We see a variety of individuals at Acorn & Oak with a broad range of diagnoses, communication challenges and medical conditions. Diagnoses commonly seen include autism, attention disorders (ADD/ADHD), cerebral palsy, chromosomal abnormality, deafness/hard of hearing, developmental delays, down syndrome, language based learning disabilities, intellectual disabilities, stroke and traumatic brain injuries.

There are a spectrum of speech, language, neurological and hearing disorders that may benefit from intervention.



A variety of difficulties with sounds, segments and the rules that cover syllable shape, structure, and stress, as well as prosody that impact intelligibility.  Children may delete sounds, substitute sounds, add sounds, or distort sounds, for example:

  • "bu" instead of "bus"
  • "sree" instead of "three"
  • "spagbetti" instead of "spaghetti"
  • "thpoon" instead of "spoon"

Sounds develop by certain ages. If a sound isn't developed by the expected age, the child could have an articulation disorder.


Stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts throughout life. The disorder is characterized by disruptions in the production of speech sounds, also called "disfluencies."

Early intervention is critical. Stuttering can begin between 2 1/2 and 5 years of age. Research has shown that earlier treatment results in an increased likelihood of fluency improvement. As children get older and behaviors continue, treatment can still enhance fluency, but it becomes more difficult and can take longer to overcome. There are multiple evidence-based programs designed for children who stutter that approach treatment in a systematic and structured way, in partnership with families.


Childhood apraxia of speech (CAS) is a neurological speech disorder that causes the child’s speech to be hard to understand because they have a hard time putting the tongue, lips and jaw in the right position to make many speech sounds. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.

Children with CAS may also have problems with other motor skills such as cutting, coloring and writing. The difficulty with speech and later language development may even result in problems with reading and spelling as the child gets older.



An individual with a receptive language disorder has difficulty understanding language which may be demonstrated by a lack of ability to follow directions, answer questions, identify objects and pictures, and communicate with others.


An individual with an expressive language disorder has difficulty expressing themselves using language which may be demonstrated by a lack of ability to ask questions, name objects, use sentences, and use correct language parts and patterns (pronouns, possessives, verbs, tense, word order, etc.) to communicate with others.


Pragmatic problems with some situations are typical for many children. However if these issues occur often or are inappropriate based on age it may be because of a pragmatic disorder.

Pragmatics as related to language fall into three major areas:

  1. Using Language for Different Purposes
  2. Changing Language Based on Needs and Situations
  3. Following Rules for Conversations and Storytelling

Pragmatic problems can cause poor social acceptance from peers or colleagues.


Early experiences with talking and listening are the foundation for learning to read and write. These pre-literacy skills include:

  1. Mastering various parts of language such as syntax, grammar and vocabulary, and
  2. demonstrating phonological awareness including decoding and isolating sounds (for example rhyming and alliteration)

Language-based learning disabilities, such as dyslexia include challenges with appropriate reading, spelling and writing that are not intelligence based. Most individuals with learning disabilities are of average to superior intelligence.



Aphasia can cause difficulty with speaking, listening, reading and writing. It is a disorder that is caused from damage to areas of the brain that are responsible for language.

The most typical cause of Aphasia is stroke, although other diseases, and other forms of damage or disorder such as a traumatic injury or a neurological disorder can also impact the language centers of the brain.

Aphasia does not reflect intelligence. Individuals with Aphasia may also have other problems such as dysarthria or apraxia.


Cognitive impairment is a deficit in thinking skills that impact an individual’s awareness of surroundings, attention, reasoning, problem solving, initiating and reflecting. Individuals may:

  • Show an inability to structure, start and manage tasks to completion
  • Demonstrate disorganization and need for assistance with tasks
  • Be impaired in the ability to solve problems
  • React impulsively

Cognitive communication problems can be caused by traumatic brain injuries and right hemisphere brain damage. Although the left side of the brain is responsible for language, the right side is responsible for the cognitive and executive functions. Because of this, some individuals may not be aware of the cognitive problems that they have.


Apraxia is a motor disorder in which an individual cannot move their lips or tongue to the appropriate location to say sounds correctly. This is not due to weak muscles, but rather neurological damage to the parts of the brain that manage muscle movement.

One common cause of Apraxia is stroke, but it can be acquired in other ways such as traumatic brain injury or dementia.

Individuals may demonstrate speech errors, distortions and substitutions, and impaired speech rhythm.


Individuals with dysarthria demonstrate slurred and unclear speech because of weakness, slowness, or lack of coordination in the muscles supporting the mouth, voice, and lungs.

Common causes of Dysarthria include stroke and brain injury. It can also be caused by cerebral palsy, and by degenerative diseases such as ALS, MS and Parkinson’s. There are several different types of dysarthria. The type of dysarthria a person has is determined by the area of the nervous system that’s damaged.

Dysarthria can affect more than just speech. An individual with dysarthria may look like his or her face is drooping, and may have difficulty with swallowing, eating and/or drooling.


Memory falls under the cognition umbrella for communication, and memory itself has many types including short term, long term, delayed, procedural and semantic. Memory requires the brain to absorb information, code it, store it and make it available for retrieval. Memory issues can stem from a variety of causes, including traumatic brain injuries, stroke and dementia.

One key focus area for individuals faced with memory problems is in developing compensatory strategies related to short term memory loss, including association, repetition, visualization, grouping and note taking. Other strategies may include labeling and organizing (for example pill bottles) as well as external aides like calendars and alarms.



Augmentative and alternative communication (AAC) covers the spectrum of communication methods that supplement or replace speech and writing.

AAC provides tools and aids that supplement or replace nonfunctional speech, to enable individuals to express themselves. AAC can also function as a model for children who are still developing proper syntax (grammar) and ability to increase utterances in verbal children.

AAC aids can include picture or symbol boards, books and electronic devices. Some aids generate speech or written output.

There is no best kind of AAC system. There are pros and cons for each system, and the most suitable approach may depend on each individual’s abilities, needs and personal preferences. Many individuals have more than one AAC method and can choose depending on the situation and the listener.


Aural rehabilitation focuses on providing therapy to individuals who are hard of hearing. Because it may include diagnosing hearing loss and implementing various amplification devices, it is done in partnership with an Audiologist.

For adults, therapy may focus on helping individuals adjust to the hearing loss as well as leveraging assistive devices and managing conversations.

For children, the intervention may be focused not on restoring lost skills (rehabilitation), but rather giving them the skills they may have never obtained initially (habilitation). This will depend on the current age of the child as well as when the hearing loss occurred, how acute the hearing loss is, and when any hearing was restored, and how they currently communicate.


Auditory processing disorder (APD) may be diagnosed when there is a struggle to process and make meaning of sounds even though there is no evident hearing impairment. Children with APD typically have normal hearing, however things break down between what is heard by the ear and what the brain processes.

Children with APD may not be able to quickly interpret what they hear. This is not because of a lack of understanding of the meaning of what is said, but rather the sounds of spoken langage itself.

Symptoms include the inability to distinguish between separate sounds, the ability to focus on important sounds in a noisy setting, the ability to recall what is herd, and the ability to recall sounds or words in the right sequence.