Have a Question?
Send us a message directly and we will get back to you shortly
What is Speech Therapy?
Speech Therapy is a service offered to children and families to enhance communication, language, speech and social skills. A child that is experiencing speech delays or having trouble communicating using words or sentences will benefit from speech therapy strategies. Speech Therapists (Speech Language Pathologists – SLPs) are experts in the appropriate developmental milestones of speech and language skills in children and can determine the root causes of concerns. Our Speech Therapists always meet the child at the level they are at and will provide challenges and experiences to enhance their skill to the next level. We engage the child with creative and fun techniques to enhance their skill while enjoying the therapeutic process.
Availability:
- In Clinic
- In Home
- Remote/Virtual
How can Speech Therapists Help my Child?
Our Speech Therapists focus on treating a variety of communication and speech disorders.
Our Speech Therapists can address the following:
Helping Children SPEAK
Articulation
Articulation is the production of individual speech sounds — how we make sounds with using our mouth, lips and tongue. Each word we produce can be broken down into distinct sounds. Articulation errors occur when these sounds are distorted, pronounced incorrectly, or substituted for other sounds. Certain articulation errors are typical for certain ages. We refer to these errors as age-appropriate or developmental. For example, a 3-year old’s /r/ sound error is developmental since the /r/ sound is typically developed at a later age. Along with age, articulation can be influenced by other factors such as the languages we speak, hearing loss, speech perception, and oral motor skills.
Phonology refers to speech sound systems or patterns in a language. The sounds in a word follow specific patterns and rules. For example, if you add an /s/ to the end of a word, the /s/ sound is pronounced as a /z/ sound (e.g., one dog, two dogs). Even if given a word that does not exist in the English language (e.g., one wug, two wugs), we know to follow this rule. Phonological errors occur when these patterns or rules are not followed. As children learn to talk, they simplify these rules resulting in phonological processing errors. For example, some children may drop the final sounds in words (‘map’ sounds like ‘ma’) or delete weak syllables in long words (‘efent’ for ‘elephant’). Similar to articulation, some errors are age-appropriate, while others are not.
Clarity of speech, sometimes referred to as ‘speech intelligibility’ or ‘speech understandability’, is how well an individual is understood by others when they speak. Often, an individual may be more clearly understood by familiar listeners compared to less familiar listeners. Clarity of speech is influenced by a few different factors, including environmental characteristics (e.g., noise level in a room) and speech characteristics, including articulation, how quickly speech is produced, speech volume, and speech fluency. Also, an individual may have appropriate articulation but difficulties staying on topic, explaining their ideas, and using suitable grammar or vocabulary. Their speech intelligibility may be decreased due to these language barriers.
Lisps are a common term used to describe a speech sound substitution of /s/ and /z/ sounds for ‘th’ sounds. For example, the word ‘sun’ may sound like ‘thun’. Lisps are caused by incorrect tongue placement. Interdental or frontal lisps occur when the tongue moves in between the teeth. Lateral lisps occur when air escapes through the sides of the tongue resulting in a ‘slushy’ /s/ or /z/ sound. In very young children, interdental lisps are typical may resolve with age.
Helping Children SPEAK
Language Development
Language refers to how we use words to communicate with others. Our expressive language refers to our ability to share our thoughts, ideas, and feelings. Our receptive language refers to our ability to understand what others say. As we learn language, the following skills are developed:
- Building vocabulary and understanding the meanings of words (called Semantics)
- Knowing which words to say and how to say them in different scenarios (called Pragmatics)
- Learning the sound patterns in language (called Phonology)
- Learning how words are formed (called Morphology)
- Learning Syntax (how to put words are put together).
A ‘late talker’ refers to a toddler between 18-30 months who has typically developing skills in all areas (e.g., receptive language, play, motor movements, thinking, and social skills) but has limited spoken vocabulary, or expressive language. There is no clear cause for this delay. Some late talkers seem to catch up without intervention; however, language learning difficulties may persist into school age. Therefore, early intervention (as opposed to waiting to see if a child catches up on their own) is recommended. Though we do not know which children will catch up without intervention, some children are more likely to have persisting language difficulties. Risk factors for persisting language difficulties include:
- Family history of communication delay or learning difficulties
- History of ear infections
- Difficulty understanding what others say
- Uses few gestures when communicating
- Uses mostly object labels (e.g., nouns) and few action words (e.g., verbs)
- Does not use symbolic play gestures – linking ideas from the real world into play
- Difficulty interacting and playing with others
Children build their vocabulary through interactions and conversations with others. Vocabulary builds quickly during the early years of life, and continues to grow as children are exposed to new environments and experiences. Children typically acquire 15-20 words by 18 months and have a steadily increasing vocabulary as they start to put words together into phrases around 2 years. Children tend to understand more words than they use. For example, you child may point to his car when asked ‘where is your car’ before they say the word ‘car’. Some children develop vocabulary at a quicker rate and others at a slower rate. A common question is whether bilingual children are more likely to develop language at a slower rate. Children learning two languages may have smaller vocabularies in each language compared to other children who speak one language, but their total vocabulary (words from both languages) is typically the same. Bilingualism alone does not cause slower vocabulary development.
