In every profession there are trends. Most people follow trends, it's hard not to. Some trends are benign, some strange and some may turn out to be harmful. The field of Speech Language Pathology also has trends with oral motor therapy for articulation disorders being the most recent.

For those of you who do not know what oral motor therapy is, it is blowing whistles, doing tongue exercises, blowing bubbles etc with the hope of correcting speech errors and making speech clearer.

The acronym is NS-OME (non speech oral motor exercises). These exercises are being used by 85% of speech language pathologists to change speech sound productions according to a nation wide survey of 537 SLP's by Lof & Watson (2004; In press). In a recent presentation by Gregory L. Lof, Ph.D., CCC-SLP, this statistic was reported along with other frightening information about Speech Language Pathologists and their use of NS-OME.

While there is no current research to support its use, 61% of clinicians reported that "The literature I have read strongly encourages the use of NS-OME." There are numerous therapy guides, activity books and tons and tons of material to purchase, yet no evidence to prove its effectiveness. Lof stated and I agree that parents should be made aware of this and be informed that oral motor therapy is experimental.

When the trend first began I found myself falling into the trap as I went to several conferences encouraging the use of oral motor exercises to improve speech production. I tried all the tricks purchased all the material and talked the oral motor talk. However over time I found myself using less and less of these techniques because for me they were not working.

For me, they proved to be a waste of time and energy when using them for speech production. I found if I taught a child to blow bubbles he got really good at blowing bubbles, however if I wanted him to say "hoo" we better practice saying "hoo".

An analogy given by Lof is comparing NS-OME to teaching a basketball player to pretend to hold a ball and then pretend to throw it toward a non-existent hoop with the eventual hope of improving free throwing. It just will not work and either does NS-OME.

Oral Motor therapy does have its uses. While it is ineffective for improving speech production it is effective for treating many issues related to feeding. And that is an important distinction. If your child is drooling, or unable to move food around with his tongue and chew, Oral Motor Therapy can be very effective if provided by a competent therapist.

So for those of you who may have children receiving this type of therapy ask questions, get involved, and make a change if necessary!

Learn more about oral-motor therapy at the FAQs page.

Valentine's Day makes me think about all the people and things in my life I love. The most obvious being my sweet little Maya and her Daddy. Perhaps less obvious to others, yet overwhelmingly so to me is the love I have for my work.

I am often asked "How did you get into this field"?

The story behind this is interesting and unique. Growing up I always knew I wanted to care for things. Whether it was my dolls, my assortment of pets or my baby brother, I was always caring for something. Then one summer, when I was about 15 years old, my future found me.

My older sister had taken a summer job at Jawanio in New City, NY as a teacher's aide for a class of 3-5year olds with special needs. My sister was 18, perfect for the job and ready to start. But at the last minute she found a different job that interested her more and decided to turn Jawanio down.

My mother suggested that she call Jawanio and tell them that she decided to take another job, but that she had a little sister that would be perfect for the teacher's aide position. They were hesitant at first since I was only 15, several years younger than they usually hired. However, they agreed to interview me and I got the job.

Before my first day my mother said something to me that I will never forget. She said, "no matter how severe the disability a child might have, always remember that every child is someone's baby".

I took that statement with me and have kept it in my heart at all times.

For the next few summers I worked at Jawanio. It was there, with my mothers words in mind, my passion for working with children with special needs began. It is the first time I watched a Speech Language Pathologist teach children the power of communication. And I decided that I wanted to do the same thing one day. (I had been on the receiving end of speech therapy though, when I was five, for a lisp.)

My passion continued from that very first summer, through college, three states, multiple positions and in to my own practice.

When pregnant with Maya I often wondered and feared that I would loose my passion to care for others when I had my own baby at home to take care of. Luckily that was not the case. I feel more devoted as I realize the excitement of each developmental step Maya takes. And I now have even more empathy for the families I work with.

I consider myself very fortunate to be able to work with so many children, some that I have known since they were brought home from the hospital.

It is incredibly rewarding to be a part of so many families' lives. Whether it's helping nonverbal kids become chatterboxes, unintelligible kids become understandable, helping kids learn how to eat solid foods or even just enjoy mealtimes with their family.

There are not many people who can truly say they love what they do. I am proud to say that I do.

Each and every child has a place in my heart… and I am happy to say that there is always room for more!

