11030 5th Ave. NE Ste. B, Seattle, WA 98125
(206) 522-6464
shellygramza@pacificsl.com

Frequently Asked Questions

How do you work with kids who are not talking yet?

I didn't have as much time to spend with this child as I did my first child. Did I cause my child's language delay?

My mom told me I didn't talk until I was 5, and I turned out OK. Could my child just be a "thinker" rather than a talker?

Could my child be "tongue-tied?"

How do ear infections affect speech and language development?

What's the difference between a speech therapist and a speech-language pathologist?

Can I speak two languages to my child?

My doctor said he'll grow out of it, but I'm still worried about my child's speech. Am I overreacting?

How long will my child need therapy?

Is my child stuttering?

My child has been diagnosed with Apraxia. What does this mean?


How do you work with kids who are not talking yet?
Children do not just start talking out of the blue. They must learn many skills before they actually speak in words. Just a few prerequisites include cooing (e.g., "aaahh"), babbling (e.g., "dadada"), gestures (reaching, pointing, etc.), and understanding some familiar words. Children who are late in developing these prerequisites are at risk for language delay.

I didn't have as much time to spend with this child as I did my first child. Did I cause my child's language delay?
No. Although we have strategies that can be used by parents and caregivers to improve language, nothing you did or didn't do caused your child's delay. We have increasing evidence in the literature for a biological cause of language delay/disorder. Some children are just more biologically susceptible to language delay or disorder. Rather than worrying about the cause, it's best to focus on what can be done to help.

My mom told me I didn't talk until I was 5, and I turned out OK. Could my child just be a "thinker" rather than a talker?
It's very rare for language delay to remediate itself so suddenly, especially after the age of 3. More often than not, a language delay will persist without intervention and may even grow more pronounced as a child gets older. We cannot predict with any certainty which children will catch up and which will not. There is no reason to wait to provide help for these children, and the younger, the better.

Could my child be "tongue-tied?"
This refers to limited mobility of the tongue that results from a very short lingual frenulum (the tissue that attaches the tongue to the muscle underneath). It is very rare for the frenulum to be so short as to interfere with speech intelligibility. If your child can touch the upper teeth with the tongue with the jaw down, chances are it's not the short frenulum that's the issue.

How do ear infections affect speech and language development?
Frequent ear infections in infancy and early childhood are linked with language delay. If speech is not heard correctly in these early years, it cannot be produced correctly. Overuse of antibiotics can lead to drug-resistant bacteria. Ear tubes often help to prevent recurrence of the infection. There is strong evidence in the research that children with ear infections have allergies or sensitivities to dairy products. A change in diet may be all that is needed.

What's the difference between a speech therapist and a speech-language pathologist?
"Speech therapist" is an older term that is sometimes used for the sake of brevity and familiarity. The American Speech-Language-Hearing Association (ASHA) officially discouraged the term "therapist" in 1972 and bestowed the title "speech-language pathologist" in 1976. Anyone who has a master's degree in speech-language pathology is considered a speech-language pathologist (SLP). A pathologist differs from a therapist in that she is qualified to diagnose as well as provide therapy. Unlike occupational or physical therapists, SLPs can practice independently of a physician, even though a prescription/referral may be needed for insurance purposes.

The "language" part was added to more accurately define the scope of our practice. Many people associate our profession with articulation and stuttering, but our field encompasses much more. SLPs diagnose and treat disorders of articulation, language, communication, fluency, voice, swallowing, and related disabilities.

Can I speak two languages to my child?
According to current research, children who learn two languages early will learn to use both languages well. Many parents believe that using two languages at the same time will confuse their child. However, if you wait until your child is older to teach the second language, the child will have a harder time learning it. Research shows that bilingual children are not behind monolingual children (those that speak only one language) in language development. If your child has a language delay or disorder, it is especially important to continue to speak the child's first language (the language you speak at home) while you are teaching the second language. Even in children with delays, there is no evidence that using two languages slows down language development.

When in doubt, remember to: a) use the language you feel the most comfortable using with your child, and b) keep using your first language while teaching your child a second language.

My doctor said he'll grow out of it, but I'm still worried about my child's speech. Am I overreacting?
If you are concerned about your child, it's a good idea to consult with a speech-language pathologist. An evaluation can't hurt, and it can put your mind at ease to know where your child stands. If therapy is recommended, it's best to start as young as possible. Children who receive therapy early generally have better outcomes.

How long will my child need therapy?
This is a difficult question and the answer varies with each child. I may be able to make an educated guess after seeing your child for a few months, but children are difficult to predict! Some children require just a few months of sessions, and others will need therapy throughout their lifetime.

Is my child stuttering?
It really depends on the types of dysfluencies your child is using. A certain level of dysfluency is typical through the preschool age. However, if your child is repeating initial sounds or syllables (e.g., "buh-buh-buh-ball") prolonging sounds (e.g., "mmmmmommy"), it's best to seek out professional advice. It is particularly important to call for an evaluation if your child shows signs of struggle or tension with speech, uses secondary behaviors to "get the word out" (eye blinking, stamping foot, etc.), or seems aware of his difficulty speaking.

My child has been diagnosed with Apraxia. What does this mean?

Apraxia is a disorder of programming and sequencing motor movements that is not caused by muscle weakness. Apraxia can occur in the whole body (often termed “limb apraxia”) and in the speech muscles (Apraxia of Speech, or AOS). In adults, AOS is caused by a brain injury (due to stroke or head injury), and the areas of damage can be documented on brain scan. Childhood apraxia of speech is referred to as Developmental Apraxia of Speech, or DAS (a.k.a. Developmental Dyspraxia of Speech, Developmental Verbal Apraxia/Dyspraxia). The term “developmental” distinguishes childhood apraxia form the acquired AOS found in adults. Children with DAS demonstrate similar symptoms as adults with AOS.

Apraxia of speech is characterized by errors in: speech sequences (e.g., “tuk” for cut), multisyllabic words and longer phrases/sentences, and prosody (pitch, duration, and timing). It is very difficult, if not impossible, to diagnose DAS in a child who is not producing enough words to analyze these specific skills.

Developmental Apraxia of Speech (DAS) is controversial because it cannot be objectively diagnosed as it is in the adult form. There are no universal criteria to diagnose DAS, and many symptoms overlap with other speech disorders (e.g., severe language disorder/delay, phonological disorder, articulation disorder). Deborah Hayden, creator of the PROMPT method, states that motor speech programming disorder (i.e., “pure DAS”) in the absence of motor speech control issues is rare. In other words, it is very difficult to tease out speech programming from speech control. Many PROMPT-trained SLPs believe that it is more helpful to treat apraxia as a motor speech disorder, individualizing treatment to the individual rather than worrying about labels.

The bottom line is: the label your child receives is less important that the experience and competence of your speech-language pathologist. You should seek an SLP with training and experience in treating motor speech disorders similar to your child’s.