When children have a slower vocabulary development, it can affect their ability to express themselves, understand what others say, and develop literacy skills. Research provides suggestions for caregivers to help build their child’s vocabulary:
- Read to your child and talk about the world around you
- Use many words and different types of words (location words like on, off; descriptive words like cold, fast; action words like go, stop.
- Follow your child’s lead and talk about things that interest them
- Pair words with actions, facial expressions, and gestures that help explain their meaning
- Repeat and emphasize words when reading (e.g., I see a hungry caterpillar)
- Make comments instead of questions (e.g., it’s a blue car vs what colour is it?)
- Use more difficult or complex words such as ‘purchase’ for ‘buy’
- Have conversations about past and future events, and give explanations for things
Syntax or ‘sentence composition’ refers to the way we put words together to form sentences, including using correct verb tense, grammatical markers, and word order. For example, simple sentences in English follow a subject-verb format. For example, we say “what is he doing?” instead of “what he is doing?”. Each language follows specific rules to form grammatical sentences. As language develops, individuals can use and understand more complex sentence structures. Difficulties with syntax fall under expressive language difficulties and can also impact narrative skills (telling a story) and literacy skills (reading and writing).
Developmental Language Disorder (DLD) is a relatively new term for a condition previously described as “expressive-receptive language disorder”, “specific language impairment”, and “speech-language impairment”. Children with DLD have language skills persistently below the level expected for their age, and have no known biomedical conditions (e.g., Autism Spectrum Disorder, Down Syndrome) interfering with their language ability.
DLD emerges in childhood and errors continue into school age and adulthood. It is common – occurring in 7.5% of 4–5-year-old children, and can be misdiagnosed as poor attention or listening skills. The causes of DLD are not yet fully know, but are influenced by genetic and environmental factors.
DLD can affect expressive and receptive language (speaking and understanding), speech sounds, vocabulary development, grammar, morphology (using word endings like –ed), discourse (conversation, narrative/story-telling) and pragmatics (social communication, inferencing, figurative language). For example, a child with DLD affecting their expressive language may use non-specific words, and short sentences to express meanings in which more complex sentence would typically be used for their age. DLD affects academic skills since learning is mainly through language.
Helping Children SPEAK
Social Communication
- We communicate for different reasons. These reasons, referred to as communicative functions, including: greeting (hi, bye), commenting (I like race cars, I will be right back), requesting (I want some water), protesting (stop, no), and asking questions (what time is it?).
- We change our language based on our environment, listener, and situation. For example, we may talk differently to an authority figure compared to a friend. We may use different vocabulary or body language when giving a formal presentation compared to conversation during a casual meal.
- We follow conversational rules. These rules vary by culture and other factors. For example, in Canadian culture, we often consider interrupting others to be rude. However, in some other cultures, interruptions are common and acceptable. Other conversational rules we follow include: taking turns, staying on topic, maintaining personal space, restating with different words if someone does not understand us, and more. Social cues (e.g., facial expressions, tone of voice, body posture) help to guide conversations through nonverbal communication.Since social skills can be learned without direct teaching, the development and use of social skills may come easily to some individuals compared to others. The term ‘hidden curriculum’ refers to “the set of rules or guidelines that are often not directly taught but assumed to be known” (Myles, 2004).Consider this example: You were invited to a ‘language exchange’ group. You were unsure of what the group entailed or what the expectations would be. Would it be formal discussion or casual conversation? Would you be expected to teach or learn multiple languages throughout the event? To answer these questions, perhaps, you scanned the room and noted how others behaved. Maybe you asked a friend who had attended the event before what to expect. Maybe you began to mingle, and as you saw others mingle, you modified your behaviour to mimic what was expected. In this example, you were not taught directly how to act during a language exchange event; however, you used different strategies to learn the ‘hidden curriculum’. Individuals who do not access the hidden curriculum as easily as others may find themselves uncertain in interactions and may not be aware of social cues presented to them.
Helping Children SPEAK
Fluency
Fluency is the easy and effortless flow of speech. It is characterized by (1) Continuity, the smoothness of speech; (2) Rate, how fast or slow speech is produced; (3) Rhythm, how the rhythmic patterns of speech are presented depending on intonation, stress pattern, and duration of sounds; and, (4) Effort, the mental and physical effort of speaking. Sometimes children have one main area of difficulty and sometimes a few different areas may be involved.
