Let’s Talk! Speech Therapy Blog


Coping with Sensory Processing Issues and Sensitivities

It’s hard to show sensitivity for things you can’t see. It can also be difficult enough “just” to open up about your struggles. It’s often even more difficult to ask for what you need, lest you feel like a burden or demanding to family and loved ones.

These are huge obstacles to the critical task of building community and support, particularly for people with disabilities.

Most material available on sensory processing issues focuses on children – likely since that is the common age of diagnosis – but these problems affect people of all ages and can be extremely disruptive. Because of misguided brain signaling, specific sensory triggers – of any sense – can become absolutely debilitating and unbearable.

In this piece, after a brief overview of the issues, we’ve compiled a list of tips to be aware of and help alleviate the symptoms at home. At the very least, we hope this piece facilitates safe, open conversations between you and your loved ones about how to best be supportive.

What are sensory processing issues?

Any disruption of the senses that causes hypersensitivity to that particular sense counts as a sensory processing issue, and results from dysfunctional processing of that particular sense or senses. There are many different ways that these issues may arise, and they usually accompany other health issues.

Sensory Processing Disorders

Though not recognized as their own diagnosis, sensory processing disorders tend to fall into a few different categories that consistently present alongside other disorders, such as autism spectrum disorder (including Asperger syndrome), ADHD, learning and language disabilities, and even Fragile X syndrome. An added layer here is that people with SPDs might not be comfortable communicating their triggers, and so you might see the effects – such as isolation, avoidance, aggression, depression, and anxiety – without readily seeing the causes. Some of the most common sensory processing disorders include:

  • Sensory Modulation Disorder occurs when the brain’s responsiveness to sensory stimuli is altered. It can result in over-responsivity to stimuli, under-responsivity, or sensory seeking (where only the most intense stimuli are recognized by the brain, and therefore people need constant rich sensory input). The solutions we list here are particularly helpful for those with sensory modulation disorder.
  • Sensory Discrimination Disorder occurs when people have trouble making sense of sensory input. They can receive stimuli – for example, they can experience the sensation of touch – but those with tactile SDD cannot use touch to tell the difference between different objects. There are eight different subtypes: tactile, vestibular, auditory, proprioceptive, visual, interoceptive, olfactory, and gustatory (the last two often occur together). The recommendations we make here in this piece might help people with SDD by simplifying the sensory landscape and facilitating other therapeutic methods to help hone their processing.
  • Dyspraxia occurs as a result of developmental issues in coordination of motor movements, and is most commonly recognized as motor problems in people who are otherwise healthy (so, other diseases – such as cerebral palsy – are first ruled out).

Sensory Sensitivities

One issue not discussed as much is that sensory sensitivities may result as part of other diseases and/or their treatments. The list of potential conditions that can cause sensory sensitivities is rather long and beyond the scope of this piece, however we wanted to draw attention to some of the more common ones. You may encounter people on a daily basis who are silently struggling with these sensory sensitivities. Again it is important to remember that these sensitivities can be completely disruptive and must not be taken lightly. Because there is often no clear, established pathologic association between the two, these sensitivities might be unfairly dismissed.

Some – by far not all – body-related causes of sensory sensitivity include:

  • Migraines can often be triggered by light, sound, or even certain smells. Then, while suffering from migraines, many individuals find it helpful to isolate themselves – e.g. go into a quiet, dark room – to help alleviate the symptoms until the headache goes away. Because migraines can be such a moving target for treatment, it is extremely valuable – when a trigger is known – to act on it.
  • Cancer chemotherapy can often render people extremely sensitivity to smell and/or taste. While medical workers are encouraged to use fragrance-free hygiene products to prevent causing discomfort to their patients, applying this to your home might help make it a more comfortable place.
  • Kidney and liver disorders can cause multiple chemical sensitivity, including very strong reactions to particular odors.
  • Specific medications can render people more sensitive to particular sensitive stimuli. For example, people on tetracycline or doxycycline are known to become more sensitive to light.
  • Anxiety is the most common mental illness, affecting almost 1in 5American adults per year. Sensory problems, particularly to touch or sound, commonly arise.
  • Peripheral neuropathy can cause changes – and thus sensitivity – in sensation. The most common cause for peripheral neuropathy is diabetes, which affects almost 10% of the US adult population (with almost 20% of the population estimated to have prediabetes).
  • Fibromyalgia is a very common pain disorder that can be caused by a wide variety of factors, but which can cause high sensitivity to sensory stimulation, especially to touch.
  • Pregnancy while certainly not a disease does affect how your body functions, including from a sensory capacity. Pregnant women may become extremely sensitive to particular tastes and sounds, getting physically ill if exposed to them.

What can be done at home?

The home should be the ultimate source of comfort and nurturing. If you or a loved one are dealing with any of these sensory sensitivities, aside from discussing therapeutic possibilities with your doctor, you definitely want to ease the burden at home and create an environment that is restful.

Some of these fixes carry over very well into the workplace, and so you may wish to find ways to either incorporate these into your workplace yourself, or speak with your company to find ways to make these accommodations readily available. (It’s a good idea to have some form of medical documentation if you choose to pursue the latter.)


