Free Informational Tour
We gladly offer a free informational tour which includes a fifteen minute tour of our facility and a brief meeting with a licensed, certified therapist. At this time any questions regarding speech therapy and the patient's specific needs will be answered.
Full Speech & Language Evaluations
Evaluations are scheduled for one hour sessions in which the patient will meet with a therapist for standardized and non-standardized testing. Once the evaluation portion of the session is completed the therapist will counsel the family on results and therapy recommendations. Following an initial evaluation, the therapist will prepare a formal written evaluation which will be submitted to the patient's primary care physician. This evaluation will serve as a prescription for services for six months. Re-evaluations are completed every six months to measure progress and update goals.
Individual Therapy Sessions
Sessions are thirty minutes in length and begin once the evaluation and prescription for speech therapy has been signed by a physician. Achieve requests all physician signatures and required paperwork on behalf of our patients.
Insurance & Referrals
In Texas, it is not necessary to obtain a doctor's referral to see a speech pathologist in a private practice or public school setting. However, some private health insurances may require a doctor's referral letter before they will pay benefits for speech pathology services. As a courtesy, Achieve gladly obtains referrals and prescriptions for speech therapy. It is always a good idea to call the member services department to have them quote what steps are needed to receive speech therapy. It may also be beneficial to examine insurance benefits booklets to be aware coverage limitations. Insurance companies provide many different policies that cover different services. Not all insurance plans at the same insurance company provide for the same coverage.
Though families generally do not think of speech therapy when purchasing health insurance, communication is a necessary life function and, when disrupted, is life altering. Many health insurance plans cover speech therapy. There are often limitations to the amount of coverage a member will receive, but in many cases the coverage is enough to provide for the needs of the patient. Prior to a first appointment for a screening or initial evaluation, Achieve will call to verify benefits under insurance policies for speech therapy services. Achieve notifies patients of any limitations or exclusions for speech therapy. Typically an insurance company will not deny the referral to the initial evaluation. Coverage for services will be based on information obtained during the initial evaluation.
Groups are designed to help children improve their acceptance of new or undesired foods and improve their oral motor feeding skills in order to develop age appropriate feeding skills needed for adequate growth and nutrition. Various sensory and oral motor activities are incorporated into each session through a series of transitions from one activity to the next. The group setting and predictable routine gives the added benefit of learning through peer interaction. By creating a fun, relaxed atmosphere and interacting with children of similar ages, we hope to reduce anxieties your child may have with trying new or undesired foods, thus increasing opportunities for food exploration and working toward expanding his/her diet! Some children may have appropriate oral motor skills needed for efficient feeding and some may need additional help. Basic chewing and oral preparation for safe and efficient swallowing will be targeted in each session.
Our LEAP program (Language Enrichment Around Play), targets the following: developing oral language skills, including building vocabulary skills and the ability to share experiences and tell stories, developing pre-reading skills, such as sound awareness, reinforcing school readiness skills such as staying focused and attending in group activities, waiting for a turn, remembering instructions, and practicing emerging speech skills in a variety of activities. Each child has the opportunity to practice these goals in theme related games, stories, food preparation and craft activities. Student volunteers are also involved with supporting the program and helping out with activities.
It’s important to know that learning to read is about more than just knowing the letter names and their sounds. The foundational skills necessary to become an efficient reader are known as phonemic and phonological awareness. Phonemic awareness is the understanding that words are made up of sounds and is developed, in part, by listening to rhymes, rhyming words, poetry, songs and wordplay. Phonological awareness is the observation of the sound segments in words and the ability to manipulate them. Our reading group is designed for school-age children and targets the comprehensive abilities in phonological awareness, phonics, vocabulary, reading fluency and comprehension. The approach we use is a multi-sensory, total language approach. We integrate visual, auditory, and kinesthetic modalities to address spoken language, reading and writing.
The Social Group program focuses on improving social skills and language in small group contexts for school-age children. The group targets problem solving skills, conversation skills, assertiveness, cooperation, social cognition/perspective-taking, making and keeping friends, understanding emotions, resolving conflicts, and active listening.
