Music: A Cure For All?

We've all heard how music therapy can do wonders for many populations including Autism, trauma, Alzheimer's, stuttering, pain management, etc.  How about for children with Central Auditory Processing Disorder (CAPD)?

I remember reading, in an ancient text from graduate school (okay, that was only seven years ago, not THAT ancient), that nursery rhymes could be beneficial in auditory training due to the predictable and repetitive rhyme. However, it wasn't until last months issue of the ASHA Leader did I see an article on music therapy enhancing the performance in CAPD individuals.

In the article titled, "This Is Your Brain On Music", the interviewee, Dana Strait, discusses his success with shaping cognitive development in those with Auditory Processing Disorder. He suggests starting by learning a single-lined instrument to reduce motor complexity. For example, a guitar or the drums. He also states that age 7 is a critical age in which white mater develops, leading to implications on a good age to start playing an instrument or, "making music", as he refers to it.

Strait goes on to discuss that if the process of learning is enjoyable, the child will make greater gains. Music is one way to enjoy learning. Strait couldn't provide research on the benefit of musical electronic games including Rock Hero; but, he did say that they could be a viable first step.  What Strait could say is that there is a direct correlation between the time spent practicing music and the amount of neural/cognitive benefit.

If you or someone you know may be interested in music therapy as benefit for Central Auditory Processing Disorder, please visit http://leader.pubs.asha.org/article.aspx?articleid=1841209

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Tired from Listening

A recent article, from the March, 2014 edition of the ASHA Leader,  highlighted the relationship between hearing loss and fatigue. The study demonstrate that children with hearing loss suffered from general sleep/rest fatigue as well as cognitive fatigue more so  than their hearing peers. The study aimed to identify the impact that the fatigue due to hearing loss has on the education of elementary aged students.

This study could also be useful in generalizing effects not only to those with a hearing loss, but, also to student who have difficult with hearing/auditory-related difficulties. Central Auditory Processing Disorder (CAPD) is the inability for the brain to process auditory information the way you and I do. CAPD, similar to hearing loss, is diagnosed by an Audiologist; however, often will go un-diagnosed in many children as these kids have normal hearing function. However, placed in a noisy or distracting environment, children with APD will seem to have attention issues, difficulty following directions, and recall challenges. Since hearing the differences in sounds is difficult, they may start to have problems in reading and spelling; similar to a learning disability.

So, if kids with a hearing loss are shown to fatigue more quickly than classmates with normal hearing, we might be able to assume,that children who have CAPD also will fatigue more easily. It's important that we keep a lookout for these kids in our schools, clinics, and homes.

More information of CAPD can be found at http://kidshealth.org/parent/medical/ears/central_auditory.html

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Are Basic Concepts 'Basic' for All Children?

What exactly are basic concepts? Should my child know many of these concepts before kindergarten? According to Susie Loraine, M.A, CCC-SLP, “basic concepts are the foundation of a child’s education”. Basic concepts are commonly used words that aid in speech and language development. The understanding of basic concepts will help your child become successful in many environments (e.g. home, school, playground, etc.) and across situations and people.   We will provide you with a list of the most common basic concepts. This list is not complete.

• Basic colors: red, orange, yellow, green, blue, purple, pink

• Quantities - one, one more, less, more, most, few, many, some

• Sequences - first, next, after that, and finally, before, after,

• Shapes - circle, triangle, square, rectangle, diamond, oval, round

• Size - small, large, big, little, huge, tiny

• Social/Emotional States (feelings) - happy, sad, mad, angry, silly, surprised

• Textures - bumpy, rough, smooth, soft, prickly, hard

• Time - morning, afternoon, evening, late, early, today, tomorrow, week, month, year, day

• Spatial Relationships- on, off, in, out, under, in front, behind, top, bottom, up, down,

As a parent, you are, more than likely, modeling many of these concepts during daily routines and play. Basic concepts allow your child to express him/herself in greater detail. It also allows them to understand and give meaning to their world, by following directions and carrying out activities of daily living independently. Around the age of 18 months, your child should have approximately 50 words in his/her vocabulary, typically words with high meaning for them (food items, toys, family members). At this time, children begin combining 2 words (e.g. "mommy go", "more cookie"). This is when a parent can begin modeling and demonstrating basic concepts. Talk about what you are doing, when you are doing it. Add descriptive words to what your child touches, looks at, plays with, smells, etc. This is called direct teaching. Children learn about their world primarily through play and interaction. Emphasize target words by saying it louder, this is referred to as auditory bombardment. For example, “ball”, “BIG ball”. Offer your child a choice of 2. For example, say “BIG ball or LITTLE ball?” Your child might make a verbal or gestural choice. If a gestural choice is made, label the item that was pointed to/reached toward/touched/etc. Repeat, label, and model the target concept many times. Use ‘error-free’ language. If you want your child to choose the BIG ball, have the big ball in closer proximity so you child is successful!

