Big Voices in Little People: Understanding Vocal Nodules in Children

What Are Vocal Nodules?

  • Vocal nodules, often called singer’s nodules, are callus-like bumps on the vocal folds.
  • Caused by repeated misuse or overuse of the voice, they prevent the vocal folds from closing completely when producing sound.
  • Unlike vocal polyps (blister-like growths that can form from a single event, e.g., yelling), nodules develop gradually over time.
  • Their size can range from a pinhead to a split pea and, if untreated, can lead to further vocal strain and damage.

Common Causes of Vocal Nodules

  • Vocal Abuse Behaviors in Children:
    • Excessive talking for extended periods.
    • Loud vocalizations like shouting, screaming, whining, cheering, or crying
    • Frequent coughing or throat clearing
    • Strained vocal sounds (e.g., imitating vehicles, animals, or superheroes)
  • Vocal Misuse and Other Contributing Factors:
    • Poor breath support during speaking or singing.
    • Straining the voice or using incorrect pitch or volume outside of one’s natural range
  • Environmental and health factors:
    • Chronic upper respiratory infections or allergies
    • Acid reflux
    • Exposure to second-hand smoke or air pollution, which exacerbates swelling and inflammation

Healthy Vocal Practices and Alternatives

To reduce strain and help nodules heal, children should follow these guidelines:

  • Avoid loud talking
    • Family members should take turns speaking so that the child does not need to talk over other members in the family to be heard. Also, the child should walk closer to the listener instead of yelling from a distance.
  • No screaming when angry
    • Offer alternatives like punching a pillow or tearing paper.
  • Stop imitating loud sounds (e.g., animals, motors, superheroes)
    • Use a gentle humming sound instead.
  • Refrain from talking over background noise
    • Turn off TVs or radios during conversations to avoid shouting.
  • Replace throat clearing with a hard swallow
    • This clears secretions without damaging the vocal folds.
  • Pause singing for now
    • Encourage playing a musical instrument or using a whistle instead.
  • Stay hydrated
    • Drink plenty of water and avoid caffeinated drinks. Caffeine causes dehydration, making vocal folds more prone to injury.

Encouraging Compliance

  • Positive reinforcement works best. Use tools like sticker charts to track progress.
  • Offer gentle reminders rather than nagging if rules are broken.

By adopting these practices with consistent effort and patience, vocal nodules will typically heal over time. Your speech-language pathologist can assist your child in regaining healthy vocal habits and preventing future issues.

By Kathleen Winger, M.S., CCC-SLP

Great Games for Gifts from a Speech Therapist

…and fun ways to target speech and language

As a speech therapist, we always love to incorporate fun in games into sessions. It’s the best way to engage kids in therapy while also targeting their goals to improve speech and language. Here are some favorites and goals you can target with the game! 

Pop the Pig (ages 4+, 2-6 players) 

  • Turn taking
  • Two step directions (e.g., roll the dice, then feed the pig; feed the pig, then press his head)
  • Speech sounds (e.g., say a word before every turn)
  • Simple “what” questions (e.g., what color did you get?; what number is it?)

Feed the Woozle (ages 3-6, 2-5 players)  

  • Following directions 
  • R words in phrases (e.g., chocolate covered flies, moldy macaroni, spider egg pudding)
  • L words in phrases (e.g., liverwurst popsicle, lemon flavored underwear, iced garlic
  • S words in phrases (e.g., sugar coated sardines, baseball sandwich, soggy sausage)

Zingo (ages 4+, 2-6 players)  

  • Naming objects in pictures
  • Turn taking 
  • Answering yes/no questions for facts (e.g., do you have a tree?)

Tell Tale (ages 5+, 1-8 players)  

  • Using story telling elements 
  • Maintaining conversation topic
  • Answering wh- questions
  • Retelling stories

I Spy Eagle Eye (ages 5+)  

  • SP blends in phrases (e.g., I spy…)
  • Naming objects in pictures 
  • Where questions (e.g., where is it?)

