Friday, July 13, 2012

4 yr old Female with Misarticulations and Loud Volume

4 yr old female with Misarticulations and Loud Volume

Q:  "My daughter will be four in less than a month. She was a preemie, but has caught up in most areas. She still uses "h" a lot instead of s, f, t ....ex: hog instead of frog, hurt instead of shirt, hee instead of tree. At what age should I be worried that she needs help? 2nd question ... She talks soooo loud all the time. First her ent said it was bc of hearing loss and it would get better after her tubes were put in. It didn't get any better. :( Anything we can do to help her talk more quietly?? Thank you!!!"

Great questions!  I will address each question separately! 

Q Part 1: My daughter will be four in less than a month. She was a preemie, but has caught up in most areas. She still uses "h" a lot instead of s, f, t ....ex: hog instead of frog, hurt instead of shirt, hee instead of tree. At what age should I be worried that she needs help? 

A:  Let me address the age question first.  The following sounds should be mastered by the following ages:  /t/-4yrs, /f, v/-5yrs, /sh, ch, soft g/-6yrs, /s, z/-7yrs (according to Goldman, Smit, Sander, Templin, Prather).  I do caution parents NOT to look at these ages and say “Ok than my child is fine”.  There are several indicators that would make me question whether an articulation deficit exists.  The first concern I have is that the TYPE of substitution for these sounds (/h/) is considered atypical or non-developmental in nature.  And I wonder how this substitution affects your daughter’s overall intelligibility (i.e. understandability) with people who are not familiar with her speech pattern.  So what can you do?

Step 1: Make sure hearing is within normal limits. 
For parents out there that see similar things and your child has NOT received a hearing screening this may be indicative of a hearing deficits IF there is a systematic deletion of sounds (i.e. your child cannot produce this sound in isolation, or in any syllable or word positions) that have similar frequencies (higher frequencies such as the fricative sounds /s, z, f, v/ and affricates /sh, ch, soft g/).  If your child has not had a proper hearing screening, I would make sure he/she can actually HEAR the sounds before we expect him/her to say them.  With that said, you mentioned she is a preemie and is currently being followed by an ENT so I will assume at this point that you know her hearing acuity is within the normal range.  What’s next?

Step 2:  Make sure your child is “marking” the sounds in question. 
Does your child actually know this particular sound exists by producing it in contexts (e.g. in isolation-if you here her making /sh/ for “quiet” or “spraying hose” sound, or making the sound in other parts of words-maybe she can make a /f, sh/ at the ends of word-maybe she puts the /f, sh/ on the end of familiar words)?  If the answer is YES, than your child marks that sound!  GREAT!  I would recommend you model the sound in the words she does not use it in and describing the sound is a great way to do this.  “Oh, honey remember that “frog” has that “bite your lip sound” in the beginning” or “You know “shirt” has that “quiet sound” in the beginning.  Watch mommy say it.”  Begin with modeling with no expectation of her self-correcting (less pressure and really you are just wanting her to become aware of when to say those sounds).  Many times children will attempt to self-correct just from your model and will begin to try to say it in other instances.  And of course you can do lots of modeling/practice (there are TONS of ideas on the internet but some of my favorites I will add here):  singing familiar songs, playing games that have those sounds… “I spy with my little eye” or Rhyming games, etc.  I usually recommend to parents to just take 5 minutes a day looking at books or in play and model, model, model, those sounds (technical term-bombarding the child’s Auditory System with this sound).  If there are no additional difficulties, a typically developing child will likely pick up on these models and begin to use them.  It doesn’t happen overnight, but if you are seeing improvements, no matter how small they may seem, than you know its working.

Step 3:  If your child is NOT marking the sound (meaning she does not say the sound in any context we may be looking at a more significant articulation deficit), see if your child can make the sound in any context (usually isolation is the easiest context but not always). 
If she can achieve the sounds, than she is NOT AWARE that she is not making the sound itself and it’s a matter of improving awareness while working on these sounds from the simplest to most complex sound contexts (isolationàsyllable level (CV, VC)àsingle syllable words (CVC)àmultisyllabic words or multiple single syllable sentencesàreading or for young children repetition of familiar finger plays, rhymes, books etc.àconversational speechàgeneralization).  Heidi Hanks, M.S. CCC-SLP has a WONDERFUL blog out there called Mommy Speech Therapy ( that explains how this process works.  Type in the search box “The process of Articulation” and you will find a simple and concise explanation of how this process works and what you can do to help your child.  Again there are a TON of free speech therapy activities on the internet that you can find to aid in this practice.

If your child CANNOT elicit this sound isolation after models and practice than we must move to….

Step 4:  Consult a Speech-Language Pathologist near you!  There may be a more significant articulation disorder that requires outside therapy!


Q Part 2:  “She [my daughter] talks soooo loud all the time. First her ENT said it was bc (because) of hearing loss and it would get better after her tubes were put in. It didn't get any better. :( Anything we can do to help her talk more quietly?

A:  Thank you for this question!  It really is an important one for several reasons.  Using a higher vocal intensity (technical term for “volume level”) is a form of vocal abuse and over time can result in a voice disorder!  It can also prevent others from wanting to communicate with your child if they feel your child is too loud.  So thank you, thank you for this question! Often times volume is overlooked and is a very important part of communication.

Again, assuming that hearing acuity is within normal limits, this should be a much easier fix.  Many children are not aware of the volume they typically use.  It is not uncommon for children with various medical diagnoses to use a higher volume level (or even an inappropriate pitch-hoarse voice, high pitch, etc.) than would be appropriate for conversation.  However, the good news is that volume level can be practiced and improved upon!

Step 1:  Make your child aware that there are different volume levels for various situations.  Explain that we use a “whisper voice” when we want are at the movies, church, telling secrets, etc. (however you want to describe it).  An “inside voice” is the voice we use to talk to mommy and daddy and our friends when they are next to us.  An “outside voice” is a voice we use when we are playing on the playground. 

Step 2:  Practice makes perfect!  Now you play games and practice using all 3 kinds of voices.  You can make up any game you want to practice these skills. A simple example would be when playing with stuffed animals/dolls, have the dolls use “whisper voices” to tell secrets to each other, an “inside voice” to talk in the doll house when playing, and an “outside voice” (with the dolls far apart to show more distance needs higher volume) when the dolls are outside of the house playing!   

Step 3:  Make a visual to demonstrate volume level and encourage carryover!  Some people use a rating system with numbers or colors showing various levels of volumes.  For PK kiddos I have used a “stop light” with pictures next to it.  Red-“outside voice”-with a picture of kids on the playground.  Yellow-“inside voice”-picture of a family inside, maybe playing or at the kitchen table.  Green-“whisper voice”-picture of someone whispering into another person’s ear.  You can create any visual you think your child will understand.

Step 4:  Post this visual where you are most often in your house and even make one to take with you on errands etc.
When your child is doing a GREAT job, give her lots of praise, and show her at which volume level she is speaking.  If your child is struggling, show her at what level she is currently speaking and at what level she should be speaking to encourage her volume to decrease or increase as needed.  If volume is not increasing/decreasing with visual and verbal encouragement go back to Step 3.  We need more practice!

Great Questions!  Good luck and let me know how this works out for you!

No comments:

Post a Comment

Related Posts Plugin for WordPress, Blogger...