Education & Treatment

Speech Therapy

Speech-language pathologists are professionals educated in the study of human communication, its development, and its disorders. By evaluating the speech, language, cognitive-communication, and swallowing skills of children and adults, the speech-language pathologist determines what communication of swallowing problems exist and the best way to treat them. Speech-language pathologists also assist those who may need to use an alternate form of communication like signing or an electronic communication device. Read more about SLPs below.

Children with fragile X syndrome (FXS) almost always experience difficulties in both speech and language. With respect to speech production, many children with FXS may not start talking until age 3 or 4. A small percentage of males with FXS (about 15%) never develop functional speech. However, almost all of these children can learn to communicate with assistive technology devices. Assistive technology or "alternative communication" can be as simple as a series of laminated picture cards on a key ring that the child points to in order to get his point across to the most sophisticated of computerized devices that "speaks" when one or more keys are pressed. The vast majority of children with FXS do develop speech. In fact, most become quite verbal and need assistance slowing down the rate of their speech and/or learning correct word order or sentence structure. Many have ongoing problems with speaking clearly. Since most children with FXS have some degree of low muscle tone and loose connective tissue, their ability to make the smooth rapid transitions required in conversational speech are difficult to master.

Many of the communication and language processing problems evidenced by children with FXS seem to be closely tied to their attentional, anxiety and sensory integration problems. Consequently, making improvements in listening and communicating almost always requires that therapists, parents and teachers work together to modify the environment and tailor the communication demands to the child's comfort and tolerance levels. For example, if the child becomes very anxious when asked a direct question, two or three specific choices could be offered and paired with a picture--e.g. "Do you want to paint, go to the book corner or play dress-up?" The child selects the picture representing the activity he wants, responds verbally (e.g. "I want to paint."), and carries the picture with him to the appropriate area as a transition aid. Other areas of particular difficulty for children with FXS include difficulty staying on topic--when distracted, difficulty changing topics--when absorbed, verbal perseveration (i.e. repeating words and phrases over and over) and echolalia. The following strategies might be included in a program to reduce these difficulties:

Staying on Topic ("topic maintenance" or "verbal exchange")

• Use "sequence pictures" (start with just 2 or 3)
• Use verbal cue like "tell me more" or "What happened next?"
• Conversation or story "ladder"--each step is another part of the exchange or story
• Teach "what"; "where", "why", "how" and "who" to tell about an event (let child pick the topic). Start with just 2--e.g. "what" and "where." Remind with picture cues

Changing Topics (related to difficulties with transitions of all kinds)

• Have child put picture representing task or completed task in a "finished box"
• Talk about day's schedule at beginning of day or beginning of session
• Prepare child for new activity a few minutes before time to transition

Perseveration and Echolalia

• Monitor level of anxiety and adapt situation accordingly (e.g. decrease need for eye contact, change positions, reduce background noise)
• Teach specific hand or picture cues for "turn-taking" (Use this for "topic maintenance" also)
• Slow pace and allow for processing time
• Model appropriate verbal sequence with puppets, parent or another child

More about Speech-Language Pathologists

Speech-language pathologists usually provide assessment and treatment services as part of or in consultation with a team of professionals. The "team" should always include the parents or caregivers. When this does not occur, family members should not be bashful about putting themselves on the team. Parents and other family members can be particularly helpful when the team is designing the most appropriate intervention plan. For example, the most common speech-language recommendation made by school-based IEP (individualized education program) teams is for 3, 30 to 45-minute one-on-one sessions per week. However, there are many other options including shorter, more frequent sessions; "integrated sessions" which can take advantage of classroom activities and peer interactions to practice or integrate new skills; or small group sessions that can provide practice on new skills with a small, "friendly" audience.

A Speech-language pathologist's involvement with a child usually begins with an assessment of current abilities and needs in the areas of receptive language, expressive language, pragmatics (i.e. social language), speech and oral-motor skills. Based on the assessment and input from those who know the child best--e.g. parents, teachers, siblings, etc.--an intervention program is devised. Intervention strategies should include sessions in different contexts (e.g. one-on-one, in the classroom, on the playground and with different communication "partners" (e.g. parent, teacher, peer, sibling). Carry-over activities or "homework" should also be provided to parents and classroom teachers so that new skills can be put to use in the most needed situations. For example, if the goal is to improve the child's ability to follow verbal directions, specific tasks should be targeted based on input from parents and teachers about what would be most helpful. Then the Speech-Language Pathologist may work on specific "scripts" or routines with the child one-on-one. When his or her responses are consistent, one or two peers might join the child and therapist for more practice. Finally, specific goals can be set on a poster or chart. When the child successfully follows directions given without visual cues by his teacher and parents, stickers are added to the chart until a reward--selected by the child--has been earned.

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Questions, comments? Contact Amy Claassen Site last updated: November 2001