Stuttering

Also referred to as a disfluency disorder or stammering. Stuttering can be described as a disruption in the fluency of speech.

These disruptions are involuntary and can include the following behaviours:
  • Repetitions (repeating sounds, syllables or words)
  • Prolongations (E.g. maaay I have)
  • Blocks (which are usually silent periods where the person appears stuck)

 

These behaviours may also be accompanied by other associated behaviours such as eye blinking, facial grimacing or body movements.

The precise cause of developmental stuttering is yet unknown although research has found genetic links. Neurological stuttering can also occur following a brain injury such as a car accident or an illness that causes the brain to swell. Developmental stuttering commonly begins at 3 years of age, this is the time at which children are combining words into sentences.

Many children who begin stuttering achieve natural recovery. It is important to consult a Speech Pathologist and begin therapy if:
  • Your child is not yet at school and the stutter has been ongoing for a number of months (consultation should be sought prior to one year after onset)
  • Your child has 12 months or less before they commence primary school
  • Your child is at school
  • Your child’s confidence or willingness to talk is being affected
  • Your child’s stutter began after a brain injury
  • You are an adult

Stuttering therapy is most successful between the ages of 3-5 years old

 

Impacts on my child & my family:

Your child is likely to take longer to say things then they have previously. — It is important to be patient; give them time to get out their words out. Hints or cues to get the words out are unlikely to help them get it out.

Your child may avoid speaking so that they don’t stutter. — Stuttering is confronting for some children as they have no conscious control of it.

Your child may be affected by bullying or negative comments/options. — Unfortunately there are negative stereotypes and attitudes that exist in society around stuttering.

Your children may also experience other speech sound or language difficulties. — Many children who stutter also have co-occuring speech and language difficulties, this can complicate and exacerbate symptoms and there effects on your child.

 

How can we help?

Assessment

Speech pathologists are able to perform assessments that determine:
  • Type of stutter
  • Severity of stutter
  • The stutters impact on quality of life

This will then allow the Speech Pathologist to tailor evidence based therapy based upon the child’s age.

 

Monitoring

As a result of natural recovery, some young children (less than 3 years) will simply require monitoring. Speech Pathologists will monitor for recovery, change in nature of stutter, severity of stuttering, the effects on the other areas of communication development and the effects on the child emotionally.

Therapy

For children in preschool and the first years of schooling the Lidcombe Program has the best available evidence in terms of its effectiveness. This treatment is parent mediated and involves specific instruction in how to reduce stuttering behaviour. There are other treatment approaches available that involve acknowledging and altering the stuttering behaviours.

For older children and adults, therapy from a psychologist may also be recommended. Research evidence suggests that for teenagers and adults therapy from a psychologist in conjunction with therapy from a Speech Pathologist can reduce psychological harm and improve stuttering treatment outcomes.

For further information please consult Speech Pathology Australia’s fact sheet on Stuttering.

 

Other areas that might relate
  • Speech Sound Difficulties
  • Language Difficulties
  • Psychology
sad boy
 

Difficulty Following Directions
boy looking through chain link fence

A large part of comprehension is a child’s ability to interpret and follow directions. Some children may find it difficult to follow instructions that are written or when spoken. Following instructions requires a child to identify the key information and act upon this information.

Difficulty following directions may present as:
  • Missing key information
  • Taking a long time to respond
  • Difficulty distinguishing between important and unimportant information
  • Appearing to be listening but are unable to complete task

 
Children are able to rely heavily on context and routine to supplement their ability to follow directions. As a result a child may appear like they are understanding things well until they do not have these supports, e.g. a family member who does not know the child well tries to teach them a new game.

Impacts on my child & my family:

A child requires the ability to following instructions of increasing length, so they are able to participate in all environments. If a child has difficulty following instructions this may impede their ability to complete school work appropriately as they may misinterpret the key information and may struggle to complete the tasks correctly. This inability to comprehend instructions may impact on future employment.

 

How can we help?

Assessment

The assessment protocol used will vary upon the child’s age. Although a Speech Pathologist will always assess both their receptive language (ability to comprehend instructions, sentences, and key concepts and vocabulary) and expressive language (ability to express themselves in a way that is accurate, grammatical and appropriate for their age). This is because these skills are intertwined, e.g. a child’s ability to use the word ‘before’ correctly in a sentence will reflect their ability to follow a direction containing ‘before, particularly when that instruction is complex and out of routine.

