Speech And Learning Difficulties

There are six main types of fluency disorders namely: normal developmental disfluency, stuttering, neurogenic disfluency, psychogenic disfluency, language based disfluency, and mixed fluency failures. Due to the uniqueness and difference of each case, all of them require a different kind of management approach in speech therapy.

Management For Normal Developmental Disfluency

Developmental disfluency occurs during the critical period of speech and language development. A child is considered to have this condition if 5% or less of his overall speech-sample are repetitions and 1% or less are prolongations.

Etiologies of this condition could be: excitement while speaking, demands of Language Acquisition, Speech-Motor control is lagging, environmental factors like stress in the family (e.g. separation of parents) and the situations they are in, and daily pressures of competition.

Concerned parents still make their children with this kind of disfluency undergo therapy even if this could still possibly decline. These children are taught how to: decrease the rate of their speech, relieve other pressures that the therapist and parents mutually agree to change, and simplify their language.

Management For Stuttering

The onset of stuttering may occur between ages 1 ½- 11 years old but it mostly occurs during early childhood stage, which ranges from 2-6 years old. A condition is diagnosed to be stuttering when the speech has 5% or greater repetitions and 1% or greater prolongations. 

There are several approaches to therapeutic intervention for early stuttering namely: environmental manipulation, direct work with the child, psychological therapy, desensitization therapy, parent-child interaction therapy, fluency-shaping behavioral therapy, and parent and family counseling

Management For Neurogenic Disfluency

The onset of neurogenic disfluency is varied. It can occur at any age but it usually appears during adulthood or among the geriatric population. The neurological events that can trigger the onset of neurogenic disfluency are as follows: strokes, head trauma, extrapyramidal diseases, tumors, dementia, drug usage, anoxia, cryosurgery, viral meningitis, and vascular disease.

Self-monitoring program is one of the most suggested modes for the management of this kind of disfluency.

Management For Psychogenic Disfluency

The onset of psychogenic disfluency is also varied. A condition is said to be under this category when 90% of the patient’s utterances have become disfluent when the emotional stimuli is present. This condition originates in the mind. The etiology could be acute or chronic psychological disturbances. Stress is another factor that may also cause the disorder.

Psychologists, psychiatrist and counselors can only provide treatment of this kind of fluency disorder. Speech pathologists prioritize treatment only of the bad speech habits, which may still be present after resolving the emotional issues of the patient.

Management For Language Based Disfluency

This kind of fluency disorder may arise in a child as soon as any newly introduced language skill emerges, specifically during the toddler to preschool stage. The fluency failure may be due to linguistic or motor immaturity. It can also be a result of the child’s struggle to acquire newly introduced and more complex language rules.

The management of this kind of disfluency usually focuses on improving the child’s language skills to increase his/her linguistic and motor maturity.

Management For Mixed Fluency Failures

The onset of this condition cannot be exactly determined, since it is an overlap pf two or more causative factors. No specific age for identification since onset may be sudden. Therapists must prioritize the most debilitating and/or the most correctable aspect of the disfluency.

There is a lot of fluency shaping techniques used in speech therapy for fluency disorders. However, due to the advancements of technology, a new kind of fluency shaping approach is now available. This is possible by the use of biofeedback mechanisms.

Fluency Shaping At A Glance

In fluency shaping therapy, motor skills are acquired. But in order to have a successful therapy the client needs to have feedback. Since it involves physically learned behavior, the client should know if what he is doing is right or wrong.

For example, a therapist asks his patient to use diaphragmatic breathing. The client and the speech therapist knows if the client is doing it right or wrong because they could observe it by putting a hand in the patient’s stomach.

On the other hand if the therapist asks the client to execute air with vocal tension, and he does so, and then therapist asks the client to do it faster; it would be hard to observe and see the difference between the two actions. That’s why biofeedback devices were invented.

