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