At Home Speech Therapy for Children and Adults in Northern NJ

Providing Our Clients With the Freedom to Speak
At Home Speech Therapy for Children and Adults in Northern NJ

Blog

The Liberty Speech Associates blog discusses information pertaining to speech and language development, communication disorders in children and adults, accent modification, technology, and telepractice/teletherapy.  Comments and questions are welcome and encouraged!


view:  full / summary

Understanding Eligibility Criteria for School-Based Speech Therapy

Posted on October 7, 2017 at 8:40 PM Comments comments (0)



Children (age 3 and up) are allowed to receive speech-language therapy and related services through their local public school district. However, students must meet specific criteria in order to be eligible for these services. The eligibility criteria vary from state to state. Because my practice is based in New Jersey, the purpose of this post will be to discuss the eligibility criteria for speech-language therapy in NJ Public Schools.


Speech-language therapy and related services in NJ Public Schools is mandated by Chapter 14 of the New Jersey Administrative Code. If you have a child in need of services or already receiving services, it’s important that you read and familiarize yourself with the Code to ensure your child is getting the services s/he deserves.


Preschool child with a disability” is the classification used for children between the ages of 3 and 5, who present with developmental delays. A developmental delay is described as a 33% delay in one area of development or a 25% delay in two or more areas of development. Areas of development include: physical (gross and fine motor), intellectual, communication, social-emotional, and adaptive/self-help. A child may also qualify for speech-language therapy and related services under this classification if s/he has a diagnosed disabling condition that could impact education.




Communication Impaired” is a classification used for children older than 5. A child receives this classification if s/he presents with a language disorder that negatively affects his/her ability to learn. A child may have difficulties in any or all of the following areas: morphology, syntax, semantics, pragmatics. To determine if a child falls under the “communication impaired” classification, s/he should undergo functional assessment outside of the testing situation and participate in at least two standardized language tests (when appropriate). If the child’s performance is more than 1.5 standard deviations below the mean, s/he is eligible for speech-language services.




In addition to the two aforementioned classifications, a child may also qualify for speech-language therapy as a result of a speech disorder. A speech disorder is a disorder in any or all of the following areas: articulation, phonology, fluency, voice. Difficulties in any of these areas should be considered unrelated to dialectal or cultural differences or influences from a foreign language. Criteria for classification of a speech disorder are listed below:


  • Articulation/phonology: Using a standardized articulation or phonology test, a child must present with one or more sound production errors on sounds that 90% of children of the same age have reached mastery. A child must also consistently produce the errors in a speech sample.
  • Fluency: A child must display a mild rating or higher on a fluency rating scale and in a speech sample. A child must also exhibit dysfluencies on at least 5% of words spoken.
  • Voice: A child must perform below the expected level for vocal quality, pitch, resonance, loudness and/or duration using a voice rating scale. The voice difficulties must be present on two separate testing sessions held at least three sessions apart.

This post is only a short summary regarding the eligibility criteria for speech-language therapy for preschool and school-aged children. It is solely meant to be an informational resource for parents and should not be considered a replacement for carefully reviewing the complete Code and speaking with relevant Board of Education personnel.


About the Author


Courtney Caruso, M.S., CCC-SLP, is a bilingual (English/Spanish) speech-language pathologist and the owner and founder of Liberty Speech Associates LLC, a speech therapy practice in northern New Jersey. She obtained her MS in Speech-Language Pathology with a bilingual focus from Teachers College, Columbia University. Courtney is licensed to practice speech therapy in the state of New Jersey and holds the Certificate of Clinical Competence from the American Speech-Language-Hearing Association. Courtney is an active member of the New Jersey Speech-Language-Hearing Association, and is the Chair of its Multicultural Issues Committee. She is also a member of the ASHA Hispanic Caucus, as well as the Greater Blairstown Business Association. Courtney has experience working with pediatric and adult clients with an array of disorders and disabilities, including, but not limited to, autism spectrum disorder, cerebral palsy, cleft palate, aphasia, receptive/expressive language disorders, and articulation/phonological disorders. Courtney is passionate about her job and, when she’s not working directly with clients and their families, she enjoys giving in-person and web-based presentations and spreading awareness about speech and language through her website and social media. Follow Courtney on Facebook, Instagram, Twitter, Google +, LinkedIn, Pinterest, and YouTube.


Interested in speech or language therapy? Contact Courtney at 201-658-4400 or ccaruso@libertyspeechassociates.com.

Stroke 101

Posted on September 20, 2017 at 4:35 PM Comments comments (0)


Today’s blog post is all about stroke – signs, risks, and types. This post is based off of my video by the same name.