By Jess Wi MS, CCC-SLP

The Frightful Facility

A parody of Disney’s Haunted Mansion ride attraction

When asking for candy is an appropriate behavior
And fun and colorful doors decorate the halls
When you get a pumpkin sticker
Because your speech therapist said you did well
That is the time when kids are learning
Practicing their speech sounds in “ghoul”, “witch”, and “fright”.


Welcome, SmallTalk families, to our Halloween celebration. I am your speech therapist. Well,
your child’s speech therapist. Kindly reschedule any missed appointments, and call ahead for
planned absences. Please switch to a virtual session if you’re sick.


Our lesson begins here on this blogpost, where you see lists of words for some of our
frequently-targeted speech goals.


Your puzzled facial expression betrays your sense of skepticism, almost as though you think
this might be a waste of your time. Is practicing just five target words daily actually useful? Or is
it just more busywork? And consider this interesting observation: your child is motivated to say
these ghostly words this time of year…which offers you this additional challenge: to think of
more spine-chilling Halloween words! Of course, there’s always Halloween word lists published
online.


Did you know that when practicing speech sounds, repeating target words is often more
effective than practicing a long list of new words? Here are lists of some of our commonly-
targeted speech sounds to incorporate into your regular speech practice routine at home. If you
don’t see a list appropriate to your child’s speech sound goals, try making your own!

Final /l/
candle
chill
ghoul
howl
caramel apple


Initial /k/
costume
cauldron
candy corn
coffin
cobweb


Medial K
Pumpkin
decay
licorice
Chocolate
rock candy


Final K
Shriek
Spook
Panic
Cloak
Magic


SK blends
skeleton
skull
scarecrow
scream
Skittles


SP blends
spooky
spider
spell
spirit
Spice Drops


SN blends
snack
Snickers
snake
Sneak
sneer

SM blends
smash
Smarties
smoke
smelly
smile


SW blends
swarm
swoop
swamp
Swedish Fish
SweeTARTS


SL blends
slime
slug
slash
slay
slab


ST blends
street
glowstick
sticky
stem
Starburst


Medial ST blends
Costume
Frankenstein
Gravestone
Haystack
monster


Initial R
rat
raven
robe
robot
Reece’s


R Blends
Creepy
Broom
Frankenstein
Dracula
Graveyard

“AR”
dark
carve
larva
Mars bar
hard candy


“ER”
October thirty-first
spider
wizard
Butterfinger
Hershey


“AIR”
werewolf
fairy
eclair
gummy bears
Ghirardelli


“IRE”
vampire
dire
conspire
bonfire
entire


“EAR”
fear
appear
hero
3 Musketeers
Zero


“OR”
trick-or-treat
decorate
candy corn
Lindor
Oreo

Happy Halloween from all of your friends at SmallTalk!

By Kathleen Winger, M.S., CCC-SLP

OMG, it’s an OMD!

What is an oral motor disorder?

Difficulty with the function of the muscles and structures involved in speech and feeding

May be the result of:

  • A physical, structural issue such as cleft palate or tongue-tie
  • Prolonged pacifier or sippy cup use, which interferes with natural oral development
  • Injury
  • Fetal Alcohol Syndrome
  • A neurological condition such as cerebral palsy and Down syndrome which includes issues with muscle tone, resulting in dysarthria

Signs of an oral motor disorder include:

  • Droopy or “long” face with mouth that frequently hangs open
  • Drooling past the age of 18 months
  • Speech which is difficult to understand
  • Lisped speech
  • Difficulty sticking out tongue or moving it from side to side
  • Difficulty producing certain consonants or deleting them past age 3
  • Refusal to eat certain foods, especially meat or other tough foods to chew
  • Frequent gagging when eating
  • Open-mouth breathing (may be only when sleeping) and/or snoring

Key components affected by oral motor disorders include:

  • Articulation:  Difficulty in coordinating and controlling the movements of the lips, tongue, and jaw which can lead to reduced intelligibility
  • Chewing:  Challenges chewing and manipulating food in the mouth
  • Swallowing: Difficulty with coordinated and sequential movements required for safe and effective swallowing
  • Facial Expression:  Limited control over facial muscles, impacting facial expressions and non-verbal communication

If you suspect that your child may have an oral motor disorder which is impacting articulation and/or feeding, it is important to seek treatment with a speech-language pathologist and/or occupational therapist.  We are here to help!

