ADHD? Don’t You Mean Sleep Disorder?

sleep disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects millions of adults and children. ADHD is best characterized by problems with concentration, impulse control, organization, and memory. These symptoms are frequently accompanied by feelings of frustration, inadequacy, and isolation from others.

However, what if the individuals diagnosed with ADHD are, in fact, suffering from an entirely different disorder – sleep apnea? A little known fact is that symptoms of ADHD are closely related to symptoms of a sleep disorder. A list of behavioral traits for a child with ADHD includes:adhd-workingmemory-wordcloud

  1. Lack of Focus which includes difficulties listening, retaining information, paying attention, and organizing information
  2. Impulsivity which includes difficulty sitting still, remaining quiet, sharing, turn-taking, and talking when appropriate

These behaviors contribute to deficits in the areas of social interaction, cognitive development, and academic performance. The same behaviors discussed above are also found in children suffering from insufficient and inadequate sleep quality. A recent study found that children with obstructive sleep apnea were at higher risk to suffer from behavioral problems; specifically those that mirror ADHD. These children also demonstrated poorer academic performance.

Therefore in order to decrease the possibility of misdiagnosis, all children and adults being treated for ADHD should also be screened for sleep disorders.

Jessica Eberhardt M.S. CF-SLP, TSSLD

The Real Deal on Feeding Disorders in Children


Does your child struggle with eating a variety of foods, consuming a variety of textures/consistencies, and/or gaining weight/growing? Then the SOS Approach to Feeding may be appropriate for your child. The SOS Approach to Feeding is a trans-disciplinary feeding program for assessment and treatment of children with feeding deficits from birth to 18 years of age. It incorporates a variety of factors including posture, sensory sills, motor skills, behavioral learning, medical, and nutritional components to understand how these cause and maintain feeding/growth problems. My experience in the field thus far has taught me that feeding disorders are rarely the result of an isolated issue. It is typically a combination of factors that cause this difficulty with feeding. It is our job as speech-language pathologists to thoroughly assess your child in order to determine what factors may be causing or maintaining the feeding dysfunction.

Children who eat a limited variety of foods are typically referred to as “Picky Eaters”; however, did you know there are specific distinctions between a picky eater and a problem eater. Typically, a picky eater eats 30 foods or more, stops eating foods due to “burn out” but will regain these foods after 2 weeks, can touch and taste new foods even though they’re nervous, and will add new foods to repertoire in 15-25 steps on the eating hierarchy. In contrast, problem eaters eat less than 20 different foods, foods that are lost due to food jag are NEVER re-acquired, has an emotional reaction such as crying to new foods, refuses an entire category of food textures, almost always eats a different food than the family, and acquires a new food in more than 25 steps on the eating hierarchy.

Here is a list of red flags from the creator of the program, Kay A. Toomey, PhD, to determine if your child is a candidate for referral:

  1. Ongoing poor weight gain (rate re: percentiles falling) or weight loss.
  2. Ongoing choking, gagging or coughing during meals
  3. Ongoing problems with vomiting
  4. More than one incident of nasal reflux
  5. History of traumatic choking incident
  6. History of eating & breathing coordination problems, with on-going respiratory issues
  7. Inability to transition to baby food purees by 10 months of age
  8. Inability to accept any table food solids by 12 months of age
  9. Inability to transition from breast/bottle to a cup by 16 months of age
  10. Has not weaned off baby foods by 16 months of age.
  11. Aversion to all foods with a specific texture
  12. Food range is less than 20 foods
  13. An infant who cries with arching back at majority of meals
  14. Meals are battles
  15. Child is difficulty for everyone to feed
  16. Child rarely meets weight goals.

If you answered “yes” to many of the above items, then you should contact one of our centers to be evaluated by a qualified Speech-Language Pathologist.

