Two groups of children struggling with reading

(by M.)

It is quite common, unfortunately, for children to be labeled as unintelligent or incapable early on in their education because of language and reading difficulties. These factors are often largely outside the child’s control but with the help of a speech-language pathologist, reading specialists, etc. they can catch up to their peers and avoid the stigma of labels. This article will focus on two common types of reading difficulties seen in children: dyslexia and comprehension deficits in the absence of dyslexia.

Dyslexia

Foremost, dyslexia is an incredibly common reading disability, it is estimated that 15 to 20% of the U.S population has dyslexia (Bailet, 2012). A base definition for dyslexia is “a language-based learning disability […] which result in people having difficulties with specific language skills, particularly reading” (IDA, n.d.). Though different in each individual, word recognition, spelling, and writing are the language skills most commonly affected in those with dyslexia (IDA, n.d.). Children who struggle with word recognition cannot “accurately pronounce printed words,” therefore lacking skills in areas such as: phonological awareness, alphabet knowledge, and letter-sound correspondence. A child with dyslexia may comprehend a story which is told to them but when reading on their own they cannot recognize the words, and therefore their meanings.

Comprehension deficits in the absence of dyslexia

Conversely, children with reading difficulties may also experience specific reading comprehension difficulties. This disorder is less concerned with word recognition and more so with word comprehension. Oftentimes, this is not seen until the child is older (usually 3rd grade or older), when reading passages become more advanced and may require the readers to make assumptions, draw on the background knowledge and make inferences. Such individuals can recognize words and letters to sounds when reading out loud, but they will have difficulty understanding such more advanced reading passages.

References

Catts, H.W., & Kamhi, A.G., & Adlof, S.M. (2011). Defining reading disabilities and classifying subgroups of poor readers. In A.G. Kamhi & H.W. Catts (Eds.) Language and Reading Disabilities, Third Edition (pp. 45-76). Boston: Allyn & Bacon.

Speech in cleft lip and palate

(by K.)

Working with a speech language pathologist as early as possible is considered important because they can share information about the best feeding techniques and how parents can encourage pre-verbal skills in their baby who has cleft lip or palate. Forming a level of comfort and trust between the SLP and the child is also important to achieve the best speech outcomes from therapy.  Speech therapists can also work with children who have experienced some hearing loss as a result of ear infections and improper drainage that are common in cleft lip and palate.

Children with an orofacial cleft may experience a delay in speech and a variety of articulation and resonance difficulties, but this varies on the type of cleft, timing, and type of surgeries. Many children who have had a cleft palate may have speech problems due to velopharyngeal dysfunction (VPD), where the valve in the soft palate is not operating properly. This can lead to hypernasality of speech, where there is too much sound in the nasal cavity; nasal air emissions, when air leaks out abnormally during speech production of a consonant; and compensatory articulation.  VPD causes problems with proper airflow during speech, called resonance.

Children with a cleft palate may have trouble with consonants like p, b, t, and d. Blended consonants, such as bl, br, pl, and st may also be difficult for these children and those with a cleft in the alveolar ridge. Intelligibility of the consonants k, g, f, and v may come easily, unless articulation of the k and g sounds are affected by a cleft in the soft palate, or f and v sounds are affected by a cleft in the alveolar ridge. Later, most children with a cleft are able to master the s, z, sh, ch, tch, zh, l, and r sounds.

An SLP will help with proper sound placement. After gaining trust from the child, the SLP will focus on isolated sounds through drills and activities. The end goal is for the child to pronounce the sound correctly in fluent speech consistently. Parents can help their child by talking to their child as much as possible to expose them to proper pronunciation of sounds, encouraging their child to try to say new words, and listening to their child’s SLP to practice what they are learning in speech therapy at home.

If the cleft is severe, there may be a point in speech development where correct pronunciation cannot yet be produced until another surgery is performed. This is another reason why the team approach is advised for treatment. A plan of action for the next step of treatment can then be created.

Treatment to correct an orofacial cleft may take an extensive period of time, but since most clefts can be fully surgically corrected, the goal of speech therapy should be normal speech, with proper articulation and resonance, as opposed to settling for just acceptable speech.

