Speech and Language Evaluation, Treatment and Management
Watch the video
Hearing and Speech Disorders Q&A
Tommie Robinson, Ph.D., CCC-SLP, the division chief of the Division of Hearing and Speech, answers questions about common hearing and speech disorders in children.
Children’s National Hospital speech-language pathologists are trained to evaluate speech and language from birth to young adulthood. We use both standardized and informal measures to assess overall performance and skills. We utilize different techniques, depending upon your child's developmental/chronological age.
Our evaluations may include:
- Case history
- Parent interview
- Patient interview
- Hearing screening
- Oral motor examination
- Behavioral observation
- Clinical observation
- Trials of speech generating devices
- Norm referenced testing
If you suspect your child needs a speech or language evaluation, contact us at 202-476-5600.
Speech Treatment and Management
We provide support for children and families as they navigate the transition from diagnosis to treatment for a variety of speech disorders. This includes parent education/training and coordination of care with other providers.
A motor speech disorder is present when a child struggles to produce speech because of problems with motor planning or muscle tone needed to speak. There are two major types of motor speech disorders which are as follows:
- Dysarthria: Dysarthria is a speech disorder in which there is a disturbance in the control of the muscles involved in speech production. This can be due to paralysis, weakness or incoordination of the muscles of the lips, tongue and lungs.
- Apraxia of Speech: Apraxia is a speech disorder characterized by the child’s inability to coordinate the complex oral movements needed to create sounds into syllables, syllables into words, and words into phrases. Typically, muscle weakness is not to blame for this speech disorder.
A phonological delay/disorder refers to a child’s failure to use sounds that the child should be able to produce and uses a simplified version of adult speech. These are predictable rule-based errors that affect more than one sound. For example, [dat] for [cat]; and [fog] for [frog].
A speech articulation disorder is a failure to produce speech sounds accurately. It may involve distortion of sounds, substitution of some sounds for others and omission of sounds. For example, some children make a lisp when saying "s" and "z" sounds.
Stuttering is difficulties with the rate and rhythm of speech, characterized by repeating sounds, words and sentences, and getting stuck and/or prolonging sounds. Your child may sometimes show tension and struggle, which may include eye blinking, facial grimaces and avoidance behaviors.
A voice disorder is a change in your child's vocal quality. Some symptoms of voice disorders include a breathy or hoarse vocal quality, decreased loudness or change in the pitch of your child's voice that is not developmentally appropriate. This can be caused by:
- Trauma to the voice box (i.e. larynx)
- Inflammation of the voice box
- Vocally abusive behaviors (i.e. shouting, increased consumption of caffeine)
- Environmental factors (i.e. smoking in the household)
Language Treatment and Management
A language delay is a type of communication disorder. Your child may have a language delay if they don’t meet the language developmental milestones for their age. They may have trouble expressing themselves, interacting with peers/adults or understanding others.
Language Delay Basics
A language delay can be:
- Receptive. A receptive language deficit happens when your child has difficulty understanding language.
- Expressive. An expressive language disorder happens when your child has difficulty communicating verbally.
- Pragmatic. A pragmatic language disorder happens when your child is unable to interact socially.
A language delay can also be a combination of any of the above types.
If your child has a language delay, there will be difficulty reaching language milestones at the typical age. Common symptoms of a language delay may include:
- Not babbling by the age of 6 months
- An inability to express single words by around the age of 1 year
- An inability to combine words by around the age of 2 years
- An inability to speak in short sentences by around the age of 3 years
- Difficulty following directions
- Difficulty putting words together in a sentence
- Leaving words out of a sentence
- Reduced vocabulary in comparison to other children of the same age
- Impaired ability to use words and connect sentences to explain or describe something
- Reduced ability to have a conversation
- Saying words in the wrong order
- Repeating a question instead of responding
Your child may have a language disorder if the issue is persistent and does not improve.
Potential risk factors for speech and language problems may include:
- Born prematurely
- Low birth weight
- Family history of speech or language problems
- Genetic and/or neurological conditions
Our speech-language pathologist will tailor a treatment program to your child's individual needs depending on age and extent of the impairment. The speech-language pathologist will work directly with your child supporting their development through language-based activities in the clinic. You will be given exercises to do at home so that your child continues to make progress between treatment sessions.
Every child’s care outcome will vary depending on their specific condition and age. Our team is here to help your family throughout your child’s care journey.