By Kathleen Winger, M.S., CCC-SLP

Summer Themed Activities for Speech and OT 

Summer is finally here! We are excited to share some summer-themed activities you can enjoy with your child. These activities offer therapeutic benefits, helping your child work toward their goals while still enjoying the summer season. 

Ice Cube Animal Rescue 

To do this activity, put little plastic animals in an ice cube tray, fill it with water, and freeze it. Gather some tools found in your home to break the ice and rescue the animals. For example, use a small hammer to break open the ice, tongs/tweezers to pull the animals out, or an eye dropper with warm water to melt the ice. Use the tools to break and melt the ice more quickly. Once all of the ice melts, you have rescued the animals! 

To target language goals, talk about the animals using descriptive language. Describe the animal’s appearance, where they live, and the sounds they make. Use language like, “Oh no, we need to rescue the animals,” “The animals are stuck,”  “It feels very cold,” “This animal is really fast,” “That animal has cool stripes,” etc. 

To target occupational therapy goals, use a variety of tools, as mentioned above, to work on hand strengthening, force modulation, and grasping patterns, which will contribute to your child’s overall fine motor development.

Use your imagination with this activity! If you do not have little animals, you can freeze other mini objects or toys, little craft pom-poms, etc.

Fun with Chalk 

Use sidewalk chalk to draw pictures to target both speech and language goals! Draw pictures and practice speech sounds your child works on in speech therapy. For example, if your child is working on “s,” draw a sun, a bus, an octopus, ice cream, etc. Play pictionary! Take turns drawing pictures and guessing the drawing. Use language to describe colors, patterns, etc. Drawing with chalk is great for developing fine motor and visual motor skills as well! 

Make a sensory path! Use sidewalk chalk to create a series of guided movements to challenge your child’s gross motor skills while providing regulating sensory input. These movements could include anything that involves running, jumping, skipping, spinning, or balancing. 

For example, start with a two-foot bunny hop, then walk along a curved line, trying to maintain balance. From there, do an animal walk, such as a bear walk or frog jumps, followed by a hopscotch sequence. Then, balance on one foot for 10 seconds and end with a race to the finish line! Get more inspiration on Pinterest or Instagram!

For an added challenge, have your child create their own sensory path to work on executive functioning skills such as planning and organization. See how creative they can get!

Scavenger hunt

Get outside and look for items in nature that are a specific color, texture and/or size! For example, look for something pink, yellow, bumpy, smooth, crunchy, etc. This simple activity can target skills such as describing, following directions, and increasing vocabulary. It is also great for tactile sensory processing, for example, exploring and discriminating between textures. Scavenger hunts can also help your child develop visual perceptual skills, such as finding differences between items and scanning through a busy background to locate an item. 

By Nathalie-Rose Malecot, MS CCC-SLP and Jamie Carlson, OTR/L

How SLPs Make a Difference

Raising awareness, changing lives

May is national speech, language and hearing month – a time to celebrate and acknowledge the profound influence and dedication of speech-language pathologists (SLPs). We are so grateful to all of our SLPs for their unyielding commitment, and the remarkable impact they make on the lives of so many families. Here are some of the areas that SLPs in pediatrics focus on:  

  • Speech sounds—A child may substitute one sound for another, leave sounds out, add sounds, or change a sound. It may be hard for others to understand them.
  • Spoken and written language—A child may have trouble understanding what others are communicating to them and may have problems explaining what they are thinking or feeling. They may also have difficulty with reading and writing.
  • Stuttering (fluency)—A child may get stuck on certain sounds or words. They also may have tension or negative feelings about talking. This tension can get in the way of how they talk to others.
  • Cognition—A child may have problems with long- or short-term memory, attention, problem solving, or organization.
  • Social communication—A child may have difficulty understanding how others feel or following the rules of conversation, such as knowing how to take turns.
  • Voice—A child may lose their voice frequently or use a hoarse or breathy voice. They may also speak with strain or effort.
  • Augmentative and alternative communication—A child may need to find other ways to communicate besides talking, such as using a picture board or a speech-generating device.
  • Feeding and swallowing—Problems with feeding and swallowing can make it hard for a child to participate in their school day. Speech-language pathologists help students eat and drink safely during the school day so that they have the energy to learn.

