Diagnosis: Diagnostic Considerations Form the Basis for Treatment

Megan receiving PROMPT therapyDifferential diagnosis is a complex process and involves much more than assigning a label.


Communication Disorders — Is there an underlying problem with language, cognitive or social learning?

The term "communication disorder" is very general, encompassing a wide variety of difficulties in receptive or expressive language, speech production, hearing and central auditory processing. Communication disorders range from mild to severe and diagnosis may be complex because of the tendency for a child to exhibit difficulties in more than one area. We provide comprehensive speech and language evaluations, utilizing standardized assessment protocols as well as historical and clinical information.


Speech Production Disorders — Is there difficulty with speech motor control?

Many complex processes contribute to a child’s ability to speak, one of which is motor learning. "The production of a single syllable requires the participation of 8-10 body parts and the coordinated action of 70 muscles."

Esther Thelen

In our experience, many children who do not develop speech at expected ages are those who tend to have low muscle tone and/or difficulty planning purposeful movements for speech production. Children with developmental motor speech disorders may have no specific neurologic diagnosis. However, an understanding of the nature of their motor learning difficulties provides the basis for effective treatment.

Diagnosis of speech production difficulty in young children involves understanding of phonological development (linguistic) and the process of developing speech motor control (motor). Understanding the relative contributions of phonology and motor control to overall impairment in speech production is critical to the process of making appropriate treatment decisions. If a motor disorder is identified, our role is to further define each child’s strengths and weakness in specific stages of speech motor development.

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What will a PROMPT® evaluation provide?

Since PROMPT views speech as movement, videotape is an important component of the evaluation process. Each stage of motor control that contributes to speech production is assessed, and speech sounds selected for treatment are those that will develop this control. Each child’s speech and language is also evaluated thought the use of phonemic inventories, articulation tests and standardized receptive and expressive language testing.

The most frequently used assessment tool is the Systems Analysis Observation which is used in conjunction with the Motor Speech Hierarchy to determine strengths and weaknesses at 7 stages of motor control (Deborah Hayden, 1985):

  • Stage I: Muscle Tone (Is muscle tone normal, low or high?)
  • Stage II: Phonation (Is there control of voicing, devoicing, and nasality?)
  • Stage III: Mandibular (Jaw) Control (Are movements graded and symmetrical?)
  • Stage IV: Labial–Facial Control (Is there control of lip closure, rounding and retraction?)
  • Stage V: Lingual (Tongue) Control (Does the child produce front, mid and back tongue sounds?)
  • Stage VI: Integration (Is there coordination or appropriate sequencing of movements for connected speech?)
  • Stage VII: Prosody (Is there appropriate intonation and use of stress?)

Three stages are selected and prioritized for treatment to ensure that motor control develops at the appropriate levels and in the sequence that is optimal for the child at any given phase of PROMPT treatment.

Donna Lederman, Speech-Language Pathologist, P.C.
Call Today: (917) 715-4303