Vocal Hygiene & Voice Therapy

Voice disorders may be caused by several different factors, events, physical ailments, and diseases. Voice therapy has been administered to those who experience hoarseness, breathiness, or raspy vocal quality. The purpose of voice therapy is to help an individual use their voice without stress or tension and relieve the vocal symptoms that may be bothering him/her. Each voice therapy program should be tailored to the personal needs of the individual. For example, some individuals may join a voice therapy program to reduce the feeling of “something” in their throat, others may come to reduce a strained feeling in their neck, increase their volume, attain the voice quality they always wanted, or relieve achy tension in their throat.

Just like anything else, it is important for individuals to take care of their voice.  Vocal hygiene refers to the habits used to support a healthy and strong voice throughout an individual’s life. Important vocal habits include:

  • Healthy diet and lifestyle
  • Not smoking
  • Eliminating habitual and frequent throat clearing
  • Drinking water to hydrate
  • Control vocal loudness
  • Balance vocal demands and voice rest
  • Control breath support
  • Use caution with medications (over the counter & prescription)
  • Monitoring symptoms Acid-reflux
  • Vocal warm-ups before use

Speech therapists can work with adults and children who suffer from voice disorders that affect pitch, loudness, and overall vocal quality. Often speech therapists will work on the following areas:

  • Airflow
  • Voicing
  • Easy onsets
  • Resonance

Breath support is a key component that helps to create the power behind an individual’s voice. Speech therapists can work on diaphragmatic breathing. Using this technique can help an individual gain control of their airflow while they are using connected speech.

Voicing refers to the vibrations of the vocal folds. The goal of voicing is to adduct the vocal folds together without strenuous pushing or squeezing.

Easy onset refers to the interaction of the vocal folds during the production of a word beginning with a vowel sound. The individual will want to restrain themselves from producing a hard glottal attack and abusive burst of air through the vocal folds. Using this technique can help an individual focus on easily transitioning into sounds.

Lastly, resonance refers to the vibratory properties of the sound/voice above the laryngeal level or glottis. Focusing on establishing vocal production at a higher level can help to reduce tension at the level of the voice box.

Remembering Steps for Vocal Hygiene 
V    Value your voice through healthy diet and lifestyle.

O    Optimize your voice with vocal warm-ups before use.

I      Invest in your voice with training in proper voice technique.

C    Cherish your voice by avoiding voice misuse, overuse, and abuse.

E    Exercise your voice to increase endurance and power.


Kimberly Chirco MA CF-SLP, TSSLD


Stuckey, K., M.Ed, CCC-SLP, & Daymut, J. A., M.A., CCC-SLP. (2011). Promoting Easy Vocal Productions. Retrieved from http://handyhandouts.com/pdf/335_Vocal_Productions.pdf

Voice Disorder Prevention. (n.d.). http://voicefoundation.org/health-science/voice-disorders/overview-of-diagnosis-treatment-prevention/voice-disorder-prevention/



What is MLU?

What is Mean Length of Utterance (MLU)?

The term “mean length of utterance” is often used when speech therapists talk about increasing the sentence length of children. For example, if a child is learning how to talk they often have a MLU of one because they are only using one word at a time. As a child grows their MLU should increase with their age.

Speech-language pathologists measure MLU in morphemes. A morpheme is the smallest unit of language that holds its own meaning. If you separate a word into parts, each part would have its own meaning. For example, the word “banana” is one morpheme. You cannot divide the word into smaller words with meaning. If you add an “s” to the end you get “bananas”, you have two morphemes because you can divide the word into “banana” (meaning the yellow fruit) and “s” (meaning more than one). Another word that has two morphemes is “smelling.” The word could be divided into “smell” (the action) and “ing” (meaning it is currently happening).


Why is this important?

MLU is important because if a child says “my toy,” that’s two morphemes. If the child says “my toys” then the child used three morphemes. If you were counting by the number of words the child used, they both used two, however the child who added the “s” made the utterance more linguistically complex.

According to Brown’s Stages of Language Development a child should be developing at the following:

12-26 mos  ~  1.0 – 2.0

27-30 mos  ~  2.0 – 2.5

31-34 mos  ~  2.5 – 3.0

35-40 mos  ~  3.0 – 3.75

41-46 mos  ~  3.75 – 4.5

47 mos +  ~  4.5 +

So what can you do for your child at home?

