Speech-Language and Learning Conditions & Challenges

a full range of diagnostic and therapeutic services for individuals with communication disorders and language-based learning problems. Through accurate diagnosis and early intervention, we help children and adults realize their full potential as communicators by improving speaking, articulating, learning and other language skills. At Cincinnati Center for Improved Communication, Inc, be assured that you and your family will be treated with the utmost in care, competence and confidentiality.

If you, or someone you know, is affected by one of the following disorders, our staff can help.

Apraxia

Childhood apraxia of speech (CAS), or developmental apraxia, is a neurological condition that results from the brain’s inability to coordinate the muscle movements necessary for speech. A child diagnosed with CAS knows what he/she wants to say but has trouble saying it.

Children who are diagnosed with apraxia have problems saying sounds, syllables and words. The emergence of their first word may be delayed. The child with apraxia typically has only a few different consonant and vowel sounds in their repertoire and experiences difficulty imitating speech. The apraxic child demonstrates difficulty combining sounds; longer words or phrases prove more difficult. Sound errors are inconsistent which results in speech that is hard to understand, especially for the unfamiliar listener. The child may same the same word in different ways on different occasions.

Intensive intervention is the typical recommended course of treatment to establish motor pathways to improve speech sound accuracy. Speech therapy sessions frequently incorporate the use of sign language to facilitate communication and reduce frustration for the child with CAS.

If you have concerns regarding your child’s speech production, the professionals at C.C.I.C., Inc. can help.

Articulation disorders, or speech sound disorders, range from simple substitutions to multiple phonological process errors. Many children experience difficulty pronouncing specific sounds during their preschool and early elementary school ages.

Sound errors may be of several types:

  • Substitution of one sound for another, for example “w” for “r” or “th” for “s”
  • Deletion of sounds, particularly initial or final consonants, for example “bu” for “bus” or “es” for “yes”
  • Distortion of sounds, for example a fuzzy “s” or distorted “r”

Phonological process errors may include:

  • fronting (making back sounds at the front of the mouth – “tootie” for “cookie”)
  • gliding (using a “w” for “l” or “r”, for example “gwove” for “glove” or “twuck” for “truck”)
  • cluster reduction (omitting one sound in a blend, such as “sool” for “school” or “tar” for “star”)

By the age of 7 years to 8 years, children should be able to produce all speech sounds correctly. If errors persist, a diagnostic speech evaluation is indicated. The evaluation includes in-depth testing of all speech sounds in all contexts, stimulability for correct production or approximation, and an orofacial examination to determine structural adequacy of articulators. Typically a hearing screening is also completed.

If you have concerns regarding your child’s speech skills, the professionals at C.C.I.C., Inc. can help.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disability that causes problems with social skills and communication. Autism is different for every individual who is diagnosed and can range from mild to severe.

The child or individual with ASD demonstrates significant social skill deficits. Indicators include poor eye contact, poor play skills, problems making friends, obsession with specific topics/objects of interest, inappropriate emotional displays, and a dislike of being touched or held.

Communication indicators of ASD include lack of speech or limited speech, difficulty expressing basic wants and needs, poor vocabulary development and repetition of what is said (echolalia). The speech of a child with ASD may sound robotic or high-pitched. Facial affect is typically flat; the individual with ASD typically does not change facial expression to let his/her communication partner know how he/she is feeling. The individual with ASD experiences significant difficulty taking the perspective of others and may be perceived as uncaring or inappropriate in his/her interactions.

The individual with ASD experiences difficulty dealing with the world around them. Changes in routine are highly problematic. Self-stimulating movements such as rocking or hand flapping may be evident. The individual may develop unusual attachments to objects or use objects in unusual ways. They may eat only select foods or refuse certain food textures. Sleep problems are common, as are sensory integration issues (being either very sensitive or not sensitive enough to touch, light or sound).

In rare forms of ASD children may develop language and then regress, losing words they were previously able to say. In contrast, individuals who exhibit high functioning autism, or Asperger Syndrome, demonstrate specific social skills deficits but have average to above average intelligence. The child or teenager diagnosed with Asperger Syndrome will typically do well in academic subjects, yet struggle to make and maintain friendships. They may not be able to stay on topic or know what to say to make conversation or how to keep a conversation going. Individuals with social language issues may not say the right thing and typically interpret language and situations literally.

If your child has been diagnosed with an Autism Spectrum Disorder, the professionals at C.C.I.C., Inc. can help.

Language development is a continuum that begins with receptive language (understanding of language) and progresses to expressive language (how we use words and sentences to communicate as well as facial affect, tone and voice inflection). The next step in language development is the ability to read; the final step in the development sequence is the ability to write.