  • Filter your air well: Remove particulates, scents, and allergens to help ease the burden on your body and potentially reduce sensitivity over time. For maximum effect, make sure you consistently replace your air filters per the maintenance recommendations.
  • Maximize air flow: Use HVAC systems, fans, and open windows to keep air moving and prevent the risk of lingering scents
  • Consider keeping rooms on the side of cool: Heat maximizes molecular dispersions and allows scents to spread faster.
  • Monitor the humidity in your rooms: and the effect it has on sensitivity. Dry air and moist air carries scents differently because of the molecular interactions between the water and fragrance. Consider using an inexpensive device to monitor temperature and humidity in rooms, and then use open windows, humidifiers, or dehumidifiers as needed to find balance.
  • Install well-fitted doors to rooms prone to smells: Kitchens and bathrooms tend to be rich in both scents and odors. A sealed door might be overkill, but making sure there are partitions that are well-fitted to their frames can help keep scents contained and manage symptoms.
  • Try using natural scent absorbers: like baking soda or activated charcoal.
  • Steer clear of artificial fragrances: Check your cleaning reagents and hygiene products in particular, and always opt for “fragrance-free.” You may want to try using high-quality essential oils instead, although these are still triggers for some people.
  • Try using vinegar, baking soda, and other milder solutions to clean: Confirm that these aren’t triggers as everyone is different, but many people who cannot tolerate harsher chemical formulations and materials like bleach are able to tolerate these.


Closely linked to olfaction, there are some specific things you can do to aid with gustatory sensitivity.

  • Discuss and validate triggers: If someone notes a sensitivity to a particular food or flavor, make sure you recognize this – don’t just dismiss it as ‘being picky’ or something. Avoid using that flavor profile.
  • Log foods consumed and responses: This can help identify future triggers. This is particularly helpful as triggers may change over time, and also might affect people to varying extents. This is also a great way to work cooperatively to tackle this issue and organically discuss triggers while building and showing support.
  • Dine in well-ventilated areas: Because of the close association between taste and smell, these two can function synergistically. Keeping the air flow moving and the level of lingering odors and scents low can help alleviate some hypersensitivity.
  • Consider your meal ware: As anyone who’s drank wine knows, barware is designed to help complement and highlight the scents of different beverages; the dishes you eat out of can do the same. Try to use more open dishes to direct fewer of the scents directly at the person with sensitivity.
  • Let your food cool ever so slightly before serving: Again, heat facilitates the motion of molecules and will disperse scents further. We certainly don’t recommend completely cooling food, but just a few minutes in a separate room away from the person with sensitivity can help reduce the potency.
  • Use sealed containers to store food: This will prevent tastes and odors from migrating from one dish to another.
  • Use salt and lemons with discretion, and consider the use of complimentary flavors with discretion: Known tools to help highlight flavors, such as salt and lemon, or use of flavors that sharpen each other (e.g. tomato and basil) can make tastes pronounced past a person’s threshold of tolerance.


  • Use warm lighting: Local hardware stores have very helpful displays that showcase the differences between warm, natural, and cool lighting.
  • Remove dimmers from your house: These constantly flicker at levels below the threshold that we can consciously detect, but that flickering can still have the effect of triggering sensitive people.
  • Remove fluorescent lights or other potentially harsh sources of light: Seeing a bright light out of the corner of your eye can be enough to trigger a migraine.
  • Use task lights pointed in front of you: but never towards you.
  • Wear anti-glare lenses: to reduce your exposure to harsh light.
  • Use dark colors or simple palettes to decorate: This simplifies the triggers to which a person is exposed by simplifying their visual landscape.
  • Use thick curtains: to control lighting in the room. Many people find blackout curtains to be the most helpful, particularly as they can then build their own “cave” where they can cope if they have a particularly strong photophobic reaction.
  • Avoid mirrors: These can sharply reflect light, and because that can often vary throughout the day, it might be somewhat unpredictable: you may walk into a room that usually is very eye-friendly, only to happen to come at the exact moment the sun shines directly into the mirror and hits you in the eye.
  • Ask before you turn on lights: The sudden onset of light can trigger a person with light sensitivity, and so you want to make sure you check in before you turn them on.
  • Buy special glasses: to relieve photophobia. TheraSpecs is one brand that is generally well-reviewed and comes in indoor and outdoor options, for both prescription and non-prescription eyewear.


