Speech Therapy –does it sound right for a 10 years old?

[fac]

DD10 has seen a speech therapist twice, but I have the feeling that the therapist is struggling to figure out how to kill the time during our visit. We paid $30 for every visit as she is “specialist”, but I thought we may be wasting our time and money. I am planning to have another speech therapist, but I hope to confirm whether I am being unreasonable.

A few months ago, during DD10’s regular check up, the nurse practitioner told us that DD’s voice is hoarse (DD’s voice has always been hoarse) and recommended an ENT doctor in a medical group in our town. The ENT doctor’s 5 minute assessment was “Vocal cord nodularity giving her hoarseness, probably from secondary to vocal abuse”, he asked us to go across the hall to make an appointment with a speech therapy to see whether DD’s problem can be corrected before returning to see him.

During our first visit, the therapist talked to DD only for a few minutes and proceeded to talk to me. At one point, she even asked me what I thought may have caused DD’s hoarseness. I was thinking if I knew I wouldn’t be sitting in her office, shouldn’t it be her job to ask me the (right) question? The only questions she asked were whether DD drank soda and drank enough water.

We went for vacation for 3 weeks and saw her after we came back. The following summarizes our 2nd visit.
a. Again, she asked DD whether she drank coffee, soda (she said she forgot what we told her last time). DD told her she does not like coffee nor soda. The therapist proceeded to talk about that coffee and soda are not good and asked DD to bring water for every visit with her. (The problem was that she repeated the same "explanation" a few times).
b. She then turned her head right, left, chin down and asked DD to repeat ONCE.
c. She showed DD to breathe in and slowly breathe out. DD followed her twice.
d. She asked DD to read a passage, then corrected DD. She asked DD to breathe in after each sentence. The passage was about 5 sentences long and DD repeated twice.
e. She asked DD not to scream, talk loud.

The above took about 15 minutes. Then she took out a legal paper and slowly tore up the paper in 2 halves. (She was really slow in tearing up the paper, she folded it, turned it a few times slowly before tearing it up). She then dictated the above “voice rules” for DD to write on the piece of paper, helped DD in spelling the words. I was thinking she should have something printed out, why did she waste DD"s time to write the "rules"?

She then told us that she would teach DD some more exercises in the next visit, somehow I have the feeling that she is not sure of herself and was figuring out how to kill the 30 minutes.

Does anyone have any similar experience?

thanks

 

[Green Tea]

One of my kids had a couple different therapies. (And I had PT for an athletic injury) At all of them I would wonder how in the world is this helping, It is so benign. I wouldn't even say baby steps. I would think it was nothing. But in each case it really did work.

This is a different age group, but my mom went to a ST for horseness and difficulty swallowing after her vocal cords were damaged. It took under a month and she was fine. That was after a couple of months of thinking the difficulties were just the way she was going to be.

good luck

 

[DisneyDreams4P&B]

My children have been in speech therapy for years due to different circumstances. My advice...run don't walk to another therapist. If you have a bad feeling, follow your gut. Don't feel like you have to stay with her. Our speech therapist is amazing and pack our time full of activities/therapy. Good luck in your search for a new one!

 

[eeyorethegreat]

Sounds like since the ENT said the hoarsness could be due to vocal abuse, the speech therapist feels she needs to teach your daughter how to speak with out yelling, or in the case of what she drinks that your daughter needs to stay away from cofee and soda and doesn't necessarily believe that your dd does not drink this. I think at the next appointment I would aske her specifically to explain how these excercises work in helping to cure the hoarsness. Don't be snippy at her but say something like "so we can carry over these activities at home can you please descriibe how the activities you are doing with my daughter work?" that leaves you making her sound like the expert and her having to answer your question and by that you can judge if this therapy is appropriate for dd. If after that you do not see the usefulness of the therapy and your daughter isn't a yeller, screamer, avid singer, or otherwise uses her voice excessively as in way more than other kids her age, make an appointment with another ENT. Maybe there is something else going on or nothing at all. There is a girl my daughter goes to school with that has a very raspy hoarse voice it has been that way since she was a preschooler she is 12 now. I am not sure that the parent has looked into it medically but that is the voice that she has always had.

 

[Jsme]

Did you know your school system will provide you with free ST? If your child has a real problem they can see and address the issues.

Not saying that who you are going to is not worth your cost but it seems you appear to be disappointed or feel like there may not be an issue. If there's no money involved just maybe you can get to the bottom of the issues. Does that make sense?