If your child is not combining 2 words, basic concepts should not be taught. Children should have a well-developed core vocabulary before adding basic concepts (descriptive terms). By the time your child is 3, he/she is understanding around 1,000 to 2,0000 words and should be saying around 1,000.

Frequently, basic concepts occur in pairs and have a tendency to be opposites. Teach a variety of concepts, but don’t teach two similar concepts at the same time (e.g.  two spatial concepts at the same time, two color concepts). For example, if teaching “big” do not teach “little” at the same time. When your child learns “big” and is consistently identifying the target word correctly, introduce “little”.  There are many games that incorporate basic concepts (e.g. Candyland, Mr. Potato, balloons, memory, hide-and-seek, etc.), if not, add your own descriptive words to your daily routines and activities.

Most importantly, PLAY and have fun!

 Written by Angie

References:

Chamberlain, C. E. (1990). Best concept workbook ever: Your picture worksheets for teaching

basic concepts (vocabulary, language 4 thru 7 years, preschool thru 2nd grade). Linguisystems.

Wiig, E. H. (2004). Wiig assessment of basic concepts®. Greenville, SC: Super Duper®

Publications.

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Speech-Language Pathology (SLP) Vocabulary 101:

As a parent, you might not understand the lingo of SLPs. During a speech and language evaluation, or while reading your child’s report, your evaluator might be using terms that sound foreign. It is important, if you do not understand what your evaluator is saying, to simply ask. As you continue reading, the most frequently used words will be described.

Receptive Language: Is one of two foundational components of communication. It is what a child understands from the people and objects in his environment. It allows a child to discriminate and understand information (e.g. story comprehension, verbal commands) through spoken language.

*Receptive Language is most often a precursor to expressive language.

Expressive Language: Is the second foundational component of communication. It is how a child communicates and expresses him/herself. Expressive language is not solely the number of words your child produces. Expressive language can include things such as vocalizations, facial expressions, gestures, signs, pictures, communication devices, words, phrases, etc. Therefore, it is important to know expressive language is more than words; it also includes non-verbal means of communication.

Symbol Use (Expressive and Receptive Language): This developmental area relates to the non-verbal and verbal forms, which a child understands and uses to communicate and share experiences with others. Specifically, this refers to grammar, semantics, and syntax)

Grammar: The ability to modify the use of grammatical structures in order to make significant distinctions in the content of messages. ( e.g. “She walked” vs. “ She walkded”)

Syntax: How words are organized into sentences (word order/combinations). For example, subject + verb, attribute + object, agent + action, etc. It allows us to express meaning. “I want a cookie please” vs. “cookie want please I”.

Semantics: Refers to the meaning of a word and/or message. How a child is able to understand and use vocabulary words. (“He ate the apple” vs. “He ate the running”)

Joint Attention: Involves awareness that another person is directing one’s attention to an object, event, place or activity.  It requires coordinated attention between people and objects, orienting and attending to a social partner, shifting gaze between people and objects, sharing affect or emotional states with another person.  Joint attention also includes being able to draw another person’s attention to objects or events by using eye gaze and pointing for the purpose of sharing experiences. Additionally, it enables a child to consider another person’s perspective and point-of-view. Once, a child is able to successfully ‘joint attend’, they are able to adjust language based on the situational setting/context. Joint attention can increase your child’s self-confidence in actively participating in social activities/conversations.

Pragmatics/Social Language: The social aspects and use of language. How your child effectively interacts and communicates with his/her peers, family members, caregivers, teachers, etc., for a variety of functions. As a child learns how to communicate with others, they increase their effectiveness of getting their wants and needs met. It includes, but is not limited to the rules of conversation (e.g. turn-taking, initiating topics, shifting topics, etc.) emotional expression, figures of speech, sarcasm, etc.  This is an area of difficulty for children on the Autism Spectrum and other disabilities.

Nonverbal Communication: Includes things such as gestures, facial expressions, body language, etc. Nonverbal communication makes up roughly 80% of our total communication.

