While we normally associate summer months with children taking a break in their education, the same can not be said of school administration.  For the latter, there are no breaks for administrators that carry the district’s challenges with them in their passionate service.   Administrators who carry the specific and unique challenges of their own district are recently experiencing trends that are experienced cross-country on a national scale, and that are steadily increasing.  While the severity of these shared challenges might vary by region, they all include realities that district administrators are familiar with and have experienced at some point in their careers. Further, problems may change considerably depending on who is labeling them, whether it is students, parents, educators, or lawmakers.

So what are these common realities?  And, how do these realities contribute to servicing special education programs?

We’ve drafted a list of the top realities of Public schools across the country, based on the perspective of many involved in the world of education today.

  1.SHORTAGE OF QUALIFIED SERVICE PROFESSIONALS

Personnel shortages are the result of recruitment and retention challenges. There is both a shortage of professionals to fill available positions and a shortage of positions to meet the growing demand for services for America’s six million children and youth with disabilities who receive special education services.

According to the National Coalition on Personnel Shortages in Special education and related services,:

• 54% of speech-language pathologists (SLPs) report shortages in their schools. SLPs from the western region of the United States (mountain and pacific states) are most likely to report shortages.¹
• Overall, 15% of educational audiologists report shortages in their schools.²

• The national ratio of school psychologists (1:1182) is twice the recommended ratio (1:500–700). Further, there will be a shortage of almost 15,000 school psychologists in the United States by 2020.³
• The national ratio of students to school counselors (482:1) is almost twice the recommended ratio (250:1).⁴
• National data indicate 39% of public schools have a school nurse all day, every day, while another 35% of schools have a school nurse who works part-time in one or more schools. Twenty-five percent of schools do not employ a school nurse.⁵
• National data indicate a critical 76% shortfall in the number of certified adapted physical education (APE) teachers needed within the United States, with an estimated 20,087 additional APE teachers needed.⁶
• A recent survey performed only among schools for the deaf anticipates a demand for at least 500 teachers of the deaf in these schools over the next three years. However, the majority of deaf and hard of hearing students attend school in the mainstream, therefore this number greatly underestimates the number needed.⁷
• 49 states report a shortage of special education teachers/related service personnel for 2013–2014.⁸
• 82% of special educators and SISP from across the nation report that there are not enough professionals to meet the needs of students with disabilities.⁹

Telemedicine has helped to combat these challenges directly, in enabling students to get the treatment that they need.

2. A STEADY INCREASE IN THE NEED FOR SPECIAL EDUCATION SERVICES.

There has been a growing increase in the number of students that require school therapy services. This increase could be seen in special education, speech, occupational therapy, physical therapy, or counseling.   Consequently, the increase in demand has led to an increase in The number of students enrolled in special education programs.

Consider the following:

• Over the past decade, the number of students in the United States enrolled in special education programs has risen 30 percent, according to the National Education Association (NEA).
• Nearly six million students with disabilities attend public schools in the U.S., reports the Education Week Research Center.
• Students receiving special education services under the Individuals with Disabilities Education Act (IDEA), Part B, make up roughly 9 percent of all six-to-21-year-olds.
• three out of every four students with disabilities spend at least 40 percent of their school day in regular classrooms, alongside peers without disabilities, according to NEA. The result is an increased need for teachers trained to face the additional challenges of teaching students with a wide variety of disabilities, even as general educators.

Case Studies: How School Districts Cope with Challenges Surrounding Special Education

3. THE INCREASING COST OF SPECIAL EDUCATION SERVICES.

According to a report titled “The Misdiagnosis of Special Education Costs”, issued by The School Superintendent Association,

Local school districts nationwide are experiencing increases in special education costs. In states that are placing a high priority on education reform, the special education cost increases are rapidly compromising the ability of districts to effectively fund the implementation of these reforms. However, in searching for a way to address rising costs, policymakers often err in their diagnosis of the problem.

According to their research:

“School district policy and practice was effective in containing and even reducing the percentage of children who required special education services. We found that cost increases were primarily due to the increased number of children with more significant special needs who require more costly services.

The root causes of these increases were factors beyond the control of schools, such as advances in medical technology, the deinstitutionalization of children with special needs and privatization of services. Also contributing were economic and social factors, such as the rising number of children in poverty and the number of families experiencing social and economic stress.”

 4.BUDGET CUTS

School districts nationwide are experiencing various budget challenges – but recently, these challenges are increasingly being described as “crises.”  In fact, Budget cuts have created huge problems for most public schools in recent years. Less funding means smaller staffs, fewer resources and a lower number of services for students. While some argue that throwing more money at the education problems won’t make them go away, others assert that lack of funding caused many of the problems in the first place.

Special education programs are not immune to the national trend of budget cuts. According to the annual report issued by the Department Of Education, the 2020 Special Education Fiscal Budget Request Report further illustrates the unique challenges faced by special education.

5.TECHNOLOGY

Kids Health Guide reports that students are more technologically advanced than many teachers today, putting instructors at a decided disadvantage in the classroom. However, a student’s love of technology also tends to distract him from his schoolwork, according to NEA Today. When teachers don’t have the techno-savvy to compete with those devices, by bringing education and technology together, it can be difficult to keep students’ interest and attention to properly teach new concepts.

Technology needs to come into the classroom to keep up with the learning demands of the 21^st century. Schools that are already cash-strapped may find an unsurmountable challenge in coming up with the funding to bring computers and other forms of technology into their classes. Scholastic offers some tips for school districts that want to fit the bill for technology, including everything from asking individuals in the district for “big gifts” to going to Uncle Sam for the funding. The website also suggests negotiating prices on technology when possible and allowing student to bring their own from home.

Further, school districts have turned to teletherapy to fill their vacant roles for staff shortages.

6.Poverty

Technorati reported last fall that 22 percent of the children in the U.S. live at or below poverty level. American Graduate defines poverty as a family of four with an annual income level of $23,050 or lower. American Graduate also cites a report from the Southern Education Foundation, which shows in 17 states across the U.S., low-income students now comprise the majority of public school students in those states. Some estimates put poverty levels for public school students at 25% in the not-so-distant future.

Students living at or below poverty level tend to have the highest dropout rates. Studies show that students who do not get enough food or sleep are less likely to perform at their full academic potential. Schools know these truths first-hand, and despite efforts to provide students with basic essentials, teachers, administrators and lawmakers know there is simply not enough to go around.

7.Classroom Size

Many areas of the country are facing classrooms that are literally busting out at the seams. A report at NEA Today two years ago discussed how schools in Georgia, in the midst of major funding cuts for schools, had no choice but to lift all class size limits to accommodate students with the faculty the school system could still afford to keep. More recently, Fairfax County in Virginia has been looking into a proposal to increase classroom sizes in the face of significant budget cuts. The Board of Education in South Carolina is also weighing their options in this area.

When money gets tight, classroom numbers are often impacted. Yet, most teachers agree that they cannot effectively teach every student in a classroom, if the class size exceeds about 30. Their statements are backed up by research. Class Size Matters cites a study performed by the Tennessee Star that found classes of 15-17 students in grades K-3 provided both long and short-term benefits to both the students and the teachers in those classrooms. Minority students, those living in poverty, and male students appeared to benefit from smaller classroom sizes the most.

Learn More with Case Studies: How School Districts Cope with Challenges Surrounding Special Education –

Learn How School Districts Benefit from Telepractice

______________________________________________________________________________________

Do you believe that your school could benefit in combatting some of these challenges, including reducing costs, addressing personnel shortages/certifications, along with meeting both State and Federal guidelines?  Contact us today!!

Sources:

American Speech-Language-Hearing Association. (2018). 2018 Schools Survey report: SLP workforce/work conditions.

² American Speech-Language-Hearing Association. (2018).
2018 Schools Survey summary report: Numbers and types of responses, educational audiologists. 

³ National Association of School Psychologists

⁴ American School Counseling Association

⁵ National Association of School Nurses

⁶ Zhang, J. (2011). Quantitative analyses about market-and prevalence-based needs for adapted physical education teachers in the public schools in the United States. The Physical Educator, 68(3), 140–150.

⁷ Fischgrund, J. , & Tucker, J. , 2017, Future Needs at CEASD Schools for the Deaf. CEASD Annual Conference, St. Augustine, FL

⁸ 2011 – 2012 Special Education/Related Services Personnel Shortages List

⁹ Budget Cuts Threaten Special Education Services

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IN THE NEWS

Past Press Coverage of Abington Speech Pathology, RemoteSpeech.com and VirtualTX.  Click each listing below for a direct link.

Click Here to Read Original Article

WILLOW GROVE — As the COVID-19 pandemic continues to disrupt everyday life, a Montgomery County virtual business was prepared for a virtual working environment.

“I think that it just gets the services to more people than ever before,” said Orna Azulay, owner of Abington Speech Pathology Services and Remote Speech, LLC. Azulay is also president of Abington Speech Pathology Services and chief operating officer of Remote Speech, LLC.
Headquartered in Willow Grove, Azulay has more than 150 therapists employed across both enterprises offering staffing and services for physical, occupational and speech therapies.

