Talk to me about articulation disorders....

[hayleyvt]

DD is 4 years old and has been receiving services since she was 16 months old. She still does not have a diagnosis, but we know that it is an articulation disorder with her speech. We will be going to get her tested at a university in the fall to rule out childhood apraxia of speech. She has an amazing speech therapist, and I am happy with her progress...just wondering what types of therapies are working for other children with similar issues. Also, when did your children get a diagnosis? I have never been concerned with labeling her speech disorder, but also want to make sure that we are doing everything we can for her.

Just some quick info:
She is very difficult to understand, but understands everything you say.
She speaks in full sentences and has a very good vocabulary.
She is unable to use certain sounds....F, hard C, CH, G, J, T, TH,....just started using P and S, and SH, and I am sure that I am forgetting some.
She replaces certain sounds (but we are not sure if there is a pattern yet).
EX: Ne - nin = O-pen (even though she can say Open, she still needs some reminding.
She also leaves off the endings of words...Milk =Mil
She replaces the starting sound in some words with another sound....Snake = nA

Oh, she has lots of interesting twists in her language, and I am not expecting a diagnosis here, just wondering what works best for your kids with articulation disorders. Any books I should be reading, any programs I should suggest to her SP?
Thanks in advance mamas

[beachbaby]

Hi.

My DD has a moderate articulation issue...She's 4.5 and was dx and started speech 4 months ago. She's always been difficult to understand, but we (and EI) thought it was within the range of typical up until the beginning of this year.

She tested at a 2 year delay for articulation due to low muscle tone. Therapy focuses a lot on drills and oral-motor activities--stimulating her mouth, tongue and cheeks (rubbing with a baby toothbrush), using a chewy tube to strengthen her jaw, sucking through a straw and blowing whistles, fish kisses, etc. Interestingly, yesterday her ST noted that DD can't distinguish which parts of her tongue are being stimulated (when touched with a baby toothbrush---tip, side, or middle) therfore impacting where she places her tongue when forming sounds.

HTH some! I'm just now looking into the possibility of dyspraxia for DD. Not sure all the pieces fit, but....

Oh, and I found this book helpful, too. I was able to get it from my library.

[Aridel]

They should focus on a few sounds or word patterns (like all ending sounds etc) at a time, usually. A lot of times they will have you use different cues - like pointing to a part of your face (neck for k/hard c, lips for p/b etc) or use some verbal reminder. Lots of practice listening to that sound, like whole lists of words with "f" or "s" or whatever to read through to help reinforce what the right sound is. Lots of practice is great - focus on the specific sounds in smaller chunks at first. So not "I want a great big blue boat" but "boat" or "my boat" to get "t" at first, and work up to more! I liked an activity we used to do with word pairs that were almost the same, except for the sound that was difficult. So you get toys or pictures (the SLP should have a list of word pairs that could help) and do a game. You can find the right cards (Oh, that's a BOW, what about BOAT?) or have her ask for what she wants, and emphasize the ending sound (A boaT? OK!) so that the speech activities are meaningful.

I know some SLPs use non-speech oral motor exercises, but I would strongly suggest you research these if they are being used with your child. Some people support them and say they have seen changes, but the research right now shows they do NOT help speech. There are a lot of reasons, including the fact that speech production is controlled by a different part of the brain than other mouth movements, that strength is not very important in speech except for a child with dysarthria, and that children don't demonstrate generalization from non-speech to speech-specific exercises and skills. Anyway, like I said I would look it up before buying into anything like whistle blowing or bubble hierarchies.

The only other suggestion I'd have is a hearing test, even if she shows no symptoms of hearing loss. Any kid with a speech issue should have a hearing test to rule it out!

[hayleyvt]

Thank you for the suggestions
Since we do not know if it is an issue with low muscle tone or if it is an issue with the way her brain processes the sounds, we have been focusing more on drills that work on specific sounds with cues. We use games and fun activities to help her get through the drills. The SLP will put a flash card next to her mouth and DD will repeat the word or sound. If she gets it even remotely correct, she gets to move her piece of the game. She is only working on the 'forward' sounds right now (like b and p). We have also started working with more signs to help her communicate with everyone. I am sure there are better ways to explain what she does in ST but, I cant think of them right now She has made great strides this year, but I am always looking for moreways to help her. Oh, and she has had her hearing checked, and everything is fine.

