Making the Best Use of Speech-Language Therapy
Celia Neavel, MD, FSAHM
Lee Anne Holmberg M.A., CCC-SLP
Ellen S. Kester, Ph...
OBJECTIVES
1. Discuss speech and language in school-age
youth.
2. Identify when referral for Speech-Language
Evaluation an...
STRUCTURES INVOLVED IN SPEECH
AND VOICE PRODUCTION.
PREVALENCE SPEECH PROBLEMS
REPORTED BY PARENTS
ALL OF THE DOCUMENTS AND CHARTS IN THIS
PRESENTATION CAN BE DOWNLOADED FROM OUR
FREE RESOURCE LIBRARY.
Click here to visit...
LANGUAGE DISORDERS
 Language
 Shared system for communicating
 Involves sounds, signs, gestures, and/or spoken or
writt...
MEAN LANGUAGE SCORES AND
NON-VERBAL I.Q.SCORES
PREVALENCE HAVING READING
DISABILITY
NORMAL LANGUAGE DEVELOPMENT IN
CHILDREN AND ADOLESCENTS
 Verbal AND non-verbal; follows predictable
course
 4-5 y.o.
 2...
WARNING SIGNS SCHOOL-AGED CHILD
 Phonological awareness problems
 New inattentive or not well-controlled ADHD
 Problems...
LANGUAGE AND COGNITIVE DEVELOPMENT IN
ADOLESCENTS
 Core language skills established.
 Semantics, syntax, language concep...
IMPLICATIONS OF VOICE, SPEECH,
AND LANGUAGE DISORDERS
 Need to communicate to function in our society
 Affect emotional ...
GOALS FOR
INTERVENTIONS
 Help with developmental trajectory
 Maintain or improve self-esteem
 Maximize function
 Decre...
IDENTIFYING VOICE, SPEECH, AND
LANGUAGE DISORDERS
 Suspected by family, physician, or educator
 Consider delayed versus ...
BILINGUAL CHILDREN
Ellen S. Kester, Ph.D
President, Bilinguistics Speech and Language
Services
5766 Balcones Drive, Suite ...
EXAMPLES FROM BILINGUISTICS
 4-year-old Spanish-speaking child with a
total of approximately 20 words, who
could follow o...
WHY DO WE GET REFERRALS LIKE
THIS?
 Misconceptions about bilingual development
 Mobility of population
 Parents don’t u...
 Children code switch between languages because
they don't know either language well.
 Raising children with two languag...
 Bilingual children develop early
vocabulary at the same rate as
monolingual children (Pearson, 1993).
 Early language m...
DETERMINING SPEECH-LANGUAGE
IMPAIRMENT IN BILINGUALS
EnglishEnglish
Spanish
OK
Spanish
OK
NormalNormal
English
OK
English
...
 Difficulty learning both languages, even with adult
assistance
 Family history of language/learning disabilities
 Slow...
LEE ANNE HOLMBERG M.A., CCC-
SLP
SPEECH-LANGUAGE
PATHOLOGIST
EASTER SEALS OF CENTRAL
TEXAS
SPEECH-LANGUAGE PATHOLOGY YOU
SHOULD KNOW
• Language Disorders:
– Receptive Language Disorder
– Expressive Language Disord...
A FEW DIAGNOSIS THAT WARRANT
REFERRAL TO SPEECH-LANGUAGE
PATHOLOGIST
 Children with ADD or ADHD
 Hearing Loss or Chronic...
OTHER SITUATIONS THAT WARRANT
REFERRAL TO SPEECH-LANGUAGE
PATHOLOGIST
 Children that schools discharged from speech thera...
TESTS MOST COMMONLY USED
FOR EVALUATIONS
 Language Tests:
 Preschool Language Scale 4 (PLS4)
 Clinical Evaluation of La...
WHAT TO LOOK FOR IN SPEECH-LANGUAGE REPORT
 Speech-language diagnosis accompanies medical diagnosis,
if applicable
 Chro...
