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Speech, airway health, and education

Speech-language impairment inhibits academic achievement. Empirically supported classifications identified as early as age 5 continue to be relevant into late childhood. There is a clear relationship between auditory-motor adaptation and phonological awareness, since phoneme representations emerge before literacy acquisition, and sensorimotor representations set the ground for phonological awareness.1 For these children, the need is urgent for early intervention.2 To this end, speech-language pathologists collaborate regularly with teaching staff. Verbal and written speech and language skills are inextricably linked and key to spelling development and progress.3 Population level data provide strong evidence that all children who present with language difficulties even in kindergarten face further written academic challenges even if their issues resolve over time.4,5 This has been shown to exist as far as the age of 19 years.6 The same relationship is generally true in voice disorders, another vital point of intervention by SLP’s.7 The prevalence is high. In one emblematic study, 50.1% had at least one of the assessed disorders; of those, 33.6% had oral language disorder, 17.1% had orofacial motor skill impairment, and 27.3% had auditory processing disorder. There were significant associations between auditory processing skills’ impairment, oral language impairment and age.8 This general situation exists across all socio-economic groups,9 with some variation between boys and girls.10 In many places these children are underserved.11,12 This is even more pronounced in bilingual populations.13 Speech and language intervention for children in mainstream schools, even delivered by specialist teaching assistants, is measurably effective, however.14,15

Anxiety and depressive disorders are common among children with speech and language impairments from elementary school until youth.16 These, and other emotional behavior disorders, in turn corrode narrative, structural language, and social communication skills, particularly in alternative school settings. Here, there is a particularly strong need for speech-language pathologists to be engaged.17 This can extend to classroom bullying. Poor language skills at 3 and 5 years of age are associated with peer victimization at 5 years of age. Poor language skills at 5 and 8 years of age are associated with peer victimization and bully perpetration at 8 years of age. The association between poor language skills at 5 years of age and bully perpetration at 8 years of age is stronger for girls. Persistent paths of language difficulties at 3, 5, and 8 years of age show the highest risk of peer victimization and bully perpetration.18

Sometimes there are underlying disorders to speech and language problems. Dyslexia is one. SLP programs have improved the reading comprehension performance and increased motivation to reading in dyslexic schoolchildren.19 Sometimes the problem is a function of physical habits. Mouth breathing, something in which we specialize at BreatheWorks, is a good example. Studies have shown, as we tell educators repeatedly, that for a number of reasons mouth breathers are more likely to have learning difficulties than nasal breathers.20 It may also be that basic problems in dentition form the basis of trouble with speech sound production, in children with or without articulatory speech disorders. It is more important to draw attention to symmetrical eruption and to individual timing pattern of eruption, in these children. Research findings suggest a decreasing risk of faulty speech sound production with advancing eruption of some permanent teeth still present in 7-year-old children.21

Beyond reading and speech, problems like childhood dysphonia exist frequently in school settings. This has many origins, the most common initial symptom being altered vocal quality. We find, as research also shows, that auditory-perceptual and acoustic parameters can be moderated, and that, with help, vocal characteristics can improve with age.22

Dysphagia is another potential problem in school-age children. Speech-language pathologists in schools are increasingly evaluating and treating children with dysphagia associated with medically complex conditions. There is a rising incidence in preterm births and the survival of medically fragile children, suggesting that a greater number of children will be at risk for dysphagia in the future. School-based SLP’s are uniquely positioned to identify swallowing and feeding problems, evaluate and treat children with dysphagia, participate on dysphagia teams in the school setting, and interact with medical teams.23

Finally, and most broadly, there is a common, circular, syndrome in disordered sleep. Wide prevalence of nocturnal bruxism (tooth-grinding) is a marker for this, a known comorbidity of sleep and systemic neurobehavioral disturbances. The causes of disordered sleep can be widely varied. Its classroom consequences, unarrested, can be profound. In this too, speech-language therapists, particularly those trained in oromyofunctional airway disorders, can be extremely valuable indeed.24

1 Caudrelier T, Ménard L, Perrier P, Schwartz JL, Gerber S, Vidou C, Rochet-Capellan A. Transfer of sensorimotor learning reveals phoneme representations in preliterate children. Cognition. 2019 Nov;192:103973. doi: 10.1016/j.cognition.2019.05.010.

2 Beitchman JH, Wilson B, Brownlie EB, Walters H, Lancee W. Long-term consistency in speech/language profiles: I. Developmental and academic outcomes. J Am Acad Child Adolesc Psychiatry. 1996 Jun;35(6):804-14. doi: 10.1097/00004583-199606000-00021.

3 Moxam C. The Link Between Language and Spelling: What Speech-Language Pathologists and Teachers Need to Know. Lang Speech Hear Serv Sch. 2020 Oct 2;51(4):939-954. doi: 10.1044/2020_LSHSS-19-00009.

4 Janus M, Labonté C, Kirkpatrick R, Davies S, Duku E. The impact of speech and language problems in kindergarten on academic learning and special education status in grade three. Int J Speech Lang Pathol. 2019 Feb;21(1):75-88. doi: 10.1080/17549507.2017.1381164.

