Learning about the Speech Center

This article by:
Lynne G. Alba M.A., CCC, SLP
Children’s Speech Care Center

Historical Overview:

Lynne Alba established the practice approximately nine years ago. The clinic has been in the Torrance/South Bay area, in California, for the past six years. In these six years, the clinic has grown from one to eight speech pathologists that work on part time and full time bases. Over time the clinic has evolved into a primarily pediatric practice; however, we do continue to serve a population of adult clients. We evaluate and treat adult clients with such conditions as stroke, mild brain injury, neurogenic issues, and voice disturbances. We have therapists who have received specialized training in the treatment of adults. For more information on adult treatment, please call Lynne Alba.

All of our speech pathologists are members of the American Speech-Language-Hearing Association (ASHA). They have completed their Master's Degree and clinical rotations necessary for graduation as a speech/language pathologist. All therapists have had specialized training in pediatrics in a variety of settings. These settings include, but are not limited to, early intervention programs, primary and secondary public school settings, classroom teaching for severe language disorders, hospitals and rehabilitation centers, and private practice.

We see children and adolescents from ages 18 months through 18 years. We treat a diverse number of speech and language problems including mild to severe articulatory disorders, verbal dyspraxia, motor speech disorders related to dysarthria or poorly developed musculature, delayed and disordered language development, auditory/language processing problems, stuttering, voice disorders, and speech/language disorders related to other issues including developmental disability, autistic spectrum disorder, ADHD (attention deficit disorder with or without hyperactivity), learning disabilities, and brain injury.

Our Treatment Philosophy:

Our clinic is known as a family-based treatment center, with the family considered an essential part of the treatment team. It is our philosophy that the child and their family are integral parts to habilitation or rehabilitation. Assessments and treatment plans include feedback from parents and/or primary caregivers. The parents are primary decision-makers in the development of a treatment plan and in the child's actual treatment. They will also be guided in understanding their child’s issues and in how to assist with their child's intervention to carryover goals and new learning at home, school and in the community.

We also work as a team with all the members of your child's education and care, as decided by the family and therapist. We use assessments, reports and observations from other professionals in the child's life, including, for example, physicians, teachers, aides, psychologists, psychiatrists, educational therapists, tutors, occupational therapists, and physical therapists. We will also participate with other team members to coordinate goals and provide feedback and education, as appropriate. We welcome other team members to educate us in their various disciplines and in their specific work with your child.

All our therapists are specialists in pediatric speech/language therapy. They are well educated in a number of treatment interventions and techniques which will assist them in treating your child's particular issues or disability but also in meeting the needs of your child's personality and learning style. We do not believe in a "one size fits all" approach. This is the reason for the therapists being well versed in a number of techniques and types of intervention for various problems. Techniques include, but are not limited to, direct teaching and skill building with table top activities, floor play and play-based therapy, use of a naturalistic language approach, computer activities, and reading and writing for older students, as appropriate.

Therapy is always a mixture of learning and enjoyment. There are a number of different strategies and materials that can teach your child and make it a good and fun learning experience.

Our philosophy also includes integrating learning and skill building into functional activities, which will facilitate growth and generalization. These may include play activities for the younger child. We consider the concept that one can "map a child’s language (or speech) onto their play,” as play is what is meaningful to the younger child and represents their developing world. Incorporating their newly acquired skills into such play activities will give them a chance to communicate meaningfully and give them opportunities for multiple practice. Functional activities for the older student may include use of school materials, books and literature of interest, writing, computer activities, hobbies and interests or other aspects of their daily routine. This type of application will enable them to apply strategies immediately into activities where they will need to use their new skills.

One aspect to stress is that we believe that therapy needs to include a dual purpose of addressing your child's ability level (strengths and weaknesses) as well as their personality and learning style. It is our strong belief that one must give children respect and be a good listener for them as well as a good teacher. When we first meet your child, we will adapt to their level, physically as well as linguistically, and try to get a sense of who they are and how to approach the interaction. We will also ask you to fill out a survey of their interests so that we may bring those interests into the learning experience. This also guides us in making decisions about treatment materials, and we will buy, as needed, specialized tools to suit your child's needs and interests.

Pediatric Speech and Language is our primary focus:

We are focused on optimizing your child’s Speech and Language skills for use in the real world. All aspects of your child’s growth, development and learning are important, and it is our goal to help your child actualize their potential as a whole. However, we specialize in speech/language and are focused on applying all our knowledge to your child’s ability to communicate. We will work as a team to build their speech/language and educate everyone involved in each aspect of your child’s communication. Further, our programs are customized for each patient, simply because we do not believe one program or one approach is realistic in the complex world of communication.