In order to increase sentence length, you need to figure out what is missing from the child’s speech. In addition to seeing a speech therapist, several areas you could target at home include: talking to your child with new words, reading to your child, pointing out words you see, listen and respond when your child talks, increasing vocabulary, improving grammatical markers, and using expansions. An early vocabulary should include nouns, verbs, descriptors, possessives, negatives, demonstratives, and question words. If your child has limited vocabulary, working on increasing vocabulary could expand their language and ultimately increase their MLU. If your child says “go inside” you could expand on their sentence by saying “I go inside” or “Go inside, please.” When a parent provides models it allows the child to see how they could expand on their language. If your child does not have the appropriate mean length of utterance for their age, considering seeing a speech language pathologist (SLP). SLPs can help children with language disorders. Good language skills can create a foundation for learning, behavior, self-esteem, and social skills.

For more information please refer to the links below.

Kimberly Chirco MA CF-SLP, TSSLD


Bowen, C. (1998). Brown’s Stages of Syntactic and Morphological Development. Retrieved from http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=33 on

Clark, C., CCC-SLP. (n.d.). Increasing Sentence Length (MLU) – Speech and Language Kids. https://www.speechandlanguagekids.com/increasing-sentence-length-mlu/

Preschool Language Disorders – asha.org. (n.d.). http://www.asha.org/public/speech/disorders/Preschool-Language-Disorders/



What are pragmatic skills?

Pragmatic skills are the rules of social language. These skills play an important role in communication. An individual must use their pragmatic skills for the purposes of using language, changing language, and following rules. It is important that an individual knows how to use language appropriately in social situations in order to avoid conflict or harmful consequences.

Three major communication skills involved in pragmatic skills are: using language, changing language, and following rules. Different reasons for using language include: requesting, greeting, informing, demanding, and promising. An individual must be able to understand when they should be using a requesting statement than a commanding statement because the communication partner may not understand the needs of the situation if not appropriately asked. Changing language includes listening to the needs of the conversational partner or situation. For example, an individual should speak differently when they are at a concert than at the movies. Lastly, it is important for them to follow the rules of conversations and storytelling. For example, an individual must be able to take turns in conversation and maintain on topic.

Someone who struggles with understanding pragmatic skills may tell stories in a unorganized matter, mention unrelated topics to the conversation, and use inappropriate eye contact. If a loved one presents with some of these issues it may be beneficial to consider their social language use and age to identify if a pragmatic disorder is present. Addressing pragmatic issues early can help a child with increased social acceptance as well as prevent peers from ignoring having conversations with them.

Some suggestions to help develop pragmatics skills include: providing appropriate models to increase their syntactic complexity, role playing social situations to increase conversational abilities, explaining the use of nonverbal signals to understand feelings, and commenting on topics to encourage participation while staying on topic. Practicing reoccurring social situations is a good way for individuals with pragmatic disorder to learn how to appropriately use their language skills.

Kimberly Chirco MA CF-SLP, TSSLD



Pragmatic Language Tips – ASHA. (n.d.). Retrieved October 21, 2016, from http://www.asha.org/public/speech/development/PragmaticLanguageTips/

Social Language Use (Pragmatics) – ASHA. (n.d.). Retrieved from http://www.asha.org/public/speech/development/Pragmatics/

Speech Sound Disorders in Children


It is common for children to make some mistakes as they learn new sounds and words. Children are expected to follow a similar pattern of phoneme acquisition. The term phonological processes refer to the simplification of adult like speech that children use to communicate. Most of the processes that occur are considered typical until two years old and others until four years of age depending on the process. It is a normal part of a child’s development. A speech sound disorder is when the same mistake occurs past a certain age. Children should be able to produce sounds in English correctly by the age of eight. If these processes continue past a certain age (typically 7 or 8)it is considered atypical.

What can cause speech sound disorders?

  • Developmental disorders (e.g., autism)
  • Genetic syndromes (e.g., Down syndrome)
  • Structural anomalies (e.g., cleft palate/lip/velar cleft)
  • Neurological damage/disease (e.g., cerebral palsy; brain damage)
  • Hearing impairment/deafness
  • Linguistic deficits (e.g., development of abnormal sound patterns (learning))
  • Concomitant- co-occuring with a language impairment

Processes that exist:

Syllable structure processes: when the child modifies the syllable structure of the target sound

  1. Unstressed syllable deletion: “pajama” –> “jama”
  2. Final consonant deletion: “bed” –> “be”
  3. Doubling: “bubble” –> “bubu”
  4. Diminutization: “cup”–>“cuppy”
  5. Cluster reduction: “spoon” –> “poon”
  6. Epenthesis: insertion of an unstressed vowel “bad” –> “bad-uh”