Many individuals don't realize that they are having a stroke because they don't know the signs. Three signature signs of a stroke are facial drooping, weakness on one side of your body, and slurred speech. Look out for these signs for yourself and your loved ones. Stroke can happen to anyone.


Although it's commonly believed that stroke is something that only happens to seniors, that is not the case. In fact, there are many adults in their 20s, 30s, and 40s having strokes. There are several risk factors that put you at a higher risk to have a stroke at any age Risk factors include obesity, a sedentary lifestyle, frequent consumption of drugs or alcohol (cigarettes also fall in this category), high blood pressure, diabetes, and heart disease.


There are 3 common types of stroke, which include ischemic, hemorrhagic, and transient ischemic attack or TIA. An ischemic stroke is the most common and is caused by blocked or narrowed arteries. A hemorrhagic stroke is caused by a leak or rupture of a blood vessel. A TIA is often referred to as a "mini stroke" and is the result of a temporary blockage leading to a short period of stroke symptoms.


Be sure you always remember the signs of stroke and that you Act FAST. F for facial drooping, A for arm weakness, S for slurred speech, and T for time. The sooner you respond to the signs and symptoms and get yourself checked out, the better your odds are in the long term.

Please leave a comment below with any questions or comments you have regarding stroke. Visit libertyspeechassociates.com and the Liberty Speech Associates YouTube channel for more information on stroke and other disabilities that can impact communication.


About the Author



Courtney Caruso, M.S., CCC-SLP, is a bilingual (English/Spanish) speech-language pathologist and the owner and founder of Liberty Speech Associates LLC, a speech therapy practice in northern New Jersey. She obtained her MS in Speech-Language Pathology with a bilingual focus from Teachers College, Columbia University. Courtney is licensed to practice speech therapy in the state of New Jersey and holds the Certificate of Clinical Competence from the American Speech-Language-Hearing Association. Courtney is an active member of the New Jersey Speech-Language-Hearing Association, and is the Chair of its Multicultural Issues Committee. She is also a member of the ASHA Hispanic Caucus, as well as the Greater Blairstown Business Association. Courtney has experience working with pediatric and adult clients with an array of disorders and disabilities, including, but not limited to, autism spectrum disorder, cerebral palsy, cleft palate, aphasia, receptive/expressive language disorders, and articulation/phonological disorders. Courtney is passionate about her job and, when she’s not working directly with clients and their families, she enjoys giving in-person and web-based presentations and spreading awareness about speech and language through her website and social media. Follow Courtney on Facebook, Instagram, Twitter, Google +, LinkedIn, Pinterest, and YouTube.


Interested in speech or language therapy? Contact Courtney at 201-658-4400 or ccaruso@libertyspeechassociates.com.

What to Expect During an Adult Speech and Language Evaluation

Posted on September 12, 2017 at 3:55 PM Comments comments (0)



Adults may undergo speech and language evaluations for a variety of reasons, including, but not limited to, difficulty pronouncing sounds or words, speaking clearly, retrieving and using familiar words, understanding words they hear, speaking fluently, remembering peoples/places/events, and swallowing. Adult speech and language evaluations may be performed differently depending on the speech-language pathologist (SLP), the setting of the evaluation and/or the reason for the referral. To help you and your loved one prepare for a speech and language evaluation, below you will find detailed descriptions of what you can expect during a typical evaluation.


Intake Interview

The purpose of the intake interview is to gather information about you. This is the most important aspect of any speech and language evaluation as it helps the SLP understand why you are seeking the evaluation, how your current communication difficulties are impacting your daily life and what you hope to get out of the evaluation and/or therapy. During the intake interview, the SLP will ask you about your medical history, education and employment, cultural and linguistic background, and current and past evaluations and therapies.


Oral Mechanism Examination

The purpose of an oral mechanism examination is to assess the structure and function of your oral mechanism (e.g., lips, tongue, teeth, hard/soft palate) to support speech and/or swallowing. Examples of tasks you may be asked to do during this portion of the evaluation include moving your tongue from side-to-side, opening your mouth and saying “ah,” and raising your tongue to try and reach your nose. Assessment of


Articulation/Phonology

Articulation is the manner in which sounds are produced using the oral mechanism and phonology is the manner in which we organize sounds to form words. Assessment of articulation and phonology is important if you are difficult to understand. The purpose of this assessment is to determine what sounds you have difficulty saying and if there is a pattern to your difficulties. In addition to general pronunciation concerns, this type of assessment is important if there is suspected apraxia and/or dysarthria. General assessment of articulation and phonology typically includes obtaining and analyzing a speech sample (this is exactly how it sounds – a sampling of your speech) obtained during conversation with the SLP, as well as administration of a standardized test (e.g., Goldman Fristoe Test of Articulation, Arizona Articulation Proficiency Scale, Hodson Assessment of Phonological Patterns, Apraxia Battery for Adults, Frenchay Dysarthria Assessment). During standardized testing, you will be asked to look at and name various pictures and/or objects, repeat a variety of words and phrases of varying lengths and complexities, and/or perform different actions with your mouth. The evaluator will transcribe what you say during the assessments for later analysis.


