How Do I Know If My Child Needs Help?

At Susan L. Pike & Associates, we help you find out if your child needs help by completing a diagnostic evaluation. Then, if the answer is yes, we will work with you to determine the best course of therapy.

Early Language Development/Language Delay and Disorders:

  • Does your two-year-old still use jargon or have fewer than 50 words?
  • Does your three-year-old still use one- to two-word sentences or appear uninterested in conversation or listening to stories?
  • Is your four-year-old not speaking in full sentences or having trouble acquiring grammatical forms such as pronouns and verb tenses?

While difficulty acquiring language can be caused by specific developmental disorders or impairments, as many as half of all “late talkers” have persisting language weaknesses that may play a role in later academic performance. Other cases of language delay and/or disorders include children with genetic syndromes, pervasive developmental delay, neurological impairments, hearing loss, or specific language impairment. When a child’s language development seems to lag, parents need to know what steps to take to foster their child’s language growth.

Articulation Disorders:

  • Does your three-year-old have frequent trouble being understood?
  • Is your four-year-old’s speech not clearly understood by teachers and peers?
  • Does your five-year-old still have difficulty pronouncing several sounds?
  • Does your six- to twelve-year-old still have a certain sound or sounds that are not pronounced correctly?

A child may be bright and have lots of ideas to communicate, but if others can’t understand his speech, he can become frustrated and angry. An older child whose mispronunciation was once considered cute can become painfully self-conscious about her speech once she reaches the upper elementary grades. Articulation disorders range from simple developmental cases to more involved disorders such as dysarthria and developmental apraxia which involve underlying oral-motor issues.

Language-Based Learning Disabilities:

  • Is your school-aged child having greater than expected difficulty learning to read?
  • Is your child having difficulty paying attention and following directions in the classroom?
  • Does your child have difficulty remembering specific words, making his connected speech sound choppy or slow and halting?
  • Does your child have difficulty recalling or telling stories or giving well-organized explanations?

Language development and learning to read and write are closely intertwined. A child who has trouble understanding others or expressing himself will have difficulty in the academic world of school. Possible challenges include central auditory processing disorders; phonological processing and early reading skills; comprehension and/or production of spoken and written language.

Orofacial-myofunctional Disorders:

  • Does your child generally have his lips open at rest and during chewing?
  • Does your child thrust his tongue between his teeth (front or side) during swallowing of foods and liquids?
  • Does your child have an abnormal bite (e.g., position of some teeth too far forward)?
  • Did/does your child have a prolonged or frequent sucking habit (finger/s, pacifier, bottle)?
  • Did your child’s teeth move back to their old position after braces were removed?

An incorrect swallow pattern and/or tongue-jaw resting position can be an underlying cause of articulation difficulties and can also interfere with orthodontic treatment. Training of new muscular patterns used in swallowing and maintaining the correct resting position of the jaw and tongue can be an integral part of orthodontic treatment, as well as a necessary step in the correction of a speech disorder.


Sometimes a parent wants a second opinion, a quick screening, a review and discussion of an evaluation, or an observation of their child’s functioning in a classroom. Our consultation services also include:

  • Speaking with another specialist to discuss diagnostic findings or collaborate in treatment goals.
  • Attending a meeting with members of an educational team.
  • Conferencing on the telephone with parents to discuss a recent evaluation or treatment issues.

Consultative Services for Preschools and Daycare Centers

We collaborate with early childhood educators to create language-rich environments from which all children can benefit. We can provide:

  • A detailed, theme-based lesson plans that can be carried out by their staff or with our assistance during an on-site visit.
  • Small-group sessions to stimulate receptive and expressive language skills for various children who may have mild speech-language delays that are not severe enough to qualify them for formal early intervention services.
  • Large-group lessons that incorporate action-songs, vocabulary lessons and hands-on activities tailored to specific curriculum units.
  • Staff development workshops targeting specific areas of need.

Myofunctional Therapy

Myofunctional therapy consists of a series of very specific exercises designed to retrain and normalize the position and movements of the tongue, lips and jaw during the act of swallowing and while at rest. The course of treatment is typically completed in 15 to 20 office visits of approximately one half-hour each, and requires commitment to a few brief practice sessions on a daily basis.

Normal swallow versus a tongue thrust

During a normal swallow the tip of the tongue is placed on the alveolar ridge (gum ridge behind the upper teeth), the jaw closes with occlusion of the rear molars, and the tongue moves up in a wave-like motion to propel food back and downward. The most common swallowing disorder is a tongue thrust. In an anterior tongue thrust the tip of the tongue typically presses on or between the upper and/or lower front teeth. In a lateral tongue thrust the tongue presses out the sides, often creating open spaces in the pre-molar area. These types of movements can cause and/or contribute to a disturbance in the relationship of the teeth, referred to as a malocclusion. In addition, the resting position of the tongue and jaw may also be contributing factors.

How can myofunctional therapy help?

Myofunctional therapy can provide:

  • A normalizing influence on the position and growth of teeth.
  • Assistance in establishing correct tongue placement for production of specific speech sounds in correction of articulation.
  • Assistance to orthodontic treatment by removing the antagonistic force of incorrect tongue movements.
  • Assistance in retention of a correct bite once orthodontic treatment has been completed.
  • Improvement in overall facial appearance once correct jaw and tongue resting positions have been established.

Accent Modification

Speakers of English as a second language typically have pronunciation patterns that contain features of their native language. Sometimes this accent pattern is so strong that it can interfere with effective communication. English spoken with a heavy accent can:

  • Reduce intelligibility, making it hard to be understood.
  • Interrupt the flow of conversation due to frequent repetition.
  • Interfere with job performance where communication skills are required.
  • Limit job marketability.

How do I know if I need accent modification?

  • Have you learned to speak English but are having trouble being understood due to an accent pattern?
  • Are you a business owner with employees who need to improve their pronunciation to more efficiently interact with clients?
  • Is your accent interfering with your ability to get a better paying job, or to simply communicate easily with people you meet?
  • Do you wish you sounded more like the standard American English speaker typified by television newscasters?

Accents can be modified

Accents have rule-based, predictable features, based on the speaker’s language of origin. These consist of particular sounds (phonemes), stress patterns and intonation contours that, once identified, can be replaced with the features of standard American English. With practice, these new features can replace old habits of pronunciation. You CAN change your accent!

Fluency Disorders

  • Does your two- or three-year old have excessive whole or part-word repetitions?
  • Does your child appear to struggle or “get stuck” trying to get words out?
  • Do you observe tremors, rising pitch and loudness on words, or stoppage of breath flow?
  • Does your child appear to avoid speaking situations?

Young children typically repeat words and phrases during the years of language acquisition. These are normal “developmental” types of disfluency. Some have more difficulty than others and may be on a path toward true stuttering. An evaluation of speech fluency can determine whether intervention may be appropriate. Family members and caregivers are an integral part of treatment, which may be indirect (modifying the environment) and/or direct (providing the child with strategies to cope with disfluencies).