Her latest venture, Remote Speech, LLC. launched in 2015 and separated from the larger entity in 2019, connecting speech pathologists, and school counselors to clients nationwide and around the world.

In addition, Azulay spotlighted several options for children and adults, including those on the autism spectrum.
Azulay emphasized the importance of gaining communication skills including learning how to take turns, follow directions, look into the computer screen and maintain eye contact, and pick up on other social cues.

Azulay has found that the virtual environment has been popular for her clients. Prior to the COVID-19 pandemic, she would often use screen time as a reward at the end of a session.

“Now the therapy became the reward without them even realizing it,” she said. “So a lot of times kids on the spectrum get to interact in a way that they think is a reward now, and they’re still able to be grouped so they still have that social piece for communication of what we’re really working on.”

Now living in Horsham, Azulay was originally born in Israel, and came to the U.S. with her family when she was 9 years old.
After graduating high school in the states and completing her military service in her native Israel, she came back to California to go to school and ended up studying speech pathology.

“I never knew much about speech pathology. A family friend told me to explore it as a career option. I fell In love with it,” she said. “The ability to provide therapy that in turn restores people the ability [to] communicate and to be able to decipher what caused their issue and how to help them was and still is fascinating to me.”

Once she received her graduate degree, Azulay moved to the Philadelphia area, and opened Abington Speech Pathology Services in 1999.
Azulay had marketed Remote Speech, LLC. on a virtual platform. When schools and nonessential businesses shuttered their doors due to health and safety restrictions associated with the coronavirus, there was a seamless transition with training and continuing sessions.

“So we’re lucky enough that we were able to continue the services uninterrupted pretty quickly right after the pandemic shut everything down,” Azulay said.

For instance, in the early days of the COVID-19 pandemic, roughly 25 therapists and staff members within Lower Merion School District were taught how to conduct sessions online.

“Our expertise helped people in the area,” she said.

As Autism Acceptance Month continues, the Autism Society of America highlighted a “changing differences” campaign as a theme for the month of April. While the pandemic has hindered Azulay from putting on in-person events, her companies maintain an active presence in blog posts and on various social media platforms.

Still, she said she believes a virtual therapy format will stick around once the pandemic ends.

“It’s amazing,” Azulay said. “I do understand now that there’s a slight fatigue from the screen because everything is done online, but I think when things go back to normal, and you only leave the therapies for online, not just out of mere convenience, but really we’re able to tap into so many more therapists … and you reduce the time that the client has to travel. We reduce space problems in schools.”

For more information about the company’s virtual services, visit remotespeech.com.

The month of April is recognized worldwide for Autism Awareness. This year’s observance is unlike any we’ve experienced – with a global pandemic and lockdowns that temporarily suspended EVERYTHING.  However, despite the adversity and challenges, the world of Autism treatment and research has still managed to thrive.

In this article, we are going to take a look at developments made in the past year for the field of Autism, whether it be related to exciting developments, research, treatment, and our general understanding of the spectrum’s diversity. We will provide a summary of the subject, a description of its potential impact, and helpful links for you to follow for further research. We can say, with absolute certainty, that the dedicated researchers and educators related to Autism were not discouraged or slowed down in the slightest!

Here is our list of the top 10 most exciting developments in the world of Autism!

10.  DISCOVERIES –  MYELIN.

According to research published in the journal Nature Neuroscience, autism spectrum disorder affects the brain’s production of myelin, impacting the movement of signals through the brain.

Myelin insulates the nerves in the brain and spinal cord and enables the quick transmission of signals along nerves. An overproduction or underproduction of myelin can lead to a variety of neurological conditions.

Researchers, excited by the discovery, are saying it could be possible to make these cells “healthier” by using drugs to treat myelination.

Dr. Sarah Bauer, a developmental and behavioral pediatrician and a leader in the ECHO Autism program at Advocate Children’s Hospital, also is encouraged by the findings.

“As a developmental pediatrician, I think about how our understanding of the ‘why’ connects to what we can do to support children and families we encounter in clinic,” Dr. Bauer says. “If we understand more about why developmental differences like autism occur, the next step is figuring out how we can translate this information into early intervention and support our children’s developmental trajectories.”

Dr. Bauer also says this research provides more to support the need for individualized intervention in children.

“There is not a ‘one-size-fits-all’ treatment model for autism,” she says. “At a population level, this speaks to why we need to consider more innovative ways to meet the diagnostic and individualized intervention needs for children and families.”

Read the full Study Here

9. RESEARCH STRATEGIES – DIVERSIFYING DATA.

Though autism is an extremely diverse condition, the datasets used to study it have been less so. Researchers have been working to include autistic people of different genders, ages, races, and abilities in their studies for some time. This year, many of those efforts came to fruition.

To analyze sex differences, one team of geneticists amassed a large cohort of autistic men and women, finding that the condition may originate in a different set of mutations in women than it does in men. Other researchers examined the neurobiological underpinnings of social behavior in autistic girls for the first time. They found that, unlike boys with autism, girls with the condition have strong neural responses to social stimuli in their reward systems — in some cases, even stronger than in girls without autism. After recruiting a large number of girls, another group found that the brain appears to develop differently in girls and boys with autism.

That same group also found novel ways to image the brains of autistic people with a low intelligence quotient (IQ) and severe traits. In doing so, they identified an autism subtype marked by an unusually large brain, challenging ideas about brain size in the condition. A genetic study that included autistic people with a broad range of IQs revealed that rare mutations in autism genes are more common among people with lower IQs than among those with higher ones. And the first study to image the brains of minimally verbal autistic people found that they have trouble differentiating the sound of their names from other sounds, providing insights into their language development.

Researchers also genetically sequenced a new cohort of African children with autism and their families, conducted Greece’s first autism prevalence study and China’s largest to date, and delved into the diagnostic experiences of Black children with autism.

Investigations of adults with autism — another understudied group — showed that they may not experience the usual age-related declines in their ability to understand another person’s mental state and in the strength of connections across the brain’s visual regions.

Researchers say that diversifying the people included in autism research will lead to a fuller and more accurate picture of the condition.

8. DIAGNOSIS AND TREATMENT – DISCOVERY OF GENETIC “WRINKLES.”

Researchers at The Hospital for Sick Children (SickKids)  Toronto, conducted a program that examined the DNA of 10,000 families — many of whom have children with autism.  This research yielded the discovery of “genetic wrinkles” that occur in DNA.  This discovery is a breakthrough they believe could explain why some individuals find themselves on the autistic spectrum.  The hope is that this could be an important new clue into how to diagnose autism spectrum disorder (ASD) early, or even treat it.

Dr. Stephen Scherer is co-author of the study, and director of the Centre for Applied Genomics at SickKids.  He explains that “[the discovery] unveils a whole new class of genes that we didn’t know (were) involved in autism before,” he said.“We do know that they’re involved in brain function but we don’t know how they fit into the jigsaw puzzle.”

Current research estimates that genetic factors should be found in anywhere from 50 to 90% of individuals with ASD.

Scientists already know of about 100 genes that play a role in the development of autism, but these genes only explain less than 20% of cases.

In order to delve further into these genetic components, researchers had to “develop new methodologies,” Scherer said.

Ryan Yuen, the team leader for this new study, rose to the challenge.

Nine years ago, he developed a “new computational approach,” according to Scherer, which allowed him to search for specific characteristics within DNA itself, and compare patterns found within individuals with autism to their parents or “other controls in the population.”

Now they’ve discovered that sections of DNA from parents sometimes get doubled — or, in some cases, tripled — in their children.

These are called “tandem repeat expansions.”

Tandem repeats are nucleotides, which are the building blocks of DNA, repeated adjacently, two or more times… they’re like DNA wrinkles. When these wrinkled strands of DNA are replicated, the repeat can grow longer, which is why a tandem repeat present in a parent’s DNA could be expanded from parent to child. The larger these wrinkles are, the more likely that they could interfere with gene function.

Tandem repeats had been studied before individually, but it was difficult, as they had to be searched for in one gene at a time. Since there can be a million tandem repeats in the genome, according to a press release from SickKids, locating the tandem repeats that actually contribute to ASD “would be like looking for a needle in a haystack.”

“In this study, we pioneered a method that can effectively search and analyze terabytes of whole-genome sequencing data for tandem repeat expansions,” Said Yuen.

“Many of the genes linked to [these] repeats [were] never thought to be involved in autism before.”

Some of the new genes identified included those “involved in the nervous system,” he said. And the location of the tandem repeat expansion within the DNA itself was associated with “certain characteristics and behaviors such as IQ and life skills,” noted the press release.

“This really is a game-changer for autism and genomic research. It opens up new opportunities in precision diagnostics and medicine,” Yuen said.

Scherer said that in the almost two decades he’s been studying the autism spectrum, “this is the most exciting advance we’ve had in 15 years.” Yuen believes this research will “impact thousands of families,” and will allow scientists to provide countless individuals with autism a clear explanation for their autism by looking at their genes.

The implications of this discovery can not be underestimated.  Among them include informing patients and their families early on what type of autism they have, so they can plan for care.  The finding may also help scientists find a medication that can target these regions in the DNA itself.  Researchers suspect these genetic wrinkles may play a role in other complex conditions related to the brain — such as epilepsy and schizophrenia.

