Process
Screening
Empowered by Speech LLC offers a free 20-30 minute screening for potential clients. The in-person screening along with a short questionnaire will aid in determining whether your child would benefit from a comprehensive evaluation in one or more of the following areas: speech sound production, fluency (stuttering), language, and social communication. Findings and recommendations will be communicated with you in writing and in-person or over the phone
Evaluation
We offer comprehensive evaluations in each of the areas listed above. Evaluation fees vary based on the type of evaluation needed. Payment will be discussed prior to giving consent. A written summary of results will be provided along with recommendations for treatment.
Treatment
If treatment is recommended, we will go over a proposed treatment plan with you including goals, frequency and duration of sessions. We offer in-office and teletherapy options.
Payment Methods
Empowered by Speech LLC accepts credit card payment including HSA/FSA cards, personal checks and cash. Payment can be made in person or online. We are in process of becoming an in-network provider for Medicaid, Medicare, Healthpartners, Cigna and United Healthcare insurance. A Superbill receipt will be given to you to use for reimbursement from insurance companies out-of network at your own convenience. Reduced rates are offered based on qualifying income status. Please inquire for more details.
Speech Sound Disorders
ARTICULATION DISORDER
A speech sound disorder consisting of errors of individual speech sounds (i.e. “w” for “r”, “th” for “s”)
PHONOLOGICAL DISORDER
A speech sound disorder consisting of errors in patterns of speech sounds (i.e. fronting, stopping, final consonant deletion)
Treatment Goals:
- Articulation approaches target each sound error with the aim to correct production of the target sound(s).
- Phonological/language-based approaches target a group of sounds with similar error patterns with the aim to help the child internalize phonological rules and generalize these rules to other sounds within the pattern (e.g., final consonant deletion, cluster reduction).
CHILDHOOD APRAXIA OF SPEECH (CAS)
A neurological childhood speech sound disorder in which errors in speech sound production are due to impairment in planning and sequencing movements necessary for speech in the absence of neuromuscular deficits (i.e. abnormal reflexes, abnormal tone).
What we look for:
- Inconsistent errors on consonants and vowels in repeated productions of syllables or words.
- Longer and disrupted transitions between sounds and syllables.
- Inappropriate prosody
- Noticeably searching for correct movements
- Consonant distortions
- Increasing difficulty with longer or more complex syllable and word shapes
- Adding “uh” between consonants or at the end of words
- Slower than typical rate of speech
- Voiceless sounds produced with voice
- Vowel errors
Treatment goals:
Focus on facilitating overall communication and language skills by:
- Increasing speech production and ability to be understood by others
- Using AAC when indicated, such as gestures, manual signs, speech output devices, and communication boards
LATE TALKER, LATE LANGUAGE EMERGENCE (LLE), LANGUAGE DISORDER
Late Talker/Late Language Emergence (LLE)
A delay in language with no other diagnosed disabilities or developmental delays in other cognitive or motor domains.
LLE is diagnosed when language development is occurring below age expectations. Toddlers who exhibit LLE may also be referred to as “late talkers” or “late language learners.”
Children with expressive delays show delayed vocabulary acquisition and often show delayed development of sentence structure and articulation. Children with mixed expressive and receptive language delays show delays in oral language production and in language comprehension.
Language Disorder
A significant impairment in the acquisition and use of language due to deficits in comprehension and/or production across any of the five language domains (i.e., phonology, morphology, syntax, semantics, pragmatics).
What We Look For:
- Does not smile or interact with others (birth and older)
- Does not babble (4–6 months)
- Makes only a few sounds or gestures, like reaching (7–9 months)
- Does not understand what others say (10 months – 2 years)
- Says only a few words (19 months – 2 years)
- Does not put words together to make sentences (19 months – 3 years)
- Speaks using words that are not easily understood by others (3–4 years)
- Has trouble with early reading skills, like pretending to read or finding the front of a book (4–5 years)
What Parents/Caregivers Can Do:
- Listen and respond to your child.
- Talk, read, and play with your child.
- Talk with your child in the language you are most comfortable using.
- Know that it is good to teach your child to speak a second language.
- Talk about what you are doing and what your child is doing.
- Use a lot of different words with your child.
- Use longer sentences as your child gets older.
- Have your child play with other children.
Treatment Goals:
The goal of language intervention is to stimulate overall language development and to teach language skills in an integrated fashion and in context. Treatment focuses on one or more of the five language domains (i.e., phonology, morphology, syntax, semantics, pragmatics).
Fluency
Continuity, smoothness, rate, and effort in speech production. All speakers are disfluent at times. They may hesitate when speaking, use fillers (“like” or “uh”), or repeat a word or phrase. These are called typical disfluencies.
Stuttering
An interruption in the flow of speaking characterized by specific types of disfluencies.
