Information
What is Speech Apraxia?
- Apraxia is a motor-speech planning disorder that occurs when the brain has difficulty creating the muscle movements necessary to move the body parts involved in speech (lips, tongue, jaw).
Signs of Speech Apraxia
- In a young child:
- As an infant, the child did not babble or coo
- A late appearance of first words, sometimes missing sounds
- Trouble connecting sounds
- Long pauses in between words
- Frequently changes or omits difficult sounds to simpler sounds
- Possibility of eating trouble
- In an older child:
- An ability to understand language much better than their ability to speak it
- Speech is difficult to understand
- A difficulty in imitating speech, but imitated speech is clearer than spontaneous speech
- Groping of the lips, jaw, and tongue occur while attempting to produce a sound
- Other problems include:
- Fine motor movement difficulties
- Over-sensitivity (hypersensitivity) or under-sensitivity (hyposensitivity) of the mouth, making some foods difficult to eat or a dislike of teeth brushing
- Difficulty with word order or recalling words
What parts of learning does Speech Apraxia affect?
- Math, reading, and spelling can be difficult as a result of speech apraxia
- Extra practice on letter-sound linkage will strengthen reading and spelling skills
- Since written language is an extension of spoken language, a child with speech apraxia may find it difficult to assign meaning to words even when they are able to decode the letters
- Analyzing the structure of a word or phrase by breaking them down into syllables and sounds is difficult, and these difficulties can be translated to spelling as well (phonological awareness)
- Auditory Processing affects 16-20% of children
What is APD?
- APD refers to how the central nervous system uses auditory information
- It is a disconnect between how sounds are heard and how they are processed
- APD is NOT the result of higher-order cognitive, language, or related disorders
- However, makes it difficult for a child to process verbal instructions or even filter out background noises in the classroom
- There is a breakdown in receiving, remembering, understanding, and using auditory information
- Hearing ability is adequate
- The child’s ability to listen is impaired
Signs of APD
- Symptoms as if hearing loss is present:
- Understanding speech in noisy environments
- Discriminating (telling the difference between) similar-sounding speech sounds
- Mishearing information
- Problems attending to oral messages
- Problems following directions
- Often ask for repetition or clarification
- Distracted by background noises
- Difficulty in remembering what they hear
- Difficulties with spelling, reading and understanding information presented verbally
What parts of learning does APD Affect?
- Auditory processing determines language mastery, which impacts:
- Learning – listening accuracy and comprehension
- Reading – a language skill
- Social interaction
- Thinking – internal dialog uses language
How will Silva Clinic treat your child?
- Improve listening skills:
- Use listening and auditory comprehension programs:
- Lindamood Auditory Conceptualization
- LinguiSystems – Language processing
- Semel Auditory Processing Program
- Scientific Learning Fast ForWord and Reading Assistant Program
- Rewire auditory processing skills:
- Brain training can exercise auditory processing to build learning efficiency
What is Dysgraphia?
- the inability to write coherently and a causes trouble with written expression
- a cognitive brain-based process issue that is very common
- Working memory may play a role in Dysgraphia, as the child may have trouble with Orthographic Coding
- Orthographic Coding is the ability to store unfamiliar written words in working memory
- Preschool children: May be hesitant to write and draw and may say that they hate to color
- School-age children: May have messy handwriting (mix between print and cursive). They also may have trouble writing on a line and may print letters that are uneven in size and height.
- Teenagers: May write simple sentences that lack details. Their writing may have many more grammatical mistakes.
What happens with Dysgraphia?
- Experts are not sure what causes Dysgraphia, however some believe that one of the two writing processes tends to go off track with individuals with Dysgraphia:
- 1. Organizing information that is stored in memory
- 2. Getting words onto paper by handwriting or typing them
- Academic: Kids may fall behind in schoolwork because it takes them longer to write. Taking notes is a challenge. May get discourage and avoid writing assignments.
- Basic Life Skills: Fine motor skills may be weak. Individuals will find it hard to do everyday tasks.
- Social-emotional: Individual may feel frustrated or anxious about school and life challenges. Teachers and others may criticize them and label them as “lazy” or “sloppy”, which may add to their stress. Low self-esteem, frustration and communication problems may make it hard to socialize with other kids.
What conditions are related to Dysgraphia?