At SmallTalk, we asked some of our SLPs why they love their field. They responded: 

“I love being a speech-language pathologist because….”

  • “I get to help kids become more confident with communicating.” – Miss Sara
  • “I get to play all of my favorite games. My childhood spirit will never die!” – Miss Amanda
  • “I get to work hands-on with families and see the difference we make first-hand” – Miss Hannah

By Julia Navarra M.A. CCC-SLP

Valentine’s Day Activities for Speech and OT

As Valentine’s Day approaches, we’re excited to share some heartwarming and therapeutic activities that not only celebrate the season of love but also contribute to the growth and development of our clients. Join us on this journey of combining affection with effective therapy!

Speech and Language Therapy

Valentine’s Day provides a unique opportunity to explore the language of love. Speech and language therapy can be both educational and enjoyable as we engage our clients in activities that focus on expressing emotions, social interactions, and building meaningful connections through communication.

Activity Ideas:

  • Love Letter Writing: Encourage clients to express their feelings by writing or dictating love letters. This activity enhances language skills and emotional expression. 
  • Conversation Hearts Challenge: Use conversation hearts candy with words or phrases related to communication goals. Clients can create sentences or engage in conversations using these sweet treats.

OT- Sensory

Occupational therapy often involves sensory activities that stimulate and enhance sensory processing. This Valentine’s Day, let’s explore sensory-rich experiences that promote engagement and development.

Activity Ideas:

  • Scented Sensory Bins: Create sensory bins with Valentine-themed scents like roses, chocolate, or strawberries. Clients can explore different textures and engage their senses.
  • Heart-shaped Stress Balls: Make heart-shaped stress balls filled with different textures to provide tactile stimulation. This activity is great for hand strength and stress relief.

OT- Fine Motor Fun

Fine motor skills are crucial for daily activities, and what better way to practice than with Valentine-themed fine motor activities?

Activity Ideas:

  • Valentine’s Day Crafts: Engage clients in crafting activities like making heart-shaped cards, cutting out paper hearts, or creating tactile crafts. This enhances fine motor coordination.
  • Cupid’s Arrow Game: Use a bow and arrow game to target various objects. This activity improves hand-eye coordination and fine motor precision.

Valentine’s Day is not just about chocolates and flowers; it’s about fostering growth, connection, and joy through therapeutic activities. We invite you to join us in celebrating the language of love and the development of essential skills that make every day special for our clients. Happy Valentine’s Day!

By Amy Rawlings, MA, CCC-SLP

Tips for Stuttering and the Holidays

For many people, October-December is the most wonderful time of the year filled with good food and company. But for others, this time of the year can be busy and stressful, overfilling our internal buckets. This bucket analogy is frequently used by stuttering specialist, Dr. J. Scott Yaruss, and illustrates the idea that many factors can affect stuttering, including child factors (genetics, temperament), interpersonal stressors (life changes, fast-paced lifestyle), and communicative stressors (competition for talking time, frequent interruptions). We like to encourage families to try to lower the level of the bucket, since we all communicate best under the least amount of stress and pressure.


Here are some practical ways to try to pour out some of the bucket’s contents when it gets filled
with the uncontrollable holiday bustle:

1. Include some space and time for quiet as a family

When our homes are filled with family and friends, especially those we haven’t seen in a while, conversations can be found at every corner. This can take a toll on those who stutter who might not enjoy, and may even anxiously anticipate, constantly conversing. Before a big gathering…

  • Do: Enjoy leisure activities together that don’t require as much talking like coloring, reading, puzzles, legos, play-doh, etc.
  • Try to avoid: Activities that encourage pressure, speed, and are verbally taxing such as competitive board games.

2. Keep the joy, lower the excitement

Children may have a more difficult time speaking when worked up in either a positive or negative way. Still speak about the great time that will be had during the holidays, but try to limit ramping up emotions and building a lot of anticipation.

