Treatment - Childhood Disorders: Communication Disorders

Treatment

Speech and Language Therapy

Speech and language therapy typically has three major goals:

·           the development of communication skills with concurrent re-mediation of deficits;

·           the development of alternative or augmentative communica-tion strategies, where required; and

·           the social habilitation of the individual with regard to communication.

The speech and language pathologist plays the most direct role in treatment of these conditions. SLPs employ a wide range of techniques with children that require both science and art. As in child psychotherapy, the participation of parents is necessary. Parent–infant work involves demonstration and modeling of lan-guage-stimulation techniques. Individual therapy can usually be begun by three years of age, and early initiation of therapy is frequently recommended. Individual sessions can include formal exercises along with seemingly less structured but nonetheless carefully directed verbal and play interactions. Group therapy can also be used, especially in the development of language skills applied to a social context; but it should not be regarded as a low-budget substitute for individual treatment. Treatment requires regular reassessment, ongoing support to parents and regular re-consultation with other professionals.

The need for clinicians to avoid regarding variations in ac-cent and dialect as pathologic has been cited. Very little empirical literature on cultural variations in communication therapy is ex-tant. McCrary (1992) and others have pointed out the need for cultural sensitivity in treatment, citing the efforts of ASHA in this area.

The treatment of stuttering addresses both the mechan-ics of speech and associated attitudinal and affective patterns. Guitar (1985) notes that therapists attempt to modify speech rhythm and speed, leading subjects to regularize rhythm and, as a temporary measure, prolong their speech. Treatment also addresses respiration, airflow and “gentle” onset of phonation. Success rates for various treatments of up to 70% have been re-ported, though with varying follow-up periods and relapse rates. Some speech and language pathologists specialize in the treat-ment of this disorder.

The Role of the Psychiatrist

Children with these disorders may present for treatment of psy-chiatric disorders based on or related to communication prob-lems. Thus, the psychiatrist may in the first place be a case finder or case manager, facilitating the evaluation and treatment of these disorders by a multidisciplinary team. The psychiatric comorbidity of these disorders will necessitate the psychiatrist’s involvement on many levels, both as a clinician primarily treat-ing a child, and as a therapist, counselor, and agent of advice and support for the entire family.

Individual and family psychotherapy may be a useful aug-ment in reducing the stress these children encounter, even though psychotherapy does not directly address language disorders. The psychotherapist must, in any event, be sensitive to the manner in which communication disorders can affect or interfere with the therapeutic process. Nonverbal augments or prompts should be sensitively provided children who need them.

The role of psychotropic medication in the management of these disorders is mainly limited to the treatment of comorbid psychiatric problems according to standard practices. From time to time, some interest in the use of drugs specifically for these conditions has arisen. The author has received occasional reports of treatment of stuttering in the past with tricyclic antidepres-sants and, more recently, selective serotonin re-uptake inhibitors. The rationale for these treatments appears to be a hypothetical connection between stuttering and similar compulsive behaviors. These accounts are provocative but do not suggest any real indi-cation for these medications for stuttering alone.

Outcome

Outcome studies of communication therapy, especially for the language disorders, have often been complicated by multiple theories of language development, diagnostic and methodologic variations, lack of standardization of therapeutic techniques, and comorbidity. Thus the literature in this area is relatively sparse and not always conclusive. Nonresponse to initial treatment may be common, requiring patience and persistence. It is important to note in assessing these issues that, even when communication therapy does not lead to apparent improvements in language beyond de-velopmental improvements, it may still facilitate the child’s use of extant language for environmental and self-control.