The number of children being diagnosed with Autistic Spectrum Disorders (ASD) has been on the rise for many years. Currently, statistics show that 1 in 59 will be diagnosed with ASD. These children will require intervention for social, emotional, or behavioral differences. Early identification and treatment for these children is pivotal to achieving long-term goals and success in life. Achieve can provide professional advice and therapy including parent education, social playgroups, parent-child training, and/or individual speech therapy. Early signs of Autism include:
- A baby who shows little to no affect when near loved ones
- A young child who displays little to no awareness of social surroundings
- An 18 month old who has lost previously mastered words and phrases
- A 2 year old who is not yet talking
- A toddler who does not show interest in peers and would rather play alone
- A child with repetitive, stereotypical behaviors
- A child with an above-age-expected knowledge of any one subject
- A 2 year old who does not play with toys in a purposeful way
- A child who is overly sensitive to sound or touch
- A child who typically displays an overactive or underactive pattern of behavior
While any one of the above concerns may be seen in any child, it is the combination of multiple concerns that warrants a referral. By working together in the community to promote early identification and intervention, families can begin to feel hopeful about their child's future once again.
Adult therapy is provided by therapists at Achieve and includes, but is not limited to, post-stroke rehabilitation, brain injury, voice, stuttering, accent reduction, and speech production.
Therapists at Achieve are trained and qualified to perform accent reduction therapy. The primary goal is to focus on accent reduction, not accent elimination. Achieve helps patients to reduce areas of their pronunciation that affect intelligibility, that is, areas of their accents that make it difficult for native English speakers to understand.
Aphasia-(Related to Stroke or Tramatic Brain Injury)
Aphasia is a language disorder that typically occurs in individuals after some incident of brain damage. Individuals who previously expressed themselves and understood communication through speaking, reading, or writing suddenly find themselves unable or limited in their ability to participate in these previous activities. Aphasia can lead to social isolation. The most common cause of aphasia is stroke. It is estimated that over 1 million Americans have aphasia. Clinical evidence and research documents that individuals with aphasia benefit from the services of speech language pathologists.
One recent study indicated that people who have developed aphasia and receive weekly speech therapy make significantly greater improvement than individuals with aphasia who are not treated. Other studies conducted support the value of treatment for aphasia, particularly as it applies to individuals who have become aphasic as the result of a single, left hemisphere stroke. Improvements have been noted in terms of both quality and quantity of language. Research also suggests that treatment can be effective when it is provided on a continuous basis after the stroke.
The role of the speech language pathologist is to assess the communication impairment, develop a treatment program to help individuals with aphasia regain as much of their communication skills as possible, and to develop strategies to compensate for deficient skills. The SLP may also counsel family members and other caregivers about the individual's aphasia and help them assist in generalization of treatment gains. Many individuals with aphasia are able to return to work and leisure activities after treatment.
An articulation disorder involves difficulties making speech sounds. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand the child.
Young children often make speech errors. For instance, many young children sound like they are making a "w" sound for an "r" sound (e.g., "wabbit" for "rabbit") or may leave sounds out of words, such as "nana" for "banana." The child may have an articulation disorder if these errors continue past age-expected norms.
The following is a rule of thumb for when sounds should be developed and the order of acquisition of speech sounds:
By the age of 2, a child should be able to combine these simple consonant sounds into 2-word phrases, such as 'my toe'. A two year old should be at least 50-75% intelligible.
• m, n, p, h, w, b, t, d
By the age of 3, a child should be able to combine the previous simple consonants and following complex consonant sounds into 3-word phrases such as, 'I eat food'. A three year old should be 75-100% intelligible.
• k, g, f , y, ng
By the age of 4, a child should be able to combine 4-word sentences and be 100% intelligible. If your child continues to have sound errors by the age of four, a speech evaluation may be warranted.