  • Do: Speak positively “I love getting to try so many different kinds of candy on Halloween.”
  • Try to avoid: Speaking to heighten emotions “Aren’t you excited to show off your new costume?!”

3. Practice stressful areas

You know your child best, and when and where they communicate their best. You know if your child is a perfectionist, and can anticipate that when other children come over, win games and take toys, yours may be very thrown off. Or, you may know your child to be on the shyer side making trick-or-treating a difficult activity. Practicing these scenarios with people that are familiar to the child and in a controlled environment can help transfer readiness and emotional preparedness for the more spontaneous encounters.

  • Do: Talk about emotions! Encourage losing and still having fun. Talk about how nice it feels when your child shares a toy with you. Practice knocking on bedroom doors and saying “trick or treat!”. Have your child switch roles with you in each scenario to be the winner/loser, sharer/taker, etc.
  • Try to avoid: Rewarding only winning and reacting negatively when things don’t go perfectly.

4. Encourage and advocate

Our children may be meeting visiting guests for the first time, who may bring up that they stutter. This is a great opportunity to advocate for your child and to address the situation head on. Speaking openly and positively about stuttering helps children feel empowered to be themselves, and reduces the chance of children developing avoidance behaviors.

  • Do: Learn about stuttering with your child (myths/facts, famous people who stutter, etc.) to build their confidence and eliminate negative associated feelings about stuttering. Acknowledge the stutter, acknowledge that he/she/they is/are trying to find strategies to speak smoother through therapy, talk about your child’s strengths.
  • Try to avoid: Avoiding the conversation of stuttering and using vocabulary that portrays it as negative such as “fixing” or “correcting” it.

Feel free to reach out to your Speech-Language Pathologist for additional suggestions relevant to your child and their plan of care. For more stuttering related-resources, check out stutteringtherapyresources.com.

By Mariel Manuel, MS, CCC-SLP

The Power of Play

How to Use Play to Help Children Learn and Grow

To the untrained eye, it may look like a speech therapist is just playing with your child.  You might wonder when the actual learning is going to start with worksheets, flashcards or drills.  But the reality is that children tend to learn more from play than through structured, adult directed activities.

Play can help to increase:

  • social-emotional skills
  • cognitive skills
  • self-regulation
  • language skills

It can promote:

  • problem solving
  • collaboration
  • creativity

The mutual joy and shared connection during play can decrease stress and increase the bond between the people involved. 

When I meet a child during their first speech session with me, it is my job to get to know that child, build rapport, and figure out the best way to help them meet their speech goals.  If I were to make them sit at a table while I proceeded to lecture them and drill them for 25 minutes, some older children might do okay, but most younger children would probably either protest or not pay attention to me because I am not creating any active engagement.  My top priority during my first few sessions with a child is to create trust and connection.  Without that, it is difficult to teach anything.  I do this by finding an activity that brings them joy:  bubbles, tickles, cause/effect toys, pretend play, board games, etc..  Depending on the child’s age and abilities, there are certain activities I know that child will probably enjoy based on my experience.  I start with those, and if they do not work, I try alternatives until I find something that creates joy and engagement.  It is only then that I begin to integrate the child’s speech goals into the play to facilitate learning and growth.  Let’s talk about the different types of play and how you can use them with your child at home to help expand their language skills. 

Types of Play:

1. Physical/Rough and Tumble Play 

Playing on the playground, tickle or wrestling games, pillow fights, lifting kids in the air, hanging them upside-down, using movement or dancing with music, etc.

I personally find this type of play especially effective with children who are difficult to engage (prefer to play alone doing their own thing) or who are sensory seekers (love climbing, jumping off things, crashing into pillows, etc.).   I only do this with children who enjoy this type of play and pay attention to their body language that indicates whether they are giving me permission to tickle them or hang them upside-down.  If a child is turning away or backing away in a non-playful manner, I stop, making sure to respect their boundaries to keep that aspect of trust.  And of course, I always play these games as safely as possible.   