  • Be sensitive to the type of sound sensitivity: at hand, and modify your solutions accordingly. Some of these conditions may overlap – such as tinnitus and hyperacusis – and so you want to make sure you tailor solutions to the individual.
  • Tinnitus: is a constant ringing type of sound that is continuously heard by individuals suffering from it. Silent rooms might actually make it worse.
    • Use a white noise machine: These usually offer several different options for sounds to play, volume, timers, and other parameters that you can adjust to fit your or your loved one’s needs. Depending on the frequencies that affect you or your loved one, this device can be helpful.
    • Use pillows to elevate your head while you sleep: This tends to reduce congestion and helps make tinnitus less pronounced.
    • Avoid stimulants: like coffee, alcohol, and nicotine, which can all exacerbate the stimulants.
    • When decorating, prioritize creating a soothing environment: Stress is known to make tinnitus worse.
  • Hyperacusis: involves sensitivity to common environmental sound, particularly at higher frequencies.
  • Hypersensitive hearing: usually involves particular frequencies and is commonly seen in people on the autism spectrum.
    • Choose quieter products: Hair dryers and yard equipment are some of the more common devices that can trigger individuals suffering from hyperacusis, but you can read the specifications and compare while you shop for the quietest option.
    • Make sure your windows and doors seal: Prevent sound pollution by making sure all entryways are well isolated.
    • Use textiles as buffers: Carpets or rugs can help make footsteps more tolerable. Coasters, table cloths, and towels can ease the sound of surface contact.
    • Fill your space: As already noted, textiles and furniture in the home help prevent echoes and dampen sounds. If you suffer from hyperacusis, it might be a good idea to live in a smaller space that has more material in it to help reduce loudness.
    • Live on the top floor, preferably corner units: You want to make sure you have access to spaces free of interfering sounds. If you have to live in an apartment unit, make sure you live on the top floor (so you avoid footsteps above) and a corner unit. You might still hear your neighbors, but you’re more likely to be able to find a space in your home that is quiet.
    • Perform loud tasks when your affected loved one isn’t home: Vacuuming is the classic example of this. Alternatively, if you live by yourself, consider hiring someone to conduct loud tasks – e.g. cleaning your home – and time it so that you are not home when they do this.
    • Wear ear plugs only when absolutely necessary: There are special ear plugs with maximum noise cancellation that might be the ideal for you. It’s not good to always wear ear plugs, both for risk of ear infection as well as rendering the ears hypersensitive, but having ear plugs on hand for ‘surprise’ loud environments might make all the difference in keeping you functional.


  • Consider the texture of all skin-on-skin contact: Discuss towels, sheets, and even furniture covers to make sure everyone is on board with how they feel.
  • Consider weighted blankets or layering multiple blankets: Deep pressure can help soothe the anxiety that some people with tactile sensitivity might have.
  • Layer clothing across the seasons: This keeps the basic clothing in contact with you or your loved one’s skin constant, so you’re only adjusting to additional weight – not new sensations, which can be overwhelming.
  • Buy clothing and textiles without seams and remove all labels: These can exacerbate things for anyone with tactile sensitivity
  • Monitor air flow: Direct air currents – such as being in front of a vent – can trigger symptoms. Position furniture so that it is not directly in front of any sources of air flow. When opening windows, be mindful of the flow of air that results, and alert loved ones if need be.
  • Discuss food texture: People with tactile sensitivity might be very sensitive to the textures of foods, and so the way you cook and present food might make all the difference.
  • Make sure dangers are flagged: People with touch issues might be subject to hyposensitivity or altered processing, and so they might not register pain as a danger sign. Make sure you or your loved ones knows how to tell negative physiological effects that result from injury.
  • Always let someone know before you touch them: You might think hugs between loved ones are a no-brainer, but your surprise contact could completely set someone else off and/or cause them pain.
  • Ideally, you could discuss with them the ways in which they prefer to receive affection, and make sure you align accordingly.

If you don’t suffer from any of these sensitivities, it can be hard to understand what the person is enduring as a result of exposure. It is critical that you remain sensitive and open to discussing and implementing solutions to help accommodate.

Note: The information contained here is intended as general suggestions, but this piece is not meant to substitute for a consultation with a qualified health professional.









May, 2017

I attended a great Santa Clara County Speech & Hearing workshop earlier this month on best practices for working with children on the autism spectrum.  Ann England from the California Diagnostic Center gave helpful tips to Speech Pathologists on what the best evidence based practices were.

Social Stories, scripting, visual schedules, and prompting were among the 27 practices that had the best possible outcomes in therapy.

Here is a partial list of the best evidenced based practices for working with children on the autism spectrum:

Please go to this website sponsored by the California Department of Education for more information:

captain website






March, 2017


By Carol Fenwick, M.Ed., CCC

How many of you have ever had a hoarse or raspy voice?  This happens to all of us from time to time.  A hoarse raspy voice can be caused by a cold, allergies or possibly by the way you use your voice.


I cannot help you with colds or allergies but I can help with suggestions for improving the way you use your voice and how to keep your voice healthy.


If you do a good amount of public speaking or if you have an occupation that requires you to use your voice frequently, such as teaching, politician, lawyer, sales, or any a position where you must interact frequently with the public, these suggestions would be particularly important for you.  I just had a friend from high school call me unexpectedly on Friday afternoon.  She has been told by her doctor that she has a voice dysfunction and wanted my advice about voice therapy.



A Little Bit About Your Voice:


How your voice works:  You have vocal cords that can be compared to rubber bands.  The cords  vibrate when air passes through them, which creates the sound of your voice.  If your vocal cords are healthy, the sound should be clear.

