About

Assessment

When a child is referred to see a Speech Pathologist, it is typically because the parent or another important person in that child’s life (e.g. a relative or a teacher) is concerned about the child’s communication skills. A comprehensive assessment allows the speech pathologist to gain insight into the child’s strengths, interests and any areas requiring further development. Each assessment is individualised based on: the child’s age; linguistic background; any previous diagnoses; background history and the concerns, values and priorities of the child and their family. An assessment involves more than just ‘testing’ the child. We collect valuable information about the child through interviews, questionnaires, observations and rating scales, to name a few methods.

Therapy

What?

We can support your child with their language, speech and literacy skills. We develop therapy goals in collaboration with you, and where possible, with your child.

When?

Depending on your child’s goals and needs, therapy can be provided on a weekly or fortnightly basis.

How long?

Sessions are typically 30 minutes, 45 minutes or 60 minutes in length. We typically offer 10-week-long therapy blocks. At the end of the block, we review your child’s progress and we discuss whether another block of therapy would benefit your child.

Where?

We work with children predominantly in the school or preschool setting. We have limited availability for home visits. We also offer services via telehealth.

What does it take to read and write?

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Children typically learn and develop the skills of reading, writing and spelling during their first years of primary school. However, we know that children need exposure to books and daily shared reading with an adult from even as babies to have the best start possible.

In the later years of primary school and beyond, the emphasis changes from learning to read to reading to learn.

Learning to read and write is no mean feat. Let’s look more closely to see what reading and writing involves.

What does it take to read?

Accurate and fluent reading requires the following skills and knowledge:

  1. Phonemic awareness – this refers to the knowledge that words are made up of sounds. It also refers to the ability to identify various sounds in a given word (e.g. the first, last, and middle sound) and to manipulate sounds (e.g. if you take the /s/ sound off “spin” you get “pin”). Excellent phonemic awareness skills are essential for excellent literacy skills.
  2. Letter identification – this is the ability to identify letters in both upper and lower case (e.g. a, A, B, b) and to be able to differentiate between letters and non-letters (e.g. numbers, other symbols)
  3. Knowledge of letter-sound correspondence – this is the knowledge of the sound that each letter – or a group of letters –  makes (e.g. the letter “a” makes the sound /a/ as in “apple”,  the letter “gh” makes the sound /f/ as in “laugh“, /g/ as in “ghost, or it can be silent in words like “through“). This is one of the most crucial skills to learn.
  4. Position coding – this is the ability to read letters in the correct order. (e.g. “could” is not the same as “cloud”)
  5.  Blending – this is the ability to join the sounds of a word together in order to “decode” the word (e.g. b + l + a + ck = “black”)
  6. Language skills – in order to understand what you read you must have adequate vocabulary, grammar, and verbal working memory. Your background knowledge helps with comprehension also.

Next, it is important to develop reading fluency.

In order to remember and understand what they read, children must read with automaticity. Children achieve fluency by having repeated exposure to the words they read. Once a word is very familiar to the reader, she/he no longer decodes it, but rather identifies it as a whole, making reading much faster.

This does not mean that, as accomplished readers, we always read words as a whole. Even experienced adult readers will come across words they do not know, and will have to use their letter-sound knowledge and blending skills to read these unfamiliar words.

Try it yourself! Read: hippopotamus and then read: onychocryptosis.

You should have been able to read “hippopotamus” quickly, just by looking at the word, even though it is long, whereas (unless you have a medical background), you probably had to break down “onychocryptosis” (which means ‘ingrown toenail’) into individual sounds or syllables and blend these together. Knowledge of syllables can help to chunk sounds together to read long words (e.g. “fan-tas-tic”).

Knowledge of spelling rules helps to speed up reading as it reinforces the various letter combinations that make certain sounds (e.g. the letters “f”, “ph”, “gh” all make the sound /f/). Finally, knowledge of sight words is also important for reading fluency. Sight words are the common words in English which do not follow typical spelling patterns (e.g. “could”, “who”, etc.) which are “memorised” or taught “by sight” instead of blended. It is important to note that learning letter-sound rules to decode should always be taught prior to introducing sight words.