Assessment of Voice

Voice refers to the quality, loudness, pitch, resonance and prosody of one’s speech. A person typically undergoes a voice assessment due to vocal concerns as the result of a neurological condition (e.g., Parkinson’s Disease), a vocal pathology (e.g., nodules, cyst), or dysarthria. A thorough voice assessment cannot be completed without prior evaluation from an otolaryngologist (ENT) to determine the potential etiology of the vocal concerns. After a patient has been seen by an ENT, a voice assessment can be completed by an SLP and components of the assessment may include a discussion of how you use your voice and your feelings about the current status of your voice, use of computerized software to analyze your speech compared to other adults of similar ages, and/or use of laryngeal imaging.


Assessment of Fluency

Fluency refers to fluidity of one’s speech. Assessment of fluency is crucial if you have concerns that you stutter. A fluency assessment typically involves engaging in conversation with the SLP on topics of interest so she can obtain a speech sample for later analysis, as well as discussing your feelings about your stuttering administering a standardized fluency test (e.g., Stuttering Severity Instrument). During the standardized test, you will likely be asked open-ended questions, instructed to read passages and describe pictured scenes, and/or tell a story.


Assessment of Language and Cognition

Language refers to receptive and expressive language. Receptive language is an individual’s ability to understand language; where as expressive language is an individual’s ability to use language. Language goes beyond the spoken word and also encompasses written words, gestures, and facial expressions. Cognition describes a person’s memory, attention, problem solving, executive function, reasoning, organization, perception, and judgment. Assessment of language and cognition is typically completed when there is a suspicion of aphasia and/or a noted neurological decline, which may be the result of a traumatic brain injury, stroke, or neurological condition (e.g., Alzheimer’s, Parkinson’s). Assessment of language and cognition includes obtaining a language sample, as well as administering standardized tests (e.g., Western Aphasia Battery, Boston Diagnostic Aphasia Examination, Montreal Cognitive Assessment, Cognitive Linguistic Quick Test). The tasks you would be asked to do would depend on the test(s) administered; however, like with most standardized tests, you are likely to be asked questions about different pictures, words, objects, stories, and concepts. For example, you may be asked to find a letter or word named by the SLP.


Assessment of Swallowing

The purpose of a swallowing assessment is to determine what, if any, difficulties you have swallowing, at what stage the difficulties occur, and what types of food and liquid consistencies are safe for you to consume. Swallowing assessments can be done with and without instruments. Non-instrumental swallowing assessments involve the SLP watching you as you eat different foods and taking notes on what happens as you eat (e.g., do you cough after swallowing?). Instrumental swallowing assessments (e.g., videofluoroscopic swallowing study, fiberoptic endoscopic evaluation of swallowing) involve using medical equipment to watch your swallow internally.


Discussion of the Results

At the conclusion of the evaluation, the SLP should discuss the results with you. The discussion should include information related to her findings (diagnoses, observations) and recommendations (e.g., if additional testing by an SLP or related professional is recommended or required and/or if speech/language therapy is warranted). You should also be given the opportunity to ask any questions you may have.


About the Author

Courtney Caruso, M.S., CCC-SLP, is a bilingual (English/Spanish) speech-language pathologist and the owner and founder of Liberty Speech Associates LLC, a speech therapy practice in northern New Jersey. She obtained her MS in Speech-Language Pathology with a bilingual focus from Teachers College, Columbia University. Courtney is licensed to practice speech therapy in the state of New Jersey and holds the Certificate of Clinical Competence from the American Speech-Language-Hearing Association. Courtney is an active member of the New Jersey Speech-Language-Hearing Association, and is the Chair of its Multicultural Issues Committee. She is also a member of the ASHA Hispanic Caucus, as well as the Greater Blairstown Business Association. Courtney has experience working with pediatric and adult clients with an array of disorders and disabilities, including, but not limited to, autism spectrum disorder, cerebral palsy, cleft palate, aphasia, receptive/expressive language disorders, and articulation/phonological disorders. Courtney is passionate about her job and, when she’s not working directly with clients and their families, she enjoys giving in-person and web-based presentations and spreading awareness about speech and language through her website and social media. Follow Courtney on Facebook, Instagram, Twitter, Google +, LinkedIn, Pinterest, and YouTube.