Read the Complete Press Release from AutismSpeaks.
Read the Full Study Here

7. DISCOVERY – AUTISM GENES.

Over the past decade, scientists have identified hundreds of genes that, when mutated, can increase a person’s chances of having autism. But several studies this year support the idea that few of these ‘autism’ genes are specific to autism.

Autistic people who carry rare, spontaneous mutations in these genes tend to have a lower intelligence quotient than people without such mutations, according to one study. And many of the genes mutated in autistic people are also mutated in people with other neurodevelopmental conditions, including intellectual disability, developmental delay and attention deficit hyperactivity disorder. Most people who carry a mutation in the autism-linked gene DDX3X, for example, have intellectual disability.

Part of the overlap may stem from inconsistent or inaccurate diagnoses: Doctors often struggle to discriminate autism from intellectual disability or other related conditions. For instance, one popular autism screening tool misses most toddlers with autism but instead flags most children who actually have intellectual disability. A new test battery that reliably measures the cognitive abilities of people with intellectual disability may help to resolve this diagnostic dilemma.

One team made inroads into predicting the effects of mutations in the autism-related gene FMR1. Among boys who carry mutations in this gene, those with autism have about half as much FMRP — the protein encoded by FMR1— as those without autism; and those with severe intellectual disability have even lower levels of the protein.

Whether or not someone has autism or a related condition may also reflect a different type of genetic factor — inherited variants. A study of families in Sweden lent support to the idea this year by showing that autism alone is more heritable than autism with intellectual disability. Another 2020 study identified two regions of the genome in particular that seem to harbor inherited variants linked to autism.

Read the full Study Here

6. RESEARCH STRATEGIES AND MACHINE LEARNING.

From identifying a new antibiotic to generating the first-ever image of a black hole, machine learning is changing how scientists approach questions in many fields. Autism researchers are being equally creative, using machine-learning methods to improve diagnosis, classify the condition into subtypes and provide support for people on the spectrum.

One of the most common applications of machine learning is in making predictions: where and when a hurricane will make landfall, for example, or what the next word in a person’s text message might be. One team has applied similar methods to predict which newborns would later be diagnosed with autism¹.

The researchers studied the medical records of the parents of nearly 100,000 children born in Israel from 1997 to 2008. About 1,400 of the children went on to be diagnosed with autism.

Using a variety of machine-learning techniques, they analyzed the parents’ age, socioeconomic status and medications.

The algorithms successfully predicted about one-third of the children’s autism diagnoses. The predictions were strongest when the researchers combined data from both of a child’s parents, rather than from only one parent. The team published their findings in February in European Psychiatry.

Predictive algorithms could also be useful for identifying factors that may contribute to autism. For example, the algorithms found an association between autism and the parents’ use of substances such as caffeine and certain antidepressants. Previous research on such drugs’ contribution to autism is mixed.

Learn more about these techniques here

5. RESEARCH AND TREATMENT –SOCIAL PROFILES.

Social difficulties have been considered a defining characteristic of autism since Leo Kanner published the first clinical descriptions of the condition in 1943. However, people with autism can show striking variability in social function: Some lack social interest and awareness of other people and have a limited ability to communicate. Others are keenly interested in forming social bonds and readily communicate their needs, thoughts, and emotions.

Given these differences, not every person with autism has the same intervention needs — and different supports are more or less effective depending on an individual’s specific pattern of social strengths and limitations.

Despite the clear need to better understand differences in social skills in autism, there have been surprisingly few attempts to identify groups of autistic people with similar profiles of strengths and vulnerabilities. Prior studies, although informative, have mostly focused on particular behaviors and characteristics, without considering other important aspects of social functioning^1,2,3.

Navigating the social world requires a range of basic skills that, if impaired, can create the social difficulties we see in people with autism. These skills include social motivation, or the desire to interact and affiliate with others; social communication, or the ability to convey social and emotional information to others through various means, such as eye contact, facial expression, gestures, body language, and tone of voice; and social recognition, or the ability to perceive and interpret information communicated by other people.

Researchers and clinicians have several excellent tools at their disposal to diagnose autism and measure its overall severity, but to better understand an autistic person’s strengths and areas of need, they must also be able to measure essential social skills.

Stanford Medical developed the Stanford Social Dimensions Scale (SSDS) specifically for this purpose.  As Stanford notes:

“We designed the SSDS through an exhaustive review of the literature and in consultation with autism experts and clinicians, and we have shown it is valid and enables a comprehensive assessment of different aspects of social motivation, social communication, and social recognition⁴. We believe this work represents an important step toward uncovering the origins of social difficulties in autism and informing personalized intervention and case management plans for autistic people. We also believe that this work has the potential to be useful and informative for understanding social functioning across other neurodevelopmental and neuropsychiatric conditions as well.”

Learn more about the research deployed using the SSDS here

 4. EARLY INTERVENTION

As we have repeatedly stated, it is impossible to overestimate the value of early intervention (both for the treatment of the child as well as their long-term education and development. Perhaps one of the most profound and positive breakthroughs in ASD treatment has been the recognition of this condition, and an emphasis on encouraging parents to bring children in for evaluation. Children can show some of the symptoms of ASD, such as a lack of eye contact, discomfort at physical contact, or a fixation on details and repetitive actions even before they are toddlers.

If vigilant parents see some of these behaviors and bring a child in for an evaluation, this can go a very long way towards making ASD much more manageable and giving a child a much better start in life. With professionals evaluating the exact nuance of a child’s ASD, and parents being informed early on what to expect and how to handle it, everything from going to school to learning to read suddenly becomes much more feasible, and the impact of ASD on the child’s life in a negative way can be minimized.

Despite the proven benefits of early-intervention, research is still being conducted to drive the message home. For 2020, the science staff and advisors of Autism Speaks drafted their annual list to highlight the top 10 “studies that most powerfully advanced understanding, treatment and support of people on the spectrum.”  Three of the 10 were related to advances in screening, diagnosis, and interventions for autism.  They include:

1. Rogers SJ, Yoder P, Estes A, et al. A Multisite Randomized Controlled Trial Comparing the Effects of Intervention Intensity and Intervention Style on Outcomes for Young Children With Autism. J Am Acad Child Adolesc Psychiatry. 2020.
2. Mazurek MO, Parker RA, Chan J, Kuhlthau K, Sohl K, for the ECHO Autism Collaborative. Effectiveness of the Extension for Community Health Outcomes Model as Applied to Primary Care for Autism: A Partial Stepped-Wedge Randomized Clinical Trial. JAMA Pediatrics. 2020;174(5):e196306.
3. Wood, JJ, Kendall, PC, Wood, et al. Cognitive behavioral treatments for anxiety in children with autism spectrum disorder: A randomized clinical trial. JAMA Psychiatry. (2020) 77(5), 474-483.

Learn more about the benefits of Early Intervention

3. RESEARCH AND TREATMENT – STEM CELL THERAPY.

Umbilical cord blood is normally thrown away at birth. But for World Autism Awareness Day on April 2^nd of this year, a team of doctors and scientists are calling on new mothers to collect and save the blood because it could be used for lifesaving – or even life-changing – treatments.

A cord blood treatment is starting to give hope to some children with autism.  Dr. Omer Bar Yosef, a clinical and research neurobiologist at Sheba Medical Center, Tel Hashomer, has thus far treated 25 children with autism as part of a Phase II trial using a protocol developed at Duke University Medical Center.

Patients receive a one-time infusion of their own cord blood cells.

“There is no chemotherapy involved, no chemical medications,” explained Dr. Moshe Israeli, who serves as scientific director at Taburit, one of the leaders in the field of umbilical cord blood collection and preservation in Israel. “There is no concern; it’s not risky.”

The results in some cases are improved communication and emotional and social responsiveness.

“We don’t know 100% why it is working,” Israeli said. “There is a unique type of stem cell in the cord blood. These cells make their way through the blood to the brain, and we think they promote the growth of new synapses in the brain.”

Synapses connect neurons in the brain to neurons in the rest of the body.

These cord cells can only be found in cord blood; they are not found in adults later in life.

“One or two years after treatment, we see through brain imaging that there are more synapses,” Israeli explained. “The treatment influences the brain to grow and become more efficient and have better communication.”

While Israel only allows the use of one’s own cord cells or their siblings’ cells, a Phase III trial being run at Duke also allows for the use of third-party cord blood cells, meaning the cells of an unrelated donor that is stored in one of the cord blood banks.

In the US, the treatment is already approved for compassionate use.

While the results of this study are promising, Stem Cell research has a long and often controversial history. A recent study titled “Cell therapy approaches to autism: a review of clinical trial data” provided a review of such research projects using stem cell therapy, and examined their success and considerations.  The study notes:
“A number of clinical trials of cell therapies for autism spectrum disorder have been conducted, and some have published their outcomes. This review considers the data that have emerged from this small set of published trials, evaluates their success, and proposes further steps that could be taken if this field of endeavor is to be pursued further. A number of reservations arise from this tranche of studies, specifically the absence of identified therapeutic targets, and deficiencies in the therapeutic approach that is being employed. If this therapeutic direction is to be pursued further, then additional pre-clinical studies are recommended that might lead to improvements in patient stratification, biomarkers, the defined mode of action, and the preparation and identification of the therapeutic cells themselves.”