As you can see, there are a lot of skills involved in learning to read! A breakdown in any one of these areas can cause reading failure. Most typically, it is the letter-sound correspondence rules which are most difficult for novice readers to learn. And it is no wonder why decoding is challenging – the relationship between a sound and a letter is not intuitive; it is purely arbitrary. It is simply a code.

What does it take to spell?

This answer will be shorter! Learning to spell requires all the skills necessary for reading (listed above) but instead of blending, we use segmentation.

Segmentation is the ability to break a word into its individual phonemes. It is a phonemic awareness skill.

For example, in order to spell “frog” you would have to segment this word to find that it contains 4 separate sounds /f/ + /r/ + /o/ + /g/. Your letter-sound correspondence knowledge and spelling rules would help you to write the correct letter for each phoneme: f + r + o + g = “frog”.

As with reading, a child would need to learn sight words in order to write words high frequency words with irregular spelling.

How can a Speech Pathologist help?

Reading difficulties have been shown to impact on a child’s academic progress as well as on their wellbeing. A child who struggles to read and spell may have difficulty with one or more of the skills of literacy. All the skills can be assessed during a thorough Speech Pathology assessment in order to identify the areas that require support. Scientific research has repeatedly shown that systematic synthetic phonics is the best way to teach literacy skills. Systematic synthetic phonics teaches novice and struggling readers the relationships between sounds and letters in a systematic, explicit and direct way.

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What is a speech sound disorder?

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Speech sound disorders are common in children, making up the majority of a Speech Pathologist’s caseload. Before going into disordered speech, let’s have a glimpse at what happens in typical speech development.

Typical speech development

Speech develops gradually. Over time, children develop their:

  • Intelligibility: they speak more clearly
  • Articulation (or Phonetics): they produce increasingly complex sounds with accuracy, by making the correct oral movements.
  • Phonology: they organise the sounds of their language in a way that resembles adult speech. This involves ‘storing’ the sound correctly in their mind, and ‘saying’ the sound correctly. The way each sound is ‘stored’ and the way it is ‘said’ will correspond correctly when mastered.

So, certain speech errors are a part of typical speech development. But by the time the child is about to start school, they should be 100% intelligible, and should be making few speech errors.

Speech Pathologists refer to milestone guides to determine what is expected, developmentally, in terms of a child’s intelligibility, articulation, and phonology.

See Speech for the Early 8, Middle 8 and late 8 consonant sounds that children acquire (i.e., articulation development) and examples of phonological processes (i.e., phonological development).

What is a speech sound disorder?

Children with speech sound disorders (SSD) differ in terms of: the kinds of speech errors they produce; the severity of their errors; the cause of the disorder; the age at which the disorder appeared, and their response to therapy.

As such, children with SSDs are a heterogenous group and the term “speech sound disorder” is only an umbrella term. In order to know which treatment is best suited to each child with a SSD, researchers have tried to classify SSDs using a variety of approaches. Classification approaches were based on: why the problem exists; how children with a SSD process speech, and what the SSD looks like (Waring & Knight, 2013).

Although there is no consensus on which classification system to use, recent research has supported the third approach, which involves the precise description and analysis of the child’s speech errors and linguistic abilities. This classification system has been shown to be useful in differentially diagnosing children and selecting appropriate intervention (Crosbie, S., Holm, A., & Dodd, B., 2005)

This approach identifies 5 subgroups of SSD (Dodd, 2014). A precise description of each subgroup is too technical for the purpose of general reading, so I will describe the 5 subgroups very simply:

Articulation disorder – a child with an articulation disorder will make consistent sound substitution or distortion errors. A lisp is a common example of an articulation disorder.

Phonological delay – this is where a child continues to speak using typical error patterns (i.e., phonological processes) that are no longer age-appropriate.

Consistent atypical phonological disorder – this is where a child makes phonological errors that do not occur in typical development. For example, it is typical for a young child to say “dou” instead of “go” (this process is called “fronting”) but it is not typical for a child to say “goor” instead of “door” (this atypical phonological process is called “backing”).

Inconsistent phonological disorder – a child with an inconsistent phonological disorder will say certain sounds in words inconsistently. For example, a child may say the /k/ sound in “car” differently, calling it “car”, “tar”, and “gar” on three separate occasions.

