Back to School Screenings and Evaluations-Part 2

Last Monday, I talked about the importance of doing a complete oral exam and focused on nasality screening. Today I want to talk about and open a discussion on the importance of doing those diadochokinetic rates.

How many times have you been tempted to just skip over those because the child does not “appear” to have motor sequencing issues? Or, as one SLP said to me, “He does not have his back sounds (/k/-/g/) so we canʼt do that.” With eyebrows raised in astonishment I say, “What? Oh but yes you can!” There are ways to screen for motor sequencing issues without back or even front sounds.

Typically we have the child do the puh-tuh-kuh, or buttercup, or maybe patty-cake. So what do you do when they donʼt have those back sounds? You have them say a rapid sequence of tip-lip-tip movements by saying “lippity-lippity-lou.” You do not time them as you would the puh-tuh-kuhs. You simply have them say it quickly three times. Can they sequence those oral movements efficiently? Now should the /l/ be missing from their repertoire have them say “dippity-dippity-doo.” If they donʼt have any front sounds (/t/-,/d/) at all have them say “gippity-gippity-goo.” If you hear "gippy-gippy-goo" with the omission of /t/ don't worry about it. They are giving you a rapid back to lip-back to lip-back sequence. Again remember you are screening for motor sequencing not the articulation of sounds. Regardless of which sound pattern you have them do, the scoring is the same: can they say it three times, rapidly, fluidly, without breaking down. Remember the focus of this particular screening task is for the detection of possible motor sequencing issues and to determine the need for further testing in that area. And too, remember this is just a screening task not an entire oral motor evaluation.

There has been much discussion in later years regarding is it apraxia or a severe phonological disorder. In my opinion, the best place to start is with a simple check of diadochokinetic rates and the above tips should allow you to check those on any child.

Next week, I will be talking about sub-mucosal clefts. Until then, have a great week with your kids!

Disclaimer: You are reading a blog which is just our opinions and our tips and tricks. It is not intended to replace sound teachings.

Back to School Screenings and Evaluations-Part 1

It’s Monday! I’m ready and raring to go with this first series that I’m calling “Back to School Screenings and Evaluations.” When pondering where to begin all these blogs, I let mass screenings be my deciding factor. These first six blogs will all relate to screenings, evaluations, and placement considerations.

I felt the most appropriate place to start would be with a quick refresher of the oral mechanism examination. If your workload is anything like that which I faced, you’ll find yourself rushing through the oral mech or just doing a cursory exam. I found, after doing therapy for many years, that when a child presented as a simple artic disorder my exams tended to consist of a quick look inside the mouth and a few basic tongue movements. Not good. You’ll get into therapy and a few weeks or possibly months later find that this kid has an oral deficit that you didn’t pick up during the oral exam. So you have to back up and start again and that might even involve having to rewrite your IEP goals/benchmarks/objectives, and that means scheduling another meeting. You really don’t want to have to do another meeting do you? Me either! So do a thorough oral exam the first time and avoid creating headaches for yourself later in the year. The time spent now will save you frustrations later.

I can’t recommend one specific exam over another, but I can strongly urge you to do a complete exam. Beyond checking the structure and function of the lips, teeth, tongue, and palate, you need to really look at and note ALL findings. Many times we do note them on the oral mech record sheet but then ignore it as insignificant when considering the child’s overall assessment, or can’t remember what the implication of that would be. The next few blogs will target some of these, but today I’ll simply refresh your memory regarding nasality.

A quick screen for nasality is to simply have the child occlude their nostrils and say “oo”. I always demonstrate the procedure as I give the direction. The sound should be produced completely out the mouth. There should be no sound from the nose. If you hear nasality have the child try it two more times with additional instruction on how to do it correctly. Some children just don’t understand what to do the first time, and can be successful on subsequent attempts. If they are unable to do this correctly after three attempts, then that is a red flag that you should consider referral to an ENT.

Now for a refresher tip: when I am looking in the child’s mouth instead of having them say “ah” I have them say “uh-uh-uh” (three short repetitive sounds) because it lifts the velum higher and more than once, so I can clearly see the movement. Is it lifting up as it should? Is it lifting on one side higher than the other? This is your first indicator of possible neurological involvement (nerve damage) or velopharyngeal incompetency or insufficiency.

NOTE: Velopharyngeal insufficiency and incompetency are NOT interchangeable terms. Velopharyngeal insufficiency is an anatomical defect. It is a physical problem and could warrant surgery. You do not do therapy for that.
Velopharyngeal incompetence is not anatomical. It is an articulation problem and you would address it in therapy.