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Auditory Processing Disorder (also called Central Auditory Processing Disorder or CAPD) is a general term referring to disordered processing of sounds that takes place in the pathways between the auditory nerve, which connects to the ear, and the higher-level auditory pathways in the brain.  It is important to know that auditory processing disorders are not the result of a hearing impairment – people diagnosed with APD hear normally, and a hearing impairment must be ruled out before an auditory processing disorder can be diagnosed.  Auditory processing disorders are near to my heart because many of my pediatric speech therapy clients have either been diagnosed with APD or show symptoms of it!

What are the signs and symptoms?

Inconsistent listening skills are a common sign of APD, especially when environmental noise is present.  Other signs include:

-needing instructions to be repeated multiple times

-saying “What?” or “Huh?” several times per day

-misunderstanding what is said often

-difficulty paying attention when someone is talking

-short attention span in general (ADD/ADHD often coexist with APD)

-difficulty with phonics / letter sounds

-being slow to respond to what has been said

-appearing to hear but not understand

How do I find out if my child has an auditory processing disorder?

Auditory processing disorders are typically diagnosed by an audiologist, who rules out a hearing impairment before diagnosing APD.  A speech therapist can verify symptoms of APD and provide treatment after a child is diagnosed.  They also evaluate and treat language processing disorders, which are similar to APD but involve how receptive and expressive language is processed in the brain rather than auditory input in general.  Feel free to contact Child and Family Development if you have any questions about auditory processing.

Yes, it can. Thumb-sucking and speech problems go together like peanut butter and jelly, Bert and Ernie, Charlotte and banking, milk and cookies – you name it. 

Just like milk and cookies, thumb-sucking can be a good thing in moderation. A child who sucks his or her thumb has an effective, instant self-soothing strategy, which is a good thing when the child is anxious or upset. However, if thumb-sucking becomes a habit, speech (pronunciation, or “articulation,” as speech therapists call it) can be affected. The repetitive act of placing the thumb inside the mouth causes the tongue to be pushed backwards, bunching up in the back of the mouth. Over time, this negatively affects tongue position and tongue movement, even when the thumb ISN’T in the child’s mouth. As a result, the child may begin to thrust his or her tongue too far forward during speech (e.g., “lisping” S and Z sounds), may have trouble lifting the tongue up to produce L or R sounds, or may distort other speech sounds.

If a speech-language evaluation determines that a child is not pronouncing speech sounds at age-level, the speech therapist can work with him or her on the specific speech sounds that are troublesome. At the same time, the speech therapist may use some oral motor therapy exercises to help the child’s tongue strength and positioning so the tongue muscles can “recover” from the effects of thumb-sucking.

Speech therapists are often asked how parents can help their children kick the habit of thumb-sucking. Some common approaches include:

• Giving praise or rewards at home when the child is NOT sucking the thumb
• Behavioral therapy – where the child is given alternatives to thumb-sucking, such as squeezing or tapping fingers together
• Nontoxic liquids or salves that coat the thumb, making it taste bad
• A dental appliance in the roof of the mouth – this makes sucking the thumb uncomfortable, and must be fitted by a dentist. Because habitual thumb-sucking pushes the upper  front teeth forward and out, a dental appliance used to stop the thumb-sucking may help prevent additional orthodontic needs later in childhood.
  
  

(This post is the 2nd in a series of 2 posts by this therapist addressing sign language)

Teaching signs to a child who has a developmental delay or a language impairment such as autism or childhood apraxia of speech can be helpful for increasing communication and decreasing frustration. After all, using signs to communicate is much more effective than having no way of communicating at all! After the initial speech-language evaluation, a speech therapist may begin teaching a child with limited verbal skills to sign by choosing 1 sign to start with, and adding more signs as the child learns the cause-and-effect of communicating with signs. 

From here, the course of therapy truly depends on the individual child. For many children, the use of signed words helps verbal skills come along. In addition to or in lieu of signs, the therapist may implement an augmentative/alternative communication approach. 

Is signing right for your child? For the short term?  For the long term?  There are many factors that a speech therapist takes into account when deciding whether or not to teach signs to a child. Feel free to contact a speech therapist at either of our Charlotte offices – we’ll be glad to hear your concerns and answer your questions.