[Aridel]

Originally Posted by hayleyvt

Thank you for the suggestions
Since we do not know if it is an issue with low muscle tone or if it is an issue with the way her brain processes the sounds, we have been focusing more on drills that work on specific sounds with cues. We use games and fun activities to help her get through the drills. The SLP will put a flash card next to her mouth and DD will repeat the word or sound. If she gets it even remotely correct, she gets to move her piece of the game. She is only working on the 'forward' sounds right now (like b and p). We have also started working with more signs to help her communicate with everyone. I am sure there are better ways to explain what she does in ST but, I cant think of them right now She has made great strides this year, but I am always looking for moreways to help her. Oh, and she has had her hearing checked, and everything is fine.

You described it very well! It sounds like she is doing well, and you have some great strategies for her.

[quaz]

This sounds very similar to my daughter.


I just did a speech eval last week. I'll get results soon. She was unclear to anyone outside of the family until about 4 1/2. I don't know that she completely fits apraxia, but maybe oral apraxia. At this point, I think we just need something different. She is understandable now, but she is still not clear for someone her age.

How is her oral motor? Can she lick her lips all the way around? if you put whip cream on her top lip, can she lick it off? If you put a lollipop to the corner of her mouth, can she lick it. If you put licorice on the inside side of her mouth, can she chew it, or does she turn her head?

My daughter has some oral issues going on as well, and these are some of the items we see, so in her case it isn't straight articulation.
She was intially diagnosed with severe phonological delay, but I think there is more to the store. She shows apraxic tendencies.


I know some SLPs use non-speech oral motor exercises, but I would strongly suggest you research these if they are being used with your child. Some people support them and say they have seen changes, but the research right now shows they do NOT help speech.

This is very dependent. I wouldn't recommend using them by themselves, and that is it for therapy. I think for some kids, though, using these can be helpful as one part of an overall speech program.

As an example, while my daughter has an issue with articulation, she also has an oral motor issue. She couldn't even lick her lips full circle until she was about 7. At a minimum, oral motor exercises have at least have helped her oral motor skills.


Honestly, I don't know how much it helps, but I don't know if much of anything else an SLP has done has helped either. At a minimum, I have seen some progress on her oral motor. Of course, if she is apraxic, it may explain some of the issue.

Tammy

[Aridel]

Originally Posted by quaz

This sounds very similar to my daughter.


I just did a speech eval last week. I'll get results soon. She was unclear to anyone outside of the family until about 4 1/2. I don't know that she completely fits apraxia, but maybe oral apraxia. At this point, I think we just need something different. She is understandable now, but she is still not clear for someone her age.

How is her oral motor? Can she lick her lips all the way around? if you put whip cream on her top lip, can she lick it off? If you put a lollipop to the corner of her mouth, can she lick it. If you put licorice on the inside side of her mouth, can she chew it, or does she turn her head?

My daughter has some oral issues going on as well, and these are some of the items we see, so in her case it isn't straight articulation.
She was intially diagnosed with severe phonological delay, but I think there is more to the store. She shows apraxic tendencies.


I know some SLPs use non-speech oral motor exercises, but I would strongly suggest you research these if they are being used with your child. Some people support them and say they have seen changes, but the research right now shows they do NOT help speech.

This is very dependent. I wouldn't recommend using them by themselves, and that is it for therapy. I think for some kids, though, using these can be helpful as one part of an overall speech program.

As an example, while my daughter has an issue with articulation, she also has an oral motor issue. She couldn't even lick her lips full circle until she was about 7. At a minimum, oral motor exercises have at least have helped her oral motor skills.


Honestly, I don't know how much it helps, but I don't know if much of anything else an SLP has done has helped either. At a minimum, I have seen some progress on her oral motor. Of course, if she is apraxic, it may explain some of the issue.

Tammy

They can absolutely help non-motor skills like licking, blowing out candles, but there is zero evidence they help speech, as part of an overall program or on their own. I'm not saying there will never be evidence, but all the existing evidence (and neuro info) shows that it is unlikely they have any speech impact. It's fine for anyone who wants to work on non-speech movements - they can be great for that!

[BethSLP]

As an SLP, I wholeheartedly agree with what Aridel is saying. Non-speech oral motor drill will not benefit speech. The research shows this over and over. But there are plenty of people making big bucks (Sara Rosenfeld Johnson being one) that promote all kinds of horn hierarchies, bubble blowing, button pulling, etc. It is simply not evidence based at all, and I'm surprised its been allowed to continue in our field. Other non-evidence based practices have been essentially done away with for the same reason. For some reason, this bugger has held on. My suspicion is that lots of clinics are doing it because its perceived as "medical" and they get reimbursed easily from insurance. Articulation is harder to bill for.