Learn More about Israeli Researchers studying Stem Cell Therapy for the Treatment of Autism HERE
Learn More about the overview study of stem cell research here.

2. TECHNOLOGY.

The Covid pandemic has taught us many things (including a seemingly “accidental” discovery that came with remote treatment).  More than ever, we are learning the critical role of technology in the diagnosis and long-term treatment of children on the spectrum.

Orna Kempler-Azulay is President and CEO of Abington Speech Pathology Services., INC. and RemoteSpeech, LLC. She began to address industry challenges about 5 years ago, as she began to identify problems that are still pervasive today.  “We had a nationwide growing demand for speech pathology services for children across the spectrum.  The problem was that this demand was growing at a rate that far-outpaced the availability of licensed specialists that were available to deliver treatment.” The shortage is still prevalent to the present day.  According to the Bureau of Labor Statistics, the industry has a projected job growth of 21% through 2024.  As with most things, when shortages occur, those most impacted are those with the least amount of resources (in this case, amongst children residing in rural and metro areas.)

Azulay launched RemoteSpeech.com to account for these disparities. RemoteSpeech.com has pioneered the delivery of speech therapy in an online environment, that connects the nation’s leading Speech-Language Pathologists and school psychologists with children, adults, and educators for live, face-to-face interactions for the delivery of speech therapy.  But there was still more work to be done. While traditional challenges for children with special needs (such as the national shortage of certified Speech-Language Pathologists and a low student reach) had been mitigated with the service delivery model developed by RemoteSpeech,  Kempler-Azulay began to identify additional challenges towards the start of the Covid pandemic, specific to remote learning and therapy.

When Covid 19 arrived in 2020, parents, students and school administrators were left scrambling to migrate students and staff online.  Kempler-Azulay was able to use her five years of experience and success in online treatment to help counsel school districts.  “We offered our services and consult to numerous public school districts and private individuals anywhere, that were in need of help in dealing with children with special needs,” recalls Kempler-Azulay.

Among these challenges were school districts’ ability to vet quality service providers and to provide quality therapy using adaptive learning.  Resources for quality therapy sessions were highly inadequate and limited. Management for treatment programs became difficult to track, progress reports were often difficult to secure and billing processes were cumbersome.  Kempler-Azulay and RemoteSpeeech.com took these challenges head-on, and in 2020, launched “VirtualTx” as a direct response.

VirtualTx is a cloud-based software application web portal for all things related to service delivery of Speech Pathology– including assessments, evaluations, treatment, and service management. VirtualTx borrows from the virtual features of RemoteSpeech for telepractice, and the staffing expertise of Abington Speech Pathology, to create a “one-stop-shop” for virtual therapy in one user-friendly online environment that is interactive, engaging, and effective – and in many cases, is able to outperform the alternative of treatment in-person.    “We created VirtualTx based upon the operational challenges that patients, parents, therapists, and school districts encounter with programs for children that have special needs,” explains Kempler-Azulay. “VirtualTx is cloud-based.  Users can access VirtualTx with any device and internet connection – with technology that is in compliance with HIPPA.  We are looking forward to seeing the impact that VirtualTx will have, specifically as it relates to children that are still without treatment.”

Learn More about VirtualTx here

1.EDUCATION AND AWARENESS.

Awareness of autism spectrum disorder (ASD) has grown dramatically in recent years, which reflects an increase in autism tests and diagnoses — and in the public’s understanding that, even late in life, an autism diagnosis can offer major benefits and relief. We believe that the number one advancement in the world of Autism is Education and Awareness.  Every time we learn about Autism, we are better equipped to support those on the spectrum and their community. Check out some of our favorite resources to stay up-to-date on the latest news for Autism Spectrum Disorders!

• Autism Speaks

• Autism Society

• American Autism Association

• The Autism Research Institute

• HealthyChildren.org

_______________________________________________________________________________________

The response to the COVID-19 virus is unprecedented. Because of our unique role in children’s K-12 education, we feel a responsibility to do what we can to assist schools, therapists, and students with this transition to online learning and seclusion. To ensure that our clients remain engaged and supported, our therapists will be providing complimentary “Support Sessions” to the country’s youth. We will also be assisting schools by training therapists for remote therapy.

Click here to schedule a complimentary consultation with an Executive Member of our Team.

Abington Speech Pathology and RemoteSpeech.com are uniquely prepared to provide assistance for parents of children with Speech-Language Pathology.

About Abington Speech Pathology

Abington Speech Pathology is managed and owned by a licensed speech-langauge pathologist. All of the company’s directors are licensed and remain clinical to better direct and support both the company’s clients and the clinical staff.

Through the years the company’s client base continues to grow and remains loyal.  ASPS, INC has expanded its services to include Physical therapy, Occupational therapy, Teachers of the visually and hearing impaired, and School psychologists. ASPS, INC. now operates two offices.  The corporate office is in eastern PA and services all 5 major counties surrounding the metro Philadelphia area. The Southern CA office services the Los Angeles and Orange County metro areas and at this point only offers speech pathology services to all settings.

The company offers the professional staff a lending library of materials. In PA, there are 2-3 continuing educational seminars to assist on clinical growth and state and national mandated continuing education requirements.

About RemoteSpeech.com

RemoteSpeech is a subsidiary of Abington Speech Pathology Services, a multi-faceted Rehab company that has provided Speech Staffing and support throughout the country for more than 20 years. RemoteSpeech combines crystal clear voice with the sharpest video to provide next-generation video calling and high-definition video delivery.

Prior to the Covid 19 pandemic, Orna Kempler-Azulay, President of RemoteSpeech, says the demand for speech-language therapists was outpacing the supply in some cities. RemoteSpeech is here to meet the demand. With its live, face-to-face interaction, RemoteSpeech is not the next best thing to being there in person — it’s just as good, and, in some cases, even better. With advanced state-of-the-art games, activities, and interactive screen sharing, students and adults will actually look forward to their therapy sessions.

Click Here to Learn More About Our Telepractice – Remote Speech-Language Therapy!

The month of April is globally recognized as Autism Awareness Month, including “World Autism Awareness Day” on Friday, April 2, 2021.  This year’s observance will be unlike any other, as it will run just two weeks after the one-year anniversary of the start of the Covid 19 pandemic. The anniversary of Covid 19 is accompanied by a diverse range of solemn reflections, as every aspect of society has been directly affected by the pandemic (some, more than others). Parents who have children with special needs are well-aware of the challenges faced, of migrating their child’s education to an online environment.  While these transitions have had their own set of unique challenges and frustrations, the online migration has resulted in an “accidental” and welcome discovery – children with social anxiety are finding tremendous benefit from virtual interactions.

In part 1 of our series for Autism Awareness Month, we will take a look at an overview of anxiety and how it relates to children across Autism’s diverse spectrum. Then, we will explore a few welcome positive strategies for treating children with social anxieties in the not-so-social age of Covid 19.

WHY IT MATTERS – RATES OF AUTISM ARE RISING.

The prevalence rates of autism spectrum disorders (ASDs) have risen dramatically over the past several decades. In the United States, research suggests that one in every 91 children (one in 58 boys) is affected by Autism Spectrum Disorder.  Research suggests that these prevalence rates are similar across the globe.

ANXIETY PLAYS A MAJOR ROLE IN AUTISM SPECTRUM DISORDERS.

As noted by The National Center for Biotechnology Information:
One factor linked to increased impairment beyond core ASD symptoms is the presence of anxiety [8]. Up to 80% of children with ASDs experience clinically significant anxiety [9–11], with high comorbidity rates for social phobia, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD) and separation anxiety disorder (SAD) having been observed (30, 35, 37 and 38%, respectively) [9,10,12,13]. The presence of clinically significant anxiety is associated with compounded functional impairment beyond a single ASD diagnosis [14]. Anxiety comorbidity is associated with greater ASD symptom severity and concomitant impairments in psychosocial functioning [15–19]. For example, patients with ASDs and comorbid anxiety are at increased risk for displaying externalizing behavior problems [20], social avoidance [16,18–20], difficulties establishing/maintaining peer relationships, sleep problems and disruptions in family functioning [21,22]. Among youths with ASDs and anxiety, these problems are also present in school settings, with studies reporting increased disruptive behavior, noncompliance with teacher demands, and disengagement from peer-centered activities [23–27].

Or, more simply put, the presence of anxiety serves as a trigger in the large majority of children with an Autism Spectrum disorder. This anxiety oftentimes serves as the “root” cause for more complex and specific dysfunctions – resulting in more than one impairment. Plus, the tendency for multiple anxiety disorders leads to greater severity of symptoms. Anxiety begets anxiety, making the diagnosis more difficult. When anxiety is present in conjunction with autism spectrum disorders, it is linked to increased psychosocial, familial, behavioral, and academic impairment beyond the core autism symptoms.