Developmental fluency or ‘normal stuttering’ is typical in young children between 2-5 years old. These disfluencies do not change in rate, rhythm, and are not produced with effort. Some examples include adding ’um’, ‘like’ or ‘well’, revising a phrase to say it a different way, easy repetitions of a sound, word, or phrase observed without tension or effort. These disfluencies tend to come and go overtime as a child continues to develop.
In contrast, fluency disorders or ‘true stuttering’ involve differences in rate, rhythm, and effort, such as rushed and tense speech. There are three main components to fluency disorders.
- Core behaviours are disfluencies which cannot be controlled, including:
(1) Repetitions: repeating a sound, syllable, or word (e.g., I-I-I-I want to go, the b-b-ball is red)
(2) Prolongations: holding a sound for an extended time (e.g., I waaaaaant to play too)
(3) Blocks: when sound or aid is stopped at the vocal chords or articulators (e.g., he……..was swimming). - Secondary behaviours are learned reactions in response to core behaviours, including:
(1) Escape behaviours: when a speaker is stuck on a word and tries to get out of this position, by blinking, stomping head turning, etc.
(2) Avoidance behaviours: when a speaker anticipates becoming stuck on a word and tries to prevent it. - Negative feelings can be felt by speakers with fluency disorders, including guilt, shame, fear, embarrassment, and hostility. These feelings can affect a speaker’s attitudes about speaking, themselves and others.
At the moment, researchers are unsure about what causes stuttering. There is ample evidence suggesting stuttering is influenced by genetic factors. This influence is not impacted by severity. For example, if a parent stutters severely, it does not mean a child has a higher risk to develop stuttering. Along with genetics, other factors including a child’s environment, neuromuscular development, and language processing influence outcomes.
Slurring and mumbling refer to when an individual is not pronouncing sounds clearly. They may appear to mumble or have changes in the speed and rhythm of their speech, making it unclear to others. Sometimes words are combined together, sound garbled in sentences, are produced quickly and quietly, or parts of words may be missing. Slurring and mumbling are influenced by speech muscle movement, voice, and breathing. For example, if the speech muscles are weak and unable to move quickly, an individual’s speech may be slurred. If an individual has damaged their voice box (or larynx), their voice may be quiet and difficult to understand.
Slurred speech can be a symptom of dysarthria, a motor speech disorder characterized by weakness, damage, or paralysis of the muscles involved in producing speech. Dysarthria can occur after illness or injury, such as a stroke or traumatic brain injury.
Prosody refers to how our speech flows – the stress patterns, intonation, loudness, pausing, and rhythm of speech. Let’s look at this sentence: Jim bought a red car. Is it a question or comment? What if Jim’s least favourite colour is red and he has always wanted a blue car. Could the sentence read as a question: Jim bought a red car? Prosody affects how a message is communicated and understood. By stressing different words, changing our loudness, changing our pitch, and using different tones of voice, we can communicate messages in different ways. By using and interpreting prosody, we can make sure we heard someone correctly by emphasizing different words (e.g., Did you say car or scar?), learn about a speaker’s emotional state, understand jokes or sarcasm, differentiate a sentence from a question, and so forth.
Helping Children SPEAK
Motor Speech
Motor speech disorders are characterized by “neurological impairment affecting motor planning, programming, neuromuscular control, or execution of speech” (Duffy, 2005). As communication develops, speech motor skills typically develop as well. For example, as a child produces more vowel sounds when babbling, they are learning to stabilize their jaw, spread their lips, round their lips, and combine speech movements together. With time, these speech movements become more refined and coordinated. When children have difficulty with speech production due to motor planning challenges or muscle weakness, they present with motor speech difficulties.
Apraxia of speech is a speech disorder characterized by motor planning difficulties. Apraxia is not caused by weakness of the muscles. Rather, the brain pathways which plan and sequence the movements for speech production are affected. Apraxia of speech can range in severity – some individuals have difficulty with a few sounds or longer words; other individuals benefit from alternative communication methods.
Apraxia can be acquired or developmental. Acquired apraxia is caused by injury to the parts of the brain involved in speech production. Childhood apraxia is present from birth. The causes are not well-understood though genetics, having a family member with a speech-language disorder or learning disability, may play a role. Apraxia may also occur as a primary or secondary sign in complex neurodevelopmental disorders.
