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Speech & Language

The following are past questions and answers from Dr. Larry Silver on this topic.

My preschool child has a severe speech impairment. What interventions are available for him?

My son Benjamin is bright and can do what some four-year-old children can't, like swim and ride a two-wheel bike. But he has a speech impairment and developmental delays. I tried to get help when he was two because he would just sit on the floor and cry when he could not express in any way what he wanted. Early Steps turned him down because he had good motor skills; and when he entered Head Start, they tested him for speech and passed him because they did not want to deal with him.

Now he is in preschool, and they tested him and found that his development is almost two years behind and his speech impairment is kind of bad. My question is … should I get other testing done by, say, a geneticist or a neurologist for different things? Should I put him and myself through this?

It is unfortunate that he did not get help earlier. It is critical that all of his needs be addressed now. Have you been to the public school yet? He is eligible for a program called Child Find. The public school team will assess for motor, cognitive, language, and social concerns. If they find concerns, the appropriate interventions should be provided by the public school. I would get these efforts started first. Depending on the findings, you might discuss with his family doctor whether medical evaluations would help clarify the reasons for his difficulties.

Who diagnoses an auditory processing disorder?

My son is 9 years old. His teacher questioned whether he has an auditory processing disorder. The school is going to test him shortly but everyone tells me I should have it done privately instead. It is not covered under insurance.

If his school tests him, is there a specific or more thorough assessment that I as a parent could ask for? Thanks.

Speech and language therapists evaluate for a possible auditory processing difficulty. Most health insurance companies will pay for this assessment. But you should also discuss your concerns with the principal of his school, and request that the school's speech and language therapist see your son.

How can I get a 4-year-old who can only say three words tested?

How can I get an assessment or evaluation for a child who has turned 4 but can only say three words? I think he is too old for the Babies Can't Wait program.

Under the public law, IDEA, every public school program must have a Child Find program to evaluate children ages 3 to 5 who appear to be delayed in any area of development prior to entering kindergarten. Speak with the principal of your neighborhood school about how to register for Child Find.

Our pre-kindergartner can only speak in words (not sentences) and shows little interest in learning. What should we do?

Hello Dr. Silver,

I have a 5-year-old boy that had craniosinostosis surgery when he was 3 years and 9 months old. Next year he is going to be in kindergarten but he can't talk well - he can say words but not sentences. He does not know his colors, numbers, or letters and he is not interested in learning. He has short attention span (2 or 3 minutes at most). I'm really concerned. Please advise.

You should be concerned. Have you discussed your questions with the professionals who have been working with your son? Given your descriptions, I suspect that you have had evaluations and services since he was three. If not, you should know that you are entitled to a full assessment and services from your public school. Discuss this with the principal of the school where he would attend for kindergarten. Don't stop asking until you get your answers.

Our daughter is in preschool and doesn’t talk to anyone except us. How can we get her to open up?

Dear Dr. Silver,

My daughter is 4 years old and she does not speak to anyone except to us, her parents. She started going to preschool a little before age 3 and for nine months did not speak to the preschool teacher. We tried seeking help from the school district and they wanted to place her in a special program.

If she is with children who have disabilities, will she progress there? I am not sure that is the proper environment for her. I honestly think she needs more individual attention. Unfortunately, the preschool setting does not provide that. They usually have 24 kids with two teachers. What can I do in order to help my daughter open up, participate, and communicate with kids her age and other adults?

Please help.

Thank you,


Your daughter has what is called selective mutism. There are several possible causes. Have her evaluated by a child and adolescent psychiatrist. The interventions needed will be based on the reasons for her behavior. Don't worry about the impact of one program or another on your daughter. Focus on the cause first.

What is the relationship between Auditory Processing Disorder and ADD?

My fourteen-year-old son has ADD and APD. He’s currently on medication, but does not seem to help. Could the APD keep the medication from working?



The Auditory Processing Disorder will not interfere with the medications used for ADHD (ADD). The question is whether what is seen as inattention is truly ADHD (ADD) or a reflection of his Auditory Processing Disorder. If it is the latter, medication will not help. Speech-language therapy will.

What are some effects of language disabilities?

What helps a teenage boy who has a diagnosed dyslexic processing issue to fill in the gap between him being asked a question and his response? He has to develop a coping mechanism to not seem as if he is stalling the teacher or uninterested in a friend's story.


Your description suggests that in addition to his learning disability (current school term for dyslexia) he might have a receptive/expressive language disability. If this is correct, a speech-language therapist will be able to help him. If this concept is new to you, learn about language disabilities.

How can a teacher help a child with ADHD who has trouble reading and speaking?

I am a fifth grade teacher and I have a student who is medicated for ADHD with a patch. He shows an attention rate of about 85 percent throughout a school day. However, I have found that he experiences trouble in reading and in speaking at times. When called upon to orally read in class, he must stare at the text for approximately 20 seconds in order to verbalize his words. He also experiences this at times in beginning communication. Do you have any ideas of what the causes may be, or how I can assist him? Maybe games or skills practices that could help.



