Speech and Language Remediation Center, Inc.

Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have difficulty saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems with motor planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.

Articulation is the formation of sounds used for speech production. An articulation problem exists when a person produces sounds, syllables, or words incorrectly. The incorrect production of sounds can cause listeners to have difficulty understanding what is being said and to pay more attention to the sounds of the words than to their meaning.

Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological condition characterized by lack of attention and concentration, increased activity, distractibility, and impulsivity. This disorder interferes with a person's ability to function in daily activities at work, school, and home. ADD or ADHD also affect personal relationships, the ability to complete homework assignments, and participation in extra-curricular or work activities. To be diagnosed properly, symptoms must be consistently observed for six months or longer and be present in multiple settings. Attention deficit disorder may be divided into three sub-categories: a predominately inattentive type, a predominantly hyperactive or impulsive type, and a combined type with both decreased attention and hyperactivity. ADD or ADHD often occurs in conjunction with other conditions such as depression, anxiety, or learning disabilities.

Auditory processing describes what happens when the brain recognizes and interprets sounds from the environment. Sounds traveling through the ear become electrical information that can be interpreted by the brain. The "disorder" part of auditory processing disorder (APD) means that something is adversely affecting the memory, processing, or interpretation of auditory information.

Autism Spectrum Disorder (ASD) is a broad spectrum of disorders that affects the development of social interaction and communications skills. This disorder usually becomes evident during the first three years of life. Individuals with ASD generally exhibit difficulties in verbal and non-verbal communication, social interaction, behavior, and leisure or play activities. ASD includes autistic disorder, pervasive developmental disorders (PDD), and Asperger's Syndrome.

Dysarthria is a speech disorder resulting from weak or poorly coordinated muscles of the mouth, face, larynx and respiratory system. Dysarthria can affect all motor speech processes: breathing, articulation, resonance, and the rhythm of speech (prosody). Speech may be slow, imprecise, slurred and uncoordinated. The voice may be soft or monotone. There may be limited movement of the tongue, lips, and jaw. Dysarthria is a neuromuscular impairment that can affect children and adults and can be caused by a stroke, brain injury, or disease.

Dyslexia refers to learning problems associated with reading. A person with dyslexia has difficulty identifying words quickly and accurately. This lack of word identification often translates into difficulty in reading, writing, spelling, math, or organization despite the individual's high level of intelligence.

Language is a code used to communicate ideas and express wants and needs. Speaking, reading, writing, and gesture systems are all forms of language. A language disorder is an impairment of comprehension or expression of language, including social interaction and appropriateness. Individuals whose language ability is not at the level expected for their age, cognitive ability, or level of language exposure may have a language delay or disorder. A language disorder is likely to significantly impact academic progress. Language problems, like other learning disabilities, are often identified by different names, including language delay, language disorder, and language disability. Children who appear to be developing all aspects of language at a slower rate are considered to have a language delay. Children who appear to be developing language in an unexpected way or have uneven language development have a language disorder or disability. It is important to identify children whose language is not developing normally so that more specific stimulation and intervention can begin as early as possible. Receptive language is the ability to understand spoken language, including comprehension of age-appropriate vocabulary, word meanings, word relationships, and syntactical and grammatical structures. Children learn language by listening to the spoken language around them and practicing what they hear. They discover the rules of the language code over time. Problems in understanding language will affect almost every aspect of school, including following directions, learning vocabulary, understanding instructions, and reading comprehension. Expressive or oral language is the ability to convey ideas, wants, and needs in an organized and appropriate manner. The development of oral language normally occurs without formal teaching as a result of exposure to spoken language. Oral language is the foundation for reading and written language. Individuals with expressive language problems also may have difficulty organizing their thoughts and ideas into spoken or written language, holding a conversation, telling a story, and using different forms of language for different listeners, purposes, and situations. Even mild problems in spoken language can have an impact on learning in school. A mixed receptive-expressive language disorder causes impairment in both the understanding and the expression of language.

