NJ STEPS 

Pediatric Speech & Language Therapy Services

• Articulation Disorders: Errors in speech that are made and continue past a certain age. Children typically acquire speech sounds in a developmental sequence. (ie: difficulty saying the /r/ sound)
• Phonological disorders: When there are patterns of not saying words correctly. (ie: “dut” for “duck”
• A motor speech disorder: When the child has trouble moving muscles required to talk. There are two types of motor speech disorders: dysarthria and apraxia.
• Dysarthria: the muscles of the mouth, face, and respiratory system become weak, move slowly, or do not move at all.
• Childhood Apraxia of Speech (CAS): Childhood Apraxia of Speech is a speech disorder of motor programming and planning that affects a child’s ability to develop and produce intelligible speech. CAS causes a child to have difficulty in voluntarily planning, producing and sequencing the movements needed for speech. 

Our skilled therapists are trained in a variety of strategies that are incorporated into the treatment sessions. Therapy may include passive and/or active stimulation. This is done in a positive play environment tailored to your child’s individual needs.

• Talk Tools ® Oral Placement Therapy for Speech Clarity and Feeding
• SysteMatic Intervention for Lingual Placement (SMILE) 
• PROMPT - Prompts for Restructuring Oral Muscular Phonetic Targets.
• The Kaufman Speech to Language Protocol (K-SLP)
• The Cycles Phonological Remediation Approach 
• Tapping Cues/Pacing Boards
• Prosodic Facilitation 
• Interactive Metronome® 

An expressive language disorder is difficulty using words to communicate needs and ideas. Children who have this disorder may leave words out of sentences, mix up word tense, and repeat phrases or parts of sentences. It can lead to problems in social settings and at school. 

These children may:

• Have a hard time putting words together into sentences, or their sentences may be simple and short with the words in the wrong order
• Have difficulty finding the right words when talking, and often use placeholder words such as “um”
• Have a hard time asking questions
• Have a hard time learning songs and rhymes
• Have a vocabulary below the level of other children the same age
• Leave words out of sentences when talking
• Use certain phrases over and over, and repeat (echo) parts or all of questions
• Use tenses (past, present, future) improperly

A receptive language disorder impacts how people understand oral and written language. They may have difficulties processing and retaining auditory information, and have difficulty with instructions and directions.

They may have:

• A hard time understanding what other people have said
• A hard time understanding what gestures mean
• A hard time answering questions
• A hard time taking turns in a conversation
• Problems following directions that are spoken to them
• Problems organizing their thoughts
• Problems understanding the meanings of the words or concepts used by others
• Problems understanding meaning when words are imbedded into sentences
• Problems understanding complex sentences

Treatment will start with a thorough formal evaluation of your child’s communication skills. Appropriate, functional goals and attainable objectives will be written and shared with the parents. Therapy will consist of activities designed to build on your child’s strengths in a fun, positive manner, and to target the needed areas.

• It Takes Two to Talk® — The Hanen Program® for Parents of Children with Language Delays 
• Interactive Metronome® 

Mealtime can be stressful! Not only does eating become unpleasant  but it could become dangerous. If your child struggles with chewing and swallowing, malnutrition and respiratory issues become real concerns.

Whether your child reacts physically with discomfort or choking, avoids eating, we can help! Feeding therapy provides treatment for these difficulties and can result in great success and positive outcomes.

We help children who struggle with eating, chewing, swallowing, and other mealtime activities. We want to make meals pleasurable for your family once again, and help your child get the nutrition he or she needs!

Feeding Therapy Evaluation:

The first step in a successful feeding program is a proper diagnosis. We examine the complete eating process and determine where the problems are occurring, and whether or not there is an underlying cause. It could be physiological, deficient sensory-motor development, decreased muscle coordination, dysphagia (swallowing difficulty), or psychological. Accurate diagnosis is critical to development of a treatment plan.

Treatment:

• Dysphagia
• Orofacial myofunctional disorders (tongue thrust)
• Difficulty swallowing
• Difficulty eating
• Disorder related to picky eating
• Choking, spitting up, or gagging
• Sensory-Motor Dysfunction

Successful therapy will result in:

Being more relaxed at mealtimes

Enjoying a greater variety of foods and drinks

Quicker and less messy meals

Healthier physical growth and weight gain

Better nutritional support

Ankyloglossia is a condition where the skin under the tongue, lips or cheeks is too tight and causes restricted movement of the tongue, lips and cheeks impacting clarity of speech, feeding/swallowing and sleeping.

