Speech Therapy - Frequently Asked Questions

Does My Child Need Speech Therapy?

It can be difficult to decide if your child needs speech therapy. There is a wide range of what is considered "normal" as every child develops at his/her own pace. The best way to identify if your child is having difficulty is to determine if your child is mastering the skills necessary for speech and language during its natural progression.

There is a general age and time when most children pass through these periods. These milestones help doctors and other health professionals determine when a child may need extra help to learn to speak or to use language. Understanding what is typical for each age can help signal when something may be wrong.

The bottom line is, if you are concerned you should have your child evaluated as soon as possible. Early identification of speech and language delays is critical and no child is too young to be helped. If there is a problem, early attention is important. If there is no problem, then you will be relieved of your worry!


What is Childhood Apraxia of Speech (CAS)?

Childhood Apraxia of Speech (CAS), also known as verbal apraxia, developmental apraxia of speech, or verbal dyspraxia, is a motor speech disorder. No matter what name is used, the most important concept is the root word "praxis" which means planned movement. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. In CAS, the brain has problems planning to move the body parts that are needed for speech such as the lips, jaw and tongue.

The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words. It is not a developmental disorder, meaning a child will not grow out of it. Rather CAS is the result of a neurological disorder that affects a child's ability with motor planning and coordination resulting in extremely unintelligible speech and possibly severely reduced expressive language.


What are Signs of Childhood Apraxia of Speech (CAS)?

A Very Young Child

  • Does not coo or babble as an infant
  • First words are late, and they may be missing sounds
  • Only a few different consonant and vowel sounds
  • Problems combining sounds; may show long pauses between sounds
  • Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
  • May have problems eating

An Older Child

  • Makes inconsistent sound errors that are not the result of immaturity
  • Can understand language much better than he or she can talk
  • Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
  • May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
  • Has more difficulty saying longer words or phrases clearly than shorter ones
  • Appears to have more difficulty when he or she is anxious
  • Is hard to understand, especially for an unfamiliar listener
  • Sounds choppy, monotonous, or stresses the wrong syllable or word

What is PROMPT?

PROMPT (PROMPTs for Restructuring Oral Muscular Phonetic Targets) is a speech-language treatment technique allowing a trained therapist, during communicative exchange, to physically manipulate a child’s jaw, face and mouth to show him/her how a speech sound, sounds in the words, or words in sentences are produced. The clinician uses her hands to cue and stimulate articulatory movement, and at the same time helps the child eliminate any unnecessary movements. Research has shown that PROMPT has made positive results in children with motor speech disorders such as Dysarthria and Childhood Apraxia of Speech (CAS). www.promptinstitute.com


What is an Orofacial Myofunctional Disorder?

An Orofacial Myofunctional Disorder (OMD) involves behaviors and patterns created by inappropriate muscle function and incorrect habits that involve the tongue, lips, jaw and face. Of the many possible myofunctional variations, those involving the tongue and lips receive the most attention. For example, the tongue moves forward in an exaggerated way during speech and/or swallowing (e.g., tongue thrust). The tongue may also lie too far forward during rest or may protrude between the upper and lower teeth during speech and swallowing, and at rest. This incorrect positioning of the tongue may contribute to improper orofacial development and maintenance of the misalignment of the teeth. Additionally, incorrect position of the tongue can also cause sounds like /s/,/z/, "sh", "zh", "ch" and "j" to sound differently (e.g., a lisp). For example, the child may say "thumb" instead of "some" if they produce an /s/ like a "th". Also, the sounds /t/, /d/, /n/, and /l/ may be produced incorrectly because of weak tongue tip muscles.


What is Orofacial Myofunctional Therapy?

Orofacial Myofunctional Therapy is a structured therapeutic approach that is used to restore or retrain normal oral functioning. Its purpose is to correct the improper function of the tongue and facial muscles that are used at rest, for chewing, for swallowing and/or speaking. Orofacial Myofunctional Therapy may include any or all of the following:
  • Elimination of damaging oral habits (digit sucking, nail biting, etc.).
  • Reduction of unnecessary tension and pressure in the muscles of the face and mouth.
  • Strengthening of muscles that do not adequately support normal functioning.
  • Development of normal resting postures of the tongue, jaw, and facial muscles.
  • Establishment of normal biting, chewing, and swallowing patterns.

What Causes an Orofacial Myofunctional Disorder?

