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FAQ Part 5
FREQUENTLY ASKED QUESTIONS
about Speech-Language Pathology
Caroline Bowen

Vocal nodules
I just read your web site regarding vocal nodules and voice strain in children. My four year old son was recently diagnosed with "textbook" vocal cord nodules (as described by his ENT). After years (well actually only about 3 to be exact) of thinking my son's "raspy" voice was cute, I now am somewhat concerned. The ENT felt that these nodules would likely just go away on their own as my son grows older and develops better vocal habits. She said that I could see a speech pathologist if I wanted to, but that my son was probably a little young to be able to actually benefit from speech therapy at this time. After reading your web page, it does seem as if some of the concepts would be beyond his realm of understanding right now. Do you feel that a four year old could benefit from speech therapy services for this condition? Being a pediatric occupational therapist myself, I often find that physicians may not be aware of exactly what benefits a certain type of therapy may or may not have. I appreciate your very informative and easy to understand web page regarding this topic.

RESPONSE
Yes, a four year old is likely to benefit from speech therapy services for vocal nodules. I encourage you to seek an SLP assessment.

Wait for SLP assessment for a four year old, or act now?
I am an occupational therapist in NC but I am writing about my son. When do you recommend getting articulation therapy for a lisp and some substitutions? My son is four and has sucked his thumb since he was four months old. He only sucks it in his sleep now, but he has an overbite and some of his speech sounds (vowels and consonants) are odd, almost like he has a New York accent! (we are from the south) I am debating on getting a speech evaluation for him now or waiting until he is a little older to see if he corrects some of the sounds. He is extremely bright and very verbal. I am worried about him getting teased when he starts preschool.

RESPONSE
The presence of "different sounding" vowels (as opposed to consonants) prompts me to suggest an immediate SLP assessment for your son. There is information in Table 3 and Table 4 about the normal sound replacements young children make when they talk.

Waiting too long for therapy
Thank you very much for the opportunity to read this information. I have found it extremely informative. I have a 31-month old who does not speak, and I'm really trying to understand why. He babbles with full expressions, and you would swear that he is telling you a story, but unfortunately I cannot understand a word of it. Occasionally, he pops out an English word, but then he seems to forget how to say that word again. I don't know what to do. I have taken him to a speech pathologist and she recommends speech therapy, however there is a minimum six-month waiting list. It's ridiculous. I am so frustrated. I've had people tell me it could be anything from just being a slow-talker, to having mild autism. I don't know what to think anymore.

RESPONSE
This may not be a viable option where you live, or in terms of your financial circumstances, but...if at all possible organise three of four consultations with a private SLP with a view to (1) obtaining a diagnosis, (2) accessing techniques you can use at home to help your child while you are waiting the six months. You may also be interested in Beyond Baby Talk, the Hanen site, and the First Words Project.

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Page updated 04 Feb 2010

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