Childhood apraxia of speech (CAS) – this is a rare SSD that affects multiple areas of difficulty (i.e., phonetic and phonemic planning as well as oral motor coordination). Inconsistency is one of the key signs as well as difficulty in imitation and “groping” (i.e., searching for the correct oral position).

How common are Speech sound disorders (SSDs)?

SSDs are very common, making up more than 70% of a Speech Pathologist’s paediatric caseload (Mullen & Schooling, 2010). SSD’s begin in childhood and may persist into adulthood if not treated.

Of the subgroups, phonological delay is the most common, followed by consistent atypical phonological disorder, articulation disorder, and least common are: inconsistent phonological disorder, and childhood apraxia of speech (Dodd, 2014).

What causes speech sound disorders?

Most developmental speech sound disorders have no known origin.

We do not know what causes phonological disorder, articulation disorder or childhood apraxia of speech. These disorders often run in families, but this is not always the case.

We do have some information on risk factors. According to an Australian study, boys with a family history of speech impairment whose mother attained a low level of education were found to be 7.71 times more likely to have a speech impairment than a child without any of these factors (Campbell et al., 2003).

The SSDs with known origins include:

Structural disorders: e.g. cleft lip and/or palate, and other craniofacial anomalies. In these cases, the speech disorder is directly caused by the structural differences of the head or face.

Hearing loss: can be present at birth or it can be acquired. It can range in severity from mild to profound. It is common in certain genetic syndromes (e.g. Down Syndrome, Treacher Collins Syndrome) and it can occur after certain diseases (e.g. meningitis, chicken pox). It can also occur due to certain kinds of noise exposure. Children with recurrent ear infections are at risk of hearing loss. Hearing loss impacts on speech directly because it prevents the child from hearing and learning speech sounds accurately.

Genetic disorders: e.g., Fragile X. Genetic disorders impact on a child’s articulation, phonology, motor coordination, etc., in different ways.

Neuromotor disorders: e.g. Cerebral palsy. Cerebral palsy affects a person’s muscle control or coordination. As a result, many people with cerebral palsy have unclear speech (dysarthria) due to impaired muscle function.

Assessment

A thorough speech assessment is necessary to correctly diagnose the SSD and to select the intervention that has been shown to be most effective for the specific deficits identified. Sometimes, there will be more than one choice and I will discuss this with you.

As there is a high co-occurrence of speech difficulties and language difficulties, assessment of both speech and language is recommended. An initial screening of speech and language can confirm whether language assessment should be conducted.

For more general information, see Assessment.

What is stuttering?

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Stuttering is a speech disorder which makes it difficult for people to talk. It involves disruptions to fluent speech characterised by the following behaviours:

  • Repetitions – this is where a sound, syllable or a word is repeated. E.g., “m-m-m-m-my tower is taller”, “can-can-can-can I go to the park?”
  • Blocks – this is where a person becomes stuck mid-speech and no sound comes out
  • Prolongations – this is where a sound is stretched out E.g., my naaaaaaaaaaaaaame is John

Stuttering is different from person to person. The severity of a person’s stuttering can range from mild to severe.  The types of stutters – repetitions, blocks and prolongations – that a person produces also vary. Stuttering can be triggered in different situations. For example, children tend to stutter more when they are talking about something very exciting. Sometimes, facial movements such as blinking or grimacing may accompany the stuttering.

What causes stuttering?

There is no known cause of stuttering.

Stuttering often runs in families – people who stutter are 60% more likely to have a family history of stuttering – but there are also cases where the person with a stutter has no known family history. No single gene causes it.

Stuttering affects more boys and men than it does girls and women. The ratio of men to women is between 3:1 and 5:1, depending on the source. Approximately 1% of the population has a stutter.

What stuttering is not

  • Stuttering is not part of a child’s typical speech development.
  • It is not an emotional disorder. That is, it is not caused by anxiety, shyness or trauma. However, people who stutter may develop anxiety disorders due to their negative experiences (e.g. bullying) and unhelpful thoughts (e.g. “they’ll laugh at me”) about their stutter.
  • It is not related to a person’s intelligence.

My child has developed a stutter. Should I contact a speech pathologist?