References

Facts about cleft lip and cleft palate. (2013, July 15). Centers for Disease Control and Prevention. Retrieved April 3, 2014, from http://www.cdc.gov/ncbddd/birthdefects/cleft

Guman-Trinkner, C. T. (2001). Your cleft-affected child: The complete book of information, resources, and hope. Alameda, CA: Hunter House.

Krummer, A. W. Speech therapy for cleft palate of velopharyngeal dysfunction (VPD). Retrieved from Cincinnati Children’s Hospital Medical Center Web site:  http://www.cincinnatichildrens.org/assets/0/78/759/781/65e90133-9243-4926-a065-8a97951944fb.pdf

What is cleft lip and palate

(by K.)

Cleft lip and cleft palate are birth defects that affect organs used to articulate speech. An orofacial cleft is occurs in the womb when a child’s lip and/or roof of the mouth (palate) did not fully grow to connect, leaving a division or “cleft.” Orofacial clefts are not an injury and do not cause pain. On average 1 in 700 births result in the birth of a child born with a cleft. Usually a cleft is fully correctable through surgery, which would allow for normal facial functioning, with minimal scarring from the surgery.

Cleft palates include a division in the roof of the mouth, called the palate. A cleft palate can also appear as a division in the upper gum, called the alveolar ridge, or as a hole in the palate, called a fistula. A complete cleft palate extends the entire length of the roof of the mouth including both the hard and soft palate (roof of the mouth towards the throat). A cleft lip is a division in the lip that can appear on either side of the mouth (unilateral), both sides of the mouth (bilateral), or in the middle of the lip (midline). A complete cleft lip extends into the nostrils. Incomplete clefts involve a smaller portion of the lip or palate. These orofacial clefts can occur by themselves or in any combination. Orofacial clefts are one of the most common birth defects and 70% of orofacial clefts are isolated clefts, meaning they appear without other birth defects.

The team approach, where a team of various specialists work together over the course of treatment, to care for cleft palates and cleft lips is recommended. This type of treatment allows for comprehensive long term planning with specialists, as opposed to seeking various specialists who may not work together. Craniofacial teams are usually formed through cleft palate clinics or large hospitals. Treatment through a team is considered best because the team works together and communicates to bring about the best method of care for a child with a long term plan. Since every orofacial cleft is different, the methods and timeline of corrective surgeries will vary from case to case. The team can include a combination of the following or additional specialists:

  • a specialist of the ears, nose, and throat (called the ENT);
  • a plastic surgeon to specialize in reconstruction;
  • an orthodontist to correct placement of the teeth;
  • a pediatrician to benefit the health of the child;
  • a speech language pathologist (SLP) to help with feeding and work on proper speech
  • an audiologist to test hearing;
  • a psychologist to help with the mental and emotional side effects of an orofacial cleft;
  • a social worker to advocate for proper care and provide information about social and financial support programs;
  • nurses to answer parents’ questions and act as a liaison between specialists and family;
  • parents to support and advocate for the care they want their child to receive.

Orofacial myofunctional disorder

(by Chelsey Wierzbinski)

Orofacial myofunctional disorder (OMD) is a muscle and function disorder of the face, mouth, lips, or jaw. Individuals may experience abnormal posture and position of the muscles in and around the mouth during rest, swallowing, and/or speech.

Causes

There are a number of causes of orofacial myofunctional disorder. Some causes of OMD are inherited genetically from a parent. There is not one factor that directly contributes to OMD; it is usually a combination of one or more contributing factors. The following are common causes of OMD:

  • Tightening, blockages, or infections of airways, e.g., deviated septum, enlarged tonsils, or inflammation due to infection
  • Low muscle tone in the facial muscles
  • Low-lying resting position of the tongue
  • Disproportioned growth and development of the teeth, possibly caused by constant pressure of the tongue on or between the teeth, oral habits continued over time (e.g. thumb sucking)
  • Poor development of the facial bone

Symptoms

Orofacial myofunctional disorder affects various aspects of speech, swallowing, and breathing in some individuals. Symptoms in speech include poor articulation of speech sounds, or lisping. Some common speech sounds affected are /s/, /z/, “sh”, “zh”, “ch” and “j”. Some other speech sounds that are known to be affected are the /t/, /d/, /n/, and /l/ sounds, but these sounds are less common. In some cases, speech may not be affected at all.

