Many children, when they are young and learning to talk, develop a stutter. Their brains are processing thousands of new sounds and words in the first years of their lives (aptly named a “language explosion”). As our Fort Myers speech therapists can explain, their vocabulary “explodes,” but the brain’s neural pathways are still catching up, and may have difficulty coordinating. This can be a factor in stuttering.
Sometimes, kids struggle with repetition of syllables, sounds and words. Others’ sounds are prolonged and some have so-called “blocks,” or speech interruptions. Some speculate there is a genetic component involved. No matter the specific type of stutter or the underlying reason, our Fort Myers speech therapists can help treat it.
Different Types of Stuttering
Stuttering is what’s known as a “fluency disorder.” As noted by the American Speech-Language Hearing Association (ASHA), someone who has a fluency disorder knows what they want to say, but has difficulty speaking in a way that is flowing, or fluid. They might say parts of the word or a whole word repeatedly. There might be an awkward pause between words. That’s stuttering, which is only one type of fluency disorder. There’s also “cluttering,” where one speaks rapidly and their words run together. Or they might say “um” with great frequency.
By Rachel Revehl, FOCUS Therapy Parent
Earlier this year, prior to the pandemic, one of our son’s speech therapists from FOCUS approached me with what seemed at the time an absurd idea: Would we consider allowing him to do some of his speech therapy sessions via teletherapy? He’d be a great candidate, she said. She also thought it might help us with our busy schedule.
That last part was tempting, but…
“Um, thanks,” I replied. “But, I just don’t think that would work for him.”
Seriously, how could it? He would NEVER sit for a full session without a therapist physically in front of him, I thought.
The FOCUS speech therapy team is flush with great ideas when it comes to using a deck of playing cards to get your child talking.
Card-playing is a popular past time because decks are small, portable and offer endless possibilities. Our speech therapists love cards too because they can be used during sessions (or at home) as a “communication temptation” for our patients. A communication temptation is any type of motivation we use to get kids engaged, talking and practicing the various skills we’re working on in speech therapy.
In addition to classic card games for kids (think Go Fish, Gin Rummy and Crazy Eights), it’s fun to make up games directly tailored to the skills of the children with whom we’re working. Here, we’ll outline some examples. Feel free to try them out yourself or make up your own!
Speech impairment is a common challenge for children with Down syndrome. This is one of the many issues our Fort Myers speech therapists address for our Down syndrome patients at FOCUS Therapy. We encourage any parent whose child has been recently diagnosed to contact our office to set up an evaluation for speech therapy, occupational therapy, physical therapy and possibly ABA therapy. The earlier we are able to intervene, the better the long-term progress and prognosis.
Speech is the ability one has to vocally communicate by articulating sounds and using language.
To understand why children with Down syndrome struggle in this regard – and how we can help treat it – we first need to break down some of the observable symptom clusters affecting multiple body systems that are common among children with this diagnosis.
In our many years of collective experience as speech-language pathologists, our FOCUS team has amassed lots tools to help us address children’s speech and language problems. We have loads of interactive games, cool crafts, brightly-colored books, fun toys and the technology that made us one of the first providers of online speech therapy for kids in Fort Myers (even prior to the pandemic). We also glean a lot of insight working with other professionals in a multi-disciplinary clinic.
But the most powerful tool we have? Parents!
Parent involvement in a child’s speech therapy is so, so important. Those who are committed to our process and make efforts to use our strategies at home are going to see their children make more significant, faster strides. That’s our personal experience, but there’s a lot of research to back us up on this.
We get it, though: Easier said than done. Parents these days are pulled in a thousand directions at once. This is only compounded if your child has been diagnosed with a developmental delay or disorder. There are appointments for doctors, specialists, therapies and school programs – on top of the everyday demands of work and other commitments.
It can be very tempting to simply rely on your speech therapy team to”fix” the speech problems. It’s true that we do (as we sometimes joke) “have ways of making you talk.” We bring to the table proven clinical strategies to help improve your child’s communication skills. But at the end of the day, parents are the rock star reinforcements.
All children develop at their own pace and in their own way, each displaying their own strengths. This is as true for speech and language development as it is for anything else. But while the traditional wisdom when it came to late talkers was to simply wait-and-see, medical professionals are increasingly urge parents to have their kids evaluated sooner than later. Our Fort Myers speech therapists encourage the same, knowing that while some kids really are late bloomers, a language problem becomes more difficult to correct the longer you wait.