Historically, we think of sign language as something that is used by members of the Deaf community. More recently, however, all kinds of articles, books, and videos are being advertised to parents of babies and toddlers, encouraging them to teach their children “baby signs” as a means to assist language development.    After talking with parents all over Charlotte, it seems the “more” sign has become a universal “first word” for babies!

Why should I sign with my baby? I want my baby to talk, not sign.

It’s important to understand that using signs helps verbal communication come along. Signs are a precursor to verbal communication, just as pointing and reaching are precursors to verbal communication. Signing with your baby will not keep him or her from talking because, once your child is able to speak, saying words will always be faster and more efficient than signing the words.

How exactly does signing help my baby’s language development?

A typically-developing baby should say his or her first word right around 12 months of age. Babies who are familiar with a handful of signs that are used consistently by the parent may sign their first word as early as 8 months of age, and understand what the signs mean even earlier. Plus, every time the parent signs a word while saying the word, the baby experiences multi-modal learning – the baby hears the word with his or her ears, while seeing the sign being made with his or her eyes. Being able to hear and see the word at the same time (rather than hearing the word only) helps to ingrain that vocabulary word in the baby’s mind.

I’m interesting in signing with my child. How many baby signs do I need to teach my child?

Not as many as you think. I met a toddler recently who can sign hundreds of signs when asked, and I know other toddlers who sign only 2 or 3 signs. The number of signs doesn’t seem to matter nearly as much as the  fact that the act of signing provides such a great visual or gestural aide for learning language. If you begin with a handful of common signs (for example, “more,” “milk,” “ball,” and “mommy”), and use those signs as you’re talking throughout the day, it's a great start. As your baby grows and begins to sit up independently, reach, and point, you can teach your baby more directly by helping his or her hands to make the sign.

My child has a developmental delay, autism, apraxia, or another diagnosis – will signing help?

My next post will address how speech-language pathologists use basic signs very frequently in order to increase communication (and decrease frustration!) in children with speech and language difficulties. Check back soon!

Writing difficulties are often seen in children in the upper elementary grades, as well as in middle school and high school.  Many of these children present with or have a history of language delays, language processing difficulties, or even diagnosed learning disabilities.  

As children matriculate into middle and high school, academic writing demands increase dramatically.  Putting thoughts onto paper may be tough enough to begin with, but organizing those thoughts into cohesive, grammatically-correct essays that contain appropriate academic-style syntax can truly throw these children for a loop! Understandably, decreased confidence and motivation for writing assignments goes hand-in-hand with writing difficulties.

A few interesting facts:

-Because it is such a cognitively complex activity, writing is often the last hurdle in treating (and overcoming) a language delay or learning disability.
 

-The majority of U.S. schoolchildren have writing skills that are judged to be below grade level.
 

-Essays written by children with writing difficulties are often too short, due to limited details, and too simplistic. Spelling and grammar errors are typically found throughout. 

 -Children with writing difficulties often free-write instead of following a structured prompt.
 

-Children who present with writing difficulties often speak at an age-appropriate level; that is, their grammar and syntax during speaking tasks may be appropriate or even advanced.

In order to write at grade-level, a child must employ receptive-expressive language skills, working memory, and other organizational and language processing skills simultaneously.  If any of these cognitive functions are out of sync, writing success becomes very difficult to achieve.  

A speech therapist may recommend speech-language therapy in order to address language and processing skills.  A psychological-educational evaluation may also be recommended in order to get a broader look at the child’s learning style.  In addition, educational therapy can directly treat a learning disability that causes writing difficulties.

In my experience as a speech-language pathologist, February has always been a busy month for speech-language evaluations and newcomers to therapy, particularly for school-age children and older preschoolers. At this point in the school year, first semester is over, report cards are handed out, parent conferences are held, and, for the older children, end-of-grade tests are looming. Recommendations for speech therapy are made to parents of children who have not made adequate academic progress due to possible speech and language concerns. 

The speech therapists here at Child and Family Development would be happy to evaluate your child in order to pinpoint the source of the academic or social concerns. Testing and subsequent therapy for receptive language (comprehension) skills, expressive language skills, and articulation (pronunciation) skills may be administered, as well as testing for a variety of language processing skills, including phonological skills (pre-reading and spelling skills), memory, and word retrieval skills. Difficulties in any of these areas can impact academic and social functioning in the classroom. Feel free to contact us!