Interested in speech or language therapy? Contact Courtney at 201-658-4400 or ccaruso@libertyspeechassociates.com.

5 Tips for Communicating with Students who Stutter

Posted on September 4, 2017 at 1:40 PM Comments comments (0)



School is finally back in session! With every new school year come new stresses, expectations, and faces. In speaking to a few teacher colleagues and friends, it’s become apparent that teachers are often not taught how to communicate with students with disabilities, particularly students who stutter. Without this knowledge, both students and teachers are put in an uncomfortable situation. For that reason, I decided to write this blog post to provide teachers with 5 tips on communicating with students who stutter and, in turn, help all students feel more comfortable speaking in the classroom. This blog post is based off of my YouTube video 5 Stuttering Tips for Teachers.


Here are the 5 tips:

1) Avoid saying, “slow down” or “think about what you want to say”


  • This is probably the most important of the 5 tips. Stuttering is not an issue of speaking too quickly or not thinking, so using these phrases with a student who stutters will have no positive effect. In fact, using these phrases may cause frustration or anxiety for the student who stutters. 



2) Don’t complete your student’s sentence/thought

 

  • If your student is in the midst of a stutter, completing his sentence/thought is not going to help the situation. Your student has his own unique thoughts and ideas and likely wants to share them like any other student. Although it may take a student who stutters longer to express himself, doesn’t mean he shouldn’t be afforded the opportunity. The best thing you can do as a teacher is to be patient and give the student ample time to speak. 



3) Give your student an opportunity to educate his peers about stuttering

 

  • Unfortunately many children with disabilities are bullied or mocked because their peers don’t understand their situations. It could be helpful to do lessons on disabilities and/or acceptance, as well as allow your student who stutters to present or do a project on the topic. 



4) Monitor your own body language when communicating with a student who stutters


  • You may feel uncomfortable communicating with your student who stutters because you don’t know how to help. If you feel this way, it could be evidenced in your body language by avoiding eye contact, looking away, etc., so be mindful of how you are reacting to the stutter both verbally and nonverbally. 



5) Model slow, relaxed speech


  • By modeling slow, relaxed speech your student may feel more comfortable communicating with you and may also try and imitate your rate which, in turn, may have a positive effect on the student’s stuttering episode. 



I hope you find these tips helpful in communicating with your students who stutter. Please leave a comment with tips you’ve found to be the most helpful when communicating and interacting with students with disabilities.


About the Author:

Courtney Caruso, M.S., CCC-SLP, is a bilingual (English/Spanish) speech-language pathologist and the owner and founder of Liberty Speech Associates LLC, a speech therapy practice in northern New Jersey. She obtained her MS in Speech-Language Pathology with a bilingual focus from Teachers College, Columbia University. Courtney is licensed to practice speech therapy in the state of New Jersey and holds the Certificate of Clinical Competence from the American Speech-Language-Hearing Association. Courtney is an active member of the New Jersey Speech-Language-Hearing Association, and is the Chair of its Multicultural Issues Committee. She is also a member of the ASHA Hispanic Caucus, as well as the Greater Blairstown Business Association. Courtney has experience working with pediatric and adult clients with an array of disorders and disabilities, including, but not limited to, autism spectrum disorder, cerebral palsy, cleft palate, aphasia, receptive/expressive language disorders, and articulation/phonological disorders. Courtney is passionate about her job and, when she’s not working directly with clients and their families, she enjoys giving in-person and web-based presentations and spreading awareness about speech and language through her website and social media. Follow Courtney on Facebook, Instagram, Twitter, Google +, LinkedIn, Pinterest, and YouTube.


Interested in speech or language therapy? Contact Courtney at 201-658-4400 or ccaruso@libertyspeechassociates.com.

Learning to Talk: Speech and Language Milestones Birth to 3

Posted on August 28, 2017 at 7:30 AM Comments comments (0)


The first 3 years of a child’s life are crucial to overall development; in just 3 short years a lot of changes occur, such as walking, talking, and developing a unique personality. It can be an exciting time for families as they watch their children develop new and exciting skills. But how do you know if your child is developing “normally” (especially if this is your first child)? I’m here to help you navigate through the first 3 years with this blog post about speech and language milestones.


Before discussing the milestones, I’d like to briefly explain the terminology used to describe communication. Understanding the differences between these terms is important in monitoring your child’s development.