All children follow this sequence in developing language skills, although not always at the same pace. Between birth and six months of age, a child will respond to sounds and changes in vocal tone. Expressive language at this time consists of vocalizations that contain no real consonants or vowel productions but seem almost like the sounds adults make.

By one year of age, a child will listen when spoken to and can recognize words for common items. They also begin to respond to requests. The one year old will begin to use true words – single productions that contain a clear vowel sound and are used specifically in conversation with another.

Between one and two years of age, receptively a child will follow one-step directions, understand simple questions and listen to simple stories, songs and rhymes. Expressively the child says more words every month and by eighteen months should be putting two words together.

The age span of two years to three years brings an increased ability to follow directions, listen for longer periods of time and understand differences in meaning. By the age of three years, the typical child is using more than one thousand words and can understand even more. A three-year-old should be able to talk about events that have happened or will happen in addition to events in the present.

Three years to four years of age is a big year in language development. Children in this age range should be able to answer simple WH questions. Most of their sentences will consist of four or more words and pronoun usage should be correct. Children of this age are able to understand perspective which is illustrated by their use of different vocal register and intonation for animals/younger children versus parents/other adults.

By the age of five years, children are “mini adults” in terms of their language skills. The five-year-old understands and uses indirect language and hints as well as responds to clarification requests. They use varied sentence structure, correct word endings, and use language to get what they want or need.

If you have concerns regarding your child’s language development, the professionals at C.C.I.C., Inc. can help.

An auditory processing disorder (APD) may also be referred to as a central auditory processing disorder (CAPD). There are different types of auditory processing disorders, and it is difficult to know whether a child or adolescent has an APD or is struggling due to a language disorder or an attention problem.

Characteristics of an auditory processing disorder include difficulty understanding speech in noisy places, following directions, hearing differences between sounds and words and knowing where sounds are coming from. In the classroom setting, a child with APD may experience problems listening to and remembering information and lengthy directions, tuning out noise from other classmates/environmental sounds or accurately hearing information presented orally.

A team approach is typically used to identify an auditory processing disorder. Evaluation involves hearing testing, speech and language testing, and input from teachers and or psychologist. Children with APD can have trouble in school; accurate diagnosis allows the speech-language professional to address specific areas of weakness through compensatory strategies and classroom modifications.

Language processing disorders are characterized by difficulties in the areas of processing information that is spoken or written. These difficulties may occur in understanding and use of vocabulary, understanding multiple meanings and figurative language, following directions or long instructions, remembering information that is spoken or read, putting thoughts into words and organizing information.

Many children who have had language problems since they were young experience language processing issues as they get older. They may not be able to keep up with the language demands of the curriculum in middle school or high school. Language is a skill needed in school to learn math, history, science, and language arts/English. If not addressed, language processing disorders can lead to higher dropout rates and lower self esteem, especially for teens.

In some cases, children may have a language problem as a result of an accident or illness; a more common cause of this in teens is brain injury.

The professionals at C.C.I.C., Inc. can help individuals improve auditory and language processing skills. Call us to schedule a consultation.

Individuals who demonstrate written language issues may have difficulty with the writing processes involved in spelling words, organizing discourse texts, formulating and punctuating sentences, and revising, editing, and presenting their work. Spoken language provides the foundation for the development of reading and writing; each builds on the other to result in general language and literacy competence, starting early and continuing through childhood into adulthood.

Since written language is further along the language development continuum, written language issues may stem from deficits in receptive or expressive language. The fundamental connections between spoken and written language necessitate that intervention for language disorders target written as well as spoken language needs. Difficulties in written language can involve any of the components of language—phonology, morphology, syntax, semantics, and pragmatics. Problems can occur in the production, comprehension, and awareness of language at the sound, syllable, word, sentence, and discourse levels. Individuals with writing problems also may experience difficulties using language strategically to communicate, think, and learn.

Children who struggle to learn and remember sounds and the symbols that represent them may demonstrate spelling difficulties. For older children, sentence formulation, punctuation, and paragraph organization issues may be prevalent. Such issues would warrant formal evaluation of written language skills.

If you have concerns about your child’s written language skills, the professionals at C.C.I.C., Inc. are able to help.

A voice disorder may affect one or more of the aspects of vocal production including vocal quality, vocal volume, vocal pitch/intonation and resonance. Voice disorders may be due to physiological or functional causes. A frequent voice disorder found in children, adolescents and adults is dysphonia caused by vocal cord nodules.