The amount of breath control you use when you are speaking makes a different in how strong your voice sounds.  If you use your vocal cords too harshly (a lot of yelling) on a regular basis, they can become susceptible to vocal polyps or nodules.  These sometimes have to be removed with surgery, but without proper use of the vocal cords, could return.


The thicker your vocal cords are, the lower the sound frequency.  Males typically have a lower sound frequency or pitch  than females.  A male’s voice pitch usually changes (become lower) around puberty (age 12 or 13).  I see this  in  middle school male students.  They have a young child’s voice in 6th grade and when they are  in 7th grade, they have frequent pitch breaks (voice sounds like its cracking) while their voice becomes lower.  The voice change is not as dramatic in females.



How can you keep your voice healthy?


Drink plenty of water.  Hydration helps keep secretions flowing to lubricate your vocal cords.  Caffeine and alcohol can dry out your vocal cords making them hoarse.  I  avoid caffeine  since it has an immediate effect on my sinuses and affects my vocal folds and voice for days afterwards.


Try not to scream or yell.  Chronic yelling  will smash your vocal cords together and can cause vocal cord damage..  I have worked with  children who abused their voice (screamed at home and on the playground) and ended up with a chronically hoarse voice and vocal nodules.  Adults who often scream and yell at rock concerts or at sporting events are also at risk.

Children who frequently yell and scream on the playground may benefit from use of a vocal chart such as this one:

Speech pathologists frequently use visual reminders to cue children when their voices are inappropriately loud, especially when inside a classroom.  If a child feels the need to yell, sometimes a toy horn or other noisemaker can be substituted for the voice.


If you are giving a speech or have a career where you speak all day, it is advised to warm up your voice  first.  Singers warm up their voices before a performance.  Your speaking voice needs to be warmed up also before teaching a class, or giving a speech.  You can simply glide from low to high tones on different vowel sounds, lip trills (motorboat sound) or tongue trills.


Don’t smoke.  This is an obvious one.  Laryngeal cancer can be caused by smoking.  Smoking also causes inflammation and polyps of the vocal cords.  That is why the voice of heavy smokers sounds husky, hoarse and weak.


Use good breath support.  Fill your lungs before you speak.  Don’t wait until you are out of air before taking another breath to power your voice.


Use a microphone.  If you have one available, it is a good idea to use one in a speech or presentation to lessen the strain on your voice.


If your voice is hoarse, don’t push it.  You need to decrease your voice use so that your vocal cords can recover.  If you continue to talk with a hoarse voice, you could cause significant problems.


How do you know if you have a Voice Disorder?

If you have a voice disorder, you may sound

_ hoarse or breathy for an extended period of time.

_ like you are talking out of your nose, called


_ like you have a cold and are stuffed up, called


_ like your voice is too high or too low, called a pitch


_ like you are talking too loudly or too softly.

— You  lose your voice when you are speaking. (ASHA)


Seek care from an otolaryngologist or Ear, Nose and Throat specialist to rule out any vocal cord pathology.  An  ENT must rule out vocal pathology in a client before he/she can receive voice therapy.(ASHA)

See a doctor if you have allergies or sinus or

respiratory infections.  Control gastroesophageal reflux disease which can contribute to hoarse voice quality

(GERD or heartburn)  with diet or medication.


If you need voice therapy, you can check the American Speech & Hearing website for professional referrals.  (www.ASHA.org)


I hope I’ve helped you think about how to keep your voice healthy !


December, 2016


What you can do to prevent hearing loss.

Our ability to hear sounds and conversation around us may not be appreciated until our hearing ability decreases as we age.  That’s why it is important to protect your hearing when you are young.  This is a brief presentation  on how we hear and how we can protect our hearing.   Loud noises over time can damage your hearing.  One of the most common effects of continuous loud noise is a permanent hearing loss.



How do we hear?  Sound waves travel into the ear canal until they reach the eardrum.  The eardrum passes the vibrations through the middle ear bones into the inner ear or cochlea.  Inside the cochlea, there are thousands of tiny hair cells.  Hair cells change the vibrations into electrical signals that are sent to the brain through the hearing or auditory nerve.  The brain tells you that you are hearing a sound and what that sound is.


Close up of hair cells in the cochlea


Once the hair cells are damaged, there is no proven treatment at this time to repair them.  However, there are recent reports of a drug given to deaf mice that encourages regrowth of damaged cochlear hair cells.

The Occupational Safety and Health Administration (OSHA) rules  that a noise level of 85 dB over an 8 hour workday is potentially damaging.  The louder the noise, the faster the damage.  For each 3 dB increase in sound level, potential damage to the ear doubles.  Loud noise can also increase fatigue and irritability and can reduce the ability to pay attention to tasks and reduce productivity.  Loud noise can also cause:

High blood pressure

Increased heart rate

Upset stomach

Difficulty sleeping

Tinnitus is continuous ringing or buzzing in the ears.  If you go to a loud concert, you may notice this effect for a few hours after the fact.  It’s like having constant white noise in the background.

