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Screenings are available for children ages 2-15. Screenings will be performed by a state licensed, nationally certified Speech-Language Pathologist. The screening will assess your child’s articulation of sounds, voice quality, oral motor skills, and fluency of speech. The language screening will briefly assess your child’s comprehension and ability to use age appropriate language and vocabulary. The screening may also include phonemic awareness and auditory processing upon request. A screening is NOT the same as an evaluation. A screening helps identify those children who may have a speech, language, and/or hearing impairment. If your child is found to have mild difficulties yet a full speech/language evaluation is NOT recommended, home programming ideas will be discussed in order for you as parents to help facilitate these skills at home. If an area of concern is identified, a complete evaluation by a speech-language pathologist and/or audiologist will be recommended. I-xcel is available to provide a full speech-language evaluation (cost for screening will be applied to cost of full evaluation), as well as follow-up therapy.

Call today to schedule your appointment 404-966-9496!

UPDATE: As of APRIL 2009, I-xcel now accepts Medicaid!

We accept check, major credit cards, or cash. I-xcel does not routinely directly bill private insurance companies. We will support you by providing appropriate documentation of the speech-language services we provide if requested and encourage parents to file on their own. In some cases, I-xcel will file insurance for you, but an administration fee for doing so is assessed. There are no guarantees of insurance payment on your claim.

If you plan to seek reimbursement, you must let your therapist know before beginning therapy and the following are required:

1. Child’s pediatrician receives evaluation report and writes a prescription for speech language therapy with the appropriate diagnosis code for your child’s file.
2. Copies of your child’s treatment notes are available to you when requested by your insurance company. It will be your responsibility to send your insurance company additional information requested such as evaluation report or treatment notes from therapy sessions. Keep in mind that if your insurance company requires a report of progress every quarter or every six months (in addition to regular treatment notes), these are prepared for you at a set rate per report.

• Other than Medicaid, I-xcel is an out of network provider with all private insurance companies.

Understanding Your Policy

What kind of policy do you have?

HMO, PPO, POS, etc.? Typically, HMOs require you to see a participating provider (someone that has contracted their services to that insurance company for a set fee). PPOs and POSs allow you to receive services from professionals that are “out of network”.

Check your policy booklet or call your insurance company to find out about your benefits. Look for terms like “speech therapy”, “speech-language pathology”, “physical therapy and other rehab services” or “other medically necessary services or therapies” to see if it is a covered service.

Understand if there are any limitations in your insurance policy. These may be in the form of specific diagnosis and/or certain number of visits per year. We will not become involved in disputes between you and your insurance company regarding plan benefits, deductibles, co-payments, co-insurances, covered charges, coordination of benefits, “usual and customary” charges, etc., other than to supply factual information as necessary. You are responsible for the timely submittal of claims submitted to your insurance company.

Is Pre-Approval Required?

Your policy booklet or your insurance representative may clarify if a referral or pre-approval is needed for treatment or an evaluation.

If a referral is required for pre-approval, be sure to get the referral from your primary physician before your child begins treatment. This referral may be a form your doctor fills out or he/she may be required to write a letter of referral.

Often the insurance company will pre-certify a specific number of therapy sessions over a specific amount of time. If so, request the pre-certification letter be mailed directly to you so that you may keep track of the number of visits.

Keeping Good Records

Start a file and keep an accurate record of all conversations with the insurance company representatives you speak to. Always write down their full name and telephone extension number. Keep a copy of all written correspondence. Have your policy ID number handy when calling them and include it on all correspondence to the insurance company.
Submitting A Claim

If your child receives speech-language treatment once or twice a week, claims may be submitted at the completion of each session or after a block of sessions. If more sessions are needed at the end of that time, documentation of progress may be requested by the insurance company in order to approve additional sessions. Your insurance company is required to notify you of their decision within 30-60 days.

If you are told that treatment for your specific diagnosis is not covered, request the reasons in writing. This will be helpful to have in the event of an appeal. By the same token, if you are told your treatment will be covered, request that information in writing as well. Often an insurance company will consider reimbursement for services if they are medically necessary. They often deny claims that they deem educational or developmental in nature.