When you speak, your brain undergoes three steps to transform your idea into spoken words: Speech motor planning, motor programming and execution. In Speech motor planning, we ask the question: What movements need to happen to produce speech? Which movements do your articulators (jaw, lips, tongue) need to make for all the sounds in a word? What is the sequence of these movements? For example, the motor plan to produce the /p/ sound in ‘pool’ would require your lips to push out slightly compared to the /p/ sound in ‘pig’. Once the plan is formed, motor programming occurs. We ask the question: What muscles are needed for these movements to happen? How much amount of force, tension, and range of motion is required for each movement? Lastly, the motor plans and programs are executed resulting in speech sounds. When children learn to speak, repeating words becomes more automatic and less effortful. The precise speech motor plans and programs are refined and stored in the brain. As a result, they can be accessed with less effort and time.
Helping Children SPEAK
Diagnoses
Medical diagnoses can help explain an individual’s symptoms and inform treatment plans. The diagnostic process can involve several steps or professionals. Medical professionals gather information through clinical interviewing, collaborating with other professionals, and conducting specific assessments or testing. Then, they interpret the information and communicate a diagnosis. The diagnostic process occurs overtime and within the context of the health care system.
Developmental milestones are skills children typically acquire by a certain age. Tracking children’s developmental milestones overtime helps to monitor their development and understand their behaviour. Reaching developmental milestones at an early age may reflect advanced skills compared to other children of the same age. Reaching developmental milestones at a later age may reflect developmental delay for which children benefit from support and services.
Developmental milestones fall into four domains. Some milestones may fall under more than one domain. The domains are listed here:
- Socio-emotional: How children interact with others and express emotions.
- Communication: How children communicate, express needs, refuse/protest, share ideas, and understand communication from others.
- Cognitive: How children learn, problem-solve, and acquire academic skills such as counting.
- Physical development: How children move their bodies.
While a developmental delay reflects a delay in acquiring certain skills in which children can catch up to their peers, developmental disabilities are lifelong conditions. Developmental disabilities are a group of conditions, beginning in early childhood, that impact an individual’s socio-emotional, communication, cognitive and physical development. These disabilities limit an individual’s ability reach certain milestones and typically impact an individual’s daily functioning throughout their lifetime. Examples include: Autism Spectrum Disorder, Cerebral Palsy, and intellectual or learning disability. The term ‘global developmental delay’ can be used to describe a significant delay in two or more areas of development.
Intellectual disability is a type of developmental disability in which an individual has limitations in intellectual functioning, involving their communication, social skills, and adaptive behaviour (i.e.., skills required for day-to-day functioning). The degree of intellectual disability can vary across individual. Individuals take a longer time to learn new skills including speaking, walking, eating, getting dressed, and learning in school. Individuals may have difficulty with reasoning, planning, abstract thinking, and experiential learning. Intellectual disability can be caused by an injury, disease, stroke, serious head injury, or a problem in the brain which occurs before birth or after birth before adulthood. For some individuals, the cause is unknown. Others may have developmental disabilities causing intellectual disability, such as Down Syndrome and genetic conditions.
Autism Spectrum Disorder (ASD) is a developmental disorder characterized by challenges in communication, social skills, adaptive behaviour (e.g., skills required for day-to-day functioning), and the presence of restricted, repetitive behaviours. Individuals may also have sensory and feeding challenges and co-occurring conditions such as sleep disorders or epilepsy. Autism is referred to as a ‘spectrum disorder’ because the characteristics vary by type and severity across individuals. Characteristics of ASD are often recognized within the first 2 years of life; however, ASD can be diagnosed later in life. The process of diagnosing ASD includes observing the child, asking caregivers questions about the child’s development, and developmental assessment by doctors who are experienced in diagnosing ASD (e.g., developmental pediatricians). Other health professionals may be involved as well. Individuals with ASD often have strengths in visual learning, focusing on details, rote memory, and rule-based thinking.
Cerebral palsy (CP) refers to “a group of disorders impacting an individual’s ability to move and maintain balance and posture” (Centre of Disease Control and Prevention, 2021). Symptoms of CP vary across individuals and can change throughout one’s lifetime. Individuals may experience the following communication challenges: sharing ideas with others, understanding what others say, and controlling muscles involved for speech, facial expressions, gestures, and voice production (i.e., muscles in the face, throat, head, neck, and chest).
Selective mutism is an anxiety disorder in which children are consistently unable to speak and communicate in specific environments where speaking is naturally expected (i.e. often at school), despite being able to communicate in familiar settings (American Psychiatric Association, 2013). Children with selective mutism may communicate nonverbally through pointing or writing. Speech-Language Pathologists can work in collaboration with behavioural health professionals (e.g., psychologist, social worker) regarding assessment and treatment.
Down Syndrome is a condition characterized by an extra copy of chromosome 21. Individuals with Down Syndrome may have communication challenges relating to pronouncing speech sounds, expressing ideas, and understanding what others say. Research suggests specific learning strengths found in many individuals with Down Syndrome including visuo-spatial processing and using visual supports in communication, whole-word recognition in reading, social skills, and empathy (Martin et al., 2009).