Treatment

There are a vast array of treatment that a Speech Pathologist may implement to improve a child’s comprehension of instructions depending on their assessment results and factors related to the child.

They may focus on:
  • Improving use and comprehension of different parts of speech (e.g. adjectives- ‘big, small, red, long’ or verbs ‘skip, crawl’)
  • Improving use and comprehension of different concepts (e.g. ‘under, between’)
  • Implementation of visual aids to implement in the home and classroom.
  • Strategies and practices to extend recall of instructions.

 

Other areas that might relate
  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Auditory Processing Disorder (APD)
  • Working memory difficulties
Late Talkers

A late talker is considered to be a toddler between 18 and 30 months who has good understanding of language, typically developing play, motor and social skills, however, has limited spoken vocabulary. Late talkers generally have typically developing skills in all other areas of development, except their expressive language.

A child considered to be a late talker may present with any of the following characteristics:
  • Limited number of consonant sounds
  • Using mostly nouns
  • Doesn’t imitate new words
  • Uses few gestures to communicate

 

Impacts on my child & my family:
  • This may impact on the child’s ability to have their needs and wants met.
  • Late talkers may have difficulty expressing their feelings and thoughts and can therefore become frustrated.
  • A child’s ability and difficulties with communication may impact their interactions with others.

 

How can we help?

Assessment

Assessment of your child’s expressive language skills (i.e. their play, gesture, vocalisations and words) and receptive language skills (i.e. their ability to follow instructions and understand conversation and stories).
 

Therapy

Speech Pathology therapy for late talkers will involve a combination of direct therapy and parent training. Parent training will involve teaching parents how to optimise the interactions between themselves and their child. These strategies will help the child to improve and develop their expressive communication. Depending on the difficulties of the child and the preferences of the parent, augmented communicative strategies can also be implemented. Augmented communication, such as key word sign, are used to supplement but not replace spoken words. Key word signs can be helpful to children who are late talkers for developing their expressive vocabulary and their ability to combine words.

 

Other areas that might relate
  • Autism Spectrum Disorder (ASD)
  • Social communication difficulties
  • Anxiety
Lady and child
Fussy Eating
girl eating with spoon

A child’s relationship with food and drink can be crucial in the early years of development. With the introduction of different textures, flavours and smells this can be an emotional experience for both child and carer. Difficulties with swallowing and feeding in babies and children may lead to poor nutrition and impact on development. It is important to introduce babies and toddlers to a variety of textures and flavours before they turn 2 years of age, as this is when neophobia (or a fear of new food) typically begins. A fussy eater can be described as a child that consumes an inadequate variety of food through the rejection of foods.
 

May present as:
  • Refusing food based on sensory characteristics (such as texture, smell, taste, temperature)
  • Prolonged mealtimes
  • Taking small volumes of food, over-packing or pocketing food in the side of the mouth
  • Difficulty chewing foods

 

Impacts on my child & my family:
  • Malnutrition — Fussy eating can impact on a child’s overall development. They may lack vital micro and macronutrients such as magnesium, iron and calcium.
  • Family stress — Fussy eating can cause a large amount of family stress. Children may receive different meals from the rest of the family, mealtimes may take an extended period of time and dining out can be difficult or impossible. All of these factors and more can cause disruption to family life and conflict.
  • Stagnated or poorly developed feeding skills — Fussy eaters can also reduce the feeding skills they are developing. For instance, a child who does not like the texture of meat may avoid it and thus poorly develop the strength and coordination required to chew red meat.
  • Negative social consequences — If left untreated fussy eaters are likely to experience negative social consequences of their restricted diets. They may not be able to eat at birthdays, attend restaurants with friends or be excluded from sleep overs.

 

How can we help?

