Statistics currently show that 1 in 36 children are diagnosed with ASD. These children will require intervention for social, emotional, and behavioral differences. Early identification and treatment for these children are pivotal to achieving long-term goals and success in life. Achieve can provide professional recommendations and services which include social language skills, parent-child training, augmentative communication, and individual speech therapy. While any one of the above concerns below may be seen in any child, it is the combination of multiple concerns that warrants a referral. Early signs of Autism may include:

• A baby who shows little to no effect when near loved ones
• A young child who displays little to no awareness of social surroundings
• An 18 month old who has lost previously mastered words and phrases
• A 2 year old who is not yet talking
• A toddler who does not show interest in peers and would rather play alone
• A child with repetitive, stereotypical behaviors
• A child with an above-age-expected knowledge of any one subject
• A 2 year old who does not play with toys in a purposeful way
• A child who is overly sensitive to sound or touch
• A child who typically displays an overactive or underactive pattern of behavior

A speech production disorder involves difficulties making speech sounds. Speech production disorders may be caused by (but not limited to) ear infections, childhood apraxia of speech (CAS), phonological processing or a delay in development. When a child is demonstrating concerns with speech production, speech sounds may be substituted, omitted, added or changed. These errors may make it hard for people to understand the child.

By the age of 2, a child should be able to combine simple consonant sounds into 2-word phrases, such as ‘my toe’. A two year old should be at least 50-75% intelligible and able to produce the following sounds in simple words and phrases:

• m, n, p, h, w, b, t, d

By the age of 3, a child should be able to combine simple consonants and complex consonant sounds into 3-word phrases such as, ‘I eat food’. A three year old should be 75-100% intelligible and be able to produce all of the age 2 sounds plus the following:

• k, g, f , y, n

By the age of 4, a child should be able to combine 4-word sentences and be 90-100% intelligible. A child should be able to produce all age 2-3 sounds plus the following sounds should be present:

• sh, ch, y, j, s, z, v

By the age 5-6, a child have all of the above sounds and should begin to acquire later developing sounds which include:

• l, r, th, v, r-blends, s-blends, l-blends

Therapists at Achieve are trained and qualified to perform accent reduction therapy. The primary goal is to focus on accent reduction, not accent elimination. Achieve assists adult-patients in reducing areas of their pronunciation that effect clarity in their daily routines.

Deficits in executive function are closely related to language and literacy and often become more noticeable in school-aged children. Achieve can provide professional recommendations and services which include social language skills, family training, literacy programming, and individual therapy specifically addressing the deficits listed below. Individuals with executive function impairments may exhibit a variety of difficulties such as:

• Initiating and/or completing tasks
• Self-regulation
• Organization
• Dealing with change
• Working memory
• Impulse control
• Attention
• Time management
• Social/emotional skills

Achieve therapists have been trained in implementing the Sound Sensible and SPIRE programs in order to directly target reading skills in preschoolers and school-aged children. If a child has a history of speech/language delays or learning deficits in the area of reading, these programs are designed to pinpoint areas of growth to strengthen reading and reading comprehension skills. This program is particularly effective if you suspect dyslexia or symptoms of a learning disability. Therapists at Achieve specialize in important phonological awareness skills children may miss in a regular school setting. These include: rhyming, segmenting/blending sounds, isolating/deleting sounds, and decoding.

Achieve therapists are highly trained and certified in the Lidcombe program to treat stuttering. In addition, therapists at Achieve are well-versed in the most current therapy approached for children and adults. There are typically three key factors we look for when discerning probability that stuttering will persist. If the patient exhibits any two of the three a referral is warranted at any age.

• Family history of stuttering
• Stuttering has persisted more than 6 months
• Heightened awareness or frustration surrounding the stuttering moments

The most important factor is related to signs of heightened awareness. If unfavorable reactions and emotional responses such as shame, embarrassment, anxiety, or refusal to talk are present, an immediate referral for an evaluation is appropriate.

Cognitive communication disorders refers to any disruption of communication that is effected by cognition, which prohibits one to act on information, to think, and to learn. Some examples of cognitive processes include: attention, memory, organization, problem solving/reasoning, and executive functions. Cognitive deficits can also impair safe and independent living. Examples of illnesses or disease that can impact cognition range from stroke, brain Injury, many progressive neurological diseases and even dementia. 

Aphasia is a language disorder that typically occurs in individuals after an incident of brain damage. Individuals who previously expressed themselves and understood communication through speaking, reading, or writing suddenly find themselves unable or limited in their ability to participate in these previous activities. It is estimated that over 1 million Americans have aphasia. The role of the speech language pathologist is to assess the communication impairment, develop a treatment program to help individuals with cognitive impairments regain as much of their communication skills as possible. The SLP may also counsel caregivers about the individual’s aphasia and help them assist in generalization of treatment gains. Many individuals with cognitive communication deficits are able to return to work and leisure activities after treatment.

