When you make the initial contact with your speech-language pathologist, background information will be requested. The type of information requested will depend on what your concerns are regarding your child. A review of your child's health and development will be needed. This helps identify any "red flag" behaviors, such as delayed milestones for walking, a family history of language or learning problems, complications at birth, frequent ear infections, allergies, or other pertinent concerns that may signal a problem. After gathering information, the evaluation process will begin with your child. An evaluation of your child's skills will be conducted through formal and informal testing. Formal testing will be conducted with the use of standardized tests and informal testing will include activities initiated by the speech-language pathologist for a specific purpose.

The areas addressed during the evaluation will depend on what your primary concerns are regarding your child. Following the evaluation, a report will be provided. The results of the testing and recommendations will be discussed between you and the speech-language pathologist. Areas include: • Receptive Language Skills: what a child is able to understand. • Expressive Language Skills: a child’s spoken language. • Auditory Processing Skills: how a child hears what is said. This may include auditory vigilance (the awareness of and response to sound, e.g. knowing that your name has been called and giving a response to it), auditory discrimination, auditory memory, and phonological awareness skills as they relate to language, reading and spelling skills. • Pragmatic Skills: the use of language that is appropriate to the situation (social skills). • Articulation and Phonology: how a child pronounces words. • Oral-Motor Function: the ability of the tongue, lips, and other muscles to move adequately for good speech production and swallowing. • Voice Quality: the quality of a child's voice (i.e. loudness, clarity). • Fluency: refers to stuttering. • Critical Thinking and Reasoning Skills: a child's ability to find and explain solutions to problems.

Listening is an active process of hearing and comprehending what is said. Auditory processing is what we do with what we hear. An auditory processing disorder (APD) is a difficulty in processing auditory information although hearing and intellectual ability are unimpaired. Areas that may be affected by an auditory processing disorder are: • Receptive language and vocabulary • Auditory memory for meaningful and non-meaningful information of increasing length and complexity. Meaningful information involves the ability to recall directions and interpret them. Non-meaningful information is the ability to recall unrelated words and numbers. • Phonological awareness skills. That is, an individual's explicit knowledge of the sound segments (phonemes) which form words. These skills consist of being able to blend, delete, substitute, rhyme, segment and isolate sounds. Difficulties in the area of phonological skills may precede difficulties in reading and spelling. • Thinking and reasoning: the ability to use common sense and ingenuity to solve common thought problems. • Auditory vigilance: the awareness of and response to sound. For example, knowing that your name was called and giving a response to the fact that your name was called. • Auditory discrimination: the ability to discriminate paired words with phonemically similar consonants, cognates and vowel differences.

• Not listening carefully to instructions. • Being easily distracted by background noises. • Difficulty with phonics or speech sounds, spelling and/or reading. • Poor learning through the auditory or hearing channel. • Behavioral problems. • Below average academic performance.

Fluent speech is produced with ease. It is flowing, smooth, continuous, and relatively rapid, and normally rhythmic. Fluent speech is free from an excessive amount or duration of dysfluencies. Stuttering is called dysfluency by professionals in the field of speech-language pathology. Dysfluent speech is an excessive amount and duration of dysfluencies. It is halting, discontinuous, not smooth, and not rhythmic because of the dysfluencies. There are many forms of dysfluencies such as: • Repetitions: Part -word ( e.g. dddd dog), whole-word ( e.g.,“How How How How; are you”?), phrase (e.g.“My name is.. My name is .. My name is…Bob.”) • Prolongations: Silent prolongations known as “blocks”. • Sound prolongations ( e.g.“sssssomebody”.) • Interjections: Sound /syllable ( e.g.“I go to um.. um .. um high school.”) • Word (e.g.“ I want uh like like like go home.”) • Phrase (e.g.“ This is um like um like um like my friend.”) • Pauses • Broken Words • Incomplete Sentences • Revisions There may be other behaviors associated with stuttering such as motor behaviors (rapid eye blinks, lip pursing, knitting of eyebrows) and abnormal breathing (talking on inhalation, tensed breathing, speaking without first inhaling a sufficient amount of air). Important : Remember, stuttering is the occurrence of the above listed dysfluencies in excessive amount and excessive duration. Some children go through a normal period of dysfluency during the preschool years which usually “peaks” at about 3½ years of age and consists of “easy” whole word and phrase repetitions ( e.g.“mommy, mommy, mommy what is what is what is that?)

Typically developing children will go through a period of time, usually preschool age (2-4 years of age) where stuttering would be considered developmentally appropriate. During these years there is tremendous language growth and development that their brains get overloaded and it moves faster than their mouths. BUT, there are warning signs which may indicate a need for further evaluation. WARNING SIGNS: If there is a familial history of stuttering If there is a change in the stuttering (i.e., the stuttering gets more intense, increase in frequency) Self-confidence begins to be affected (i.e., not wanting to speak to people). An awareness of the stuttering Facial grimaces when speaking or about to speak Associated motor movements (head tilting, arm/leg movements)

The term verbal apraxia (dyspraxia) is used to describe a child who is exhibiting difficulty with praxis (performing an action) as it relates to verbal abilities (articulation). A child diagnosed with verbal apraxia may have difficulty with articulation, the ability to use spoken sounds and words. The muscles of the tongue, lips, cheeks, and jaw usually appear to be working normally, but the child has difficulty saying sounds and words. The child may be old enough to talk and sometimes says isolated words out of the blue, but if you ask the child to repeat the word or to imitate you, they often can’t. ​ Apraxia can be treated by teaching ways of imitating through articulator placement awareness activities and frequent repetition of patterns.

While it is out of the scope of practice for a speech pathologist to diagnosis Autism, there are “red flag” warning signs we look for to determine if a referral to a psychologist or behavioral/developmental pediatrician would be recommended. Child has lost language skills Child does not show interest in other children Child does not engage in pretend play Child does not engage in reciprocal social games like peek-a-boo or pat-a-cake Child’s eye contact is minimal, for only a second or two Child does not point with index finger to show you something Child does not bring objects to you to show you Child does not engage in spontaneous imitation of adult verbalization or gestures Child is overly sensitive to food, noises, or textures Child tantrums excessively when there is a minimal change in routine Child engages in ritual or obsessive play (i.e., lining toys up or doing the same activity repeatedly) Child makes repetitive body movements (like rocking or spinning) or unusual hand/finger movements

While every child is different, even within the same family, there are typical speech and language skills children should have or be developing at this age. Below is a partial list of these skills. Expressive vocabulary of 200-300 words Should be using 2-3 word phrases Able to understand and answer simple “wh” questions, such as “what’s this?”, “what do you wear on your head?” Will begin to ask questions, such as “where cookie?”, “where mommy?” Responds to commands involving body parts, such as “show me your foot” Follow 2-step directions, such as “Get your cup and bring it to me” Demonstrates understanding of several verbs by selecting corresponding pictures Speech is intelligible 50-75% of the time