What is a Speech Language Pathologist?

What is a Speech Language Pathologist?

Formal Definition:
A Speech Language Pathologist (SLP), also known as a Speech Therapist is a person who assesses and treats disorders of communication.  This may include treating fluency, language, speech, voice, swallowing, social communication, and cognitive communication disorders.

Further Explanation:
A certified Speech Language Pathologist (SLP) is a highly educated professional who has attended university to obtain at least a Masters level education which includes clinical training, taken and passed a national certification test, and completed their formal training with a Clinical Fellowship Year (CFY) under supervision. Additionally, in order to maintain their certification status, they are required to complete at least 30 hours of continuing education every 2 years, keeping them abreast of changes and new research in the field.

All of that education and clinical training is focused on communication and, more specifically, disorders of communication. Each Speech Language Pathologist is initially trained in assessing and treating disorders such as:

• Language- disorders of language can affect both children and adults. Many children have difficulty developing language (some are non-verbal and require alternative communication devices, others are very verbal but struggle with grammatical rules or reading and writing). Adults typically lose the language they have through some sort of medical occurrence including stroke, traumatic brain injury, etc.
• Fluency- also known as stuttering can affect both children as young as two and adults.
• Speech- including articulation disorders such as lisping or difficulty pronouncing /r/. Stuttering is also included under the umbrella of speech disorders.
• Voice- difficulties may include vocal nodules or polyps, or other conditions such as spasmodic dysphonia
• Swallowing- also known as dysphagia can affect both children and adults. It is often diagnosed through a specialized live x-ray called a Modified Barium Swallow Study (MBSS) or through a bedside exam. 
• Aural (Re)Habilitation- children and adults with hearing impairment require specialized  training in order to improve their speech, listening, and other communication skills
• Social Communication- especially for those suffering from difficulties such as Autism Spectrum Disorders, the social aspect of speech and language is especially difficult and may require therapy in order to treat.
• Cognition- Some children and adults may require therapy in order to maintain or improve their cognitive skills such as memory and other executive function skills including organization, time management, etc.

SLPs are also trained in other important topics such as:

• Speech Science- this includes the nitty-gritty scientific details of speech such as frequency, formants, measurements of aspiration, etc.
• Professional Ethics- as part of the Allied Health community, it is important for SLPs to understand professional ethics as they relate to speech language pathology
• Multicultural Issues- bilingual children and adults and children and adults from other cultures are growing rapidly in American society. As SLPs treat these clients they need to understand the differences and accurately assess these differences to determine if a disorder does in fact exist and how to go about treating it in a culturally sensitive fashion.
• Augmentative and Alternative Communication Devices (AACs)- some children and adults are unable to use verbal communication and may require alternative devices to communicate such as an iPad, pictures, a communication boards, or other specialized devices.

SLPs work in conjunction with a multitude of people and professions including parents, loved ones, physicians, allied health professionals, teachers, etc. in order to help as many clients as they can achieve the greatest speech and language growth they can. It is truly a blessing to be a part of people's lives in this way.

My Favorite Speech Therapy Resources

My Favorite Speech Therapy Resources

I love providing teachers, parents, grandparents, and friends with great resources that they can use at home. Sometimes the resources are more informational, sometimes they are exercises that they can do with their loved one. I think knowledge is power and it is fantastic when I see empowered parents, students, and teachers who are able to help my clients make important strides in their communication skills. 

These resources should be used in conjunction with consultation with a certified Speech Language Pathologist. While many of them won't harm anyone, it's important to make sure you are getting the most accurate information possible. When a Speech Pathologist and a client are on the same page, speech and language growth can increase, but it may be difficult to work together if consultation is not taking place. 

Informational Resources:

• Handy Handouts: www.handyhandouts.com If you have a speech topic you would like to know more about, Handy Handouts is one of my favorite resources. Not only are the articles both in English and Spanish, but they are written in client-friendly language and have additional resources if you would like to learn more. They also include some Occupational Therapy resources.
• American Speech Language Hearing Association (ASHA): www.asha.org The American Speech Language Hearing Association is the national organization for Audiologists and Speech Language Pathologists. Topic overviews, research, position statements, conference notes, and journal articles are all available through this site.
• Playing With Words 365: www.playingwithwords365.com This informational blog has parent resources, resources for clinicians, and free activities. Geared towards children with speech and language difficulties, this site is loaded with great information.
• Caroline Bowen Speech Language Therapy: http://speech-language-therapy.com/ Caroline Bowen is a respected Speech Language Pathologist with over 40 years of research and clinical experience. In the Articles section of the website, she has some fantastic information on development, disorders, and intervention.
• National Aphasia Association (NAA): http://www.aphasia.org/ The National Aphasia Association is for both those suffering from aphasia and their family members. Information including FAQs, aphasia types, and communication tools are provided along with news in the field. 
• National Association of the Deaf (NAD): http://nad.org/ The National Association of the Deaf website shares resources about the community, events, and parental resources. 
• National Stuttering Association (NSA): http://www.westutter.org/ The National Stuttering Association is a great resource for People Who Stutter. There are national conferences and events for both national and local chapters. There are also newsletters and other resources for all age groups.

Activity Resources:

• Little Bee Speech: www.littlebeespeech.com is a site which sells apps for articulation. In addition to the apps, they also have some good downloadable pdfs which are fantastic for tracking articulation difficulties and understanding articulation and phonological development
• Speaking of Speech: www.speakingofspeech.com is a great website for finding activities in the material exchange. While the site is geared toward SLPs, if you understand your goals you should be able to quickly find activities to do at home. Most of the site's activities are for children, but many of the activities can be modified and used for adults as well.
• Teachers Pay Teachers: www.teacherspayteachers.com is a materials exchange site where teachers and other education professionals, including speech therapists, sell their materials. There is a large free section which is chock full of fantastic activities including some activities that are normally $3-4 a piece. If you register with them you can receive a weekly email which also contains 10 featured free activities, many of which can be used for speech and language practice.
• DLTK Kids: http://www.dltk-kids.com/ is a craft and printable game website with multiple paper crafts and games (crosswords, word searches, etc.). If you're looking for a good activity to do with your kids or even with friends (some of the activities are geared towards older children or can be easily modified for adults) that will include lots of language, this is the site to go to.
• Pinterest: www.pinterest.com Just search for speech and language and hundreds of pins come up with hundreds of activities. You can search a little more specifically within your goals (for example- search /s/ sentences instead of just articulation) to find activities and information quickly and easily
• Google: www.google.com This may seem completely obvious, but Google can be your very best friend when searching for speech and language activities. You can quickly find research articles, activities, etc. If you want coloring pages to do while working on goals for following directions, use Google images. If you'd like some specific information about an approach the clinician is using with you or your child use Google scholar.
• Super Duper Publications: www.superduperinc.com Many speech therapy and occupational therapy resources are sold on this site. Most are aligned to common core curriculum and many of them are research based, solid activities. Make sure to consult with your speech therapist to decide if purchasing these resources is right for your goals.

These sites are definitely only a place to get started, but they are some of my favorites and ones that I return to again and again. I hope they help you as you go on your speech and language journey.

I think my child has an articulation disorder...What can I do?

I think my child has an articulation disorder...What can I do?

First of all, welcome to Jessica Washer Speech Therapy. Simply by beginning to research what you can do you are already well on your way to helping your child receive the best help possible.  First, let's address if your child has a problem...

Does my child have an articulation disorder?

Basically, by age 2 your child should be 50% intelligible, by age 3 they should be 75% intelligible, and by age 4 your child should be 100% intelligible to new listeners. Your child may be having difficulty with individual phonemes (sounds). The following is an excellent list of the development of those sounds. You can use this list to decide if a speech therapy consultation or assessment is appropriate. (For example, if your 3 year old is still having difficulty with /r/, it's developmentally appropriate, you don't need speech therapy quite yet).

Here is a great list of sound development from teachmetotalk.com

By 18 months –

• Child produces 3 to 6 different consonant sounds with each child having a little different consonant inventory.

 By 24 months 

• Initial Sounds – /p, b, m, t, n, d, h, k, g/
• Final Sounds – /p, m, n/
• Produces Most Vowel Sounds Correctly and at least 6-8 different consonant sounds.

 By 28 months 

• Initial Sounds  /d, f,  and y/
• Final Sounds – /s, d, k, f/ and n /

 By 32 months 

• Initial Sounds – /w/
• Final Sounds? - /t, b, r/

 By 36 months 

• Initial Sounds – /s/
• Final Sounds – /l, g/ and /er/ endings
• Child uses at least 9-12 different consonant sounds.

