Phonological Processes Extinction Norms

Fluency is described as the rate or flow of speech.  Typically speech is fluid with words flowing smoothly as one speaks.  Occurrences in which there are pauses, repetitions, etc. that break up the steady flow of words are referred to as disfluencies.  Between the ages of 18 months and 60 months many children will demonstrate disfluent speech.  This occurs when children are thinking faster than their tongue can move to express their thoughts.  When children are excited or tired an increase in disfluencies usually occurs. Everybody experiences some degree of disfluency.  

Speech is considered dysfluent/stuttered when the following characteristics are observed:

1. stuttering after age 5.
   
2. facial grimacing or tics associated with his speech.
   
3. frequent repetitions of sounds, syllables, or short words
   
4. frequent hesitations or pauses in speech
5. speech flow is not smooth
6. unreasonable self-consciousness or fear about speech.
   
7. more than 10 words in every 100 are dysfluent
   
8. dysfluencies do not improve after trying the suggestions below for 2 months.
   

Examples of dysfluency/stuttering types:

      1. Repetitions - “Sh-sh-she wants to swing."

      2. Prolongations - "Mmmmmmmy car is blue."

      3. Blocks - Silent and fixed prolongations.

      4. Hesitations - "________ I am six."

      5. Interjections - " I um, er, um want some cake."

      6. Revisions - "I would like, I want to, I need to get my books."

Tips for helping your child:

1. Encourage conversation. At least one time daily, sit and talk with your child about pleasant and enjoyable topics. Avoid using this time to make corrections and keep these times relaxed.
   
2. Help your child relax during stuttering events.  If the stuttering is not causing your child any discomfort, ignore these events.  When your child is having trouble speaking, reassure him/her that you can understand what is being said.  If your child asks about the stuttering, let them know that speaking will become easier and one day they will not have trouble anymore.
3. Do not correct your child’s speech.  During moments of dysfluency, avoid correcting grammar or speech or making comments such as “Think before you speak.”  The dysfluencies are beyond your child’s control.  
4. Avoid praising your child for “good” speech.  This implies that previous utterances were not acceptable.
5. Do not interrupt your child’s speech.  Allow plenty of time for your child to finish speaking.  Prevent others from interrupting or completing his/her sentences.
6. Do not ask your child to repeat himself or start over.  Listen very carefully.  Only ask your child to repeat what was said if the comment appeared to be important.  Restate what your child said to ensure that you understood.
7. Do not practice particular words or sounds.  This just increases anxiety and makes your child more self-conscious about speaking.
8. Do not ask your child to speak slower.  Let your child know that you have plenty of time to listen to what he/she has to say by slowing your own speech and pausing in whatever task you are doing to give him/her your full attention.
9. Do not label your child.  Labels tend to become self-fulfilling prophecies so do not talk about your child’s speech difficulties with him/her present.
10. Ask others not to correct your child’s speech.  Share these tips with everyone your child communicates with on a regular basis.  Do not allow siblings to tease or imitate your child’s stutter.
11. Help your child relax and feel accepted in general.  Try to slow down the pace of family life

Voice production is characterized by:

1. Quality - pleasant and clear voice versus unpleasant, strained, raspy, and/or hoarse voice.
   
2. Intensity (loudness) - appropriate versus inappropriate loudness for a given situation.
   
3. Pitch - pitch that is appropriate for age/sex versus pitch that is too high or low
   
4. Resonance (nasality) - proper emission or balance of air through mouth or nose.
   

Causes of Vocal Problems

Vocal folds may be “abused” due to screaming, yelling, and speaking loudly frequently throughout the day. If this happens often enough over long periods of time, “vocal nodules” (growths on the vocal folds) may appear and prevent proper function.

Allergies, sinus and adenoid problems may result in a denasal (stuffed up) vocal quality.  Decongestants and antihistamines given to dry up the nose also dry out the vocal folds and can cause voice problems in children.

Vocal Quality Issues

• denasal/ “stuffed up” 

• dry cough 

• persistent throat clearing 

• a voice problem which persists for 2-3 weeks 

• hoarseness 

• harshness/low in pitch and very strained 

• breathiness/whisper-like noise 

• pitch breaks/pitch goes up and down 

• low volume 

If a child demonstrates one or more of the above characteristics:

1. Talk to a Speech-Language Pathologist
   
2. Monitor the child’s speech voice for 3 weeks by simply making notes (“cleared throat constantly” or “voice breathy today”)
   
3. Discourage straining the voice (screaming, clearing throat, etc.)
   
4. Encourage the student to drink lots of water and allow him/her to keep a water bottle at the desk
   
5. Encourage the student to take a sip  of water before speaking
   
6. If the problem continues for 2-3 weeks, it is best practice to have the child seen by an Otolaryngologist/ENT doctor to rule out growths on the vocal folds that may require surgery, as opposed to cases that may benefit from therapy in order to shrink the growth
   

Voice disorders in children can be reduced when we all work together. The first important step is recognizing when a child may have a voice disorder. The proper steps to eliminate the problem may then be taken.

If your child is able to produce the sound correctly, but is not yet using the sound consistently in everyday speech these ideas will help increase their awareness of their speech so they can produce their sound accurately in all situations/settings.  Children need many opportunities to use a new sound throughout the day before correct sound production becomes a habit.  Below is an outline of specific speech tasks for additional practice.  These tasks give ideas for short, daily speech task and are sequenced in a hierarchy to allow for practice at each level as your child perfects their sound(s).  Start with the first task and when your child can produce their sound accurately and quickly they are ready to move to the next task.  Please try to complete a task each day.