Biofeedback Mechanisms

A biofeedback mechanism is an instrument that shows the user’s physiological activity’s display and measurement. It is very helpful to increase the awareness of the client. The client has an increased control of the activity too. It provides real time feedback that is more reliable and precise than human observation. It is able to measure what can’t be seen or heard by human senses.

It is also helpful with to that SLP so that he can concentrate on the other behaviors of the client. If the client is a visual learner, it would benefit him very much and it may speed up his way to successful fluency therapy. There are devices that can be used not only in the clinic but at home too, so the client can practice even at home.

Some examples of this kind of devices are CAFET or the Computer-Aided Fluency Establishment And Trainer, Dr. Fluency, EMG (Electromyograph) and Vocal Frequency Biofeedback.

The Dr. Fluency and CAFET are computer based biofeedback systems. They make use of a microphone to monitor the user’s vocal fold activity. A chest strap is also used to monitor breathing. The change in vocal fold activity and breathing is displayed on the computer display. Instructions and error messages are also seen.

The device trains a lot of fluency skill behaviors such as: continuous breathing, relaxed diaphragmatic breathing, pre-voice and gradual exhalation, gentle onset, continuous phonation, adequate support of breath, and phrasing.

In a study of CAFET, 197 teenagers and adults used the program reported that just after six months of finishing the program, eighty-two percent met the fluency criteria. After twelve months, eighty-nine percent were fluent. Lastly, in two years of post-therapy, ninety-two percent were fluent.

EMG and Vocal Frequency Biofeedback is a device using an EMG working with a DAF (Delayed Auditory Feedback) mechanism. The EMG monitors muscle activity and if it detects something wrong a red light would turn on and the DAF would automatically play.

The use of biofeedback mechanisms can be considered to a breakthrough in the realm of speech therapy and fluency disorders. However, not every one can have access through it, since getting such devices can be very expensive.

Nonetheless, other fluency shaping approaches are still viable and have been proven effective already from years of practice.

There are a variety of tools and materials, which are designed for speech therapy in the market right now, thus giving the therapist much more options when it comes to choosing the equipments that could best maximize his services. One variety of materials are toys. And there are various reasons for the rise in its use.

The Toys and Their Functions

Before the therapy starts, an evaluation of the patient’s oral motor structures is usually done. This is where the therapist inspects the various structures that are inside and around the patient’s mouth that are used for speech. Some of these are the lips, tongue, teeth, jaw and cheeks.

For the structures to be seen more accurately, a penlight is usually used. The only problem with it is that the child may not find it very pleasant to have a flashlight in his mouth. This is now why there already is the colorful and jelly-like oral light system, which gives the same amount of light minus the metallic appearance.

The examination of these muscles also usually requires gloves and tongue depressors; in which kids do not appreciate both of whose smell and taste. This is now the reason why colorful and fruit flavored gloves and tongue depressors are already available.

After the said oral motor examination has been performed, the therapist may find a weakening in one or some of the structures. Some seemingly ordinary materials and toys may aid the strengthening of these muscles. One of them is the straw, which can come in all colors and designs. It serves two purposes.

The first purpose is for the rounding of the lips. This activity is important for the articulation of vowels and the semi-vowel /w/. Another function is the act of sipping. In this activity, the velum, the muscle right above the throat is exercised. This muscle is used when producing vowels and back consonants like /k/ and /g/.

Another commonly used material is a toy, which has to be blown. An example would be the whistle. The whistle is considered a difficult blow toy. It means that among the toys that work when blown, it is one of those, which requires more effort for it to perform its function.

The whistle, like the straw, aids in the exercise of the muscles of the lips. Another structure, which it strengthens, is the cheeks. It maximizes the capacity of the cheeks to hold in air and to gradually blow it out.

Other materials that are more commonly used are picture cards and interactive books. They usually contain pictures of words, which represent all the speech sounds. When these cards are used, all the therapist has to do is to show the picture and have the child produce the word together with the speech sound within the word.

Why Play?