WHAT A SPEECH-LANGUAGE
PATHOLOGIST CAN OFFER
• Speech and language Screenings, evaluations,
and treatment.
• Recommendatio...
WORKING WITH THE SCHOOLS:
WHAT SPEECH-LANGUAGE PATHOLOGIST
FOCUSES ON
 Collaboration with teachers, school speech-languag...
QUESTIONS TO SCREEN FOR
POSSIBLE SPEECH-LANGUAGE
DELAYS
Young Children:
 How much is your child talking?
 How many words...
QUESTIONS TO SCREEN FOR
POSSIBLE SPEECH-LANGUAGE
DELAYS
Adolescents:
 How is your child functioning in school?
 How much...
WHAT IS AUGMENTATIVE ALTERNATIVE
COMMUNICATION (AAC)?
Augmentative and alternative communication
(AAC) includes all forms ...
TYPES OF AAC
 Unaided AAC: Using body to communicate with
others. Includes, gestures, body language, and/or sign
language...
TOTAL COMMUNICATION APPROACH TO
AAC
 Includes use of combination of speech, gestures, sign,
and AAC.
 Important because ...
TYPES OF CLIENTS WITH AN AAC DEVICE
SEEN AT EASTERS SEALS
 Clients with Down Syndrome
 Clients with profound oral apraxi...
AAC 101
Jon Yates
AAC Specialist
DynaVox Mayer-Johnson
ASSESSMENT
 AAC Devices recognized as treatment by:
 American Medical Association
 American Academy of Neurology
 Amer...
CONDITION SETS THAT BENEFIT FROM THE 
USE OF A COMMUNICATION DEVICE
•Cerebral Palsy
•Down Syndrome
•Mental Retardation
•Au...
SOME INTERESTING FACTS
 8 out of 1000 people worldwide cannot use 
speech to communicate.
 2‐3 million in U.S. could ben...
WHAT BENEFITS DOES AAC PROVIDE TO YOUR PATIENTS?WHAT BENEFITS DOES AAC PROVIDE TO YOUR PATIENTS?
 Improves overall qualit...
FUNDING: SHOW ME THE MONEY
 Medical Model
 Medicare
 Medicaid
 Private Insurance
 STAP
 Other Organizations
 ALS
 ...
FUNDING: MEDICAL MODEL
Private Insurance
 Many insurers follow Medicare guidelines.
 Call insurance company and ask ques...
FUNDING: MEDICAL MODEL
Texas Medicaid Assistance 100%
 Covers approved equipment with no out pocket cost to
client
 Does...
FUNDING: STAP
 STAP stands for:
 Specialized Telecommunications Assistance Program
 Falls under umbrella of DARS
 Depa...
FUNDING: STAP
 Process
 Fill out STAP application and provide small report.
Application must be accompanied by proof of ...
FUNDING: STAP
 With this funding there is no reason why anyone in
Texas should be without a voice. 
 This is also a gre...
RESOURCES
 0-3 y.o. Early Childhood Intervention
 =/ >3 y.o. Child Find through School/School District or
youth’s school...
REFERENCES
http://www.nidcd.nih.gov/health/voic
e/ National Institute on Deafness
and Other Communication
Disorders, Nati...
CODING
 784.3 Aphasia
 784.40 Voice and
resonance disorder,
unspecified
 784.42 Dysphonia
 784.43 Hypernasality
 784....
CODING
 315.31 Expressive
language disorder
 315.32 Mixed
expressive-receptive
language disorder
 315.34 Speech and
lan...
Click to visit www.bilinguistics.com
Rapidly identify speech-
language patterns related to
second language acquisition to
distinguish difference from
disorder....
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Making Best Use of Speech-Language Therapy: When to Refer and What to Expect

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In this presentation, we discuss speech and language in school-age youth, identify when referral for Speech-Language Evaluation and Therapy would benefit the patient, and explain utilization of Alternative and Augmentative Communication (AAC).