SOCIAL ANXIETY DISORDER – AN OVERVIEW:

STATISTICS:

Approximately 15 million Americans suffer from social anxiety disorder.  Recent estimates indicate that 6 % of children and 12.1% of adolescents meet the criteria for this diagnosis. Social anxiety disorder starts as early as age 5 and peaks around age 12. When untreated, it runs a chronic course into adolescence and eventually adulthood. Children with the disorder tend to start noticing symptoms between the ages of 8 and 15, but if they hide how they are feeling, parents might not realize anything is wrong for some time.

 THE SIGNS:

Children with social anxiety disorder are extremely self-conscious about how they appear to others.

There are two main types of social anxiety disorder. The first focuses on performance, with kids worrying about things like speaking in public or trying out for a team. The second type involves social situations in general — not just situations when a child is in the spotlight. Kids with this type of social anxiety may fear things like going to school, eating in public, using public restrooms, meeting new people, and even having conversations. Most people with more general social anxiety also experience anxiety about performing.

The defining feature of social anxiety disorder includes marked fear or anxiety about one or more social situations in which the person might be subject to possible scrutiny by others. Examples include social interactions, being observed by others, and performing in front of others.

Other symptoms of social anxiety disorder include the following:

• The person feels that he or she will act in a way or show anxiety symptoms that will be negatively evaluated
• The social situations always trigger fear or anxiety (in children this can manifest as tantrums, clinging, crying, freezing up, or failure to speak)
• Social situations are avoided or endured with intense feelings of fear and anxiety
• The fear or anxiety is out of proportion to the actual threat
• The fear, anxiety, and avoidance lasts for 6 months or more
• Causes clinically significant distress in social, occupational (school), or other areas of functioning
• Dread of social events that can occur weeks in advance
• Excessive clinging to familiar people
• Tantrums when faced with anxiety-provoking social situations
• Blaming others for perceived social failures
• Physical symptoms: Blushing, racing heart, shaky voice, trembling, nausea, difficulty speaking

Social anxiety disorder has many effects on the body and mind, causing physical, emotional, and behavioral symptoms.

Children with social anxiety may experience physical symptoms such as shaking, sweating, flushing, and shortness of breath. They may express their anxiety by asking, “What if I do something stupid?” or “What if I say the wrong thing?” Young children sometimes throw tantrums and cry when confronted with a situation that terrifies them. Children may experience anxiety symptoms well in advance of the situation they are worried about.

In children, the symptoms appear in interactions with both adults and peers. Their feelings of anxiety might appear as:

• crying
• throwing tantrums
• freezing
• clinging to a parent or caregiver
• shrinking
• not speaking in social situations

Social Anxiety Disorder – Treatment 

Cognitive-behavioral therapy is a widely accepted psychological approach for breaking severe cycles of anxiety.  However, research into anxiety treatments for children and adults on the spectrum is limited. There are no major clinical trials or proven methods to guide patients, families, or doctors as to which medications work best, for which symptoms, and in which patients who have autism.

How Virtual Therapy is helping children with ASD and Social Anxiety in the Age of Covid.

Orna Kemplar-Azulay, Founder and CEO of RemoteSpeech.com, Abington Speech Pathology, and VirtualTx has been managing treatment programs for children across the diverse spectrum of autism and social anxiety disorders for decades. In 2015, she launched RemoteSpeech.com to respond to the growing demand for therapeutic services for speech-language pathology and to combat the shortage of licensed professionals available to provide treatment.  As Azulay notes, the covid pandemic lead to some positive observations.

“I’ve observed a number of advantages from virtual therapy among children on the spectrum,” says Azulay.  At the launch of RemoteSpeech.com, Azulay learned that children were far more responsive to therapy delivered in a virtual environment. “We received a great response from children receiving therapy through RemoteSpeech.  Pre-Covid, our therapists would reserve the last 10 minutes of therapy for games on the computer or tablet. Children often associated the desktop or tablet with ‘fun’ which quickly changed their perception of therapy to be a ‘reward,’” notes Azulay.  Now that all facets of education and therapy are reserved for a virtual environment, we are seeing kids address therapy in more positive ways.  It completely changed their perception, motivation, and engagement.”

The Covid 19 pandemic provided an additional “hurdle” that previously went unexplored in the treatment of children on the spectrum. Suddenly, children of all ages were receiving the entirety of their education through an online environment. While speech-language pathology had been “virtually established,” a new opportunity slowly drifted to the surface – treating children with social anxiety disorder.

“We are noticing that children that suffer from social anxiety disorder feel less restricted when engaging with their peers online,” says Azulay.  “All of the symptoms that are often present with social anxiety disorder can be mitigated and are much easier to control in online interactions.  Previously, children would be slowly introduced to social interactions.  But now we are learning that in virtual environments, the perceived consequences are no longer present, and the anxiety is dramatically reduced.”

While we are just one year into the Covid pandemic, Azulay shares cautious optimism.  “Although there is such little research on the treatment of social anxiety disorder amongst adolescents across the spectrum of Autism, the correlation between the two disorders is well-established. Our therapists are well-versed in the signs to help to diagnose our patients across the spectrum. Technology has dramatically reshaped the way we treat children on the spectrum, and I have no doubt that there are still many innovations for treatment yet to be discovered.”

———————————————————————————————————————————————————————-

The response to the COVID-19 virus is unprecedented. Because of our unique role in children’s K-12 education, we feel a responsibility to do what we can to assist schools, therapists, and students with this transition to online learning and seclusion. To ensure that our clients remain engaged and supported, our therapists will be providing complimentary “Support Sessions” to the country’s youth. We will also be assisting schools by training therapists for remote therapy.

Click here to schedule a complimentary consultation with an Executive Member of our Team.

Abington Speech Pathology and RemoteSpeech.com are uniquely prepared to provide assistance for parents of children with Speech-Language Pathology.

About Abington Speech Pathology

Abington Speech Pathology is managed and owned by a licensed speech-langauge pathologist. All of the company’s directors are licensed and remain clinical to better direct and support both the company’s clients and the clinical staff.

Through the years the company’s client base continues to grow and remains loyal.  ASPS, INC has expanded its services to include Physical therapy, Occupational therapy, Teachers of the visually and hearing impaired, and School psychologists. ASPS, INC. now operates two offices.  The corporate office is in eastern PA and services all 5 major counties surrounding the metro Philadelphia area. The Southern CA office services the Los Angeles and Orange County metro areas and at this point only offers speech pathology services to all settings.

The company offers the professional staff a lending library of materials. In PA, there are 2-3 continuing educational seminars to assist on clinical growth and state and national mandated continuing education requirements.

About RemoteSpeech.com

RemoteSpeech is a subsidiary of Abington Speech Pathology Services, a multi-faceted Rehab company that has provided Speech Staffing and support throughout the country for more than 20 years. RemoteSpeech combines crystal clear voice with the sharpest video to provide next-generation video calling and high-definition video delivery.

Prior to the Covid 19 pandemic, Orna Kempler-Azulay, President of RemoteSpeech, says the demand for speech-language therapists was outpacing the supply in some cities. RemoteSpeech is here to meet the demand. With its live, face-to-face interaction, RemoteSpeech is not the next best thing to being there in person — it’s just as good, and, in some cases, even better. With advanced state-of-the-art games, activities, and interactive screen sharing, students and adults will actually look forward to their therapy sessions.

Click Here to Learn More About Our Telepractice – Remote Speech-Language Therapy!

 

Click Logo to View Original Article

By Christine Tarlecki

Published: 12:24 pm EST February 26, 2021     Updated: 10:42 am EST February 26, 2021

CEOs share their philosophies on “what it takes” to lead in this competitive and transformative new decade.

   Feb 22, 2021, 12:42pm EST

About five years ago, when most people were giving little thought to coronaviruses, Abington Speech Pathology expanded into a new service line when it began offering teletherapy.

That decision gave the Montgomery County company plenty of time to perfect its service model before the Covid-19 outbreak arrived last year and telehealth became a necessity.

The company, which formed a separate subsidiary in late 2019 called RemoteSpeech, is now ready to export its teletherapy expertise nationally with the introduction of a new product called VirtualTx.

Orna Azulay, the owner, and CEO of Abington Speech Pathology and Remote Speech, said she is talking with outside investors in hopes of raising $3 million to accelerate expansion plans for VirtualTx.

“We want to take this to a national level,” she said. “There’s a need. There were 350,000 students in need not receiving speech therapy [because of access issues] before Covid-19.” The pandemic, she said, has only made access problems worse.

Abington Speech Pathology — which places speech therapists at schools and other care settings — created RemoteSpeech as a separate entity to target the American and international school market for its virtual speech therapy services. Azulay said while schools in the United States were hesitant to embrace the teletherapy model, international schools quickly embraced it.

“They were already using video and teleconferencing,” she said. “One of our clients is a school in Bahamas. For six years they didn’t have a speech pathologist on the island. We’re able to help kids and adults that would normally have to take a two-hour boat ride to see a therapist.”

Azulay said the company created VirtualTx after finding there was no one place where somebody could go and find all the components needed to offer remote speech therapy services — assessments, evaluations, treatment materials, and service management such as billing — in a virtual and private environment. “Everything was piecemeal,” she said. “We decided to do it on our own.”