If the patient sees the materials they have for therapy are colorful and fun toys, he will come to think that the reason he is in the clinic is to play and have fun. And having the child thinking this, will allow the child to cooperate with the therapist.

Play is a universal activity that blends social, cognitive, linguistic, emotional, and motor components. It is an integration of the many aspects of a child. Play serves as a representation of the thoughts and abilities of a child. Through play, the therapist will be able to know how to approach the concerns of his patient.

During the assessment of an individual with suspected fluency disorder, there are some things to remember to make the assessment more comprehensive and useful. Here are some of those critical points to take note of during assessment.

Benefits Of Obtaining Both Reading and Conversation Sample

It is more beneficial to obtain both reading and conversation sample from school children and adults because this would give more reliability and credibility to the samples taken.

Since stuttering varies in different situations, a reading and conversation sample would allow the clinician to see the behaviors of the person in two different tasks. A conversational speech sample is likely to have more variability, while a reading passage would likely have less variability.

Information To Assess Motivation

Through interview, a therapist can learn a lot from his client. In fact, insight about the client’s motivation could be seen by asking the following questions like ”What do you believe caused you to stutter?”, “Has you stuttering changed or caused you more problems recently?, “Why did you come in for help at the present time?”, “ Are there times or situations when you stutter more? Less? What are they?”.

Benefits Of Continuing Evaluation

No individual could be understood in an hour or two; that’s why continuing of evaluation is recommended. The clinician might overlook an important element at times and some times a vital clue will not be present in the samples of behavior taken from the limited time of the evaluation period.

Note The Difference When Assessing Feelings and Attitudes

Assessing a school-age child’s feelings and attitudes would require the clinician to establish rapport and to get to know the child much better after some time, because the clinician’s judgment is also a fair measurement in the case of school-age children.

Talking to the child and observing his behaviors would be necessary. When the clinician has known the child much better, he could administer the A-19 Scale to the child. Other methods could also be used such as “Worry Ladder” and  “Hands Down” that could be found in the workbook, The School-Age Child Who Stutters: Working Effectively with Attitudes and Emotions.

For adults and adolescents assessment of feelings and attitudes are usually done by administering tools such as, the Modified Erickson Scale of Communication Attitudes, the Stutterer’s Self-Rating of Reactions to Speech Situations, the Perceptions of Stuttering Inventory and the Locus of Control of Behavior Scale.

Remember The Role Of The IEP Team

An Individualized Education Program (IEP) team is appointed to a child to be the ones to consider reports by the clinician and other information. They decide if the child meets the state’s eligibility standards and if the child’s stuttering has a negative effect on his education.

If a child is eligible for services measurable, the IEP team sets goals and short-term objectives for the child. They also provide services needed by the child for improvement in the educational setting.

Goals Of Trial Therapy

Trial therapy for a school-age child is done to understand what approach might work and what might be difficult for him. This could increase the child’s motivation and positive outlook for the treatment. In the case of adults and adolescents, trial therapy is done for 3 main reasons.

First, is to get an idea of how a client would respond to different therapy approaches. Second, is to make a differential diagnosis between developmental, neurological or psychological stuttering. Third, it gives a preview to the client of what to expect during therapy sessions, in effect it would give them motivation to go on their treatment.

PROLAM-GM is an acronym for the various intervention and transfer strategies used in the management of stuttering. PROLAM, which stands for physiological adjustments, rate manipulation, operant controls, length and complexity of utterance, attitude changes, and monitoring, are the intervention strategies. GM, which stands for generalization and maintenance, are the transfer strategies.

Physiological Adjustments

Physiological adjustment strategies include tactics that manipulate bodily components known or thought to be involved in the production of stuttered speech. An example of this would be the attempt to use gentle contact between the articulators when talking.

The rationale behind this approach is that the physiological components necessary for the production of normal fluent speech are in some way used inappropriately when stuttering occurs. Therefore, the therapy tactics used will result in a “readjustment” of the disordered component, or in use of compensatory behaviors and strategies.