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Making Best Use of Speech-Language Therapy: When to Refer and What to Expect

  1. 1. Making the Best Use of Speech-Language Therapy Celia Neavel, MD, FSAHM Lee Anne Holmberg M.A., CCC-SLP Ellen S. Kester, Ph.D Jon Yates, AAC Specialist 2012, Dell Children’s Hospital, Austin, TX
  2. 2. OBJECTIVES 1. Discuss speech and language in school-age youth. 2. Identify when referral for Speech-Language Evaluation and Therapy would benefit the patient. 3. Explain utilization of Alternative and Augmentative Communication (AAC). 4. Describe community resources for youth with speech and language delay and their families.
  3. 3. STRUCTURES INVOLVED IN SPEECH AND VOICE PRODUCTION.
  4. 4. PREVALENCE SPEECH PROBLEMS REPORTED BY PARENTS
  5. 5. ALL OF THE DOCUMENTS AND CHARTS IN THIS PRESENTATION CAN BE DOWNLOADED FROM OUR FREE RESOURCE LIBRARY. Click here to visit the Resource Library
  6. 6. LANGUAGE DISORDERS  Language  Shared system for communicating  Involves sounds, signs, gestures, and/or spoken or written words  Specific Language Impairment  Absence other developmental problems  Other language disorders assoc. with  Hearing impairment  Autism  Mental retardation  Congenital or acquired disorders of brain development  Head injury, brain tumors.
  7. 7. MEAN LANGUAGE SCORES AND NON-VERBAL I.Q.SCORES
  8. 8. PREVALENCE HAVING READING DISABILITY
  9. 9. NORMAL LANGUAGE DEVELOPMENT IN CHILDREN AND ADOLESCENTS  Verbal AND non-verbal; follows predictable course  4-5 y.o.  200-300 words; can describe, define, answer why; tell simple story; understandable to all  5-6 y.o.  Understands > 2000 words, sequencing, rhyming; creates stories; carries out series 3 directions  School Years;  Huge demand on skills for school and social acceptance; emerging figurative language
  10. 10. WARNING SIGNS SCHOOL-AGED CHILD  Phonological awareness problems  New inattentive or not well-controlled ADHD  Problems reading, writing, understanding social interactions  Feelings hurt or gets angry/frustrated  Trouble learning second language  Parents with language/literacy problems
  11. 11. LANGUAGE AND COGNITIVE DEVELOPMENT IN ADOLESCENTS  Core language skills established.  Semantics, syntax, language concepts and basic pragmatic skills  Early adolescents more concrete  Adult pragmatic and social language skills being refined, including ability to:  Interact with adults and peers in classroom and social activities  Maintain or shift topic of the conversation; participate appropriately in conversation  Take another person’s point of view to know what information is needed during a communication event  Incorporate subtle variations in tone, word usage, rhythm depending on situation
  12. 12. IMPLICATIONS OF VOICE, SPEECH, AND LANGUAGE DISORDERS  Need to communicate to function in our society  Affect emotional and social life, education and job  Substantial cost in life quality and human potential  Number will likely increase  Improved survival for medically fragile infants and individuals who sustained injury or acquired disease
  13. 13. GOALS FOR INTERVENTIONS  Help with developmental trajectory  Maintain or improve self-esteem  Maximize function  Decrease anxiety  Educate other important adults so can:  Understand youth’s weaknesses  Make appropriate modifications and contribute further to interventions
  14. 14. IDENTIFYING VOICE, SPEECH, AND LANGUAGE DISORDERS  Suspected by family, physician, or educator  Consider delayed versus disordered  ASK FUNCTIONING AGE  Speech-language pathologists evaluate & diagnose  History, exam, comparison to standardized norms  Voice assessment  Speech assessment  Motor speech disorders and/or stuttering  Language assessment  Formalized questionnaires; direct observation; testing vocabulary, understanding, word and sentence production, language in social situations  Must take into account the native language of the speaker
  15. 15. BILINGUAL CHILDREN Ellen S. Kester, Ph.D President, Bilinguistics Speech and Language Services 5766 Balcones Drive, Suite 205 Austin, TX 78731 (512) 480-9573 Phone (512) 458-9573 Fax www.bilinguistics.com
  16. 16. EXAMPLES FROM BILINGUISTICS  4-year-old Spanish-speaking child with a total of approximately 20 words, who could follow one-step commands with gestures but not without gestures. Intelligibility of 30-40%.  3-year-old bilingual child who has difficulty following simple directions with gestures. He uses single words and two- word utterances. Intelligibility is 40-50%.  Neither of these children had been referred for a speech-language evaluation previously.