What can be done? Always wear hearing protection when engaged in noisy activities.  If you find your ears ringing after a noisy activity, this is a sign you may have caused some temporary damage.  Lawn movers, power tools and hammering are harmful to your ears, especially if they are intense short, sharp sounds.  Protect your ears when doing these types of activities.  Block noise by wearing earplugs or other hearing protective devices when involved in loud activities.  “Hearos” (noise reduction earplugs) can be ordered online.  Turn the sound down on stereos and mp3 devices.  Listening to an mp3 device at maximum volume (105 decibels) can cause permanent damage.

Protect the ears of children who are too young to protect their own.  If you suspect hearing loss, have an hearing exam by an audiologist  who is a health professional trained to measure and help individuals with hearing loss.  A speech pathologist can also help with care of hearing aids in the school setting.


American Speech & Hearing Association

National Hearing Conservation Association

Dangerous Decibel

 Click below to see chart of how hearing is affected by sounds in the environment. 


FALL 2016

Fall is here and school has started!  If your child wears hearing aids, you have an extra item to consider when preparing your child for school.  Here are some helpful tips regarding hearing aid care reprinted from the American Speech & Hearing website.

Daily Care for the Hearing Aid

Hearing aids require special care to ensure that they function properly. Your audiologist will show you how to care for and check them regularly. Ask how you can obtain a listening tube, a battery tester, a forced air blower, and a drying container.

Perform listening checks: Listen to the hearing aid every day. Using a listening tube, you can listen to the hearing aids to be sure that they sound clear and not weak or scratchy. Your audiologist will teach you how to listen for intermittency and internal feedback.

Check batteries: Batteries should last about 1 or 2 weeks. Using a battery tester, check that the batteries are at full strength so that the hearing aids are working at peak performance. Always keep spare batteries with you. Store them in a cool, dry place. Discard batteries one at a time. Batteries are toxic, so handle them carefully and dispose of them properly.

Clean the hearing aids regularly with a soft, dry cloth. Check for dirt and grime. Earmolds can be removed from the hearing aids and cleaned with a mild soap solution. Dry them carefully using a forced air blower (not a hair dryer!). Be sure they are dry before reattaching them to the hearing aids.

Minimize moisture in the hearing aids. This is important for proper function. A hearing aid drying container will help keep moisture from building up inside the hearing aids and will lengthen their life. Be sure to take the batteries out of the hearing aid before placing them in the storage containers.

Avoid feedback: Feedback is the whistling sound that can be heard from the hearing aid. It occurs when amplified sound comes out of the earmold and reenters the microphone. You should not be hearing feedback if the hearing aid is securely seated in your ear. Hearing feedback may suggest that the earmold is too small and needs to be replaced or that there is too much earwax in the ear canal.

Talk to your audiologist about what you should do when you start hearing feedback. Turning down the volume of the hearing aid will cut down on the feedback but will also not allow you to hear important sounds.

Regular audiology visits are important for hearing testing, to check the performance of the hearing aid, and to make necessary adjustments.


Reprinted from the American Speech & Hearing Association website:

What are the signs of an articulation disorder?

An articulation disorder involves problems making sounds. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand you.

Young children often make speech errors. For instance, many young children sound like they are making a “w” sound for an “r” sound (e.g., “wabbit” for “rabbit”) or may leave sounds out of words, such as “nana” for “banana.” The child may have an articulation disorder if these errors continue past the expected age.

To see the age range during which most children develop each sound, visit Talking Child’s speech chart.

What are the signs of a phonological disorder?

A phonological process disorder involves patterns of sound errors. For example, substituting all sounds made in the back of the mouth like “k” and “g” for those in the front of the mouth like “t” and “d” (e.g., saying “tup” for “cup” or “das” for “gas”).

Another rule of speech is that some words start with two consonants, such as broken or spoon. When children don’t follow this rule and say only one of the sounds (“boken” for broken or “poon” for spoon), it is more difficult for the listener to understand the child. While it is common for young children learning speech to leave one of the sounds out of the word, it is not expected as a child gets older. If a child continues to demonstrate such cluster reduction, he or she may have a phonological process disorder.

To see the ages at which phonological processes should disappear, go to Elimination of Phonological Processes, and for descriptions of the common processes see Phonological Processes.

How are speech sound disorders diagnosed?

A speech-language pathologist (SLP) is the professional that evaluates children or adults with speech and language difficulties. The SLP listens to the person and may use a formal articulation test to record sound errors. An oral mechanism examination is also done to determine whether the muscles of the mouth are working correctly. The SLP may recommend speech treatment if the sound is not appropriate for the child’s age or if it is not a feature of a dialect or accent. For children, the SLP often also evaluates their language development to determine overall communication functioning.

What if I speak more than one language? Is an accent a speech sound disorder?

An accent is the unique way that speech is pronounced by a group of people speaking the same language. Accents are a natural part of spoken languages. It is important to realize that no accent is better than another. Accents are NOT a speech or language disorder. An SLP can work on accent modification services if a client wishes to reduce or modify his or her accent. (Please go to Foreign Accent Screening link on Home Page for a free screening of your foreign accent)

What treatments are available for people with speech sound disorders?

