Ask the Expert- Pamela Malley

Pamela Malley is a speech-language pathologist and the parent of a child with Tourette Syndrome. She was recently appointed to the education committee for the Tourette Association of America and provides in-services for parents and educators on various topics related to improving social, academic and communication skills in children with TS.

Q: Is stuttering a tic related to TS?

A: Although Tourette Syndrome and stuttering have many similarities, stuttering is not generally considered to be a tic. Both conditions worsen in stress and they share neurological characteristics, so it is possible that they are related conditions. However, the dysfluencies noted in individuals with TS are typically characteristic of “normal” dysfluencies found in the general population and do not share the same characteristics as true stuttering. That being said, some individuals with TS can also have a stuttering disorder just as they can have any other diagnosis that is not necessarily part of TS. The Stuttering Foundation has a great article about TS and Stuttering, which I highly recommend for more detailed information on this topic.

Q: How can speech therapy help children with TS tics?

A: Speech-language pathologists do not provide therapy for tics; treatment for tics is best provided by counselors, psychologists, psychiatrists, social workers and physicians. However, speech-language pathologists can help individuals with TS in managing other difficulties. As we know, people with TS can have co-occurring conditions such as learning disability, ADHD, OCD, or Asperger’s; when these diagnoses co-occur, there is a greater chance that the individual may benefit from speech pathology services. Often, these individuals will have language-based learning disabilities, executive function disorders, or other communication disorders. The terms “speech therapy” and “speech therapist” can be misleading because people often associate them with sound production or stuttering, but we can help with so much more.

Speech-language pathologists are communication disorder specialists trained to diagnose and treat a wide variety of conditions beyond the production of speech sounds. For example, people with language-based learning disabilities may have difficulty understanding and learning new vocabulary, word relationships (such as antonyms and synonyms), word structure and/or grammar. They may have difficulty understanding questions, learning to ask questions, following directions, giving directions, and/or understanding information they hear. Problems may occur with spoken language, written language, or both. Speech-language pathologists conduct thorough evaluations to tease apart all of the components of language to determine exactly which areas of language are strong and which areas are impaired.

So, if a child is having difficulty in math but knows math facts and only has difficulty when complicated word problems are presented, then the problem may not lie with math but with understanding the language concepts involved in math, such as greater than, less than, more, fewer, etc. Or, the child may understand these concepts but cannot understand the words when presented in writing. It is the speech-language pathologist who can complete an in-depth evaluation to determine exactly which areas of language might be causing the math difficulties.

Another area of language which can be impaired in individuals with TS is pragmatics, or social skills. Speech-language pathologists often lead social skills groups to teach appropriate interpersonal skills. Goals for this type of therapy focus on teaching appropriate eye contact, personal space, topic maintenance, turn taking, conversation, and other skills needed to form successful relationships in the school, social and/or work environments.

Executive function skills are those skills which help you to plan and complete tasks, keep yourself organized, and attend to details. Individuals with TS may have difficulties in these areas, especially when they also have the diagnosis of ADHD. The speech-language pathologist can provide exercises to improve working memory and attention and teach strategies to compensate for planning and organizational problems.

Last, speech disorders are those disorders which render speech difficult to produce and understand. These include articulation disorders, which occur primarily in children who are not learning correct sound production, stuttering disorders, and other motor speech disorders which typically occur due to neurological damage. Speech disorders can occur in individuals with TS just as they do in the general population, but these disorders really are not related to this diagnosis; regardless, a speech-language pathologist can remediate these difficulties as well, if they are present.

Q: Can speech therapy help adults with TS become more comfortable with public speaking?

A: This is a tricky question, as it really depends on the cause of the difficulty. If the individual has a true stuttering disorder, we can provide services to improve fluency. If the difficulty is due to attention, focus, an executive function or language disorder, we can offer treatment to help manage the specific problem and this may result in improvement with public speaking. However, if the difficulty is due to psychological or emotional issues, a psychologist, counselor, or psychiatrist would be the appropriate professional to provide services. So, the answer to this question depends on the specific cause and nature of the problem and more information is needed to determine whether speech pathology services could help. I suggest contacting an ASHA certified speech-language pathologist to discuss your specific concerns and to determine whether or not speech pathology services are appropriate for you.

Q: How do I obtain speech therapy services?

A: Speech-language pathologists work in a variety of settings, from the public schools to hospitals to private practice. If your child is enrolled in public schools, you can request an evaluation at any time and if he or she qualifies, services are provided free of charge. If you are seeking services from a private practitioner or from someone working in a hospital or other agency setting, be sure to find out if your insurance will cover the services. I always recommend that you find someone who is ASHA certified. ASHA, the American Speech-Language Hearing Association, is the governing organization for speech-language pathologists and it sets stringent requirements for continuing education and ethical standards which must be met in order to maintain certification. Therefore, ASHA certified therapists will provide the quality of service required to meet ASHA standards.

If you would like more information about speech pathology services and how they can help individuals with TS, listen to the new audio conferences that are available on the TAA’s website and you can get general information at ASHA’s website.