Transcription:
Pediatric Speech Therapy

Melanie Cole (Host): Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole and today we're discussing the field of Speech Pathology. Joining me is Gayle Morris. She's the Senior Licensed Speech Language Pathologist at Weill Cornell Medicine with over 29 years in the field. Gayle, it's such a pleasure to have you join us today. Tell us a little bit about Speech Therapy and some conditions that would lead a parent to really seek it for their child.

Gayle Morris, M.S. CCC Guest): Hi Melanie. Thanks so much. It's great to be here. It's a very good question. And it's a broad question and it has a broad answer. We actually treat so many different speech, language, voice, communication, feeding issues. I mean, it's really a tremendous breadth in our field. So, if I can give you some examples of typical issues that parents might be concerned about, sometimes parents are concerned that their kids aren't speaking.

So, when should a parent be concerned? Well, we look back at the different developmental milestones, right? So, kids at about six months, they start to babble. At about a year, that's when the first words emerge. At about 18 months, they start putting together two words. At about two, they start phrases. At about three they're speaking in sentences, and then four and five, we should understand almost everything kids say, but when does a child usually come in to see me? I would say, if they're not speaking, usually by 18 months, you want to actually start with a conversation with your pediatrician. And then the pediatrician sort of has a checklist on does the child understand certain things?

Are they having difficulty with certain things? So, then we sort of want to look at whether or not a child, you know, is following directions and understands most of what's going on in their environment. So, there's actually so many different disorders that I could speak about, but that's just a general idea of a guideline of maybe when we might be concerned about getting a kid in to see a Speech Therapist. Of course, other things come up, like if a child begins to stutter or something like that.

Host: And so we're going to get into that. And as a parent who did early intervention, which is just wonderful, parents listening, because my daughter wasn't speaking and early intervention helped her with a Speech Pathologist. And now of course at 18, wow. Who even remembers that long ago. Tell us about stuttering, Gayle. What is it? Because people don't really understand it. The president of the United States had this issue. Tell us a little bit about what this is.

Gayle: Well, it can be a little complex when you think of the actual definition, but when I just try to give an explanation to a parent or a child and even some adults that I treat, I basically tell them that it's a stoppage of air somewhere in the system. Somewhere in our respiratory speech system when the two come together right, there's a block somewhere. So, it's sort of like things are out of sync. So, is that block in the vocal tract area, is it in the mouth? So, it's really a stop of air somewhere in the system. And for kids, it can be something that just occurs during development and a developmental disfluency, which can be common. Years ago and as you mentioned, I've been in this field for almost 30 years, at the beginning of my career; pediatricians, speech therapists used to have a wait and see kind of attitude.

Now we really like to intervene early. Because we don't always know if that developmental disfluency is just going to go away on its own. So, we like to treat it early. Because it can become a chronic problem. So, as far as the causation of stuttering, it used to be where there were lots of theories as to why it developed. But now they're thinking that it can be something neurologically related. And so parents will often say, how do I know when to bring my child in for intervention or for an evaluation?

And so we usually tell parents and pediatricians, if the child has been stuttering for more than three to six months, we may want to have a look at them. If they have a family history, that's even more of a reason to bring them in a little bit earlier. And then if they're exhibiting other signs of struggle, like it's not just an easy repetition of speech, then we also want to bring them in. So, if there's any kind of like twitching or facial tension or something like that, or frustration that the child is sort of complaining that they just can't get the words out.

Host: Such an interesting situation. So, now tell us about expressive language disorder. We don't have a lot of time on these podcasts Gayle, but this is really such a great topic. And as you said, so many different broad conditions that we could discuss forever so long. But tell us about expressive language disorder and receptive language disorder and why parents should know about these.

Gayle: It's a great question, Melanie, and that's really interesting. Lots of times parents become confused. Is it a speech issue, or language issue? So, I know you're asking me about language, but speech is really the production piece. Right? Language is really how well a child uses and understands.

So, expressive language is how a child expresses their needs and wants and desires. And it starts out through gestures, sort of prelinguistically, starts as gestures. And then children can use their words to express how they're feeling or what they want. Receptive language is how well a child understands or processes information. So, as Speech Therapists, we need to delineate is this an expressive issue where a child can't come up with the words, or is it a receptive issue where the child's not understanding some basic concepts in their environment, or maybe they're having difficulty following directions. And then I'm going to add Melanie, there's a third component to language, which is called pragmatic or social language.