Jessica Eberhardt M.S. CF-SLP, TSSLD

How to Foster Early Language Development in the Home

          Early language and communication skills are essential to achieving developmental milestones and later academic success. Language skills are subdivided into two primary category, which include how a child understands language (i.e. receptive language) and how a child expresses oneself (i.e. expressive language). Expressive language includes more than just verbal communication, such as body language, facial expressions, and gestures. Studies have shown that children who develop stronger language and communication skills in their early years are more prepared to succeed upon entrance into school. Additionally, these children encounter fewer obstacles when learning how to read and write.
          Parents always ask me what they can do at home to help foster their child’s speech and language skills. Finding additional time in the day to target speech and language can be difficult, especially for the working parents. However, promoting language development is as easy as adding these five daily routines into your schedule!
  1. Mealtime- This is your opportunity to label the foods you are serving and describe them in depth regarding the colors, the textures/consistences, the tastes, and the temperature. This aids in expanding your child’s concrete and abstract vocabulary. Furthermore, this can also serve to decrease frustration with picky eaters by providing them with the tools to explain why they do not like certain foods, tastes, textures, etc.fussykid-large
    1. A fun activity is to provide your child with a variety of snacks and two paper plates labeled “Sweet” and “Salty.” Have the child taste each food and then sort the foods appropriately onto their corresponding plate.
  2. Getting Dressed- Here is your chance to discuss the weather and how we dress differently based on how it is outside. Take time to label/discuss weather attributes (i.e. cold, warm, cloudy, sunny, rainy, snowy, etc.) and the corresponding clothing that is most appropriate (i.e. sweater, pants, t-shirt, shorts, bathing suit, rain coat, coat, boots, etc.)
    1. An easy activity to try is to provide your child with “absurdities” or silly statements that they can correct. For example, “In the winter, I wear a bathing suit.” They love playing the teacher role in any situation.
  3. Reading – Explore the vivid illustrations, characters, and settings in all of the books that you are reading. Follow along with your finger to aid in recognition of sight words. Read the same book over and over again too!kids-reading-book
    1. An easy activity before bedtime is story retell. After you read a story to your child, allow him/her the opportunity to tell the story how they want. This helps promote narrative development, creativity, and sequencing of events.
  4. Backyard Play – This is a great time to narrate the child’s actions and play routines for all outside games (i.e. roll the boll, swing on the swing, ride in the wagon, drive the car, blow the bubbles, etc.).
    1. While playing outside, do not fall into the trap of constantly quizzing your child (e.g. “What is this?”, “What color is this?”, “Where is this?”, etc.). Studies show that auditory bombardment of set phrases describing a child’s actions is an effective way to promote language development. The child gradually corresponds the actions with the words used to describe it.
  5. Bath time – This is the opportunity to label body parts from head to toes, as well as their function (e.g. eyes are for seeing, ears are for listening, legs are for walking, etc.).bathtime_s
    1. Find a toy, such as a barbie doll or action figure, that is water safe and bring it into the tub. Model body part identification on the doll and reciprocate the questions for your child. For example, “Here are Barbie’s eyes. She uses them to see. Where are your eyes?”


Jessica Eberhardt M.S. CF-SLP, TSSLD

Step Away From the Sippy Cup!

There seems to be a progression from breast/bottle to sippy cup. Often, the sippy cup is used past the age of one year. The reason for this is because using a sippy cup for a prolonged time promotes sucking methods that hinder expressive speech and swallowing abilities – the article notes, “The spout blocks the tongue tip from rising up to the alveolar ridge just above the front teeth and forces the child to continue to push his tongue forward and back as he sucks on the spout to extract the juice.”  According to the author, “I frequently hear from parents how excited they are to begin teaching their baby to use a sippy cup.  They often view it as a developmental milestone, when in fact it was invented simply to keep the floor clean and was never designed for developing oral motor skills. Sippy cups were invented for parents, not for kids.” The author suggests that the transition should be breast, bottle then an open cup which would be managed by an adult to prevent spills. In addition, the parent could use a straw for their child, but they should cu the straw down so that the child can get their lips around it.

With that said, the same goes for prolonged breast, pacifier, and thumb sucking.

Stefanie C. Fedun, MS CF-SLP




Pediatric Voice Disorders – What you need to know

Often if children present with a hoarse/raspy vocal quality since early childhood, parents think this is “normal” since they have been speaking like that their entire life. However, this could be an indicator that something is structurally wrong in their vocal anatomy, and/or a sign of other difficulties (e.g. reflux, allergies, or respiratory issues). According to “A voice disorder may be characterized by hoarseness, vocal fatigue, raspiness, periodic loss of voice, or inappropriate pitch or loudness.”  Reflux can be a cause of a hoarse vocal quality – so if your child experienced reflux during infancy and/or exhibited signs of discomfort during feeding, then that may be the cause.

Another common cause may be vocal nodules or polyps. In fact, about 40-80% of hoarseness in children are caused my nodules. According to “Vocal cord nodules are also known as “calluses of the vocal fold.” They appear on both sides of the vocal cords, typically at the midpoint, and directly face each other. Like other calluses, these lesions often diminish or disappear when overuse of the area is stopped.” Whereas ” A vocal cord polyp typically occurs only on one side of the vocal cord and can occur in a variety of shapes and sizes. Depending upon the nature of the polyp, it can cause a wide range of voice disturbances.”