Always keep copies of everything you send to the insurance company in your file. Also, call the insurance company a week after you have mailed your claim, or a day after you have faxed it, to confirm that it has been received.

Often reimbursement takes time; it may be a lengthy process and require you to make follow-up phone calls. If you have not heard from your insurance carrier within 2 weeks, we advise you to be proactive by contacting them and making sure they have all of the information they need to process your claim.
How Can I-xcel Speech and Language Help Me?

We will provide you with an itemized invoice that will list all of the codes necessary to seek reimbursement. Keep in mind that if the insurance companies require reports of progress every quarter or every six months (in addition to regular weekly treatment notes), these are prepared for you at a set rate per report.

I-xcel is available to help you determine your insurance benefits.
Call for more information! 404-966-9496

(Effective January, 2009)

Bruce Willis - Walter Bruce Willis (born March 19, 1955) is a German-born American actor and singer. He came to fame in the late 1980s and has since retained a career as both a Hollywood leading man and a supporting actor. Being the leading actor in some of the greatest action movies Bruce Willis has had stuttering problems throughout his youth and was always scared it would affect his acting career. Fortunately he successfully grew out of it not too much from a therapist but from being an actor, it actually removed his speech disorder.
See a full list of all the people you know with speech problems here…you may be surprised - Allyson

“Polly want a cracker?” is language modeling in its simplest terms. When a parrot hears a human voice repeating the same thing over and over again, chances are they will utter the phrase — often when you least expect it. Language modeling refers to stating or restating sentences. Modeling is used to expose correct grammatical structures without requesting imitation.

read full article at www.preschoolerstoday.com

When I was a kid, the first thing I would do on a Saturday morning was rush downstairs and watch Bugs Bunny cartoons. I loved how Bugs, Daffy and the gang played tricks on one another, told silly jokes and most of all how they talked. I remember how I burst into uncontrollable laughter when Daffy would spit when he spoke or how Sylvester said, “thuffering thuckatash.” Today, when I hear, “I thaw a puthy cat outthide,” I no longer laugh, because those words are usually coming from one of my clients.

read the full article at www.preschoolerstoday.com

Q:  What is an articulation disorder?

A: An articulation disorder refers to difficulty producing sounds.  Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand your child.

Young children often make speech errors. For instance, many young children sound like they are making a “w” sound for an “r” sound (e.g., “wabbit” for “rabbit”) or may leave sounds out of words, such as “nana” for “banana.” The child may have an articulation disorder if these errors continue past the expected age.

To see the age range during which most children develop each sound, visit Talking Child’s speech chart.

Q:  What is a phonological process disorder?

A: A phonological process disorder involves patterns of sound errors. For example, substituting all sounds made in the back of the mouth like “k” and “g” for those in the front of the mouth like “t” and “d” (e.g., saying “tup” for “cup” or “das” for “gas”).

Another rule of speech is that some words start with two consonants, such as broken or spoon. When children don’t follow this rule and say only one of the sounds (”boken” for broken or “poon” for spoon), it is more difficult for the listener to understand the child. While it is common for young children learning speech to leave one of the sounds out of the word, it is not expected as a child gets older. If a child continues to demonstrate such cluster reduction, he or she may have a phonological process disorder.

To see the ages at which phonological processes should disappear, go to Typical Speech Development: The Gradual Acquisition of the Speech Sound System.

Q:  My 2 year old isn’t talking, should I be concerned?

A: By two years old, many children are using 50 or more words, which they may combine to make short phrases.  However, there is a range at this age with some children using more spoken words, and some using far less.   If you are concerned about your child’s speech or language development, contact a licensed speech-language pathologist certified by the American Speech and Hearing Association (ASHA). A speech-language pathologist compares the child’s language to that of other children his age. If there is cause for concern, communication intervention at a early age is crucial.

Q:  Do ear infections affect speech and language development?