Achieve specializes in diagnosing and treating swallowing disorders. Our clinic offers fiberoptic endoscopic evaluation of swallowing (FEES scope). The FEES procedure allows for an objective assessment of the swallowing physiology via a small, painless, flexible nasal endoscope. The endoscope is passed through the nose and allows the speechpathologist to see the structures of the throat and how those structures are affecting the mechanics of the swallow. Some people with dysphagia have problems swallowingcertain foods or liquids, while others can't swallow at all. Warning signs of dysphagia include:

• coughing or choking when eating or drinking
• bringing food back up, sometimes through the nose
• a sensation that food is stuck in your throat or chest
• persistent drooling of saliva
• being unable to chew food properly
• a gurgly, wet-sounding voice when eating or drinking

Speech pathologists in our clinic are experienced with treating symptoms in adults and children consistent with hoarse, harsh or breathy vocal quality. Problems with voice include, but are not limited to, vocal nodules, polyps, vocal cord dysfunction, paralyzed vocal cords, velopharyngeal dysfunction, dysphonia, aphonia, and chronic hoarseness. A referral to an ENT must be made prior to any treatment to rule out any structural deviations and aid in appropriate treatment planning. Our clinic specializes in the Lee Silverman Voice Treatment program (LSVT). Symptoms of a voice disorder may include:

• Volume level consistently or intermittently too loud or too soft
• Pitch inappropriate for an individual’s age and gender
• Soreness or pain in neck, sensation of something in throat
• Complaints of vocal fatigue and a need to increase vocal effort to speak
• Presence of vocal tremor
• Inappropriate resonance

Feeding disorders affect 25 to 45 percent of typically developing children and up to 80 percent of children with special needs and/or chronic health issues. A feeding disorder applies to a child who cannot consume a balanced diet of age-appropriate food or liquid to support steady growth and development. When speech language pathologists and other health care professionals treat a child with a feeding disorder, they work toward improving the child’s ability to eat a variety of foods. Feeding therapy is available for all ages at this facility, including newborns and infants which may include breastfeeding support for new mothers. Lactation consultants are also available on-site. Achieve is  certified in the Sequential Oral Sensory (SOS) Approach to Feeding. This program was developed by Dr. Kay Toomey, in conjunction with colleagues from several different disciplines including: pediatricians, occupational Therapists, registered dietitians, and speech pathologists. The SOS program integrates motor, oral, behavioral/learning, medical, sensory and nutritional factors and approaches in order to comprehensively evaluate and manage children with feeding/growth problems. The treatment component of the program utilizes these typical developmental steps towards feeding to create a systematic desensitization hierarchy of skills/behaviors. This approach can be beneficial in making mealtimes more pleasant. Children may be considered a ‘picky eater’ or ‘problem feeder’ if one or more of the following issues are present:

• Difficulty controlling food in mouth
• Gags or is unable to tolerate certain foods or textures
• Decreased range or variety of foods
• Eats less than 30 different foods
• Unable to tolerate new foods on plate
• Eats different foods than the rest of the family
• Has been tube fed or is presently tube fed
• History of difficulties gaining weight
• History of GERD or issue with feeding as an infant

Orofacial myofunctional disorders (OMDs) are disorders of the muscles and functions of the face and mouth. Disordered patterns involving oral and orofacial musculature may interfere with normal growth, development, or function of orofacial structures (Mason, n.d.A). OMDs can be found in children, adolescents, and adults. OMD refers to abnormal resting labial-lingual posture of the orofacial musculature, atypical swallowing and chewing patterns, dental malocclusions, blocked nasal airways, and speech problems. (Hanson, 1982)  Most issues originate with insufficient nasal breathing which causes irregular oral breathing. Signs/symptoms of OMDs may include one or more of the following:

• Open mouth, habitual (lips open) resting posture (inability to breathe through nose)
• Restricted lingual frenulum (ankyloglossia/tongue tie)
• Dental abnormalities, such as excessive anterior overjet, anterior, bilateral, unilateral, or posterior open bite, and under bite
• High, narrow oral palate
• Abnormal tongue rest posture, either forward, interdental, or lateral posterior (unilateral or bilateral), which does not allow for normal resting relationship between tongue, teeth, and jaws (Mason, 2011)
• Distorted productions of /s, z/ often with an interdental lisp and/or abnormal articulatory placement of speech sounds
• Drooling and/or poor oral control, specifically past the age of 2 years
• Nonnutritive sucking habits, including pacifier use after age of 12 months, as well as finger, thumb, or tongue sucking
• Lack of a consistent linguapalatal seal during liquid, solid, and saliva swallows
• Airway incompetency, due to obstructed nasal passages, either due to nasal structural obstructions (e.g., enlarged tonsils, adenoids, hypertrophied turbinates, allergies and/or chronically congested nose, that do not allow for effortless inspiration and expiration) (Bueno, Grechi, Trawitzki, Anselmo-Lima, Felicio & Valera, 2015).
• Bruxing (teeth grinding), jaw pain (TMJ), or facial pain
• Poor sleep (sleep apnea, snoring, sleep disordered breathing)
• Bedwetting or delayed toilet training
• ADHD tendencies and/or difficulties learning
• History of difficulties breast feeding and/or feeding (which includes picky eating)
• Irritability
• Slow growth
• Dark circles under eyes or “allergic shiners”