In response to the OP, does your daughter have varied sound production for the same target. For example, kids with artic disorders might say "tat" for "cat" but they will say "tat" every time. A kid with apraxia has a problem with motor planning, so they might say "tat" "tot" "tap" etc. They grope and their productions vary. Another tell tale sound is vowel errors. Vowel errors are often seen in apraxia, but rare otherwise. You will also see a noticeable breakdown as words lengthen and there is more coordination demand. Simply adding a syllable or a phrase instead of a word can make a person with apraxia's speech fall to pieces.

From what I'm hearing from your OP, it just sounds like articulation. Some phonological processes (such as final consonant deletion) as well. But all that means is that your child's articulation errors follow a pattern and your SLP is working well with her by using her "rules" to teach the correct way. Like teaching her the "forward" sounds.

Traditional artic therapy teaches each phoneme separately, but phonological processing research shows they come in quicker if you teach the rule system. So instead of teaching K, then G. You would talk about "back sounds" and possibly achieve both together.

It sounds like your SLP is doing everything right to me. Unless you see your daughter groping, making vowel errors, and having wildly different productions (or her artic getting substantially worse as the length increases and requires more coordination), then I would not think of apraxia.

For what its worth, I have been an SLP for 8 years, and only seen one child with true apraxia. It is very rare, but is becoming a buzz word lately. Like dyslexia and auditory processing, it seems to be a diagnosis that more and more people are getting.

XOXO
B

[hayleyvt]

Originally Posted by BethSLP

As an SLP, I wholeheartedly agree with what Aridel is saying. Non-speech oral motor drill will not benefit speech. The research shows this over and over. But there are plenty of people making big bucks (Sara Rosenfeld Johnson being one) that promote all kinds of horn hierarchies, bubble blowing, button pulling, etc. It is simply not evidence based at all, and I'm surprised its been allowed to continue in our field. Other non-evidence based practices have been essentially done away with for the same reason. For some reason, this bugger has held on. My suspicion is that lots of clinics are doing it because its perceived as "medical" and they get reimbursed easily from insurance. Articulation is harder to bill for.

In response to the OP, does your daughter have varied sound production for the same target. For example, kids with artic disorders might say "tat" for "cat" but they will say "tat" every time. A kid with apraxia has a problem with motor planning, so they might say "tat" "tot" "tap" etc. They grope and their productions vary. Another tell tale sound is vowel errors. Vowel errors are often seen in apraxia, but rare otherwise. You will also see a noticeable breakdown as words lengthen and there is more coordination demand. Simply adding a syllable or a phrase instead of a word can make a person with apraxia's speech fall to pieces.

From what I'm hearing from your OP, it just sounds like articulation. Some phonological processes (such as final consonant deletion) as well. But all that means is that your child's articulation errors follow a pattern and your SLP is working well with her by using her "rules" to teach the correct way. Like teaching her the "forward" sounds.

Traditional artic therapy teaches each phoneme separately, but phonological processing research shows they come in quicker if you teach the rule system. So instead of teaching K, then G. You would talk about "back sounds" and possibly achieve both together.

It sounds like your SLP is doing everything right to me. Unless you see your daughter groping, making vowel errors, and having wildly different productions (or her artic getting substantially worse as the length increases and requires more coordination), then I would not think of apraxia.

For what its worth, I have been an SLP for 8 years, and only seen one child with true apraxia. It is very rare, but is becoming a buzz word lately. Like dyslexia and auditory processing, it seems to be a diagnosis that more and more people are getting.

XOXO
B

Thank you for that awesome response! Our SLP has been doing just what you said...working the forward sounds and many like sounds in groups. Because she is unable to find a set pattern in DD's speech she suggested bringing her into the University to have her observed by other SLPs. She did not suggest Apraxia as a diagnosis, but did think that it could help if we could rule that out first...along with phonological disorders. After reading your examples of Apraxia, I really doubt that this is it. She uses the same sounds over and over, and she is very good with vowels.

Oh, and to the pp that was talking about motor control.....I had her lick her lips this morning, and she was able to lick them all the way around ( No lollipops in the house)

[quaz]

No, I agree. I haven't seen that it helps with speech persay. In our case, the therapy is still needed, though, as part of speech because of the overall oral motor. It's why I stated it depends, and why I would never stated it needs to be used as the item of focus in speech.

