WHAT
ARE VOICE PROBLEMS IN CHILDREN?
Pediatric
voice problems involve pathologic laryngeal conditions, including
inflammation of the vocal folds, chronic laryngitis, vocal
nodules, vocal polyps and contact ulcers, all of which can
be identified by the child’s Ear, Nose and Throat doctor.
These conditions, usually caused by vocal abuse, are normally
reversible
with the elimination of laryngeal overuse and tension, along
with a program of vocal hygiene.
HOW
DO VOICE PROBLEMS DEVELOP?
Shouting
is the primary way in which children abuse their voices. Typically,
children yell from room to room in the house and scream to
each other on the playground. At times, they make funny noises
or imitations of character voices. Children who are excessive
talkers may experience inadequate breath supply and support,
causing them to push down harder on the vocal folds to complete
lengthy utterances. All of these behaviors — shouting,
screaming, yelling, excessive talking — are used by children
to get the attention of playmates, siblings, parents and teachers.
However, these behaviors can result in serious vocal abuse
problems.
HOW
DOES SPEECH THERAPY HELP?
A prerequisite
to successful vocal rehabilitation is the development, through
listening, of an awareness of abusive vocal patterns. The
child must be able to identify and develop a perceptual awareness
of vocal behaviors that cause abuse to the larynx. Once these
specific abusive behaviors are recognized, parents, teachers,
siblings and friends can assist the child in identifying situations
that promote poor vocal habits and
| The
speech clinician at the Center for Speech, Language, and
Occupational Therapy, Inc. can work with the child using
tapes and models... |
offer regular feedback to the child. The speech clinician at the Center for Speech,
Language, and Occupational Therapy, Inc. can work with the child
using tapes and models of appropriate and inappropriate vocal
productions to heighten the child’s auditory awareness.
Once awareness is developed, the child can learn to identify
both adequate and inadequate voice patterns.
After
establishing baselines of frequency of vocal abuse and learning
about situations in which voice abuse occurs, abusive vocal
activities must be eliminated. Behavioral management programs
using positive reinforcement are most effective in eliminating
abusive behaviors.
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Abuses
too difficult to be entirely eliminated must be modified.
Such abuses are coughing, throat clearing, loud talking and
speaking at inappropriately low pitch. All of these abusive
activities involve closing the vocal folds too tightly and,
with the exception of inappropriate pitch, too abruptly. The
resulting voice is strained or tight, and sounds harsh.
Special
help for children with voice disorders is needed to show how
to clear the throat easily and softly by exhaling air using
a "silent cough." An easy-soft voice using /n/ sounds,
/h/ words, and the "yawn-sign" technique are effective
in teaching the child how to close the vocal folds softly
for voice production.
HOW
CAN PARENTS HELP?
Children
often adapt their vocal behavior in response to the vocal
patterning of an adult. Speaking to children in a soft breathy
voice can help model an easier method of phonation; a whistle
can be used by parents and children to get attention from
a distance; and, if appropriate, the child can learn to increase
pitch with modeling.
Upon elimination
or modification of abusive vocal behaviors, the child’s
natural voice normally returns. After use of these intervention
techniques, the referring physician, on reexamination of the
child’s vocal folds, usually reports reduction or elimination
of the pathologic condition which necessitated the original
referral.
See Vocal Abuse in
Children.
Ellen
Golden, M.S., CCC
Speech
and Language Pathologist
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