What we look for:
- monosyllabic whole-word repetitions (e.g., “Why-why-why did they go there?”)
- part-word or sound/syllable repetitions (e.g., “Look at the b-b-boy”)
- prolongation of consonants when it isn’t for emphasis (e.g., “Ssssssssometimes we stay home”)
- blocking (i.e., inaudible or silent inability to initiate sounds)
- production of words with an excess of physical tension or struggle.
- Secondary behaviors such as eye blinking or jaw tightening
- Increased frequency
- Negative emotional reaction to stuttering
- Avoidance behaviors
Treatment goals:
Preschool Children Who Stutter
- to eliminate, greatly reduce, or help the child manage their stuttering and
- to help them not develop negative emotional reactions related to their stuttering (H. S. Arnold et al., 2011; Yaruss et al., 2006).
School-aged children, teens and adults
- increasing effective and efficient communication
- increasing acceptance and openness with stuttering
- reducing secondary behaviors and minimizing avoidances
- improving social communication
- increasing self-confidence
- managing bullying effectively
- minimizing the adverse impact of stuttering (Yaruss et al., 2012).
Indirect
Indirect treatment focuses on counseling families about how to make changes in their own speech and how to make changes in their child’s environment
- reducing the communication rate
- using indirect prompts rather than direct questions
- recasting/rephrasing to model fluent speech or techniques (Millard et al., 2008; Yaruss et al., 2006), and
- resilience building within the child and family (Berquez & Kelman, 2018).
Direct
- speech modification (e.g., reduced rate of speech, prolonged syllables)
- stuttering modification strategies (e.g., modifying a stuttered word, “pulling out” of a stuttered word)
Social Communication Disorder (SCD)
Difficulties with the use of verbal and nonverbal language for social purposes in the areas of: social interaction, social understanding, pragmatics, language processing,
Social communication encompasses the following components:
- pragmatics—communication that focuses on goal-consistent language use in social contexts (N. Nelson, 2010)
- social interaction—communication that occurs between at least two individuals
- social cognition—an understanding of the mental and emotional states of self and others, social schemes, and social knowledge that beliefs and values cause social events, expected socially appropriate behavior and consequences of inappropriate behavior
- language processing—internal generation of language (expressive), and understanding and interpretation of language (receptive)
Treatment Goals:
- increasing active engagement and building independence in natural communication environments.
- one-on-one, clinician-directed interventions are useful for teaching new skills.
- group interventions are used along with one-on-one services to practice skills in natural communication settings and to promote generalization.
Augmentative and alternative communication (AAC)
AAC is augmentative when used to supplement existing speech and alternative when used in place of speech that is absent or not functional.
AAC uses a variety of techniques and tools to help the individual express thoughts, wants and needs, feelings, and ideas, including the following:
- manual signs
- gestures
- tangible objects
- line drawings
- picture communication boards and letter boards
- speech-generating devices
Autism spectrum disorder (ASD)
A neurodevelopmental disorder characterized by deficits in social communication and social interaction and the presence of restricted, repetitive behaviors.
The core features of ASD include
- impairments in social communication
- impairments in language and related cognitive skills, and
- behavioral and emotional challenges.
What we look for:
- Parents of children with ASD reported first noticing abnormalities in their children’s development—particularly in language development and social relatedness—at about 14 months of age on average (Chawarska et al., 2007).
- Infants at risk for—and later diagnosed with—ASD showed a decline (from previous normative levels) in eye fixation within the first 2–6 months of age. This pattern was not observed in typically developing infants (Jones & Klin, 2013).
- By 12 months of age, infants at risk for—and later diagnosed with—ASD demonstrated atypical eye gaze, social smiling passivity, decreased positive affect, and delayed language (Zwaigenbaum et al., 2005).
- Children with autism used fewer joint attention gestures and behaviors as infants and toddlers (based on early home videos) than did age-matched peers who were typically developing (Watson, et al., 2013; Werner & Dawson, 2005).
- Children with autism showed subtle differences in sensory–motor and social behavior at 9 to 12 months of age (based on early home videos) when compared with typically developing peers (Baranek, 1999).
- Children with autism showed lower rates of canonical babbling and fewer speech-like vocalizations across the 6- to 24-month age range (based on early home videos) than did typically developing peers (Patten et al., 2014).
- Infants at risk for—and later diagnosed with—ASD used significantly more distress vocalizations (e.g., cries, whines, screams, and squeals) than did children who were typically developing and children who were developmentally delayed; this may reflect the difficulties that children with ASD have with emotional regulation (Plumb & Wetherby, 2013).
Causes:
Although no single cause has been identified, the available data suggest that autism results from different sets of causal factors, including genetic, neurobiological, and environmental factors.