Rate of Speech Manipulations

Use of a reduced speech rate to modify stuttering operates in the belief that: (a) reduction of rate results in simplification of the physiological speech processes, thus allowing easier synchronization or; (b) reduction in the rate of speech prevents the stutterer from anticipating feared stimuli that result in the production of the stuttering response.

The rate of the stutterer’s speech may be reduced by: prolongation, combining prolongation with continuous phonation, and using an instructional rate control method.

Operant Controls

Use of operant controls in the management of stuttering believes that if stuttering is an operant behavior (behaviors whose frequency or probability of occurrence are influenced by the consequences they generate), then its frequency will increase if it is reinforced, and its frequency of occurrence will decrease if it is punished.

Two of the most frequently used operant procedures for treating stuttering are positive reinforcement of fluency and punishment of stuttering.

Length and Complexity of Utterance

Controlling the length and complexity of the stutterer’s utterance reduces stuttering and increases fluency. This technique is often used to increase fluent speech. Most of the approaches utilizing this technique combine manipulation of length and complexity of the client’s language with operant controls (punishment of stuttering and reinforcement of fluency).

Attitude

There are two components of stuttering namely: the feelings accompanying it and the speaking behaviors that are resulted from it. It is believed by some that to have a successful therapy, a balance of treating both factors should be done. That’s why attitude manipulation is done in some approaches while in other approaches it can be optional depending on the case of the client.

Monitoring

In the science of Speech Pathology, especially in the field of stuttering, there are a lot of meanings for the term ‘monitoring’. Some say it’s a process in which the PWS becomes aware of what he is doing at the time he is doing it. Some say it is a specific form of consciousness where the act of speaking is raised from an automatic level to a purposeful level. Basically, it has three key components: self-awareness, deliberate control and self-feedback.

Generalization

The technical term for generalization is “the occurrence of a relevant behavior under different nontraining conditions.” The term generalization is usually interchanged with ‘transfer’ or ‘carryover’.

Maintenance

Sometimes, when clients are able to achieve fluency, they think the fight is over. They forget to maintain their skills and in result they have a relapse with their stuttering. Maintenance refers to different after-treatment activities to help clients keep the skills they learned from therapy intact.

Some activities to help maintain skills are daily self-monitoring activities, regular clinic contacts, refresher programs and having self-help groups.

One of the main categories of speech problems in need for speech therapy are fluency disorders. However, there are different types of fluency disorders, even though they may all seem the same. Each type has its own cause, and defining characteristics that make them stand out from one another.

There are basically six main types of fluency disorders, while some are considered to be other conditions that are related to fluency disorders.

Normal Developmental Disfluency

Normal developmental disfluency, is a fluency disorder that is a lot of times mistaken to be stuttering. This condition occurs with children from ages 1:6- 6 years old, although the peak of the condition is considered to be 2-4 years of age.

A lot of parents may be concerned of the way their child speaks, but in reality, this is a normal condition that every child goes through. Normal developmental disfluency is a normal part of a child’s development. So there is really no need to worry at all.

A child would normally get over this stage as his speech skills develop. However, a proper environment, and interaction is needed for that to happen. If a child is pressured by his parents or people around him about his speech, the higher the probability that his disfluency would become a problem in the future and could develop to stuttering.

Stuttering

Stuttering is a disorder of childhood (developmental) that is characterized by an abnormally high frequency or duration of stoppages in the forward flow of speech. Although normal developmental disfluency has its own share of stoppages, stuttering on the other hand has some extra characteristics that normal developmental disfluency doesn’t have.

What makes stuttering different, from normal developmental disfluency, is that stuttering has escape behaviors, avoidance behaviors, and other secondary behaviors. These so called behaviors are also called physical concomitants. Some examples are eye blinks, head nods, jaw tremors and total body gyrations.

Neurogenic Disfluency

This kind of disfluency is a result of an identifiable neuropathology in a person that has no history of fluency problems prior to occurrence of the pathology. People who have accidents that caused brain problems, which induced their disfluency, fall into this category.