SLPs provide treatment to improve articulation of individual sounds or reduce errors in production of sound patterns.

Articulation treatment may involve demonstrating how to produce the sound correctly, learning to recognize which sounds are correct and incorrect, and practicing sounds in different words. Phonological process treatment may involve teaching the rules of speech to individuals to help them say words correctly.

What causes speech sound disorders?

Many speech sound disorders occur without a known cause. A child may not learn how to produce sounds correctly or may not learn the rules of speech sounds on his or her own. These children may have a problem with speech development, which does not always mean that they will simply outgrow it by themselves. Many children do develop speech sounds over time but those who do not often need the services of an SLP to learn correct speech sounds.

Some speech sound errors can result from physical problems, such as:

  • developmental disorders (e.g.,autism)
  • genetic syndromes (e.g., Down syndrome)
  • hearing loss
  • illness
  • neurological disorders (e.g., cerebral palsy)

Children who experience frequent ear infections when they were young are at risk for speech sound disorders if the ear infections were accompanied by hearing loss.Speaking with an accent and/or dialect is not a speech sound disorder.

How common are speech sound disorders?

In young children learning to speak, speech sound errors are quite common. In fact, very few children develop speech without producing errors early on. By the age of 8, children should be able to produce all sounds in English correctly.  (Contact Carol@FenwickSpeechTherapy.com if you would like a screening of your child’s articulation skills).



April 2016

Happy Spring!





February 2016

Happy Valentine’s Day and President’s Day.  February is a short month packed with holidays and vacation time.  It’s a busy time for parents of school-age children.   Below are  a couple of Valentine activities that you can do with your child to improve articulation and language skills.



This game that improves understanding and expression of spatial concepts can be changed up for various holidays.  For  Valentines Day, hide small paper hearts around the house or in a specific room.    As your child to find the heart “under the table” or “behind the chair.” Other spatial concepts:  “on the wall, ”  in back of the chair,” “above the desk” “in the book,” “under the paper,”  “beside the ball,” “between the chairs,” “next to the computer,” “below the bookcase,” etc.   For St. Patrick’s Day, the children can search for  plastic gold coins or “treasure.”


Older children can use  their target articulation words to write a poem or short story inside of a homemade valentine for a parent or a special friend or relative,  After putting the words in the story or poem, they can practice it  then read it to the parent or friend on Valentine’s Day.





January 2016

Happy New Year!  Best wishes to parents and children for a safe and happy 2016!

To start off the new year, I have included an article on how parents can best help their children with articulation or speech sound disorders.     Thanks for reading my blog!

How Parents Can Help Facilitate Articulation Skills
by Harriett Hoeprich, Speech/Language Specialist

Be a practice partner.
Ask your child’s speech/language therapist to let you know when it would be helpful for you to practice at home. Then practice your child’s successful words, using word cards or objects, at home. Use games and other fun activities, and make your sessions short and frequent. (5-15 minutes a day)

Don’t directly correct sounds that your child has not worked on yet.
Direct correction has been shown to be largely ineffective and disruptive. This is especially true when the child has not had the opportunity to have the new skill presented in a more isolated way than connected speech. At some point, your therapist will let you know if your child is at the stage where gentle reminders may be effective during connected speech for the targeted sound. This is usually after mastery has been achieved at the single word level, however.

Use revision every day to address the articulation needs as a whole.
Parents don’t realize how powerful this can be, particularly if the revision is used consistently and simply. Revision is the technique where you repeat what the child has said, but use the correct pronunciation. You may want to give the sound a little extra emphasis. (Example–Child: Look at bu! Adult: Look at that bug! Go, bug, go!)

Don’t directly imitate your child’s errors. Model good speech.
Some of the cute things our children say are very precious to us. But don’t inadvertently reinforce the incorrect productions by laughing or drawing attention. Certainly don’t imitate the incorrect production. Repeat the utterance using the correct pronunciation. And make a tape or video recording to save your memories of some of the adorable things your child says at this age! Model good speech.

Address health issues that may contribute to the problem.
Fight ear infections. Address other physical difficulties that may contribute, such as mouth breathing or voice difficulties.

Read to your child.
It’s amazing how much this accomplishes. Use reading as a way to surround your child with the targeted sound. (See “Ideas for Books to Enhance Articulation Skills”.)

Play with your child.
Spend time talking with your child in play, while you model the correct productions very simply, using revision.

Talk to your child.
Talk to your child as you go through your daily routine. This is a chance to model many correct productions, use revision, and stimulate language development, too.