“Tongue-thrust”, or also referred to as “reverse swallowing” is common in patients with OMD. “Tongue-thrust” is common swallowing pattern in infancy, but disappears around 6 months of age. In patients with OMD, the tongue is positioned against the back of the front teeth during swallowing. More severe cases may exhibit difficulty swallowing or not swallow all together.

Due to the irregular positioning of the tongue and teeth, patients demonstrate irregular breathing patterns. Mouth breathing or lack of breathing through the nose may occur. Snoring is a common result of these breathing patterns, which negatively impacts sleeping patterns in OMD patients. Pressure of the tongue on the back side of the teeth causes the mouth to remain open in the resting position, resulting in dry mouth.

Dental and cosmetic problems related to OMD are typical, but can be reversed with treatments.

Professionals involved in treatment

There are many options for individuals seeking treatment for orofacial myofunctional disorder. Treatment can be sought out by many professionals including:

  • Orofacial myofunctional therapist
  • Speech-language pathologist
  • Dentist
  • Orthodontist
  • Ear, nose and throat specialist

A collaborative approach by a combination of professionals has been proven effective for treating OMD. Treatments have been effective in correcting the resting position and posture of the tongue away from the teeth. With treatments the facial muscles are able to correct themselves, thus improving speech, swallowing and breathing patterns. Most patients are able to increase and maintain muscle tone in facial muscles. Correction of dental issues by an orthodontist may prevent the reoccurrence of OMD.

References and Resources

Orofacial Myofunctional Disorders (OMD) Symptoms and Treatment. (n.d.). International Association of Orofacial Myology. Retrieved April 17, 2014, from http://www.iaom.com/orofacialMyology.html

Orofacial Myofunctional Disorders (OMD). (n.d.). Orofacial Myofunctional Disorders. Retrieved April 19, 2014, from http://www.asha.org/public/speech/disorders/OMD/#b

Health Topics. (2013, May 1). Orofacial Myofunctional Disorders. Retrieved April 19, 2014, from http://www.cincinnatichildrens.org/health/o/orofacial-disorders/

Orofacial Myofunctional Disorders. (n.d.). Myo Academy. Retrieved April 17, 2014, from http://www.myoacademy.net/what-is-a-myofunctional-disorder

Obrock,E. L. (n.d.). Orofacial Myofunctional Disorders. Corner Stone Dental Health. Retrieved April 19, 2014, from http://www.cornerstonedentalhealth.com/speech/faq-19.htm

Paskay, L. (2012, March 1). Orofacial Myofunctional Disorders: Assessment, Prevention, and Treatment. Journal of the American Orthodontic Society, 34-40.

Hahn V and Hahn H (1992) Efficacy of Oral Myofunctional therapy. IJOM,18.

Moeller, J. L. (2009). Orofacial myofunctional therapy. Rdh, 29(11), 56-61.

Resources for childhood apraxia of speech

(by Chastanae Williams-Mack)

Childhood apraxia of speech (CAS) is a motor speech disorder. Motor speech disorders are issues in the production of fluent speech (sounds, syllables, and words). This is not because of muscle weakness or paralysis, but due to the brain having problems planning to move the body part (such as the lips, jaw, or tongue) needed for speech.

Below are websites and resources for parents and patients with childhood apraxia of speech:

  • http://www.apraxia-kids.org/
  • The internet’s largest, most comprehensive and trusted website for information on childhood apraxia of speech. Here, you find resources for families, researchers in this field, and professionals
  • http://mommyspeechtherapy.com/?p=2247
  • This site offers a lot of information and support for parents of children with CAS. Resources listed on the site include general information about CAS, inspiration stories of families affected by CAS, and educational material for children with CAS.
  • https://www.facebook.com/ApraxiaKIDS
  • This Facebook page was created by the Childhood Apraxia Speech Association of North America (CASANA). Here you will be able to find events about CAS awareness as well as information about CAS awareness day, which is on May 14.  

