You're welcome. Because today, we're digging into something I bet you're seeing on your back porch right now, and nobody is talking about it. Asthma and speech sound disorders. If you have a child on your caseload with significant asthma, this episode is the one you need tomorrow. Roll up your sleeves with me. We're going to get our hands really, really dirty, and we're going to talk about where the research stops and where the practitioner begins. Because this is where you have to have skin in the game. This is where it matters that you know your little professors closely, that you study what's happening under your own magnifying glass. Here's what we cover: What the research tells us. A Northwestern-led study of 337,285 children found that asthma, hay fever, and food allergy are significantly associated with speech disorders, and the more severe the disease, the greater the risk (Strom & Silverberg, 2016, Pediatric Allergy and Immunology). A 2006 population-based study of 7,389 eight-year-old children identified asthma as one of the factors associated with voice disorders (Carding et al., 2006, Journal of Voice). So we know there is a connection. And that is where the research stops. What I'm seeing on my back porch. This is where things get gnarly. The children with significant asthma are breaking the rules of speech development. They're stopping fricatives, they're fronting velars, they're voicing voiceless sounds, and they're deleting the /h/. Looks like phonological processes, right? Except phonological processes happen across positions of words. What I'm seeing with these kiddos is 0% accuracy in the initial position of words and 100% accuracy in the medial and final positions. That is not linguistic. Do you dare disturb the universe? Yes, you do. That's physiology. Why this is happening. My hypothesis, and this is practitioner experience, not research on large populations, is that these children have insufficient subglottal air pressure. Continuant sounds need continuous airflow from the respiratory system. After the vowel gets going, the vocal folds are doing the work and producing those sounds becomes easy. But in the initial position of words, when you're starting cold, you don't have that help. So fricatives stop, velars front, voiceless sounds get voiced, and the /h/ gets deleted. What the child is telling you. Mouth breathing at rest. Chin jutting. Head forward to get more air in. Tense neck and visible effort while speaking, like they're yelling at conversational volume. Fluctuating accuracy that tracks with allergy season and asthma flare-ups. The clear boogers come out and suddenly the phonological processes you thought were suppressed come right back. That is not a child regressing. That is a child without the respiratory support to do the work in initial position. What to do differently (DSD). You've been doing best practice. You're doing the complexity approach, you're doing DTTC, you're doing multimodal cueing, you're holding the 80% challenge point. And you're still at 0% in initial position. So we're going to do something different. We're going to capitalize on what the child can do. They can produce these sounds after a vowel, so we anchor with a vowel. We say "a sun, a sun." Or we use the end of one word to start the next, "yes sun, yes sun." And then over time, we stretch the pause longer and longer until that target is sitting in the initial position of the word on its own. That is how we DSD. This is one to take notes on. And if you have one of these kiddos on your back porch right now, shoot me an email. This is exactly the kind of clinical pattern I want to research next. 🌟 Join the SIS Membership Today If you learn from doing, and you want highly effective, engaging therapy materials ready to go without the prep, the Sparkle in School Membership was built for you. Educationally rich activities, 100% planned, prepped, and delivered to your inbox every Friday. So your energy goes into cueing the child in front of you, not building materials at midnight. 👉 Join today at kellyvess.com/sis 📘 For the deeper dive, grab Speech Sound Disorders: Comprehensive Evaluation and Treatment on Amazon, with 100+ video clips of best practices illustrated. 📧 Got a kiddo with asthma who's daring to disturb the universe on your back porch? Email me at Kelly@KellyVess.com. I want to hear about it. Be better. Do better. Create better. Make the world a better place, one child at a time. You will always be first. 📚 Research Cited Strom, M. A., & Silverberg, J. I. (2016). Asthma, hay fever, and food allergy are associated with caregiver-reported speech disorders in US children. Pediatric Allergy and Immunology, 27(6), 604–611. doi:10.1111/pai.12580. Pooled analysis of 337,285 U.S. children from 19 population-based cohorts (NHIS 1997–2013 and NSCH 2003/4 and 2007/8). Carding, P. N., Roulstone, S., Northstone, K., & ALSPAC Study Team. (2006). The prevalence of childhood dysphonia: A cross-sectional study. Journal of Voice, 20(4), 623–630. Cohort of 7,389 eight-year-old British children, with asthma identified among the factors associated with increased risk of voice disorders. Tags: speech sound disorders SSD pediatric speech therapy preschool SLP asthma and speech respiratory support subglottal pressure phonological processes stopping fronting voicing errors glottal fricative initial position of words articulation therapy evidence-based practice DTTC complexity approach multimodal cueing physiological speech disorders differential diagnosis do something different DSD Kelly Vess KellyVessSLP The Preschool SLP SIS Membership Sparkle in School SLP podcast speech-language pathology early intervention school SLP