Both of my children went to ST. My son started at 4 and was not in school and when they were in school they were in private school. However, since you pay taxes your are still provided certain assistance inside the public school system.

 

[eeyorethegreat]

Did you know your school system will provide you with free ST? If your child has a real problem they can see and address the issues.

Not saying that who you are going to is not worth your cost but it seems you appear to be disappointed or feel like there may not be an issue. If there's no money involved just maybe you can get to the bottom of the issues. Does that make sense?

Both of my children went to ST. My son started at 4 and was not in school and when they were in school they were in private school. However, since you pay taxes your are still provided certain assistance inside the public school system.

That is a good point. It sounds like this therapy may have started over this summer and therefore not on the school's tab. Also another thing to realize is that even though there may be a speech issue there also may be a waiting list at the school if there isn't enough speech therapists to go around.

 

[Green Tea]

It is only provided by the school in cases where it impacts learning/has an educational component. Like not speaking, or articulation errors. I suspect tone of voice wouldn't be covered.

 

[Lisa loves Pooh]

Was this your daughter's very FIRST session?

If so, often first sessions of anything are usually an intake with a few therapeutic things at the end.

Your therapist would have no idea how to treat you without getting some information and some feelers.

So I wouldn't necessarily run from her, yet. I would ask her what the process of therapy will be like though. You are the consumer after all.

My son is in speech, but he is only 2. But his very first session had very little therapy at all. His ST wanted to get to know him. Sure she had his report from the state that showed what he couldn't do but that isn't the same as a diagnosis.

I would hate for any therapist in ANY field to blindly throw any exercise out their based on their educational paradigm. I have various therapies and regardless of the field, they all began the same way on the first visit.

For my son, it turns out he is apraxic (inability of brain to communicate to his mouth) and cannot do traditianal ST. He is provided therapy in a much different way than other children.

I would simply address your concerns with the therapist and i would want to know what the diagnosis is so that you understand how the exercises fit within that diagnosis to improve your daughter's speech.

I know someone in college who was in broadcasting and she had speech issues that were not impairments. She did go to ST to address these issues so that she could work on her career post grad with her voice like she wanted to. It was never an issue while growing up though.


Air has a lot to do with how you voice/speak. So the exercises to me make a lot of sense to me.


As far as the writing, as weird as it sounds--it seems like the therapist was having your daughter take ownership of what she has learned to help impress it in her memory so that she could remember on her own. Handing a piece of paper would not have been as effective.

It doesn't seem to me that she was trying to "kill 30 minutes".

But that's just me.

My sons therapy started out with him simply playing with toys while the therapist "stuttered and babbled". There was method to the madness, but on the surface that is what it sounded like.

 

[rapmarks]

Lisa Loves Pooh just said what I was going to say.

My daughter had 9 years of intensive speech therapy.

She was probably asking about coffee and soda to see if she could have acid reflux. She had her write it down to take ownership and imprint on her tactile memory.
It sounds to me like she is doing things, and $30 is not a high price if she knows what she is doing. It takes awhile for the therapy to work. I never knew that ENT's had speech therapists on staff.

I wonder if the speech therapist has a lot of experience with children? I know my daughter was helped a lot more by the therapist that was used to working with very young children compared to getting a therapist that usually worked with 4th and 5th graders when she was 3.

 

[tinker625]

Hello. My brother had problems with his throat and found out he had pallups on is vocal cords. He had them removed, however, this is a virus so they do come back. Just check again with a special ENT doctor to get her checked. If she always had a horse voice, its just a checkup, but if this has come on slowly(GET a second check)

 

[leamom2princesses]

My oldest daughter has been in speech therapy for 5 1/2 years. She is now 9. I agree with rapmarks and Lisa loves Pooh. It sounds like the therapist may be trying to empower your daughter (through knowlege) and give her ownership by making her part of the process. As no parent can be with their child 24/7, especially when they are school age, it is really important that DD understands what she can and can't do when Mom isn't there to help. I'm sure writing the "rules" out was just an activity to help plant them in her memory. I hope it all works out. Speech therapy has worked miracles for my daughter.

