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Pediatric Speech Therapy

Speech and language therapy services (ST) help children gain the speech and language skills that are needed to be successful communicators. ST also helps to improve literacy and social skills to promote learning and social success. Listed below are some common speech and language concerns that typically require skilled therapeutic intervention.

Speech Therapy


Autism, or autism spectrum disorder, refers to a complex developmental disability in which the child demonstrates repetitive patterns of behaviors and has challenges with social interaction skills. The symptoms are of varying degrees for each child but are present from early childhood and affect daily functioning.

Signs of Autism may include:

  • No words by 16 months, or meaningful phrases by 24 months of age
  • Any loss of speech, babbling or social skills at any age
  • Avoids eye contact and prefers to be alone
  • Has difficulty adapting to any changes in schedule or environment
  • Repeats the same actions or movements repeatedly, such as flapping hands
  • Lacks “pretend play,” has a lack of interest in interacting with others
  • Preoccupation with a narrow topic of interest, often involving numbers or symbols
  • Does not know how to connect with others, play, or make friends
  • Repeat words or phrases over and over (echolalia)
  • Gives unrelated answers to questions
  • Has unusual attachments to toys or strange objects such as keys, light switches, or rubber bands
  • Has trouble understanding other people's feelings or talking about their own feelings.
  • Takes what is said too literally (misses undertones of humor, irony, and sarcasm)

Late Talker

A late talker is a child typically between the ages of 18-30 months that is able to understand language but has a limited spoken vocabulary. The child has typical development in other developmental areas including play, motor, cognitive, and social skills.

Signs of a Late Talker may include:

  • Does not say first word by 12 months of age
  • Has less than 20 words by 18 months of age
  • Lack of combining words by 24 months
  • Has difficulty getting their wants and needs met
  • Gets frustrated when others do not understand him/her

Childhood Apraxia of Speech (CAS)

Childhood apraxia of speech is a motor speech disorder in which the brain has difficulties with the planning of movements needed for speech. This results in the child having difficulty saying sounds, syllables, and words.

Signs of Childhood Apraxia of Speech (CAS) may include:

  • Did not babble as an infant
  • Says only a few consonants or vowel sounds
  • Can understand language much better than he or she can talk
  • Difficulties combining sounds, often have pauses between sounds
  • Has more difficulty saying longer words or phrases clearly than shorter ones
  • Makes inconsistent sound errors

Oral Motor Skills

Oral motor skills are skills that include the awareness, strength, coordination, range of motion and endurance of the jaw, tongue, and lips needed for adequate speech production.

Signs of an Oral Motor Skills Disorder can include:

  • Drooling/low oral tone
  • Has trouble with coordinating mouth movements such as moving the tongue from side to side, smiling, frowning, and puckering the lips
  • Has a protruding tongue during speech production
  • Lack of precise speech production and rate of speech

Speech Sound Skills

Speech sound skills are the speech sounds and sound patterns that children produce to make words. A speech sound disorder occurs when children make mistakes in their speech that continue past a certain age or impact the ability for others to understand them.

Signs of a Speech Sound Disorder may include:

  • Difficulty producing sounds (articulation disorder) such as:
  • Substituting the “w” sound for the “r” sound (wed/red)
  • Distorting the “s” sound by producing “th” sound (thuper/super)
  • Difficulty with producing patterns of sounds, (phonological disorder) such as:
  • Lack of use of syllables (da/dinosaur)
  • Leaving off word endings (cu/cup)
  • Elimination of consonant blends (tar/star, wing/swing)

Language Skills

Language skills include a child’s ability to understand language (receptive language), communicate their thoughts and ideas (expressive language), and interact with others (social-pragmatic skills).

Signs of a Language Disorder may include:

  • Difficulties with following directions
  • Difficulties with answering/asking questions
  • Problems identifying/naming objects and pictures
  • Using correct words to form sentences, such as pronouns, “I”, “he”, “they”
  • Difficulties with expressing ideas verbally or in writing

Social Skills

Social skills are skills which allow children to meet their milestones through learning from peers and adults the appropriate ways to interact with their world. Engagement in social settings promotes positive relationships, play, attention, and self-regulation skills.

Delays in social skills may include the following:

  • Lack of eye contact
  • Difficulties with turn-taking in play
  • Becomes upset when “loses” a game
  • Unaware of others’ feelings and reading verbal and nonverbal social cues
  • Interrupt others frequently, have significant difficulty sharing
  • May not understand consequence of their actions

Literacy Skills

Literacy skills are the skills needed for children to be able to read and write. Literacy skills include the awareness of the sounds of language, the relationship between letters and sounds, and awareness of print. Literacy also includes vocabulary, comprehension, and spelling skills.

Literacy problems can include:

  • Difficulties learning nursery rhymes
  • Difficulties with naming letters and the sounds they make
  • Problems identifying the first sound in a word
  • Problems counting out syllables in words
  • Spelling difficulties
  • Problems telling a story with a beginning, a middle, and an end
  • Difficulties answering questions about information they have read

Fluency Skills/Stuttering

Fluency refers to the smoothness in the flow of sound, word, and sentences during normal speech production. Disfluency/Stuttering occurs when there is a disruption in the ability for a child to talk smoothly.

Signs of a Fluency/Stuttering disorder may include:

  • Frequent repetition of repeating sounds or words (I-I, that-that)
  • Prolongation of sounds (Mmmmm-my)
  • Pauses in speech
  • Struggle or tension behaviors such as eye blinking when producing words
  • Speech is mumbled or child talks fast
  • Avoids talking

Voice Disorders

A voice disorder occurs when the child has difficulties with the quality of their voice. This can include pitch, volume, and tone quality. Voice disorders are a medical condition and warrant a referral to an ENT (Ear, Nose and Throat) specialist.

Signs of a voice disorder may include:

  • Hoarseness, raspiness, or strain in the voice
  • Hoarseness/raspiness “has always been there” – parent feels it may be the child’s “natural” voice
  • Hoarseness or intermittent voice loss during or after sports, shouting, singing
  • Child’s voice makes him/her sound older
  • Voice sounds different (lower/higher) than most children of similar age

Augmentative and Alternative Communication (AAC)

Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. This may involve pointing, using pictures, sign language, or using an AAC device. Many times, AAC can be a short-term option to support communication skills and model speech and language skills.

Signs that AAC may be beneficial for child:

  • Not able to communicate effectively through verbalizations
  • Severe expressive communication disorder
  • Difficulty getting wants and needs met
  • Problems initiating interactions with others
  • Gets frustrated when unable to communicate with others


New Patient Intake

Speech Therapy Case History

Parent Questionnaire for Speech Fluency/Stuttering

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