Speech-language pathology is a health profession aimed at helping individuals develop effective communication and swallowing skills. Professionals in this field are educated and trained to evaluate and treat children and adults with speech, language and swallowing problems.

Many speech therapists have the credentials “CCC-SLP” after their names. This means that the therapist has been awarded their Certificate of Clinical Competence in Speech Language Pathology by ASHA.

A speech-language evaluation at Metro Speech Therapy is performed by a speech-language pathologist to gain insight into a child’s developing speech, language, communication, feeding, and oral function skills. A speech-language pathologist will obtain a variety of scores from the tests utilized in the evaluation. These scores (standard scores, age equivalents and percentile ranks), as well as information from other types of tests, help the speech-language pathologist determine if a child has delayed or disordered language. In addition to determining if a language delay or disorder is present, speech-language pathologists at Metro Speech Therapy may give informal/formal assessments, observational scales and parent report measures to gather information about social, play, communicative, feeding and behavioral patterns. A report is generated that uses this information to help other professionals make diagnostic decisions and to make recommendations for intervention.

The state has specific requirements that children must meet to receive speech or language therapy in school. Additionally, the disability must have a negative impact on the student’s education. For example, a student who has a lisp that does not affect her ability to spell or discourage her from participating in class may not qualify for services in the school. However, insurance may cover these services in our outpatient setting.

Many of our patients receive services in school and the outpatient setting! The two professionals may collaborate throughout the year, discussing the student’s goals and progress. Parents must give their consent before professionals can speak about a student. Private speech-language pathologists usually work with students individually, and can focus on all areas of need.

This is highly dependent on the individual. Each case needs to be looked at individually and discussed with the professionals, family members, and patients involved.

Our speech-language pathologists work with children from infancy to adolescence. If you are concerned about your child’s communication skills, please call to find out if your child should be seen for a communication evaluation and/or consultation.

A referral to occupational therapy may be recommended if there are concerns regarding safety, social/emotional development, sensory/emotional regulation, and/or delays in developmental milestones. This way, your speech therapist and occupational therapist can work as a team to develop a treatment plan that is best for your family. 

At Metro Speech Therapy, we believe in providing holistic, comprehensive care. As part of our intake forms, we include information relating to occupational therapy. If your case history indicates that you would benefit from an occupational therapist, a referral will be placed for a screening or evaluation. In order to maximize the benefit of therapeutic services, including an occupational therapist will be considered the gold standard of care for your child. You can postpone the recommendations; however, we will revisit our plan of care in three months to see how therapy has progressed without the support of all recommended team members. At that time, we may require the addition of an occupational therapist to your team to ensure best practice.

Our practice firmly believes in “regulation before expectation,” and if your child is demonstrating challenges regulating with their external environment, it may be challenging for them to organize their body and access higher level speech, language, and feeding skills. In addition to the skilled individualized therapy they provide, OT supports ST by supporting foundational neurological safety, creating an optimal learning environment for additional ST services.

Hearing & Understanding Milestones

  • Child points to a few body parts when prompted.
  • Child follows simple commands and understands simple questions (e.g., “Roll the ball,” “Kiss the baby,” “Where’s your shoe?”).
  • Child listens to simple stories, songs, and rhymes.
  • Child points pictures in a book when they’re mentioned.

http://www.asha.org/public/speech/development/12.htm

Talking Milestones

  • Child’s vocabulary grows every month.
  • Child begins using some one- or two- word questions (e.g., “Where kitty?”, “Go bye-bye?”, “What’s that?”).
  • Child puts two words together (e.g., “More cookie,” “No juice,” “Mommy book”.)
  • Child uses many different consonant sounds at the beginning of words.
  • For a complete guide to children’s milestones, visit:

http://www.asha.org/public/speech/development/chart.htm.

  • Model language from your child’s perspective! When adults talk with children, they provide a model for children to emulate. Kids can learn about language, intonation and speech patterns when they listen to adults’ voices
  • Narrate family daily routines to stimulate their children’s speech and language development. Such occasions include, but are not limited to feeding, dressing, playtime, and bath-time.

When children have ear infections (otitis media), fluid can build up in their middle ear. When this occurs, it can affect how they hear sounds. The sounds that they hear may seem distorted. For instance, imagine what it would sound like to hear someone talking while your head was under water. In order to learn to speak, children need to be able to hear speech sounds accurately and clearly. If they experience frequent ear infections while their language is developing, they may be at risk for speech and language problems.