A cleft lip is an opening in the upper lip. It may occur in one or both sides of the lip, and may extend in the upper jaw and gum. A cleft palate is an opening on the roof of the mouth – it occurs when “the tissues joining the roof of the mouth do not join together completely during pregnancy” (Centre for Disease Control and Prevention, 2020). It may occur on one or both sides of the mouth. A submucous cleft palate, also referred to as a ‘hidden’ cleft, occurs when a cleft is covered by mucous membrane in the mouth. Children may present with a cleft lip or both a cleft lip and palate. Depending on the type of cleft, clefts can be diagnosed during pregnancy by an ultrasound, at birth, or later in life when a child begins feeding or talking.
Children with cleft lip and/or palate may have challenges with feeding and speaking, frequent ear infections or fluid in the ear, and hearing difficulties. Some children may have difficulty with developing speech their sounds or have too much air coming out of the nose during speech making speech hard to understand.
The body’s hearing system consists of the outer ear, the middle ear, the inner ear, and the auditory or hearing nerve. When there is an impairment within the system, hearing loss or impairment occurs. Hearing loss varies by type including (1) Conductive loss (occurs when sound does not move from the outer to the middle ear), (2) Sensorineural loss (occurs when the inner ear or hearing nerve are not working correctly), (3) Mixed hearing loss (both conductive and sensorineural), and (4) Auditory Neuropathy Spectrum Disorder (occurs when sound is not understood by the brain due to damage to the inner ear or hearing nerve). Hearing loss varies by severity. An individual with a mild hearing loss has difficulty hearing soft speech or speech in a noisy room. To understand what a mild hearing loss may feel like, plug your ears or wear earplugs. Some individuals may not hear quieter or higher frequency speech sounds such as ‘s’ or ‘p’. Without these sounds, our brains need to fill in the missing sounds. An individual with a moderate hearing loss has difficulty understanding speech at a normal volume and may benefit from hearing aids. An individual with a severe hearing loss has difficulty understanding speech at a normal volume even if using hearing aids, but they may hear loud noises from a close distance. An individual with a profound hearing loss has difficulty understanding speech at a normal volume including loud voices even if using hearing aids. Hearing aids are less beneficial to children with profound hearing loss. Cochlear implants are available supports for individuals with severe and profound hearing loss. Hearing loss in young children can lead to delayed receptive and expressive language development, including vocabulary, sentence structure, and speaking.
The International Dyslexia Association (2002) defines dyslexia as:
- “A specific learning disability that is neurobiological in origin characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities.
- These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction.
- Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”
Individuals with dyslexia have difficulty learning to read. Difficulties are related to recognizing, decoding, and spelling words, and understanding what they read. Almost all individuals learn to read when specific support is provided. Reading instruction for individuals with dyslexia includes Structured Literacy, Orton- Gillingham, Simultaneous Multisensory, Explicit Phonics, and others.
Helping Children SPEAK
Orofacial Myofunctional Disorders (OMD)
Orofacial myofunctional disorders (OMDs) involve atypical movement patterns of the face and mouth. If these movement patterns occur frequently, the bones and muscles of the face and mouth (used for breathing, speaking, and swallowing) can be affected. Many OMDs are characterized by oral or mouth breathing in which the muscles adapt to an improper breathing pattern, resting the tongue between or against the teeth, tongue thrusting, and other oral habits.
To swallow, our body must coordinate movements with the muscles and nerves in our face, mouth, throat, and cheeks. Improper swallowing can lead to the tongue thrusting forwards against or between the teeth. As a result, OMDs may lead to dental problems, including malocclusions where the top and bottom teeth are not properly aligned (e.g., overbite, underbite). OMDs may also lead to speech problems, including a frontal lisp or difficulty pronouncing certain speech sounds. When our face and mouth muscles are moving incorrectly, we may develop temporomandibular joint dysfunction, headaches, and other health issues.
Breastfeeding issues can occur throughout the early stages of development. Examples include pain while breastfeeding, an infant’s difficulty latching or aversion to food, and aspiration. Speech-Language Pathologists may work with lactation consultants or occupational therapists to support these difficulties. Breastfeeding issues may occur if an infant is premature, has oral motor difficulties, developmental disabilities or genetic disorders, cleft lip and palate, a tongue tie, or other health issues.