 

[Kriii]

First the disclaimer: I am a speech pathologist. The scenerio you describe sounds like your SLP is doing some diagnostic work in order to figure out the causes of the vocal abuse and best treatment recommendations, which is absolutely correct. Part of what we are trained to do includes taking a detailed case history, which is what your SLP was doing with the questions. I don't find it weird that she asked the parent's opinion about the cause of the hoarseness...parents are a valuable resource and their input can be pretty critical. Ask the SLP why she does what she does and you may feel better once you get an explanation. There is no one "recipe" for voice therapy - the SLP may have to work w/dd a bit to figure out the problem and best treatment. Voice cases can be tricky. I would be more suspicious of the SLP who handed you a list of exercises without taking the time to figure out the underlying problem first. If you still feel uncomfortable, go ahead and ask for the second opinion. Just as a general FYI for anyone reading who is interested, the speech therapy for nodules is recommended if the nodules aren't yet too hardened. By learning to avoid and eliminate vocal abuse, the nodules can be reabsorbed into the vocal folds. If the nodules are already too hard, they need to be surgically removed. ENTs often recommend trying ST first in hopes of avoiding surgury . If you have more specific questions about voice therapy, try contacting the American Speech Language and Hearing Association (and honestly, you'll get more knowledgeable advice than from strangers on the Disboard, as great of a group as they are!). Hope all goes well for dd!

 

[polineedyan]

First the disclaimer: I am a speech pathologist. The scenerio you describe sounds like your SLP is doing some diagnostic work in order to figure out the causes of the vocal abuse and best treatment recommendations, which is absolutely correct. Part of what we are trained to do includes taking a detailed case history, which is what your SLP was doing with the questions. I don't find it weird that she asked the parent's opinion about the cause of the hoarseness...parents are a valuable resource and their input can be pretty critical. Ask the SLP why she does what she does and you may feel better once you get an explanation. There is no one "recipe" for voice therapy - the SLP may have to work w/dd a bit to figure out the problem and best treatment. Voice cases can be tricky. I would be more suspicious of the SLP who handed you a list of exercises without taking the time to figure out the underlying problem first. If you still feel uncomfortable, go ahead and ask for the second opinion. Just as a general FYI for anyone reading who is interested, the speech therapy for nodules is recommended if the nodules aren't yet too hardened. By learning to avoid and eliminate vocal abuse, the nodules can be reabsorbed into the vocal folds. If the nodules are already too hard, they need to be surgically removed. ENTs often recommend trying ST first in hopes of avoiding surgury . If you have more specific questions about voice therapy, try contacting the American Speech Language and Hearing Association (and honestly, you'll get more knowledgeable advice than from strangers on the Disboard, as great of a group as they are!). Hope all goes well for dd!

Former Opera Singer here, agreeing with you wholeheartedly...
As I read the OP, I was waiting for her to at some point mention her child yelling. Thats my first instinct when I hear nodules. Agreeing with you on the nodules reabsorbing, but not until the child speaks efficiently. The pathologist wants the child to bring water, so that the teacher can hear the hoarseness without other cruddies that may contribute. Therapy is grueling in that it seems so darn basic. like, duh? But its necessary.
I remember our two year old who wouldnt talk. The speech therapist was teaching her, just as my singing coaches had taught me. I just started applying that at home, and voila! (now she wont shut up)
I would say to try the teacher for awhile, and see how you feel. The peripheral websites are all very good.
NO YELLING!!

 

[Lisa loves Pooh]

Just wanted to say that when I took my son to Speech today, I mentioned your dilemma and the therapist said that she heard nothing out of the ordinary that your therapist did.

Hope it all works out and her voice gets better.

 

[Parksfamily5]

My son is 4 and has been going to speech 3 weeks now. He absolutely loves it. He looks forward to it. I think he likes his therapist b/c she calls him "hotshot". lol. Anyway, since it was your first visit, If it were me I would give it another one. If you are still feeling uncomfortable after that visit maybe you should request a different therapist. It isn't helping anyone if you don't like to work with each other.
Is your 30.00 copay? I know it costs 100+ here per session.

 

[brekin67]

My daughter receives SLP weekly for one hour. We had the same SLP for 8 years, but she had to retire this week. She has been diagnosed with Alzheimers. We loved Miss Mary. She worked so hard with DD, she brought books, crayons, flashcards, and tools to help train Jorie to speak better. While we were interviewing replacements, one SLP said she would pick up DD from daycare and take her to school once weekly to do therapy on the drive....Uh, NO! One said she only did 30 minute sessions and we were unable to accept that because it takes several minutes to get DD settled down. We are interviewing a 3rd this Friday, and we have spoke about her treatment methods. From my experience with Miss Mary, I think you should try to find a new SLP. Good luck.

