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The Source® for Children's Voice Disorders
Ages: 5-14   Grades: K-9

Be prepared for referrals to treat children with typical voice disorders with this book of tools, techniques, methods, and materials. 


  • Correctly interpret and integrate the components of a voice evaluation
  • Understand various vocal pathologies and their implications for voice treatment
  • Design treatment sessions that target a variety of vocal behaviors
  • Students understand vocal hyperfunction and abuse, respiration, and oral-nasal resonance problems and what to do
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** This is a Cloud E-Book that is accessible from any device with Internet access. .

This book is a great reference for the busy clinician looking for "need to know" information and organizational helps in one handy place.  

Chapter 1: Describes the kinds of things that can go wrong with the voice and gives descriptions of problems related to voice abuse.  Medically-related causes of voice problems (e.g., GERD, upper respiratory infections) are also addressed as well as congenital medical disorders with related voice problems (e.g., cleft plate, cerebral palsy).

Chapter 2: Reviews the clinical (i.e., non-instrumental voice assessment) and includes a Clinical Voice Evaluation Checklist, observation form, case history form, and educational handout. 

Chapter 3: Gives an overview of instrumental evaluation measures and how to interpret them.

Chapter 4: Includes helps for implementing appropriate interventions with sample forms and treatment plans, and a master list of goals and treatment objectives.  Suggestions are given for addressing the challenges of:

  • helping the child understand his/her voice problem
  • utilizing a behavior change reinforcement system
  • determining prognosis and length of treatment
  • insurance/reimbursement

Chapter 5:  Covers treatment of the hyperfunctional voice (voice produced with too much tension).  The types of hyperfunction and their respective treatments are discussed.  Illustrated exercises and take-home activities are included.

Chapter 6: Describes specific strategies for helping children replace vocal abuses with good vocal hygiene techniques as well as techniques to address the aspects of respiration, phonation, and resonance that effect vocal hyperfunction.  Suggestions for motivating the child, goals and objectives, and specific treatment methods with data collection forms and illustrated exercises are provided. 

Chapter 7: Shows how to teach children to use a better respiratory pattern and includes illustrated activities.  

Chapter 8: Focuses on three aspects of phonation that may be problematic for children: volume, pitch, and voice onset.  Sample treatment goals, a sequence of activities, and illustrated activities are included.

Chapter 9: Deals briefly with hypernasality and covers tone focus in detail.  Treatment techniques are reviewed and illustrated activities are included.

Chapter 10: Gives information on paradoxical vocal fold dysfunction (PVFD).  Although PVFD is not a voice disorder, its treatment requires a knowledge of respiration and phonation. 

Copy the student activity pages or print them from the FREE CD.  An educational PowerPoint presentation on How to Keep a Healthy Voice is also included on the CD.

Copyright © 2005

179-page book plus a CD of reproducible pages and an educational PowerPoint presentation. Evaluation, documentation, and educational tools and therapy activities are included in the book.

I'm a school speech therapist working in the Sierra Nevada Foothills.  I have been using The Source for Children's Voice Disorders with a hearing impaired student with chronic hoarseness & a small nodule.  It's been a wonderful tool in my work with him.  He loves the drawings and charts and has taken great responsibility for his vocal hygiene program.  I can happily say that he has eliminated abusive behaviors by about 90%.  Thank you for providing such a valuable resource for my therapy!

Dyann Castro-Wehr, SLP
Nevada City, CA

  • ASHA (2005) supports voice therapy for treatment of dysphonia.  Voice therapy is a preferred behavioral intervention before pursuing invasive medical interventions, such as vocal fold injections or surgery.  Voice therapy can improve surgical outcomes with certain types of etiologies, such as vocal fold nodules.
  • Ramig and Verdolini (1998) found evidence to support voice therapy for voice disorders of various etiologies.  Speech-language pathologists (SLPs) have the educational training and clinical experience to assist an individual with a voice disorder improve his/her voice, leading to improved functional communication, social interactions, willingness to participate in school, and psychological well-being.
  • Effective voice therapy for children needs to involve multiple components, including education on how the voice functions, etiology, contributing behaviors, vocal hygiene, and direct voice therapy.  A multidisciplinary team approach, including parents, teachers, and medical professionals, will produce the most comprehensive results (Hooper, 2004).
  • Use of instrumentation and verbal feedback from the SLP is highly desirable for a child to learn correct and incorrect use of voice production (Harvey, 1996).
  • Paradoxical vocal fold motion is often diagnosed in children and adolescent athletes who are labeled "high achievers."  The SLP can play an important role in education and intervention for this complex and often misdiagnosed disorder (Mathers-Schmidt, 2001).

The Source for Children's Voice Disorders incorporates these principles and is also based on expert professional practice.


American Speech-Language-Hearing Association (ASHA). (2005). The use of voice therapy in the treatment of dysphonia [Technical Report]. Retrieved August 4, 2009, from

Harvey, G.L. (1996). Treatment of voice disorders in medically complex children. Language, Speech, and Hearing Services in Schools, 27, 282-291.

Hooper, C.R. (2004). Treatment of voice disorders in children. Language, Speech, and Hearing Services in Schools, 35, 320-326.

Mathers-Schmidt, B.A. (2001). Paradoxical vocal fold motion: A tutorial on a complex disorder and the speech-language pathologist's role. American Journal of Speech-Language Pathology, 10, 111-125.

Ramig, L.O., & Verdolini, K. (1998). Treatment efficacy: Voice disorders. Journal of Speech, Language, and Hearing Research, 41, S101-S116.