  17. 17. WHY DO WE GET REFERRALS LIKE THIS?  Misconceptions about bilingual development  Mobility of population  Parents don’t understand “no cost” options  Parents not comfortable expressing concerns  Parents not aware of developmental differences  Parents may be aware of differences, but not know value of early intervention  Language barriers may impede referral process
  18. 18.  Children code switch between languages because they don't know either language well.  Raising children with two languages will confuse them.  Children with language impairment should not learn more than one language at a time.  Children who use the sentence structure of one language when speaking the other likely have language impairment.  We should expect bilingual children to be delayed in developing communication skills
  19. 19.  Bilingual children develop early vocabulary at the same rate as monolingual children (Pearson, 1993).  Early language milestones are similar (single words, lexical spurt, 2-word phrases, following directions) (Pearson and Fernandez, 2001).  Conceptual scores are similar (Pearson, 1998).
  20. 20. DETERMINING SPEECH-LANGUAGE IMPAIRMENT IN BILINGUALS EnglishEnglish Spanish OK Spanish OK NormalNormal English OK English OK SpanishSpanish NormalNormal EnglishEnglish SpanishSpanish Impaired*Impaired*
  21. 21.  Difficulty learning both languages, even with adult assistance  Family history of language/learning disabilities  Slower development than siblings  Difficulty interacting with peers  Inappropriate pragmatic/social language skills (i.e., turn-taking, topic maintenance, considering listener needs, non-verbal communication)  Difficulty with language in many routines  Idiosyncratic error patterns  Language performance unlike others with similar cultural/linguistic experiences Click here to visit the Resource Library
  22. 22. LEE ANNE HOLMBERG M.A., CCC- SLP SPEECH-LANGUAGE PATHOLOGIST EASTER SEALS OF CENTRAL TEXAS
  23. 23. SPEECH-LANGUAGE PATHOLOGY YOU SHOULD KNOW • Language Disorders: – Receptive Language Disorder – Expressive Language Disorder – Pragmatic Language Disorder • Articulation Disorders: – Oral Apraxia – Stuttering- – Voice Disorder • Feeding Disorder: – Dysphasia
  24. 24. A FEW DIAGNOSIS THAT WARRANT REFERRAL TO SPEECH-LANGUAGE PATHOLOGIST  Children with ADD or ADHD  Hearing Loss or Chronic Ear Infections  Cleft Palate or other Craniofacial Anomalies  Difficulty Feeding and Swallowing  Autism Spectrum Disorders  Variety of Syndromes including- Down Syndrome, Fragile X Syndrome, Turner’s Syndrome, etc.  Children with Cerebral Palsy
  25. 25. OTHER SITUATIONS THAT WARRANT REFERRAL TO SPEECH-LANGUAGE PATHOLOGIST  Children that schools discharged from speech therapy  Learning disabilities or children struggling in school  School-aged and cannot identify significant details in story or situation and then sequence them in understandable way  2 – 5 y.o. with very small vocabulary and having difficulty stringing words together in phrases and sentences  When parent of a 2 y.o. or older says, “My child is not talking and using words, and does not seem to understand me.”  When parent says, “I do not understand what my child says.” Please do not tell a parent who is concerned to wait until child is 4 or 5 y.o. A lot of speech-language development goes on before then!!!!