5 Schuele CM. The impact of developmental speech and language impairments on the acquisition of literacy skills. Ment Retard Dev Disabil Res Rev. 2004;10(3):176-83. doi: 10.1002/mrdd.20014.

6 Stoeckel RE, Colligan RC, Barbaresi WJ, Weaver AL, Killian JM, Katusic SK. Early speech-language impairment and risk for written language disorder: a population-based study. J Dev Behav Pediatr. 2013 Jan;34(1):38-44. doi: 10.1097/DBP.0b013e31827ba22a.

8 Rabelo AT, Campos FR, Friche CP, da Silva BS, de Lima Friche AA, Alves CR, de Figueiredo Goulart LM. [Speech and language disorders in children from public schools in Belo Horizonte]. Rev Paul Pediatr. 2015 Dec;33(4):453-9. doi: 10.1016/j.rpped.2015.02.004.

9 McKinnon DH, McLeod S, Reilly S. The prevalence of stuttering, voice, and speech-sound disorders in primary school students in Australia. Lang Speech Hear Serv Sch. 2007 Jan;38(1):5-15. doi: 10.1044/0161-1461(2007/002).

10 Steffen T, Codoni S, Gutzwiller II, Ackermann-Liebrich U. [Language competence of 14-year-old adolescents in relation to their sociocultural origin: results from a logopedic study in the framework of the Basel kindergarten study]. Soz Praventivmed. 1992;37(6):276-83. German. doi: 10.1007/BF01299133.

11 McGregor, Karla K. (2020): How we fail children with developmental language disorder. ASHA journals. Journal contribution.

12 McGregor KK. How We Fail Children With Developmental Language Disorder. Lang Speech Hear Serv Sch. 2020 Oct 2;51(4):981-992. doi: 10.1044/2020_LSHSS-20-00003.

13 Arias G, Friberg J. Bilingual Language Assessment: Contemporary Versus Recommended Practice in American Schools. Lang Speech Hear Serv Sch. 2017 Jan 1;48(1):1-15. doi: 10.1044/2016_LSHSS-15-0090.

14 Mecrow C, Beckwith J, Klee T. An exploratory trial of the effectiveness of an enhanced consultative approach to delivering speech and language intervention in schools. Int J Lang Commun Disord. 2010 May-Jun;45(3):354-67. doi: 10.3109/13682820903040268.

15 Ebbels SH, Wright L, Brockbank S, Godfrey C, Harris C, Leniston H, Neary K, Nicoll H, Nicoll L, Scott J, Marić N. Effectiveness of 1:1 speech and language therapy for older children with (developmental) language disorder. Int J Lang Commun Disord. 2017 Jul;52(4):528-539. doi: 10.1111/1460-6984.12297.

16 Lee YC, Chen VC, Yang YH, Kuo TY, Hung TH, Cheng YF, Huang KY. Association Between Emotional Disorders and Speech and Language Impairments: A National Population-Based Study. Child Psychiatry Hum Dev. 2020 Jun;51(3):355-365. doi: 10.1007/s10578-019-00947-9.

17 James K, Munro N, Togher L, Cordier R. The Spoken Language and Social Communication Characteristics of Adolescents in Behavioral Schools: A Controlled Comparison Study. Lang Speech Hear Serv Sch. 2020 Jan 8;51(1):115-127. doi: 10.1044/2019_LSHSS-18-0090.

18 Øksendal E, Brandlistuen RE, Wolke D, Helland SS, Holte A, Wang MV. Associations Between Language Difficulties, Peer Victimization, and Bully Perpetration From 3 Through 8 Years of Age: Results From a Population-Based Study. J Speech Lang Hear Res. 2021 Jul 16;64(7):2698-2714. doi: 10.1044/2021_JSLHR-20-00406.

19 Martins LZ, Cárnio MS. Reading comprehension in dyslexic schoolchildren after an intervention program. Codas. 2020 Feb 10;32(1):e20180156. Portuguese, English. doi: 10.1590/2317-1782/20192018156.

20 Ribeiro GC, Dos Santos ID, Santos AC, Paranhos LR, César CP. Influence of the breathing pattern on the learning process: a systematic review of literature. Braz J Otorhinolaryngol. 2016 Jul-Aug;82(4):466-78. doi: 10.1016/j.bjorl.2015.08.026.

21 Pahkala R, Laine T, Lammi S. Developmental stage of the dentition and speech sound production in a series of first-grade schoolchildren. J Craniofac Genet Dev Biol. 1991 Jul-Sep;11(3):170-5.

22 Hoffmann CF, Cielo CA. Characteristics of the Voice of Dysphonic School Children from 4:0 to 7:11 Years Old. J Voice. 2021 Jul;35(4):664.e11-664.e19. doi: 10.1016/j.jvoice.2019.12.004.

23 Lefton-Greif MA, Arvedson JC. Schoolchildren with dysphagia associated with medically complex conditions. Lang Speech Hear Serv Sch. 2008 Apr;39(2):237-48. doi: 10.1044/0161-1461(2008/023).

24 Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med. 2011 Aug;12(7):641-5. doi: 10.1016/j.sleep.2010.11.013.

MyoNews from BreatheWorksTM is a report on trends and developments in oromyofunctional disorder and therapy. These updates are not intended as diagnosis, treatment, cure or prevention of any disease or syndrome.

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