To alleviate symptoms associated – you should try and reduce vocally abusive behaviors. Or, management in diet or medication may suffice if reflux is the cause. This should be done in conjunction with voice therapy by a Speech Language Pathologist. Examples of vocally abusive behaviors are as follows (According to ASHA)

  • allergies
  • smoking
  • tense muscles
  • singing
  • coaching
  • cheerleading
  • talking loudly
  • yelling
  • drinking caffeine and alcohol (dries out the throat and vocal cords)

Therefore, voice disorders in children (and adults) are treatable.🙂 make sure to contact your pediatrician and/or SLP to explore this further if you suspect you or your child has a voice disorder.

Pediatric Voice Disorders


How diet can affect mental health and overall behavior

There has always been information in the media as to how eating different foods/changing your diet can affect your general mood, attention span, behavior, and overall well-being. However, what about for different disorders. Though this is a recent discovery, it seems favorable that changing your child’s diet may help to manage symptoms associated with ADHD/ADD, Autism, and overall behavior. According to the attached articles written by and, diet is a major factor in managing symptoms associated with the above mentioned disorders.

According to “Dietary intervention is a cornerstone of a evidence-based medical approach, and there is convincing empirical evidence that special diets help many with autism. A group of parent leaders who successfully implemented diets for their children compiled the following information and suggestions. These include references, resources, and links to aid parents as they begin exploring effective, evidence-based treatments.”

According to, ‘What some foods do seem to do, however, is worsen ADHD symptoms or affect behavior that mimics the signs of ADHD in children. “Excessive caffeine and excessive use of fast foods and other foods of poor nutritional value can cause kids to display behavior that might be confused with ADHD,” said Frank Barnhill, MD, an expert on ADHD and the author of “Mistaken for ADHD.”

Terrible foods for children who suffer with ADD/ADHD (and other behavior issues/inattention) include the following:

  1. Candy
  2. Soda
  3. Frozen fruits and veggies that contain organophosphates
  4. Cake mixes and frostings
  5. Energy drinks
  6. Fish and other seafood (with mercury)
  7. Other food sensitivities (e.g. allergies or intolerances)

Therefore, with that said, it is clear that changing your child’s (or your) diet will not solve/cure these disabilities… however, they can help manage associated symptoms, but talk to your pediatrician first🙂

Childhood Apraxia of Speech – What you need to know…

More and more people are becoming increasingly aware of Childhood Apraxia of Speech (CAS). However, it is important for parents to know about the disorder, so that they can look for any red flags.  Children who experience CAS gave a difficult time saying sounds, syllables, and words. This is NOT because of a muscle weakness, but rather because their brain has difficulties planning for the production of their speech. Think about how many muscles and nerves are involved in speech; what the lips, jaw, and  tongue do to produce even a single sound. In summation, the child knows what he/she wants to say, however his/her brain has a hard time coordinating and planning the muscle movements needed to execute the words.

In order to diagnose CAS the child must first go to an audiologist to rule out any hearing loss. Then, a Speech-Language Pathologist who has knowledge and experience with oral-motor abilities, prosody/melody of speech, and sound acquisition can diagnose CAS. Or, a neurologist can as well.


with knowledge and experience with CAS conducts an evaluation. This will assess the child’s oral-motor abilities, melody of speech, and speech sound development. The SLP can diagnose CAS and rule out other speech disorders, unless only a limited speech sample can be obtained making a firm diagnosis challenging.

Below is a list created by the American Speech and Hearing Association (ASHA) on some signs and symptoms of CAS. 

“Not all children with CAS are the same. All of the signs and symptoms listed below may not be present in every child. It is important to have your child evaluated by a speech-language pathologist (SLP) who has knowledge of CAS to rule out other causes of speech problems. General things to look for include the following:

A Very Young Child

  • Does not coo or babble as an infant
  • First words are late, and they may be missing sounds
  • Only a few different consonant and vowel sounds
  • Problems combining sounds; may show long pauses between sounds
  • Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
  • May have problems eating

An Older Child

  • Makes inconsistent sound errors that are not the result of immaturity
  • Can understand language much better than he or she can talk
  • Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
  • May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
  • Has more difficulty saying longer words or phrases clearly than shorter ones
  • Appears to have more difficulty when he or she is anxious
  • Is hard to understand, especially for an unfamiliar listener
  • Sounds choppy, monotonous, or stresses the wrong syllable or word

Potential Other Problems

  • Delayed language development
  • Other expressive language problems like word order confusions and word recall
  • Difficulties with fine motor movement/coordination
  • Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like toothbrushing or crunchy foods, may not be able to identify an object in their mouth through touch)
  • Children with CAS or other speech problems may have problems when learning to read, spell, and write”