What we’ve traditionally thought about regarding Autism is constantly evolving. Autism is a spectrum for a reason. If we’ve met one Autistic child, we’ve met one Autistic child! For more information on Autism and neurodivergence, please see this link: https://my.clevelandclinic.org/health/symptoms/23154-neurodivergent. Your therapist is more than willing to discuss this in-depth with you regarding your individual child.

In general, speech therapists aim to improve both their client’s “Expressive” and “Receptive” language skills. Receptive language refers to the ability to understand spoken language and follow directions. For example, a child’s ability to listen to and follow the directions, “point to your shoe,” relies on their receptive language. Typically, children are able to understand language prior to being able to produce it, themselves. A child who is unable to comprehend language may have receptive language difficulties. In contrast, expressive language refers to the ability to communicate verbally or with written words. Children that have difficulty communicating their wants and needs may have expressive language difficulties. For example, children might be experiencing expressive language difficulties if they are unable to inform their caregivers that they are hungry. It is important to note that this is just one example of an expressive language difficulty. If you have concerns about your child’s speech and/or language development, you should consult with a pediatric speech-language pathologist.

Pediatric speech-language pathologists work with children exhibiting either or both receptive and expressive language difficulties. Receptive and expressive language can be improved by providing language stimulation. Parents of young children (ages 1-3) can improve their children’s receptive and expressive language by repeating what their children says, and expanding on those utterances. If the child says, “Ball,” the parent can then expand on that utterance by saying something like, “Yes, you have a big ball.” The child will then begin to learn from their caregiver’s model, and should gradually begin to combine multiple words together to form phrases.

It is important to note that there are two different ways children can learn language: analytical language processing and gestalt language processing. Analytical language processors learn language in what is accepted as a more traditional way. This is the way in which language development milestones are often based: starting with one word, progressing to two-­word combinations, and growing to original, flexible language composed of complex sentences. However, gestalt language processors naturally process language as whole, intonational chunks, or gestalts, rather than as individual words.

There are four main stages of gestalt language processing, referred to as Natural Language Acquisition, that gestalt language processors move through. Stage 1 is known as echolalia or scripting. In this stage, gestalt processors often imitate the language they hear, such as “Let’s go outside!”. We cannot take gestalts literally at this stage; however, they are intentional and carry meaning for your child. At this stage, their utterances may sound unintelligible or only be identified by consistent, intentional intonation. In Stage 2, or mitigated gestalts, the gestalt language processor starts to change, or mitigate, those original gestalts, such as “Let’s go + home!” instead of the original “Let’s go outside!”. In Stage 3, the gestalt language processor starts to acknowledge the value of the single word as they isolate single words and produce two​​​­-word combinations. Finally, in Stage 4, there is the emergence of beginning grammar, ultimately resulting in the same original, flexible language that analytical language processors also achieve. Stage 4 is also where gestalt language learners have acquired the foundational language skills necessary to begin answering wh-­questions functionally, rather than as a rote skill. Language learners can be gestalt language processors, analytical language processors, or a combination, known as dual language processors.

Your speech-language pathologist will do the detective work with you to determine how your child primarily processes language and adjust goals as appropriate. For more information, please refer to: https://communicationdevelopmentcenter.com/

Motor speech disorders can make it very difficult for individuals to clearly and effectively express themselves, which can be very frustrating. People with motor speech disorders know what they want to say, but cannot get it out. The two types of motor speech disorders are:

  • Dysarthria:  This is when the muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all. Sometimes people refer to dysarthric speech as “slurred” speech.
  • Apraxia: The term apraxia (dyspraxia) is used to describe a child who is exhibiting difficulty with praxis (performing an action). Childhood Apraxia of Speech is a label/category of a speech sound disorder that is explained by difficulties with planning and/or programming of the motor movements that result in speech. Our speech-language pathologists have received training in Dynamic Temporal and Tactile Cueing (DTTC) for Childhood Apraxia of Speech. People with apraxia of speech have trouble sequencing the sounds in syllables and words.