Below are some fun ideas of games and activities you can use to practice your child’s sounds. Many of these games involve the use of simple picture cards which can be made out of index cards and catalogs.
Use the picture cards to play Concentration (Memory) or Go Fish.
Play a board game like Candyland, but have your child say a word before he takes a turn each time. Don’t forget to take a word yourself! Then it’s one more model your child gets to hear. When your child is ready for this step, let your child “catch” you making the sound “the old way” and let him show you how it should be said with the “new sound”.
If your child isn’t quite ready to enjoy traditional board games like Candyland, use something like Hi-Ho Cherrio, which is a simpler type of game. Use the picture cards in the same manner, however.
Play more active types of games, such as Nerf Golf, Bean Bag Toss, Ring Toss, and Bowling by simplifying the game to include less movement. This works really well with the minimal pairs. Put out two bowling pins with a picture card of the pair against each one (pin-bin, for example). Then try several approaches: Have your child tell you which one he knocked over, or which one he will knock over. Then gently tell him: “You said you were going to knock over the picture of ‘pin’. You knocked over ‘bin’.”
Hide the picture cards and let your child “find” them. You can also hide the pictures in other containers, such as plastic eggs

Ideas For Books To Enhance Articulation Skills

by Harriett Hoeprich, Speech/Language Specialist 

The following are only a brief beginning list of possible books to enhance articulation skills. One reason that reading can be a helpful way of enhancing articulation is by “bombarding” the child with many opportunities to hear the correct pronunciation of the targeted sound. When you know your child has worked on a certain sound in therapy, it can also be another way to practice new skills. When you talk about the book with your child, the sound should come up naturally because of the topic or words in the book. You can use a “closure” technique to elicit certain words, if you feel fairly confident that your child can produce the sound. (For example: “Caps for sale! Fifty cents a ____.” letting your child fill in the blank.) Or you could have the child “read” part of the book with you, if it’s a story he is very familiar with. Very repetitive stories are also helpful in eliciting phrases–such as “Polar Bear, Polar Bear, what do you hear?”

Remember to use a very natural, low-key approach. Drilling under pressure will probably result in the child disliking the activity and possibly the whole idea of reading and speaking, which is certainly not your goal! Remember that even if your child is “only” listening, she is still gaining the auditory bombardment of the sound and opportunities to hear the correct pronunciation in a controlled setting, not to mention all the other benefits of spending time with you and reading.

CAPS FOR SALE by Esphyr Slobodkina
CATS AND CANARY by Michael Foreman
CAN I KEEP HIM by Steven Kellogg
CORDUROY by Don Freeman


A DARK, DARK TALE by Ruth Brown

EACH PEACH, PEAR, PLUM by Janet and Allen Ahlberg
PAT THE BUNNY by Dorothy Kunhardt
THE PIG’S WEDDING by Helen Heine
POPPY THE PANDA by Dick Gackenbach

FAMILY by Helen Oxenbury
FINDERS KEEPERS by Will and Nicholas Mordvinoff
THE FOOT BOOK by Dr. Seuss
THE FOOLISH FROG by Pete and Charles Seeger
FIX-IT by David McPhail
GONE FISHING by Earlene Long
THE LITTLE FUR FAMILY by Margaret Wise Brown

MOON MAN by Tomi Ungerer
MAMA DON’T ALLOW by Thatchur Hurd
MADELINE by Ludwig Bemelmans
MARY HAD A LITTLE LAMB by Mary Josepha Hale
MAX’S FIRST WORD by Rosemary Wells
MITCHELL IS MOVING by Marjorie Weinman Sharmat


GOOD MORNING, CHICK by Mirra Ginsburg
GOOD-BYE HOUSE by Frank Asch
GONE FISHING by Earlene Long
GOODNIGHT MOON by Margaret Wise Brown

THE THREE LITTLE PIGS by many different authors
HIPPOS GO BERSERK by Sandra Boynton
HOW DO I PUT IT ON? by Shrego Watanabe
HUSH LITTLE BABY by Jeanette Winter

I AM A BUNNY by Ole Risom
HUSH LITTLE BABY by Jeanette Winter
PAT THE BUNNY by Dorothy Kunhardt
THE RUNAWAY BUNNY by Margaret Wise Brown

I KNOW AN OLD LADY by Nadine Bernard Wescott
I LOVE MY BABY SISTER by Elaine Edelman
A LION FOR LEWIS by Rosemary Wells
THE LITTLE FUR FAMILY by Margaret Wise Brown
LYLE, LYLE, CROCODILE by Bernard Waber


HUSH LITTLE BABY by Jeanette Winter
SHEEP IN A JEEP by Nancy Shaw
SHEEP IN A SHOP by Nancy Shaw
SHHHH! by Suzy Kline
SHHHHH…BANG by Margaret Wise Brown
SHINE, SUN! by Carol Greene

THE THANK YOU BOOK, by Francoise Seignobuse
THINGS I HATE by Harriett Wittels
TEETH by Michael Ricketts
THANK YOU by Edith Flack Ackley
THUNDERSTORM by Mary Szilagyi
THUMP AND PLUNK by Janice May Udry
THE THINKING BOOK by Sandol Stoddard
THE THINKING PLACE by Barbara Joosse
THREE BY THE SEA by Edward Marshall

ROSIE’S WALK by Pat Hutchins
ROTTEN RALPH by Jack Gantos
LITTLE RED RIDING HOOD by the Brothers Grimm

SWIMMY by Leo Lionni
SEE AND SAY by Antonio Frasconi
THE SEAL MOTHER by Mordicai Berestein
SEARCH FOR SAM by Neil Morris
SEEN ANY CATS? by Frank Modell
SEEDS by Terry Jennings