Vocal cord nodules are benign growths on the vocal cords caused by vocal abuse. Vocal nodules can be compared to a callous that you may develop on your finger from the act of writing. The development of nodules on the vocal cords means that the cords do not meet along their entire length when the cords vibrate to make sound. The tiny space created by the nodules allows air to rush through resulting in a vocal quality that sounds hoarse or breathy. Chronic overuse of the voice, use of a loud voice, yelling or screaming, making noises with the voice, constant throat clearing or excessive singing can lead to the development of vocal nodules.

Disorders of vocal volume may occur due to diagnosis of a disease such as Parkinson’s Disease or due to partial paralysis of a vocal cord. In the absence of a physical concomitant, vocal volume may be decreased due to shyness or fear of speaking to groups.

Vocal pitch and intonation disorders result in speech that is too low or too high or that is monotone. Regional and foreign accents may also be perceived as a vocal intonation disorder since such speech patterns differ from the Standard Non-Regional Dialect pattern that is accepted in television and radio reporting and in the business arena.

Vocal resonance is the vibration of sound in the cavities of the vocal tract. Abnormal vibration results in resonance or nasality that is either too little or too much. These conditions are commonly referred to as hyponasality or hypernasality. Such voice deviations may be due to medical conditions such as allergies or congestion or to insufficient closure during phonation.

If you have concerns regarding your voice or your child’s voice, call us to schedule a complimentary consult.

Fluency is the area of speech production that involves how well speech flows. Stuttering is a disorder characterized by the disruption in the flow or production of speech sounds, and is also called dysfluency. Everyone has tines when their speech is not smooth, when we repeat a sound or word or use “um” or “uh”. Moments of dysfluency are not necessarily a problem; however they can impede communication when a person produces too many of them.

Stuttering has no known cause and no known cure. Frequently, young children between the ages of three years and seven years may demonstrate dysfluent speech patterns. If these dysfluencies consist of whole word repetitions in the absence of tension or pitch rise, they are most likely due to the child’s processing speed outpacing his/her ability to articulate thoughts. Such a period of non-fluent speech would be considered “normal” non-fluency rather than true stuttering since it typically decreases/ceases spontaneously. Parents should not react negatively to such dysfluent speech patterns in a young child, but rather respond to the child’s message instead of the manner in which it is relayed. Undue attention to the dysfluent speech may result in increasing the child’s concern over the way they speak, which can lead to an increase in dysfluency.

Stuttering or dysfluencies that consist of repetitions of sounds or syllables, prolongations of sounds or blocks where the mouth is positioned to say a sound, sometimes for several seconds with little or no sound forthcoming, are considered factors indicative of true stuttering behavior. These types of dysfluencies would benefit from direct intervention to teach the individual techniques to monitor and control speech output to minimize moments of dysfluency.

If you have concerns regarding your child’s speech fluency, the professionals at C.C.I.C., Inc. can help.

A cleft lip is an opening in the upper lip which can be small or extend from the lip to the side of the nose. Clefts of the lip can be unilateral (found on one side of the face) or bilateral (found on both sides of the face).

A cleft palate is an opening in the roof of the mouth. Clefts of the palate can range from a small hole to a large opening across the roof of the mouth. Individuals with a cleft palate may not be able to close off the nose from the mouth while drinking or talking. This condition is known as velopharyngeal insufficiency or VPI.

Clefts occur before birth while the baby is forming, typically during the first trimester of pregnancy. Sometimes clefts run in families; some clefts occur with other problems. Most clefts are corrected with surgery, although it may require more than one surgery to completely close the cleft.

Clefts of the lip in the absence of a cleft of the palate may not result in any speech difficulty; however clefts of the palate can result in a number of problems. The child may have difficulty feeding as a baby, may sound as if he/she is speaking out of his/her nose, may not say all speech sounds correctly, and may be hard for the listener to understand, or make snorting and grunting noises when talking. Children who have a cleft of the palate may also experience increased ear infections, dental problems, hearing loss or other learning problems.

If your child has had surgery to repair a cleft lip or palate, the professionals at C.C.I.C., Inc. can help to improve their communication skills.

Executive function skills are those skills that allow an individual to manage time and attention, change focus, plan and organize and remember details. Executive function skills are vital to success at work or school, to independent functioning and to maintaining appropriate relationships.

Organization and regulation are the two major categories of executive functioning. A person can be born with deficits in executive function and the disorder has been found to run in families. Executive function problems are associated with disorders such as depression, ADHD and learning disabilities. Brain damage related to Alzheimer’s disease, stroke or head injury can also cause deficits in executive function.

