Paediatric Services

  Children typically begin uttering their first words around their first year, although some might commence speaking later than their siblings or peers. Parents might hear from other caregivers remarks like: "My child was quiet and all of a sudden, around age 3 or 4, started talking incessantly! This is often what we refer to as Late Bloomers." 

Conversely, late talkers experience a delay in the onset of language without any medical or developmental issues or diagnoses. On the other hand, some children could receive a diagnosis of delayed language or language disorders. In fact, the Speech-Language Pathologist can inform you, post-assessment, whether your child has delayed language, a language disorder, or simply falls into the category of being a late talker.

A child with delayed language may or may not have a medical or developmental disorder or another diagnosis. The child might have delayed in expressive language (verbal or gesture use),  receptive (understanding) language, and/or social language. In contrast, language disorder can sometimes be linked with specific diagnoses such as Autism. A child with a language disorder might exhibit impairments in pre-verbal skills, play skills, receptive and expressive language, as well as social skills.

The Speech-Language Pathologist (S-LP) possesses the expertise to evaluate your child's language capabilities through formal and informal assessments, while  observing a parent-child interactions and communication. Subsequently, they will communicate the assessment results and proceed to devise the most suitable treatment plan in collaboration with the parents.

 Articulation disorder is a condition in which a child or an adult has difficulty producing speech sounds clearly and accurately. Some examples that highlight the struggle of an individual with Articulation Disorders: 

1. Lisping: This refers to the inability to pronounce certain sounds correctly, often resulting in a "th" sound (e.g., "thun" for "sun").

2. Deletion: This involves omitting specific sounds from words, such as saying "lea" instead of "leaf."

3. Substitution: This occurs when one sound is replaced by another sound, such as saying "tar" instead of "car."

 A speech motor disorder is a condition in which a child is having difficulty planning, controlling, and sequencing the movements of the oral structures to produce the appropriate speech sounds in words and phrases. Articulation and speech motor disorders may range from mild to severe, depending on their impact on speech clarity. There are several causes of speech disorders, which can be functional or structural. A speech-language pathologist (S-LP) with expertise and trained in speech motor assessment and treatment is able to professionally assess your child's speech production and design an appropriate treatment plan to improve and target the oral sensory and motor structures, oral muscle control and movement.

  It is not uncommon to hear a child talking like this: 'I I I want I want a car.' This disfluency is normal in children around the age of 3 years. On the other hand, we may hear a child speaking in a different way: 'I I wwwant a ccccar.' Their speech may also have some tension, and you might notice that their words are getting stuck. This child may hesitate, block, or repeat some syllables or sounds in their speech, which is known as 'stammering' or 'stuttering.' Stuttering is one of the most common fluency disorders. There are other types of fluency disorders, such as cluttering—mostly known as talking too fast—and high normal-disfluency. Speech-language pathologists (S-LPs) with training in the Lidcombe Program are professionally equipped to coach parents on how to reinforce and praise fluency, as well as to teach children with stuttering techniques and strategies to cope with and minimize moments of disfluency in their speech when needed (Fluency Shaping Strategies).

 Have you ever heard a child with a harsh or hoarse voice, or perhaps a child who has lost his/her voice? This child may be experiencing a voice disorder. The cause could be either medical or functional (voice misuse or abuse), which may lead to vocal diseases (such as vocal nodules, polyps, etc.). Voice disorders can impact your child's voice quality, loudness (volume), and pitch (tone). A speech-language pathologist (S-LP) will conduct a voice assessment, which involves perceptual judgment and the use of specialized instruments, in collaboration with the Ear Nose Throat Specialist diagnosis. Based on the diagnosis and clinical findings, the S-LP can provide voice therapy.

Orofacial myofunctional disorders are one or a combination of Poor oral rest Posture, Tongue Thrust during speaking and swallowing (Tongue moves forward or lateral between teeth), and  Oral Habits (e.g. Thumb Sucking) or Sucking Habits with objects (e.g. Pacifier).

The natural and proper oral rest posture includes: lips together, nasal breathing, teeth slightly parted and tongue resting on the roof of the mouth.

Oral rest posture is connected to speech production. The tongue moves to the right position (i.e. behind teeth at the roof of the mouth) to produce some sounds like Z, S, SH, CH, J, D, T, N, and L. If the tongue is resting between teeth (to the front or lateral), the sounds will be most likely produced from that position.

There are many factors that cause poor oral rest posture: 

1. Restricted or obstruction nasal airway- e.g.: enlarged tonsils/adenoids, allergies, asthma, sinusitis.

2. Oral habits- prolonged thumb or finger sucking, nail biting, tooth clenching etc.

3. Structural abnormalities- restricted tongue mobility (e.g. tongue tie), macroglossia (abnormally large tongue- but it is very rare) or micrognathia (abnormally small jaw).

4. Neurological or developmental abnormalities

Poor oral rest posture can cause difficulties in breathing, sleeping, speaking, swallowing, feeding, and dental malocclusion. 

 An Orofacial Myofunctional Trained or Certified Therapist can set goals to correct the oral rest posture for better dental and facial development and to improve overall breathing, sleeping, eating, and speaking, and proper orthodontic correction and stability.

Autism Spectrum Disorder (ASD) is attributed to differences and variations in the brain. The primary characteristics of children with ASD revolve around difficulties in social communication and interaction. Additionally, other characteristics, though not limited to these, might also be observed:

1. Poor eye contact.

2. Language disorders.

3. Sensory integration dysfunction (hyper- or hyposensitivity).

4. Repetitive behaviors.

5. Restricted interests.

6. Challenges with preverbal skills (e.g., joint attention).

7. Difficulties with emotional expression.

8. Play skills difficulties (constructive play/functional play/pretend play).

9. Repetition of words/phrases (echolalia).

10. Cognitive and executive function challenges.

The Speech-Language Pathologist (S-LP) will collaborate with other professionals (such as Behavioral Therapists, Occupational Therapists, Teachers, Physicians, etc.) to optimize treatment and enhance the child's overall quality of life. Some children with ASD are verbal, while others are non-verbal. S-LPs assess each child to recommend the best communication method to express their needs, feelings, and thoughts—whether through spoken language, gestures, Aided or Unaided Augmentative and Alternative Communication (AAC), Robust Vocabulary, or multimodal communication (a combination of methods). This guidance also aims to improve a child's interactions and play with peers.

For more information about the Ontario Autism Funding Program, please don't hesitate to contact us.!