Voice Disorders in Children Require a Team Approach

Traditional approaches to voice therapy may need to be altered to meet the needs of children and to improve compliance. According to Dr. Theis, traditional voice treatment approaches that focus on vocal hygiene, implementing worksheets and reducing “abusive” behaviors such as yelling have limited effectiveness. She recommends the following approaches to improve a child’s vocal technique:

• vocal hygiene and hydration that focus on directly improving vocal quality and establishing intrinsic motivators to encourage compliance, with an emphasis on education rather than admonishment;
• behavioral voice treatment approaches that focus on improving vocal technique using child-friendly language and including the child’s caregiver in the sessions to help facilitate practice;
• resonant voice treatment that focuses on achieving a continuum of oral sensations and easy phonation from basic speech productions through conversational speech; and
• diaphragmatic breathing, lip trills, stretching and neck/laryngeal massage that focus on improving voice quality and decreasing vocal effort and fatigue by improving breath support, local fold closure and forward focus resonance and decreasing excess muscle tension.

Dr. Verdolini Abbott also emphasized the ineffectiveness of traditional voice therapy that focuses on telling children “not to abuse their voice.” She and her colleagues have developed a voice therapy program based on research they’ve done on the biomechanics of phonation, learning and compliance in children. Called “Adventures in Voice,” the game-based program is geared for children between the ages of four and 11 and uses video games and other technology to teach them how to produce a normal and loud voice safely rather than restricting their phonation.

One of the tenets of the program is that voice patterns used by children reflect what they are exposed to in their families and with their peers, often at school. “We are looking at socially driven voice patterns,” she said. “Many of the voice patterns used by children are used by the rest of the family.”

Because school represents the environment in which a child has his or her most active social life, an aim of Dr. Verdolini Abbott and her colleagues is to incorporate activities from the program in the school setting. However, she emphasized the challenge of convincing schools that voice problems can affect a child’s school performance, because the majority of speech pathologists who work in the schools have limited knowledge of voice therapy. When referring their patients for voice therapy, she encourages otolaryngologists to find a speech pathologist who has specialized in voice and pediatric voice. “If you refer to a generic speech pathologist, they won’t know what to do,” she said.