Morphology: the smallest unit of a word. It is a part of a word that carries meaning. For example, past tense –ed changes the meaning of word, to indicate something you have done.

Grammatical Markers: Sounds that mark grammatical categories in English. According to Brown, there are 14 grammatical markers: present progressive –ing (e.g. walking), prepositions (e.g. in, on), regular plural –s (e.g. cats), irregular past tense (e.g. ate), possessive ‘s (e.g. dog’s food), uncontractible copula (e.g. This is hot), articles (e.g. a, an, the), regular past tense –ed (e.g. walked), regular third person (e.g. she works), irregular third person (e.g. she does), uncontractible auxiliary (e.g. Jess is winning), contractible copula (e.g. It’s a bird) and contractible auxiliary (e.g. He’s eating).

Jargon: Nonsense words, consonant-vowel or vowel-consonant combinations. Intonation and prosody imitate that of an adult’s speech. It is sometimes referred to as “gibberish”.

Fluency: How your words and sentences flow together smoothly (e.g. rate of speech). A disruption in fluency is referred to as stuttering. Disruptions can include, but are not limited to repetitions of sounds, words, phrases, etc.

Intelligibility: Clarity of speech sound productions.

Articulation: Refers to correct production of sounds in words. As a child is able to correctly produce sounds, his/her intelligibility will increase. Therefore, a child with an articulation delay/disorder will have difficulty producing one or more sounds (atypical speech) due to motoric movements. Errors can include, but are not limited to substitutions, omissions, deletions, distortions, etc. Speech sound acquisition depends on the age of the child. Even in typically developing children, speech sound acquisition varies. According to Goldman-Fristoe, 2000, Smit, et al 1990, Sanders 1972, Prather, et al 1975 Templin 1957, the following sounds should be mastered by the following ages:

3-/m, b, n, w, d, p, t, h/

3.5-/k, g/, “ing”

4-/f/, “y”

6-/l/

6.5-/v/

7-/s, z, r/, “ch”, “dg”, “sh”, th”

*All sounds should be mastered by the age of 7.

Phonology: A class of speech sound errors (patterns) that are produced in error at the cognitive or linguistic level. A child may be able to produce a speech sound correctly, but not use it correctly. Entire classes of sounds can be classified into place, manner and, voicing. This can include things such as stop consonants /p, b, t, d, k, g/ (manner), labio dental consonants /f, v/ (place), and voicing /b, d, g/. Patterns of speech errors are referred to as phonological processes. Generally speaking, children with phonological disorders are more difficult to understand than a child with an articulation disorder. There are multiple phonological processes, in which they all should be resolved by the age of 7, or the first grade.

Voice: What we hear when we speak. It includes pitch, intonation, loudness, and vocal quality (e.g. hoarseness, “wet”, rough, etc.)

Oral Motor: Oral motor is adequate speech muscle strength, muscle tone, coordination, speed, accuracy in articulation, and range of motion to produce intelligible speech. It includes muscle movements of the face (e.g. lips, jaw, tongue, soft palate, etc.)

Attention and Routines: Attention is required in order for children to actively learn during an activity. When children are engaged in an activity, they are able to learn about the world around them .Routines are predictable events performed repeatedly (i.e. brushing teeth, getting dressed, eating dinner, etc.). When routines are used in a predictable context, they assist in facilitating language. Since children can predict what events will happen, they are able to appropriately finish the routine with correct language use. Routines help children learn how to initiate and terminate conversations, ask and answer questions, and request information or help.

Play: Play is a child’s work. It is their job. It is their way to express themselves and how they learn. Play is important in overall childhood development. Play stimulates the body and the brain. It fosters cognitive, fine and gross motor, communication, social-emotional and self-help skills. Play is so important to optimal child development, that it has been recognized by the United Nations High Commission for Human Rights as a RIGHT OF EVERY CHILD. Children learn that a toy is a representation of a “real” object. In the same manner, words are symbolic representations of ideas, objects and concepts.

Written by Angie

Just Playing: The Importance of Play

As a child, I remember playing for hours. I enjoyed riding my bike around the neighborhood, playing at the park, playing tag, hopscotch, jump roping, dress-up, etc. The list is endless. I enjoyed playing dolls and Barbie’s, while my brothers enjoyed playing Legos and building blocks. Play is a child’s work. It is their job. It is their way to express themselves. Play is important in overall childhood development. Play stimulates the body and the brain. It fosters cognitive, fine and gross motor, communication, social-emotional and self-help skills. Play is so important to optimal child development, that it has been recognized by the United Nations High Commission for Human Rights as a RIGHT OF EVERY CHILD.