- Dyslexia
- Difficulty with reading and also make writing and spelling a challenge
- Language disorders
- Problems with written and spoken language
- Attention-deficit hyperactivity disorder (ADHD)
- Problems with attention, impulsivity and hyperactivity
- Dyspraxia
- A condition that causes poor physical coordination and motor skills which can affect writing and printing
Signs of Dysgraphia
Language
- May have difficulty understanding or using language (spoken or written) that make it difficult to listen, think, speak, read, write, spell or do math calculations
- Has trouble getting ideas down on paper quickly
- Has trouble understanding the rules of games
- Has a hard time following directions
- Loses train of thought
Visual-Spatial Difficulties
- Has trouble with space-discrimination and letter spacing
- Has trouble organizing word on the page from left to right
- Writes letter that go in all directions, and letters and words that run together on the page
- Has a hard time writing on a line and inside margins
- Has trouble reading maps, drawing or reproducing a shape
- Copies text slowly
Fine Motor Difficulties
- Has trouble holding a pencil correctly
- Show difficulty tracing, doing puzzles
- Has difficulty cutting food and tying shoes
- Is unable to use scissors well or to color inside the lines
- Holds his wrist, arm, body or paper in an awkward position when writing
Spelling Issues/Handwriting Issues
- Has a hard time understanding spelling rules
- Has trouble telling if a word is misspelled
- Can spell correctly orally by makes spelling errors in writing
- Spells words incorrectly and in may different ways
- Has trouble using spell-check
- Mixes upper- and lowercase letters
- Blends printing and cursive
- Has trouble reading his own writing
- Avoids writing
- Get a tired or cramped hand when writing
- Erases a lot
Grammar and Usage Problems
- Does not know how to use punctuation
- Overuses commas and mixes up verb tenses
- Does not start sentences with capital letter
- Does not write in complete sentences but writes in a list format
- Writes sentences that “run on forever”
Writing
- Handwriting tends to be messy
- Struggles with spelling
- Difficulty putting thoughts on paper, telling a story and may start in the middle
- Leaves out important facts and details, or provides too much information
- Assumes others know what he is talking about
- Uses vague descriptions
- Writes jumbled sentences
- Never gets to the point
- Is better at conveying ideas when speaking rather than writing
What is Dyslexia?
- Dyslexia is a chronic problem with reading
- Not just reading right to left or reversing words and letters
- It is a common learning difficulty
- Affects a large percentage of those labeled “learning disabled”
- 15% of U.S. population has significant difficulty learning to read
- People with dyslexia have issues with reading, writing, spelling, math and sometimes, music
- Dyslexia can be accompanied by, but not a result of:
- Lack of motivation
- Emotional or behavior problems
- Sensory impairment
Signs of Dyslexia
Language
- Had difficulty learning the alphabet, numbers and days of the week
- Trouble staying on topic
- Getting or staying interested in stories or books
- Understanding the relationship between speaker and listener
- Has trouble pronouncing words correctly
- Learning and correctly using new vocabulary words
- Has/had difficulty rhyming words
Reading
- Naming letters
- Recognizing letters and matching letters to sounds
- Learning to read
- Accurately blending letter sounds within words
- Recognizing and remembering sight words
- Remembering printed words
- Learning and remembering new vocabulary
- Skips words when reading
What happens with Dyslexia?
- Scientists have found that Dyslexia runs in families
- A gene has been identified that may be responsible for the condition
- People with dyslexia have difficulty breaking the letters of written words into the distinct sounds (Phonological Awareness)
- There is a different structural difference in people with dyslexia’s left hemisphere
- They compensate by using more of the front-brain (Broca’s Area) that is used for language processing and speech
- Brains of people with dyslexia show very little activity in areas known to be highly important in linking written forms of words with their phonetic components
- In order for people with dyslexia to read, they must develop alternative neurological pathways
Children with Dyslexia
- Tend to be:
- Visual
- Multidimensional thinkers who are intuitive
- Highly creative
- Excel at hands-on learning
- Shine in:
- Arts
- Creativity
- Design
- Computing
- Lateral thinking
What is expressive language difficulty?
- Children with expressive language difficulty have a hard time conveying or expressing information in speech, writing, sign language or gesture.
- Some children are late in reaching typical language milestones in the first three years, but eventually catch up to their peers. These children are commonly referred to as ‘late-talkers’. Children who continue to have difficulty with verbal expression may be diagnosed with expressive language disorder or another language impairment.
Symptoms of expressive language disorder
- Children have difficulties combining words to form accurate phrases and sentences. For example, a child may not use the correct form of the verb tense (they might say ‘I goed’ when they mean ‘I went’) or they might omit important grammatical words (they might say ‘I going’ when they mean ‘I am going’).
- They typically produce much shorter phrases and sentences than other children of the same age, and their vocabulary (the number of words they know and use) is smaller and more basic.
- Children with expressive language disorder are usually below the average level for their age in:
- putting words and sentences together to express thoughts and ideas
- recalling words
- using language appropriately in a variety of settings with different people (for example, at home, in school, with parents and teachers).