 

Changes in diagnostic criteria of autism

(by Laura Galanti)

There have been changes in criteria for the diagnosis of autism from the fourth edition of the diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to the DSM-V. The changes from the DSM-IV to the DSM-V include the combination of the subgroups Asperger’s syndrome and not other specified (PDD-NOS) into one autism spectrum disorder category (Hoogenhout & Malcolm-Smith, 2014). The changes were made because there was not enough evidence to support the differences, which led to problems with research but the study by Hoogenhout and Malcolm-Smith (2014) supports that the DSM-5 was more successful in determining the Theory of Mind development beyond intellectual functioning.

The new criteria to diagnosis ASD states that the following four criteria must be met (Justice & Redle, 2014):

  1. Symptoms of ASD must develop during childhood
  2. The symptoms of ASD must affect an individual’s everyday functioning
  3. The symptoms must include problems with social communication and social interaction (for example, problems with participating in and initiating conversations)
  4. The symptoms must include restricted and repetitive patterns of behavior (example, fixed interests and repetitive behaviors)

References

Hoogenhout, M., Malcolm-Smith, S. (2014). Theory of mind in autism spectrum         disorder: Does DSM classification predict development? Research in Autism Spectrum Disorders, 8(6), 597-607.

Justice, L. M., & Redle, E. E. (2014). Communication sciences and disorders: a clinical   evidence-based approach (Third ed.). Upper Saddle River, NJ: Pearson Education Inc.

 

Causes of autism spectrum disorders

(by Laura Galanti)

Autism is most likely caused by the combination of genetic risk factors and the specific interaction with the environment, for example a rare mutation in a gene can contribute to autism (Autism Speaks Inc., 2010). 10-15% of cases of autism have a specific genetic cause such as Angelman’s Syndrome, Fragile X Syndrome, and Tuberous Sclerosis (Autism Speaks Inc., 2010). Exposure to certain environmental agents such as chemical or infections agents can also lead to autism (Autism Speaks Inc., 2010).

Autism is four more times likely to affect boys than girls, although girls usually have more severe symptoms (Justice & Redle, 2014, p. 211). Also genetics is a determining factor in autism, there is a higher rate in individuals who are children of family members who are also affected by the disorder (Justice & Redle, 2014, p. 212). There is no strong evidence of the link between vaccination and risk of developing autism, although some people used to believe that the MMR vaccinations may lead to autism (Justice & Redle, 2014, p. 212).

References

Autism Speaks Inc. (2010). Autism: Diagnosis, causes, and symptoms. Retrieved from http://www.autismspeaks.org/sites/default/files/100_day_kit_section_1.pdf

Justice, L. M., & Redle, E. E. (2014). Communication sciences and disorders: a clinical   evidence-based approach (Third ed.). Upper Saddle River, NJ: Pearson   Education Inc.

What is dysphagia

(by H.)

Dysphagia is a swallowing disorder that occurs in one of three phases during the swallowing process. While there are various causes that would contribute to a person having Dysphagia most are centered on damage to the nervous system from stroke, brain injury, Alzheimer disease and muscular dystrophy. However there are other factors that could contribute to dysphagia such as missing or decaying teeth, and poorly fitted dentures, immune system problems that causes swelling and weakness, such as polymyositis. Cancers of the throat, mouth or esophagus, as well as cancer treatments, can result in many smokers having difficulty swallowing.

The symptoms for patients that are believed to have dysphagia vary from case to case but most patients will experience difficulty chewing and swallowing which results in poor nutrition as well as possible weight loss. I have noticed in patients who are recovering from a stroke is the coughing during or immediately after eating or drinking. A wet or gurgling voice in a patient after eating usually draws attention in fear of  he or she aspirating.

The tests involved in assessing dysphagia range from assessing the muscles of the throat and jaw or performing one of the following test:

  • Modified barium swallow: the patient eats or drink food or liquid with barium in it, and then the swallowing process is viewed on an X-ray.
  • Endoscopic assessment: a lighted scope is inserted through the nose, then the swallow can be viewed on screen.
  • Observing feeding to see posture, behavior, and oral movements during eating and drinking.

Resources

American Speech-Language-Hearing Association. Swallowing Disorders (Dysphagia) in Adults: http://www.asha.org/public/speech/swallowing/Swallowing-Disorders-in-Adults/

What is aphasia

(by Abby Wingard)

Language is an integral part of communicating in society.  One disorder that affects the language part of brain is called Aphasia. Aphasia can affect speaking, listening, reading, and writing.  This disorder affects spoken language, as well as comprehension of language, and can also affect individuals who speak sign language as well as oral language.