A: When a child has a middle-ear infection, fluid accumulates in the middle ear. This fluid build up causes a temporary hearing loss.  Children with prolonged fluid in the ears have a higher incidence of speech and language disorders.  Even a mild hearing loss, as little as 20dB, which would not be detected by a screening, can cause a child not to hear high-frequency sounds ( such as f,z,s,sh,ch), some word endings (such as the plural “s” and past tense “ed”) and some word final consonants ( such as the t in cat).

Q:  My preschooler is stuttering.  Is this a problem?

A: There is a period of normal disfluency between ages 2 and 5.  Children this age are learning to use language in new ways, and often will repeat words or syllable once or twice ex. li li like, or use fillers such as um, uh.  A child who may truly be stuttering may also show other signs such as tension in the facial muscles, prolongations (holding out a sound), or a block when no there is no airflow or voice for several seconds.  If you are concerned that your child may be stuttering, then an evaluation by a speech-language pathologist is recommended. There are techniques that can be used with young children to improve their fluency and reduce their frustration.

Q:  What are the signs of a voice problem?

A: If your child’s vocal quality is hoarse for longer than 10 days in the absence of a cold or allergy, you should take your child to be examined by an Ear, Nose, and Throat doctor (ENT).  This will help determine if there is a vocal pathology such as vocal cord nodules or polyps present.  Vocal nodules are the most common reason for voice disorders in children.  They are caused by vocal abuse, such as talking too loudly or screaming, using a pitch that is unnatural, constant throat clearing or coughing.  Many voice disorders can be remediated with the help of a speech-language pathologist.  Some voice disorders will require the combined approach of medical or surgical treatment AND voice therapy conducted by a speech-language pathologist.

Q:  What is a swallowing/feeding disorder?

A: Swallowing disorders are usually related to a structural weakness or dysfunction.  A swallowing disorder refers to difficulty with moving food from the mouth to the stomach.  A feeding disorder is often behaviorally motivated and is characterized by the refusal or aversion to food.  Swallowing disorders, or dysphagia, can result from decreased function of the oral, pharyngeal, or esophageal structures.

Signs and symptoms of a swallowing or feeding disorder:

• Coughing or choking with food or liquid
• Wet vocal quality (gurgly voice)
• Runny nose or watery eyes with meals
• Food refusal or prolonged eating times
• Pneumonia or respiratory problems
• Low grade fever following meals
• Abnormal oral feeding/difficulty chewing or overstuffing food
• Food aversion or refusal
• Failure to thrive
• Difficulty advancing to age appropriate food consistencies and textures
• Vomiting, gagging, or choking during or following meals

Feeding/swallowing disorders can be diagnosed and treated by a Speech-Language Pathologist.  Treatment will focus on identifying the cause of the disorder, developing a plan to address both behavioral and physical concomitants, and educating the family and caregivers.

Q:  What is a language-based learning disability?

A: These problems may include difficulty with the following:

• Expressing ideas clearly, as if the words needed are on the tip of the tongue but won’t come out. What the child says can be vague and difficult to understand (e.g., using unspecific vocabulary, such as “thing” or “stuff” to replace words that cannot be remembered). Filler words like “um” may be used to take up time while the child tries to remember a word.
• Learning new vocabulary that the child hears (e.g., taught in lectures/lessons) and/or sees (e.g., in books)
• Understanding questions and following directions that are heard and/or read
• Recalling numbers in sequence (e.g., telephone numbers and addresses)
• Understanding and retaining the details of a story’s plot or a classroom lecture
• Reading and comprehending material
• Learning words to songs and rhymes
• Telling left from right, making it hard to read and write since both skills require this directionality
• Letters and numbers
• Learning the alphabet
• Identifying the sounds that correspond to letters, making learning to read difficult
• Mixing up the order of letters in words while writing
• Mixing up the order of numbers that are a part of math calculations
• Spelling
• Memorizing the times tables
• Telling time

Q: How is reading related to speech and language development?

A: The child who is having difficulty reading or learning to read may not have a solid foundation in language skills or phonological awareness.  A child’s development of understanding language (receptive) or using language to express himself ( expressive) form the basis for leaning to read and write. This includes vocabulary, grammar, word and sentence meaning. The ability to comprehend spoken stories as well as to organize and formulate ideas in order to tell stories are also important aspects of language. Without a firm language foundation, a child may experience academic problems, especially in the areas of reading, spelling and writing.