Learning disabilities interfere with a person's ability to process and interpret information. They are characterized by a discrepancy between a person's ability level and his or her performance in academic or functional areas. Learning disabilities occur in individuals who have at least average intelligence and have difficulty learning in spite of quality instruction. These disabilities may be hereditary and are caused by a difference in brain structure or function. Learning disabilities may be broken into three categories: language-based learning disabilities, non-verbal learning disabilities, and difficulties with executive functioning. Language-based learning disabilities (LLD) are the most common subgroup, and may lead to problems in all academic areas, including listening, reading, writing, spelling, and math. These disabilities are related to problems with language processing and production, and do not indicate impaired intelligence. Language-based learning disabilities create a gap between a person's true capacity and his or her performance on language-based tasks. Individuals with LLD may have problems with organization, storage (memory), and retrieval of novel or learned information. Other difficulties may include understanding and answering questions, following complex directions, using and understanding grammar, using and understanding figurative language, clarifying miscommunications, and maintaining a conversational topic. These individuals may have a small vocabulary, use short, common, or nonspecific words (i.e., thing, stuff), exhibit weak association and categorization skills, and demonstrate weak narrative skills. Expressive language is often simple and immature without much elaboration. Sometimes, attention, motor, or emotional problems exist in conjunction with a learning disability. Dyslexia is one language-based learning disability that affects the development of reading, spelling, and written language skills. Dysgraphia is a learning disability that involves difficulty in expressing thoughts in writing. It generally includes extremely poor handwriting. Non-verbal learning disability (NLD) is a learning disability that originates in the right hemisphere of the brain, causing problems in motor skills, visual-spatial-organizational skills, and social skills. Weaknesses may include lack of motor coordination and balance, poor visual memory, difficulty with spatial relationships and spatial perception, problems understanding nonverbal social cues such as intonation and facial expression, and difficulty adjusting to transitions. Academically, weaknesses may be seen in mathematical calculation and reasoning, reading comprehension, handwriting, and the ability to learn new information. Individuals with NLD may have strong verbal skills, excellent auditory memory skills, early speech and language development, increased attention to detail, and average or above average intelligence. Executive Functioning refers to problems with attention, memory, impulse control, organization, planning, and hierarchical thinking. However, it does not fit neatly into the aptitude/achievement discrepancy model used by many school systems to diagnose learning disabilities. Individuals use executive functioning skills to learn from past experiences, set goals, anticipate problems, evaluate actions and delay immediate gratification. Executive functions are critical to playing, organizing and carrying out complex human behavior over long periods of time. One specific component of executive functioning is "working memory," the ability to hold information in one's mind while processing and manipulating it. This function is necessary for something as straightforward as performing mental math computations or as complex as listening to a college lecture, organizing the information and relating it to previously acquired knowledge. Younger children rely on these abilities to follow a sequence of instructions: "Brush your teeth, get dressed and come downstairs for breakfast."

The On Cloud Nine® Math* program is for students who need visualizing and verbalizing for math. The program uses concrete experiences to help students think with numbers, image relationships, and do mental and written computation. It builds within the student a sensory-cognitive mathematical base for mathematical reasoning.

An oral-motor disorder exists when a person has difficulty using the lips, tongue, jaw, cheeks, or soft palate. Decreased muscle strength, control, range of motion, and coordination may create problems with eating, drinking, speaking, swallowing, or facial expression. In an oral-motor examination, the speech-language pathologist assesses the structures of the mouth and the muscle movements. Many clients benefit from exercises that strengthen the muscles, increase their range of motion, and improve their coordination and control.

Pragmatics is the area of language function that embraces the use of language in social contexts. Children with pragmatic difficulties have weaknesses in using language socially for their chronological age level. Pragmatic skills include maintaining appropriate eye contact, participating in a conversation by taking turns with the other speaker, and knowing how to initiate, maintain and end a conversation. Good pragmatic language users keep in mind the listener's informational needs and respond appropriately to the non-verbal aspects of language such as tone of voice, body language, and facial expressions. Children with pragmatic language difficulties often have trouble making and keeping friends and interacting with peers and adults.

Visualizing is the ability to create whole images (pictures in the mind) from information that is heard or read. Often, the individual with visualizing difficulties understands only part of the information rather than the complete picture. Weaknesses in visualizing can result in problems with reading comprehension, listening comprehension, critical thinking, following directions, and participating in conversations. At times, these individuals have difficulty expressing their ideas orally or in writing in an organized, cohesive manner.

Visualizing and Verbalizing® Program* for language comprehension is a highly structured program developed by Nanci Bell to improve concept imagery for language comprehension and thinking. Visualizing and Verbalizing® Program* is most effective when taught intensively. Once an individual can fully visualize, improvement is generally shown in listening and reading comprehension, critical thinking skills, memory, and oral and written organization.

A voice disorder is characterized by any change in the voice that affects its sound quality, pitch, or volume, or interferes with the ability to communicate. An individual with a voice disorder may sound hoarse, breathy, or nasal; may use a voice that sounds too loud or too quiet; or may use a pitch that sounds too high or too deep. A variety of voice disorders exist, which may be caused by vocal abuse, disease, allergies, medications, or trauma. Vocal abuse includes speaking too loudly, yelling, using improper pitch, or using inappropriate breathing patterns. Vocal fold nodules or polyps are the most common problems resulting from vocal abuse. A person with a voice disorder must be treated medically by a physician prior to consulting with a speech-language pathologist (SLP). Together, the physician and the SLP can develop a treatment plan, which may include medical or surgical intervention and voice therapy.