What is Speech and Language Therapy?

The following is a brief version of speech and language therapy. Please note that there is more to speech and language therapy then what is written below.

Speech/language therapy has two parts. The speech portion which is helping a child produce sounds/words correctly and the language portion which is helping a child understand and verbally use language.

Speech

Articulation – The production of sounds.

Focus during evaluation = The Speech Language Pathologist (SLP) first finds out what sounds the child consistently produces in error which the child should be producing correctly (i.e., the child says “tar” for “car”). The SLP also looks at the child’s oral-motor skills (The child’s ability to move their articulators –tongue, lips etc.).

Focus during therapy = The SLP teaches the child how to correctly produce the sounds which were produced in error, so they can be understood. The sounds are practiced in isolation and gradually increase in difficulty to the conversational level. If needed, physical assistance is provided to teach the child the correct production of sounds.

Voice/ResonanceThe quality and loudness level of a child’s voice as he/she phonates as well as whether the phonation is nasal, laryngeal, or oral.

Focus during evaluation = The SLP looks to see if there are any behaviors which abuse your voice (i.e., yelling, impressions, etc.), listens to the child’s phonation (i.e., voice quality, loudness level, resonance, and pitch) and checks the physical mechanisms (i.e., child’s type of breathing, breath support, tension sites).

Focus on therapy = The SLP gives alternatives to abusive behaviors, teaches proper breath support and type of breathing, and teaches child how to relax while talking.

Fluency The production of fluent “smooth” speech (I went to the store) vs. disfluent “bumpy” speech (I wwwwent to the store)

Focus during evaluation = The SLP obtains a 100 word language sample and calculates the percentage of words produced fluently vs. disfluently. The SLP observes the types of disfluencies (typical = interjections, revisions, phrase repetitions, multi-syllabic whole word repetions) vs. atypical (part-word repetitions, 3 or more iterations, prolongations, blocks). Secondary characteristics are also noted. SLPs look to see if there are any communicative stresses, interpersonal stresses, or child factors influencing the child’s disfluencies.

Focus during therapy = The SLP teaches the child how to produce fluent speech using direct therapy (reduced rate, light contact, decreased tension, breath support, yawn-sigh, pull-outs, etc.) or indirect therapy (i.e., having parents reduce rate, pause before answering questions, give the child plenty of time to talk with no interruptions, modifying questions). The SLP will also address the child’s feelings towards stuttering if necessary.

Language

Receptive Language = The understanding of spoken language (i.e., following directions, understanding that each word has a meaning attached to it).

Focus during evaluation – The SLP determines if the child is not following commands due to a lack of understanding, behavior problem, or hearing impairment. If the child is not following commands due to a receptive language impairment, the child will wander aimlessly with no real reaction when told a command such as “come here.” (give speech/language therapy) If the child is not following the command due to a behavior problem, the child will run in the opposite direction when told “come here” or speed up when told “no.” (refer to Applied Behavior Analysis (ABA) Therapy) If the child is not following commands due to hearing, the child may only respond when the command is given in a loud voice or when the child is looking and visual cues are given (refer to audiologist). If the problem is in understanding, the SLP assesses what words/commands the child does understand and what he/she does not yet understand (i.e., the complexity of commands, receptive language vocabulary).

Focus during therapy – Starting at the level the child is unable to understand, the SLP gives tasks such as following commands. As the child is able to independently follow a command, the commands gradually increase in length (i.e., moving from following one-step commands such as “sit down” to three-step commands such as “go get the ball, come back, and sit down”) and complexity (i.e., moving from commands containing simple words such as nouns and verbs such as “get the ball” to commands containing more complex words such as adjectives - color, size, quantity, adverbs, negatives, and prepositions such as “get the small ball that is under the chair” or “get two balls that are not red”). The SLP also works on increasing a child’s receptive language (the understanding of what words mean).

Prompts

Physical (help the child obey the command or help the child point to the picture/object with hand over hand assistance.

- Verbal (tell the child a key word/phrase in the command when necessary (i.e., the child was told to go get his/her cup and put it on the table. The child gets his cup and then starts to walk aimlessly due to forgetting the second part of the command. At that point, the verbal prompt would be “put the cup on the table”))

- Visual (pointing, gesturing to help the child obey – tell the child to get his/her cup and point to the cup while giving the command)

Expressive Language = The syntax (sentence structure), semantics (meaning of words), morphology (prefixes and suffixes), and pragmatics (use of language) of a child’s utterance.

Focus during the evaluation – The SLP assesses a child’s vocabulary, syntax (sentence structure), morphology ( prefixes and suffixes), and pragmatics (the use of language – is the child using language in a functional way). If the child does not yet have true words, the SLP assesses the child’s ability to imitate sounds/words.

Focus during therapy –The SLP provides the child with language enhancing activities that will encourage the child to move from imitating sounds/words to using phrases/sentences to communicate wants/needs as well as talk about experiences and give narratives. The goal is for the child to initiate talking with others and use language in a functional spontaneous manner. Through modeling, storybook reading, and imaginary play SLPs teach the child to expand his/her length of utterances using a variety of sentence structures as well as a variety of words.

Theory of Mind and Signs

Children with disabilities or language impairments often have difficulty with Theory of Mind the ability to realize (that his/her thoughts may be different from the thoughts of someone else and) that what he/she does can affect what someone else does. For example, a typical child will point to a toy in order to have someone either look at what he/she sees or to have someone get that toy for him/her. This pointing then leads to the child saying the word to request or comment. Children with disabilities will try to get the toy on his/her own without realizing that asking for it would help him/her. These children do not see the benefit of learning to talk. So, the first step is to help that child realize that he/she is capable of talking and that talking is beneficial to that child. SLPs do this by creating scenarios where the child has to request a toy/desired object. The SLP will then have the child attempt to say a word/sound for the toy/desired object. If the child does not make an attempt to say the sound/word, the SLP will help the child sign the word and then give the toy to the child as a reward. The child will begin to associate making the gesture with getting the toy which in turn teaches (him/her) theory of mind. That child will be more motivated to imitate sounds and use words in order to get toys/desired objects.

Play /Pragmatics

Play is also an important part of teaching language. By playing with a child, the SLP is modeling language to the child as well as teaching the child turn-taking which is part of communicating. Talking about what the toys are doing and using words such as “I have an idea” or “I think this will work” helps the child realize that people think of things in their heads and then talk about them. This will help the child create mental models which will in turn help him/her with reading comprehension and creating narratives when he/she is older. The SLP provides the child with opportunities to learn how to ask and answer questions, request, comment on others conversations, greet others, and maintain eye contact.