Ms. Fish works with children with a variety of communication challenges, including:


Delayed speech and language development

Receptive and Expressive Language Disorders

Language-Based Learning Disabilities

Specific Language Impairment (SLI)

Word Retrieval Disorders

Articulation Disorders

Childhood Apraxia of Speech

Phonological Disorders

Speech Prosody Difficulties

Phonological Awareness Difficulties

Social Communication/Pragmatic Language Challenges


scroll down to read more about each of the communication challenges listed above



When children do not reach developmental milestones at an expected age, it is natural for parents to become concerned. Well-meaning friends and relatives may advise the parents to "wait and see" or share stories about how their own child spoke very late, but now their child "never stops talking." If a parent is concerned that their child's speech is delayed, the parent should seek the advise of a speech-language pathologist (SLP) who specializes in pediatric speech and language development. The SLP can complete an evaluation of the child's receptive and expressive language and analyze the child's speech sound production patterns to determine what, if any, underlying factors may be contributing to the child's speech delay then guide the parents about the next steps. 

If the child shows only minor delays, the SLP may provide the parents with suggestions about ways to encourage and stimulate speech and language development at home and recommend the parents return in a couple of months to reassess the child's speech. Parents of children with more substantial delays or specific challenges in development may be advised to enroll their child in speech-langauge therapy services or other types of early intervention programs to support the child's speech and language development.



Following an evaluation, a child may be diagnosed with a receptive language disorder, expressive language disorder, or a mixed receptive-expressive language disorder. Let's talk about each.

Receptive Language Disorder: Receptive language refers to the ability to understand both spoken and gestural language. Children who have a receptive language disorder may have difficulty:

  • Understanding the meaning of words most individuals their age understand

  • Understanding conceptual words, such as colors, numbers, shapes, spatial terms (e.g., behind, below, center, corner)

  • Following directions 

  • Understanding question forms 

  • Recalling details from stories that are read to them or that they read (if they are old enough to read)

  • Performing higher order thinking tasks, such as: placing objects in categories, recognizing similarities and differences between objects, sequencing pictures of a story, predicting what will happen next in a story

  • Understanding simple to increasingly complex sentences structures

Expressive Language Disorder: Expressive language refers to the ability to use speech and gestures to express ideas. Young children who exhibit expressive language challenges may have difficulty:

  • Using gestures

  • Saying their first words at the expected age and then progressively adding new words to their vocabulary

  • Stringing two and three words together to form early phrases

As children get older, other expressive language challenges may be observed, including difficulty:

  • Acquiring new vocabulary

  • Asking questions 

  • Forming sentences of increasing length and complexity

  • Using the structures of grammar expected for the child's age; for instance, the child may mix up verb tenses ("goed" for went)

  • Telling a story about something that happened earlier that day

  • Summarizing a storybook

  • Explaining their ideas in a clear way that people listening can understand

  • Expressing themselves easily without becoming frustrated

Mixed Receptive-Expressive Language Disorder: When a child has difficulty with both understanding/comprehending language and using language to express their ideas, the child is diagnosed with a mixed receptive-expressive language disorder

If you suspect your child is struggling with receptive language, expressive language, or both, it is important to seek the advise of a speech-language pathologist. The SLP can conduct an diagnostic evaluation to determine the nature of your child's language challenges and develop a treatment plan with goals that support your child's language development. Getting an early start is key, as language impairments are commonly associated with learning difficulties, especially in the areas of reading, writing, and spelling.



There is a close correlation between attainment of literacy skills (reading, writing, and spelling) and the attainment of receptive and expressive language skills. It is not unusual for a child with a mixed receptive-expressive language disorder to be diagnosed with learning disabilities, especially in the areas of reading, writing, and/or spelling. These language-based learning disabilities may present themselves in young children who struggle to learn the letters of the alphabet and corresponding sounds those letters make, spell their names, learn new vocabulary, and remember details of short stories read in class. In older children, struggles with both oral and written forms of communication may be impacted. School-age children may have trouble retelling a story, sequencing the events of a story or answering questions about what was read in their textbooks, learning to spell words, recalling what they have read, understanding story problems in math, and using executive functioning skills to mediate their classroom assignments (e.g., thinking about how to organize the content of a short essay before starting to write, keeping track of their school supplies and assignments). SLPs can provide support to children with language-based learning disabilities.



Children who demonstrate challenges in the acquisition of receptive language and/or expressive language, but whose language disorder is not accompanied by/related to another diagnosis, such as hearing loss, emotional disorder, intellectual disability, autism spectrum disorder, or developmental delay, are considered to have a specific language impairment (SLI). A child with a suspected specific language impairment should be evaluated by a speech-language pathologist and receive treatment to support their communication challenges.



Word retrieval or word finding refers to the ability to think of the words you want to say quickly and efficiently. We have all experienced times when we struggled to think of someone's name or struggled to think of a word, even though we were very familiar with the name or word we were trying to say. When an individual struggles fairly regularly to think of words he/she knows or when difficulties trying to think of words impact the flow of conversation or the individual's willingness to express themselves, we say the individual has a word retrieval disorder. An individual with a word retrieval disorder may demonstrate a variety of characteristics including:

  • Needing to take extra time to think of or "find" the word they want to say
  • Miming or acting out an idea, rather than using words, to express that idea
  • Choosing a synonym to express what they want to say because they can not think of the word they originally intended to say (e.g., "Lion are very fero . . . . . mean.")
  • Giving hints and clues to their listeners when they can't think of a word or a name (e.g. "Why don't you ask . . . . . oh you know, she's the one with the long, brown hair who sits behind Charlie in math.")
  • Repeating a portion of a sentence to bide their time while thinking of the word they want to say (e.g., "I went to went to went to went to Mexico with my family for winter break.")
  • Using fillers to bide their time when they struggle to think of the word they want to say (e.g., "Mom, can I have some, uh, the um, um, chocolate milk?") or waiting silently as they think of the word (e.g., "Ms. Harper, I need a new . . . . . pencil.)
  • Using vague terms rather specific terms (e.g., "Can you just put that thing over there on top of that big thing?")
  • Substituting a similar word for the word they actually intended to say (e.g., "We camped out and slept in a um um teepee" when they actually slept in a tent.)
  • Substituting a word that sounds similar to the intended word, but has a very different meaning (e.g., "My teacher told me I had to substitute the first chapter of the book" rather than summarize.)