Spending time playing is establishing and building your child’s self-esteem. Play between children and their parents, creates a bond and let’s your child know they are important. It allows the parent to role-play real life situations and teaches the child how to problem-solve certain social situations. For example, play during recess creates endless social and communication opportunities. Since there have been nation-wide budget cuts; children around the country no longer have recess and/or fewer physical education days. This means, children are playing less at school. Additionally, in today’s age of technology, children are less likely to play, are less likely to go outside and explore and have a decreased imagination. It is important to limit the time your child spends in front of the television.

There are many types and stages of play, and as your child grows, their play evolves. Play begins in infancy. For example, when your child begins playing with a rattle and begins looking around. Simple give-and-take games, such as peek-a-boo and smiling back and forth is encouraging interaction-attachment. Play progresses, where a child takes on different roles, common goals, plays with one to two leaders. It becomes relatively long and complex.

Play parallels language, meaning if your child is playing with one object they should be saying one word. If your child is combining objects into play, he/she should be combing words. Therefore, as your child’s play becomes more sophisticated, his/her language will follow. Play is fun and can be free. It is important to avoid telling your child what to do and try avoiding asking too many questions. Follow your child’s lead by commenting on what he/she is doing. Research has concluded, families who play together have better communication and are more supportive. Play is important in promoting a healthy development and creating child-parent bonds. In our busy worlds it is important to make time to play!

As a parent, ask yourself these questions:

1. When was the last time you played with your child?

2. What games and toy preferences does your child have?

3. How long does your child play for on a daily or weekly basis?

 “When you asked me what I did in school today and I say, 'I just played.' Please don’t misunderstand me. For you see, I am learning as I play. I am learning to enjoy and be successful in my work. Today I am a child and my work is play.”

Anita Wadley, 1974

~Written by Angie

Communication Strategies for Infants and Toddlers

Your baby starts communicating with you before they take their first breath. It's true,  little Johnny and Susie are communicating even before they leave the womb. Sure, early communication seems like a lot of crying and grunting at first, but quickly becomes so much more! As you understand early communication, you will be better equipped to enhance your baby's language from infancy through adulthood.

Communication can be broken down into two fundamental categories: expressive language and receptive language. Expressive language is an individual’s ability to communicate using words, phrases, build sentences, report information, tell stories, have conversations, etc. for means of social, academic and safety needs.  Receptive language is most often a precursor to expressive language, therefore, it is essential to establish before vocalizations begin.

Expressive Language:

Around 10 months of age, your child should begin using variegated babbling, using different consonant+ vowel (CV) syllables and more sounds should begin appearing. Adult-like intonation and prosody (the up and down tones in our voice) emerges. Frequently used consonants include the following sounds /h, d, b, m, t, n, w, p/. Before your child turns one, they should have approximately 2 words in their vocabulary (i.e. mama and dada). Your child should be able to imitate CV combinations and non-speech sounds (i.e. clicks, raspberries, animal sounds). They should also begin imitating the name of familiar objects such as “ball, milk, baby”. Communication continues to grow and expand at an exponential rate. By the age of 15 months, your child should begin saying 8-10 words spontaneously and begin asking to have their needs met.After birth, vocalizations are reflexive, including crying, coughing and sneezing. As your child begins to cry, they are communicating a need (i.e. hungry, tired, dirty diaper). At two months of age, a parent is beginning to distinguish cries for different needs. As your child grows to four to six months of age, he/she is beginning to communicate by laughing, babbling CV and VC syllable sequences and vocalizing feelings through intonation. Reduplicated syllables, such as “baba” begin emerging around 7 months, as do gestures. Gestures are a precursor for verbal language skills. For example, gestures can include reaching towards a rattle, looking at their bottle, smiling when approached and spoken to, establishing eye contact, grabbing for a toy, etc.

 By 18 months your child should have approximately 50 words in his/her vocabulary and should begin asking questions (“daddy go?”). At 24 months your child should have approximately 250 words and be using new words regularly!! Your child should consistently be combining 2-3 words and should be approximately 50% intelligible (percentage of time your child is understood by an unfamiliar listener). By 36 months, your child should be able to relate recent experiences through words, begin conversing, begin counting and combing 3-4 words and be approximately 75% intelligible.