A stutter can emerge gradually over a period of weeks or months, or it can emerge suddenly. It typically emerges during the preschool years, before the age of 5. Some children do not appear to be concerned by their stutter, whereas others may struggle to ‘get their words out’ and become frustrated. It is recommended to contact a speech pathologist as soon as your child begins to stutter, especially if your child is displaying signs of frustration.

Stuttering treatment is most effective during the preschool years until approximately 6 years of age.  Intervention for adults who stutter is different to treatment for children. Treatments such as the Camperdown Program teach the speaker strategies to control their stutter, not to eradicate it.

Is treatment effective?

The Lidcombe Program is a safe and effective treatment for preschool-aged children. It is the only treatment for this age group with replicated Randomised Control trial evidence demonstrating that it is effective in getting rid of stuttering.

Will my child recover naturally?

Natural or spontaneous recovery is common among pre-schoolers.  However, we do not know which child will recover spontaneously and which child will not. We do know that treatment is very effective for preschool-aged children and that stuttering is more difficult to treat in adulthood. There is also a lot of research on the possible negative social and emotional consequences of stuttering in adulthood (e.g. unhelpful thoughts, social anxiety). Not many children who have been stuttering for a year will recover spontaneously.  This is why early intervention is considered best practice.

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What is speech?

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Speech is not the same thing as Language. Speech refers to the individual building blocks of language – the speech sounds that make up words, that make up sentences that make language.

Every language is made up of a specific set of speech sounds, or phonemes. Standard English has 44 phonemes. Yes, that is more phonemes than the 26 letters of our alphabet.

How do we make speech sounds?

Production of speech sounds requires accurate coordination of the body parts that we use to speak: lips, tongue, hard palate, soft palate, teeth, vocal folds (for voice), velopharyngeal port (a gateway directing the air from our lungs to go through our nose or mouth, depending on the sound) and lungs (for air).

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oral-anatomy

For example, to make the “m” sound, we need to have  we need air flow from our lungs (1) to make our vocal folds (2) vibrate to make sound,  our lips (3) need to be sealed and we need our velopharyngeal port (4) to be open, allowing the air to exit through our nose (5).

Speech Pathologists should always do an evaluation of the child’s oral structures to ensure that there aren’t any physical or neurological causes for speech difficulties.

Physical causes for speech impairments may include:

  • cleft lip or palate – this is typically identified before or soon after birth
  • submucosal cleft palate – this is a concealed cleft palate, and it is often identified later, when the child is at preschool or school.
  • tight lingual frenulum – this is when the tissue under your tongue is “anchored” too tightly to the floor of the mouth restricting tongue tip movement.

Children with speech difficulties should also have their hearing tested, especially if they have a history of ear infections. Adequate hearing is essential for speech sound development.

My child doesn’t say sounds correctly. Should I contact a Speech Pathologist?

The short answer –

You should contact a Speech Pathologist if:

  • You are concerned about your child’s speech
  • You have noticed that your child makes more speech errors than his / her peers
  • Your child’s educator / teacher has approached you because they are concerned about your child’s speech
  • Your child is about to start school and unfamiliar listeners do not understand them
  • Your child is being teased / bullied about their speech
  • Your child is anxious about his / her speech

The long answer –

As we know, learning to speak doesn’t happen overnight! Certain sounds are more difficult for young children to learn to make than others. Researchers have studied the order in which children master speech sounds in order to understand what is normal articulation development. The findings vary slightly from researcher to researcher. This is in part because the criteria for the acquisition of a sound was different for different studies (e.g. in some studies, the acquisition of a sound was tested only in one-syllable-length words, in other studies the sound had to be produced correctly 90% of the time, etc.). The other reason for the differences in findings is because there is a wide range of what is “normal development”. Children develop at different rates. This is why Speech Pathologists refer to these norms as a guide only. Nevertheless, certain patterns of acquisition have been identified. Shriberg (1993) noticed the following developmental pattern:

  • Early 8 sounds: m, n, j, b, w, d, p, h
  • Middle 8 sounds: t, ng (as in ‘sing’), k, g, f, v, ch (as in ‘child’), j (as in ‘jam’)
  • Late 8 sounds:  sh, zh, l, r, s, z, th (as in ‘thing’), TH (as in ‘that’)

According to Shriberg’s findings, we would expect a 3 year old to be able to say words containing the early 8 sounds (e.g. mud, pat, bad), but we would expect this child to possibly make errors with their production of some of the middle sounds and most of the late sounds.