A speech-language pathologist can evaluate and help individuals with word retrieval difficulties to make it easier for them to express themselves with greater confidence, effectiveness, and efficiency.



Articulation refers movement of the lips, tongue, soft palate and other articulators to produce the speech sounds of a specific language. In the English language, most children learn to say all the consonant and vowel sounds by seven- to eight-years of age. The development of a complete repertoire of speech sounds (also called phonemes) is a gradual process and follows a loose sequence/order from phonemes that tend to be acquired at a younger age (such as 'p' and 'd') to phonemes that tend to be acquired a little later in a child's development (such as 'th' and 'r'). When an individual has not acquired correct production of a phoneme at an age when he/she is expect to do so, the speech-language pathologist may make a diagnosis of an articulation disorder or a functional speech disorder and develop a treatment program to support the child's ability to say the sound(s) correctly. 

Some common types of functional speech disorders/articulation disorders include: 

  • Distorting the acoustic quality of a phoneme (e.g., lisping when attempting to say 's' or 'z')
  • Substituting one phoneme for another (e.g., saying 'w' in place of 'r,' as in "wabbit" for rabbit)
  • Omitting a phoneme in a word (e.g., leaving out a sound from a word, as in "ba" for ball)



Childhood apraxia of speech (CAS) is a pediatric motor speech disorder characterized by significant difficulty planning and producing the complex motor movement required for precise speech production. The child with CAS typically has trouble making accurate and smooth transitions from sound-to-sound and syllable-to-syllable in words, using appropriate prosody (melody) in speech, and being consistent in repeated productions of the same word or phrase. Children with CAS may omit sounds and syllables of words, have greater difficulty in longer or more complex words than in simpler words, make more errors as the length of the phrase or sentence increases, demonstrate "groping" or trial-and-error behavior when trying to speak, have errors in production of vowels, as well as consonants, and have gaps between syllables. When a child is diagnosed with moderate to severe CAS, it is recommended that the child receive an intensive amount of direct speech-language treatment from an SLP with specific training and experience in treatment of pediatric motor speech disorders. The diagnosis of CAS should be made by an SLP after completion of a thorough motor speech evaluation.



Some children struggle to organize the sound features and word patterns of their language and, thus, may demonstrate error patterns such as omitting final consonants in words (e.g., "bow" for boat); replacing fricative consonants such as 's,' 'z,' and 'sh,' with stop consonants such as 't,' and 'd' (e.g., "toap" for soap); replacing velar consonants 'k' and 'g' with alveolar consonants 't' and 'd' (e.g., "dumb" for gum); omitting a consonant in a cluster of consonants (e.g., "top" for stop). Helping children to learn to make accurate contrasts in the sound features of the sounds of the language and the word patterns of their language is what the SLP working with a child with a phonological disorder will do. A careful phonological assessment of a child's speech should be completed prior to beginning therapy, so an appropriate treatment plan can be developed.



Some individuals speak with an unusual melody pattern that makes their speech stand out as unusual. They exhibit difficulty figuring out how to achieve a natural-sounding melody with appropriate stress, intonation, and rhythm in their speech. Difficulty with prosody may be observed in individuals with apraxia of speech or in individuals with autism or Asperger's syndrome, as well as in the speech of individuals without an accompanying diagnosis. SLPs can offer support to help individuals with robotic-sounding or other unusual-sounding speech prosody to develop more natural-sounding speech.



Phonological awareness refers to the ability to manipulate the sounds/phonemes of a language and think about the sounds of words separate from the meaning words. For instance, a child may count the number of syllables of a word, tell what sound starts or ends a word, think of words that rhyme with a given word, or blend the sounds a word in which the sounds are segmented (e.g., C + A + T = "cat"). These skills begin to develop in the preschool years and become stronger in kindergarten and first grade. Individuals with poor phonological awareness skills may be at risk for difficulty learning to read and spell. An SLP can evaluate a child's phonological awareness skills and provide treatment to strengthen these skills.



Social communication refers to the use of language (verbal and non-verbal communication) to connect with others in a social way. In social situations, communication is used for a wide variety of purposes, including: greeting, requesting an item or activity, getting someone's attention, sharing stories, asking questions, expressing opinions, making comments, rejecting, protesting, informing, instructing, and expressing our feelings. Difficulties with social communication can interfere with an individual's ability to initiate and maintain a conversation, interact with a peer or group of peers in play-based activities, and connect with others in home, school, community, or work settings. When an individual struggles to use language in conventional ways (depending on the setting and the people to whom they are speaking) for a wide range of purposes/functions, the person may be diagnosed with a social communication disorder or a pragmatic language disorder.

A social communication/pragmatic langauge disorders may occur as a distinct diagnosis or may be part of another diagnosis, including, but not limited to autism spectrum disorder, language-learning disability, attention deficit disorder, intellectual disability, severe problems with speech intelligibility or expressive language, and traumatic brain injury. Speech-language pathologists can help individuals with social communication challenges improve their social language and conversational skills.