There are two types of language: receptive and expressive. Receptive language is our ability to understand words. Receptive language is fundamental in the development of expressive language and speech. A child’s ability (or inability) to understand sounds and words will impact how s/he uses those words. Expressive language is our ability to express ourselves. Many people think that expressive language is synonymous with speech, but that, in fact, is not true. Expressive language is a broader term. It’s how we express ourselves in all modalities, whether it be speaking, writing, gesturing…Speech, however, is the physical act of talking; it is the way we make sounds.


So now that you understand the different aspects of speech and language, let’s see how your child is doing:


Before 6 months, a child typically:

Vocalizes and coos

Varies vocalizations based on needs

Begins babbling


By 1 year, a child typically:

Follows some simple directions

Identifies familiar objects

Enjoys Peek-a-Boo

Imitates sounds and words

Says a few words

Waves and uses gestures




Between the ages of 1 and 2, a child typically:

Points to objects/pictures upon request

Pays attention to books and pictures

Answers simple questions

Uses new words frequently

Begins combining words

Uses words instead of crying or gesturing

Says the b, d, p, m, n, and h sounds correctly

Is understood 50% of the time by age 2


Between the ages of 2 and 3, a child typically: 

Follows two-step directions

Uses 2- and 3-word phrases and sentences

Tries to have a conversation

Is understood 75% of the time by age 3

Says the w, t, k, g, and f sounds correctly


It’s important to keep in mind that all children are different and speech and language development can vary slightly from child to child. Think about your child in comparison to other children in your family or in your community that are around the same age. If your child is not following the pattern described above, or a pattern similar to those of the children in your family or community, your first step should be to have your child’s hearing tested by an audiologist. An audiologist is a hearing doctor and can complete a thorough examination of your child’s hearing ability (a pediatrician cannot perform this type of test). Hearing loss (even very mild hearing loss), as well as frequent ear infections or fluid in the ear, can impact a child’s speech and language development. After you’ve had your child’s hearing tested, your next step should be to contact a speech-language pathologist to have your child’s speech and language skills evaluated.


References:


ASHA (n.d.). How does your child hear and talk? http://www.asha.org/public/speech/development/chart/


Coplan, J., & Gleason, J.R. (1988. Unclear speech: recognition and significance of unintelligible speech in preschool children. Pediatrics, 82,447-452.


McLeod, S. (2009). Speech sound acquisition. In J.E. Bernthal, N.W. Bankson & P. Flipsen Jnr (Eds.), Articulation and phonological disorders: Speech sound disorders in children (6th ed., pp. 63-120 + 385-405). Boston, MA: Pearson Education.


About the Author:


Courtney Caruso, M.S., CCC-SLP, is a bilingual (English/Spanish) speech-language pathologist and the owner and founder of Liberty Speech Associates LLC, a speech therapy practice in northern New Jersey. She obtained her MS in Speech-Language Pathology with a bilingual focus from Teachers College, Columbia University. Courtney is licensed to practice speech therapy in the state of New Jersey and holds the Certificate of Clinical Competence from the American Speech-Language-Hearing Association. Courtney is an active member of the New Jersey Speech-Language-Hearing Association, and is the Chair of its Multicultural Issues Committee.  She is also a member of the ASHA Hispanic Caucus, as well as the Greater Blairstown Business Association.  Courtney has experience working with pediatric and adult clients with an array of disorders and disabilities, including, but not limited to, autism spectrum disorder, cerebral palsy, cleft palate, aphasia, receptive/expressive language disorders, and articulation/phonological disorders. Courtney is passionate about her job and, when she’s not working directly with clients and their families, she enjoys giving in-person and web-based presentations and spreading awareness about speech and language through her website and social media. Follow Courtney on Facebook, Instagram, Twitter, Google +, LinkedIn, and Pinterest.


Interested in speech or language therapy? Contact Courtney at 201-658-4400 or ccaruso@libertyspeechassociates.com.

What to Expect During a Pediatric Speech and Language Evaluation

Posted on August 11, 2017 at 8:05 PM Comments comments (0)


Although all speech-language pathologists structure their evaluations a little differently, there are crucial components that should be expected as part of all pediatric speech and language evaluations. These components include a family interview, an oral mechanism examination, assessment of articulation/phonology, assessment of voice, assessment of fluency, assessment of receptive and expressive language, and a discussion of the results. Depending on your child’s age, his reported difficulties, and/or the location of the evaluation, additional components of the evaluation may include: a teacher interview, a hearing screening, a play assessment, a feeding/swallowing assessment, and/or a narrative assessment. Each of the crucial components will be described in detail below:


Family Interview

The purpose of the family interview is to gather information about your child’s background, such as birth and medical history, speech and language concerns, past evaluations and/or therapies, developmental milestones, languages your child speaks and/or hears.


