Frequently Asked Questions

Why is my child delayed in speaking or very difficult to understand?
Families who contact us have young children who are delayed in developing speech, or children of any age who have difficulties with speech intelligibility and/or expressive communication. Movements for speech production are highly complex, requiring accurate positioning and precise timing of movements of the jaw, lips and tongue. Some children who present with delayed or disordered speech acquisition have difficulties that are related to motor processes, and they benefit from approaches that focus on motor as well as linguistic aspects of communication. At Donna Lederman, SLP, PC, we treat a variety of childhood communication disorders, and we specialize in the area of childhood motor speech disorders.
How will I know if my child has an underlying problem with motor speech development?
  • Children who are minimally verbal, highly unintelligible, or making very slow progress in speech language therapy despite “traditional” services are good candidates for a motor speech assessment. Additional indicators are diagnoses of neurogenic disorder, muscle tone abnormality, motor planning deficits, phonological delay, childhood apraxia of speech, hearing impairment, sensory integration disorder, pervasive developmental disorder or autistic spectrum disorder.
  • A motor speech assessment, in addition to an evaluation of language and articulation/phonological skills, provides information about strengths and weakness in speech motor sub–systems. Poor control of phonation, jaw movements, movements of the lips and tongue and/or sequencing difficulty may contribute to the child’s speech production difficulty.
  • If indicated, PROMPT therapy will be recommended improve the control and coordination that underlies successful, consistent production of speech sounds, words and phrases.
What is PROMPT therapy and how is it different from 'traditional' speech language therapy?

  • “Traditional”speech language therapy for children utilizes visual and auditory modalities to provide information about phoneme (speech sound) production and places emphasis on auditory discrimination, or the ability to hear differences between similar sounds. Once the child is able to discriminate the target sound, he or she is asked to look at the clinician, listen to instructions and imitate the production, with or without the use of a mirror for increased visual feedback.
  • PROMPT therapy introduces a third modality for learning, which is the tactile–kinesthetic system. PROMPTs provide support to the system and specific information to the muscles about timing, tension and place of muscle contraction. This information is stored and “feeds forward” as the child with motor speech disorders practices sounds, words and phrases during daily routines and/or academic settings.
How many times per week will PROMPT therapy be recommended?

  • PROMPT therapy is generally recommended 1–2 times per week. Each child with motor speech disorders is different and should be evaluated globally (with consideration to all developmental areas) and specifically (with attention to careful analysis of speech motor control and coordination). A high level of practice (mass and distributed) is provided during each therapy session, and target sounds are put into words and phrases to be practiced within home and school routines.
  • As long as there is communication among the PROMPT clinician, caregivers and related professionals, the above frequency level is usually highly effective.
What is a 'PROMPT Certified Clinician'? (

  • The first step is to take the Introduction to PROMPT Technique course, which is a three–day course that provides extensive hands–on training in PROMPT Technique.
  • The second course, Bridging PROMPT Technique to Intervention is a three–day course focusing on assessment and treatment planning and a more sophisticated approach to PROMPT application principles.
  • The Certification Project is an extensive independent study completed over a 4 month period. It requires in–depth evaluation and treatment planning for a child with motor speech disorders. The completed project is then reviewed by a Senior PROMPT Instructor, who determines whether or not the requirements for certification have been met.
Is My Child 'Apraxic'?

  • There has been much over–diagnosis of CAS (Childhood Apraxia of Speech) as well as considerable disagreement in the field of speech language pathology regarding issues associated with the definition of apraxia of speech in children. Previously referred to as “Developmental Verbal Dyspraxia” or “Developmental Apraxia of Speech”, this disorder has recently been the topic of a technical report developed by the American Speech Language and Hearing Association (ASHA), and can be read in its entirety at, or
  • Differential diagnosis of CAS is a complex task, and decisions are often not considered conclusive until a child is 3–4 years old. Some children labeled “apraxic” have motor speech disorders (planning, execution), but their symptoms are not consistent with a diagnosis of CAS. (See Clinical Interventions: Children with Motor Speech Disorders and Clinical Interventions: Childhood Apraxia of Speech.)
  • Many children in our practice who come in with diagnoses of “Apraxia” have made rapid and significant gains in the speech intelligibility and expressive communication skills, whether or not the label was accurate.
What is the best age to begin remediation?

  • When there are questions about a child’s speech development, it is always best to pursue a consultation or evaluation by a speech pathologist with experience in working with the pediatric population.
  • The best age to begin treatment is determined on a case–by–case basis, and variables include etiology (causation), family history, and the nature and type of speech sound disorder.
  • Once a communication disorder has been diagnosed, it is my preference to begin treatment as early in development as possible. The neurological system has higher levels of “plasticity” at younger ages, meaning that the system is more easily able to make changes based on sensory information provided.
What is the value of non–speech oral motor exercises in improving speech sound production in children?

  • There has been a significant level of controversy regarding the use of nonspeech oral motor exercises (NSOME’s) to change children’s speech production. NSOME’s are defined as “any therapy technique that does not require the child to produce a speech sound but is used to influence the development of speaking abilities”. (MGH Institute of Health Professions, Boston, MA). NSOME’s may include blowing, tongue wagging, alternating pucker–smile, cheek puffing, tongue–nose–chin, etc.
  • “Controversies About the Use of Nonspeech Oral Motor Exercises for Childhood Speech Disorders” is addressed comprehensively in Seminars in Speech and Language, Vol 29, No 4, November 2008. Editor Gregory L. Lof, Ph.D., questions the theoretical basis for their use and reports that numerous research studies have been conducted and do not support therapeutic effectiveness of NSOME’s in changing speech sound productions.
  • PROMPT therapy does not use NSOME’s as part of diagnosis or treatment planning for children with speech production disorders. Among numerous reasons, the following are most important:
    1. There are differences in movements of the articulators for speech and non–speech actions.
    2. Research has refuted the concept that children with speech sound disorders have inadequate strength in their articulatory muscles.
    3. Children with Childhood Apraxia of Speech in particular benefit from the use of techniques that are grounded in principles of motor learning.
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