Al­pha­bet SOUP

The A to Zs of de­tect­ing and cor­rect­ing speech and hear­ing anom­alies at al­most any age

201 Health - - Hearing And Speech Therapy - WRIT­TEN BY BROOKE PERRY

“The sig­nal pro­cess­ing of the hear­ing aids has be­come more so­phis­ti­cated, the sound qual­ity has im­proved thanks to tech­no­log­i­cal in­no­va­tions and the size of the de­vice has got­ten smaller.”

DR. KEN­NETH BOD­KIN HACK­EN­SACK UNIVER­SITY

MED­I­CAL CEN­TER

Me­lanie Feller, founder of Ber­gen County-based Al­pha­bet Soup Speech Con­sul­tants, doesn’t let time zones and her ge­o­graphic lo­ca­tion – cur­rently the Pa­cific North­west – get in the way of help­ing chil­dren over­come their speech and lan­guage chal­lenges. An ASHA-cer­ti­fied speech lan­guage pathol­o­gist and clin­i­cal su­per­vi­sor, Feller is on a spe­cial as­sign­ment with a school dis­trict in Ore­gon but carves out am­ple time for her tri-state area pa­tients through telether­apy.

There is a broad range of speech, lan­guage and hear­ing dis­or­ders, and each has its own char­ac­ter­is­tics and rec­om­mended ther­a­pies. Though they are of­ten in­ex­tri­ca­bly linked, they can dif­fer quite widely, Feller says. When a per­son is un­able to pro­duce sounds cor­rectly or flu­ently, or has prob­lems with his voice, for ex­am­ple, he has a speech dis­or­der. Those can in­clude dif­fi­culty pro­duc­ing sounds, ar­tic­u­la­tion is­sues and stut­ter­ing. In con­trast, when a per­son has trou­ble un­der­stand­ing oth­ers or shar­ing thoughts, ideas and feel­ings – called re­cep­tive and ex­pres­sive lan­guage – he has a lan­guage de­lay or dis­or­der.

Al­though Feller spe­cial­izes in pe­di­atrics, with an em­pha­sis on chil­dren from birth to 3 years old, she is cer­ti­fied to eval­u­ate and treat all man­ner of lan­guage delays and dis­or­ders, ar­tic­u­la­tion is­sues, dysarthria and apha­sia.

“I have a strong back­ground in pe­di­atric lan­guage de­vel­op­ment, speech is­sues with sen­sory deficits and speech deficits that re­late to an autism

spec­trum dis­or­der,” says Feller, who re­cently wrote “Seven Com­mon Myths of Child­hood Apraxia of Speech” for the on­line com­mu­nity Spe­cial Ed­u­ca­tion Ad­vi­sor.

A par­tic­u­lar area of ex­per­tise is child­hood apraxia of speech, also known as ver­bal apraxia, “a mo­tor dis­or­der that is fre­quently un­der-di­ag­nosed but, con­versely, can also be over-di­ag­nosed,” she says. “It be­comes more no­tice­able as a child be­gins to pro­duce two-syl­la­ble words and be­gins at­tempt­ing to put sim­ple words to­gether. There is also ac­quired apraxia of speech, but that may hap­pen af­ter a stroke or trau­matic brain in­jury. Many chil­dren who have it are passed off as just hav­ing a lan­guage de­lay, and many chil­dren who don’t have it wind up with ex­ces­sive, un­nec­es­sary speech ther­apy. The cor­rect di­ag­no­sis is es­sen­tial.”

A rel­a­tively new de­vel­op­ment, telether­apy is be­com­ing more and more pop­u­lar.

“It started with schools in ru­ral ar­eas and has ex­panded widely, thanks to its cost-ef­fi­ciency and ease on the pa­tient,” Feller says.

Al­though its ap­pli­ca­tion isn’t gen­er­ally ap­pro­pri­ate for chil­dren younger than 6, Feller has had great suc­cess treat­ing her el­e­men­tary- and mid­dleschool-age pa­tients through on­line video ses­sions.