 

[Maybelle]

Did you know your school system will provide you with free ST? If your child has a real problem they can see and address the issues.

Not saying that who you are going to is not worth your cost but it seems you appear to be disappointed or feel like there may not be an issue. If there's no money involved just maybe you can get to the bottom of the issues. Does that make sense?

Both of my children went to ST. My son started at 4 and was not in school and when they were in school they were in private school. However, since you pay taxes your are still provided certain assistance inside the public school system.

It is only provided by the school in cases where it impacts learning/has an educational component. Like not speaking, or articulation errors. I suspect tone of voice wouldn't be covered.

First the disclaimer: I am a speech pathologist. The scenerio you describe sounds like your SLP is doing some diagnostic work in order to figure out the causes of the vocal abuse and best treatment recommendations, which is absolutely correct. Part of what we are trained to do includes taking a detailed case history, which is what your SLP was doing with the questions. I don't find it weird that she asked the parent's opinion about the cause of the hoarseness...parents are a valuable resource and their input can be pretty critical. Ask the SLP why she does what she does and you may feel better once you get an explanation. There is no one "recipe" for voice therapy - the SLP may have to work w/dd a bit to figure out the problem and best treatment. Voice cases can be tricky. I would be more suspicious of the SLP who handed you a list of exercises without taking the time to figure out the underlying problem first. If you still feel uncomfortable, go ahead and ask for the second opinion. Just as a general FYI for anyone reading who is interested, the speech therapy for nodules is recommended if the nodules aren't yet too hardened. By learning to avoid and eliminate vocal abuse, the nodules can be reabsorbed into the vocal folds. If the nodules are already too hard, they need to be surgically removed. ENTs often recommend trying ST first in hopes of avoiding surgury . If you have more specific questions about voice therapy, try contacting the American Speech Language and Hearing Association (and honestly, you'll get more knowledgeable advice than from strangers on the Disboard, as great of a group as they are!). Hope all goes well for dd!

Another SLP here. I work in the public schools, and unless your child is demonstrating difficulty academically, she probably will NOT qualify for services through the school system...but...she may be able to be monitored there. It is up to the district.

I agree with the other SLP that responded to you. The therapist was probably trying to: gain diagnostic info., develop a rapport with your daughter, develop and understanding on how "vested" both your daughter and you are for therapy. Voice therapy is very tricky, and involves a lot of work for both the client and the family involved. It not only involves excercises and lots of thought and practice of easy voice "tachniques," but, for a child, it also takes lots of reminders from the parent and lots of time and effort in determining what environmental factors could be contributing to the issue. For example, I had a client one time who played ice hockey. He was not willing, and the parent was not willing, to take him out of the sport, but he was constantly yelling, and damaging his vocal chords while on the ice, to the point that he would totally lose his voice. We worked for a while on strategies to decrease his yelling on the ice and did come up with some alternatives, but ultimately, I had to dismiss the client, because he was not willing to make the behavioral changes needed to improve the problem. The therapist, depending on the severity of the problem, may look at periods of vocal rest where your daughter will have to refrain entirely from talking...There are lots of techniques that may be used, including relaxation of the breathing mechanism, understanding of the voice and vocal process and decreasing overall body tension in order to decrease vocal tension.

My recommendation would be to question the therapist if you have any direct concerns, and if you are not comfortable, find another therapist...that is your choice. Your daughter, and you need to be comfortable with the therapist for the service to be beneficial. If your daughter knows you are questioning the therapy, she will more than likely not buy into it either. If you do choose to seek out another therapist, you MAY need to do some similar things that you have already done.

**Your Primary question to the therapist should be: How many children with vocal nodules have you treated in the past. It could be that this therapist just does not have the experience to treat this issue.

Other general recommendations for your daughter:

*Have her stay well hydrated!
*If she has allergies that could contribute to the problem...have them dealt with.
*Provide her with lots of quiet opportunities to remain "quiet"
*Monitor times that she is excessively loud or talkative, singing a lot, arguing loudly with siblings, etc...to report back to the therapist...this will help the therapist know what to target.

Good luck!

 

[erin.w]

Another SLP here. I work in the public schools, and unless your child is demonstrating difficulty academically, she probably will NOT qualify for services through the school system...but...she may be able to be monitored there. It is up to the district.