Assessment

Assessment of a fussy eater will involve evaluation of:
  • The food aversions (type, taste, texture, environment)
  • Daily intake
  • The effect on quality of life
  • Feeding skills (e.g. sucking, cup drinking, chewing)
  • Feeding safety (is your child choking, coughing, throat clearing)

 

Treatment

Depending on the results of the assessment treatment may include one or a combination of behavioural strategies, varied and incremental exposure to foods, desensitisation with food play, parent education, and development of feeding skills. An Occupational Therapist may also be involved in the child’s care to assist with sensory sensitivities and significant difficulties with regulation around food. A dietician and GP may also be involved in the child’s care to ensure intake is sufficient for growth and development.

 

Other areas that might relate
  • Feeding skills difficulty
  • Sensory Processing Disorder
  • Anxiety
  • Dietician
Reading Comprehension Difficulties

Reading comprehension is a child’s ability to understand and interpret written text. This include the ability to create a mental representation of what they are reading. Although a child may present with difficulties in reading comprehension, they may also have adequate reading fluency and decoding skills (i.e. the ability to sound out words and recognise sight words). Reading comprehension relies heavily on well developed word recognition skills, well oral language comprehension and mental imagery (i.e. an ability to create mental images in your mind based upon what you hear or read).

Reading comprehension difficulties may present as difficulty with:
  • Identifying the main ideas or key information in text
  • Making inferences regarding the written text
  • Understanding story structure
  • Poor mental imagery
  • Over reliance on pre-existing knowledge to supplement reading comprehension

 

Impacts on my child & my family:

Difficulties with poor reading comprehension can affect a child’s

  • Academic success
  • Attitude towards reading
  • Late identification of difficulties (as they may progress well through home readers, while meaning is being supplemented by pictures)
  • Interest in reading for pleasure

 

How can we help?

Assessment

Assessment of reading comprehension difficulties will involve evaluation of your child’s:

  • Reading comprehension
  • General reading skills (accuracy and rate)
  • Oral language skills (comprehension of written and verbal text, and language)

 

Treatment

Treatment will focus on areas of breakdown and may include:

  • Improving oral language
  • Improving general reading skills
  • Improving mental imagery
  • Improving comprehension of questions
  • Improving understanding of text structure
  • Improving ability to search for keywords

 

Other areas that might relate
  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Auditory Processing Disorder (APD)
  • Visual Processing Difficulties – impact reading ability and further comprehension
  • Language delays and difficulties
  • Working memory difficulties
baby using a laptop
Feeding Skill Delay
girl eating with spoon

Also called delayed or immature oral motor skills. Similar to other motor skills that your child will develop, like walking, crawling and holding a pencil, your child will also develop motor skills required for feeding. Eating requires a host of muscles in our face, tongue, soft palate, throat and oesophagus to be strong, coordinated and stable. It also requires a gradual increase in voluntary control of movements related to reflexes. Feeding skills include the ability to safely drink from the breast/teeted bottle/straw/open or spouted cup, to chew and manage lumps/mixed consistencies/hard foods, and to chew efficiently.
 

Children with feeding skill delay may present with:
  • Safety concerns — e.g. coughing, gagging, vomiting or choking on food, they also may present with recurrent chest infections.
  • Difficulty transitioning to different textures as a result of delay in skill development — e.g. difficulty transitioning to solid foods from purees.
  • Prolonged mealtimes
  • Taking small volumes of food, over-packing or pocketing food in the side of the mouth
  • Difficulty chewing foods

 

Impacts on my child & my family:
  • Malnutrition — Feeding skill delay can impact on a child’s overall development. They may lack vital micro and macronutrients such as magnesium, iron and calcium as a result of limited access to foods.
  • Family stress — The safety concerns sometimes associated with feeding skill delay can be distressing for both child and family. Children with feeding delay may be restricted from social events involving food and/or require altered family meals.
  • Fussy eating may develop — Children with feeding skill delay may experience negative events with different foods as a result of their ability to safely and comfortably consume them. Fussy eating can sometimes be the result.
  • Negative social consequences — Children with feeding skill delay may require food and feeding utensils appropriate for a much younger child. For instance, a child in primary school may require a pureed meal.

 

How can we help?