Oral Mechanism Examination

The purpose of an oral mechanism examination is to assess the structure and function of your child’s oral mechanism (e.g., lips, tongue, teeth, hard/soft palate) to support speech and/or feeding. Examples of tasks your child may be asked to do during this portion of the evaluation include moving his tongue from side-to-side, opening his mouth and saying “ah,” and raising his tongue to try and reach his nose.


Assessment of Articulation/Phonology

Articulation refers to the way we produce sounds using our oral mechanism and phonology refers to the way we organize sounds to form words. The purpose of assessing articulation and phonology is to observe what sounds your child can say, as well as to determine if your child has any errors in his speech and if there are patterns to those errors. For young children (under the age of 3), assessment of articulation and phonology is primarily done through a speech sample obtained during various play activities. A speech sample is exactly how it sounds – it is a sample of your child’s naturally occurring speech. For older children (above 3), assessment of articulation and phonology typically includes analysis of a speech sample obtained through conversation and/or play, as well as administration of a standardized test. During the standardized test, your child will look at pictures and/or objects, which represent all of the consonants (and depending on the test, also vowels) in Standard American English, and be asked to name them. The evaluator will transcribe what your child says for analysis.


Assessment of Voice

Voice refers to the quality, loudness, pitch, resonance and prosody of one’s speech. For most pediatric evaluations, especially for young children or when vocal characteristics are not a concern, assessment is done through a speech sample. The evaluator listens to your child’s speech to see if it appears appropriate for his age or gender. However, for older children and/or for those with vocal concerns, assessment may include a discussion of how your child is using his voice and his feelings about his voice, use of computerized software to analyze your child’s speech compared to same-age children, and/or laryngeal imaging.


Assessment of Fluency

Fluency refers to fluidity of one’s speech. The purpose of a fluency assessment is to determine if your child experiences stuttering and/or cluttering. For young children, assessment of fluency focuses on obtaining a speech sample to analyze any disruptions in the flow of your child’s speech. For older children with fluency concerns, assessment involves obtaining a speech sample, as well as discussing feelings about the fluency difficulties and situations when fluency skills are better/worse and administering a standardized fluency test. During the standardized test, your child may be asked a series of conversational questions, instructed to read different passages, and/or asked to describe various picture scenes.


Assessment of Receptive and Expressive Language

The purpose of a language assessment is to determine your child’s ability to understand and use language for a variety of purposes. Assessment of language includes obtaining a language sample, as well as administering standardized tests. The tasks your child is asked to do would depending on the test(s) administered; however, like with most standardized tests, your child is likely to be asked questions about different pictures, objects, and stories. For example, he may be asked to find a picture described by the evaluator (e.g., show me the big black dog). Discussion of the Results At the conclusion of the evaluation, there should be a discussion of results with the evaluating speech-language pathologist. The speech-language pathologist should share her findings (diagnoses, observations), inform you if additional testing by a speech-language pathologist or related professional is recommended or required, discuss if speech/language therapy is warranted, and answer any questions you may have. 


About the Author:



Courtney Caruso is the owner of Liberty Speech Associates LLC and is a bilingual speech-language pathologist in Northern NJ. She works with children and adults in their homes so they can work on their skills in a natural environment where they are most comfortable.

Interested in speech or language therapy? Contact us at 201-658-4400 or ccaruso@libertyspeechassociates.com.

What is Dysphagia?

Posted on August 4, 2017 at 10:20 PM Comments comments (0)


Dysphagia is the term used to describe difficulty with swallowing. The action of swallowing has three phases (oral, pharyngeal, and esophageal) and dysphagia can occur during any of these phases. Dysphagia can occur in both children and adults.



Symptoms may include:
Coughing after eating
Gagging/coughing while eating
Leaking of food or liquid from the mouth or nose
Requiring extra time or effort to chew and/or swallow
Experiencing chronic pneumonia or respiratory infections
Changing vocal quality after eating (may sound gurgly, hoarse or breathy)

Because eating and drinking are crucial components to our daily lives, dysphagia can lead to both nutritional and social problems. For example, a person with dysphagia may experience dehydration or weight loss and/or may be less willing to participate in social activities due to embarrassment.


Some possible causes of dysphagia in children include:
Reflux
Prematurity
Cerebral palsy
Encephalopathy
Cleft lip and/or palate

Some possible causes of dysphagia in adults include:
ALS
Stroke
Brain injury
Parkinson’s Disease
Alzheimer’s Disease

If you suspect that you or a loved one is experiencing dysphagia, it is important that you speak to your doctor and undergo a swallowing evaluation. These evaluations are performed by speech-language pathologists with expertise and training in dysphagia. To find a speech-language pathologist who is board certified in swallowing and swallowing disorders, visit the American Board of Swallowing and Swallowing Disorders.  