Sometimes, this message can get a bit muddied when reports of some studies, such as one published by The American Academy of Pediatrics, are reported under headlines such as, “Late Talkers Do Fine as They Grow Up.” This ends up giving many parents a false sense of assurance. That study tended to show little to no lasting behavior or emotional problems associated with late-talking toddlers by age 5. However, it didn’t assess the language outcomes, so it’s a leap to say those kids went on to be “fine.”
Somewhere between 70 percent and 80 percent of toddlers who talk late will outgrow that language delay – but only if it is an expressive language delay (difficulties with verbal and written expression). Those with receptive language delays (understanding what is being said to them) may have a more difficult time. What our speech therapists want parents to bear in mind is that while many toddlers will outgrow a language delay, 20 percent to 30 percent will not – unless they have access to early intervention like speech therapy.
Medical providers are increasingly relying on telehealth services to ensure patients' needs are met - by meeting patients where they are. It's been used by nurses, psychologists and therapists too. FOCUS Fort Myers is now among the first providers in Southwest Florida to offer online speech therapy for kids.
Sometimes called virtual therapy or teletherapy, it's any therapy that can be conducted via technological device (iPad, phone, computer, laptop, etc.). FOCUS began offering online speech therapy services sporadically about 18 months ago. Recently, we established our Teletherapy Department, consisting of two pediatric speech therapists who exclusively operate remotely.
"The same diagnoses and conditions that can be treated in our clinic can be treated effectively via teletherapy," said Haley Ott, FOCUS speech-language pathology assistant and director of the Teletherapy Department.
The process is similar to a Face Time call, except it's through a secure, HIPAA-compliant app.
"It's fairly simple from there," FOCUS SLP and TD department founder and executive director Emmi MacIntyre Ring explained. "We provide our clients with a meeting code, the client enters it into their device, and we pop up on their screen and utilize a variety of online platforms to target their therapy goals. It's an evidence-based and supported administration of therapy services that we've found to be extremely convenient and effective for our clients at FOCUS."
Some local schools contract with companies that strictly offer teletherapy services. However, only a small number of private therapy clinics offer it - for now.
In many regions - including Southwest Florida - the need for speech therapists is greater than the supply. The new Advanced Report on Telehealth and Telemedicine Market Analysis Forecast indicates that by 2026, the global market for all telemedicine is expected to exceed $185 million.
The cost for speech teletherapy is the same as an in-clinic visit, and it's covered in FOCUS' contract with Medicaid. We also extend this service to private pay clients, and are working to expand availability for patients in other insurance networks.
Therapists don't need any special training for telehealth services except for use of the app. If there are parent concerns about how attentive a child will be in online speech therapy, we encourage quiet observation of a session or two in the background. After the first few, though, kids usually make more progress when given space to connect one-on-one with their therapist - even from a distance.
Effectiveness of Teletherapy for Speech
Because telehealth is relatively new in the medical field, researchers are still gathering data and anecdotal evidence that will provide definitive proof of its effectiveness. Still, early impressions are that online speech therapy could be a game-changer for many kids who might otherwise be limited in the early intervention services they could receive.
One study found that kids receiving speech teletherapy outperformed control groups and national benchmarks in expressive and receptive language, social pragmatics and articulation skills.
Research published in the spring 2017 edition of the International Journal of Telerehabilitation concluded: "The evidence presented showed that telehealth is a promising service delivery method for delivering speech and language intervention services to school-age children. This alternative service delivery model has the potential to improve access to SLP services for children living in geographically remote areas, reducing travel time and alleviating the detrimental effects of communication difficulties on education, social participation and employment."
In other words: We KNOW that early speech and language communication skills are a strong indicator of a child's future success. The sooner we can treat speech and language deficits, the better off that child will be long-term. Online speech therapy is a way to extend the same services to kids who might have a difficult time to make it to the office everyday.
"The therapy we're offering isn't different - the mode of delivery is," explained Ott. "Many therapists believe that teletherapy is especially beneficial and a superior method for children in schools because it allows for a FULL session, without having to take time out of a session to transport students. More minutes means more progress."
It's also important to note that while screen time for young kids is generally frowned upon, teletherapy is different. While most television and online games deprive kids of key social interaction, the whole point of speech teletherapy is engaging them.
"Teletherapy is led and directed by a licensed, certified clinician, working specifically on therapy goals in a way that is tactical and motivating for each child and their needs," MacIntyre said.
Parent Feedback on FOCUS Online Speech Therapy Program
Parents come to FOCUS Fort Myers from all over Southwest Florida because we are one of the most trusted providers of speech, occupational, physical and ABA therapy in the region. But teletherapy is still fairly new, so it's understandable parents and even some providers would approach it with healthy skepticism. Ott said the primary concern initially is, "What if my child doesn't pay attention?"