TEN, NINE, EIGHT by Molly Bang
TOUCH! TOUCH! by Riki Levinson
TEENY TINY by Jill Bennett
TASTING by Richard Allington
TAN TAN’S HAT by Kazuo Iwamura
TICKLE TICKLE by Helen Oxenbury
TIGER CAT by Slawomir Wolski
TIC, TAC AND TOE by Bruno Munari


LOUIS THE FISH by Arthur Yorinks
MOON MAN by Tomi Ungerer
PERFECT THE PIG by Susan Jeschke
CAN I KEEP HIM? by Steven Kellogg
A DARK, DARK TALE by Ruth Brown
THE FOOT BOOK by Dr. Seuss
GOODNIGHT MOON by Margaret Wise Brown
OLD MACDONALD HAD A FARM Several versions available
HOP ON POP by Dr. Seuss
TEETH by Michael Ricketts
TIC, TAC, AND TOE by Bruno Munari
You will probably come up with many more of your own favorites!





 December 2015

As the holiday season approaches, I want to give a shout out to the parents of children with disabilities everywhere.  It can be exhausting and challenging for a parent of a child with a severe disability especially during the stress of the holidays..  I hope that all parents and their children have the opportunity to relax and enjoy their time together during the holidays!

Warm wishes,

Carol Fenwick.


 August, 2015



June 2015                                                                                                                        



  1. Stay on the topic longer.

Stay on a topic that the child is interested in. Extend and deepen conversation so he has more time to talk about a preferred topic of interest. Ask questions about his topic and encourage him to answer. This encourages turn-taking skills which are important during conversation.

  1. Associations

Relate or associate new vocabulary words to familiar words. If your child knows big, use other words like huge or large.

  1. Complete the sentence

 Have the child complete the sentence with the new vocabulary word.  An adult provides part of the sentence and the child completes it with the new vocabulary word.  If the target word is “cookies”, you could say “Today we had fun; we made __________”.  Wait for him to finish the sentence.4Making longer utterances

4.  Making longer sentences

Expanding and extending is a technique for adding words that are missing from the child’s utterances.   If the child says:  “baby eat” you can say “The baby is eating cereal.”  For “Big dog” you could say “I am patting the big dog.”

    5. Predicting, Analyzing and Summarizing

If your preschooler has some expressive language, you can ask them questions that help them predict, analyze or summarize information.  They have already acquired language and are beyond the emerging language stage. You can ask them questions while reading a book together, watching a movie or after an event.  Examples are: What’s going to happen next? Why did the girl feel that way?  Can you tell me what happened in the story (or during the birthday party?)





May 2015

I thought this was a great article from the AAPC website and wanted  to share it with you.  Check their website at: Asperger Autism Publishing Company.

Avoiding the Awkward Moment: Intentions Versus ImpactAuthor: Julie Brusio

A few weeks ago, I asked the following question on my Ketchup With a Side of Autism Facebook page: What are some well-meaning comments people have made that annoy you?

The response was overwhelming. In general, the consensus was that people have the best intentions but that even well-intended comments can have the opposite effect. Here are some of the comments many of my readers have heard over the course of their journeys with children on the spectrum:

  • He’s picky with food? Don’t feed him for a day. He’ll change his tune
  • He must be mild.
  • He doesn’t look autistic.
  • Did you know they have people who can teach you techniques to control his behavior?
  • She’ll grow out of it.
  • I heard … insert cure of the day from the news media … will cure autism. Have you tried that?
  • One day she will talk and you will want peace and quiet

And the comment that came up the most is…

  • G-d only gives special kids to special people.

People have a habit of not thinking before they speak. Unfortunately, with comments like those above, parents feel hurt or as if they are being patronized. As parents of these kids we, have a tendency to take comments like that on the chin. But all that does is lead to animosity among the ranks and that is not helpful to anyone. After all of those responses had come in, one of my readers mentioned that it would be interesting to find out what parents would really like to hear about their kids. So I asked readers: What do you want to hear from others with regard to autism? Here is a sample of their responses:

Instead of yelling at him when he melts down, ask him what’s wrong.

  • When he asks you to leave him alone, please be respectful and do so.
  • “What can I do to help?”
  • “Tell me more about autism.”
  • “Your child is awesome! I would love for him to come over and play.”

And the number one thing autism parents would love to hear is…

  • “Let me come over and give you a break!”

That’s it in a nutshell. Instead of giving out unwarranted advice, ask what you can do to help. Take an honest interest, and if you’re not sure what to do or ask, simply say, “Please tell me more about autism. I’d really like to learn.” Include autistic kids in play dates, parties, and family functions. If possible, try to give parents a break.  We need our alone time just as much as any other couple does. When you take an honest interest and give true support, you will give an irreplaceable gift that will last a lifetime – love! Think about your words. Think about what you can do to help. Make sure your intentions have the intended impact!

“Autism is full of ups and downs and because of it I have more patience than I used to and can appreciate the “little” things in life.”