  26. 26. TESTS MOST COMMONLY USED FOR EVALUATIONS  Language Tests:  Preschool Language Scale 4 (PLS4)  Clinical Evaluation of Language Functioning (CELF)  Clinical Evaluation of Language Functioning-Primary (CELF- P)  Test of Language Disorders (TOLD)  Articulation Tests:  Goldman Fristoe Test of Articulation
  27. 27. WHAT TO LOOK FOR IN SPEECH-LANGUAGE REPORT  Speech-language diagnosis accompanies medical diagnosis, if applicable  Chronological age of child included  Standard scores from formal testing (average range 85- 115)  Language age levels in all subtests of formal testing  Narrative discusses child’s strengths and weaknesses  Specific recommendations  Stated goals to be addressed in therapy
  28. 28. WHAT A SPEECH-LANGUAGE PATHOLOGIST CAN OFFER • Speech and language Screenings, evaluations, and treatment. • Recommendations for referrals to other therapies i.e. OT, PT • Collaboration with other service providers (doctors, psychologists, other therapists, and schools). • Education on the child's communication issues for parents, and other providers • Parent training on communication and the child’s needs and goals
  29. 29. WORKING WITH THE SCHOOLS: WHAT SPEECH-LANGUAGE PATHOLOGIST FOCUSES ON  Collaboration with teachers, school speech-language pathologists, and counselors  Education and training on specific techniques that are working well in the child’s therapy  Opening a dialogue to share progress and difficulties the child is experiencing
  30. 30. QUESTIONS TO SCREEN FOR POSSIBLE SPEECH-LANGUAGE DELAYS Young Children:  How much is your child talking?  How many words is your child using?  How many words is your child stringing together?  Is your child able to follow directions (Go get your shoes.)?  Does your child understand what your are telling him/her?  How much are you able to understand your child?
  31. 31. QUESTIONS TO SCREEN FOR POSSIBLE SPEECH-LANGUAGE DELAYS Adolescents:  How is your child functioning in school?  How much of what your child tells you are you able to understand?  Is your child able to use logical sentence?  Is their spoken grammar correct?  Is your child able to identify the main details in a story?  Then is your child able to sequence these main details to retell the story?  Can your child follow multi-step directions?  Does your child have pronunciation difficulties?
  32. 32. WHAT IS AUGMENTATIVE ALTERNATIVE COMMUNICATION (AAC)? Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. asha.org
  33. 33. TYPES OF AAC  Unaided AAC: Using body to communicate with others. Includes, gestures, body language, and/or sign language.  Aided AAC: Using tools along with the body to communicate with others. Tools can include:  Pencil and paper.  Communication boards or communication books.  Electronic Voice Output Devices (VOD). www.asha.org
  34. 34. TOTAL COMMUNICATION APPROACH TO AAC  Includes use of combination of speech, gestures, sign, and AAC.  Important because it gives person variety of methods to use for successful communicate with others.
  35. 35. TYPES OF CLIENTS WITH AN AAC DEVICE SEEN AT EASTERS SEALS  Clients with Down Syndrome  Clients with profound oral apraxia  Autistic clients  Clients with severe Cerebral Palsy
  36. 36. AAC 101 Jon Yates AAC Specialist DynaVox Mayer-Johnson
  37. 37. ASSESSMENT  AAC Devices recognized as treatment by:  American Medical Association  American Academy of Neurology  American Academy of Physical Medicine & Rehabilitation  American Speech-Language Hearing Association
  38. 38. CONDITION SETS THAT BENEFIT FROM THE  USE OF A COMMUNICATION DEVICE •Cerebral Palsy •Down Syndrome •Mental Retardation •Autism •Muscular Dystrophy Congenital/ Develop‐ mental Acquired Child Adult •Traumatic Brain Injury (TBI) •Spinal Cord Injury (SCI) • TBI • Stroke • SCI • Amyotrophic Lateral Sclerosis (ALS) • Parkinson’s Disease • Huntington’s Disease • Multiple Sclerosis (MS) Degenerative Acute •Cerebral Palsy •Down Syndrome •Mental Retardation •Autism •Muscular Dystrophy
