Berkshire Speech + Language
Andrea S. White, MEd, MA, CCC-SLP

When to refer to Berkshire Speech + Language

who needs speech-language therapy?

A child may benefit from speech-language therapy if he or she cannot communicate as well as other children of the same age, or if the child has difficulty with any aspects of feeding or swallowing. The earlier a child begins treatment, the better the outcome. A referral to Berkshire Speech + Language should be considered if a child demonstrates any of the symptoms described in the following sections and if the child is not receiving adequate services from his or her school:

Language Disorder

A child with a language disorder may have difficulty understanding language, following directions, or choosing appropriate words and combining them correctly in sentences. Language disorders can affect the child’s ability to interact with others and to learn. Some characteristics of a language disorder at different ages include the following:

  • 4 months: Has poor eye contact or is inattentive to the speech of others
  • 6–8 months: Doesn’t use gestures
  • 12 months: Has difficulty understanding speech or following simple directions
  • 16–18 months: Uses no words or has a limited vocabulary
  • 24–26 months: Does not combine words for short sentences
  • 3 years: Echoes words or phrases or has many “grammatical” errors in sentences
  • 3–4 years: Cannot retell stories or talk about past events
  • 6 years: Has trouble with attention, memorization of facts, learning, or reading

Articulation (Speech Sound) Disorder

A child with an articulation (speech sound) disorder may have difficulty producing individual sounds. As a result, the child may substitute an easy sound for a harder one (for example, tun for sun), omit sounds (for example, ool for school) or distort sounds (for example, shlun for sun). In some cases (for example, apraxia of speech), the child may have difficulty combining the movements of speech sounds in sequences as required for words and sentences. Articulation errors often make speech very hard to understand. Some characteristics of an articulation disorder at different ages include the following:

  • 8–9 months: Does not babble in a repetitive manner
  • 18 months: Uses primarily vowels or only a few consonants
  • 3 years: Leaves out consonants or has unclear speech
  • 4 years: Has distorted speech that is often hard to understand
  • 6 years: Cannot produce some speech sounds

Parents, grandparents, and others close to the child sometimes find articulation errors cute and therefore allow the child to persist with them. While well-meaning, this can prolong the error and make moving on to more articulate speech much more difficult for the child later on.


Fluency Disorder (Stuttering)

A child with a fluency disorder (stuttering) has frequent abnormal disruptions in the flow of speech. Characteristics of a fluency disorder include the following:

  • Involuntary repetitions, hesitations, prolongations, blocks, or disruptions during speech
  • Tension during speech or abnormal movements such as jerking or forceful eye blinking
  • Refusal to talk to strangers due to a fear of stuttering
  • Embarrassment during speaking

Voice Disorder

A child with a voice disorder has either abnormal vocal cord structure or abnormal function. Characteristics of a voice disorder include one or more of the following symptoms:

  • A chronically hoarse, harsh, breathy, or raspy voice quality
  • An inappropriate vocal pitch for the child's age or sex
  • Frequent pitch breaks
  • A voice that is consistently too soft
  • When any of the above symptoms is made worse by vocal strain (from speaking, singing, yelling, etc.)

Since symptoms might be caused by a medical problem, an evaluation of a child with a suspected voice disorder involves collaboration between a Speech-Language Pathologist and an Otolaryngologist (Ear, Nose, and Throat Physician).


Feeding Disorder or Swallowing Disorder (Dysphagia)

A child with a feeding or swallowing disorder may have one or more of the following signs or symptoms:

  • Difficulty swallowing liquids and/or solids
  • Difficulty sucking or drinking from a cup
  • Difficulty taking foods from a spoon or chewing foods
  • Avoidance of certain types of foods or certain food textures
  • Gagging, choking, or coughing during feeding

Causes of Communication and Feeding or Swallowing Disorders

The exact cause of a communication disorder is not always known. However, common causes include abnormal structures (oral, pharyngeal, or laryngeal), oral-motor dysfunction, neurological problems or brain injury, learning problems, and hearing loss. Causes of feeding and swallowing disorders include structural abnormalities and neurological problems.