The typical errors that children make as they learn their speech sounds are called phonological processes. Each phonological process typically ‘goes away’ or ‘resolves’ by itself by a certain age.

Here are some examples of typical phonological processes and the age by which they should no longer be used:

Final consonant deletion

This is where the final consonant sound is left off

E.g. I have a red ball → I ha a re ba

Age eliminated by: 3 years 3 months

Fronting

This is where sounds that are normally produced further back in the mouth (e.g. k, g, sh) are produced with the tongue tip in the front of the mouth (e.g. t, d, s)

E.g. the girl cuddled the black cat → the dirl tuddled the blat tat

Age eliminated by: 3 years and 6 months

Consonant Cluster Reduction

In English, many words contain 2-3 adjacent consonants (e.g. strange). These groups of adjacent consonants are called “clusters”. This error pattern occurs when a consonant is omitted from a cluster

E.g. two blue spots and six green squares → two bu pots and sik geen quares.

Age of elimination: 4 years

Weak syllable deletion

Words can be broken up into syllables. Syllables can be strong, like “ma” in”to-ma-to” or weak, like “um” in “um-bre-lla”. Weak syllable deletion occurs when the weak syllable is omitted from the word

E.g. the elephant sat on the banana → the efent sat on the nana.

Age of elimination: 4 years

Deaffrication

This is where phonemes called “affricates” – “ch” and “j” – are produced as “fricatives” – “sh” and “zh”

E.g. The dog chewed the judge’s shoe → the dog shewed the zhuzhes shoe

Age of elimination: 5 years

Gliding

This is where “r” is pronounced as “w” and “l” is pronounced as “y” or “w”

E.g. Ronnie the lion roared at the little lamb → Wonnie the yiyon woawd at the yitu yam

Age of elimination: 5-6 years

*This list is not exhaustive.

By the time children start school, they should be saying almost all of their 44 phonemes correctly and they should be understood by an unfamiliar listener.

When phonological processes persist beyond the expected age of elimination, this then becomes a phonological disorder. Phonological disorders should be treated to prevent negative social and academic consequences such as:

  • being misunderstood by others
  • being asked to repeat themselves, which could lead to frustration or embarrassment
  • being teased by peers
  • having difficulty with literacy

References:

Bowen, C. (2011). Elimination of Phonological Processes. Retrieved from http://www.speech-language-therapy.com/ on 12/12/16.
Dodd, B., Zhu, H., Crosbie, S., Holm, A., & Ozanne, A. (2002). Diagnostic evaluation of articulation and phonology (DEAP). Psychology Corporation.
Shriberg, L.D. (1993). Four new speech and prosody-voice measures for genetics research and other studies in developmental phonological disorders. Journal of Speech and Hearing Research, (36), 105-140.
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What is a Developmental Language Disorder (DLD)?

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Children with a Developmental Language Disorder (DLD) may have difficulties using expressive language (e.g. talking, or writing messages) or with receptive language (understanding what is said or written), or both.

A child with difficulties using language may:

  • use non-specific words, which makes it hard to know what they’re talking about
  • speak in short sentences
  • find it difficult to sequence their thoughts, ideas or stories
  • have difficulty changing their language to suit different social interactions
  • have difficulty asking questions
  • have difficulties knowing how words are related

A child with difficulties understanding language may:

  • have difficulty following instructions
  • have difficulties maintaining attention during story-time
  • provide irrelevant or strange answers when asked questions
  • have difficulty taking turns in a conversation

Children with DLD may have difficulty with any of the following specific areas of language: the sounds of language (phonology), understanding and using the smallest units of meaning (morphology), sentence structure (syntax), meaning (semantics), and understanding how context impacts on meaning (pragmatics).

Children with DLD are at risk of having difficulty learning to read and write. This is an important reason why early identification and evidence-based support is recommended.

What is language?

This is a question that has been investigated for thousands of years. In the 19th Century, Linguistics emerged as an area of study. Linguists addressed various questions about the structure of language, about language change and development, as well as about how infants learn language: language acquisition.