Fluent speech is produced with ease. It is flowing, smooth, continuous, and relatively rapid, and normally rhythmic. Fluent speech is free from an excessive amount or duration of dysfluencies. Stuttering is called dysfluency by professionals in the field of speech-language pathology. Dysfluent speech is an excessive amount and duration of dysfluencies. It is halting, discontinuous, not smooth, and not rhythmic because of the dysfluencies. There are many forms of dysfluencies such as:

  • Repetitions: Part-word ( e.g., “dddd dog”), whole-word ( e.g., “How How How How; are you”?), phrase (e.g., “My name is.. My name is .. My name is…Bob.”)
  • Prolongations: Silent prolongations known as “blocks”.
  • Sound prolongations ( e.g., “sssssomebody”.)
  • Interjections: Sound /syllable ( e.g., “I go to um.. um .. um high school.”)
  • Word (e.g., “I want uh like like like go home.”)
  • Phrase (e.g., “This is um like um like um like my friend.”)
  • Pauses
  • Broken Words
  • Incomplete Sentences
  • Revisions

There may be other behaviors associated with stuttering such as motor behaviors (rapid eye blinks, lip pursing, knitting of eyebrows) and abnormal breathing (talking on inhalation, tensed breathing, speaking without first inhaling a sufficient amount of air).

Important: Remember, stuttering is the occurrence of the above listed dysfluencies in excessive amount and excessive duration. Some children go through a normal period of dysfluency during the preschool years which usually “peaks” at about 3½ years of age and consists of “easy” whole word and phrase repetitions ( e.g., “mommy, mommy, mommy what is what is what is that?”)

Listening is an active process of hearing and comprehending what is said. Auditory processing is what we do with what we hear. An auditory processing disorder (APD) is a difficulty in processing auditory information although hearing and intellectual ability are unimpaired.  Areas that may be affected by an auditory processing disorder are:

  • Receptive language and vocabulary
  • Auditory memory for meaningful and non-meaningful information of increasing length and complexity: Meaningful information involves the ability to recall directions and interpret them. Non-meaningful information is the ability to recall unrelated words and numbers.
  • Phonological awareness skills: That is, an individual’s explicit knowledge of the sound segments (phonemes) which form words.  These skills consist of being able to blend, delete, substitute, rhyme, segment and isolate sounds.  Difficulties in the area of phonological skills may precede difficulties in reading and spelling.
  • Thinking and reasoning: the ability to use common sense and ingenuity to solve common thought problems.
  • Auditory vigilance: the awareness of and response to sound. For example, knowing that your name was called and giving a response to the fact that your name was called.
  • Auditory discrimination:  the ability to discriminate paired words with phonemically similar consonants, cognates and vowel differences.

Research demonstrates that bilingualism has a positive impact on speech and language development. Bilingualism does not hinder language development and can even provide cognitive advantages.

Aphasia is a language disorder, usually caused by damage to the left side of the brain. There are different types of aphasia that affect people in various ways. Aphasia can make it difficult for a person to understand spoken or written information. It can also affect a person’s ability to speak or write. Sometimes an individual can have impairments in all of these areas to some degree. The different types of aphasia are known as global, Broca’s, transcortical motor, conduction, anomic, transcortical sensory and Wernicke’s aphasia.

Dysarthria is a condition where muscle weakness in the jaw and mouth area cause problems with speaking. Dysarthria is often the result of a disease like cerebral palsy, multiple sclerosis, Lou Gehrig’s Disease or a stroke or accident causing damage to the brain.One way to improve the muscle movements is an activity that uses oral motor therapy. The instructor asks the patient to pretend he is a mirror. The patient is to mimic the movements the instructor makes. These movements include making silly faces, smiling and frowning, blowing kisses and using the tongue to lick all the way around the lips. This is a fun activity that exercises necessary mouth muscles to improve speech function.

Voice is the sound produced by vibration of the vocal cords (vocal folds) in the larynx (voice box). A voice disorder occurs when the vocal folds do not vibrate effectively to produce a clear sound.

Common Causes:

Causes of voice disorders can include abuse or misuse of the voice, such as yelling, excessive throat clearing, or speaking too loudly. These types of behaviors result in excessive hard closure of the vocal folds causing blister-like bruises that can harden into callous-like lesions called vocal fold nodules. Other causes of voice disorders can include Laryngo-Pharyngeal Reflux (excessive stomach acid backing into the larynx), vocal fold polyps, vocal fold paralysis, vocal fold cysts, etc.

