We treat all types of communication disorders which may or may not be secondary to the diagnosis of: Autism, Asperger’s, ADD/ADHD, NVLD, Auditory Processing, Language-based LD, Aphasia, Dyslexia, Cleft lip/palate, Down Syndrome and other neurological disorders.
McLean Speech and Language Services offers diagnostic and treatment of neurogenic speech and language disorders. Treatment is integrative and focuses on seeking natural, functional opportunities in which to practice communication and thinking strategies while incorporating clients’ specific interests and needs. Actively collaborating with family and allied caregivers in order to foster greater independence and success in the community is a cornerstone of the treatment.
Articulation is the ability to make speech sounds. If an individual is having difficulty producing these sounds correctly, it can be difficult to understand them. Common misarticulations include:
- Substitutions: “t” for “k” (“tat” for “cat”), “d” for “g” (“doh” for “go”)
- Omissions: leave sounds out of words, such as “nana” for “banana” or “ca” for “cake.”
- Distortions: a modified production of the intended sound (like an “er” that doesn’t sound quite right)
- Frontal/Lateral Lisps: “th” for “s” (frontal), air escaping from the sides of the mouth producing a “slushy” sound quality (lateral)
Myofunctional therapy is conducted when an individual demonstrates the following:
- The tongue moves forward in an exaggerated way during speech and/or swallowing.
- The tongue may lie too far forward during rest or may protrude between the upper and lower teeth during speech and swallowing, and at rest.
Although a “tongue thrust” swallow is normal in infancy, it usually decreases and disappears as a child grows. If the tongue thrust continues, a child may look, speak, and swallow differently than other children of the same age. It is also a common cause of dental malocclusions. The tongue pushes against the front teeth and can cause an open bite or overbite, if not corrected.
Childhood apraxia of speech is not due to muscle weakness or paralysis but an inability to plan the motor movements needed to produce speech. An individual with Apraxia will produce the following:
- Inconsistent sound errors
- Difficulty imitating speech
- Groping behaviors when trying to coordinate the mouth, lips and tongue for voluntary movements
- Difficulty saying longer words or phrases
Expressive language is the ability to verbally communicate your thoughts and ideas. It is our ability to tell a story, give directions, maintain a conversation and have our daily needs and wants fulfilled. Expressive language difficulties include:
- Using complete sentences
- Limited vocabulary
- Telling a story
- Giving directions
- Asking and answering questions
- Communicating daily needs
Receptive language is the ability to understand language. It is our ability to interpret meaning, follow directions and fully comprehend the message of another speaker. Receptive language difficulties include:
- Following directions
- Processing vocabulary
- Interpreting the message of a speaker
- Idiomatic Language
- Problem Solving
Stuttering affects the fluency of speech which compromises the overall intelligibility. It often includes repetitions, prolongations, interjections and/or blocks. A child may experience normal childhood dysfluencies between the ages of 2 ½ and 5 years old.
Cluttering affects the fluency of speech but is most prominently characterized by an abnormally fast speaking rate. A person can experience disfluencies but are not consistent with typical stuttering. Other symptoms can include: lack of awareness of the problem; poor handwriting; confusing, disorganized language or conversational skills; misarticulations; social problems; distractibility; hyperactivity; auditory perceptual difficulties and learning disabilities
Voice disorders are often caused by vocal abuse (talking at an increased pitch, yelling, singing). Vocal abuse can cause cord nodules or polyps on both vocal cords. People with voice disorders can experience the following symptoms:
- A “rough” voice
- A “scratchy” voice
- Decreased pitch range
- Voice and body fatigue
Accent Modification training is for those who wish to modify their regional or foreign accent. Though accents are a natural part of spoken language, they can affect people’s communication in the following ways:
- People may have difficulty understanding you
- Feeling frustrated and anxious when people have you repeat yourself
- People not understanding the content of your message because they focus more on your accent
- Any of these difficulties can cause strain on your daily activities, job performance and educational progress.
Speech language pathologists serve a tremendous role in reading and writing disorders. In ASHA’s definition, “spoken language provides the foundation for the development of reading and writing. Spoken and written language have a reciprocal relationship, such that each builds on the other to result in general language and literacy competence.” Individuals who have difficulty with reading and writing also tend to have spoken language difficulties. Speech therapists can provide the necessary services to assist in the development of phonological awareness, decoding, vocabulary, reading fluency, reading comprehension and written language skills.
Autism is a developmental disability that begins at birth or within the first two and a half years of life that causes difficulty with communication and social skills. Autism is known as a spectrum disorder because it ranges in severity.
There are Autism related disorders known as Asperger’s Syndrome or Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). Asperger’s syndrome is the label currently used for those who were previously diagnosed as “High Functioning Autism.” Individuals diagnosed with Asperger’s have no language impairments but demonstrate Autistic-like behaviors. PDD-NOS is diagnosed in children who do not meet the full criteria for Autism or Asperger’s.