At the most basic level, language can be viewed as a vehicle that conveys our thoughts to another person. But it would be too simplistic just to view language as a way of transferring information. Language conveys affection, it builds social connections and it builds relationships between individuals, groups and societies. Language difficulties can impact on a person’s ability to initiate and sustain positive relationships with others.

Language has different aspects and components that are governed by rules. Knowing and understanding the major components of language help Speech Pathologists to pinpoint a person’s specific difficulties and understand how these difficulties impact on their overall communication.

Speech Pathologists commonly refer to three key components of language: FORM, CONTENT, USE (Bloom & Lahey, 1978). A good command of all three components is necessary in order to communicate successfully.

FORM

Each language has rules about the order and construction of its sounds, words and sentences.

  • Syntax

Word order is important. Syntax are rules about the order of words in a sentence. In English, the sentence: “the dog bit the boy badly” is easily understood. Contrast that with  “dog bite boy bad” or “badly bit the dog the boy”.

  • Morphemes

In English, we can add or change the meaning of a word by adding a “morpheme” to some words. We add “-ed” to the end of “walk” to talk about the past (e.g. “yesterday, I walked to the park”). We can add “un-” to the beginning of “happy” to mean its opposite.

Children who make “morpheme errors” typically omit the morpheme. E.g., “I walk to school yesterday” instead of “I walked to school yesterday”. Children typically acquire morphemes by the age of 5.

Older children may have difficulty understanding more complex constructions, such as passive constructions, where the position of the person “doing” the action (i.e., the girl) moves from the head of the sentence to the end of the sentence.

Active sentence: The girl kicked the boy

Passive sentence: The boy was kicked by the girl.

A child with a language delay or impairment may interpret the passive sentence based on the order of the words. In which case, the above passive sentence would be understood as the boy kicking the girl.

  • Phonology

Words are made up of units of sounds called “phonemes”. The contrasts between phonemes are important because together, they affect the meanings of words. For example, the combination of the phonemes in sentence 1 means something different to the combination phonemes in sentence 2, below.

  1. sh + e + l = “shell”
  2. s + e + l = “sell”

A child that does not use “sh” and “s” contrastively may say “sell” for both “shell” and “sell”. Children with insufficient contrasts in their phonological repertoire are difficult to understand. In order to make ourselves understood and to communicate effectively, we must know the contrastive sounds and sound combinations that are used in English.  Difficulties with phonology can impact on a child’s ability to learn new words and grammatical structures.

CONTENT

Language depends on word knowledge (vocabulary), and  knowing word meanings (semantics). It is important to know specific vocabulary in order to describe things or retell events effectively. Children with limited vocabularies may use non-specific language like “the thing” or they may use circumlocution to try to make themselves understood in a roundabout way. As a result, the information provided by a child with a limited vocabulary can be incomplete, inaccurate or unclear. Children with language delays may take longer to learn and retain new words, and they may lack in-depth understanding of the meaning of words. An in-depth understanding of words is important for understanding the relationships between words (semantic categories) and for comprehension of more sophisticated uses of language including humour, metaphors, and figurative language.

USE

There are specific “social rules” which influence our communication style, our choice of words, the volume of our voice, our level of formality, and the type and amount of information that we contribute depending on the situation and on our relationship to the person or people with whom we are speaking. These social rules are also known as “pragmatics”. Children with poor pragmatic skills may:

  • answer questions with irrelevant information or too much information
  • have difficulty initiating or maintaining a conversation with their peers
  • talk only about a preferred topic
  • have difficulty modifying their level of formality in different contexts

Language is functional

Apart from knowing and understanding the major components of language,  it is also important to appreciate the many purposes of language. We use language to achieve many different goals on an every day basis in our interactions with other people. It is important to consider how language difficulties impact on a person’s ability to achieve these goals.