  39. 39. SOME INTERESTING FACTS  8 out of 1000 people worldwide cannot use  speech to communicate.  2‐3 million in U.S. could benefit from speech  generating devices.  Only 5% of these people have a speech device.  Funding is available.  Source: Univ of Nebraska Lincoln Website
  40. 40. WHAT BENEFITS DOES AAC PROVIDE TO YOUR PATIENTS?WHAT BENEFITS DOES AAC PROVIDE TO YOUR PATIENTS?  Improves overall quality of life  Supports meaningful personal relationships  Develops functional communication skills  Improves Functional Communication Measures  Reinforces traditional rehabilitation activities  Schedules (appointments and daily activities)  Reminders (medication and appointments)  Videos (physical therapy examples)  Helps patients communicate important medical and  personal information to healthcare teams
  41. 41. FUNDING: SHOW ME THE MONEY  Medical Model  Medicare  Medicaid  Private Insurance  STAP  Other Organizations  ALS  VA  School  IEP  Third Party Billing  Other  Fund Raising
  42. 42. FUNDING: MEDICAL MODEL Private Insurance  Many insurers follow Medicare guidelines.  Call insurance company and ask questions about benefits. Confirm whether coverage available for Durable Medical Equipment/Speech Generating Devices.  Payment varies by policy.  Ask if met deductible and Out of Pocket Maximum for calendar year.  Any co-payments or deductibles need to be collected before device is shipped. Go through STAP for this!!
  43. 43. FUNDING: MEDICAL MODEL Texas Medicaid Assistance 100%  Covers approved equipment with no out pocket cost to client  Does require 30-DAY trial period  Process takes about 2 months with trial
  44. 44. FUNDING: STAP  STAP stands for:  Specialized Telecommunications Assistance Program  Falls under umbrella of DARS  Department of Assistive and Rehabilitative Services This is a TAX that we pay for on our phone bills every month
  45. 45. FUNDING: STAP  Process  Fill out STAP application and provide small report. Application must be accompanied by proof of TX residency.  Everyone in Texas with a dual diagnosis qualifies for STAP.
  46. 46. FUNDING: STAP  With this funding there is no reason why anyone in Texas should be without a voice.   This is also a great alternative for schools!  STAP timeline is about 4 weeks. Times do fluctuate!! Follow up with STAP!!
  47. 47. RESOURCES  0-3 y.o. Early Childhood Intervention  =/ >3 y.o. Child Find through School/School District or youth’s school if already enrolled  Non-Profit Therapy Organization  Private Therapy Organization  Consider:  Hours  Location – home or center-based; family’s transportation  Type Insurance Accepted  If Youth-focused  Waiting List  Areas of Specialization THANK-YOU DCMCCT speech therapists for sharing list!
  48. 48. REFERENCES http://www.nidcd.nih.gov/health/voic e/ National Institute on Deafness and Other Communication Disorders, National Institutes of Health asha.org American Speech- Language-Hearing Association  Crossed Wires: Identification, Impact, Management and Outcomes of Language Disorders presentation by Lynn Wegner, MD at Texas Scottish Rite March 6, 2010
  49. 49. CODING  784.3 Aphasia  784.40 Voice and resonance disorder, unspecified  784.42 Dysphonia  784.43 Hypernasality  784.44 Hyponasality  784.49 Other voice and resonance disorders  784.59 Other speech disturbance,NOS  784.61 Alexia and dyslexia  783.42 Delayed Milestones
  50. 50. CODING  315.31 Expressive language disorder  315.32 Mixed expressive-receptive language disorder  315.34 Speech and language delay due to hearing loss  315.39 Other language disorder (phonologic, articulation)  315.5 Mixed developmental disorder  315.8 Other specified delays in development  315.9 Unspecified delays in development/ learning disorders NOS
  51. 51. Click to visit www.bilinguistics.com
  52. 52. Rapidly identify speech- language patterns related to second language acquisition to distinguish difference from disorder. DIFFERENCE OR DISORDER: UNDERSTANDING SPEECH AND LANGUAGE DEVELOPMENT IN CULTURALLY AND LINGUISTICALLY DIVERSE STUDENTS

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