VirtualTx is a proprietary cloud-based software application web portal and online environment that helps therapists, students/patients, and school districts facilitate and manage effective programs for speech therapy in remote settings. Azulay said VirtualTx is designed to be “interactive and engaging,” and can in some cases outperform in-person treatment.

RemoteSpeech has grown steadily since its launch as a subsidiary. Azulay said its client base doubled since the pandemic hit, but she declined to provide a specific number of clients, which include school districts and individuals, for competitive reasons. In addition, she said, Abington Speech Pathology’s work with about 30 clients moved over to the RemoteSpeech platform after the pandemic hit. One of its newer clients is the Lower Merion School District.

Kimberly Fraser, the district’s director of student services and special education, said when the pandemic forced schools to close, the district immediately began investigating options for providing services remotely.

“Our district has a long-standing partnership with Abington Speech Pathology and we were thrilled that they were able to connect us to these resources,” she said. Fraser said Lower Merion has had a positive experience with VirtualTx.

“It has allowed us to consistently provide related services to our students with special needs during times when remote learning is required,” she said. “Initially we were concerned [about how school district services would be provided] because like all school districts we were forced into closure. We unexpectedly had to face that we could not access our students in person, which forced us to rethink service delivery.”

John George
Senior Reporter
Philadelphia Business Journal

Continued from Part 1 of Our Series on Adult Services

Stuttering

What it is.

Talking to people can be hard if you stutter. You may get stuck on certain words or sounds. You may feel tense or uncomfortable. You might change words to avoid stuttering.

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.

As ASHA Explains:

“We all have times when we do not speak smoothly. We may add “uh” or “you know” to what we say. Or, we may say a sound or word more than once. These are called disfluencies.”

People who stutter may have more disfluencies and different types of disfluencies. They may repeat parts of words (repetitions), stretch a sound out for a long time (prolongations), or have a hard time getting a word out (blocks).

Stuttering is more than just disfluencies. Stuttering also may include tension and negative feelings about talking. It may get in the way of how you talk to others. You may want to hide your stuttering. So, you may avoid certain words or situations. For example, you may not want to talk on the phone if that makes you stutter more.

Stuttering can change from day to day. You may have times when you are fluent and times when you stutter more. Stress or excitement can lead to more stuttering.

Stuttering – How Common is it?

More than 70 million people worldwide stutter, which is about 1% of the population. In the United States, that’s over 3 million Americans who stutter.

Stuttering affects four times as many males as females.

Source

Stuttering – What are the Causes?

There is no one cause of stuttering. Possible causes include the following:

• Family history. Many people who stutter have a family member who also stutters.
• Brain differences. People who stutter may have small differences in the way their brain works during speech.

You cannot always know which children will continue to stutter, but the following factors may place them at risk:

• Gender. Boys are more likely to continue stuttering than girls.  Data are currently limited to individuals who identify as male or female.
• Age when stuttering began. Children who start stuttering at age 3½ or later are more likely to continue stuttering.
• Family recovery patterns. Children with family members who continued to stutter are also more likely to continue.

Stuttering – What are the Symptoms?

The following typical disfluencies happen to many of us and are not stuttering:

• Adding a sound or word, called an interjection – “I um need to go home.”
• Repeating whole words – “Well well, I don’t agree with you.”
• Repeating phrases – “He is–he is 4 years old.”
• Changing the words in a sentence, called revision – “I had–I lost my tooth.”
• Not finishing a thought – “His name is . . . I can’t remember.”

The following types of disfluencies happen when someone stutters:

• Part-word repetitions – “I w-w-w-want a drink.”
• One-syllable word repetitions – “Go-go-go away.”
• Prolonged sounds – “Ssssssssam is nice.”
• Blocks or stops – “I want a (pause) cookie.”

You may also notice other behaviors like head nodding or eye blinking. Sometimes people who stutter use these behaviors to stop or keep from stuttering. They may also avoid using certain words or use different words to keep from stuttering.

Feelings and attitudes can affect stuttering. For example, frustration or tension can cause more disfluencies. Being excited or feeling rushed can also increase disfluencies. A person who stutters may also stutter more if others tease them or bring attention to their speech. Stuttering may cause a person to be embarrassed and make them feel nervous about talking.

Stuttering – What Does Treatment Look Like?

There are different ways to help with stuttering.  Treatment will depend on one or more of the following:

• Frequency of stuttering
• Reaction when stuttering
• How stuttering impacts your everyday life
• How others react to your stuttering

For older children and adults, treatment focuses on managing stuttering. An SLP will help them feel less tense and speak more freely in school, at work, and in different social settings. The SLP will also help the person face speaking situations that make them fearful or anxious. This might include speaking on the phone or ordering food at a restaurant.

Some adults who started stuttering as a child may want to see an SLP every once in a while. The SLP will talk to the person about how stuttering affects their everyday life and can help the person practice ways to manage stuttering.

Children and adults who stutter may want to look into local support groups, where they can talk with others who stutter and learn about other helpful resources.

Stuttering – How does Treatment Improve Quality of Life?

One of the main consequences of stuttering is the false impressions and stigma associated with the disorder.  When one is able to eliminate the rate of frequency of their stuttering, they are also able to eliminate these false ideas, such as:

• People stutter because they are nervous
• People stutter because they are shy
• Stuttering is a psychological disorder
• Stuttering is caused by bad parenting

Stuttering – Resources

• National Stuttering Association
• Stuttering Foundation of America
• American Board of Fluency and Fluency Disorders
• International Stuttering Association
• Stuttering Association for the Young
• Friends: The National Association of Young People Who Stutter
• Stuttering Home Page
• StutterTalk

Voice Disorders

What is it?
**All content below quoted from the American Speech Language and Hearing Association (ASHA).**

A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual’s age, gender, cultural background, or geographic location (Aronson & Bless, 2009; Boone, McFarlane, Von Berg, & Zraik, 2010; Lee, Stemple, Glaze, & Kelchner, 2004). A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs—even if others do not perceive it as different or deviant (American Speech-Language-Hearing Association [ASHA], 1993; Colton & Casper, 1996; Stemple, Glaze, & Klaben, 2010; Verdolini & Ramig, 2001).

A number of different systems are used for classifying voice disorders. ASHA classifies voice disorders as follows:

• Organic — voice disorders that are physiological in nature and result from alterations in respiratory, laryngeal, or vocal tract mechanisms
  • Structural — organic voice disorders that result from physical changes in the voice mechanism (e.g., alterations in vocal fold tissues such as edema or vocal nodules; structural changes in the larynx due to aging)
  • Neurogenic — organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism (e.g., vocal tremor, spasmodic dysphonia, or paralysis of vocal folds)
• Functional — voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal (e.g., vocal fatigue; muscle tension dysphonia or aphonia; diplophonia; ventricular phonation)

Learn more about specific voice disorders here:

• Chronic Cough
• Paradoxical Vocal Fold Movement (PVFM)
• Spasmodic Dysphonia
• Vocal Fold Nodules and Polyps
• Vocal Fold Paralysis

Voice Disorders – How Common are they?

Voice disorders have been estimated to be present in between 3% and 9% of the U.S. population (Ramig & Verdolini, 1998; Roy, Merrill, Gray, & Smith, 2005). However, information from a large U.S. claims database (Cohen, Kim, Roy, Asche, & Courey, 2012) indicates the point prevalence (i.e., the number of individuals with the condition in the database at the time that data were retrieved) of voice disorders is 0.98% in a treatment-seeking population. This likely suggests that a large number of those individuals with voice disorders do not seek treatment.

The prevalence of voice disorders among treatment-seeking individuals has been shown to be affected by gender, age, and occupation:

Gender

• Prevalence is higher in adult females than in adult males, with a reported ratio of 1.5:1.0
• In children, voice disorders are significantly more prevalent in males than in females

Age

• Prevalence has been reported to be higher in elderly adults, with estimates ranging from 4.8% to 29.1% in population-based studies
• In the pediatric population, the reported prevalence of a voice disorder has ranged from 1.4% to 6.0%

Occupation

• Occupational groups that appear to be most at risk for developing a voice disorder include teachers, manufacturing/factory workers, salespersons, and singers
  • The estimated prevalence of reporting a current voice problem was higher in teachers (11.0%) than in nonteachers
  • Reported prevalence for teachers at a single point in time ranged from 9% to 37%
  • Reported lifetime prevalence (i.e., the percentage of teachers who experienced a voice disorder at some point in their lifetime) was between 50% and 80%

Voice Disorders – What are the Causes?

A disturbance in one of the three subsystems of voice production (i.e., respiratory, laryngeal, and subglottal vocal tract) or in the physiological balance among the systems may lead to a voice disturbance. Disruptions can be due to organic, functional, and/or psychogenic causes.