Our Shared Foundation:

We begin by forming a partnership with you and your child.

Our clinic is dedicated to providing your child with the best possible customized care and support concerning every aspect of Speech and Language Pathology. We believe our assistance will significantly contribute to your child reaching their full potential as a productive, happy and integrated member of the community for the rest of their lives. We believe in seeing your child as a “whole” individual, and maximizing their ability to communicate in the various aspects of their lives.

Our Basic Approach:

Phase One: Assessment

An assessment is the procedure by which we gather specific information about your child's levels of performance in speech and/or language. We conduct a comprehensive, individualized evaluation to determine the type of challenge(s) your child faces. This includes assessments of strengths, weaknesses, and learning styles. Procedures to acquire this information may include clinical interview with the parent(s) and/or other caregivers, as appropriate, parent questionnaires, informal observations in natural communication situations and/or play (e.g., interview and/or observation in play and/or conversation), use of records/reports from other professionals, and formal and informal testing.

Formal testing consists of administering standardized tests, which have been standardized on children and/or adolescents and are suitable for your child's chronological age. Formal testing may include, but is not limited to, tests that utilize visual (e.g., objects, pictures, written words/sentences) and verbal stimuli (with or without pictures/objects/written words/sentences) to determine speech and/or language abilities. Informal testing may include non-standardized clinical observations of your child in conversation and/or play and use of other informal materials and procedures (e.g., pictures, blocks, puzzles, reading material, written samples) to probe certain skill levels or skill mastery.

A full assessment typically ranges from one and a half hours to three hours depending on your child's age and issues. Assessments are performed in a manner which allows your child to feel at ease and comfortable. For the young child, the evaluation is frequently play based and/or may involve play breaks and reinforcers (rewards). A formal speech/language evaluation report will be written after the testing is completed. This report will outline all the measures used, your child's performance levels and speech/language diagnoses. It will show a profile of strengths and weaknesses, clarify where your child needs assistance, and include an individualized treatment plan.

Phase Two: Treatment Plan:

A treatment, or therapy, plan is written as part of the formal report. The plan is based on your child's speech and/or language profile and the areas of need.

Treatment programs are often complex, depending on diagnoses and needs. The complexity arises from the need to build on the patient’s current ability and their potential to develop needed skills for the future. These factors vary greatly from person to person and case to case.

The speech and language we take for granted every day is actually a fantastic web of elements that involve the brain, nerves, lungs, throat, vocal cords, palate, nose, jaw, tongue, teeth and lips all working in wondrous coordination with each other and within split second timing. The physical elements of speech must be in sync with the thinking/processing parts of the brain so that our ideas can be voiced, or communicated, and come to fruition through the coordination of this well-developed system.

The clinical strategies used to remediate Speech and Language issues can be as diverse as the different types of issues that are possible. More often than not, more than one issue presents itself to the diagnostician and therapist. Treatment plans are there often multi-leveled and dynamic to be effective. The student progresses from one level to the next.

The treatment plan is a working plan in motion. Goals and objectives are reviewed and updated or revised as is appropriate for the child’s growth and development. Strategies to approach treatment goals, as well as the goals/objectives themselves, are updated depending on your child’s responsiveness and need support as it changes across time, and on their increased independence as new skills emerge.

Phase Three: Integration:

Therapy consists of a combined effort between the child, therapist, family, and, if appropriate, other caregivers and/or professionals in the child’s life. To increase the effectiveness of your child’s therapy, others may be accounted for in the treatment plan depending on your child’s needs and issues. This may include primary caregivers/parents, siblings, peers, teachers, and other therapists involved with your child’s overall treatment. Inclusion of others assists development and generalization of skills, and maximizes your child’s ability to communicate effectively.

Speech and Language Therapy Description:

Speech and Language therapy typically involves sessions ranging from one to three times per week. A speech pathologist specializing in pediatrics and with specific clinical knowledge in the areas of concern for your child provides the treatment. The pathologists are knowledgeable in both formal and informal therapy techniques. These may include, but are not limited to, structured or direct teaching involving drill or skill-building, various tabletop activities, play-based therapy, language intervention within naturalistic environments and natural communication paradigms, and for the school-age child, the use of reading/writing to facilitate language goals and integration of learned skills into educational needs and functional living activities.