In children, executive function problems may first be evident during elementary school when schoolwork must be completed on time. The child with executive function problems may have difficulty planning projects and estimating how much time homework assignments or projects will take. They may have difficulty initiating tasks, memorizing information and retaining information while doing something with it. Children with executive function issues may also have difficulty telling stories, whether verbally or in written form. Early attention to executive function problems can help the child outgrow and compensate for weaknesses since the brain continues to develop into adulthood.

Adults with executive function difficulties will experience the same issues as children do. Executive function problems can prevent a person from achieving goals and controlling behavior. Such problems are evident in the individual’s inability to evaluate a situation and change behavior in response to it, since experience and prior knowledge must come into play. There are numerous strategies for adults to utilize to improve planning, time management and general organizational skills which will assist them in coping with executive function deficits.

Call us to learn how the professionals at C.C.I.C., Inc. work with individuals to manage executive function difficulties.

Orofacial myology disorders are characterized by exaggerated forward movement of the tongue during speech and swallowing. The tongue may lie too far forward during rest or may protrude between the upper and lower teeth.

A “tongue thrust” swallow is normal in infancy, but usually decreases and disappears as a child grows. If the tongue thrust continues, a child may look, speak and swallow differently than other children of the same age.

OMD most often causes sounds such as /s/, /z/, sh, ch, zh and j to sound differently. Also, the sounds of /t/, /d/, /n/, and /l/ may be produced incorrectly because of weak tongue tip muscles. Sometimes speech is not affected at all by the tongue thrust.

The following may cause OMD:

  • Allergies
  • Enlarged tonsils and adenoids
  • Excessive thumb or finger sucking, lip and fingernail biting, lip picking and teeth clenching and grinding
  • Family heredity

Common disorders related to sucking habits:

  • Malocclusion and open bite
  • Chronic mouth breathing
  • Deformed hard palate
  • Speech development

CCIC, Inc. provides evaluation and treatment of orofacial myology disorders. We also utilize the Unplugging the Thumb program to eliminate thumb sucking in children age seven years and older.

We treat speech and language problems associated with:

Developmental Delay

Developmental delays are significant lags in one or more areas of a child’s emotional, mental or physical growth. Developmental delays in infants and young children may occur in language or speech, vision, motor skill development, social and emotional skills and cognitive skills. It is possible for a child to have delays in more than one area. If a child demonstrates delays in all areas, it is referred to as a global developmental delay. Global developmental delay is typically due to genetic defects, a syndrome such as fetal alcohol syndrome or fragile X syndrome, or severe medical problems associated with premature birth. There are instances, however, when the cause of global delay cannot be pinpointed.

Language and speech problems are the most common type of developmental delay in children. These delays can be caused by a variety of things including a learning disability, hearing loss, a problem with muscular control, or autism spectrum disorders. At times, no cause for the delays is evident. Warning signs of possible developmental delay may appear as early as three to four months of age if the child is not responding to loud noises or babbling. A child who is not using single words by the age of one year or is not speaking at least fifteen words and using two-phrases by two years may have delayed language.

Early intervention is critical to making progress and/or catching up to age appropriate skill levels. Each child develops at his/her own pace and the range of normal development is wide. It is important, however, to be aware of any indication of possible delay and seek evaluation.

C.C.I.C., Inc. provides services to children as young as 1½ to 2 years of age. If you have concerns regarding your child’s speech and language development, our professionals can help.

Hearing loss is the third most common problem in the United States. Hearing loss can affect quality of life and relationships and can significantly impact a child’s development if not identified.

There are three levels of hearing loss:

  • Mild – The individual has no trouble with 1:1 conversation, but has difficulty hearing every word in the presence of background noise
  • Moderate – The individual often needs to ask others to repeat during face to face conversation as well as telephone conversations
  • Severe – The individual finds it almost impossible to follow a conversation without the assistance of a hearing aid

Advanced age is the most common cause of hearing loss. Research reveals that one out of every three individuals aged sixty-five to seventy-four has some level of hearing loss. Exposure to noise and genetic factors can contribute to decreased hearing ability. Certain medications can also affect aspects of hearing ability, especially hearing acuity and balance. In addition, certain illnesses, trauma and infection may result in a loss of hearing.

Hearing loss symptoms include difficulty understanding phone conversations or speech when there is background noise. The individual may complain that others are mumbling or not speaking clearly, and frequently ask others to repeat themselves.

Hearing loss in children is frequently associated with middle ear infection, or serous otitis media, which can significantly reduce hearing acuity. Treatment with antibiotics typically resolves the infection and hearing returns to normal. Persistent episodes of otitis media may necessitate the placement of pressure equalization tubes to prevent continued infections and resulting fluctuations in hearing acuity.