With love,

-Isa

Childhood Apraxia of Speech (CAS) is known by many names. Developmental Verbal Apraxia, Childhood Verbal Apraxia, and Developmental Apraxia of Speech are just a few of the names; however, CAS is the current preferred term for the severe speech disorder.

CAS affects 2-3 children per 1000. There is no universal criteria list used to diagnose the disorder like there is with Autism or ADHD. And there are no chromosomal abnormalities like Down Syndrome or Apert Syndrome. Recently there has been a gene linked to the disorder; however, far more research is required in the area of genetics.

There are several standardized measures used to diagnose CAS. This has lead to over-diagnosis. The Childhood Apraxia of Speech Association of North America is currently working on guidelines for Speech Language Pathologists for diagnosis and treatment of the disorder, which should help.

I try to learn as much as I can in regards to the treatment and diagnosis of CAS. It is one of my areas of expertise in which I provide therapy and am often called in to provide a second opinion or training to a treating therapist.

So what is CAS?

To put it simply, the structures of the mouth are adequate yet the message is not getting from the brain to the mouth to produce clear speech.

Some characteristics of CAS include, but are not limited to, vowel distortion, more sound errors with longer sentences, and inconsistent sound errors. Children with this severe speech disorder are extremely difficult to understand and may or may not develop clear speech as adults. Similar characteristics may be seen in other severe speech disorders as well, making diagnosis difficult.

Good, appropriate speech-language therapy is key in helping children with CAS learn to produce intelligible speech. Multiple short therapy sessions have proven to be most effective. The more a sound is produced in therapy the faster the progress as the skill must be learned and become automatic.

There is no one "right" therapy however there is a "wrong" therapy. If you have a child with CAS (or any other severe speech disorder) beware of oral-motor therapy that is used to teach clear speech.

Oral motor therapy is therapy that does not involve speech production while moving the mouth. To improve speech, speech must be worked on. As a feeding therapist I often use oral motor therapy to help with chewing, swallowing, and drooling. However, while effective with feeding, there is no research proving that these exercises will improve speech.

CAS remains a challenge for speech language pathologists, parents of children with the disorder and the children themselves. While research is underway we are only at the beginning of understanding this severe and complex disorder.

For more information, resources or if you know someone that needs expert advice please feel free to contact me by phone or email.

Everyone needs to be able to trust in other's expertise, especially when it comes to our children and loved ones. A common complaint I hear over and over again from parents of children with special needs ranging from mild speech disorders to autism spectrum disorders is they were told by their pediatrician, "Don't worry, he will grow out of it".

One mother of twins, a boy and a girl, was told "boys develop slower than girls"… Her son has since been diagnosed with Autism. The diagnosis came after she followed her own instinct and took her son to see an "expert" in the field.

As a speech and feeding therapist, families seek me out for my expertise. They trust what I say and do because I have years of experience in the field. However, when I am asked questions regarding sleeping, potty training or discipline I will always refer to an expert that knows more than me.

What are you an expert in? Taxes? Computers? Neurosurgery? Education? Can anyone learn to do what you do by spending twenty minutes on the Internet?

Living in a time when there is a world of info at our fingertips it is very tempting to try to become an expert in everything. In my opinion the internet helps us be more informed, know the right questions to ask and find the right experts to help us. We need to be careful not to think we know more than we do.

I recently saw a speech therapist send an e-mail to a listserve asking "how to work with swallowing". She had just taken on two swallowing clients. Talk about dangerous! I can't imagine someone working with swallowing without being properly trained. I'd like to say I'm stunned by this. Unfortunately there are many people who will take any client they can get. I hope she has good insurance.

Recently I had a conversation with the mother of one of the kids I see. He has always had significant tooth decay regardless of his oral-hygiene, which is very good by the way. Anyway, being an expert in the area of feeding disorders, I suspected reflux was the culprit. So I suggested the child be assessed by either a pediatric Gastroenterologist or a pediatric ENT to determine if this was the case.

Having worked with feeding disorders for so long I have become an expert in "suspecting" reflux; however a medical doctor must do the diagnosing. The child's pediatrician told his mother that I was "Crazy" and that "he definitely does not have reflux".

Mom went to the ENT anyway.

The ENT diagnosed the child as having active reflux. And then said it is "100% causing his tooth decay".

