About voice therapy for children
Paediatric voice disorders are more common than you think, with the incidence rate ranging from 6% to 23% (Maddern, Campbell, & Stool, 1991). Most cases are typically due to poor vocal behaviours of the child, such as constant screaming. However, the common misconception that the child will “grow out of it” often means that direct voice therapy techniques are not always provided.
Studies looking into the changes in pitch, loudness, and overall vocal quality associated with the disorder have highlighted the negative effects on communicative abilities and quality of life. Children and adolescents reported that their voice disorders resulted in negative perception and attention from others (Lass, Ruscello, Stout, & Hoffmann, 1991; Lass, Ruscello, Bradshaw, & Blankenship, 1991) and limited their participation in activities (Connor, Cohen, Theis, Thibeault, Heatley, & Bless, 2008).
Voice therapy for children typically consists of a speech pathologist determining the cause of the voice disorder and providing education regarding healthy vocal hygiene techniques to both the child and their parents. However, some children have already developed a maladaptive ‘unhealthy’ vocal quality. In such cases, it is necessary to provide further intervention in order to avoid negative outcomes of voice disorders. This can be a challenge and since starting work as a Speech Pathologist, I have discovered some key factors that determine the effectiveness of therapy.
The keys to effective voice therapy for children
Parent involvement
Healthy vocal behaviours just like many other behaviours, start at home. If children are constantly exposed to poor vocal behaviours such as shouting from across the house rather than moving close to their communication partner, they are likely to deem this behaviour acceptable and adopt it themselves. Parents spend the most time with their children, so it is crucial to provide examples of good vocal behaviours at home for children to follow in order to prevent voice disorders from developing.
Explaining the reason and importance of healthy vocal habits
Children are often inquisitive and will ask for a reason why they have to do something. Providing a reason that resonates with that child, e.g. ‘It will stop your throat from hurting’ or ‘you can talk to your friends for longer’, will remind them why they are doing the activity. This will also motivate children to continue using the right strategies and create everyday memory triggers to use healthy vocal behaviours.
The age and maturity of the child
Children below the age of 5 years will often have a lot of difficulty understanding the concepts within voice therapy. However, some children are more mentally mature than others are and may understand how to use a technique easier than a child who is older. It is important for the speech pathologist conducting a therapy, after the initial voice assessment, to determine whether it is the correct time to begin therapy.
Providing child friendly feedback
Many of the the therapy techniques used by speech pathologists for treating voice disorders have difficult concepts and can be a struggle to grasp even for some adults. It is important for your speech pathologist to modify effective adult voice techniques to more children friendly techniques in order for the child to understand what they are required to do and why. This may include using characters that your child knows and enjoys to assist with good voice productions. Even identifying characters with poor vocal behaviours, such as Donald Duck or Mickey Mouse, can be helpful. Providing the right type of feedback to help achieve a good voice quality is also very important. Feedback should include simple language and multiple sensory cues such tactile, visual and auditory cues to help the child gauge if they are achieving the target sound production.
Providing the right reinforcement
Like adults, children need an enticing motivator in order to follow through with a task. As a parent, you know what motivates your child best. It is important to provide a motivator to help your child enjoy the tasks, without providing copious amounts of lollies or unsustainable rewards. Instead, try a fun game where your child can take turns for each successful attempt, or a reward at the end of the week for achieving their speech goals.
This article was written by speech pathologist Ashleigh Fattah. For more information about voice therapy for children or any speech pathology topic, contact ENT Clinic and make an appointment with one of our speech pathologists.
References
Connor, N.P., Cohen, S.B., Theis, S.M., Thibeault, S.L., Heatley, D.G., & Bless, D.M. (2008). Attitudes of children with dysphonia. Journal of Voice, 22(2), 197–209.
Maddern, B.R., Campbell, T.F., & Stool, S.(1991). Pediatric voice disorders.Otolaryngologic Clinics of North America, 24(5), 1125–1140.
Lass, N.J., Ruscello, D.M., Bradshaw, K.H., & Blankenship B.L. (1991). Adolescents’ perceptions of normal and voice-disordered children. Journal of Communication Disorders, 24(4), 267–274.
Lass, N.J., Ruscello, D.M., Stout, L.L., & Hoffmann, F.M. (1991). Peer perceptions of normal and voice-disordered children. Folia Phoniatrica, 34, 29–35.
