Your Speech & Language Questions Answered!

Patti Hamaguchi, M.A., CCC-SLP

Readers, this month I’m again answering some frequently asked questions.

Q. My child has problems with the pitch and tone of her voice. It sounds monotone. Is there anything that can be done to help that?

A. We often find that children on the autism spectrum have a “different” sounding cadence or pitch when speaking. The clinical term is “prosody”, that is the rising and falling our voice does, the flow, and melodic contours. Interestingly, we know that many of these same children have difficulty interpreting these very same elements in the voices of others, which makes interpreting sarcasm, emotion, and meaning challenging. (“You went WHERE? In an angry voice vs. “You went where?” Such as in “I can’t hear you.”) Sometimes the child will sound monotonic and sometimes the voice is more sing-songy than a typical child or choppy. These difficulties can be extremely challenging to change, and many times it is best to work on them as the child learns. For example, if the speech pathologist is working on asking a question to a peer such as, “Where should I stand?” we will want to incorporate work on pitch at the same time we work on sentence structure, articulation and gaining someone’s attention. Using visual supports to provide feedback—to show the voice rising and falling—is helpful, but often a challenge. Sometimes, software programs that address pitch and sustaining voice can be used, as well as some apps. Frequently, this is an area that is addressed for children who have more advanced language skills and are very high-functioning. Some people also report that using therapeutic listening programs or programs such as Fast ForWord also train the ear to hear pitch and indirectly provide some improvement in this area, but research is sparse on their effectiveness in this area.

Q. Why is it so difficult for my child to talk about what happened at school, on our vacation or why he’s upset? He’s got verbal skills but having conversations about things that are not in front of him is a challenge. Is there anything we can do to work on that?

A. What you are observing is a common issue for children who struggle with language. In particular, they can look at something and ask for it or sometimes say something about it, but once it’s gone, it becomes much more difficult to do. Why is that? For one thing, most children on the autism spectrum have difficulty staying focused, and their visual sense (letters, puzzles) is often more developed than their auditory sense (listening, comprehending what people say). When trying to have a conversation with you and react to your questions, your child has to tune out all of the visual input he sees (posters, a fly on the wall, his shoelaces, his hands) and focus on something—words—that are invisible. Without something to “see”, talking about it becomes more demanding. So start small. Use toys or things in sight and talk about them. Cover them up with a towel or something and try to repeat it. Set a timer and let your child know you’ll be talking about it again in 5 minutes (or 1 minute, if you need to start here). Over time, try to stretch out the time between the visual exposure and the conversation about it. When you go out and about to stores, doctor’s visits, etc., take a quick snapshot on your cellphone. When you get home, try to elicit language without looking at the pictures, but pull them out if needed. (“What did we eat at the yogurt place? I had strawberry frozen yogurt. What did you have?”) Provide the first sound if needed to help with word retrieval (“You had some chooo…?”) and if that doesn’t help, pull out the picture, then and then repeat the conversation a short time later.

Q. The IEP season is quickly approaching and I know my daughter is going to do poorly on the speech tests. It’s a stressful process for her and I don’t think it really captures all of her strengths and weaknesses. Should we decline to have her tested?

A. In a word, no. Schools and private practices, hospitals, etc. are required to show progress—that the therapy is in fact working—as part of the therapeutic process. The difficulty with children on the autism spectrum is that their performance is so variable. It really depends on what moment in time you do it, what mood they’re in, and who is doing the testing. A good clinician knows that formal assessment is only a small piece of the assessment plan for children on the autism spectrum. Much of the important information will be gained from interviewing the parents and teachers, watching the child in a number of settings—especially with peers, and engaging in play and conversation. Formal tests do give us a quick snapshot of how your child performs the exact same tasks from year to year but it should not be the only measure of your child’s progress.

About the Author

Patti Hamaguchi, M.A., CCC-SLP is a licensed speech-language pathologist and the Director at Hamaguchi & Associates Pediatric Speech-Language Pathologists Inc., (Cupertino) and the CEO of Hamaguchi Apps for Speech, Language & Auditory Development. She is the author of Childhood Speech, Language & Listening Problems: What Every Parent Should Know (Wiley & Sons, 2010 3^rd ed.), A Metacognitive Program for Treating Auditory Processing Problems (Pro-Ed, 2003) and It’s Time to Listen (Pro-Ed, 2002) as well as an expert on speech topics for BabyCenter.com.