In the presence of normal hearing acuity, one can have an auditory imbalance in any one or combination of ways that can interfere with both education and coping with life. Dr. Berard developed AIT to rehabilitate disorders of the auditory system. Auditory imbalances can include: sound sensitivity, difficulties with background noise, auditory distractability, and slow processing….just to name a few!
The Berard Method was initially developed in the 1950’s in France by Guy Berard, M.D., a surgeon. At age 40, Dr. Berard started developing Tinnitus, or ringing in the ear. He then started studying to become an ear, nose and throat doctor. Dr. Berard initially treated hearing loss when he began developing his program. He gave the Berard Profile to his daughter because she had learning disabilities, saw she had some imbalances and ran her through AIT. Afterwards, his daughter improved and Dr.Berard learned more about language processing and auditory processing. As he discovered different ways listening was interfering with people’s lives, he started doing research. After 30 years of research and clinical work, he wrote the book, Hearing Equals Behavior. The book received its title due to Dr.Berard’s belief that behavior can be dictated by how we hear.
The evaluation, known as the Berard Profile, is conducted using an audiometer and the individual is required to answer simple questions about auditory perception. If the individual can understand the directions and provide consistent responses, then a determination may be made as to the presence or absence of an auditory imbalance. Occasionally, an individual may not be able to complete the testing due to an inability to follow the directions of the evaluation. However, these individuals are still able to complete the training and receive full benefit.
In addition, for individuals 5 years old and older, the SCAN, A Test for Auditory Processing Disorders, is administered to identify an auditory processing problem which may warrant the need for intervention.
If one or more types of auditory imbalances is found and is thought to be interfering with the candidate’s physical comfort, socialization and/or processing of information, then the Berard Method of Auditory Training is recommended. The Berard Method uses one of the two machines approved by Dr. Berard, either the Audiokinetron or the Ear Educator. The training consists of two 30 minute sessions per day for 10 consecutive days. In basic terms, music is presented through the machine to exercise the stapedius muscle, cochlea and auditory nerve. The program is individually planned depending on each candidate’s particular imbalances. While the training takes place over 10 days, the full results are expected to emerge over the subsequent year.
Audio tests are typically obtained prior to, at the midpoint, and at the end of the 10 hours of listening. The first and mid-point tests are used to determine whether any narrow-band filters will be used.
Berard AIT is provided personally and under direct (on-site) supervision by a certified Berard AIT Professional Practitioner, with the audio stimulation direct from the Berard AIT device. The modulation is NEVER provided by CDs.
Berard AIT can be administered to all ages, the minimum age is 3 years old.
Hearing Equals Behavior by Guy Berard
The Sound of a Miracle by Annabel Stehli
Auditory processing is the ability to appropriately process and interpret auditory information. This includes the ability to follow directions, listen in a noisy environment, appropriately develop phonological awareness skills and many other skills. It is important to note that it can be difficult to differentiate processing difficulties from attentional problems such as ADD and ADHD.
The following is a list of characteristics typical of a child experiencing problems with auditory processing:
- The child covers their ears, grimaces, cries or becomes irritable in the presence of loud sounds or “particular” sounds.
- The child seems to hear sounds that others do not.
- The child seems unaware of sounds even though there is no hearing loss.
- The child becomes hyperactive, agitated, or aggressive in a noisy environment. There is a notable deterioration of behavior in a noisy versus quiet environment.
- The child becomes withdrawn in a noisy environment.
- The child watches others before following directions.
- The child does not respond when their name is called.
- The child stares at you after a direction has been given.
- The presence of certain sounds appears to disorient the child and/or contribute to a loss of balance.
- The child seems to be calm and “listen well” in one-on-one situations, but not in a group.
- The child has trouble localizing sound.
- The child has difficulty discriminating speech sounds.
- The one child in class who is most likely to say, “What?” or “I didn’t hear you.”
- The child seems to “tune out” auditory information when visually or motorically engaged.
- The child is physically exhausted at the end of the day.
- The child has atypical speech and language development.
- The child talks constantly but does not answer questions or engage in conversations. They constantly do a “monologue.”
- The child has difficulty making friends and has a tendency to play alone.
Social language is the language used in everyday conversations. This language has to be altered according to a variety of social situations. Individuals with pragmatic language problems may say inappropriate things during a conversation, tell stories in a disorganized manner or have difficulty varying their language. In addition, they may have difficulties with the following:
- Tone of voice
- Volume control
- Turn taking
- Staying on topic
- Eye contact
- Reading social cues
- Personal space
Evaluations are conducted based on the individual’s needs and concerns. These areas include:
- Expressive and Receptive Language
- Pragmatic Language/Social Skills
- Reading and Writing Development
- Stuttering and Cluttering
- Accent Modification