Feller es­ti­mates there are sev­eral dozen types of speech and lan­guage delays and dis­or­ders, al­though ar­tic­u­la­tion, ex­pres­sion and re­cep­tive delays are the most com­mon. Treat­ment varies, de­pend­ing on the age of the pa­tient, but “it should al­ways be gen­tle, fun and en­gag­ing,” she says.

EARLY AC­TION

What­ever the anom­aly, speech pathol­o­gists agree that early in­ter­ven­tion is the key.

“You don’t want to do it when they are 6 and the speech pat­terns are imbed­ded in,” Feller says. “I like to get in and get out as quickly and ef­fi­ciently as pos­si­ble. Gen­er­ally speak­ing, the ear­lier you ad­dress it, the quicker the ther­apy will be.”

“There are lots of vari­ables in speech and lan­guage de­vel­op­ment in the early years,” says Chris­tine Keeler, a speech pathol­o­gist at St. Joseph’s Re­gional Med­i­cal Cen­ter in Pater­son. “But if a child has no sound play – no bab­bling – by the age of 1, it could sig­nal a prob­lem. Sim­i­larly, it is a con­cern when a child has very lit­tle vo­cab­u­lary de­vel­op­ment and is not be­gin­ning to put words to­gether by the age of two.”

Keeler also en­cour­ages par­ents to go with their gut feel­ing. “If the child’s de­vel­op­ment seems dif­fer­ent from his or her peers, it’s a warn­ing sign,” she says.

Other im­por­tant things to con­sider are a fam­ily his­tory of speech or lan­guage delays, chronic ear in­fec­tions (which can lead to pe­ri­ods of hear­ing loss and af­fect lan­guage de­vel­op­ment), and ge­netic or neu­ro­log­i­cal de­fects.

Typ­i­cally, once a speech or lan­guage dis­or­der is ad­dressed – a process that can range from months to years – a child’s be­hav­ior may im­prove.

“There are many be­hav­ioral is­sues that can stem from the frus­tra­tions re­lated to speech and lan­guage dif­fi­cul­ties,” Keeler says.

She ap­plauds Ber­gen County for pro­vid­ing a va­ri­ety of in­no­va­tive pro­grams for school-age chil­dren with speech and lan­guage dis­or­ders, in­clud­ing spe­cial­ized schools, par­ent sup­port groups, recre­ational pro­grams and so­cial skills groups.

Kather­ine Malmrose, a se­nior speech pathol­o­gist at En­gle­wood Hos­pi­tal and Med­i­cal Cen­ter, agrees.

“For chil­dren un­der the age of 3,” she says, “the New Jersey Early In­ter­ven­tion Sys­tem is a state-spon­sored pro­gram that sends a speech pathol­o­gist to a child’s home.”

One of the big­gest chal­lenges par­ents face is find­ing a cer­ti­fied spe­cial­ist.

“Through­out the area,” Malmrose says, “there is a high de­mand for the ser­vices of speech/lan­guage pathol­o­gists for preschool-age chil­dren. Most hos­pi­tal-based pe­di­atric out­pa­tients tran­si­tion to a speech pathol­o­gist at school by age 6 or 7.”

Even if a speech or lan­guage dis­or­der is not di­ag­nosed in its ear­li­est stages, Malmrose en­cour­ages par­ents to “first ap­proach your child’s teacher about how your child is func­tion­ing in the class­room and re­quest to have a Child Study Team eval­u­a­tion. Don’t lose hope. It’s never too late to seek out ser­vices.”

“It’s never too late to seek out ser­vices.”

KATHER­INE MALMROSE EN­GLE­WOOD HOS­PI­TAL MED­I­CAL CEN­TER

FAST AC­TION What­ever the anom­aly, speech pathol­o­gists agree that early in­ter­ven­tion is the key.

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