Super Star Speech

Most people are somewhat familiar with speech therapy in the areas of articulation, stuttering, and language, and have at least a vague idea of what happens in speech therapy in these areas. Voice therapy, however, is an area of which many people are unaware.

A voice disorder is an “abnormal pitch, loudness, and/or vocal quality resulting from disordered laryngeal, respiratory and/or vocal tract functioning.” (Ramig & Verdolini, 1998)  This definition can cover a variety of abnormal qualities of the voice, but the most common voice disorder seen in children is hoarseness caused by vocal abuse, or misuse of the voice. Misuse of the voice, such as excessive yelling or hard vocal onset can cause swelling of the vocal cords or vocal nodules, resulting in a chronically  breathy, harsh,  or hoarse voice. In adults, vocal cord swelling and nodules are often seen in singers who overuse or abuse their voices. Many of us probably know someone with a continually hoarse or breathy voice, but may not have considered this as a voice disorder.

Any child with a suspected vocal disorder should be seen by an ENT because often medical/surgical treatment may be needed. However, speech (voice) therapy is often prescribed either instead of or in addition to medical treatment. In voice therapy, the child will learn how to use his voice in a healthy manner. This will help to reduce the occurrence of medically managed disorders  and can even allow damaged vocal cords to heal without surgery.

Voice therapy is likely to include:

1. Education about the speech mechanism and how it works–lungs, breath control, the role of the larynx and vocal cords in sound production.

2. Education about the correct ways to use the speech mechanism, including practice and experimentation with both positive and negative behaviors. The child’s specific habits will be discussed.

3. Practice in using the voice and breath in a relaxed manner. The child will often be taught to use a quieter and more breathy voice and an easy onset of speech utterances. These practices reduce trauma to the vocal cords and allow them to heal.

4. Environmental influences will be addressed, such as changes that might be made in the home or school to minimize the need for shouting or other vocal abuse.

More information about voice disorders and treatment, as well as referrals to certified speech-language-pathologists can be found at the American Speech-Language-Hearing Association (ASHA) website.

When you think of a speech/language disorder, what comes to your mind? A child who stutters? One who says, “wabbit” for “rabbit?”  An autistic child who has only a few words in his spoken vocabulary?  Speech-language pathologists work with a wide range of issues. These issues fall into several main categories:

Articulation

Articulation disorders include any type of speech sound errors.

Language

A language disorder is a deficit in receptive language (comprehension), expressive language (speaking), or both.  The child may have deficits in vocabulary, have difficulty formulating complete sentences or difficulty answering questions. He may exhibit poor grammar or misuse pronouns. His speech may sound fairly normal, but he may not use it appropriately in social situations.

Stuttering

A child (or adult) who stutters has difficulty with the fluency of his speech. He or she may repeat sounds or syllables. He may stretch out sounds at the beginning of words or “get stuck” when speaking. He may avoid social situations that he fears will cause him to stutter.  Many children exhibit short periods of disfluency between the ages of two and four as their language skills are rapidly increasing. This can be perfectly normal. If the symptoms are severe, or if the patterns continue beyond four, it may be indicative of a stuttering problem that needs speech therapy.

Voice Disorders

The most common voice disorder in children is a hoarseness caused by vocal abuse. This is typically seen in little boys that scream a lot. It is also common in singers. This vocal abuse can cause physical damage that requires surgery. A speech pathologist can work with the child to help him or her learn speaking methods that will be gentle on the vocal folds, allowing the damage to heal.

Another common voice issue with children is hyponasality or hypernasality. These are generally affected by cleft palate (repaired or unrepaired) or hearing impairment.

Speech-language pathologists also work with some issues that are not directly related to speech, such as swallowing disorders.

If you suspect that your child may have a problem in any of these areas, a speech and language assessment may be advisable. A speech pathologist can help determine whether your child’s speech behaviors need remediation, should be watched and rechecked later, or are within normal limits for his age.