Aphasia is an acquired disorder. It is most commonly caused by stoke which causes damage to various areas of the brain. It can also be caused by a traumatic brain injury from trauma to the brain including, but not limited to, automobile accidents, blunt force trauma, falls, etc. Additionally, brain tumors and infections are other causes of aphasia as they affect the brain directly.

People may assume an individual with aphasia has a cognitive deficit (limitations in intelligence), this is untrue.  Aphasic individuals may have completely normal cognitive functions, but his or her brain has been affected in an area that controls language to some degree. Individuals with aphasia may have trouble finding the words they want to say, this is called anomia.  You will often see patients “looking” for a word, they understand the concept entirely, they just cannot find the word to label the concept.  Some people with aphasia have a hard time understanding and comprehending what others are saying.  Aphasia does not cause muscle weakness or any other muscular disorders. Although, muscular disorders, such as dysarthria, may be found in conjunction with aphasia. There are different types of aphasia that include the different symptoms.  Fluent aphasic patients will speak with a nice flow of words and sentences, although what the person is trying to say may not make sense to the listener. Nonfluent aphasic patients often produce fewer words than a person not affected.  In this type of aphasia, you will often see a patient speaking in a “choppy” way. For example, the patient is speaking, but the words are coming out slowly and laboriously.

Speech in cerebral palsy

(by Natasha Gravel)

Speech and communication problems are extremely prevalent in individuals with cerebral palsy. Communication problems may affect the language development but may also be due to the mere inability to motion in an appropriate manner with the hands, arms, or with the articulators involving speech, such as lips, tongue, and teeth. A study done in 2012, in Sweden shows that of the 129 children studied with cerebral palsy, over half of them had speech difficulties and 21% of them had diagnosed speech disorders (Himmelman, 2012). The study also shows that the speech problems increased as motor impairment increased, meaning the more severe the CP patient’s overall motor skill impairment, the more severe their speech problems will be as well.

Cerebral palsy is incurable; therefore the speech problems associated with the disorder are treated through a collection of therapies and assistive devices. Patients with speech problems caused by cerebral palsy have shown great progress in their speaking and communication through sessions with SLPs, or Speech Language Pathologists. In one study, researchers tested the effects of an intensive voice treatment in children with spastic cerebral palsy and dysarthria (Fox & Boilek, 2012). All treated participants made significant improvement in at least one of the tested areas of speech and acoustic measure, while the untreated group of individuals made no improvements. This supports the idea of treating patients with speech disorders caused by cerebral palsy through speech therapy. Speech therapy is important not only in improving speech, but also in helping to develop muscles involved in eating, breathing, swallowing, etc.

Approaches other than speech therapies have also shown improvement in patients with speech disorders caused by cerebral palsy. AAC, or augmentative and alternative communication systems are used to output a voice via a machine or computer when the user inputs certain information. For example, one could download an app on an iPad which has a list of pictures. When the user clicks on a picture, the iPad will produce a voice describing the selected picture. These AAC systems are generally used by patients who are very severely affected by their speech disorder, and who are usually nonverbal, or unable to produce any coherent or intelligible speech whatsoever. New advances in this field have made it possible to personalize the voice that the device or computer produces, so that it will sound more “normal” and human, rather than robotic and monotone. This advance will most likely be more user friendly, and will be more widely used than the original AAC systems with computer-generated voices. AACs can also include more basic tools, such as paper charts and flashcards with pictures or words that the patient can point to or show to the listener.

References

Himmelmann, K. (2012). Speech problems affect more than one in two children with cerebral palsy: Swedish population-based study. Acta Paediatrica, 102, 161-166.

Boliek, C. A., & Fox, C. M. (2012). Intensive Voice Treatment (LSVT LOUD) for Children With Spastic Cerebral Palsy and Dysarthria. Journal of Speech, Language, and Hearing Research, 55, 930-945.

Pennington, L., Roelant, E., Thompson, V., Robson, S., Steen, N., & Miller, N. (2013). Intensive dysarthria therapy for younger children with cerebral palsy. Developmental Medicine & Child Neurology, , 464-471.