A kid with apraxia has a problem with motor planning, so they might say "tat" "tot" "tap" etc. They grope and their productions vary. Another tell tale sound is vowel errors. Vowel errors are often seen in apraxia, but rare otherwise. You will also see a noticeable breakdown as words lengthen and there is more coordination demand.


This is why I'm not sure about apraxia, because in many aspects she doesn't fit it.

She does not nor has ever had issue making the varied mistakes. She doesn't do tat, tot, tap. The productions do not vary. On the other hand, her vowels do seem off. Her speech utterly breaks down when the words lengthen and coordination increases. Her overall speech doesn't seem to have an issue with it being volitional, but perhaps orally it may?

On the other hand, I've looked at this before and
http://www.shop-in-service.com/oral_apraxia.htm

She fits dead on with the signs of oral apraxia and NOT oral motor.

I've seen apraxia as Developmental apraxia of Speech, and I've heard of oral apraxia.

Is it possible just to have oral apraxia?
At the same time, her phonological processes are poor. It took her until she was 6 in order to rhyme. She is 7 and reading at a 5th - 7th grade level, though, because she is a sight word reader.

Tammy

[momtoalexsarah]

OP, by any chance does she have a high arch palate, or a split uvula - this can be signs of a sub-mucus cleft palate. Open you get hyponasal speech, but not always. The sounds that she is having problems with are the same ones as my DD, she is 4, has/had a submucus cleft, repaired at not quite 3 years old. The mucles where all in the wrong places, the corrected some and her speech improved alot - but the stuff your DD is missing Megan still struggles with because the muscles have to be taught how to move. It is a slow prosesse, but at 4 she still working on it. Does she start school this year, if so be sure that you try and get some additional in class support for her so that she dosn't get frustrated

[ericswifey27]

Originally Posted by momtoalexsarah

OP, by any chance does she have a high arch palate, or a split uvula - this can be signs of a sub-mucus cleft palate. Open you get hyponasal speech, but not always. The sounds that she is having problems with are the same ones as my DD, she is 4, has/had a submucus cleft, repaired at not quite 3 years old. The mucles where all in the wrong places, the corrected some and her speech improved alot - but the stuff your DD is missing Megan still struggles with because the muscles have to be taught how to move. It is a slow prosesse, but at 4 she still working on it. Does she start school this year, if so be sure that you try and get some additional in class support for her so that she dosn't get frustrated

hmmm (sorry to hijack!)... my son has a high arched palate and has speech issues. His voice tone is different imo, more high pitched and girlish. He is about to turn 3. He just had a speech evaluation and the SLP asked that I come back in 6 mos since he was borderline for his age. If it is something physical, like a sub-mucuous cleft, I of course would want to look in to that. Would I ask for a referral to an ENT or a specialist in sub-mucous clefts?

[hayleyvt]

So, I would think that we would have been informed if she had any malformation in the mouth at birth or soon after, right? Or is this something that is easily overlooked? I have never noticed any issues in her mouth, but I guess I did not know to look for any. This thread has brought many questions up for me that need looking into. Off to research

[aspeechthx]

Actually, issues with the palate, submucous clefts... are easy to overlook and often are not discovered at birth.

[BethSLP]

HayleyVT,

It IS possible to have a submucous cleft and have it undiagnosed, but tons of children have speech errors for no "reason" at all.

There is nothing in your post that would make me think submucous cleft. Although, a good SLP will be doing an oral peripheral exam and would be looking for any anomalies.

Obviously, some kids have this and its good information, but don't want all mamas of kiddos with articulation errors to worry about submucous clefts.
XOXO
B

[hayleyvt]

Well,
She has ST tomorrow, so I can ask about it then....of course it is summer, so her regular SLP will not be there, but at least I can ask this SLP's opinion
I have been having a challenging week with her struggles of communication. She has this new confidence that is so wonderful, and has made her much more social....the downside, that other little girls and boys don't understand her, and 2 times this week she was made fun of because of her speech. I hate seeing the scene play out, and feel like her new found confidence will be crushed by the remarks made by unknowing 4/5 year olds. Not that I expected her to be "cured" by ST, but I never expected the process to be so slow and challenging. Anyway, I am hopeful that she will make some bigger strides now that she is not super shy around other people. Sorry to take the thread to a different direction, just needed a quick vent.

[aspeechthx]

Didn't mean to imply that submucous cleft should be considered as a cause for the articulation issues in this post. Just answering hayleyvt's question above.

[Momma Aimee]

subbing to come back and read when i am not being pulled on. OP's DD sounds JUST LIKE my DS1... (see my new post from today )