C.C.I.C., Inc. professionals complete a hearing screening as a routine part of each evaluation. Should an individual fail the hearing screening and recheck, referral to the primary care physician is made for follow up with an audiologist or ENT.

Learning disabilities are sometimes called dyslexia or language-based learning disabilities. Dyslexia is a reading problem. The term language-based learning disability shows the strong connection between spoken language (speaking and listening) and written language (reading, writing, and spelling).

A child with learning disabilities may have some of the following language problems:

Understanding

  • Has difficulty understanding questions or following directions
  • Finds it hard to learn new words from school and books
  • Doesn’t remember details from a story or from class
  • Has trouble understanding some hand gestures or facial expressions
  • Has trouble telling time

Talking

  • Has trouble saying what he thinks
  • Uses vague words like “thing” or “stuff”
  • Makes up and mispronounces words
  • Has a hard time saying numbers in order, like telephone numbers and addresses
  • Has problems learning words to songs and rhymes

Reading

  • Doesn’t know or confuses letters and numbers
  • Has problems learning the alphabet
  • Doesn’t sound out words
  • Doesn’t show much interest in stories or books
  • Has trouble reading out loud and understanding when reading

Writing

  • Mixes up the order of letters in words
  • Mixes up the order of numbers for math
  • Makes a lot of spelling mistakes
  • Doesn’t like writing
  • Has trouble rereading and correcting his work

C.C.I.C., Inc.’s professionals test how your child speaks, understands, reads, writes, and spells to determine if your child has language problems that are leading to learning problems in school. We use what your child is learning in class to work on goals. Your child’s textbooks and assignments can be used to help with reading, writing, and practicing for oral reports. We work closely with your child’s teacher to coordinate efforts and facilitate carryover of skills.

Attention Deficit Hyperactivity Disorder (ADHD) is a condition of the brain that affects an individual’s ability to pay attention. It is a chronic disorder; the symptoms are pervasive, occurring in multiple settings.

An individual who is diagnosed with ADHD has difficulty concentrating, focusing and sustaining attention; planning, organizing and completing tasks on time are also difficult. An individual with ADHD may demonstrate poor self-regulation of behavior. They may seem unable to sit still, restless and fidgety and may bounce from one activity to the next. Such an individual often tries to do more than one thing at once.

An individual with ADHD typically exhibits difficulty in the area of working memory due to attention issues and lack of focus. This may manifest itself in reading comprehension problems and inability to remember directions or listen to class lectures and take notes for the school-age child or teenager. Outside of the classroom, attention deficits may impair ability to listen effectively during participation on a sports team or in general conversation with others. The individual’s tendency to be impulsive can at times lead to poor judgment in decision making.

Individuals may have an attention deficit disorder without the hyperactive component. Students who are diagnosed with ADD present as passive learners. They typically are not engaged during class and do not seek out information. They experience similar problems in terms of concentration, focus, sustained attention and working memory as students who have the added designation of hyperactivity.

Call C.C.I.C., Inc. to schedule a free parent consultation to discuss your concerns and find out how our professionals may be able to help.

Language-based learning disabilities are characterized by problems with age-appropriate reading, spelling and/or written language skills. Because of the nature of language development, most children who experience reading problems have receptive or expressive language deficits. Dyslexia is a disorder in which the individual has trouble almost exclusively with the written or printed word. The child who has dyslexia as part of a larger language learning disability has trouble with both the spoken and the written word.

The difficulties for individuals with language-based learning disabilities encompass the entire continuum of language development. In terms of receptive language skills, the individual typically experiences difficulty learning the alphabet, vocabulary terms, and math times tables. Recalling numbers in sequence, understanding information and following directions that are presented orally, and reading and comprehending material also prove difficult. An inability to express ideas clearly and an increased use of non-specific terms such as “stuff” and “things” or filler words are common. Spelling skills may be poor due to issues with identification of sounds that correspond to letters and mixing up the order of letters in words while writing.

Students with language disabilities experience difficulty distinguishing important from unimportant information, identifying how to organize information meaningfully, relating information to a limited range of background experiences, remembering large quantities of information, and analyzing information to arrive at conclusions and solve problems found in academic tasks.

School age children with language problems are often not proficient readers and writers. A difference in style and complexity of language is initially encountered at the fourth grade educational level, and increases throughout subsequent grades. For these students, it is necessary to help make the leap from conversation to higher-level school language, and assist in the application of learning principles that underlie effective studying.

Call C.C.I.C., Inc. to learn more about how we can help to improve your child’s language-based learning skills.

Additional information regarding speech and language disorders and treatments can be found at the American Speech-Language-Hearing Assocation.