Pediatric Voice

We are pleased to assemble an issue in Seminars on pediatric voice disorders. With some exceptions, this topic has long received comparatively short shrift in mainstream speech-language pathology over the past decades. Unfortunately, voice problems are the most common communication disorder among children, and their functional consequences can be devastating. Moreover, as discussed in this issue, children with voice problems are badly underserved by our profession.

In the past, limited options were available for the treatment of voice problems in children. The traditional approach tended to orient toward a voice conservation model of therapy, encouraging children with voice problems to limit vocal communication. Advancing science in the 21st century has enriched our choices, and we present some of them to you in this issue.

A first article by Dr. Bari Hoffman Ruddy, Ms. Vicky Lewis, and Dr. Christine Sapienza kicks off the series by providing an excellent overview of voice management within the framework of the Individuals with Disabilities Education Improvement Act. The second article by Dr. Marshall Smith provides crucial information about pediatric voice disorders from the perspective of an otolaryngologist. Both of these articles emphasize the critical information of obtaining a physical examination, preferably by a pediatric otolaryngologist, for every child with dysphonia. They suggest possible solutions where obstacles are encountered. Next, we have an excellent overview of developmental changes in voice, environmental and other risk factors for voice problems in childhood, and evidence-based medicine in pediatric voice, by our Swedish colleagues Dr. Anita McAllister and Dr. Peta Sjölander. Following is my own article on general principles that may be used to guide evolving voice therapy approaches for children. The issue concludes with three outstanding articles on specific therapies for voice and laryngeal problems in children. An article by Dr. Barbara Kiernan and Dr. Shelley Gray describes a novel “Talk It Out” therapy. The next article by Ms. Lauren Marcus, Dr. Barbara Kiernan, and Dr. Julie Barkmeier-Kraemer provides data on the outcomes of a classroom-based intervention program. The final article, by Dr. Sally Gallena and Dr. Marie Kerins, describes diagnostic and treatment issues for conditions in which many pediatric clinicians may not be well versed but are critical to clinical practice: nonspecific chronic cough and paradoxical vocal fold motion disorders in children. Throughout this series, the clinician will find useful information about implementation of voice therapy programs in the schools, which can present special challenges.

The astute reader may note the conspicuous absence of the terms vocal abuse and misuse in this series. The reason is linked to suggestions that the terms fail to convey much information useful to the clinical process, they may undermine the therapeutic alliance due to their emotionally negative connotations, and they may harm self-efficacy for voice (i.e., one's belief in one's vocal competence).[1] In fact, recent data for adults are consistent with this latter proposal.[2] The relevance of self-efficacy is that it is among the most powerful variables to influence patient compliance with health care directives, as any brief search of www.pubmed.com or other medical database will reveal. I personally hope these terms can be eradicated from clinical language altogether in the near future. Neutral, descriptive terms such as phonotraumatic behaviors or, for children, simply yelling and screaming provide much more information to a child without attaching negative emotional overtones that may be harmful to the therapeutic process and moreover to the child's overall self-esteem.

We hope that this issue can be part of a larger effort to help to increase speech-language pathologists' awareness of voice problems in children, their importance, and newly emerging options in their treatment. We are grateful to have the opportunity to participate in this effort.

• References

• 1 Verdolini K. Critical analysis of common terminology in voice therapy: a position paper. Phonoscope 1999; 2: 1-8
• 2 Gillespie AI, Abbott KV. The influence of clinical terminology on self-efficacy for voice. Logoped Phoniatr Vocol 2011; 36: 91-99