Speech Therapist – Treatment of Speech Disorders

 

Who is a speech therapist, and what is their role?

Speech therapy is a science that deals with the prevention, detection, diagnosis, and treatment of communication, speech, and language difficulties.
A speech therapist is a specialist who independently operates within the field of speech therapy, conducting assessments, diagnoses, and rehabilitation of verbal and non-verbal communication disorders.

The areas of work of a speech therapist include:

• Aphasia and other neurological language disorders (dysarthria, apraxia)
• Language difficulties
• Articulation difficulties
• Neurodegenerative diseases
• Voice and phonological disorders
• Communication difficulties
• Fluency disorders
• Feeding and swallowing difficulties (dysphagia – problems swallowing food and liquids)
• Written language difficulties (dyslexia, dysgraphia, dyscalculia)
• Difficulties caused by cerebral palsy
• Hearing impairments

 

A speech therapist also plays a crucial role in working with children with neurodevelopmental disorders, such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders.

 

What are speech and language difficulties?

Speech difficulties refer to challenges in producing or shaping speech sounds. These include pronunciation problems, voice disorders, and fluency difficulties.

On the other hand, language difficulties relate to issues with understanding and using spoken and/or written language. They can be recognized through a limited vocabulary, poor comprehension of others’ speech, incorrect word usage in communication, and similar issues. Language difficulties can be developmental (emerging during language acquisition) or acquired (after the age of 3 or 4). If present from birth, they are referred to as specific language impairments.

The term “speech and language difficulties” encompasses both categories of impairments.

 

When Should a Child See a Speech Therapist?

The need for a speech therapy evaluation depends on whether a child’s speech, language, and communication abilities deviate from the typical development of their peers.

By the age of one, signs that may indicate the need to consult a speech therapist include the absence of:

• Eye contact or response to their name
• Reactions to environmental sounds
• First words (expected between 9 and 14 months)
• Interest in play
• Responses to interaction, such as understanding gestures, simple instructions, and words (by 18 months)

A speech therapist may be necessary if, by the age of four, a child: godine:

• Speaks less than their peers (rarely initiates or maintains a conversation)
• Struggles to understand questions
• Does not use gestures
• Speaks unclearly or produces non-articulated sounds
• Cannot form sentences following grammatical rules
• Has difficulties pronouncing sounds and letters (e.g., omitting or substituting sounds like saying iba instead of riba or liba instead of riba)
• Exhibits voice and speech changes, such as nasal, hoarse, or breathy speech; speaking too loudly or softly; abnormal pitch (too deep or too high); or frequent voice loss
• Experiences fluency issues, such as stuttering, which can manifest as repetitions, prolongations, or pauses that disrupt natural speech flow

 

For preschool and school-aged children, attention should be given to reading and writing difficulties, including dyslexia and dysgraphia, as well as challenges in keeping up with school material.

Dyslexia is characterized by inaccurate and slow reading, skipping lines, pronunciation and word-finding difficulties, trouble understanding text, difficulty remembering letters, numbers, and colors, and confusing letters with similar shapes (e.g., b and d).

Dysgraphia involves writing difficulties, including frequent spelling and grammatical errors, often accompanied by illegible handwriting.

As an additional tool to determine if a child needs speech therapy, parents can refer to pronunciation norms based on the only standardized articulation test in the Croatian language (Vuletić, 1990).

According to these norms, a child should correctly pronounce:

• By 3 years and 6 months: all vowels (a, e, i, o, u), p, b, m, t, d, n, k, g, h, f, v, j, l
• By 4 years and 6 months: all of the above plus s, z, c, lj, nj
• By 5 years and 6 months: all Croatian language sounds, including š, ž, č, dž, đ, r

Early speech therapy assessment and intervention are crucial for proper speech, language, and communication development. The optimal time for therapy is between ages 2 and 4, with a maximum delay until age 5, to improve the child’s skills before starting school.

 

When Do Adults Need a Speech Therapy Evaluation?

In adults, communication and speech-language difficulties can arise due to certain illnesses or after traumatic events.

Some of the most common conditions in adulthood include:

• Neurological impairments, such as:
  • Apraxia – the inability to move the muscles required for speech due to neurological damage.
  • Dysarthria – impaired articulation caused by neuromotor damage, leading to slurred, breathy, or irregular speech.
  • Aphasia – partial or complete inability to express or understand spoken or written language due to damage to the neurological and circulatory system.
• Spasmodic dysphonia – voice changes caused by spasms in the laryngeal muscles (vocal cords).
• Hoarseness
• Fluency disorders (e.g., stuttering, cluttering)

The most common causes of these conditions are: stroke, traumatic brain injury, degenerative neurological diseases (multiple sclerosis, muscular dystrophy, cerebral palsy, Parkinson’s disease), vocal cord injuries and diseases (throat cancer, vocal cord nodules, certain medications), dementia.

Whether speech difficulties appear suddenly or gradually, a medical evaluation is necessary to determine the underlying cause. Based on this, a treatment plan—including speech therapy—can be developed.

 

What Does a Speech Therapy Evaluation Look Like?

A speech therapy evaluation consists of assessing the communication, speech, and language status of a child or an adult, diagnosing any difficulties, and creating a therapy plan if necessary.

The core parts of every evaluation include a conversation with the individual (and the parent if the patient is a child) and various tests designed to assess: understanding of questions, speech clarity, pronunciation of sounds and words, vocabulary and language accuracy, speech tempo and rhythm, reading comprehension, written expression, etc. The evaluation also includes an examination of the structure and mobility of the articulatory organs and orofacial muscles, which are essential for proper speech production.

When a child comes for an evaluation, the first step is to make them feel comfortable by allowing them to explore the environment and feel safe. This is followed by a conversation with the parent, during which the speech therapist gathers anamnestic data: the family and child’s medical history, information about pregnancy and birth, psychomotor and speech development of the child, their play, sleep, and eating habits, as well as how they function in daily life and social settings.

Next, the assessment of the child’s communication and speech-language characteristics takes place, using various methods such as play-based activities (for children under 3 years old), questionnaires, rating scales, standardized tests, picture materials (coloring books, storybooks), and tasks involving repetition of specific sounds/words.

Based on the assessment, a diagnosis is determined, and parents receive instructions and a therapy plan if necessary. It is recommended that a parent remains present during the evaluation to help the child feel more comfortable, secure, and cooperative.

For adolescents and adults, the evaluation also involves conversations and tests assessing verbal speech, nonverbal communication, and written language skills.

At the end of the session, the speech therapist provides feedback on observations and explains how the current condition compares to typical expectations. If any abnormalities suggest a physiological cause of the difficulties, the individual may be referred for further specialist examinations. If needed, speech therapy is recommended, including a schedule based on the type and severity of the condition.

A speech therapy evaluation typically lasts about 60 minutes.

A speech therapy evaluation typically lasts about 60 minutes.
For more information or to schedule an appointment, contact us at +385 1 5005 970 or email info@sinteza.hr.

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