References:
ASHA. (n.d.). Feeding and Swallowing Disorders (Dysphagia) in Children. Retrieved from http://www.asha.org/public/speech/swallowing/Feeding-and-Swallowing-Disorders-in-Children/

ASHA. (n.d.). Swallowing Disorders (Dysphagia) in Adults.  Retrieved from http://www.asha.org/public/speech/swallowing/Swallowing-Disorders-in-Adults/

About the Author:


Courtney Caruso is the owner of Liberty Speech Associates LLC and is a bilingual speech-language pathologist in Northern NJ. She works with children and adults in their homes so they can work on their skills in a natural environment where they are most comfortable.

Interested in speech or language therapy? Contact Courtney at 201-658-4400 or ccaruso@libertyspeechassociates.com.

Is it Apraxia?

Posted on July 30, 2017 at 2:15 PM Comments comments (0)


Apraxia, also known as childhood apraxia of speech (CAS), has become the go-to diagnosis for many children in Early Intervention (under 3 years of age). However, many of these children do not have apraxia or are too young to receive a true diagnosis. So what is apraxia?

Apraxia is a motor speech disorder that makes it difficult for a person to coordinate the movements of the mouth for speech. Apraxia can occur in children or adults, but for the purpose of this post, I will focus on CAS. There is some debate over the exact diagnostic features of CAS, but some commonly described symptoms are:

  • Inconsistent errors 
  • Inappropriate prosody 
  • Vowel errors 
  • Limited inventory of consonants and vowels 
  • Increased difficulty with longer, more complex words and utterances




Additionally, children with CAS tend to be “late talkers;” however, late talking in and of itself does not warrant a diagnosis of CAS. As can be seen by the aforementioned symptoms, the characteristics of CAS are described with regards to talking, so if a child is not yet talking or not talking much, a clear diagnosis of CAS cannot be made. In fact, the American Speech-Language-Hearing Association goes so far as to say that “diagnosis below age 3 is best categorized under a provisional diagnostic classification, such as ‘CAS cannot be ruled out,’ ‘signs are consistent with problems in planning the movements required for speech,’ or ‘suspected to have CAS.’ 

If you have concerns with any aspect of your child’s speech or language development, it is suggested that you contact a local speech-language pathologist so that a thorough evaluation can be completed.

Resources:


About the Author

Courtney Caruso is the owner of Liberty Speech Associates LLC and is a bilingual speech-language pathologist in Northern NJ. She works with children and adults in their homes so they can work on their skills in a natural environment where they are most comfortable.


Interested in speech or language therapy? Contact us at 201-658-4400 or ccaruso@libertyspeechassociates.com.

5 Questions to Ask a Provider Before Signing Up for Speech Therapy

Posted on July 22, 2017 at 6:15 AM Comments comments (0)


Question 1 - Are you licensed?

In most states, including NJ, a speech-language pathology license is required to practice as a speech-language pathologist (SLP). Refer to the ASHA website for specifics on what licensing (if any) your state requires. Although SLPs should be the ones providing speech therapy, there are non-SLP providers out there selling their services with claims that they are doing “speech therapy.” Unfortunately, these individuals typically don’t have a licensing board/governing body to control their practices nor do they have the background to provide sound speech and language treatments. Therefore, this question should be at the top of your list when looking to begin speech therapy.


Question 2 - Are you ASHA-certified?

While certification is not required to practice as an SLP, ASHA-certified providers are required to complete a minimum of 30 continuing education/professional development hours every 3 years to ensure that they are providing the best practice.


Question 3 - What are your areas of expertise?

Although all SLPs have the same general background on speech and language disorders, not all SLPs have the same areas or levels of expertise. Some SLPs may specialize in working with adults, while others only work with children. Some SLPs may have an extensive background in dysphagia (swallowing disorder), while others may be stuttering specialists. Not all SLPs are the right fit for you and your family.


Question 4 - Do you keep current with the research in your field? How so?

It might seem obvious that all SLPs or healthcare professionals would keep current with the research in their field, but this, unfortunately, is not always the case. There are SLPs (and other healthcare professionals) out there who don’t take the time to read peer-reviewed research articles regarding the current status of different evaluation and treatment methods. While it can be costly and time-consuming to stay in the loop of current best and evidence-based practices, it’s crucial for SLPs to do so to provide the most appropriate services for their clients. Would you prefer an SLP who frequently reads research and is continuously trying to expand his/her knowledge or one who hasn’t opened a speech-language pathology journal since s/he graduated from school a number of years ago?