I agree with the other SLP that responded to you. The therapist was probably trying to: gain diagnostic info., develop a rapport with your daughter, develop and understanding on how "vested" both your daughter and you are for therapy. Voice therapy is very tricky, and involves a lot of work for both the client and the family involved. It not only involves excercises and lots of thought and practice of easy voice "tachniques," but, for a child, it also takes lots of reminders from the parent and lots of time and effort in determining what environmental factors could be contributing to the issue. For example, I had a client one time who played ice hockey. He was not willing, and the parent was not willing, to take him out of the sport, but he was constantly yelling, and damaging his vocal chords while on the ice, to the point that he would totally lose his voice. We worked for a while on strategies to decrease his yelling on the ice and did come up with some alternatives, but ultimately, I had to dismiss the client, because he was not willing to make the behavioral changes needed to improve the problem. The therapist, depending on the severity of the problem, may look at periods of vocal rest where your daughter will have to refrain entirely from talking...There are lots of techniques that may be used, including relaxation of the breathing mechanism, understanding of the voice and vocal process and decreasing overall body tension in order to decrease vocal tension.

My recommendation would be to question the therapist if you have any direct concerns, and if you are not comfortable, find another therapist...that is your choice. Your daughter, and you need to be comfortable with the therapist for the service to be beneficial. If your daughter knows you are questioning the therapy, she will more than likely not buy into it either. If you do choose to seek out another therapist, you MAY need to do some similar things that you have already done.

**Your Primary question to the therapist should be: How many children with vocal nodules have you treated in the past. It could be that this therapist just does not have the experience to treat this issue.

Other general recommendations for your daughter:

*Have her stay well hydrated!
*If she has allergies that could contribute to the problem...have them dealt with.
*Provide her with lots of quiet opportunities to remain "quiet"
*Monitor times that she is excessively loud or talkative, singing a lot, arguing loudly with siblings, etc...to report back to the therapist...this will help the therapist know what to target.

Good luck!

Add me to the list as a practicing SLP! I agree with what the other two therapists have said. But I think perhaps one of the most important points is to ask if you're wondering/not sure about something! I never mind explaining my methods to family/patients! good luck!

 

[fac]

Six months and 2 SLPs later, we are in no better shape. With the many SLPs on this board, I am hoping someone can help ...

After about 8 sessions with the first SLP, I just didn't think she knew how to treat DD. When I discussed the "treatment" with the nurse practitioners in the pediatrician's office, both were suprised. I went back to the ENT, when I told him the SLP spent 2 sessions in telling DD to drink more water, he immediately told me that it was not the right approach, and sent me to another SLP with a local hospital. The first SLP was in his medical group and in an office not far from him, the fact that he sent me to another SLP confirmed my suspicious.

After I made the appointment with the hospital, I called the SLP directly just to make sure that it was a right match, she was suprised by the appointment, I later found out she would be out on the scheduled day but she didn't tell me during our conversation. Then her co-worker called me and told me I should be meeting with her instead. After the initial meeting, she met with DD once a week for less than 30 minutes (more like 20 minutes), majority of the time was spent on some casual conversations, then she would take out one page from her book (or notes) and have DD read out 10 sentences.

Is the session normal?
DD has several sessions already, I don't see improvements from those sessions. I wish I can take her book and just go over a page with DD every week. I hope to avoid paying the co-pay to go back to the ENT just to confirm that the approach is wrong again. Even we have insurance, I have already paid several hundreds dollars. I do not mind if it helps DD, but I just don't have confidence....

 

[luvmarypoppins]

So sorry you are still dealing with this.
I know this is the adult view but just yest. I had my vocal chords tested. My voice is still hoarse sometimes but I had alot of extensive cancer surgery on my neck etc. From your previous posts it says the ent just did a brief exam. Did he/she actually look into the vocal chords. This would require putting a scope down the nose and into the throat while being numb. Not the most pleasant thing. I know they did something similar to my ds19in his nose this summer too.

My test yest. involved the speecht heapist doing the test too in conjunction with the ent dr. They had me doing all that breathing stuff and sounds too. Asked me if I drank enough water. I really dont.

I have also taken my one son to speech therapy and its good you are watching and doing egverything at home they are doing at the visit etc.

It sounds like you are frustrated in the progress being made. I know sometimes the opeech therapist told me they get at a platateu phase and it turns not into progress then, its more just maintenance etc.

I would maybe consider getting a more thorough test from a different ent.

Best of luck to your dd.