 By 40 months 

• Initial Sounds – /l, r/
• Some consonant blends  bl, br, tr
• Final Sounds  /v/ and sh

 By 44 months 

• Initial Sounds sh and ch and fl
• Final Sounds ch

 By 48 months 

• Initial  sp, st, kl

 After 48 months 

• Initial – /z, v/ and j and th
• Final – /z/ and th and j

For most children, the list of phonemes will be all you need to determine if speech therapy is appropriate for your child. However, the following red flags are incredibly important and require immediate attention as they may signal more serious articulation or medical concerns. Again, the following list was taken from teachmetotalk.com.

Numerous Vowel Errors – Most children have mastered nearly all vowel sounds by age 2. Some errors are still acceptable are age 2, but by age 3, all vowels be mastered (with exception of /r/ vowels).

Widespread Deletion of Initial Consonants-  By 2 a child should use at least 3 to 4 different consonant sounds at the beginnings of words.  By 3 a child should have a large repertoire of initial consonants.

Substitution of Back Consonants /k/ and /g/ or /h/ for a variety of Consonants-  This is atypical phonological development and should be targeted even in very young children.

Deletion of Final Consonants after age 3- By 24 months in language delayed children some final consonant deletions are expected, but by 36 months, all children should be producing words with ending consonant sounds. 

What can I do? 

If, after reading these lists, you have decided that your child does indeed require consultation or assessment to get into speech therapy, here are some great activities you as a parent can do:

• Choose one sound they are having difficulty with, then read a book with your child and emphasize that sound. Have them repeat those words back to you.
•  Find objects out of the car window that start with your child's sound and point them out. Make it a game to find objects that start with their target sound.
•  Use playdough and make the letters for the child's target sound. You could also create playdough sculptures of objects with that sound. Another fun variation would be to draw with sidewalk chalk or with your fingers in flour.
•  Download articulation apps on your tablet or phone and have the child play. I enjoy abcmouse.com letter videos or youtube videos from "Have Fun Teaching" which review many speech sounds. The "Have Fun Teaching" videos are especially great for "auditory bombardment" (having the child listen to the sound over and over again) and are really fun to sing and dance along to.
• Use tangible and intangible positive reinforcement when practicing. When your child pronounces their target sound correctly tell them "Good job!" or "What a great sounding /s/!" Give hugs, high fives, or fist pounds to help them know they are doing a good job. You could also set up a chart that for every 10 sounds they say correctly they get M&Ms or a healthy snack they love. Make speech fun!
• Ask your speech therapist. Your speech therapist may have word lists, resources for free activities, and advice on where to start with your child. 

 My advice is its always better to be safe than sorry as far as speech therapy is concerned. If you looked at these lists and still have concerns please consult with a Speech Pathologist and get screened or assessed to see if those concerns are appropriate. Early intervention is the best intervention and outcomes for children who receive Speech therapy earlier rather than later are fantastic. Those children with early speech therapy are in speech for less time and typically have significantly better results.

 Resources:

• http://teachmetotalk.com/2009/08/31/speech-sound-development/ 
• http://fairfield.patch.com/groups/elissa-murnicks-blog/p/bp--speech-sound-acquisition-and-practice-tips-for-pa29bdfcc5ed 
• http://mommyspeechtherapy.com/?p=2676 
• http://handyhandouts.com/pdf/98_ArticDevelopment-new.pdf 

Articulation Therapy Approaches

Articulation Therapy Approaches

Articulation is the technical term for how people pronounce words. Many children and adults have no difficulty pronouncing words according to their accent. Sometimes though, children may have difficulty developing appropriate articulation, some adults may have difficulties remaining from childhood, and other adults may lose their articulation abilities thanks to a stroke, traumatic brain injury, or other medical difficulty. Speech therapy focusing on articulation is one way of addressing these difficulties. 

There are a wide range of techniques that are used by Speech Language Pathologists all over the world, however I wanted to review some of the most popular here. Traditional Articulation Therapy using minimal pairs, the Cycles Approach, and the Whole Language Approach are very different, however they contain some similar principles and all focus on treating articulation. 

