1. Childhood Voice Disorders Hyperfunctional Disorders vocal nodules and vocal strain By: Mary Beth Dehn

2. Prevalence Boone & McFarlane stated that about 7% of school-aged children experience continuing voice disorders. Lecoq & Drape (1996) looked at primary school children and found that 10% of them at the time of examination had dysphonic voices related to laryngeal or resonance disorders.

3. Signs & symptoms to look for in children who may have voice disorders: Dysphonia, a hoarse, breathy, or rough voice, may have excessive glottal fry Intermittent aphonia, recurring temporary loss of voice (first thing in the morning, end of the day, or after a specific event, for example a sports event) Voice breaks, fleeting interruptions in voice during singing or speech. Pitch breaks, abrupt changes in pitch of voice, usually when going from lower to higher pitch.

4. Signs and symptoms cont. An excessively loud voice for no reason An inability to sustain a note when singing An effortful or strained voice, voice sounds as if it takes special effort to produce and is not efficient.

5. Causes of childhood voice disorders: (Voice strain and nodules) Stress to the larynx, specifically the vocal folds This is referred to as vocal abuse. ‘Hyperfunctional’ means ‘overused’ Rare to find just “one” abusive behavior. Most common habits – Talking too long, too loudly, and with too much effort.

6. Activities in children that may cause development of vocal nodules or vocal strain: Talking and singing in excess, for example in a school play, concert, choir; shouting in the playground against background noise; overusing the voice when sick; cheerleading; overusing voice when emotionally upset or tired. Glottal attack, use of forceful voice can really damage vocal folds. Coughing, an loud forceful sneezing, children who do not rest voice when they have sore throat, asthma, or post nasal drip. Crying, laughing, loud and long outbursts of emotions, tantrums, inability to cope properly with negative emotions, related to loud, forceful use of voice. Shouting, cheering, and screaming

7. Causes cont. Grunting, during sports activity or weight training, this puts a sudden shock to the vocal folds. Throat clearing, vocal folds are slammed together every time the throat is cleared. Making sound effects or character voices, especially when breathing IN, this puts more strain on the vocal folds. Dryness, caused by overuse of certain medicines (cough drops and antihistamines), allergies, caffeine, and mouth breathing. Restricted fluid intake, for healthy vocal system good hydration is necessary.

8. Children at risk for voice disorders may have one or more of the following : Families with loud voice habits Chronic asthma or allergies Frequent upper respiratory tract infections Gastric reflux Affective disorders, ADD, hyperactivity, “temperamental personality” Behavioral problems Excessive stress or tension in child’s life ( internal, external, or interpersonal factors) Loud, outgoing competitive personality with tendency to act out emotionally

9. Treatment for voice disorders Child must first see an ENT, to determine if voice therapy is recommended. Record detailed case history (child’s early development, family relationships, ways disputes are resolved, behavior management, peer relationships, health history, child’s personality) Aim for therapy is to teach a healthy, non-abusive voice production pattern Educate child and family about nature of problem, symptoms, causes, and risk factors Explain normal anatomy and physiology of larynx in relation to child’s pathology

10. Treatment cont. Identify abusive behaviors and reduce or eliminate them Teach child about voice production: phonation (how sound is produced by vocal folds), respiration (breathing), resonance (loudness) Teach child about correct breathing style Explain how to recognize excessive neck tension around the larynx Provide a foundation for learning to produce the best voice with the least effort Resonance training teaches child to “project” voice to achieve loudness, rather than straining voice Teach voice exercises and relaxation techniques

11. Boone Voice Program for Children Designed to give children insights into why they may have voice problems related to vocal abuse. Provides guidelines and materials for evaluation and remediation of voice disorders Based on philosophy and procedures in “The Voice and Voice Therapy” http://www.psycan.com “Video Voice Speech Training”- comprehensive computerized speech therapy tool to aid in speech therapy. http://www.videovoice.com

12. Resources Boone, D.R. & McFarlane, S.C. (2000). The voice and voice therapy (6 th ed.). Boston: Allyn and Bacon. http://members.tripod.com/~Caroline_Bowen http://www.psycan.com http://www.videovoice.com http://www.unc.edu/~chooper/clinprog/childvoice/treatme nt.html http://www.unc.edu/~chooper/clinprog/childvoice/treatme nt.html http://www.superduperinc.com/P_Pages/pe9878.htm