We use language to:

  • Greet – saying hello and goodbye to friends, family, and other people
  • Request an item, an action, or permission  – asking your partner to pass the salt at the dinner table; asking a neighbour to turn down their music late at night; asking your mother if you can play at your friend’s place
  • Reject – saying “no” to a second serving of dinner at your aunt’s house, or to express that you do not want to try on the pair of shoes that the salesperson has recommended for you
  • Gain someone’s attention – calling out to the person who dropped their wallet as they got off the train; getting your friend to look at you when you want to show them something interesting
  • Comment – telling your grandmother that her cake is delicious; telling your students that the brown snakes are poisonous
  • Persuade – giving compelling reasons to your partner about why he/she should agree with your travel destination choice
  • Seek clarification / repetition – asking your mother if she wanted green or brown pears when she asked you to buy her pears; asking your teacher to say the instruction again because you didn’t hear part of it

This list is not exhaustive, but hopefully it paints a picture of some of the uses of language, which, as successful communicators, we may take for granted.

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The voice and some common problems

We can tell a lot about a person by just listening to their voice. We can guess their approximate age, their gender, their current emotional state, their wellbeing and even their level of fatigue. Our voice is linked with our identity. Needless to say, we depend on our voice to communicate verbally with others.

How does voice work?

Our voice box, or our larynx, produces voice. We make sound by bringing together our vocal folds while breathing air out from our lungs. When we do this, the vocal folds vibrate, making the buzzing sound that is our voice. We can modulate our voice to make it louder, quieter, higher and lower. We can also ‘put on’ various voices by constricting or stretching different structures in our throat, and by changing the shape of our mouth. A clear voice is achieved when the vocal folds are smooth and hydrated. Diet, lifestyle, illness and psychological wellbeing can impact on the sound of the voice.

The specific characteristics of voice that Speech Pathologists assess include:

  • Volume – how loud or quiet your voice typically is, including your range
  • Pitch – how low or high your voice typically is, including your range
  • Resonance – how nasal your speech sounds. When speech sounds too nasal it is called “hypernasal” and when speech sounds as though the nose is blocked it is called “hyponasal”.
  • Quality – this refers to the clarity of your voice. Your voice can be clear, breathy, hoarse, strained or rough.

What are some common causes of voice problems?

Voice problems are common in both children and adults. The causes of voice problems are various. Very commonly, voice problems are due to vocal abuse – that is, using your voice excessively or projecting your voice too loudly. Certain jobs rely on voice-use in loud environments (e.g. teaching a classroom of kindergarten children, teaching aerobics to loud music). These professionals commonly experience voice problems. Children also use their voice loudly while playing sports, calling out to each other in the playground and when putting on ‘funny voices’. When we yell, or shout excessively, the vocal folds develop small bumps called vocal nodules. Usually these go away on their own after a period of vocal rest, however if our vocal habits do not change, and we continue to exacerbate our voice, they will re-emerge. In the long-term, nodules can harden like callouses and eventually may require surgery.

Voice problems may occur temporarily due to mild illness, such as laryngitis. During illness, the vocal folds may become swollen and heavier than usual. This may result in a lower pitched voice and an intermittent “husky” vocal quality. Usually this goes away within a few days and no treatment is required.

Sometimes, changes in voice quality can be noticed when taking a new medication. Certain medications may dry the vocal folds. Speak to your GP if you notice changes after being prescribed a new medication.

Voice problems can be caused by gastro-oesophageal reflux. With this kind of reflux, acid from the stomach comes up the oesophagus and spills onto the vocal folds, inflaming the delicate tissue.  Reflux may be managed by changes to the diet and lifestyle, as recommended by your GP.

Voice problems, such as total lack of voice can ensue due to excessive stress or certain psychological problems.

Voice problems or disorders may also be the result of other, more serious medical conditions, such as granuloma, a cyst, papilloma, or vocal fold paralysis or paresis after stroke.

When to seek help

The voice undergoes changes across the lifetime, so it is normal to expect certain vocal changes as we age.

You should consider seeking help if you answer “yes” to any of the following:

  • it feels like there is something stuck in your throat
  • you feel a constant tickle or pain in your throat
  • your voice has not recovered after the illness or event that caused it
  • your voice is impacting on your ability to participate in your regular activities

If you are concerned about your or your child’s voice, it is recommended to visit your GP for a referral to see an Ear, Nose & Throat specialist (ENT). The ENT can view the voice box and determine the cause of the voice disorder. Depending on the diagnosis, the ENT may recommend sessions with a Speech Pathologist for education and intervention.

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