Parent Information

Working with families

How well does your child talk?

  • Do people outside your family usually understand your child’s speech?
  • Are your child’s expressive skills at the same level as his or her peers?
  • Can your child communicate thoughts, feeling and experiences?
    Does your child speak easily with repetition of syllable or words (i.e., stuttering)?
  • Does your child hear you but at times not grasp or understand what you have said?
  • Does your child have difficulty following directions from you or others?
  • Does your child’s voice sound clear with an age appropriate pitch like other children?
  • Are language problems causing your child to have academic problems in school?

How well your child talks and communicates is extremely
important for his or her future success and happiness. These
skills are so powerful and influence the total growth and
development of your child.

Characteristics of Children with Receptive Language Problems

  • Difficulty following directions
  • Difficulty understanding the point of a discussion
  • Difficulty listening to and understanding stories
  • Poor conversational skills; turn-taking nature of communication is challenged
  • Limited vocabulary and understanding of concepts
  • Watch others to ensure they are doing the right thing

Characteristic of Children with Expressive Language Problems

  • Poor grammar, such as problems with pronouns she, he, her, him, his
  • Difficulty asking and answering questions
  • Cannot find the precise words to explain and describe
  • Describes using vague language
  • Poor vocabulary


Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological condition characterized by difficulty with attention, concentration, physical activity, distractibility, and impulsivity.

These children may not pay attention in tasks or complete tasks. They may miss details and lack organization in tasks. The children with ADD may be easily distractible. Those with hyperactivity may have difficulty sitting still in school in their seat. They may fidget, wiggle, and squirm. Some children are quite impulsive finding it difficult to wait their turn. They may blurt out answers and interrupt others. These children may have other specific learning disabilities. Some children may have learning disabilities in the area of language.

Auditory Processing Disorder

Children with auditory processing difficulties have challenges interpreting what they hear. They have intact outer, middle, inner ears and auditory nerves, which allow them to correctly hear the information, but the breakdown occurs beyond this level in the brainstem and brain.

The child may have difficulty perceiving speech or sounds in noise. They may have trouble discriminating between sounds and may mishear sounds. They may have difficulty associating a sound with other information so that they can’t attach meaning to the auditory information heard. For example, not correctly discriminating all the sounds in the word “dog”, may not allow the child to know that the word means, “an animal, a pet with fur that barks”. In challenging auditory situations, such as two people starting to talk to the child at the same time, the child may be unable to separate the messages to understand what each speaker said.

Children with auditory processing problems may take in information slowly and inaccurately. They may be at risk for “auditory overload” as their auditory system shuts down in periods of over-stimulation. Many children have difficulty with understanding language. They find it hard to understand directions, as they get longer and more linguistically complex.


Autism or Autism Spectrum Disorder is a disorder caused by a combination of genetic and environmental influences. The term “spectrum” reflects the wide variation in challenges and strengths possessed by each person with Autism. While it is thought that Classic Autism begins in infancy and Regressive Autism occurs in early childhood between twelve and twenty-four months after a period of normal development, it is clear that we know that there is not one Autism but many types. A major symptom of Autism is a failure to develop normal socialization skills. The child may demonstrate reduced eye contact and interest in objects. Children with Autism may have an independent agenda and have difficulty interacting with others. Their communication skills are often significantly involved and some children are non-verbal and do not learn to speak. Some children memorize language and repeat dialogue from videotapes or previous heard “scripted” language. Children with Autism may have the need for routine and have difficulty with transitions. They may have unusual play behaviors such as holding objects, spinning objects, or lining objects up. They may have sensory differences such as reactions to loud noises, sniffing objects, walking on tip-toe or disliking certain textures of food. A hallmark characteristic of Autism is showing or having a history of restricted, repetitive patterns of behavior. Repeated body movements, obsessive fixations, excessive repeating of sounds, syllables, words or phrases and intense preoccupation with specific objects or subjects are restricted, repetitive behaviors. It is important to note that some individuals with Autism are very high functioning and may appear typical at first glance to adults and perhaps peers. The sustained impression held by peers is that of a subtly awkward and different person.

Developmental Apraxia of Speech

Developmental apraxia is a speech disorder in which the child struggles to sequence and say sounds, syllables, words and even sentences. The brain struggles to send signals to the articulators (lips, tongue, jaw) for the movements necessary for speech production. The child is well aware of what they want to say, but are unable to sequence the movements necessary to express themselves.

Parents will most often be puzzled by the fact that their child understands everything and yet cannot talk at the level at which they appear to understand. They also will often report that their child did not babble or jargon much as a baby. Some will say the babbling or jargon is limited in sounds. The child often struggles to develop an emerging vocabulary for expressing themselves. Words are often missing sounds and the child may use easy to produce sounds to replace harder to produce sounds. Speech errors are often inconsistent. Children with apraxia of speech have difficulty imitating speech and parents report groping for sounds. These children often produce shorter words with greater ease than longer words, phrases or sentences. Children with more severe forms of apraxia may also have oral apraxia, which includes difficulty with feeding.

Language Disorders

Receptive language problems occur when a child has difficulty understanding what words mean or what is said to them. They may be challenged following directions or learning concepts.

Expressive language problems occur when a child has difficulty making words using the correct grammar (jumped, friend, friendly, unfriendly). Some children have difficulty combining words to make sentences correctly. Others have difficulty expressing themselves and explaining. Describing or telling a story can be hard. Some children have difficulty using language for social interaction or meaningful conversations with others. Language problems can affect problem-solving skills, the ability to read and comprehend, and written expression often required in school.