Effective treatment methods are available.  Your child should have a language-learning evaluation  by a licensed and certified speech-language pathologist.

*Information adopted from asha.org

Fast ForWord® products are based on over 30 years of scientific research into how the brain learns. Fast ForWord® programs actually build the learning capacity of the brain in children and adolescents. By applying neuroscience principles, these intensive computer-based programs strengthen memory, attention, processing & sequencing skills which are essential for academic learning and reading success.

by Teri James Bellis, PhD, CCC-A

In recent years, there has been a dramatic upsurge in professional and public awareness of Auditory Processing Disorders (APD), also referred to as Central Auditory Processing Disorders (CAPD). Unfortunately, this increase in awareness has resulted in a plethora of misconceptions and misinformation, as well as confusion regarding just what is (and isn’t) an APD, how APD is diagnosed, and methods of managing and treating the disorder. The term auditory processing often is used loosely by individuals in many different settings to mean many different things, and the label APD has been applied (often incorrectly) to a wide variety of difficulties and disorders. As a result, there are some who question the existence of APD as a distinct diagnostic entity and others who assume that the term APD is applicable to any child or adult who has difficulty listening or understanding spoken language. The purpose of this article is to clarify some of these key issues so that readers are better able to navigate the jungle of information available on the subject in professional and popular literature today.
Terminology and Definitions

In its very broadest sense, APD refers to how the central nervous system (CNS) uses auditory information. However, the CNS is vast and also is responsible for functions such as memory, attention, and language, among others. To avoid confusing APD with other disorders that can affect a person’s ability to attend, understand, and remember, it is important to emphasize that APD is an auditory deficit that is not the result of other higher-order cognitive, language, or related disorder.

There are many disorders that can affect a person’s ability to understand auditory information. For example, individuals with Attention Deficit/Hyperactivity Disorder (ADHD) may well be poor listeners and have difficulty understanding or remembering verbal information; however, their actual neural processing of auditory input in the CNS is intact. Instead, it is the attention deficit that is impeding their ability to access or use the auditory information that is coming in. Similarly, children with autism may have great difficulty with spoken language comprehension. However, it is the higher-order, global deficit known as autism that is the cause of their difficulties, not a specific auditory dysfunction. Finally, although the terms language processing and auditory processing sometimes are used interchangeably, it is critical to understand that they are not the same thing at all.

For many children and adults with these disorders and others – including mental retardation and sensory integration dysfunction – the listening and comprehension difficulties we often see are due to the higher-order, more global or all-encompassing disorder and not to any specific deficit in the neural processing of auditory stimuli per se. As such, it is not correct to apply the label APD to these individuals, even if many of their behaviors appear very similar to those associated with APD. In some cases, however, APD may co-exist with ADHD or other disorders. In those cases, only careful and accurate diagnosis can assist in disentangling the relative effects of each.
Diagnosing APD

Children with APD may exhibit a variety of listening and related complaints. For example, they may have difficulty understanding speech in noisy environments, following directions, and discriminating (or telling the difference between) similar-sounding speech sounds. Sometimes they may behave as if a hearing loss is present, often asking for repetition or clarification. In school, children with APD may have difficulty with spelling, reading, and understanding information presented verbally in the classroom. Often their performance in classes that don’t rely heavily on listening is much better, and they typically are able to complete a task independently once they know what is expected of them. However, it is critical to understand that these same types of symptoms may be apparent in children who do not exhibit APD. Therefore, we should always keep in mind that not all language and learning problems are due to APD, and all cases of APD do not lead to language and learning problems. APD cannot be diagnosed from a symptoms checklist. No matter how many symptoms of APD a child may have, only careful and accurate diagnostics can determine the underlying cause.

