May 2012

Pediatric Speech Therapy: Much More Than Articulation

Author: Jessi Dolnik

When you hear the term “speech therapy,” what is the first thing that comes to mind? I am guessing a therapist and 7-year old child practicing the “R” sound or overcoming a lisp. While these are very important goals that a speech language pathologist may have, we do so much more. Perhaps the best way to elaborate is to describe one of my mornings at our pediatric facility.

My first patient of the day is a bright and creative 12-year-old girl. She is having difficulty hearing in a noisy classroom. Her hearing acuity is perfect, but she has been diagnosed (after a referral from her speech language pathologist to a pediatric audiologist) with Central Auditory Processing Disorder. She has a particularly difficult time concentrating and attending to directions in noise. The interfering noise, for her, can be as loud as the lawnmower outside of the window next to her desk or as quiet as her classmate tapping his pencil on his leg. We are targeting her working memory and sound discrimination skills. We are also working on her ability to stay focused on verbal directions in noisy and distracting environments. Her mom and teacher have both indicated that she is able to focus better in school and needs directions to be repeated to her less frequently.

My next patient is a busy and determined four-year-old boy. He came to Lowcountry Therapy Center two months ago when his mother, father and daycare teacher noticed that he was having a difficult time following directions in his classroom, and he was only using two- and three-word sentences. After language testing, a long interview with mom and dad and a phone conference with his daycare teacher and pediatrician, it was determined that he has a receptive and expressive language delay. He had an especially hard time with basic concepts such as “first and last,” “all and some,” “over and under,” “in front of and behind.” As you can imagine, this made group instruction and communication in general difficult for him. With mom and dad always either participating or observing, we are working on many different basic concepts in functional activities and increasing his expressive language substantially in every session. He will probably be discharged in another two months.

My 10 a.m. patient is a nine-month-old twin. He is not advancing his diet as his sister is. He is still only drinking milk from a bottle. He gags on purée baby food and is not showing interest in finger foods. That’s right! Speech language pathologists also help children with feeding and swallowing difficulties. (This is a specialty area, however. You want to be sure your therapist has experience and specific training in feeding disorders and swallowing.) This child’s mom and I are focusing on introducing new oral sensations to reduce his gag reflex. Since his mom and his pediatrician were proactive in not waiting to see if he would advance his diet on his own, he will most likely be graduating from therapy in only three months and eating what other 12-month olds are eating, including an array of purées, mashed foods and some finger foods.

My last patient of the morning is a sweet and sensitive five-year-old boy who is having difficulty identifying the sounds letters make (i.e., phonemic awareness). His classmates are already reading a few words, and his dad came to us worried that he is not “getting it.” We are focusing on using all of his senses to crack the letter-to-sound code. In addition to his reading delay, he is not always grammatically correct when speaking. He confuses his pronouns (e.g., “Him jumping.”); irregular past tense is difficult for him (e.g., “I drawed a picture.”); and helping verbs are missing (e.g., “They talking.”). Strong oral grammar is required for good writing skills. He is making great progress using a multisensory approach. His dad and his brother participate in the final 10 minutes of every session, so they know what to practice at home. His teacher and I communicate weekly via e-mail to make sure he is using his new skills in all environments.

As this particular morning illustrates, speech therapy is not just about articulation. Speech language pathologists are interested in supporting families with all aspects of communication, including listening, understanding, speaking, reading and writing. In my line of work as a private practice speech language pathologist, there is never a dull moment; I get to help children with a wide array of concerns. While I do see quite a few children for traditional articulation therapy, I have the opportunity to do much more!

The children mentioned in this editorial are a mosaic of the population that I treat. In no particular morning do I see these actual children in this order.

Jessi Dolnik, MA, CCC-SLP is a pediatric speech language pathologist, practicing at Lowcountry Therapy Center in Bluffton. If you have concerns about your child’s development, call Lowcountry Therapy Center at (843) 815.6999.

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