Substitution processes: when the child substitutes classes of sounds

  1. Gliding: “red” –> “wed”
  2. Vocalization: “poodle” –>“poodoo”
  3. Stopping: “food” –>“pood”
  4. Depalatalization: “shark” –> “sark”
  5. Velar Fronting: “key” –> “tee”

Assimilation processes: when the child changes one sound that is very close to another sound in the same phonetic environment

  1. Labial assimilation: “boot” –>“boop” (“b” has an influence on the “p”)
  2. Velar assimilation: “goat”–> “goog”
  3. Nasal assimilation: “done” –> “none” (“n” influenced the “d”)
  4. Reduplication: “bottle” –> “baba”
  5. Voicing assimilation: “toe” –> “do”
  6. Methathesis: “film” –> “flim”

Combination/multiple processes: multiple processes are occurring in a single production

  1. “bubble” –> “bubu” (labial assimilation & vocalization)
  2. “crawl” –> “ca” (cluster reduction & final consonant deletion)

If your child presents with some of these processes, visit the link below to determine if the process is appropriate for your child’s age. There are several different treatment approaches that could be used to help acquire speech sounds. The most commonly used approaches are motor based and linguistic based. Motor based approaches focus on motor learning and repetition of individual sounds. Linguistic based approaches focus on teaching the child the phonological rules of the language. Both may be paired with perceptual training, which focuses on a child’s ability to differentiate between sounds. If your child is struggling with their acquisition of speech, please consider seeing a speech-language pathologist.

Kimberly Chirco MA CF-SLP, TSSLD


Bowen, C. (2011). Table 3: Elimination of Phonological Processes. Retrieved from http://www.speech-language-therapy.com/

Speech Sound Disorders: Articulation and Phonological … (n.d.). http://www.asha.org/public/speech/disorders/SpeechSoundDisorders/

Is it stuttering or normal disfluency?

faq1Many people are familiar with the term “stuttering.” Stuttering is a disorder which affects the fluency of speech and is characterized by “disruptions in the production of speech sounds, also known as disfluencies.”(ASHA) Based on this definition, it would seem likely that identifying stuttering in an individual’s speech would be an easy task. However, accurate identification of early childhood stuttering comes with it own set of challenges.

Many children often experience periods of normal disfluency as they learn to speak and expand upon their language abilities. We term these disfluencies “normal” or “developmental disfluencies.”  These disfluencies occur most often between ages 2-5 years, and they tend to come and go. They are usually signs that a child is learning to use language in new ways. If disfluencies disappear for several weeks, then return, the child may just be going through another stage of learning. Anyone who has spent time around a toddler is familiar with the numerous revisions, interjections and filler words that seem to occupy their utterances. However, on the other hand their a a significant amount of children that begin stuttering around the ages of 2-5, and will continue to stutter well into their adulthood, becoming a lifelong disability that can restrict their education, vocational and personal life. So can we help to distinguish between stuttering and normal disfluency?

Diagnosing childhood stuttering relies on observation of the child’s speech to differentiate the early signs of stuttering from the normal disfluencies of non stuttering children. The following are signs and symptoms that speech language pathologists often rely on to help determine if stuttering treatments should be initiated:

  • The child stutters on more than 10% of his or her speech- Children who stutter are two to three time more disfluent than their non stuttering peers
  • The child produces 2 or more iterations in repetitions (repeats sounds more than twice, li-li-li-li-like this)
  • Accessory or concomitant features are evident during moments of disfluency such as Tension and struggle in the facial muscles, especially around the mouth
  • The child avoids stuttering by changing words and using extra sounds to get started
  • The child experiences prolongations over 1 second long (s-s-s-s-s-s-so)
  • Child’s feelings/ attitudes-If the child has expressed that speech is difficult for him or her, that is often diagnostic in itself
  • Stuttering is consistently present or worsens over a period of a few months- stuttering persists beyond a year or increases in frequency or severity in that period
  • There is a family history of stuttering

In my experience, I have found that concerned parents are usually correct! So if you or anyone you know is at all worried about their child’s fluency of speech, consult with a Speech Language Pathologist and set up a Speech and Language evaluation to determine if treatment is the best option!



Curlee. R.F. (1999). Identification and Case Selection Guidelines for Early Childhood Stuttering. Stuttering and Related Disorders of Fluency (2nd Edition)

Guitar, B., & Conture, E. G. (n.d.). If You Think Your Child Is Stuttering… Retrieved November 03, 2016, from http://www.stutteringhelp.org/if-you-think-your-child-stuttering

Melanie Yovino, M.A CF-SLP