Symptoms of Voice Disorders:

  • Voice quality disturbance: breathiness, raspiness, harshness
  • Voice pitch disturbance: pitch too high for age and gender, pitch too low for age and gender, pitch fluctuates excessively, pitch is monotone
  • Voice volume is too low or too loud
  • Vocal fatigue (decreased stamina, increased hoarseness following speaking)
  • Effortful voice use (having to use too much effort to speak)

Evaluation of Voice Disorders:

Voice evaluations are conducted by Speech-language pathologists who are experts in the area of voice. Evaluations include non-instrumental assessment and instrumental assessment. These assessments allow the Speech-language pathologist to measure the voice objectively, determine patterns that suggest how the larynx is functioning physically, and determine whether there is a hyper functional or hypo functional component present. Voice disorders are complex and this type of evaluation helps determine whether behavioral voice therapy, surgery or a combination of approaches would best serve the patient.

Treatment Options:

Types of voice treatment may include:

  • Vocal strengthening- exercises that can improve voice quality and stamina and can also reduce symptoms of vocal effort and fatigue. Examples of exercises are repetitions of high speech sounds, pitch glides, or glottal closure. These exercises are often used with singers.
  • Reduction of vocally abusive behaviors- During the evaluation and interview, vocally abusive behaviors are often identified. Some examples include:  talking in competition with background noise, yelling, throat clearing, loud cell phone use, not using a microphone, etc. In the treatment session, goals can be made to improve or eliminate these behaviors and provide strategies for care of the voice.
  • Improvement in vocal technique- improving respiratory support for proper voice use, reducing hard glottal attack, and improving vocal resonance. Goals are created during voice therapy sessions and home exercises are provided for continued practice. Carryover of these techniques into everyday situations is also expected.

Pre and Post surgical treatment- Counseling of proper voice care before and/or after vocal fold surgery can significantly improve surgical outcomes and assist patients in healthy return to voice use following surgery. Patients can expect gradual return to voice use following surgery.

Health insurance may sometimes cover speech and language therapy. There are variations in coverage based on carriers, individual’s policy and diagnosis. Be aware of restrictions, deductibles and co-payments. Please contact your insurance carrier for more information about your coverage.

Our speech therapists collaborate with all members of your child’s care team, although we do not provide ABA therapy.

ABA (Applied Behavior Analysis) is a behavior-based approach. It focuses on modifying behaviors using reinforcement (rewards or consequences). ABA often breaks tasks into small steps and encourages repetition to build skills through extrinsic motivation.

Often, behaviors happen because a child is trying to communicate something, such as being overwhelmed, needing a break, or wanting something they can’t yet ask for. Our speech therapists do the detective work to determine how your child communicates, what might be making communication challenging, and honoring their unique way of interacting with the world. Our goal is to give your child tools to express themselves in their own way through fostering intrinsic motivation to communicate. Speech therapy at MST is strength-based and individualized, which means your child will learn through play and real-life, naturalistic interactions, rather than rote memorization. The therapist will follow your child’s lead, building trust and encouraging natural communication. Instead of focusing on stopping behaviors (like hand-flapping or meltdowns), our speech therapists, in collaboration with our occupational therapists, try to understand the “why” behind the behavior. This is what neuro-affirming care means to us!

Both a Board Certified Behavioral Analyst (BCBA) and Speech Language Pathologist (SLP) require a master’s degree, supervised clinical hours, and a board certification exam. 

SLPs complete a supervised clinical experience of at least 400 hours during graduate school that must include work with individuals across the lifespan and with various types of severities of communication and/or related disorders (voice, fluency, swallowing, language, speech, articulation, AAC, etc). Following graduation, an SLP must complete a supervised clinical fellowship of more than 1,400 hours.

BCBAs complete supervised independent fieldwork that includes at least 1,500 hours of supervised fieldwork, a practicum of at least 1,000 hours, and an intensive practicum of at least 750 hours. They focus on modifying behaviors using reinforcement (rewards or consequences). 

An Registered Behavior Technician (RBT), has at minimum a high school diploma and a 40-hour coursework curriculum. They must be supervised by a BCBA, and have the most contact time with a child. RBT’s cannot create treatment plans, but they can follow a treatment plan created by a BCBA.