Examples of using this type of play to facilitate language:

  • Hold your hands out like you are about to tickle the child and wait for them to communicate they want you to proceed either through a gesture such as moving closer to you or a word or phrase such as “tickle” or “get me”.
  • Incorporating music- singing a song where there is a part that you tickle them, squeeze them, hang them upside-down, etc.  One I use while bouncing the child on my knees is “horsy, horsy, go to town.  Better watch out or your horse will fall…… DOWN” then hang the child upside-down.  You can wait for the child to say, “down” or gesture they want you to hang them upside down by leaning back. 
  • On the playground while pushing a child in a swing, you can hold the swing/child up so they are about to swing forward or backward (make sure the child is secure) and say, “ready…set…” and see if they can say “go” (or sign or gesture) to indicate they want you to let go.

2. Using Cause/Effect Toys

These toys are simple in that when you push a button, wind them up, etc. they do something fun.  Some examples are wind-up toys, spinning tops, ball poppers, car ramps, bubbles, etc.  These toys are great to capture a child’s attention and increase engagement.  These kinds of toys work better to create engagement when the child needs you to help them operate it.  For example, if they can’t wind up the wind-up toys on their own or they don’t know how to blow the bubbles.  In this case, they will need to communicate with you every time they want you to activate the toy. 

Examples of using this type of play to facilitate speech and language:

  • Using “ready set….” and waiting for the child to say “go” for you to activate the toy, blow the bubbles, etc.  If the child is not saying “go” you can model sign language or model a gesture, then wait for them to use it to communicate they want you to activate the toy.
  • Model describing or action words:  while popping bubbles say, “pop…pop” every time you pop a bubble.  While the top is spinning say, “spin!”.  Always use lots of excitement in your voice to increase attention and engagement.

3. Pretend Play

Pretend play can be done with toys such as people, animal figures/dolls, or vehicles becoming the “characters” in play or the child or adult themselves can be a character such as when playing dress up, playing school, restaurant, etc.  Pretend play creates a safe container for children to explore different situations and emotions and is a great way to learn language.  The first pretend play skills to develop in toddlers usually involve pretending to feed a doll or stuffed animal, or pretending to put them to sleep, or alternatively for the child to pretend to eat pretend food or pretend to sleep.  They might also push a car or fly a plane while making sound effects.  As they gain more vocabulary, they can make the characters talk and have conversations with each other and act out different situations. 

 Examples of using this type of play to facilitate speech and language:

  • As a parent, while engaging in pretend play with your child, it is common to feel the need to ask your child a lot of questions.  For example, “where are they going”, “what are they doing?”, “what color is that?”, etc.  However, questions like this take the child out of the fun and magic they are creating with their pretend world into an interaction where their parent is quizzing or drilling them instead.  It is much more beneficial for the child to have the parent join them in this pretend world by grabbing a toy and also pretending to be a character and interacting with that child’s character.  Modeling language while engaging in pretend play is a great way to teach your child.  For example, if you want to teach your child what to do when you go to someone’s house, you could do this using dolls and a doll house.  Your character could knock on the door, and another character inside the house could say, “who is it?”, and the one outside could say, “it’s Billy”, and then your character inside could open the door and say, “hi!  Come in!”.  Even if your child is not talking yet, you can have your characters talk to their characters to model appropriate language for the situation. 
  • Children also LOVE to experiment with emotions within pretend play.  It almost never fails that when I make my character fall down and cry, the child smiles and indicates they want me to do it again.  Not because they like seeing people cry, but because I am showing them a safe way to play with difficult emotions such as sadness and anger.  In real life, when a child is feeling those emotions, they are in a state of distress which shuts down the logical brain and makes learning pretty much impossible.  By pretending to have characters outside of themselves feeling these emotions, they can play with the cause and effects of emotions, and as a parent you can model ways to deal with them.  For example, when my character falls down and starts crying, I can have another character walk up to them and say, “are you okay?”, and pretend to help them or give them a hug.  This helps with emotional regulation and using appropriate language for emotionally charged real life situations.  These are just a couple examples of the things you can teach children through modeling within pretend play.  The possibilities are as endless as your imagination! 

4. Board Games/Structured Games

These are games that have a set of rules.  It can be a physical game like a sport, or tag, or a board game that comes with a set of written instructions (note:  you do not always have to play with a game according to the given instructions.  You can always tailor these rules to accommodate your child’s abilities and things you want to teach them). 