Organic causes include the following:

• Structural
  • Vocal fold abnormalities (e.g., vocal nodules, edema, glottal stenosis, recurrent respiratory papilloma, sarcopenia [muscle atrophy associated with aging])
  • Inflammation of the larynx (e.g., arthritis of the cricoarytenoid or cricothyroid, laryngitis, laryngopharyngeal reflux)
  • Trauma to the larynx (e.g., from intubation, chemical exposure, or external trauma)
• Neurologic
  • Recurrent laryngeal nerve paralysis
  • Adductor/abductor spasmodic dysphonia
  • Parkinson’s disease
  • Multiple sclerosis

Functional causes include the following:

• Phonotrauma (e.g., yelling, screaming, excessive throat-clearing)
• Muscle tension dysphonia
• Ventricular phonation
• Vocal fatigue (e.g., due to effort or overuse)

Psychogenic causes include the following:

• Chronic stress disorders
• Anxiety
• Depression
• Conversion reaction (e.g., conversion aphonia and dysphonia)

Recognizing associations among these factors, along with patient history, may help in identifying the possible causes of the voice disorder. Even when an obvious cause is identified and treated, the voice problem may persist. For example, an upper respiratory infection could be the cause of the dysphonia, but poor or inefficient compensatory techniques may cause dysphonia to persist, even when the infection has been successfully treated.

Voice Disorders – What are the Symptoms?

The generic term dysphonia encompasses the auditory-perceptual symptoms of voice disorders. Dysphonia is characterized by altered vocal quality, pitch, loudness, or vocal effort.

Signs and symptoms of dysphonia include

• roughness (perception of aberrant vocal fold vibration);
• breathiness (perception of audible air escape in the sound signal or bursts of breathiness);
• strained quality (perception of increased effort; tense or harsh as if talking and lifting at the same time);
• strangled quality (as if talking with breath held);
• abnormal pitch (too high, too low, pitch breaks, decreased pitch range);
• abnormal loudness/volume (too high, too low, decreased range, unsteady volume);
• abnormal resonance (hypernasal, hyponasal, cul de sac resonance);
• aphonia (loss of voice);
• phonation breaks;
• asthenia (weak voice);
• gurgly/wet sounding voice;
• hoarse voice (raspy, audible aperiodicity in sound);
• pulsed voice (fry register, audible creaks or pulses in sound);
• shrill voice (high, piercing sound, as if stifling a scream); and
• tremulous voice (shaky voice; rhythmic pitch and loudness undulations).

Other signs and symptoms include

• increased vocal effort associated with speaking;
• decreased vocal endurance or onset of fatigue with prolonged voice use;
• variable vocal quality throughout the day or during speaking;
• running out of breath quickly;
• frequent coughing or throat clearing (may worsen with increased voice use); and
• excessive throat or laryngeal tension/pain/tenderness.

Signs and symptoms can occur in isolation or in combination. As treatment progresses, some may dissipate, and others may emerge as compensatory strategies are eliminated.

Auditory-perceptual quality of voice in individuals with voice disorders can vary depending on the type and severity of disorder, the size and site of lesion (if present), and the individual’s compensatory responses. The severity of the voice disorder cannot always be determined by auditory-perceptual voice quality alone.

Voice Disorders – What Does Treatment Look Like?

Treatment Approaches

Norms within different settings are considered when determining vocal needs and establishing goals. For example, vocal norms and needs within the workplace may be different from those within the community (e.g., home and social settings).

SLPs often incorporate aspects of more than one therapeutic approach in developing a treatment plan.

Approaches can be direct or indirect.

• Direct approaches focus on manipulating the voice-producing mechanisms (e.g., phonation, respiration, and musculoskeletal function) in order to modify vocal behaviors and establishing healthy voice production (Colton & Casper, 1996; Stemple, 2000).
• Indirect approaches modify the cognitive, behavioral, psychological, and physical environments in which voicing occurs (Roy, et al., 2001; Thomas & Stemple, 2007). Indirect approaches include the following two components:
  • Patient education—discussing normal physiology of voice production and the impact of voice disorders on function; providing information about the impact of vocal misuse and strategies for maintaining vocal health (vocal hygiene)
  • Counseling—identifying and implementing strategies such as stress management to modify psychosocial factors that negatively affect vocal health (Van Stan, Roy, Awan, Stemple, & Hillman, 2015)

A therapeutic plan typically involves the use of at least one of the direct approaches and one or more of the indirect approaches based on the patient’s condition and goals. Some clinicians concentrate on directly modifying the specific symptoms of the inappropriate voice, whereas others take a more holistic approach, with the goal of balancing the physiologic subsystems of voice production—respiration, phonation, and resonance.

Many clinicians begin by

• identifying behaviors that are contributing to the voice problems, including unhealthy vocal hygiene practices (e.g., shouting, talking loudly over noise, coughing, throat clearing, and poor hydration) and
• implementing healthy vocal hygiene practices (e.g., drinking plenty of water and talking at a moderate volume) and practices to reduce vocally traumatic behaviors (e.g., voice conservation).

Voice Disorders – Resources:

See ASHA information for professionals on the Practice Portal’s Voice Disorders page.

• Frequently Asked Questions about Voice Therapy for Hoarseness
• Accent Modification
• Voice and Communication Change for Transgender People

In the world of speech pathology, special care is given to children and adolescents with speech disorders, as it is recognized that both verbal and non-verbal communication play an urgent role in a child’s growth and development. Great care is given to acknowledge the value of a child’s ability to communicate with the world around them. As a result, quantitative research has enabled the industry to make great strides on the value of early intervention.  However, the qualitative value (that cannot be measured in numbers) gets less attention.  Adults suffering from communication disorders face similar challenges – how do you quantify the value of being able to communicate?  What contributions does communication make to a person’s quality of life?  How does a communication deficiency affect the individual and those closest to them?

Communication is not a luxury – it is essential.   We believe that the first step in addressing stigmas and changing attitudes is through education. In this series, we are going to put a spotlight on speech-language pathology for adults.

We will start by highlighting the leading causes and conditions in adults that could benefit from speech therapy. To accomplish this goal, we have identified the five leading conditions that should be addressed with speech therapy.  For each condition,  we have taken medical designations and further explained them in relatable terms with which we can easily identify.  We seek to ask: How common are these conditions? What are the causes? What are the symptoms? Who are subject to these conditions, and what does treatment look like?

In part 3 of our series, we will examine how effective treatment programs improved the life of the patient by referencing adult patients of RemoteSpeech (we have changed their names and modified their details to remain in compliance with HIPPA regulations).

1. Apraxia of Speech (AOS)

Also known as acquired apraxia of speech, verbal apraxia, or dyspraxia.

What it is.

Apraxia is a loss of the ability to use or understand language. Aphasia is an acquired communication disorder that impairs a person’s ability to process language, but does not affect intelligence. Aphasia impairs the ability to speak and understand others. This disorder can make saying the right sounds and words very difficult.

Apraxia is a motor speech disorder, that varies by complexity.  How serious your apraxia depends on what type of brain damage you have. Apraxia can happen at the same time as other speech or language problems. You may have muscle weakness in your mouth. This is called dysarthria. You could also have trouble understanding what others say or telling others what you are thinking. This is called aphasia.

As the American Speech and Hearing Association (ASHA) explains:

“To speak, messages must go from your brain to your mouth. These messages tell the muscles how and when to move to make sounds. When you have apraxia of speech, the messages do not get through correctly due to brain damage. You might not be able to move your lips or tongue the right way to say sounds. Sometimes, you might not be able to speak at all.”

Apraxia – Types and Causes.

There are two main types of AOS: acquired apraxia of speech and childhood apraxia of speech.

• Acquired AOS can affect someone at any age, although it most typically occurs in adults. Acquired AOS is caused by damage to the parts of the brain that are involved in speaking and involves the loss or impairment of existing speech abilities. It may result from a stroke, head injury, tumor, or other illness affecting the brain. Acquired AOS may occur together with other conditions that are caused by damage to the nervous system.
• Childhood AOS is present from birth. This condition is also known as developmental apraxia of speech, developmental verbal apraxia, or articulatory apraxia. Childhood AOS is not the same as developmental delays in speech, in which a child follows the typical path of speech development but does so more slowly than is typical. The causes of childhood AOS are not well understood. Imaging and other studies have not been able to find evidence of brain damage or differences in the brain structure of children with AOS. Children with AOS often have family members who have a history of a communication disorder or a learning disability. This observation and recent research findings suggest that genetic factors may play a role in the disorder. Childhood AOS appears to affect more boys than girls.

Apraxia – How Common is it?

The incidence of apraxia refers to the number of new cases identified in a specific time period. The prevalence of apraxia refers to the number of individuals who are living with AOS in a given time period.

There are no reliable data on the incidence and prevalence of AOS in adults due to challenges associated with the common co-occurrence of apraxia with aphasia and dysarthria.  Collection of data is also challenging due to difficulty distinguishing among those disorders—particularly in distinguishing between apraxia characteristics and phonological errors that can occur in aphasia.

Duffy (2013) observed that Apraxia was documented as the primary, but not necessarily the only, communication disorder for 6.9% of all motor speech disorders in the Mayo Clinic Speech Pathology practice. This percentage would undoubtedly increase drastically if the data included cases in which AApraxia was a secondary communication disorder (e.g., less severe than aphasia or dysarthria; Duffy, 2013; pp. 269–270).

Apraxia – What are the Causes?