Neurogenic disfluency has similar characteristics as stuttering, including the physical behaviors like eye blinks and tremors. The thing is that, the main problem in conditions like these is not fluency at all, but the lesser control of muscles needed in speech production.

Psychogenic Disfluency

A disfluency with no found evidence of neurological dysfunction and no history of developmental stuttering. It is of sudden onset and attributed to an identifiable emotional crisis. Can be grouped into three categories namely: emotionally based, manipulative, and malingering disfluencies

An example of this kind of disfluency is when a person starts to stutter when a specific other is around. For instance, a student who is afraid of her teacher, starts to stutter every time her teacher is around but speaks fluently when around her friends and family.

Language Bases Disfluency

This is a disfluency that is attributed to the development of linguistic sophistication. The main root of the problem here would be language problems, which would require language based therapy rather than fluency-based therapy.

Mixed Fluency Failures

These are fluency failures that are characterized by overlapping causative factors. Speech pattern observed is the result of a blend of two or more factors/disfluency.

Cluttering

This is a condition that is related to fluency disorders. It is considered to be the extreme of stuttering. It is a disorder of timing and rhythm of speech where the person speaks too fast that his speech can’t be comprehended. The thing is, a clutterer isn’t aware that he is cluttering, while a stutterer is very much aware that he stutters.

One of the not so noticed areas of rehabilitation medicine is Speech Therapy. In fact, a lot of people may not even know that something like this existed. It may be the case that this is your first time to encounter the field or you may have heard it somewhere, but don’t fully understand what the practice is all about.

The sad truth about Speech Therapy is that you may not encounter it unless the situation calls for it. However, getting to know what the practice is can be very beneficial information.

What Is Speech Therapy?

As the name suggests, speech therapy deals with speech problems that an individual may encounter. However, the field of Speech Pathology doesn’t only tackle speech, but also language and other communication problems that people may already have due to birth, or people acquired due to accidents or other misfortunes.

Speech therapy is basically a treatment that people of all ages can undergo through, to fix their speech. Although speech therapy alone would focus on fixing speech related problems like treating one’s vocal pitch, volume, tone, rhythm and articulation.

Goals Of Speech Therapy

Speech Therapy aims for an individual to develop or get back effective communication skills at its optimal level. Recovery mainly depends on the case and severity of your problem, especially if your speech problem is acquired, meaning you had normal speech skills before then you had an accident or abrupt incident that caused your current speech problem; thus, you may or may not get back your old level of speech function.

Speech Problems

Speech problems are mainly categorized into three namely: Articulation Disorders, Resonance or Voice Disorders and Fluency Disorders. Each disorder deals with a different pathology and uses different techniques for therapy.

Articulation Disorders

Articulation Disorders are basically problems with physical features used for articulation. These features include lips, tongue, teeth, hard and soft palate, jaws and inner cheeks. If you have an Articulation Disorder, then you may have a problem producing words or syllables correctly to the point that people you communicate to can’t understand what you are saying.

Resonance or Voice Disorders

Resonance, more popularly known as, Voice Disorders mainly deal with problems regarding phonation or the production of the raw sound itself. Most probably, you have a Voice Disorder when the sound that your larynx or voice box produces comes out to be muffled, nasal, intermittent, weak, too loud or any other characteristic not pertaining to normal.

Fluency Disorders

Fluency Disorders are speech problems with regard to the fluency of your speech. There are some cases that you talk too fast, in which people can’t understand you, thus, you have a Fluency Disorder of Cluttering. The most common Fluency Disorder however, is Stuttering, which is a disorder of fluency where your speech is constantly interrupted by blocks, fillers, stoppages, repetitions or sound prolongations.

Who Gives Speech Therapy?

A highly trained professional, called a SLP or a Speech and Language Pathologist, gives Speech Therapy. Speech and Language Pathologists are informally more popularly known as Speech Therapists. They are professionals who have education and training with human communication development and disorders.