Early Intervention:

In general, early intervention can be used as a broad term referring to the early identification and treatment of young children with delays or disorders in development, from birth through the preschool years, prior to their entry into kindergarten. Our clinic’s philosophy embraces the concept of early intervention in order to remediate problems as soon and as much as possible before a child enters a formal school program. We believe this will increase a child’s readiness for school and likelihood of success. Poorly developed language skills can have a significant impact on learning and academics. Language issues can affect the development of pre-academic skills as well as reading and writing. We also believe that solid speech and language skills will contribute to building successful social relationships and positive self-esteem. Our therapists are well versed in child speech and language development and their disorders. We specialize in early intervention, and apply a multi-faceted approach, as appropriate. This may range from child exploration and play to use of theme-based units for speech/language development to tabletop work and skill building. The latter may be accomplished by using such materials as toys/objects, pictures, stories, coloring, puzzles, worksheets (specific to early speech/language development) and so forth. Parent education and involvement, as always, is an important component.

The term “early intervention” also refers specifically to the diagnosis and treatment of infants and toddlers who have been identified with delays in their development or who have a diagnosed condition placing them at risk for developmental delay (refer to: http://www.med.unc.edu/childas/refsupp/sharon.pdf. We have therapists who have specialized training in early intervention for infants and toddlers, and we provide speech/language services starting typically at 18 months of age (although we may see children earlier depending on the presenting issues, child/family needs and assessments/recommendations of other professionals working with the child). Another very good site to visit is http://e-bility.com/ecia-nsw/faq.htm

We usually see toddlers in an individual therapy paradigm that involves the parent/family. Other professionals may be involved in your child’s care. Importance is placed on collaboration and, when possible, co-treatment with your child’s intervention team. Treatment also includes goals, which will assist carryover of skills across environments (e.g., home, community, child care center, other intervention programs).

We occasionally see toddlers with their caregiver(s) in small groups in a playgroup format, which offers a wide range of toys and materials to meet the needs of children across developmental levels. There is emphasis on parent-child interaction and parent education as well as speech/language/communication and play development. Collaboration with others as well as carryover of functional skills remain an important aspect in this model.

Preschoolers may also be seen in group format when emphasis in being placed on skill generalization with peers or use of their language in social/play environments.

Speech and Language Programs:

• Private Therapy:

Private therapy sessions are one-to-one sessions with your child and their speech pathologist (and, as noted above, include the parent(s)/caregivers, especially for younger children, and/or other professionals, as appropriate). They are also referred to as individual therapy sessions. A child receives maximum one-to-one attention and multiple opportunities for practice and reinforcement of their targeted communication goals. This paradigm allows for more intensive intervention.

• Semi-Private or Small Group Therapy:

Semi-private sessions are with two students and a speech pathologist and small group sessions are with three to four or five students. Small group sessions may include an assistant, as needed. Group sessions for speech/language therapy may be offered if a child needs assistance in transferring or generalizing their skills with peers. Group sessions may also be provided if a child would benefit from the motivation of interacting with peers.

• Social/Play Skill Development Groups:

Who benefits from Social Skill Groups?

Our social skills group program is referred to as “Kid Talk.” This program is for those children who have difficulties developing social skills and peer relations. They are intended to assist children in developing and/or maintaining peer friendships and interactions, and participating in family, school, and community social events. The groups facilitate overall verbal and nonverbal (e.g., appropriate facial expression, body language) communication as well as foster improved social interaction and play skills.

The social groups are intended for children ages 4 through 12 years of age. In order to benefit from the program, students need to have an established foundation for listening, turn taking, and simple reciprocity in interaction and conversation. They also need to be able to attend and take instruction in a small group and demonstrate readiness for cooperative learning. Further, the groups are for those interested in others and motivated to be with peers and make friends.

Group Objectives:

In general, the program is intended to assist with several areas of social development. Such areas include developing and expanding play skills, improving turn taking and sharing across activities/interactions, initiating appropriate peer interactions (e.g., asking someone to play, joining a group), and making and maintaining friendships. Game playing skills are also emphasized (e.g., following rules, knowing how to win and lose). The group also targets improving a child’s ability to participate and work cooperatively in a group setting. This would include such skills as staying with the group, taking an interactive role, being a leader and a follower (as appropriate to the situation), and taking an active role in planning and carrying through with cooperative group and/or play activities.

Further skills include assisting children with expressing ideas, understanding and expressing emotions, respecting individual differences, and understanding and using appropriate body language. We emphasize improving the use of successful communication strategies and language during play and conversation. We also work on improving skills in decision-making, problem solving and negotiation with peers. This may include assisting children with their ability to understand and avoid or resolve conflicts and “work things out.”