• Pre-op and Post-op Care after a frenectomy (release of the tethered tissue) 
• Teaching stretches and exercises prior to the release and helping families correctly perform stretches for the weeks following release.
• Talk Tools®: A Sensory Motor Approach to Feeding
• Talk Tools ® Oral Placement Therapy for Speech Clarity and Feeding
• SysteMatic Intervention for Lingual Placement (SMILE) 
• PROMPT therapy

Social skills is the term that refers to a child’s ability to use language in order to interact with others. When social language is impaired, the child struggles to understand social rules, use correct body language, use appropriate language, and have empathy to understand the world from someone else’s point of view.

According to American Speech and Hearing Association:

Treatment strategies for social communication disorder focus on increasing active engagement and building independence in natural communication environments.

One-on-one, clinician-directed interventions are useful for teaching new skills. Group interventions are used in conjunction with one-on-one services to practice skills in functional communication settings and to promote generalization.

• Social Scripts—a prompting strategy to teach children how to use varied language during social interactions. 
• Social Skills Groups—an intervention that uses instruction, role play, and feedback to teach ways of interacting appropriately with peers. 
• Social Stories™— structured intervention that uses stories to explain social situations to children and help them learn socially appropriate behaviors and responses. 
• Superflex® A Superhero Social Thinking® Curriculum - By Stephanie Madrigal and Michelle Garcia Winner
• Thinking about YOU Thinking about ME®, 2nd Edition, By Michelle Garcia Winner
• Size of The Problem® - By Michelle Garcia Winner

“Stuttering is a communication disorder in which the flow of speech is broken by repetitions (li-li-like this), prolongations (lllllike this), or abnormal stoppages (no sound) of sounds and syllables. There may also be unusual facial and body movements associated with the effort to speak. Stuttering is also referred to as stammering.” The Stuttering Foundation

It is important to note that most children repeat, hesitate and have occasional difficulty with fluent speech. But if your child has been struggling for an extended period of time to complete his thoughts smoothly and freely, you should consider having him evaluated.

Treatment for stuttering begins with a parent interview and a formal evaluation to determine the frequency and severity of the sound disruptions/repetitions. Following the evaluation, a FUN, systematic, individualized program is designed to work with the child’s and family’s needs.

• Direct Therapy
• Indirect Therapy
• Involvement of Support Providers
• Interactive Metronome® 

Voice Disorder: Trauma or damage to the vocal cords causing vocal nodules, polyps and hemorrhages. 

Voice therapy: 

We Use a variety of research based techniques to improve voice and resonance disorders. The type of treatment is chosen after the client is evaluated by an otolaryngologist (ENT) followed by comprehensive evaluation conducted at NJ STEPS. 

• Flow Phonation
• Semi Occluded Vocal Tract Exercises 
• Vocal Resonance 
• Diaphragmatic Breathing
• Vocal Hygiene
• Family Training 
• Environmental Changes

Children with APD may exhibit a variety of listening and learning complaints. For example, they may have difficulty understanding speech in noisy environments, following directions, and differentiating between similar-sounding speech sounds.

Following a comprehensive evaluation conducted by an Audiologist, our speech therapists will use additional tests to assess the following areas:

• Auditory memory
• Word discrimination
• Auditory conceptualization 
• Auditory closure 
• Auditory synthesis 
• Auditory association 
• Auditory comprehension 
• Understanding and following directions 
• Phonemic awareness

Treatment for APD/CAPD is very specific to each child. The type, frequency, and intensity of therapy will be tailored to the intensity and type of APD present. Our speech therapists will work closely with your child’s school and family to provide optimal environmental and lifestyle changes coupled with a personalized treatment plan.

• Interactive Metronome

Natural Language Acquisition: There are two ways that children learn language that are both normal and valid. Most people are aware of analytic language development, where basic units of language words and the primary focus is on expanding utterance length (i.e. "ball," "more ball," "want more ball") . The second way in which children can learn language is gestalt language development where the basic units of language may actually begin with whole sentences (i.e. "Let me have the ball") that are eventually broken down into single words (I.e. "ball"). Once this occurs, children can begin to move towards self-generated language. The Natural Language Acquisition framework describes the stages in which gestalt language development occurs.

Treatment by an orofacial myologist involves short exercises, a form of physical therapy that trains your oral and facial muscles to function properly, similar to going to the gym to build up other muscles in your body.