Often it is difficult to determine one particular source as the sole cause of an orofacial myofunctional disorder. In most cases it is the result of a combination of factors including:
  • Improper oral habits such as thumb or finger sucking, cheek/nail biting, tooth clenching/grinding,
  • Restricted nasal airway due to enlarged tonsils/adenoids and/or allergies,
  • Structural or physiological abnormalities such as a short lingual frenum (tongue-tie) or abnormally large tongue,
  • Neurological or developmental abnormalities,
  • Hereditary predisposition to some of the above factors.
For more information on Orofacial Myofunctional Disorders, you can visit the International Association of Orofacial Myology (IAOM) at www.iaom.com.


What is a Lisp?

A lisp is a distortion or mispronunciation of speech sounds. It can occur with other sound substitutions or alone. When children exhibit a lisp alone, it usually does not affect their speech intelligibility – that is, how well you understand their speech. Nevertheless, a lisp sounds and looks different.


What Kinds of Lisps are There?

A frontal lisp - In a frontal lisp a child's tongue either protrudes between, or touches, their front teeth and the sound they make is more like a 'th' than a /s/ or /z/. Protruding the tongue between the front teeth while attempting /s/ or /z/ is referred to as 'interdental' production, while touching the front teeth with the tongue while attempting to produce /s/ or /z/ is called 'dentalised' production.

A lateral lisp - In a lateral lisp the person produces the 's' and 'z' sounds with the air escaping over the sides of the tongue and as a result it often sounds 'wet' or 'spitty'. Because of the way it sounds, this sort of lisp is sometimes referred to as a 'slushy ess' or a 'slushy lisp'.

A palatal lisp - In a palatal lisp, children attempt to make sounds by using their mid section of their tongue to make contact with the soft palate.

Although it may be considered a normal developmental phase for some (not all) children to produce interdental or dentalised /s/ and /z/ sounds until they are about 4½ years of age, neither lateral or palatal lisps are part of the normal speech development progression. The speech of a child with a lateral or palatal lisp should be assessed, by a speech-language pathologist, without delay.


What is PECS?

The Picture Exchange Communication System (PECS) is a form of alternative and augmentative communication (AAC) that uses pictures instead of words to help children communicate. PECS was designed for children with autism and other related developmental disabilities however it has been successful with individuals of all ages demonstrating a variety of communicative, cognitive and physical difficulties. Using PECS, the student learns to spontaneously initiate communicative exchanges.

People using PECS are taught to approach and give a picture of a desired item to a communicative partner in exchange for that item. Using PECS, students learn to gain the attention of the communication partner in order to make a request. For more information please visit www.pecsusa.com.


What is Interactive Metronome?

Interactive Metronome (IM) is a computer-based training program that has been shown to improve attention, coordination and timing for individuals with sensory processing difficulties. IM combines principles of the music metronome with the power of a computer to precisely measure and improve human performance. It is the only research-based technology program that uses interactive exercises and a patented auditory guidance system to measure and improve one’s rhythm and timing. By improving this fundamental ability, the individual learns to plan, sequence and process information more effectively. Over the course of the treatment, patients learn to:
  • Focus and attend for longer periods of time
  • Increase physical endurance and stamina
  • Filter out internal and external distractions
  • Improve ability to monitor mental and physical actions as they are occurring
  • Progressively improve coordinated performance.
For more information, visit www.interactivemetronome.com.


Will My Insurance Cover Speech Therapy?

Many private health insurance companies do provide benefits for speech therapy services, while many others do not. You will need to check directly with your insurance company to determine what they will cover. You will also need to find out what their particular reimbursement rates are and percentages allowed for speech therapy.

Some insurance companies provide insurance coverage for evaluations only and do not make it clear their benefits are just for one evaluation session and not for ongoing therapy. Other companies may cover a certain number of sessions only. Therefore it is important that you check with your insurance company to find out what they will and will not cover. Periodically your insurance companies may also request documentation regarding speech therapy (e.g., daily notes or reports).

It is strongly suggested you request information in writing rather than receive just verbal information over the phone. While there is no direct insurance billing, an appropriate super bill will be provided to you at the end of each month for you to submit which contains the relevant diagnosis and treatment codes.

Please remember, your relationship with your insurance company is between you and your company, and it is your responsibility to determine what is needed by your insurance company. However, everything will be done to try and assist you.


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