Speech and Language pathologists assess, diagnose and treat people with speech, communication and language disorders. However, they are not doctors, but are considered to be specialists on the field of medical rehabilitation.

Crouzon Syndrome is a condition that would require speech therapy. This is mainly because of the major features of the syndrome, which affect main physical components used for speech production, such as articulators.

Crouzon Syndrome

It is a result of premature closure of some cranial sutures and is also known as branchial arch syndrome as it specifically affects the first branchial arch where the maxilla and the mandible are developed. It is transmitted from generation to generation in an autosomal dominant manner.

How Often Does Crouzon Syndrome Occur?

As of year 2000, the demographics of Crouzon syndrome is that approximately one per twenty-five thousand live births have this condition. Crouzon syndrome also equally affects all kinds of ethnic groups.

Language Characteristics of Individuals with Crouzon Syndrome

The individual’s mental capacity dictates his/her ability to comprehend language. Unlike what some people think, not all individuals with Crouzon Syndrome have cognitive deficits. Usually, their mental capacity is in the normal range, which tells us that they are capable of acquiring language and using it as a means for communication.

These individuals have language skillswhich are at par with the skills of others of the same age. However, some still manifest significant mental developmental delay secondary to excessive intracranial pressure. In other cases, the presence of hearing problems contributes to the language acquisition difficulty.

Still in other cases, inappropriate breathing patterns make speaking difficult which in turn makes communication a tiring and an unpleasant experience.

Articulation Problems

In some cases, an individual with Crouzon Syndrome may exhibit oral distortions of fricatives and affricatives especially sibilants and inconsistent distortions in productions of /r/ and /l/.  Most of these errors are attributed to abnormal tongue placement as caused by the defective maxillomandibular relationship.

However, some individuals may display speech problems that are in no way related to their oral structures. Other speech manifestations are also characterized by denasalization of /m/, /n/. Problems in articulating bilabials and round vowels may also be present due to reduced skills in lip closure and lip rounding.

Voice Problems

Hypernasal speech is a common characteristic of individuals with Crouzon Syndrome. This is usually due to velopharyngeal insufficiency. Hyponasal speech may also present itself albeit less common. It is often due to nasal obstruction, which is surgically correctable.

These unusual resonance and speech patterns may either be a result of a small nose, high arched palate or the mandibular malocclusion. In terms of vocal quality, hoarseness may be present due to the development of vocal cord nodules in compensatory laryngeal activity.

Psychosocial-Emotional Problems

One psychosocial problem that individuals with Crouzon Syndrome face is the attractiveness vs. unattractiveness issue. Because of the prominent cranio-facial deformity these individual are often victims of bullying, teasing and social isolation.

The visual and hearing impairments often hinder the comfortable flow of communicative exchanges. They feel restricted and limited in their socializations, with a marked difficulty in socializing with the opposite sex. Some may even be treated as if they were less capable than their peers.

Most individuals with Crouzon Syndrome feel angry at society for demanding physical attractiveness. Although some of these issues may be generic, the people’s response varies. Some may become painfully shy and lose confidence.

And yet others may develop a rather strong character and work on proving to their community that they have worth and are just as good as everybody else.

There are different levels of play used in the assessment of children’s speech and language. These levels are used to measure children’s play skills. However, there are also play levels of social interaction that can give a general overview of the child’s play skills.

In general, there are six play levels of social interaction that children go through respectively. Each level becomes more complex than the previous one, and requires more communication and language skills than the other.

Unoccupied Play

The first level of play is unoccupied play. In this kind of play, the child may seem like he is simply sitting quietly in one corner but actually is finding simple things that he sees around him to be rather amusing. A typical adult may not notice that what the child is doing is already considered to be play, unless they observe meticulously.

The child may just be standing and fidgeting at times, but this could already be unoccupied play at work.

Onlooker Play

The second level is onlooker play. In this level, the child watches other children play but doesn’t engage in play himself. This is when children learn to observe others. Such play level can show a child’s attention and awareness skills.

