Language Therapy

"Dr. Laura Reisler is a miracle worker! We brought our daughter Gemma to her when she was a little older than 2 and diagnosed with a speech delay. Not only did she help Gemma find her words, but she was intuitive with how she worked with her. Even though she was so young, Dr. Reisler quickly assessed that Gemma comprehended everything she said, and more than just parroting words, she was able to communicate with Gemma at a higher level, and not just as a 2 year old. Without this added level of intuition into how our daughter listened as well as communicated, it would have likely taken much, much longer for my daughter to learn to speak, or worse, she would have been miserable throughout the process, and possibly have grown to resent it. Through a mix of play therapy, and genuine conversation and connection, our daughter is now one of the most verbal children you will ever meet: she went from being speech delayed to a genuine chatterbox, and we couldn't be more grateful." Jessica W.

Language is that part of the Communication Continuum that deals with the systematic means for expressing ideas, thoughts, feelings or events. Language Therapy is provided by Speech & Language Pathologists, frequently referred to, as "Speech Therapists." Speech & Language Pathologists help remediate or foster improvement in speech sound production, language and, in our case (having substantial experience in, and having developed novel and highly successful techniques) reading and all language arts. If you'd like make an appointment, or talk about your child or yourself, please call us at 718.768.3526 or email us at info@parkslopecc.com. If you are seeking information on speech sound production, such as Speech Sound Disorders: Articulation and Phonological Processes; Childhood Apraxia of Speech; Dysarthria; Orofacial Myofunctional Disorders; Stuttering and other fluency disorders; Voice disorders; Tongue thrust; Accent Reduction; or Public Speaking please visit the speech section of our website.

• Language Delay
• Language Disorders in Children
• Receptive Skills
• Expressive Skills
• Pragmatic Skills
• Auditory/Language Processing Disorders in Children
• Autism Spectrum Disorder
• Language Disorders in Adults

Children with speech and language disorders may be at risk for later reading problems. In an attempt to mitigate such problems, we not only provide direct remediation for these disorders but (where appropriate), additionally, work with your child using textual material, and provide our highly successful assistive learning technique (software) for home use, along with training. We have had cases over the years where, when textual material was incorporated into Speech/Language therapy, children excelled at reading. In addition, with pre-school children, we provide pre-literacy training to parents.

Language Delay

Research shows that children acquire the various components that comprise language in discrete stages, with each stage being associated with an age range. For example, although the emergence of single words occurs, on average, at 12 months, most children acquire first words at somewhere between 10 and 14 months. This is the typical range. All developmental language stages are defined by an age range rather than specific age. When children fail to reach language milestones in a timely manner, but they are acquiring the steps in the typical sequence, that is considered to be a language delay. There is an overall lag in development. It is one of the most common developmental lags affecting young children, and is found in 5-10% of the population. The age ranges for developmental milestones for language acquisition are:

• Cooing - open vowels such as "ah"- 1-3 months
• Babbling with respect to consonants and vowels - 3-6 months
• Reduplicative babbling, as in "bababababa nanana" - 6-9 months
• Jargon - strings of sounds that sound like speech with inflection that is typical of the child's native language-9-18 months
• First words - 10-14 months
• Word combinations - 18-24 months-when child has an expressive vocabulary of 50 words
• Short Sentences - 24-30 months
• Adult-like grammar - 3 years (You should still expect to see errors in more complex aspects of language, such as irregular past tense.) Child should be intelligible approximately 80% of the time with strangers. Children with a language delay are achieving language milestones more slowly than their typically developing peers.

To help your child with a language delay, our therapists will perform an analysis of your child's spontaneous verbalizations. Since children learn to speak in a fairly dependable sequence, we note where your child's communication skills are faltering. With younger preschool children, our therapy utilizes well established play therapy techniques that gently nudge your child's speech forward. By modeling and making the target utterance salient, we help your child acquire increasingly complex vocabulary and sentence structure. For older children, we may also utilize structured techniques that essentially cause the same result with material that is more age appropriate. Either way, your child gets what he or she needs to improve language skills. In addition, since children with delays are at risk for reading issues, we provide our KidsVoyager Online Phonic Engine Software, along with training in its use for school-age children, and pre-literacy counseling to parents of pre-school children, which you may use with your child starting at about age 3.

Language Disorders in Children

Some children have difficulty with particular aspects of communication skills. For example, a child on the autistic spectrum may have a very large vocabulary but rarely engage in any conversational speech. Thus, a language disorder, unlike language delay, may consist of receptive, expressive and pragmatic (referring to the social uses of language) levels that are not at the same age level. Children with a language disorder may have difficulty following directions, especially when they have multiple parts. Some examples of deficits which may be noted in children with language disorders include:

Receptive Skills

• Child has difficulty following directions.
• Child has lags in receptive vocabulary.
• Child has difficulty understanding age appropriate concepts.
• Child has difficulty understanding what others are saying.
• Child has difficulty organizing and storing information.