Oral health is “the health of the teeth, gums, and the entire oral-facial system that allows us to smile, speak, and chew” (Centre for Disease and Control Prevention, 2020). Poor oral health may include having mouth sores, bleeding or swollen gums, pain or discomfort around the mouth, unpleasant mouth odor, and chest infections. To have oral health, we need to practice oral hygiene. Oral hygiene improves our health by removing bacteria from the mouth, removing plaque and food debris, decreasing the risk of infection, and preventing bad breath. Oral hygiene recommendations include brushing teeth regularly twice a day, daily flossing, and avoiding sugary food and drinks. Brushing and flossing consistently may be challenging, especially for children who may be sensitive around their face or mouth. As a result, some individuals are at higher risk of having oral health problems. Children at higher risk may have:
- Feeding difficulties
- Texture modified diets
- Conditions that cause physical impairments, cognitive impairment, gastroesophageal reflux, and neuromuscular problems
- Genetic disorders affecting the teeth
- Down Syndrome and disorders increasing the risk of gum disease
- Reduced or overproduction of saliva
- Decreased or increased sensation in the mouth or difficulty chewing hard foods
- Difficulty using their tongue to clear food from their mouth or difficulty swallowing.
Oral breathing or ‘mouth breathing’ can occur when we are sick – our nose is stuffy and we need to breathe out of our mouth. Mouth breathing for prolonged periods of time can lead to health concerns or can be a sign of existing health concerns. Most children engage in mouth breathing because of a blocked or partially blocked airway. Some reasons why an airway can be blocked include nasal congestion (e.g., a cold, allergies, sinus infection), nose shape, jaw size and shape, enlarged adenoids, deviated septum, and stress and anxiety. Mouth breathing can affect the overall structure of a child’s mouth, affecting their speaking and swallowing development.
The growth and development of bones in the face are crucial for eating, speaking, and breathing. The main bones in the face include the frontal bone (the forehead), the zygomatic bone (the cheekbone), the nasal bone (the nose), the maxilla (the upper jaw), and the mandible (the lower jaw). The development of these facial bones is impacted by an individual’s oral rest posture – the position of our mouth during daily activities such as watching TV, reading, etc. Typically, oral rest posture involves proper tongue posture (on the roof of the mouth), sealed lips with the teeth lightly touching, and breathing through the nose. Take a moment to observe your oral rest posture.
When differences in rest posture occur, the facial bones may not develop as expected influencing airway development and the position and alignment of teeth. These complications can lead to malocclusions where the top and bottom teeth are not properly aligned (e.g., overbite,underbite), temporomandibular joint dysfunction, sleeping disordered breathing or sleep apnea, and head and shoulder pain.
The temporomandibular joint (TMJ) is very complex – it is the most complicated joint found in the body. It is found on each side of the head near your ears and connects your skull (temporal bone) to your jaw (mandible). This joint can rotate from side to side, and backwards and forwards. It plays an important role in chewing, swallowing, speaking, and yawning. TMJ dysfunction occurs when an individual has problems with the muscle, tissue, and bone in and around the TMJ. Common signs of TMJ dysfunction include jaw pain or tenderness, difficulty moving the jaw (e.g., muscle stiffness), earache, headache, facial pain, painful clicking or popping when opening and closing the mouth, and a change in how the top and bottom teeth fit in the mouth. TMJ dysfunction can occur due to injuries to the jaw, joint diseases such as arthritis, using dentures which do not fit properly, or habits such as biting fingernails. However, for most cases, the cause for symptoms for TMJ dysfunction occur without a clear cause.
Helping Children SPEAK
Prompt Therapy
PROMPT Therapy, referring to Prompts for Restructuring Oral Motor Phonetic Targets, is a tactile-kinesthetic (touch and feel) approach of assessing and treating speech disorders. In the PROMPT approach, a Speech-Language Pathologist uses touch cues to provide cueing for the articulators – vocal folds, jaw, lips, and tongue. These cues help to shape speech movements.
PROMPT considers 3 main domains which play an important role in a child’s development: the Socio-Emotional, the Cognitive-Linguistic, and the Physical- Sensory domains. A PROMPT-certified Speech-Language Pathologist takes into account individual’s abilities across these three domains, and assesses their speech movements. The SLP uses the Motor Speech Hierarchy, which describes the steps of motor speech development, to inform treatment goals and steps. The SLP suggests functional words to practice speech movements that are difficult, and supports an individual’s speech movements through specific touch cues. With the touch cues, a child practices sounds, syllables, words, and phrases. Touch cues fade as an individual progresses. PROMPT Therapy can be beneficial for children with a range of communication challenges, especially articulation errors and motor speech disorders.
A tactile-kinesthetic approach is a style of learning or teaching requiring touching and manipulating objects. Some individuals learn more effectively with this approach compared to visual or auditory learning. Tactile-kinesthetic learners typically like to create things and move around while learning, compared to watching or listening.
