Often times, children are referred to a speech and language pathologist by their pediatrician. Your doctor may express concern for how clearly your child speaks, their limited use of words, or difficulty understanding directions/ questions. During a speech and language evaluation, you may be asked whether your child follows directions, forms full sentences, or distorts their words. These questions may overwhelm parents who haven’t been presented with details of age-appropriate milestones for speech and language development. Caretakers may not have considered how many words the child uses per sentence, how many different words they use, or whether their pronunciation of certain words is considered age-appropriate. During an evaluation, speech and language therapists may assess which age-appropriate skills are lacking from the expected speech and language milestones. Your child can be diagnosed with either a speech disorder or language disorder, and their report will include goals to achieve speech or language skills. It is important to understand that speech skills are different from language skills; assessment and treatment will look different depending on which disorder a child is diagnosed with.
Speech skills involve your child’s articulation of sounds, words, and connected words. Children with delays or disorders of speech will have trouble repeating sounds (i.e. “quack”), words (i.e. “duck”), or sentences (i.e. “A duck is in the pond.”). You may frequently tell your child to “speak more clearly” to be understood. If you determine that your child is misunderstood by family or friends when using sounds, words, or sentences, there is most likely a speech-related concern. A speech therapist may ask if your child’s hearing has been tested recently. If your child has any degree of hearing loss, this can affect their ability to hear target sounds and produce sounds independently. It is always a great idea to schedule a hearing test before beginning speech services. The therapist will also look in your child’s mouth to asses whether dental abnormalities, tongue ties, lip ties, or other physical factors could be affecting your child’s speech.
When evaluating a child’s speech, pictures are often presented to the patient, with a verbal prompt of, “What do you see?”. This is because the therapist wants to determine how a child produces a given target word, and which sounds are being distorted. At the end of the assessment, your therapist will review which sounds were distorted or omitted from the child’s speech, and whether those sounds should be mastered by their developmental age. Parents frequently schedule a speech assessment because their son/daughter is replacing “r” sounds with a “w” (i.e. “right” becomes “white”). This concern would be addressed by a speech assessment, and speech therapy may or may not be recommended depending on your child’s developmental age. (Majority of children should master “r” by 7 years of age).
Speech therapy generally involves flash cards, pictures, or shared reading. Your child will likely have goals of imitating and independently using certain target sounds. Take-home practice may include worksheets, flashcards, or even a scavenger hunt to work on target sounds at home. When a child begins therapy, they may practice distinguishing between a target word, and their own distortion of a word (i.e. ray vs. way, tea vs. key, etc.). Seeing and hearing each word side-by-side often helps a child understand that mispronouncing words can affect the overall meaning of a word. When the child can distinguish between words with high accuracy, they are ready to practice the target sound aloud.
Language skills involve the amount of words your child uses, how they communicate wants/needs,
comprehension of directions, questions, stories, or words. If the child is non-verbal, there is a great chance they have a language concern. If you find yourself repeating directions several times, using gestures and pictures to gain your child’s understanding, or asking your son/daughter to “use their words”, it is a great idea to schedule a language assessment. During a language evaluation, your therapist may ask which words or sounds your child uses independently, what sounds or words they can imitate, and how they make requests, protest, comment or gain attention. If you have an independent child, your therapist may ask the child to perform directions (i.e. “Point to your feet”, “Open the door”, “Get the teddy bear”), and play/talk to your child to determine how many words they are using within sentences. A good rule of thumb: the amount of words per sentence should match with your child’s chronological age (i.e. A one-year-old will use one word at a time, Three-year-olds should use three-word sentences, etc.). Your child’s ability to answer wh-questions, yes/no questions, or personal/ factual questions can also be assessed. There are two forms of language, receptive and expressive language. Receptive language will involve understanding of words, sentences or stories. Receptive language also includes the ability to follow simple to complex directions or answer questions. If your child is diagnosed with a receptive language disorder, they may practice answering questions given visual picture choices, verbal choices, or yes/no choices. Take-home activities may involve asking wh-questions around the house (i.e. “Who is cooking?”, “Where is the sink?”, “What does our dog eat?”), reading books together, or pointing to objects on a page as they are named/ described. You may also be asked to prompt 1-step or multi-step directions at home (i.e. “Get my glasses”, “Grab your backpack and come to the kitchen”). Expressive language will involve how many words your child is using, and the variety of their vocabulary (nouns, pronouns, objects, verbs, and articles, etc.). During evaluation, the therapist may ask your child to name objects on a page, describe a story, or label verbs in a picture sequence (i.e. walk, walking, walked). Take-home activities may include building sentences from picture scenes, recalling a shared story, or requesting items at home using words, sentences, or questions.
Some children may require both speech and language services. If new concerns present as your child begins therapy, is it a great idea to speak with your speech-language pathologist to determine if additional testing or goals are needed. As speech-language pathologists, we treat both speech and language disorders so your child can achieve communicative excellence. Therapists should inform parents of any new concerns or changes to their plan of care as their therapy progresses.
Written By: M.A. CCC-SLP
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