Shouting is one of the primary ways 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 charact er
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.
Vocal
abuse usually results in pathologic laryngeal conditions including
inflammation of the vocal folds, chronic laryngitis, vocal nodules,
vocal polyps and contact ulcers. These conditions are normally
reversible with the elimination of laryngeal hyperfunction,
or overuse, and tension, along with a program of vocal hygiene.
| Behavioral
management programs using positive reinforcement are most
effective in eliminating abusive behaviors. |
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 offer regular feedback to
the child. The speech clinician 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.
Along with establishing baselines of frequency of vocal abuse
occurrences 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.
Abuses too difficult to be entirely eliminated must be modified.
Such abuses are coughing, hard glottal attack, loud talking
and speaking at inappropriate pitches (most often too low).
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.
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 pith 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 re-examination
of the child’s vocal folds, usually reports reduction or
elimination of the pathologic condition which necessitated the
original referral.
See Voice
Disorders in Children.
Ellen Golden, M.A., C.C.C.
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