- Common symptoms include:
- making grammatical errors
- leaving out words and using poor or incomplete sentence structure (for example, ‘He going work’ instead of ‘He’s going to work’ and ‘I talk’ instead of ‘I can talk’)
- using noticeably fewer words and sentences than children of a similar age
- frequently having trouble finding the right words
- using non-specific vocabulary such as ‘this’ or ‘thing’
- using the wrong words in sentences or confusing meaning in sentences
- relying on standard phrases and limited content in speech
- sounding hesitant when attempting to converse
- repeating (or ‘echoing’) a speaker’s words
- being unable to come to the point, or talking ‘in circles’
- having problems with retelling a story or relaying information in an organized or cohesive way
- being unable to start or hold a conversation
What is Receptive Language?
- Receptive language refers to the ability to understand or comprehend language heard or read.
What is Receptive Language Difficulty?
- When an individual has difficulties with understanding what is heard or read.
- Most children with language comprehension usually begin before the age of four years old.
- The cause of Receptive Language Difficulty is unknown, but could be a number of factors working in combination, such as:
- genetic susceptibility
- child’s exposure to language
- general developmental and cognitive abilities
- Receptive Language Difficulty can often be associated with developmental disorders (Autism or Down Syndrome), brain injury (trauma), tumor or disease. Some children may just have difficulty with reception of language and this may be the only developmental problem they experience.
Symptoms of Receptive Language Disorder?
- Not seeming to listen when they are spoken to
- Appearing to lack interest when storybooks are read to them
- Inability to understand complicated sentences
- Inability to follow verbal instructions
- Parroting words or phrases of things that are said to them (echolalia)
- Language skills below the expected level for their age
- May show difficulty organizing their thoughts
- Taking a long time to respond to a question
- Naming a general category instead of a specific word (ex. Saying “food” instead of “cake”)
- Being quick to say “I don’t know” in response to a question
- Having difficulty understanding humor or idioms
How will SILVA Clinic treat your child?
- Use visual support to supplement auditorily presented information
- By using strategies such as visualizing
- Increase sustained effort by dong activities without distraction and hold effort long enough to get the task done
- Pair in social groups to provide engagement in reciprocal interactions with others (verbally or non-verbally) to:
- compromise with others
- improve eye contact
- be able to recognize and follow social norms
- Understand idioms, figurative language or humor
- Present new information in a multi-modality and context-rich environment to tap into the other senses
- Allow more “thinking time” to prevent unnecessary pressure during moments of difficulty
- Encourage your child to request repetition or help, rather than simply saying “I don’t know”
- Improve ability to understand and respond appropriately to questions
- Develop understanding of important and key concepts
What is Selective mutism?
Selective mutism (formerly known as elective mutism) usually happens during childhood. A child with selective mutism does not speak in certain situations, like at school, but speaks at other times, like at home or with friends. Selective mutism often starts before a child is 5 years old. It is usually first noticed when the child starts school.
What are some signs or symptoms of selective mutism?
- Consistent failure to speak in specific social situations (in which there is an expectation for speaking, such as at school) despite speaking in other situations.
- Not speaking interferes with school or work, or with social communication
- Lasts at least 1 month (not limited to the first month of school).
- Failure to speak is not due to a lack of knowledge of, or comfort, with the spoken language required in the social situation
- Not due to a communication disorder (e.g., stuttering). It does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or other psychotic disorder
May also show:
- Anxiety disorder (e.g., social phobia)
- Excessive shyness
- Fear of social embarrassment
- Social isolation and withdrawal
Treatment program may include the following:
- Stimulus fading: involve the child in a relaxed situation with someone they talk to freely, and then very gradually introduce a new person into the room
- Shaping: use a structured approach to reinforce all efforts by the child to communicate, (e.g., gestures, mouthing or whispering) until audible speech is achieved
- Self-modeling technique: have child watch videotapes of himself or herself performing the desired behavior (e.g. communicating effectively at home) to facilitate self-confidence and carry over this behavior into the classroom or setting where mutism occurs
If specific speech and language problems exist, the SLP will:
- Target problems that are making the mute behavior worse;
- Use role-play activities to help the child gain confidence speaking to different listeners in a variety of settings; and
- Help those children who do not speak because they feel their voice “sounds funny”
What other organizations have information on selective mutism?
This list is not exhaustive, and inclusion does not imply endorsement of the organization or the content of the Web site by ASHA.
- K12 Academics
- NYU Child Study Center
- Selective Mutism Foundation
- Selective Mutism and Childhood Anxiety Disorders Group
What is SPD?
- When there is a dysfunction in the way the nervous system receives messages from the senses and turns them into responses. Whether you are eating chicken nuggets, sitting in class listening to the teacher or coloring with a crayon, the successful completion of the activity requires processing sensation or sensory feedback.