Receptive Language:

Soon after birth, your child learns to quiet to a familiar voice, shows awareness of a speaker and attends to the speaker’s mouth. Around three months of age, your child searches for you when he/she hears your voice, stops crying when spoken to and is beginning to respond to “no”. At the age of six months, your child is beginning to understand a few words and should beginning to follow simple commands, with gestures. For example, “come up” while holding your hands out. They should begin to recognize family members’ names (i.e. mommy and daddy) and wave in response to “bye-bye”.

Before reaching 12 months of age, your child should be attending to new words, giving objects upon verbal requests (“give me the ball”), understanding simple questions (“where’s sissy?”), and is beginning to identify one to two body parts on self. First early words include: family members, food, body parts, clothing, household objects, animals, toys, action words, etc.

By 18 months, your child should be understanding 200 words, identifying noun and action pictures when named. At 24 months, your child should begin following novel commands and two-step related commands. As receptive language increases, your child should begin understanding basic concepts (i.e. size, quantity concepts “give me one”, colors, qualitative “which one is big?”). By 36 months, your child will begin answering simple “wh” questions (who, what, and where), understand location phrases, answer “yes/no” questions correctly, and follow a two to three-step command.

As your child continues to grow and learn, there are many communication strategies we, as speech-language pathologists, recommend to ensure continued communicative development. I’m briefly going to discuss three communication strategies. These strategies are taken from the book More than Words: Helping Parents Promote Communication and Social Skills in Children with Autism Spectrum Disorder.

First, observe, wait and listen to your child’s body language and notice what they are looking at. Provide your child with enough time to carry out his/her own ideas and communication roles. Personally, wait time, was an extremely difficult strategy for me to use, I literally had to count 1-10 in my head. It is truly amazing how much more a child is capable of saying, when time wait is given. If your child does not respond after waiting, cue him/her through modeling, or hand-over-hand help your child make their request. Listen and pay attention to your child’s sounds and words. Do your best to NOT interrupt. When you are listening, you are letting your child know he/she is important.

During daily routines, talk to your child. Tell them what you are doing (i.e. “I’m washing my hands”). Tell your child what he/she is doing (i.e. “you must be mad, because you are yelling”). Follow your child’s lead, meaning every time your child leads an interaction, respond. Give your child information about the things that interest him/her, join in and play. Imitate, interpret and comment on your child’s play. Play is the most important aspect for a child’s communicative development. Play is how your child learns. Make communication fun and as a result, your child will develop an increase in spontaneous use of language and will also begin to establish the power of language for controlling people and getting their desires met.

The third strategy I use frequently is out of reach. Place highly preferred items in sight, but out of reach. This creates an opportunity for your child to seek out communication partners and it makes a specific request. This can be done easily by storing a specific toy in a clear box with a lid. Below is a quick list of additional tips you can use with your infant or toddler. It is important to seek a speech-language evaluation is you have any concerns with your child’s communicative development.

Infants:

• Encourage your baby to make vowel-like and consonant-vowel sounds such as "ma," "da," and "ba."
• Reinforce attempts by maintaining eye contact, responding with speech, and imitating vocalizations using different patterns and emphasis. For example, raise the pitch of your voice to indicate a question.
• Imitate your baby's laughter and facial expressions.
• Talk as you bathe, feed, and dress your child. Talk about what you are doing, where you are going, what you will do when you arrive, and who and what you will see.

Toddlers:

• Get down at your child’s eye level so he/she can see how you produce sounds clearly
• Sing songs and read books with sound and word repetitions. Music brings language to life. Popular children’s songs and rhymes: “Humpty Dumpty”, “Row, Row, Row Your Boat”, “Head and Shoulders”, “Itsy Bitsy Spider”, “If You’re Happy and You Know It”, etc. Allow for opportunities for your child to fill-in-the blank with sounds/words/phrases. Sing simple songs and recite nursery rhymes to show the rhythm and pattern of speech.
• Use environmental and vehicle noise, this will help your child produce a variety of vocal sounds and patterns
• Interpret the meaning of your child’s vocalizations and gestures into simple phrase/ Respond to your child’s sounds even if she can’t say that actual word/ Repeat mispronounced words correctly for your child to hear
• Expand his/her single words into short phrases
• Talk about the things you are doing, looking at, playing with, eating, etc.
• Respond to your child in a way that encourages further attempts to communicate/ Repeat what your child says indicating that you understand. Build and expand on what was said. "Want juice? I have juice. I have apple juice. Do you want apple juice?"
• Try to read every day. The earlier you begin to read and tell stories to your child, the sooner reading will become an important and enjoyable part of your child’s life.  It allows him/her to build knowledge they will need to learn to read.
• Identify colors/Count items throughout your day.
• Use gestures such as waving goodbye to help convey meaning.
• Acknowledge the attempt to communicate.
• Make a scrapbook of favorite or familiar things by cutting out pictures. Group them into categories, such as things to ride on, things to eat, things for dessert, fruits, things to play etc. Create silly pictures by mixing and matching pictures. Glue a picture of a dog behind the wheel of a car. Talk about what is wrong with the picture and ways to "fix" it. Count items pictured in the book.
• Place familiar objects in a container. Have your child remove the object and tell you what it is called and how to use it. "This is my ball. I bounce it. I play with it."
• Use photographs of familiar people and places, and retell what happened or make up a new story.

When speech and language interventions are implemented during a child’s daily routines, there is an increased likelihood that:

• Your child will become more independent. Teaching your child to communicate with the context of a daily routine such as mealtime will help your child to be able to function more independently
• Your child will increase their use of communication behaviors after the instruction has ended. When communication strategies are embedded within daily routines, your child has an opportunity to be rewarded as a natural consequence of their behavior.
• Your child will generalize their new skills across settings and situations.

Enjoy spending time engaging your child and helping them understand the world around them!

~Angie 

References:

      Lanza, J. R. (2009). Ls guide to communication disorders. (2009 ed.). East Moline, IL:

LinguiSystems, Inc.

      Rossetti, L. The rossetti infant-toddler language scale: A measure of communication and

interaction. LinguiSystems, Inc.

       Sussman, F. (1999). More than words: Helping parents promote communication and social skills

in young children with autism spectrum disorder. (1st ed.). Hanen Center.

"Tongue Tied"

We have probably heard of someone being “tongue tied”. What this really means is the tongue is fused to the floor of the mouth. The lingual frenulum is a mucous membrane that usually recedes after birth. 

With ankyloglossia, the medical term for “tongue tie”, the lingual frenulum stays attached to the tip of the tongue. This can cause restricted tongue movement. It appears that if we had restricted tongue movement, we would not be able to produce a number of our speech sounds; however, there has been no empirical research to indicate that “tongue tie” causes a speech delay/disorder. Wait, I just said it can cause restricted movement, how will one be able to protrude their tongue between their teeth for the productions of “th” and /l/. The “th” production can accurately be produced with limited tongue protrusion. The /l/ can be produced inside the mouth, with the tongue touching the alveolar ridge, decreasing the tongue extension. How is one going to make lingual-alveolar sounds such as /t, d, n, s, z/? In reality, we use such limited movement/elevation of our tongue during these sounds. These sound productions can be produced using compensatory strategies, such as slightly changing the position of the tongue (e.g. moving the tongue tip down instead of elevating it). With practice, little to no distortion should be heard, just practice!

According to the ASHA Leader, the oral cavity changes significantly in size and shape during the first 4 to 5 years of life. In return, the significance of ankyloglossia tends to decrease with oral growth. For example, with time the lingual frenulum can recede, stretch and at times rupture.

Being “tongue tied” can cause other functional difficulties, such as latching, sucking, and feeding. Literature primarily deals with potential difficulty with breast feeding (Nicholson, 1991; Jain, 1995; Fitz-Desorgher, 2003; Ricke et al., 2003). It was reported, that the majority of newborns with ankyloglossia do not have feeding difficulties.

To clip or not clip? The clipping of the lingual frenulum is called a frenulectomy. It is a decision solely left up to the parent. If there are feeding concerns, clipping of the tongue can be done. Most speech-language pathologists would rarely recommend a frenulectomy to increase correct sound productions, unless the child presents with a severe articulation or phonological disorder.

In conclusion, many physicians continue to think that ankyloglossia will cause a speech delay, regardless of no evidence found in literature. In the words of Agarwal and Raina (2003): "…there is enough evidence that good speech is still possible with significant tongue-tie and speech problems can be overcome without frenulectomy with speech therapy."

References:

Kummer, A. W. (2005, December 27). Ankyloglossia: To Clip or Not to Clip? That's the Question.. The ASHA Leader.

~Written by Angie