And that's how well children are able to be social communicators. How's their eye contact, how's their attention, how's their ability to initiate a conversation or maintain a conversation. So, again, we don't have a lot of time as you'd mentioned, but that's sort of how we would gloss over and explain the different areas of language.

Host: Well, that was a great answer. So, tell us a little bit about some of the strategies and techniques that you use with children, you know, and I understand that they're different for each different condition, but really some signs and symptoms. Red flags that parents should look out for when their children are young. And we know milestones are not always followed to the letter really, but some signs and symptoms that parents should contact their pediatrician. And then what do you do with kids? Give us a little idea of what Speech Pathology and Speech Therapy is like for the kids.

Gayle: Well, Melanie, I love how you said that milestones are not set in stone, right? I mean, therapists know this, pediatricians know this. There's a large range of normal and your child may be a late talker and they may go on to be just fine without any intervention ever needed. But what I would say is this is an interesting, fine line. You know, doctors will often say and teachers may say, you don't always want to compare your child to their siblings or other kids, but sometimes observing other children can be a little bit of a benchmark. So, we're not expecting everybody to be in the same place, but there shouldn't be a huge gap either.

So, if your child is not able to participate in their life the way that most other children can, that's a reason to start a conversation with the pediatrician. So, I would say the warning signs are, if they're not able to follow simple directions and most other kids could. What I would say with stuttering, as I mentioned before, three to six months, if they've been repeating words or having difficult time getting the words out, you want to bring them in. If children are a little more isolated because they can't play with their peers because there is a big discrepancy you know, and again, right, it depends on age and it depends on disorder, but if no one can understand the child except for mom or dad, sometimes that's an indication that we need to start a conversation. And you know, it's best to go to your pediatrician rather than Dr. Google.

Because it's very hard to sift through the information. But that's what I would probably say. And as far as how we treat kids, what I would say is, it starts out where we get a referral usually from some medical professional, usually an ENT or a pediatrician. Sometimes parents will come in after teachers have, preschool teachers or daycare providers who have a lot of experience with children will say, we think you need a speech evaluation and we always start with a thorough intake that we send to a parent even before we meet them. So, we can be cued into what disorder we might be looking at a little bit more closely. And what I will say is, parents usually have very good instincts. And so what I would say to parents is listen and trust your instincts. And even after you meet with the pediatrician, if you go home and the same concerns keep on resonating with you, ask again, ask again and stay on top of it and stay in tune with whatever your instincts are. So, to get back to your question on how we interact with them.

So, we would start with an evaluation. What we do would really depend on the disorder, the age and that sort of thing. And then we would let you know whether or not we felt that therapy is warranted. We do turn kids away when we think they don't need it. And sometimes the evaluation session will just be validation that everything's okay. Sometimes the evaluation session is about here's how you can stimulate your child's language and giving guidance to parents. I mean, that's really why we're here at Cornell, we're really a service to the community.

Host: Beautifully said. What else would you like parents to know as we wrap up? Kind of your best advice that can tell parents that there is hope that early intervention works, that speech therapy is not scary for kids and actually most of them love it. It's a lot of fun and it gives them that outlet to learn to communicate because many tantrums are a result of that inability to communicate. Kids just feel frustrated. So, give some parents out there, your best advice, Gayle. And thank you so much for joining us today.

Gayle: Oh, my pleasure. Melanie, I love that you say that because it's really true. First and foremost therapy should be effective, but if we're doing our job right, it should be fun and it should be confidence building. So, what I want to say, if I could give any advice to parents, I would say yes, therapy is a strength. I would say we could treat and really support almost anything. And just because your child is in a place right now, you can't even imagine the resiliency, the plasticity. I mean, we're not talking about neuro-plasticity here of a child's brain, but they are so responsive to therapy. And if I could give advice to a parent other than to trust their instincts, as I mentioned before, it would be get involved with your child. So, get on the floor and play with them. Get rid of all electronics. I know I'm going to all of a sudden become very unpopular. Maybe that's not realistic to get rid of all of it, but I would say minimize electronics as much as you can.

Get into playing with toys, getting them involved in household chores and routines, kids learn great through real life experiences. Take them to the supermarket, come up with a shopping list. It's a great way to develop vocabulary, to get them involved, to keep them really as language curious as possible.

Host: Great advice, Gayle. What an excellent episode. So informative. You're just lovely. Thank you so much for joining us today. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. Thank you so much to our listeners. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download subscribe, rate, and review Kids Health Cast on Apple podcast, Spotify and Google podcast. For more health tips, go to weillcornell.org and search podcasts. And don't forget to check out Back to Health. I'm Melanie Cole.