Solitary Play

The third level is solitary play where the child plays by himself and doesn’t intend to play with anyone else. This level shows an outright manifestation that the child do have play skills, only that it is still at a level that no interaction is required.

A child can be at this level when he is already able to play functionally with an object, can play by himself up to fifteen minutes, and is able to follow simple play routines.

Parallel Play

The fourth one is parallel play. This level characterizes children who play side by side but don’t communicate with each other. Neither do they share toys. It is said to serve as a transition from solitary play to group play and is at its peak around the age of four years.

A child is said to be in this stage when he is able to play alone, but the activity he is doing is similar with the play activity that other children beside him are engaging in. The child also doesn’t try to modify or influence the play of other children around him. Here, the child is playing ‘beside’ rather than ‘with’ the other kids in the area.

Associative Play

Next is the associative play. This is where the children still don’t play with each other but are already sharing the toys that they are playing with. This level shows the child’s awareness of other children, although there is no direct communication between them, other than the sharing of toys and the occasional asking of questions.

Their play session doesn’t involve role taking and has no organizational structure yet. The child still carries on the way he wants to play, regardless of what the other children around him are doing.

Cooperative Play

The last level is cooperative play. This is the final stage wherein the children are already playing together, sharing toys and communicating with each other.

This level usually happens at about the age of five or six, where children engage into group games and other highly structured play activities.

These levels can be utilized by the therapist as a guide when it comes to the interactions that he wishes to have with the child through play activities.

Play has a very important role in speech therapy. It is actually one way that speech therapy can be conveyed, especially if the one undergoing therapy is a child.

What’s Play Got To Do With It?

Play isn’t just used during the therapy proper. In fact, play is already used during the initial phases of assessment. Kids can be very choosy with people that they interact with, so seeing a therapist for the first time doesn’t promise an instant click. Rapport has to be established first, and this is usually done through play.

Benefits Of Play

Other than using it as a tool to establish rapport, play also gives a lot of benefits. First off, it gives an over view of the child’s skills, whether it be their abilities or limitations.

Then, therapy wise, play can be used to make a child cooperate with whatever exercises a therapist has lined up for him/her. Since play doesn’t put much pressure on a child, he/she would likely cooperate to do the exercises and not know that what he/she is doing is already called therapy.

When the child is more relaxed, he can be at a more natural state. If a child is at his more natural state, then his skills could show more naturally. Thus, this would be a benefit on the therapist’s part, since the therapist could get a more comprehensive assessment of the child’s skills.

Play could also make therapy more fun and less scary. Since play is an activity to be enjoyed, the child would not get bored with monotonous therapy activities that seem like chores, rather than activities.

Play As A Skill

In fact, play is considered to be a skill itself, because it is a natural activity that children do. If a child doesn’t play, then there must be something wrong with him, most probably with his Inner Language skills. This is because; play is a representation of a child’s inner language. This is just one of the many reasons why play is important.

It actually has a domino effect, if you look at the bigger picture. Play is needed to have Inner language, which is in turn needed to have Receptive language that is a prerequisite of Expressive language. Thus, if a child has no play abilities, then his whole language system may be affected.

Play And Cognition

Play is also a basis of a child’s cognition skills. The more developed a child’s play skills are, the higher the probability that his cognition skills would be at a fair state. However, play and condition are not the same. Play is more likely a prerequisite or a co-requisite of cognition.

What Parents Have To Say

Unfortunately, most parents may have a negative impression when they see the therapist playing with their child. Initially, parents get surprised and shocked that they paid a very valuable amount for therapy, only to find out that their child would only be playing.

That’s why it is very important for therapists to explain the procedures that they are going to do with the child to the parents. To make the session more interesting, the therapist could also include the parent/s in the play session with the child.

In this way, the child would definitely think that it is a play session. Additionally, the parent can also do the play activity at home with the child. Doing this, could serve to be practice of the targeted skill of the play activity.