About 50 percent of students with ADHD will also have a learning, language, and/or motor disability. If your student is in fifth grade and struggling with reading, has he been evaluated by your school system for a possible learning disability? You also describe difficulties processing what he hears and what he must organize in his head before he can speak. Has he been evaluated for a language disability?

I think it is wonderful that you want to better understand and help. Start with getting psycho-educational and speech-language evaluations. These data will help guide your classroom efforts.

Can a teenager have a receptive-expressive language disorder?

My 14-year-old eighth grade daughter has bipolar disorder and has an IEP under SED. She is in both GATE and special ed programming. She receives medical services from her HMO and from County Mental Health. She is currently stable and doing acceptable work in her academic classes. However, she has always struggled with written assignments (even before she became ill), and particularly struggles with answering the call of a question. Her grades on homework tend to be A's or F's, depending on the nature of the assignment.

Today her psychiatrist said that she almost certainly has a receptive-expressive language problem that is masked by her emotional problems and her intelligence, and that is definitely not part of the thought disorder.

However, the psychiatrist can't diagnose an educational problem so I'll have to ask the school to test my daughter.

My daughter has always had some trouble with writing mechanics and with organizing her thoughts on paper. However, she began talking at a very young age (full sentences before 12 months), has always had a precocious vocabulary, and reads well, so it never occurred to me that she could have a language-based disability. Is this possible? What testing should be done? Can a receptive-expressive language problem be remediated in a teenager?

Thank you so much.
P. Johnson

Your daughter's psychiatrist is right. In addition to her bipolar disorder (the SED program) and her learning disabilities (her special ed program), she appears to have a receptive-expressive language disability. This problem is often seen when learning disabilities exists. She needs a speech-language assessment to clarify these problems and then she will need speech-language therapy along with appropriate accommodations to succeed. Yes, it is not too late to address these problems as a teen.

How can I work with the professionals who help my son to improve his behavior difficulties?

My 4-year-old son has some language processing difficulties. I need advice on how to deal with his tantrums of hitting, throwing stuff, peeing on his pants, etc. when he is in his very frequent temperamental behavior. He does not behave like this in school though. This is affecting my other normal six-year-old son's life terribly. Not to mention mine, as well. Please help. Time out or ignoring his tantrums does not help. His tantrums most of the time is due to him not being able to interpret as to what we are asking him to do or him not having it his way.


Who identified that he has a language processing problem? I hope it was by a speech-language therapist or a special education team. Do these language processing problems interfere with his ability to process what he hears and what he tries to speak? Do they interfere with early preschool learning like letter and number recognition?

I would suspect that his behavior at home is the result of his frustrations with handling life. If he does not always know what he hears or has difficulty finding the words to express himself, he will be angry and upset. If he cannot do play activities or peer interactions at his age level, he will be frustrated.

Start by sitting down with the professionals who diagnosed him as having a language processing difficulty. Ask this person(s) to help you answer your question about his behavior. Have them explain the frustration and teach you how to help you son be less frustrated.

Note from LD OnLine: For more information on Language Processing Difficulties, visit LD OnLine's Speech and Language section.

How can I learn my basic academic skills when the high school will not help me?

I am an early high school student. I just completed eighth grade but I find that a lot of my skills seem well below my classmates skills. I have had a learning disability since before I can remember. I have dysgraphia, fine motor difficulties, and speech difficulties. However I take a combination of regular, college prep, and honors classes. I am in no "special ed. classes" with the exception of supplemental.

I know for a fact that my skills in grammar, written expression, and spelling are well below the eighth grade level. However, I am receiving no help in those areas outside of my college prep English class. My teacher seem to think of me as "stupid." I have asked for extra help but she seems too busy to provide any after or before school help. So instead she sent me home with English text books to borrow over summer which doesn't help much since it takes me hours to get through one page due to my handwriting difficulties.

I learned very little in her class and I know the skills I lack in are not taught in high school but in elementary and middle school. I fear that without these skills I won't be able to be successful in school and work. A tutor is financially out of question and my case worker, who also happens to be my supplemental teacher, doesn't seem to think that I lack these skills or just doesn't realize it. I find she doesn't pick up on a lot of my difficulties.

How can I learn these skills that I need (e.g. basic grammar, spelling, and vocabulary) if I will not receive it through my classes? Do you have any suggestions?


I am so delighted that you understand your learning disabilities and learning abilities so well. As you know, this means that you have areas of great strength and areas of weakness.

If you have learned good compensatory strategies to minimize your weaknesses, you can handle most classes. However, in some classes, you struggle. Ideally, the special education coordinator for your school would work with the teacher for this class and help to develop any necessary adaptations or accommodations. You seem to be in a difficult situation where no resources are available. And, it seems that you did not get the necessary help in elementary school to compensate for your disabilities.

Don't give up. First, let's get your parents on board. Ask them to read this response. Then, ask them to go to the library and get a copy of a book, The Misunderstood Child. This book will help them understand what help you will need.

Maybe there will be a way to provide private help. Or, maybe, your parents can go to the school and insist on more help than you are now getting. If this does not work, e-mail me again.

Note from LD OnLine: Visit Dr. Tracy Gray's section to see a Tech Expert's response to the same question.