Helping Children SPEAK
Literacy
Literacy refers to “the ability to read and write” (ASHA, n.d.). As literacy skills develop, we learn to make meaning from new information, express emotions, share ideas, and interact with others. As we learn to read and write, specific skills that build upon each other. These skills are divided into two general categories: Decoding (learning to read) and Reading Comprehension (reading to learn).
First, we learn to decode or read a word based on knowledge of letter-sound associations and patterns. Decoding requires the development of the following skills:
- Print Awareness – knowing that written words express meaning and how print is organized on a page (e.g., left to right in English)
- Alphabet Knowledge – knowing and recognizing the letters of the alphabet
- Phonemic/Phonological Awareness – ability to discriminate sounds, segment words into individual sounds, blend sounds together, and make new words using existing word knowledge.
- Phonics – associating sounds with letters
Being able to decode words does not guarantee that we understand them. Therefore, the next step in literacy development involves learning to comprehend the text. We use critical thinking skills to draw on our knowledge and experiences to ‘read between the lines’ and understand implied meanings. Reading comprehension requires the development of the following skills:
- Reading Fluency: reading with appropriate speed, accuracy, and expression
- Vocabulary: learning words in a language; learned indirectly (through conversations, listening to others, independent reading) and directly (through teaching); the strongest predictor of later academic success in children
- Spelling: understanding letter sounds, how groups of letters in patterns form different sounds (e.g., short vowel in ‘cat’ vs long vowel in ‘same’), and how groups of letters have the same meaning across different words (e.g., ‘re-’ meaning again, ‘-ed’ signifying past tense)
- Writing: gain awareness of written symbols that make up print, uppercase and lowercase letters, spacing, and punctuation; involves spelling, language structure, and vocabulary knowledge
Early literacy skills can begin to develop at a very young age as children read books with their caregivers. Research suggests reading and writing skills are closely related to speaking and listening skills. For example, being able to identify different sounds in words relates to being able to understand letter-sound associates when reading; and, understanding sentence structure when reading relates to using correct sentence structure when speaking. Therefore, children with speech or language delays are at risk for reading and writing difficulties as these skills develop.
Phonological awareness refers to being able to discriminate and manipulate individual speech sounds in words called ‘phonemes’. In this process, children begin to find similarities and differences in words. Phonemes are represented by a letter (e.g., /p/) or a cluster of letters (e.g., ‘th’). Although we have 26 letters in the English language, we have about 44 phonemes. When developing Phonological Awareness, children achieve the following skills: (1) Rhyming words, (2) Segmenting words into sounds, (3) Blending sounds together into words, and (4) Making new words by manipulating known words called ‘Phonemic Awareness’. Phonological awareness is crucial for developing reading and spelling skills and early skills predict later literacy development.
When learning to read, children’s vocabulary skills help them understand the text. They depend on the words they know orally to understand the words they see in print. The more words a child knows (e.g., has heard or used in oral language), the more words they can recognize when reading. Words that are not yet part of a child’s vocabulary are harder to understand. Children build vocabulary through communicating and interacting with others and listening to others read to them or reading on their own. Children who hear more words tend to learn more words and have larger vocabularies. With larger vocabularies, children can use more complex language, express themselves clearer, and understand more advanced texts.
Helping Children SPEAK
Feeding
The feeding process involves many steps. First, an individual need to get the food or drink to their mouth. Then, they need to open their mouth, close their mouth, seal their lips, and chew or move around the food or drink to get ready to swallow. Young children may have difficulty with some steps in this process, such as sealing their lips resulting in food spilling in their mouths. These difficulties typically resolve; however, some children have persisting difficulties resulting in feeding disorders.
As children develop oral motor skills, their feeding diversifies to include foods of different sizes and textures. This table from the Holland Bloorview Kids Rehabilitation Hospital shares oral motor skills corresponding to six developmental stages. The table helps to understand how skills develop and which foods are developmentally appropriate for a child.
Picky eating is common during the preschool years of a child’s life. It is normal for children to dislike certain tastes, textures, or shapes. Picky eating may be influenced by personality, a late introduction of solid foods, and parenting and feeding styles. It can lead to children eating fewer fruit, vegetables, vitamins, whole grains, and fibre products. Some children have difficulty moving past this phase of development without support, influencing their nutrition and social experiences and perspectives around eating. Picky eaters may be encouraged to eat new foods using different strategies such as presenting new food with food a child already likes or using fun colours and shapes. If picky eating persists past preschool or begins at a later age, support from health professionals may be warranted.
The eating environment can impact a child’s willingness to try new foods. Picky eaters may benefit from:
- Low-stress eating environments. For example, have a quiet activity prior to mealtime can help your child calm down before eating. Start small (e.g., asking your child to smell or lick some of the new food) can help them work towards taking a bite.