Apraxia is caused by any process or condition that compromises the structures and pathways of the brain responsible for planning and programming motor movements for speech. Any type of brain damage can cause apraxia. Causes most often include:

• stroke,
• traumatic brain injury (TBI),
• tumor,
• surgical trauma (e.g., tumor resection), or
• progressive disease.

Specifically, damage to the parts of the brain that control how your muscles move causes apraxia of speech.

Apraxia – What are the Symptoms?

If you have apraxia, you may experience these symptoms:

• Distorting sounds. People with AOS may have difficulty pronouncing words correctly. Sounds, especially vowels, are often distorted. Because the speaker may not place the speech structures (e.g., tongue, jaw) quite in the right place, the sound comes out wrong. Longer or more complex words are usually harder to say than shorter or simpler words. Sound substitutions might also occur when AOS is accompanied by aphasia.
• Making inconsistent errors in speech. For example, someone with AOS may say a difficult word correctly but then have trouble repeating it, or may be able to say a particular sound one day and have trouble with the same sound the next day.
• Groping for sounds. People with AOS often appear to be groping for the right sound or word and may try saying a word several times before they say it correctly.
• Making errors in tone, stress, or rhythm. Another common characteristic of AOS is the incorrect use of prosody. Prosody is the rhythm and inflection of speech that we use to help express meaning. Someone who has trouble with prosody might use equal stress, segment syllables in a word, omit syllables in words and phrases, or pause inappropriately while speaking.
• In severe cases, the patient may not be able to say any sounds at all.

Apraxia – What Does Treatment Look Like?

A speech-language pathologist will tailor your treatment regimen to address your specific needs.  Treatment might include therapy to improve the following:

• Improve how you say sounds and put sounds into words.
• Attention to getting your muscles to move correctly.
• Teach your muscles to make sounds again.
• Saying sounds over and over and using the correct mouth movements
• Slow down your speech or talk to a steady beat so that you can say the sounds you need to say.

In severe cases, patients might be required to employ augmentative and alternative communication – or, methods to find other ways to communicate (simple hand gestures, writing, pointing to letters or pictures, using a computer…etc)

Apraxia – Additional Resources

• Acquired Apraxia of Speech (asha.org)
• National Institute of Neurological Disorders and Stroke
• National Institute on Deafness and Other Communication Disorders

2. Aphasia

What it is.

A person with aphasia may have trouble understanding, speaking, reading, or writing.

As The American Speech Hearing Association (ASHA) explains:
“Aphasia is a language disorder that happens when you have brain damage. Your brain has two halves. Language skills are in the left half of the brain in most people. Damage on that side of your brain may lead to language problems. Damage on the right side of your brain may cause other problems, like poor attention or memory.”

Aphasia may make it hard for you to understand, speak, read, or write. It does not make you less smart or cause problems with the way you think. Brain damage can also cause other problems along with aphasia. You may have muscle weakness in your mouth, called dysarthria . You may have trouble getting the muscles of your mouth to move the right way to say words, called apraxia . You can also have swallowing problems, called dysphagia.

Aphasia – How Common is it?

• Research suggests that over 2,000,000 Americans currently suffer from some level of Aphasia
• While anyone can acquire Aphasia, most people who have it are in their middle to late years. Men and women are equally affected.
• Aphasia is very common among stroke patients.  In fact, approximately one-third of stroke victims will suffer from some sort of Aphasia.
• It is estimated that approximately 80,000 individuals acquire aphasia each year. However, in 2020, the annual rate doubled to 180,000 new cases.

Learn More about Current Statistics

Aphasia – What are the Causes?

Aphasia is most often caused by stroke. However, any type of brain damage can cause aphasia. This includes brain tumors, traumatic brain injury, and brain disorders that get worse over time.

Aphasia – What are the Symptoms?

Aphasia can lead to a number of different problems. You may have trouble talking, understanding, reading, and writing.

Talking

• Can’t think of the words you want to say.
• Say the wrong word. Sometimes, you may say something related, like “fish” instead of “chicken.” Or you might say a word that does not make much sense, like “radio” for “ball.”
• Switch sounds in words. For example, you might say “wish dasher” for “dishwasher.”
• Use made-up words.
• Have a hard time saying sentences. Single words may be easier.
• Put made-up words and real words together into sentences that do not make sense.

Understanding

• Not understand what others say. This may happen more when they speak fast, such as on the news. You might have more trouble with longer sentences, too.
• Find it hard to understand what others say when it is noisy or you are in a group.
• Have trouble understanding jokes.

Reading and Writing

• Reading forms, books, and computer screens.
• Spelling and putting words together to write sentences.
• Using numbers or doing math. For example, it may be hard to tell time, count money, or add and subtract.

Aphasia – What does treatment look like?

Testing for Aphasia

You should see a doctor if you have trouble speaking or understanding what people say. A doctor will determine if there is a medical cause for your problem. A speech-language pathologist, or SLP, will test your speech and language skills. The SLP will ask you about the problems you have and what you want to work on. The SLP will test how well you:

• Understand words, questions, directions, and stories.
• Say words and sentences. The SLP will ask you to name objects, describe pictures, and answer questions.
• Read and write. The SLP will have you write letters, words, and sentences. You will also read short stories and answer questions about them.
• Find other ways to share your ideas when you have trouble talking. This may include pointing or using other gestures and drawing pictures.

Treatments for Aphasia

There are many ways to work on your language. The type of treatment you get depends on what you want and need. You may work with an SLP on your own or in a small group. You may want your family to be a part of your treatment. They can help you use the skills you learn with the SLP at home. You may also join a support group or Stroke Club for social activities.

Do you speak more than one language? You may talk better in one language and have more trouble in the other. Or, you may have trouble in both. You should work with an SLP who speaks both languages if you can.

In severe cases, you may need to find other ways to answer questions or tell people what you want. These may include simple hand gestures, writing, pointing to letters or pictures, or using a computer. This is augmentative and alternative communication , or AAC.

The SLP can help you get ready to go back to work or school if that is your goal. You may need to change how you do your work. Or you may need special equipment to help you communicate. Your SLP can work with your boss or teachers to make these changes.

See ASHA information for professionals on the Practice Portal’s Aphasia page.

Aphasia – Other Resources

• Aphasia Hope
• National Aphasia Association
• American Stroke Association

3. Dysarthria

What it is.

Dysarthria is a speech disorder caused by muscle weakness. It can make it hard for you to talk. People may have trouble understanding what you say.

As ASHA Explains:

“We use many muscles to talk. These include muscles in our face, lips, tongue, and throat, as well as muscles for breathing. It is harder to talk when these muscles are weak. Dysarthria happens when you have weak muscles due to brain damage. It is a motor speech disorder and can be mild or severe.”

Dysarthria can happen with other speech and language problems. You might have trouble getting messages from your brain to your muscles to make them move, (apraxia). You could also have trouble understanding what others say or telling others about your thoughts, called (aphasia).

Dysarthria – How Common is it?

In a recent study, 64% of the 88,974 stroke survivors reviewed were communication impaired:

• 28% had both aphasia and dysarthria
• 24% had dysarthria only
• 12% had aphasia only

Another study found that Spasmodic dysphonia (a voice disorder caused by involuntary movements of one or more muscles of the larynx or voice box) can affect anyone. The first signs of this disorder are found most often in individuals between 30 and 50 years of age. More women appear to be affected by spasmodic dysphonia than men.

Dysarthria – What are the Causes?

Brain damage causes dysarthria. It can happen at birth or after an illness or injury. Anything that causes brain damage can cause dysarthria, such as:

• Stroke
• Brain injury
• Tumors
• Parkinson’s disease
• Amyotrophic lateral sclerosis, or ALS
• Huntington’s disease
• Multiple sclerosis
• Cerebral palsy
• Muscular dystrophy

Dysarthria – What are the Symptoms?

Dysarthria results from impaired movement of the muscles used for speech production, including the lips, tongue, vocal folds, and/or diaphragm. The type and severity of dysarthria depend on which area of the nervous system is affected.

A person with dysarthria may exhibit one or more of the following speech characteristics:

• “Slurred,” “choppy,” or “mumbled” speech that may be difficult to understand
• Slow rate of speech
• Rapid rate of speech with a “mumbling” quality
• Limited tongue, lip, and jaw movement
• Abnormal pitch and rhythm when speaking
• Changes in voice quality, such as hoarse or breathy voice or speech that sounds “nasal” or “stuffy”

Dysarthria – What Does Treatment Look Like?

Your work with the SLP will depend on the type of dysarthria you have and how severe it is. You may work on:

• Slowing down your speech
• Using more breath to speak louder
• Making your mouth muscles stronger
• Moving your lips and tongue more
• Saying sounds clearly in words and sentences
• Using other ways to communicate, like gestures, writing, or using computers. This is augmentative and alternative communication or AAC.

The SLP can also work with your family and friends to help them learn ways to talk with and understand you.

Dysarthria – Resources

This list does not include every website on this topic. ASHA does not endorse the information on these sites.

• Mayo Clinic
• FCC speech-to-speech services access numbers

Learn more about Adult Services for Speech Therapy,

in Part 2 of our Series