Nancy B. Swigert


Nancy B. Swigert, M.A., CCC-SLP, is president of Swigert & Associates, Inc., a private practice that has been providing services in the Lexington, Kentucky area for over 25 years.  She evaluates and treats children and adults with voice disorders through her company's contractual agreement with Central Baptist Hospital.  She works closely with several otolaryngology practices as well as a pulmonary group.  Nancy is the author of five other products for LinguiSystems, The Source for Dysphagia, The Source for Dysarthria, The Source for Pediatric Dysphagia, The Source for Reading Fluency, and The Early Intervention Kit.  She is very active in the American Speech-Language-Hearing Association, including serving as its president in 1998 and president of the American Speech-Language-Hearing Foundation in 2004-2005.


Voice disorders in children probably occur more frequently than voice disorders in adults.  Estimates of the prevalence of voice disorders in school-age children range from 6% (Hull et al. 1976) to a high of 23% (Silverman & Zimmer 1975).  Despite this high prevalence, many speech-language pathologists (SLPs) working primarily with children rarely see a child with a voice disorder.  Wilson (1979) noted that although 6-9% of elementary school children have voice disorders, only 1% of children on SLPs caseloads have voice disorders.  Andrews and Summers (2002) hypothesized that this may be related to the difficulty in getting the child examined by a physician before beginning therapy.  It may also be related to an acceptance that the child "has always sounded that way."  Sometimes parents and teachers are so accustomed to hearing the child's hoarse voice that it doesn't sound "abnormal" to them.

Whatever the reason, the fact that SLPs don't see lots of children with voice disorders may contribute to a lack of confidence in evaluating and treating these children.  Yet it can be fun and rewarding to treat children with voice disorders—they generally demonstrate quick progress and get better.  SLPs should have a critical role in the management of children with voice disorders. Often, behavioral voice treatment is the preferred treatment.

In all areas of practice, it is important that clinicians use an evidence-based approach to treatment.  This means that we should carefully analyze evaluation and treatment techniques to determine if they have been shown to be efficacious.  Voice disorders are no exception, and solid research studies do exist on treatment efficacy, though often not specific to the pediatric population.  For example, Ramig and Verdolini (1998) wrote a review article on the efficacy of treatment for voice disorders.  In this article, they indicated that the consensus is that "children with vocal hyperfunction and vocal nodules should receive voice treatment."  In a study of 31 school children with vocal nodules, 84% (after six months) had reduced nodule size and 65% had normal larynges (Deal et al. 1976).  Allen et al. (1991) also reported that voice treatment was effective in treating vocal nodules.  Vocal hygiene programs have also been found to reduce the number of children perceived as hoarse (Nilson & Schneiderman 1983).

This book is not designed to teach you everything you need to know about voice disorders in children.  There are many excellent, comprehensive textbooks that you may want to use to supplement the information provided here.  This book is designed to serve as a reference tool and to give you techniques, methods, and materials (including a PowerPoint presentation on the accompanying CD that is designed to educate children about the voice) to use with children who have typical voice disorders.  Unusual or low incidence voice problems (e.g., paralysis of vocal folds) are not addressed.  This book should be useful to SLPs in school or healthcare settings who see children from kindergarten to middle school.  Many of the techniques described can be used with older children, though the handouts may need to be adapted in some cases to be more age appropriate.  In addition, this book does not deal with voice problems unique to adolescents (e.g., puberphonia).

Chapter 1 describes the kinds of things that can go wrong with the voice.  You'll find descriptions of problems related to voice abuse/misuse and the consequences (e.g., vocal nodules) of such abuse.  Medically-related causes of voice problems (e.g., upper respiratory infections, GERD) are also addressed, as well as congenital medical disorders with related voice problems (e.g., cleft palate, cerebral palsy).

Clinical evaluation of the voice (discussed in Chapter 2) is an important step in analyzing the perceptual characteristics of the child's voice.  This analysis will provide valuable information for developing a treatment plan.  Chapter 3 gives some basic information about instrumental evaluations of voice disorders.  It does not provide enough information to prepare you to perform such instrumental evaluations.  However, it should help you understand reports of instrumental evaluations you receive from others, and to determine when and why you might want to refer a child for a comprehensive instrumental evaluation.

The combined information from both types of evaluation forms the basis for treatment planning.  Many other factors must be considered, however, when planning treatment (Chapter 4) for children.  One of the challenges is motivating the child to change something he may not perceive as a problem.  Behavior management techniques need to be utilized and other adults need to be enlisted in the effort to change the behaviors.  The framework for using short-term goals and treatment objectives is also addressed in this chapter.

Most voice problems presented by children will be problems of hyperfunction, which Boone et al. (2005) described as "the involvement of excessive muscle force and physical effort in the systems of respiration, phonation, and resonance."  A description of types of hyperfunction and the relationship of hyperfunction to the development of organic problems is described in Chapter 5.  The fundamentals for treating hyperfunction are explained, along with several specific techniques.

Since many children with hyperfunctional voice disorders are abusing their voices, Chapter 6 provides detailed information about behavior management strategies that can be used to modify vocally abusive behaviors.  The appendices in this chapter include forms that should help you in collecting data on these behaviors.

Chapters 7, 8, and 9 provide more in-depth information and treatment strategies about three specific physiologic functions that contribute to voice production: respiration, phonation, and oral-nasal resonance.  You'll find yourself referring to these chapters for the child who has an isolated problem with these functions or for the child who needs extra practice in these areas to supplement treatment of a hyperfunctional voice pattern.

Chapter 10 describes Paradoxical Vocal Fold Dysfunction.  This really isn't a voice disorder (though some children with PVFD may have an accompanying voice problem).  However, it is a problem with the larynx, and a book on voice disorders seemed the logical place to include information on how to treat it.

I hope you find The Source for Children's Voice Disorders to be a helpful resource and a trigger to seek out more information about voice disorders in children.