"This is 100 percent understandable, and is a concern of ours as well," Ott said. "However, you can apply this question to your child in most situations - including at school and during in-clinic therapy sessions. In school, your child isn't paying attention ALL the time, and in-person therapy at FOCUS isn't always smooth-sailing either. Most children need frequent breaks in order to attend, and online speech therapy is no different."
Elliot Warford, 8, of Fort Myers, has been a speech teletherapy patient for several months now.
"We love teletherapy so much," his mother Crystal Warford said. "It's a more controlled, one-to-one session, as opposed to in the clinic, where there are sometimes distractions. He loves that Haley incorporates games, and he feels more in control when he gets to choose which games to play. And of course for us, it's convenient to be able to cook dinner while he's in therapy."
Teletherapy may not be an option for every child, but we also know for some kids, it can be every bit as effective as in-person sessions. Sometimes children are more engaged in teletherapy sessions than in-person sessions because they get access to functional screen time.
This service makes a big difference for working parents and families constantly ferrying back-and-forth to other appointments and commitments. It increases access to providers, allows for greater transparency (every session can be recorded) and children enjoy it.
"It's a great way to incorporate education with something they like and aid in increasing their development," Ott said.
Andrea Cappuccilli's daughter has been attending speech therapy, occupational therapy and physical therapy at FOCUS for the past several years. Recently, the 7-year-old started doing some of her FOCUS speech therapy sessions online from home.
"Our primary purpose for speech therapy is to work on voice and breathing exercises so that her respiratory system can get stronger," Cappuccilli explained. "Teletherapy at home gives her a solid chance of improving these skills, while allowing her to avoid exposure to illnesses like the flu or RSV that can easily put her in the hospital for weeks."
And her daughter loves it.
"She knows she's doing therapy, but being on a screen - which kids are already all about - makes it seem cool, and like it's on HER terms."
FOCUS offers pediatric speech therapy and online speech therapy for kids in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
A Pilot Telerehabilitation Program: Delivering Early Intervention Services to Rural Families, Fall 2009, Jana Cason, International Journal of Telerehabilitation
While slime itself – slippery, gooey, smooshy, somewhere between liquid and solid – has a lot to offer in terms of sensory integration, the simple process of making it in a therapy session can give children a lot of practice in key skills we’re working to develop.
(And the lessons “stick” because, well – slime is cool!)
We encourage parents to try this – and other simple experiments – at home to get their kids talking!
You my notice in the FOCUS waiting room that our Fort Myers speech therapists sometimes form some basic signs with our hands while we’re speaking to some of our patients. But it’s not exactly sign language. What we’re doing in those instances is using a speech-language therapy technique known as “sign-supported speech,” sometimes referred to as SSS.
Sign-supported speech is a form of simultaneous communication (SimCom), which was originally formed for the benefit of those who are deaf or hard-of-hearing. However, the method has also proven an effective way for our Fort Myers speech therapists to teach speech and language to children with language delays and disorders.
Recent research published in the Journal of Speech, Language and Hearing Research found that when speech therapists used sign-supported speech for word learning when working with children who have a developmental language disorder, it had a positive impact on the child’s linguistic and cognitive development.
There are lullabies that promise pretty horses and twinkling stars and some over-the-rainbow places where dreams-come-true. But pediatric music and speech therapy researchers have learned that lullabies may hold another promise: Better health for premature babies.
Recent analysis shows a parent who sing to preemies still receiving treatment in neonatal intensive care unit (NICU) can:
- Soothe a child amid scary new sensations and hospital noises, bonding parent-to-child.
- Regulate breathing and improve oxygen absorption for those who haven’t yet developed reflexive breathing.
- Boost a baby’s nutritional intake, imperative for those with immature oral-facial muscles struggling to suck and swallow
Speech Therapy Pros: Preemies – All Babies – Need Your Voice
At our FOCUS Fort Myers speech therapy, occupational therapy and physical therapy clinic, we treat many children born prematurely, as they are at much higher risk of neurodevelopmental difficulties. The earlier we intervene the better, but encourage parents to start first. Even the simple act of talking regularly to your child from a young age can do wonders.
For a premature baby, lullabies serve much the same purpose – but with power that extends beyond just speech and language development extending to objectively improved odds at survival for babies born at 37 weeks or earlier.
A 2013 study published in Pediatrics found that a parent’s lullabies or even just humming – gentle and rhythmic – played to the backdrop of low guitar strings reduced stress levels and promoted bonding, as evidenced by:
- Regulated babies’ heartbeats;
- Promoted longer, deeper periods of sleep;
- Improved weight gain;
- Shorter hospital stays;
- Better long-term cognitive development and function.