Although group goals are established as part of the curriculum, individual goals are also established for each student depending on their needs. These are determined through discussion with the parent(s)/caregivers and other professionals, as appropriate.

Group Format and Schedules:

Each group consists of 3 to 6 students, and is lead by a speech pathologist and an assistant. Children are grouped according to age ranges, strengths, areas of need, and interests. The groups meet once a week for approximately one hour (this time may vary upward toward 90 minutes depending on the activities and parent educational component for the week). Group formats may vary depending on the theme of the day, as well as the students’ needs and age ranges. An example of a general structure for group follows:

Table Talk
Greetings for children not present in the waiting room during greeting time.
Conversation and sharing
(Children may share thoughts and ideas, toys/books from home/school, and/or activities or events that have happened during the week.)

Social Skill Introduction
Discussion of the social theme for the week.
Introduce and discuss the “how” of the social skill(s) to be targeted (pictured/written steps to accomplish goal).
Use of role-playing, social problem solving pictures/activities, and/or children’s literature/social story to accompany the theme.

Cooperative Group Activity/Play
Students are encouraged to plan, organize and prioritize group and play activities with increasing independence depending on age and skill level. We make use of planning boards to write lists and prioritize and group discussion/decision-making to organize the day.

Cooperative group activities include:

Snack Time
A time to participate in making/serving snacks as well as conversation.
(Usually after a cooperative group activity and/or before play time.)

Play Time
Play is encouraged at all levels, depending on age, abilities, and interests. Social skills are rehearsed and practiced during play. Play may include:

(Cooperative group activities and play may alternate or both may be included in a session depending on the emphasis for the week.)

Closing
A time to discuss the day, think about next week (possible interests/activities) and say goodbye.

Instruction includes tabletop and floor activities, as appropriate. Teaching makes use of visual aids (e.g., charts, pictures and diagrams of appropriate behavior with social skills broken down into sub-skills), role-playing, praising of successful performance to encourage peer modeling, and direct feedback in a positive environment. Role-playing is an important tool used to assist the children in practicing and learning targeted skills as well as to facilitate carryover into functional environments such as home, school and the community.

Teaching for both the student and parent includes use of social story dramatizations on CD, videotape feedback of the sessions, and social stories. Parent involvement is encouraged. Parents receive a course curriculum. They are given feedback on their child’s progress, specific social skill development, and techniques for carryover of skills.

Current Schedules for Kid Talk

(Specific ages may vary slightly depending on a child's individual needs and skill level)

      

• Computer Learning:

Commercial Software:

There are a number of commercially available learning programs that we purchase and use to build speech and language skills. They typically include products that are geared for specific skill building at various ages and/or grade levels (e.g., early concept development, reading skills, etc.), but also include learning software which is more entertainment oriented. This type of software is chosen based on its ability to develop thinking (cognitive) and language skills. These programs include those that require the child to recall and organize information, plan, strategize, and problem solve.

All software is used in an interactive manner. This means that there is reciprocity between the student and the therapist, and the student is asked to “talk about” the learning experience. Students are required to show or express what has been or is currently being seen on the screen, ask and/or answer questions about the information, express what may happen next and/or explain problems and strategies for solving those problems. They get experience in such skills as telling and describing, explaining, and retelling. Cooperative learning with the therapist is encouraged as they problem solve through the program.

For children with articulation issues, interactive computer work allows them to practice generalizing their targeted sounds in spontaneous conversation. It is a motivating way to work on sounds, and generalize acquired sounds in an environment that is less structured. The child must use self-monitoring skills while attending to and talking about an interesting task.

Speech and Language Software:

There are a number of types of programs specifically designed for speech and/or language skill building or development. These programs include but are not limited to developing skills in vocabulary, concept development, school readiness, following directions, phonemic awareness and phonics, grammar, reading comprehension, writing skills, verbal expression, articulation, fluency and voice.

Fast ForWord:

Fast ForWord is a family of technology-based programs by Scientific Learning Corporation, which build skills critical to language and reading. They are intensive four to eight week programs that are administered using the computer and earphones to optimize processing. Programs vary in terms of abilities and skills to be targeted. Clinic based programs may be individual or in small group depending on scheduling needs, and an assistant is utilized to help in monitoring students’ performance and provide positive feedback and reinforcement (refer to www.scientificlearning.comfor details).