Expressive Skills

• Child has difficulty using grammatically complete utterances.
• Child has difficulty selecting the correct word to complete an utterance. This is known as a word retrieval deficit.
• Child may have difficulty demonstrating subject-verb agreement and correct verb tenses.
• Child has difficulty using grammatical forms correctly such as, plurals, articles, helping verbs, prepositions
• Child's expressive vocabulary is below age level.

Pragmatic Skills(may apply to adults as well, for example, adults who have had strokes or brain injury)

• Child may not be aware of the listener and/or the listener's needs to understand the message.
• Child may not look at the other's face.
• Child may not be able to initiate or maintain a topic.
• Child may have difficulty with conversational turn taking.
• Child may be unable to engage in any level of conversation.
• Child may use inappropriate inflection or volume as would be fitting in the conversational setting.
• Child may be overly concrete in interpreting the comments of others.
• Child may be unable to talk about abstract ideas.
• Child may be limited in functions of verbal output; i.e., speak only to have needs met.

Auditory/Language Processing Disorders in Children

These children are diagnosed by an audiologist but they have some features that make the diagnosis seem like a probable one. The following are frequently noted observations of children with auditory processing disorders:

• Difficulty hearing speech in noise
• Difficulty discriminating similar sounding words
• Difficulty with auditory memory
• Difficulty following directions, especially multi-step directions
• Difficulty localizing sounds
• May appear inattentive
• Expressive language may be better than receptive on testing
• Difficulty ceding the "conversational floor"-less comfortable as the listener
• Rambling speech quality with abrupt topic switches-possibly related to word finding difficulty
• Difficulty with verbal abstractions

To Help Your Child with a Processing Disorder: If the child is at least 6 years of age, we refer to an audiologist for testing. We suggest therapy be scheduled 2 to 3 times per week. Our therapy addresses the children's needs in a variety of ways. First, we counsel the parents as to how to provide the best environment so that learning can occur. We also encourage parents to involve their child's teacher so that the school environment can also be optimal as well. We want the child to sit in close proximity to the teacher and we want the teacher to break instructions down into smaller bits of information so the child can follow instructions and feel successful in the classroom. Another major goal is to help children to learn to ask for what they need in order to function well in the school setting and in any other setting. Even during therapy times, children have learned to say things like, "I need to look at your face in order to follow that direction", or "The noise from the hallway is distracting me."

In therapy, we focus on developing skills that the child is deficient in. For example, if auditory memory is a problem area, sessions would include tasks that incorporate memory tasks. If auditory discrimination were the main area of difficulty, sessions would include discrimination tasks, or possibly rhyming tasks which are suitable since rhymes are words that usually differ by one sound. We also use a variety of software programs to further enhance auditory processing skills, such as Earobics, The Hear Builder family of products as well as the Fast ForWord family of products.

Autism Spectrum Disorder

We work extensively with autistic clients, from preschoolers through young adults. Autism refers to a disorder in which the most obvious symptom is a lack of communication skills. According to the National Institutes of Health "Autism is a developmental disorder that appears in the first 3 years of life, and affects the brain's normal development of social and communication skills." We see two main patterns of development: there are children who start speaking and at around the age of 18 months, and suddenly stop, and there are children who from day one are not communicative. These children are often hyper or hyporeactive to stimuli. Causes have been hypothesized as being chromosomal, environmental relating to diet, digestive problems and sensitivity to vaccines.

First, we perform a complete evaluation, as we need to determine the extent of the communication deficit. Apraxia is occasionally noted in the autistic population and may be responsible for a lack of verbal output. Treatment focuses on facilitating communicative behaviors including use of words, gestures, picture symbols and eye contact. Generally, children with autism require intensive speech and language therapy. We also offer some social language groups for high functioning autistic children who need to work on social skills.

Language Disorders in Adults

Language disorders in adults are generally the result of brain injury. For example, after a stroke or a traumatic brain injury (TBI) such as in the case of an automobile accident, speech and language abilities are often affected. Other medical conditions such as dementia and Parkinson's Disease can affect an adult's speech and language. Some conditions that adults may exhibit include:

• Aphasia-a disorder of language abilities and may include deficits with understanding spoken language, speaking, reading and/or writing.
• Language may be severely impacted such that the client is unable to understand anything that is said.
• The client may be unable to name objects (anomia)
• Sentences may be poorly formed, with many grammatical errors.
• Reading aloud may be affected or conversely it may be superior to expressive language.

What should be kept in mind is that aphasia may affect language in any way that can be imagined.

What we do with an aphasic individual depends on what the evaluation reveals. If the client exhibits anomia, then therapy will focus on words, learning them in all of their contexts. We might do closure tasks in which the answers are the t argeted words. (e.g. "I take a picture with my __________?" If reading is a relative strength, then we use reading in our therapy to elicit expressive language more consistently. As is so often the case in treatment, we use the strengths to buoy up the weaknesses. How the client progresses depends on how severe the injury was to begin with, the client's age (the more senior the client the less the likelihood of an undamaged part of the brain compensating for the injured part. In general, most of the improvement takes place in the first six months, but clients may continue to improve with continued treatment.