Speech, Language, and Swallowing Disorders

Being able to communicate and express one’s self—our thoughts, feelings, needs, and desires—is a fundamental part of everyday life.  Children with communication problems encounter difficulties developing this important social and critical skill.  Their ability to speak, listen, read, and write may be affected and their every day experiences can become increasingly frustrating—even isolating. Their academic success can be significantly compromised.

Likewise, mealtimes represent an important social ritual that is essential to the development of our children.  Feeding and swallowing disorders lead to difficult and, at times, frightening experiences for children and their parents.

Our speech-language pathologists at MGH specialize in diagnosing and treating oral and written language, feeding, and swallowing disorders.  The MGH Department of Speech, Language, and Swallowing Disorders offers comprehensive diagnostic evaluation and treatment programs for all communication and swallowing disorders in acute inpatient and outpatient populations. 

Common Conditions Treated

From infancy through adolescence, a variety of speech, language, feeding, and swallowing conditions can arise.  Some typical problems include:

• Articulation/Phonological: Difficulty making speech sounds correctly.
• Cognitive-Communication Disorders: Common in children after a traumatic brain injury, these disorders make it difficult to think clearly, remember or solve problems.
• Dysarthria: Difficulty producing speech due to muscle difficulties such as muscle weakness or paresis.
• Executive Function Disabilities: A term used to describe the ability to initiate, plan, organize and prioritize tasks while shifting attention in response to various environmental stimuli. Difficulty with executive understanding information when listening and/or reading and organizing thoughts for speaking and/or writing. Executive function difficulties may be associated with learning disabilities and/or deficits in attention
• Feeing Disorders: Often seen in infants and young children who have difficulty sucking, biting, chewing, and swallowing; also seen in children who have been fed through a tube.
• Language-Learning Disorders: Difficulty understanding or using spoken and/or written language to communicate thoughts, feelings, and experiences. Often children have learning disabilities that affect their ability to participate in regular classroom instruction despite average intelligence.
• Non-Verbal Learning Disabilities: A disorder that impacts the ability to effectively process information through the right hemisphere. Difficulties with nonverbal learning impact visual-spatial processing, organization, comprehension and expression of language, and social skills, despite strengths in vocabulary, rote memory skills for listening, speaking, reading, and writing, comprehension of abstract language (e.g., inferences, idioms, ambiguous language) and social skills.
• Stuttering: An involuntary repetition, prolongation or blockage of a word or part of a word that a person is trying to say. Stuttering often starts in childhood and may become a life long challenge.
• Voice Disorders: Hoarse, breathy, harsh or nasal voice quality as a result of mistreatment of overuse of the voice (screaming or yelling) or due to structural abnormalities (cleft palate, enlarged adenoids).

Inpatient Services

At Mass General, Speech-Language Pathologists function as part of a multidisciplinary medical team, providing consultation and treatment services in the areas of feeding and swallowing, speech, language, cognition and memory, as indicated during a child’s hospitalization. Acute care pediatric patients receive full diagnostic assessments and treatments, with recommendations for further services upon discharge from the hospital as needed.

Learning Disabilities

The Speech-Language Pathology Learning Disabilities team provides evaluations and treatment for school-aged children with spoken and written language difficulties. Students learn to develop academic based skills (i.e. study skills and note-taking strategies) in addition to traditional language-based intervention for overall communication skills. A diagnostic patient evaluation will determine each patient's individual needs and treatment plan.

In order to provide students and parents with an overview of strategies to facilitate success both at school and at home, patients will address topics such as organization and writing through direct individual or peer group instruction.

An interdisciplinary Pediatric Therapy Team of clinicians from Speech, Language and Swallowing Disorders, Occupational Therapy and Physical Therapy performs same-day, personalized, comprehensive evaluation of children, ages 3 to 17 years old, who have medical, developmental and learning needs. The PTT provides assessments in a variety of areas, including: receptive & expressive language skills, speech, reading and writing (SLP); sensory integration, fine motor skills and visual perceptual skills (OT); gross motor skills: balance, strength and coordination (PT).

Pediatric Therapy Team (PTT

An interdisciplinary Pediatric Therapy Team of clinicians from Speech, Language and Swallowing Disorders, Occupational Therapy and Physical Therapy performs same-day, personalized, comprehensive evaluation of children, ages 3 to 17 years old, who have medical, developmental and learning needs. The PTT provides assessments in a variety of areas, including: receptive & expressive language skills, speech, reading and writing (SLP); sensory integration, fine motor skills and visual perceptual skills (OT); gross motor skills: balance, strength and coordination (PT).

Feeding Team

A multidisciplinary feeding team that includes a dietician, speech-language pathologist, and a clinical nurse specialist or nurse practitioner, evaluates and treats children who have developed or are at risk for developing complex feeding problems. Children who have dysphagia, congenital heart disease, craniofacial disorders, gastrointestinal conditions, neurological disorders, pulmonary compromise or are born prematurely are among those typically evaluated.

Modified Barium Swallow (MBS)

A speech-language pathologist works with a pediatric radiologist from the Radiology Department during radiographic studies to assess children with suspected dysphagia (swallowing problem) and/or those with risk for oral-pharyngeal aspiration. During this study, the child is evaluated and images are taken as he or she swallows various consistencies of barium.

Velopharyngeal Insufficiency Studies

A velopharyngeal insufficiency (VPI) study is a multiview radiographic study preformed with the speech-language pathologist and pediatric radiologist. VPI studies evaluate the movement of the muscles for speech to determine why a child may be experiencing nasal speech.

Fluency Programs

Individual therapy is provided for children who stutter. They learn ways to modify or change speech patterns, explore attitudes and improve social and academic interactions.

Services for Children who are monolingual or bilingual in Spanish or Portuguese

Bilingual speech-language pathologists offer comprehensive evaluations and therapy to children of all ages.  Bilingual clinicians assess language dominance, delays and disorders across various domains in both languages as needed. Suggestions for direct intervention, classroom accommodations, additional services, academic consultation and ideas for language stimulation in the home environment are available.

Scheduling an Appointment

All services are provided by appointment only, Monday through Friday, from 8:00 a.m. to 6:30 p.m.

Methods of Payment

Bills for outpatient diagnostic evaluations and treatment session are mailed from the Ambulatory Care Business Office on a monthly basis. Services often are reimbursed through health insurance plans or through state and federal agencies. Patients are encouraged to review insurance plans to determine coverage for services. Special programs are offered to patient requiring services if insurance companies had denied them approval.

Current Research

Dr. Jean Ashland, in collaboration with Dr. Greg Lof and Mary Riotte are conducting a study to determine if early feeding problems in children have an effect on speech development.  The data collection in currently in progress and findings will be presented at the Speech-Language annual convention in November 2006.

Dr. Jean Ashland, in collaboration with Dr. Chris Hartnick are conducting Cine MRI examination of velopharyngeal insuffiency for children with hypernasality.