Examples of using this type of play to facilitate speech and language:

  •  If you want to teach your child cooperation, collaboration, and negotiation skills, you can come up with the rules of the game together.  You can work on skills that these games address directly- such as working on describing skills with games like Guess Who or Headbands in which you must describe a person or noun so the other person can guess who or what you are describing.  Or you can have the child practice a skill before they take a turn in the game (i.e., before you roll the dice, make a sentence about this picture or tell me the opposite of up). 
  • The type of play you choose to engage in with your child should depend on their age and interests.  Watch your child when they play by themselves and see what they tend to gravitate towards and see if you can join them in a playful and fun way to help them learn and grow.

Side Note About Media and Electronic Toys:

Some TV shows, YouTube videos, and electronic toys market themselves as educational and lead parents to believe that if you put your child in front of the TV or hand them the toy and go do your own thing, they will learn something.  But the reality is that no television show or fancy toy is a substitute for engagement with a real live person.  Children learn best with adults who are present and give their full attention.  Speech and Language skills are particularly all about communication, human interaction, and connection, which is best achieved through your presence. 

Playing with your child will not only help them to learn and grow but will also increase your connection to your child and increase joy and decrease stress for both of you.  So, find your inner child and have some fun together!!!

By Hilary Dickey, MS, CCC-SLP

What in the World is Childhood Apraxia of Speech?

What is CAS?

Childhood Apraxia of Speech, or CAS for short, is a speech disorder that results in children being unable to form the words they intend to, even though they know what they want to say.  It is associated with very low intelligibility and is arguably one of the most frustrating speech challenges kiddos and their parents face.  CAS is also sometimes also called Developmental Apraxia, but unlike this name suggests, children do not often improve spontaneously; skilled speech therapy is required to treat it.

Origins of CAS

CAS is estimated to occur in only 1 or 2 of every 1,000 children in America.  Unlike acquired apraxia, which is most often seen in adults who have had strokes or traumatic brain injury, the cause of CAS is unknown.  Rarely are there any observable differences in the brain, though CAS can sometimes occur as a symptom of a syndrome, genetic disorder, or metabolic condition (e.g., galactosemia).  CAS is known to exist at higher rates in children who have other neurodevelopmental conditions such as ADHD, Autism, and epilepsy.

Mechanics of CAS

The act of speech is a series of incredibly precise fine motor skills that requires very refined movement of the lips, tongue, and jaw.  If the neurological planning of these movements is disrupted, as in the case of CAS, low intelligibility results.  Recent research indicates that children with CAS may have difficulties with sensory feedback loops required to learn and judge the accuracy of speech. Sensory feedback is important for the subliminal knowledge of proximity between speech structures (e.g., lips, tongue, teeth, palate) during speech, which plays a role in execution of movement.

What CAS is Not

CAS does not involve physical issues with the mouth, such as muscle weakness or muscle coordination difficulties. It also does not involve the brain itself, but rather nerve pathways responsible for planning speech movements.  

CAS vs Phonological Disorder

Many times, parents of children who exhibit very low intelligibility research causes online and conclude that Childhood Apraxia of Speech is to blame for their child’s unintelligible speech.  However, children with severe phonological disorders can be just as unintelligible, or even more so, than children with CAS.  Your speech-language pathologist will need to analyze your child’s speech to discern whether distinct error patterns (e.g., deleting or substituting certain sounds in various word positions) are present, as in a phonological disorder, or whether the errors are inconsistent or random, as in CAS.  CAS and phonological disorders can also coexist.

Errors related to CAS often change as a word is repeated, and these errors cannot be grouped into categories, unlike phonological errors.  Other characteristics of CAS which distinguish it from a severe phonological disorder include errors on vowels, prosodic errors (relating to stress and intonation), increased errors as utterance length increases, and increased errors in spontaneous speech over rehearsed speech.  When your child’s speech is evaluated, your speech-language pathologist will provide an appropriate diagnosis in order to follow with appropriate treatment methods.

By Kathleen Winger MS CCC-SLP

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