Signs of SPD
- Difficulty staying in line
- Hugging too tightly
- Sensitive to touch
- Aversion to foods with certain textures
- Won’t wear clothes that feel hard or too long or too tight
- Clumsy
- Has a meltdown at parties or lunchroom
- Walks on toes
- Distractible
- Not reacting to someone calling him because he may have not processed it
What can you do to help?
- Set routines
- Break tasks down
- Use visuals such as calendars and lists for bedtime routines
- Use timer for commands he must meet
- Be consistent
- Apply appropriate consequences
- Supply a fidget bin to keep the child busy if he needs to be moving or aroused
- Have the child move before requiring the completion of a task
- Use sensory strategies to help arouse or calm the nervous system
What is Social Communication?
- Social communication is defined as the emergence of social interaction, social cognition, pragmatics (verbal and nonverbal)
- Social communication disorder may occur within the context of other conditions
- Autism spectrum disorder (ASD)
- Specific language impairment (SLI)
- Learning disabilities (LD)
- Language learning disabilities (LLD)
- Attention deficit hyperactivity disorder (ADHD)
- Traumatic brain injury (TBI)
- Family members, peers, and other communication partners may encounter barriers in their efforts to communicate and interact with individuals with social communication disorders
Signs of Social Communication Difficulties
- Problems with social interactions
- Speech style and context, rules for linguistic politeness
- Has difficulty with the following:
- Taking turns in conversation
- Introducing topics of conversation
- Staying on topic
- Rephrasing when misunderstood
- How to use verbal and nonverbal signs
- Giving background information to an unfamiliar listener
- Issues with social cognition
- Emotional competence, understanding emotions of self and others
- Has difficulty with the following:
- Talking differently to a baby than to an adult
- Speaking differently in a classroom than on a playground
- Problems with pragmatics
- Communicative intentions, body language, appropriate eye contact
- Has difficulty with the following:
- How close to stand to someone when speaking
- How to use facial expressions and appropriate eye contact
Challenges with social communication can result in
- Difficulties with shared enjoyment
- Social reciprocity in verbal and nonverbal interactions
- Play
- Peer interactions
- Comprehension of others’ intentions
- Emotional regulation
- Spoken and written narratives
Working Memory
- A deficit in working memory is a common feature of some learning disabilities and developmental disorders including dyslexia, ADHD, reading & mathematical difficulties, and specific language impairments.
What is Working Memory?
- Working memory is active and a “mental workspace” for temporarily storing and managing the information used to plan thoughts/actions, comprehend reading and math problems, and use current information in our everyday lives.
- Working memory impairment can present in an inability to complete daily activities and difficulty staying on task.
Signs of Working Memory Deficit
- Difficulties completing tasks that require a large amount of information
- Difficulty starting and following tasks with a complex set of directions
- Inattentive behavior due to losing their place during a task
- A tendency to lose track of belongings
What parts of learning does a Working Memory Deficit affect?
- A deficit in working memory impacts:
- Following directions to successfully complete a task
- Difficulty remembering incoming instruction information while trying to access how to actually do what is being asked
- Reading comprehension
- Being able to recognize words in sentences is difficult when visual working memory is impaired
- Mathematic ability
- Maintaining numeral information and accessing the necessary operation for the math problem is difficult, leaving children with less information to work with
How will Silva Clinic treat your child?
- Improve working memory function by:
- Presenting information in a variety of ways: show it, speak it, physically work with it
- Transferring information into other real-life situations
- Increasing information comprehension and retention
Tips to Boost Working Memory
- Teach Visualizing Skills. Encourage your child to create a picture of what he’s just read or heard.
- Have the Child Become the Teacher. Being able to explain how to do something involves making sense of information and mentally filing it.
- Suggest Games that Involve Visual Memory. Give your child a magazine page and ask him to circle all instances of the word “the” or the letter “a” in one minute [you can increase the difficulty of a word, depending on the child’s age and magazine topic].
- Play Card Games. Simple card games like Crazy Eights, Speed, Uno, Go Fish and War improve working memory in two ways. Your child has to keep the rules of the game in mind, but also has to remember what cards he has and which ones other people have played.
- Make Up Category Game. When words and ideas are put into categories, they’re easier to remember. Play a game in which you name as many animals [category] as you can think. One person begins by naming the first animal, then take turns naming the animals in the same exact order said by each person.
- Number Your Directions. Beginning a sentence with words like “I need you to do three things…”. This can help your child keep all of the different points in his head by numbering them by steps. You can do the same thing with other information, too, like shopping lists (”We need to buy these five items…”).
- Connect Emotion to Information. Processing information in as many ways as possible can help your child remember it. Help him connect feelings to what he’s trying to remember.
- Help Make Connections. Connections are the relationship between things. Finding ways to connect what your child is trying to remember with things he already knows can help him learn the new material.