is the idea that two people are noticing and attending one another and to a shared experience. Communicative intention is all the reasons we communication such as commenting, requesting information, protesting, requesting an object or action, providing information, provide comfort, provide assistance, to check in, to name a few. Shared meaning is an extended engagement where the people have a common theme and an exchange of ideas.
The ability to regulate one’s emotions is paramount to learning. Children develop an understanding of socially conventional means to communicate internal processes (how to protest, to request information, and to provide information using appropriate gestures, tone of voice, and language). This is a developmental process; so, it is expected that all children need to learn how to regulate through transitions (in or out), novel information and social expectations. Most often we associate behaviors with negative feelings, but a child can be overly excited which results in dysregulated behavior too. Behaviors are all interpreted as a state of dysregulation instead of opposition or noncompliance. The child will learn to develop emotional literacy, or the ability to express him/herself using socially appropriate communication.
This is the actual production of the sound. An articulation error is characterized by the distortion of the sound. It can be a lisp, a distortion of the /r/ (bood/bird) or /l/ bauh/ball), or a mispronunciation (f/th). Articulation errors often are what is left after the phonological and/or motor planning systems have been remediated.
Receptive and expressive language development are dependent on a strong foundation of social- communication concepts. Receptive language encompasses the processing and comprehension of sounds/phonology, vocabulary, grammar, morphology (parts of speech). Expressive language is the verbal output of sounds/ phonology, vocabulary, grammar and morphology. Then it grows into complex thought and reasoning; the understanding and expressing of abstract language (figurative, multiple meaning, idioms). Language is learned best within a shared experience that is both meaningful and purposeful to the child. Although our end goal is expressive output, it is important to ensure the process is respected to ensure a child develops a self-generated linguistic system.
This encompasses the rules for how a language organizes its sound system. It involves syllable shapes. In the English language, our most complex phoneme is the /dg/ and we have both complex two and three element clusters - thr-, sl, spl-skw-, to name a few. Intervention is aimed at developing the complex phonemes and the complex clusters, which will allow for a broader and faster change (development) of the entire phonological system.
voice and resonance
A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual's age, gender, cultural background, or geographic location. A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs—even if others do not perceive it as different or deviant. Intervention is conducted to achieve improved voice production and coordination of respiration and laryngeal valving. Resonance disorders are not voice disorders, although they are often mislabeled as such. Signs and symptoms of resonance disorders can vary depending on a number of factors, including the type of resonance disorder and the severity of the condition causing the disorder. Hypernasality, hyponasality, Cul-de-sac resonance, and mixed resonance are varying types of resonance disorders. The goal of treatment is to achieve improved resonance and improved articulation sufficient to allow for functional oral communication. -ASHA
Speech production is the end result of the synchronization of the social, phonological, motor planning and articulation systems into a whole. It takes about eight years for a system to completely integrate but speech should be 90% intelligible to unfamiliar listeners by the time the child is three years of age. It is the clinician's work to identify where the system might be lagging and how to best support its development. A Speech Sound Disorder (SSD) is diagnosed when one or more of these systems is behind developmental expectations. A child will move through a number of different interventions (based on individual profile) across the course of treatment. That is, there is no one program that can be utilized to treat a SSD.
This involves the complex motor sequencing of both the sound system and the linguistic system before it gets sent to the articulators. You might have heard of the term Childhood Apraxia of Speech (CAS). According to our best research, a phonological disorder and a motor planning disorder cannot be accurately differentiated. That is, children will have components of both in their speech sound disorder. What is felt to be CAS is quite rare, only 4/100 of all SSD cases. Thus, it is often misdiagnosed. The interventions that have shown to be most effective in treating a motor planning deficit are phonological intervention, Dynamic Touch, and ReST or Rapid Syllable Training.
Fluency is the aspect of speech production that refers to continuity, smoothness, rate, and effort. Stuttering, the most common fluency disorder, is an interruption in the flow of speaking characterized by repetitions (sounds, syllables, words, phrases), sound prolongations, blocks, interjections, and revisions, which may affect the rate and rhythm of speech. These disfluencies may be accompanied by physical tension, negative reactions, secondary behaviors, and avoidance of sounds, words, or speaking situations. Treatment for fluency disorders is highly individualized and based on thorough assessment of speech fluency, language factors, emotional/attitudinal components, and life impact. -ASHA
Evidence Based Practices/Treatments
The terms "evidence-based practice" and "evidence-based treatment" are often confused. While evidence-based treatments (EBTs) are interventions which have been proven effective through rigorous research methodologies, evidence-based practice (EBP) refers to a decision-making process which integrates the best available research, clinician expertise, and client characteristics. EBP is an approach to treatment rather than a specific treatment.
The intervention strategies used by the clinicians for the treatment of language, phonological/speech, reading and spelling delays or disorders are evidenced-based treatment approaches. There is solid and consistent research to support specific means to help remediate underlying deficits. Your clinician will be able to site the research for you.
With respect to treatment for children diagnosed with Autism, the clinicians use developmental approaches that target the core symptoms of ASD versus training a set of skills or behaviors. The research on the progression of typical child development is the foundation for these intervention programs. This means that the SCERTS and Floortime approachs are evidence-based practice. However, it is important to note that there is decades of published showing the efficacy of these models for the treatment of affect development, speech and language development and/or social-communication development.
There are many intervention programs available that report significant changes in children. However, these methods have not stood up to the rigorous research methodologies and thus cannot be shown to be efficacious. Unfortuntately, anecdotal changes cannot be used as proof of effectiveness.
The American Speech and Hearing Association provides position statements regarding a number of treatments and it is expected that members follow these guidelines or be in jeopardy of violating the ASHA Code of Ethics.
Your clinician will be able to provide you with summaries of research studies.
At Lynnwood Speech and Language Services, we want our services to extend beyond treatment sessions. If you’re interested in more resources, please follow the link below to a list of websites, programs, and articles for parents.