- Independence with food options. For example, give your child two vegetable snack options to choose from, or let them decide if they want to take three bites or five bites.
- Involving children in meal preparation. For example, let your child pick a recipe or meal idea, get food from the fridge, or wash produce.
- Eating with other children. For example, a child may be more likely to try a new food if their sibling or friend also tries it.
Gagging is a reflex our body uses to push food that is not chewed towards the front of the mouth. Therefore, the gag reflex protects are airway. In infants, the gag reflex occurs at the middle of the tongue. Gradually, the gag reflex moves to the back of the tongue and then the back of throat. Gagging is common in young children when they are introduced to solid foods, and typically occurs less often overtime as infants become used to eating solid foods and as they explore more textures.
Choking occurs when an object is stuck in our airway and we are unable to breathe. Choking does not involve sound and may cause watery eyes, a change in skin colour, and coughing.
The fear of eating or swallowing is commonly referred to as ‘phagophobia’. The names from Greek terms phago (meaning ‘eat’) and phobia (meaning ‘fear’). Individuals who experience phagophobia may have a range of swallowing-related symptoms without physical explanations that can be detected by clinical assessment. Individuals may have abnormal mouth behaviors, repetitive tongue movements, complaints of throat pressure and a lump in the through (i.e., globus), and difficulty starting their swallow. As a result of these symptoms, individuals may experience weight loss, anxiety, malnutrition, and avoidance of certain foods and textures. Phagophobia can occur in childhood and throughout the lifespan. Often, Individuals who experience phagophobia have experienced a traumatic event surrounding the act of eating such as choking. Recent research studies suggest swallowing therapy and psychotherapy as effective interventions to manage phagophobia.
Chewing is very important – it marks the beginning of the digestion process and prepares food and drink to be safely swallowed. As children develop mature chewing patterns, they can eat a wider array of foods. Children develop a mature chewing pattern in four main stages. At first, children do not chew; rather, they use a sucking pattern. Next, children use a ‘munching’ pattern by moving their jaw up and down. Then, they begin to mix munching with a ‘rotary chew’ pattern; this involves their jaw moving up and down, and occasionally, side to side. Lastly, children use a rotary chew demonstrating strength in their mouth muscles. A difficulty developing the oral motor skills for any of these patterns affects a child’s ability to chew and eat safely and efficiently.
There are many reasons why an individual may refuse to eat. For example, an individual may have pain associated with teething or toothaches, or a food allergy or sensitivity causing them to associate different foods with discomfort or pain in their mouth or stomach. They may be reluctant to try new foods or feel less hungry at certain times in the day. However, there are more serious reasons underlying why individuals may refuse to eat including changes associated with age, mental health disorders, stress (e.g., due to a new environment, a major life change), social factors, environmental factors, physiological impairment such as difficulty chewing or swallowing, and sensory factors relating to the smells, colours, tastes, or textures of foods and drinks. Based on the underlying causes of refusing to eat, the types of difficulties an individual faces and the length of time difficulties persist, individuals can receive individualized support by health professionals including feeding therapists, physicians, dieticians, nurses, occupational therapists and speech-language pathologists.
Sensitivity to food textures occurs when individuals have a sensory overreaction to certain foods; this overreaction can be triggered by different tastes, colours, smells, of textures of food. Sensitivity to food textures can be influenced by oral-motor and oral-sensory factors. Oral-motor factors refer to how the muscles of the mouth move and function. Individuals may prefer softer foods if they have difficulty with moving the muscles of the mouth. Oral-sensory factors refer to how the sensory receptors in the mouth process sensory information such as temperature, taste, and texture. Individuals can be oversensitive or under-sensitive to sensory information leading to a limited amount foods they will eat.
It is important to introduce infants to a variety of food textures as they develop. Different textures influence the development of oral motor skills and acceptance of new foods. For example, when infants are given solid foods, they learn oral motor skills to chew and move the food around in their mouths. If solid foods are not given when children are developmentally ready, they may refuse or have difficulty chewing certain food textures.
Why Choose Developing Hands
Pediatric Speech Therapy?
Developing Hands is comprised of a team of exceptional leaders in the therapy field who are truly passionate about helping children strive to their optimal potential, and providing support and education to families throughout that journey.
Developing Hands has been a leader in serving the community for over 12 years. Our Speech Therapists are fully licenced and regulated practitioners and have a range of years of experience working with toddlers, preschoolers and school aged children. Our multidisciplinary team works collaboratively together as needed to provide a holistic therapy experience for your child.
Please Contact Us for more information about our Speech Therapy (SLP) services.
Locations We Serve
Please select the Mode of Therapy
NOTE: Clinic visits are by appointment only