As SLPs, we are required to complete continuing education hours (as mentioned above for the ASHA certification question); however, in taking these courses, there is still no guarantee that the information disseminated has been thoroughly researched or vetted. That’s to say that an SLP could be doing many hours of continuing education, but on topics that have never truly been studied.


Question 5 - Have you worked with a client with _________ diagnosis recently?

This question is similar to the expertise one mentioned above and, probably goes without saying, but if you or your loved one have a specific diagnosis (e.g., Parkinson’s Disease, Autism Spectrum Disorder, Down Syndrome) for which you are seeking speech therapy services, it’s important that the SLP you select has experience with and has recently worked with this population. Selecting an SLP who has only worked with one Parkinson’s patient in the span of 10 years would probably not be your best bet if you or your loved one has Parkinson’s Disease.


About the Author:

Courtney Caruso is the owner of Liberty Speech Associates LLC and is a bilingual speech-language pathologist in Northern NJ. She works with children and adults in their homes so they can work on their skills in a natural environment where they are most comfortable.


Interested in speech or language therapy? Contact us at 201-658-4400 or ccaruso@libertyspeechassociates.com.

Social Communication: Definition, Assessment & Treatment

Posted on July 15, 2017 at 7:40 AM Comments comments (0)


As per request on a recent Instagram post looking for suggestions, today’s blog post will be about social communication and social communication disorder (SCD). Before explaining the disorder itself, it’s important to lay the framework of what is meant by “social communication” in general. According to Adams (2005), social communication is the combination of social interaction, social cognition, pragmatics, and receptive/expressive language.

Social interaction refers to one’s ability to acknowledge that other people are social beings (Adams, 2005). Per ASHA (n.d.), social interaction includes, but is not limited to, communication style, language use/code switching, social reasoning and competence, and conflict resolution.

Social cognition describes one’s ability to connect with and understand the emotions of oneself and others, as well as understand the nuances of language and make inferences from context cues (Adams, 2005).


Pragmatics is how we use language in social situations using unwritten rules based on the context. For example, a person may use language differently when speaking to a peer versus a parent (Adams, 2005). Pragmatic skills include, but are not limited to, maintaining the topic of conversation, initiating a conversation or interaction, making eye contact, repairing conversational breakdowns, and taking turns.

Receptive language is comprehension of language and expressive language is the expressive output of language. Language includes reading, writing, speaking, gesturing, and understanding. Components of receptive/expressive language are syntax (word order), morphology (word forms), and semantics (vocabulary), and phonology (speech sounds).

When an individual has a SCD, s/he can experience difficulties in any or all of the areas of social communication described above. SCDs can co-occur with other conditions, such as autism spectrum disorder, developmental disabilities, or traumatic brain injury, but may also stand alone. Social communication is heavily linked to culture, so an individual’s expected behavior will vary from person to person and community to community. If there are concerns with a person’s social communication skills, a speech-language pathologist can perform an in-depth evaluation to determine if any aspect of the person’s communication deviates from the norm of his/her particular society and/or culture. The evaluation would likely include interviews with caregivers and relevant others (e.g., teachers, employers), clinical observation of the client in a social situation, standardized assessment, and non-standardized analysis of all communication domains.

If it is determined that individual does have a SCD, speech therapy can be provided to assist the client in having more successful social interactions and relationships with caregivers, peers, colleagues, teachers, etc. Speech therapy sessions should be catered to individual client’s needs while taking research and best practices into account. The specific structure of a speech therapy session for SCDs would depend heavily on the client’s noted areas of breakdown. Speech therapy sessions could be provided one-on-one to teach specific social rules; however, it is important that speech therapy sessions also occur in group or social situations to ensure carryover of the skills learned. Social stories may be used to help the individual understand the difference between what s/he is doing versus what the social expectation or norm is.

Do you have specific questions or concerns about social communication or SCDs? Leave a comment below, so that it can be addressed.


References
Adams, C. (2005). Social communication intervention for school-age children: Rationale and description. Seminars in Speech and Language, 26(3), 181-188.

ASHA (n.d.). Social communication disorders in school-aged children. Retrieved from http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934980§ion=Overview.

About the Author:

Courtney Caruso is the owner of Liberty Speech Associates LLC and is a bilingual speech-language pathologist in Northern NJ. She works with children and adults in their homes so they can work on their skills in a natural environment where they are most comfortable.

Interested in speech or language therapy? Contact us at 201-658-4400 or ccaruso@libertyspeechassociates.com.

Rss_feed