Traditional Articulation Therapy

According to Van Riper (a very famous researcher) in 1978, "The hallmark of traditional therapy lies in its sequence of activities for: (1) identifying the standard sound, (2) discriminating it from its error through scanning and comparing, (3) varying and correcting the various productions until it is produced correctly, and finally, (4) strengthening and stabilizing it in all contexts and speaking situations." 

Essentially Traditional Therapy has the child identify the sound, identify the sound from the error sound (for example if they say /sh/ for /s/ the clinician would have them listen to various words and tell her/him which started with the correct /s/ sound) , correct their production through various exercises, and then expand those exercises. 

During traditional therapy, minimal pairs- pairs of words like "sheep" and "seep" or "ship" and "sip"- are often utilized to work on identifying the sound and distinguish the sound from error. Many believe that a child may be hearing a word incorrectly leading to incorrect pronunciation, so traditional therapy focuses on correcting that understanding. Typically in traditional therapy you might start with the single sound, then a syllable, then words and words in pairs, then phrases, sentences, and finally conversation.

For more information about Traditional Articulation Therapy visit

• http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=44:trad&catid=11:admin&Itemid=121
• http://www.everythingspeech.com/treatment/articulation-treatment/

Cycles Approach
Formally known as the Cycles Phonological Pattern Approach (CPPA) was created by a researcher named Hodson to help extremely unintelligible children. It is based on the theory that children gradually learn phonological (sound) patterns as they learn to speak. For example, first children may learn early syllable structures like /baba/, then they will learn back sounds like /k/ and /g/, then /s/, etc.  Some children may have difficulty learning those patterns so they either don't develop the pattern at all or they develop different patterns (for example saying /th/ instead of /s/). The Cycles Approach uses groups of "cycles" of patterns to teach children new patterns of speech depending on their need.

An example Cycles Approach may look something like this

• Week 1- work on pronouncing multiple syllables (for children who only use one syllable). For example, getting a child to say "i-un" for "Chicken" is an improvement upon just "un"
• Week 2- work on producing final consonants. The final consonants would depend on the child, but for example, if a child does not produce final /d/ or final /t/ ("da" instead of "dad" or "pa" instead of "pat") those may be the targeted sounds.
• Week 3- work on producing /s/ clusters (such as /sp/, /sl/, /st/, etc.). 

One hour of therapy time would be spent on each week's lesson and then the entire cycle would be repeated. Typically, children require 2-4 cycles to master those goals and then the cycles would move toward more difficult goals, eliminating goals mastered, and repeating goals they continue to have difficulty with.

For more information about the Cycles Phonological Pattern Approach visit

• http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=75:cycles&catid=11:admin&Itemid=108
• http://www.ushaonline.net/Resources/Documents/Hart-Cycles%20Approach%20Handout.pdf

Whole Language Approach
Many children experience both articulation difficulties and language difficulties. The Whole Language Approach attempts to address articulation through language-based activities. For example, while reading a book, the clinician may emphasize certain shttps://www.blogger.com/blogger.g?blogID=3577234683978949925#editor/target=post;postID=723103093311687439;onPublishedMenu=allposts;onClosedMenu=allposts;postNum=0;src=postnameounds while reading. The clinician may then have the child retell the story and incorporate cues, minimal pairs, or multiple repetitions to assist the child articulate correctly in a more naturalistic language setting.

For more information about the Whole Language Approach visit

• http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=84:whole&catid=11:admin
•  http://speech-language-therapy.com/pdf/tyler2002.pdf

Conclusion
The American Speech Language Hearing Association (ASHA) does not recommend one approach over another as each client is different, however they do emphasize that articulation therapy is effective.  There are multiple additional approaches to therapy and combinations of therapy approaches which can assist those who have articulation difficulties. At Jessica Washer Speech Therapy, we strive to utilize Evidence Based Practice- a combination of research, clinical judgement, and client values- when treating clients for the most effective therapy possible.  Our hope is that every client is able to be dismissed from therapy having met their goals and achieving their best speech and language abilities.

Additional Resources

• Information on Speech Sound Disorders from ASHA http://www.asha.org/public/speech/disorders/speechsounddisorders/
• Treatment Efficacy Summary from ASHA http://www.asha.org/uploadedFiles/public/TESPhonologicalDisordersinChildren.pdf
• Evidence-based management of phonological impairment in children http://www.unige.ch/fapse/logopedie/formationcontinue/inscriptionenligne/article1-ma.pdf