If his mother had not sought out an expert her son may have continued to have serious tooth decay for years to come. Luckily this... was caught before his adult teeth came in.

We all need to "trust" at times and that can be difficult, especially with stories like those above. But sometimes you have to.

So if you think something is wrong trust your gut, get informed and find an expert.

You may find that you were worried about nothing. Or, you may find that that you were right all along and that you did not waste valuable time ignoring the problem.

Studies show that as many as 3 out of 10 children, and 8 out of 10 special needs children, have feeding disorders. These disorders can range from picky eaters including those that will only eat specific foods such as chicken nuggets or macaroni, to problem feeders that can't eat at all by mouth.

As a speech language pathologist who has specialized in feeding for over 10 years I always knew and discussed how important feeding their child is to a mother and father.

There are only a few things a parent can do to take care of a new baby: feed them, keep them clean and keep them safe. This is even more magnified when children have special needs. This is why feeding disorders are so overwhelming to parents.

If a parent can't, or has difficulties feeding their child they feel stressed, sad and often… like a failure.

I can now say this with certainty after giving birth on August 10th, 2006 to a healthy full-term baby girl. I had such a strong instinct to feed her the moment she was handed to me.

I was saddened when she would not latch on immediately. While she did eventually latch on, feeding Maya continues to be a roller coaster of emotions. Each time she breastfeeds successfully I am elated.

When she has difficulty I continue to get stressed and concerned wondering what's wrong? Why is she not latching? Not eating? Is she not feeling well? Is my milk not enough for her, does it taste bad? Is she frustrated?

As a dedicated therapist I decided to go back to work full-time after only six weeks. Having my practice makes it easy to come and go and to have flexibility to go home and feed Maya between clients.

While "so far, so good" my anxiety about feeding still exists. Luckily it has now primarily shifted to "will Maya have enough milk while I am working?" She's now drinking in excess of 25oz per day. Since she's in the 90th percentile in height and the 75th percentile in weight it seems she's eating enough.

While the focus of my stress has shifted, feeding Maya remains my primary concern and often consumes me. I still worry about feeding her and will probably have strong emotions surrounding this at least until she is all grown up.

I see now why parents are concerned about their child's eating when they go off to college. How can you not be when you have been consumed by the topic for so long?

This experience has changed me for the good as a feeding therapist and has increased my passion as a person who helps parents deal with and understand feeding as a complex and emotional issue.

I am sure Maya will continue to teach me many things over her lifetime which will change me and cause me to look at things with different eyes. Oops… it's 12:00, time to feed Maya.

One Wednesday morning around 6am, my husband, Jason, and I sat in the living room drinking coffee and discussing business. Now as the proud new parents of a beautiful bouncing baby girl we're mildly sleep deprived and slightly overwhelmed trying to balance business and caring for the new baby.

Anyway, we started discussing work and our new office and suddenly, "IT" happened... Jason began to get irritated, slightly tight lipped and red in the face as he tried to repeat and further explain his point.

Now being a speech language pathologist I see this all the time. And I couldn't help but calmly explain that what we just experienced was a communication breakdown.

In our case, I explained "neither one of us is to blame, and it's not worth getting angry about". While the comment lightened the mood and we got past our communication breakdown, I immediately thought about what it must be like to have a communication disorder.

In our situation I felt what it was like to have a receptive language disorder. I felt confused and a bit embarrassed that I did not understand. And I did not want to ask Jason to repeat himself again. Jason experienced what it would be like to have an expressive language and speech disorder… I already told you how he reacted.

Imagine being a child with either of these deficits trying to communicate with friends, family and teachers. For them, life is often filled with confusion, frustration anger and even isolation.

This incident reminded me of when my, now three year-old extremely verbal, nephew was under two. Very early one morning he was lying in his crib and activated a musical aquarium toy. My sister, lying in her bed next to the monitor heard the aquarium music start and then heard Andre start softly saying "too loud". Stacia then got up, lowered it and he went back to sleep.

Imagine what would have happened if he could not communicate??

So think about "communication breakdowns" when your child acts out or cries. Also pay attention to the non-verbal cues such as body language and facial expressions. Then take a deep breath and try to better explain or understand the point. This will help you avoid communication breakdowns with your children before they happen.

If you get good at it, it even helps with husbands.

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