Voice

What is voice?

Voice is the sound that we hear when someone talks. It is produced by air coming from the diaphragm and lungs passing through the voice box (vocal folds) causing them to vibrate and make a sound. This sound is then shaped by the movement of the articulators (i.e. tongue, lips, teeth, jaw, cheeks) to make speech sounds. Each person has a unique voice which distinguishes them from another person.

The voice has a number of features including pitch, volume, quality and resonance, which are used to convey information about how a person is feeling. For example, a child who is excited will use a louder, more high-pitched voice than when they are calm.

Why is voice important?

Voice is important because it enables us to be understood by others and to verbally get our messages across to a communication partner. When a child’s voice is damaged it can lead to self esteem issues, fatigue and an inability to perform in their work/job.

What are the building blocks necessary to develop voice?

Hearing
Receptive language (understanding): Comprehension of language to understand how to modify the voice.
Articulation: Clarity of speech sounds and spoken language.
No physical impairment.

How can you tell if my child has difficulties with voice?

If a child has difficulties with voice they might:

Have a harsh, hoarse, croaky, strained or rough voice quality.
Use a high pitch or low pitch of voice.
Present with a loud or whispery voice.
Have a nasal (i.e. too much air coming through the nose) or hypo-nasal (i.e. like they have a blocked nose) voice quality.
Present with a loss of voice during the production of specific sounds.
Have periods of time when their voice is lost completely.

What other problems can occur when a child has voice difficulties ?

When a child has voice difficulties, they might also have difficulties with:

Articulation: Clarity of speech sounds and spoken language.
Self confidence: The child’s belief in their ability to perform a task.
Receptive language (understanding): Comprehension of language.
Expressive language (using language): The use of language through speech, sign or alternative forms of communication to communicate wants, needs, thoughts and ideas.
Fluency: The smoothness or flow with which sounds, syllables, words and phrases are produced when talking.
Behaviour: The child’s actions, usually in relation to their environment.
Executive functioning: Higher order reasoning and thinking skills.
Sensory processing: Accurate registration, interpretation and response to sensory stimulation in the environment and one’s own body.
Self regulation: The ability to obtain, maintain and change one’s emotion, behaviour, attention and activity level appropriate for a task or situation in a socially acceptable manner.

What can be done to improve voice difficulties?

ENT: Speech Therapists will generally refer a child presenting with a voice disorder to an Ears, Nose and Throat (ENT) Specialist to determine whether the voice box has any medical reason for the voice difficulty (e.g. nodules, polyps).
Speech Therapy: Following an ENT assessment, a detailed Speech Therapy assessment can take place and information from this and the report from the ENT specialist will be used to determine the type of therapy that will be recommended.
Education: The family and people within the child’s educational setting can be provided with information about the nature of the voice difficulty.
Voice awareness: The family and child can be taught how voice is produced and how damage can occur to the voice box.
Specific exercises, techniques and strategies can be taught to the child on how to use the voice box effectively.
Liaison: The Speech Therapist will liaise with pre-school and school staff to implement strategies and ideas into the educational setting.
Fun Activities: Activities and treatment are tailored to the individual child so that it is meaningful and fun.

What activities can help improve voice difficulties?

The activities recommended vary depending on the individual nature of the voice difficulties. Here are some general activities:

Hydration: Make sure the vocal folds/cords are hydrated by drinking water regularly.
Avoid noisy environments so that the child does not have to talk over the top of noise (i.e. background noise like loud music).
Quiet time: Have a quiet time each day where the child does not have to use their voice a lot, and if they do it is quiet (i.e. looking at books, quiet play, and television time).
‘Big voice/little voice’: Introduce the concept of ‘big voice’ versus ‘little voice’ and encourage the use of the ‘little voice’ most of the time. Praise the child when they use their ‘little voice’.
Visuals can be used to remind the child to talk in their ‘little voice’ (e.g. a picture of a child shouting in red to represent the ‘big voice’ and a picture of a child talking in blue to represent the ‘little voice’).
Demonstrate a relaxed nature and normal speaking voice for the child. You are the best model for the child.
Relaxation activities are useful to relieve tension in the neck and shoulders when talking.
Breathing: Try teaching and practicing breathing activities to aid breathing and voice control.
Resonance: Look at resonance and practice using the voice in the most effective and easy way.

Why should I seek therapy if I notice difficulties with voice?

Therapeutic intervention to help a child with voice difficulties is important to:

Prevent a small medical issue developing into a larger and longer term adult voice disorder.
Improve a child’s speech intelligibility.
Educate the child and their family about vocal hygiene and how to best protect a child’s voice to prevent damage later on.

If left untreated what can difficulties with voice lead?

When children have difficulties with voice, they might also have difficulties with:

Adult voice disorders.
Performing in a socially and age appropriate manner in the classroom or social setting.
Poor speech intelligibility and clarity.
Talking on the phone.
Relating to others in social situations.
Anxiety.
Poor self-esteem.