A multidisciplinary team approach is critical to fully assess and understand the cluster of problems exhibited by children with APD. Thus, a teacher or educational diagnostician may shed light on academic difficulties; a psychologist may evaluate cognitive functioning in a variety of different areas; a speech-language pathologist may investigate written and oral language, speech, and related capabilities; and so forth. Some of these professionals may actually use test tools that incorporate the terms “auditory processing” or “auditory perception” in their evaluation, and may even suggest that a child exhibits an “auditory processing disorder.” Yet it is important to know that, however valuable the information from the multidisciplinary team is in understanding the child’s overall areas of strength and weakness, none of the test tools used by these professionals are diagnostic tools for APD, and the actual diagnosis of APD must be made by an audiologist.

To diagnose APD, the audiologist will administer a series of tests in a sound-treated room. These tests require listeners to attend to a variety of signals and to respond to them via repetition, pushing a button, or in some other way. Other tests that measure the auditory system’s physiologic responses to sound may also be administered. Most of the tests of APD require that a child be at least 7 or 8 years of age because the variability in brain function is so marked in younger children that test interpretation may not be possible.

Once a diagnosis of APD is made, the nature of the disorder is determined. There are many types of auditory processing deficits and, because each child is an individual, APD may manifest itself in a variety of ways. Therefore, it is necessary to determine the type of auditory deficit a given child exhibits so that individualized management and treatment activities may be recommended that address his or her specific areas of difficulty.

Treating APD

It is important to understand that there is not one, sure-fire, cure-all method of treating APD. Notwithstanding anecdotal reports of “miracle cures” available in popular literature or on the internet, treatment of APD must be highly individualized and deficit-specific. No matter how successful a particular therapy approach may have been for another child, it does not mean that it will be effective for your child. Therefore, the key to appropriate treatment is accurate and careful diagnosis by an audiologist.

Treatment of APD generally focuses on three primary areas: changing the learning or communication environment, recruiting higher-order skills to help compensate for the disorder, and remediation of the auditory deficit itself. The primary purpose of environmental modifications is to improve access to auditorily presented information. Suggestions may include use of electronic devices that assist listening, teacher-oriented suggestions to improve delivery of information, and other methods of altering the learning environment so that the child with APD can focus his or her attention on the message.

Compensatory strategies usually consist of suggestions for assisting listeners in strengthening central resources (language, problem-solving, memory, attention, other cognitive skills) so that they can be used to help overcome the auditory disorder. In addition, many compensatory strategy approaches teach children with APD to take responsibility for their own listening success or failure and to be an active participant in daily listening activities through a variety of active listening and problem-solving techniques.

Finally, direct treatment of APD seeks to remediate the disorder, itself. There exist a wide variety of treatment activities to address specific auditory deficits. Some may be computer-assisted, others may include one-on-one training with a therapist. Sometimes home-based programs are appropriate whereas others may require children to attend therapy sessions in school or at a local clinic. Once again, it should be emphasized that there is no one treatment approach that is appropriate for all children with APD. The type, frequency, and intensity of therapy, like all aspects of APD intervention, should be highly individualized and programmed for the specific type of auditory disorder that is present.

The degree to which an individual child’s auditory deficits will improve with therapy cannot be determined in advance. Whereas some children with APD experience complete amelioration of their difficulties or seem to “grow out of” their disorders, others may exhibit some residual degree of deficit forever. However, with appropriate intervention, all children with APD can learn to become active participants in their own listening, learning, and communication success rather than hapless (and helpless) victims of an insidious impairment. Thus, when the journey is navigated carefully, accurately, and appropriately, there can be light at the end of the tunnel for the millions of children afflicted with APD.

Key Points:

APD is an auditory disorder that is not the result of higher-order, more global deficit such as autism, mental retardation, attention deficits, or similar impairments.

Not all learning, language, and communication deficits are due to APD.

No matter how many symptoms of APD a child has, only careful and accurate diagnosis can determine if APD is, indeed, present.

Although a multidisciplinary team approach is important in fully understanding the cluster of problems associated with APD, the diagnosis of APD can only be made by an audiologist.

Treatment of APD is highly individualized. There is no one treatment approach that is appropriate for all children with APD.