Assessment

Assessment of a child with a suspected feeding skill delay may involve evaluation of:
  • Feeding skills (e.g. sucking, cup drinking, chewing)
  • Retained reflexes (e.g. tongue thrust, over sensitive gag reflex)
  • Oro-musculature assessment (OMA) (assessment of the structure and function of the child’s oral structure)
  • Food aversions (type, taste, texture, environment)
  • Daily intake
  • Effect on quality of life
  • Feeding safety (is your child choking, coughing, throat clearing)

 

Treatment

Treatment of a feeding skill delay is tailored to the individual child. Treatment may include:
  • Integration of reflexes that conflict with feeding development
  • Manipulation of feeding environment to encourage skill development
  • Explicit teaching of feeding skill
  • Parent education

A dietician and GP may also be involved in the child’s care to ensure intake is sufficient for growth and development, and to diagnose, reduce and alleviate medical conditions related to a feeding skill difficulty.

 

Other areas that might relate
  • Fussy eating
  • Anxiety
  • Dietician
Speech Sound Difficulties

Speech sound difficulties describes a range of challenges experienced by some children that affect the sounds that they make when speaking (rather than the content/words they use).

Speech sound difficulties may include (but are not limited to):
  • Articulation delays and disorders (e.g. lisps or difficulty saying the sound ‘ch’): these errors involve a child having forming the right position to make a sound correctly.
  • Phonological delay and disorders (e.g. saying ‘tat’ for ‘cat’ and ‘sit’ for ‘sick’): for these errors a child may be able to form the sound for ‘k’ but is unable to do it in words. This error is about the child’s internal coding of sounds.
  • Children may experience difficulties specifically with intelligibility (a difficulty being understood by others). This difficulty may be caused by many things including their rate of speech, the consistency of the errors (i.e. do they have many different errors that come and go depending on the word or situation) and other factors including their volume and voice clarity.
  • Children may also experience difficulties with the planning of speech sounds. Childhood apraxia of speech is one such condition that is related to planning. Childhood apraxia of speech is incredibly rare and there are specific criteria for its diagnosis.

 

Impacts on my child & my family:

Speech sound difficulties can:

  • Make your child difficult to understand
  • Cause frustration, which may lead to a decrease in verbal output or an increase in aggression
  • Lead to negative connotations about the child
  • Be socially isolating

 

How can we help?

Assessment

Speech Pathologists are able to assess your child in order to determine the nature of the speech sound difficulty.The Speech Pathologist will compare their abilities to other children of their age in order to determine the severity of the difficulty. From this, tailored intervention and goals will be developed to treat your child in partnership with you.
 

Other areas that might relate
  • Language Difficulties
  • Literacy Difficulties
Lady and child
More than Words
girl eating with spoon

The ‘More than Words’ program is a parent training program. It is aimed at parents and caregivers of young children with Autism Spectrum Disorder or social communication difficulties.

Although this program is typically targeted at children under the age of 6, there are no limitations on who can attend as the skills can be applied to children of various ages with various skill levels. We can all develop skills in enhancing our communication with children and the strategies targeted in this program aim at empowering you as parents to be the catalyst of change for your child in your everyday communications with each other.

 

The ‘More than Words’ program aims to teach parents about:
  • Their child’s communication stage
  • How your child learns best and how to take advantage of it in everyday interactions
  • How to turn everyday interactions into opportunities for communication development
  • How to improve your child’s play skills
  • What motivates them to communication
  • How to improve their understanding of you

 
The program involves a combination of one-on-one sessions with you and your child, as well as group parent training workshops. You will problem solve and learn with the same group of parents each session. Classes are designed to be fun and engaging. You will also gain the opportunity to increase your social and support networks with other parents with similar children as your own.

We are looking at running our next Hanen ‘More than Words’ program in March 2018 and we are currently taking names of those interested.

If you would like to be a part of the program or would like further information please contact our friendly Administration staff. We will be running an orientation evening closer to the date. This orientation evening will be conducted free of charge and free of obligation.

Please see the flyer attached for further information {attach flyer}

References
  1. Lowry, L. How to tell if your child is a late talker – and what to do about it. Retrieved from Hanen
  2. Speech Pathology Australia (SPA). Swallowing [fact sheet]. Retrieved from Speech Pathology Australia’s fact sheet on Swallowing.
  3. Infant and Toddler Forum. Developmental Stages in Infant and Toddler Feeding [Fact Sheet]. Retrieved from Infant and Toddler Forum
  4. Mark, K. (2015). Infant and toddler nutrition. American Family Physician, 44(12), 886-889.

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