Learning Disability

Learning Disability is a broad term that includes:

  • Developmental speech and language disorders
  • Academic Skills Disorders
  • Other disorders such as a coordination or other non-specific learning problems

Learning disabilities affect the child’s ability to learn in school. Difficulty with spoken and written language, attention, and visual perception often indicate a learning problem. Academically, these children are often behind in school in learning to read, write or do math.

Reading Disorders are characterized by challenges with accurately decoding, reading fluently and/or understanding what someone has read. Often children with reading problems have trouble recognizing the sounds associated with letters, and distinguishing or separating the sounds in spoken words. Children with challenges in reading may have difficulty remembering what they have read, understanding the grammar and syntax used or even building images from what was read.

Writing Disorders may be characterized by deficits in language formulation, punctuation, spelling, and even handwriting problems. Some children have difficulty formulating sentences using appropriate grammar and syntax to express the meanings or thoughts they want to share. Other children have difficulty putting their thoughts down on paper. They may struggle to begin their story, sequence information and provide closure to their thoughts. The simultaneous complex process of using good spelling, punctuation and expressing ones thoughts may challenge the child. The process of reading material and writing about what one has read can be overwhelming for some children with writing disorders.

Arithmetic Disorders are characterized by challenges recognizing numbers, memorizing facts, and understanding concepts.

Source: National Institutes of Health, 1993

Oral Motor / Feeding Problems

Parents are often the first to notice feeding problems. Poor feeding may mean that the child has difficulty chewing, or drinking from a bottle or a cup. Some children may choke or gag on food while others drool and food spills out of the mouth. At times it may be the texture of the food that the child finds unacceptable, too hard or mushy. Some doctors report poor weight gain, yet many children with feeding problems find foods that are acceptable and eat those specific foods maintaining the necessary caloric intake for weight gain. Frequent respiratory infections or pneumonia may result from food or liquids being aspirated into the airway.

Oral motor problems are often present in the child with feeding problems. The suck-swallow-breathing patterns in infants may be poorly coordinated. Muscles of the tongue, jaw and lips may be too weak with chewing patterns underdeveloped. Lip closure, and tongue lateralization may be affected.

Orofacial Myofunctional Disorders (OMD)

OMDs are disorders that include at least one of the following:

  • Incorrect placement of the tongue at rest (between front teeth or on the floor of the mouth)
  • An open mouth resting posture (lips not closed together at rest)
  • Any sucking habit, such as thumb sucking, finger, lip or tongue sucking

Why be concerned about OMDs?

OMDs can cause:

  • Dental malocclusions (teeth not closing properly)
  • Atypical pattern or swallowing (tongue thrust swallowing pattern with saliva, liquids and solids)
  • Difficulty chewing food (“sloppy eaters”)
  • Mispronunciation of sounds (i.e. lisp)
  • Improper facial growth patterns (development of a long face, retruded chin)
  • Jaw joint pain
  • Weak lips

Social Communication Disorder

A social communication disorder may also be known as a pragmatic language disorder. Children that have pragmatic language disorders have trouble with the functional use of language for communication. It is characterized by difficulties with the use of verbal and nonverbal language for social purposes. Primary difficulties are in social interaction, social cognition, and pragmatics. The unwritten rules that govern social-communicative interaction are deficient. Nonverbal skills such as eye gaze, facial expressions, body posture, personal space, and gestures may be insufficient in children with pragmatic language disorders. Some children with pragmatic language problems may have difficulty appropriately requesting information, conveying information and clarifying themselves. They find themselves challenged expressing attitudes, emotions or even regulating social interaction. Conversational skills such as responding and acknowledging others, turn-taking, and topic maintenance are problematic. Some children with pragmatic language disorders find the act of verbally entering a social situation, and monitoring the social cues of others hard to do.

Speech Disorders

Speech problems occur when one has difficulty with pronunciation of words, and even the intelligibility of speech in conversation. When a child has difficulty forming a sound, this is called an articulation disorder or phonological disorder. Individuals with speech disorders may also have trouble with the way their voices sound. There may be difficulties with pitch, volume, or quality of the voice. Another type of voice disorder occurs when there is an interruption in the flow of speech, called dysfluency or stuttering. Children suffering from speech disorders may have one or more of these difficulties.


Stuttering is a speech disorder that is characterized by repetition of sounds, syllables, parts of words, whole words, and phrases. Some children will also have prolongations or stretching of sounds of syllables. Tense pauses, or hesitations may or may not occur. Reactions that accompany stuttering such as eye blinking, tremors of the lips, and foot tapping may also be present. There is variability in stuttering behavior between people. Often it depends on the speaking situation and the communication partner.

Everyone experiences periods of dysfluent speech. Normal dysfluencies tend to be simple repetitions of whole words or interjections of place markers such as um or er. Some children between the ages of two and five go through a brief stage of dysfluency. This may occur when there is a period of growth in language skills. As the child’s language skills develop the dysfluencies disappear. This is also the same period of time that stuttering develops in children so if the stuttering gets more effortful or frequent and you are concerned, you may want to have your child evaluated by a certified speech language pathologist.


Voice Disorder

Voice problems occur when the child’s voice has an inappropriate pitch (too high or too low), loudness, or resonance. For some children a voice disorder may be characterized by an unusually low pitch and chronically hoarse voice. Perhaps they became hoarse by cheering at a football game and the hoarse voice did not go away. Some children misuse their voices by talking loudly, making funny sounds and changing their pitch. The most common voice disorders in children resulting from vocal abuse are vocal nodules and polyps.