A Little About Me and This Blog

I have been a licensed Speech-Language Pathologist (SLP) since 1987. I am a member of the American Speech and Hearing Association. I have worked in the states of New York, Hawaii and Florida. I am currently in New York State. I have worked in settings that include public schools, special education preschools, hospitals, adult day treatment programs, home health rehabilitation, early intervention and preschool homebased therapy. I have provided evaluation and therapy to people ranging in age from 6 months to 100 years. I have worked with a wide range of conditions and treatments including fluency, aphasia, apraxia, voice disorders, dysphagia, cleft palate, hearing impairment, articulation delay, language delay, augmentative/alternative communication, autism, and many others through the years.
The purpose of this Blog is to share information and answer questions that you may have. I will strive to provide the correct information to the best of my professional knowledge. I may not share the same professional opinion as other licensed speech pathologists and I encourage second opinions if you want to be as informed as possible.

Sunday, January 31, 2010

Vocal Abuse in Children

     Many children abuse their voices.  A few children will actually develop serious problems as a result. Children are known to yell, scream, cry, make loud motor sounds, make character noises, growl like animals and make other harsh sounds.  Some children are exposed to smoke.  Some children do not correctly use the muscles in their necks when speaking and may tense their neck muscles. This may be a result of inadequate breath support and supply. Vocal abuse is also seen in older children such as cheerleaders, yelling spectators at a sports event or just in a family that shouts a lot. We have all experienced a bit of laryngitis after cheering a sports event, screaming or singing loudly at a concert or a day of overusing our voice.  This one time abuse does not generally have a long term effect.
     Vocal abuse, also known as vocal misuse can lead to serious problems which can include vocal fold inflamation, chronic laryngitis, vocal nodules, vocal polyps, and contact ulcers.  Children may start to exhibit a hoarse or raspy vocal quality which is a sign that something more serious is happening.
    Vocal nodules are among the most common problem that develops.  Kenny Rogers and Rachel Ray have both been diagnosed with vocal nodules.  Their chronically raspy voice is a symptom of this problem.  Vocal nodules are non-cancerous calluses that form on the soft tissue of the vocal folds, also known as vocal cords.  The voice takes on a raspy quality because the vocal folds can not easily close due to the mass on them.  It also takes more effort to get the vocal folds to touch which adds to the problem.
     A diagnosis of vocal nodules is made by an ear, nose, throat doctor, also known as an otolaryngologist. Although surgery can remove nodules, it is not usually the first plan of attack.  With surgery, the nodules can be removed, but if the behaviors are not changed, the nodules can return. Voice therapy with a Speech Pathologist is usually recommended as a first step.  This therapy will include a vocal abuse reduction plan.  The child must learn new voice behaviors that include new breathing patterns, good vocal hygiene and easy onset of speech.
     Most conditions that result from vocal abuse are reversible.  Without treatment, however, children can become adults with vocal nodules. Since it is easier for children to change speaking patterns early, it is best to address it when the problem first starts. 
     It is recommended that you try to keep your child's vocal abuse behaviors as controlled as possible.  This is often accomplished best through modeling.  It is an interesting phenomenon that if you talk very softly to children, they tend to speak more softly as well. The opposite is also true.  In a household that is loud and the family members must shout to be heard or just tend to be loud in general, the children will follow that lead.  Young children will use their voice in a variety of ways during play and that should not be discouraged completely.  They need to make environmental noises to develop speech and language skills. They just need adult reminders and direction to help them keep it under control. 
     I am opposed to the terms "inside voice" and "outside voice" because the children shouldn't be allowed to abuse their voices just because they are outside.  I prefer that they learn one phrase that reminds them to use their soft voice.  This way, they can be reminded to change their vocal behavior with the same reminder phrase no matter where they are at the time.  It is also more clear to them after you teach them the difference between soft and hard voice.


  1. I wanted to be sure and stop by and leave a comment.. I had read most of this blog earlier today.. or last night... but then the phone rang or a kid came in and I never finished it and did not get to leave a comment.. Husband and I took daughter out to do some shopping tonight.. and I found myself looking and listening to all the kids that were out and about... so many of them are talking so loudly.. and making well.. horrible noises... I could really see how it played into your post. I have thought a lot about the reasons why kids do this in the past.. one can look at some of the parents and know that no matter how loud the child is they are still not hearing them.. have thought about the emotional damage being done to the children.. but had not thought about the damage to their voice..... my kids did not have an indoor and outdoor.. we always had one voice.. and then we had sign.. if mom was signing.. it was either really important or you were in big trouble.. my baby is 16 and it still works :)

  2. i am so glad to have come across this post. one of my kiddos just recently started to use a harsh voice while talking and playing. during a speech session we used "soft voice" and it worked for a few minutes. he talks in a normal voice but uses his harsh voice quiet a few times during play/continuous speech. he is a 4 yr old with very mild Autism, suspected but not yet diagnosed. he also talks during forced exhalation quiet a lot. i recommended an ENT consult. any other suggestions?

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