• sh, ch, y, j, s, z, v
Between the ages of 5-6 a child should begin to acquire later developing sounds which include:
• l, r, th, v, r-blends, s-blends, l-blends
Auditory Processing Disorder
Individuals with APD may exhibit a variety of listening and related complaints. For example, they may have difficulty understanding speech in noisy environments, following directions, and discriminating similar-sounding speech sounds. Sometimes they may behave as if a hearing loss is present, often asking for repetition or clarification. In school, children with APD may have difficulty with spelling, reading, and understanding information presented verbally in the classroom. Often their performance in classes that don't rely heavily on listening is much better, and they typically are able to complete a task independently once they know what is expected of them. However, it is critical to understand that these same types of symptoms may be apparent in children who do not exhibit APD. Therefore, we should always keep in mind that not all language and learning problems are due to APD, and all cases of APD do not lead to language and learning problems. APD cannot be diagnosed from a symptoms checklist. No matter how many symptoms of APD a child may have, only careful and accurate diagnostics can determine the underlying cause. The actual diagnosis of APD must be made by an audiologist, however symptoms of APD may be treated by a speech language pathologist.
Treatment of APD generally focuses on three primary areas: changing the learning or communication environment, recruiting higher-order skills to help compensate for the disorder, and remediation of the auditory deficit itself. Compensatory strategies usually consist of suggestions for assisting listeners in strengthening central resources (language, problem-solving, memory, attention, and other cognitive skills) so that they can be used to help overcome the auditory disorder. In addition, many compensatory strategy approaches teach children with APD to take responsibility for their own listening success or failure and to be an active participant in daily listening activities through a variety of active listening and problem-solving techniques.
Childhood Apraxia of Speech- (CAS)
Therapists at Achieve specialize in working with children with Apraxia and have trained with Nancy Kaufman, who specializes in treating children with CAS. Children with CAS have great difficulty planning and producing the precise, highly refined and specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech. Specifically, these children may make inconsistent errors on consonants and vowels in repeated productions, have difficulty producing multi-syllable words accurately, and exhibit inappropriate prosody. CAS may occur as a result of known neurological impairment, in association with other complex neurobehavioral disorders, or as a separate, isolated, neurogenic speech sound disorder. Children with CAS have early and persistent problems in speech which often leads to difficulty with expressive language and the phonological foundations for literacy. Depending on the severity of CAS there may also be a need for augmentative and alternative communication and assistive technology. Intensive and individualized treatment of CAS focusing on repetitive planning, programming, and production practice has been shown to improve intelligibility and communication functioning. The primary goal is to improve the motoric aspects of the child's speech production, and this has been proven to be best accomplished through individual, one-on-one therapy.
Another rule of thumb is to consider how clear a child's speech sounds:
- By 18 months a child's speech is normally 25% intelligible.
- By 24 months a child's speech is normally 50 -75% intelligible.
- By 36 months a child's speech is normally 75-100% intelligible.
Every child develops at a different rate, but most go through the same stages. Listed below are the average ages of some important language and comprehension milestones as developed by the American Speech-Language-Hearing Association (ASHA). Please note that with any developmental timeline, these stages may be varied and perhaps met in a slightly different order. A child who accomplishes these milestones differently may not necessarily have a developmental delay or speech disorder and a child who hits these stages early is not necessarily a prodigy.
Birth to 3 months
- Startles to loud sounds
- Smiles when spoken to
- Responds to pleasure with 'cooing' noises
4 months to 6 months
- Notices and pays attention to sounds and music
- Shifts eyes in direction of sounds
- Makes babbling noises that resemble speech
7 months to 1 year
- Recognizes basic familiar words such as cup or ball
- Imitates different speech sounds
- Produces first words such as bye-bye or mama
1 year to 2 years
- Listens to simple stories
- Identifies pictures by name when directed (point to the cow, e.g.)
- Speaks two-word sentences such as More juice? or Where daddy?
2 years to 3 years
- Understands differences in meaning for basic words (up-down or in-out)
- Produces three-word sentences
- Can name most objects
3 years to 4 years
- Understands questions
- Talks about events
- Speech is understood by most people
4 years to 5 years
- pays attention and responds to stories and questions
- speaks clearly
- tells detailed, ordered stories
Problems can arise at any stage of development, as well as much later in life. They can be the result of a congenital defect, a developmental disorder, or an injury. If a problem is suspected, an assessment should be made by a speech language pathologist who can confirm or deny your concerns as well as diagnose and treat communication disorders. Early intervention is essential when working with children. Early detection and early intervention can have an impact on how the child responds to therapy and how long the child requires therapy. It may also be a good idea to take your child to his/her pediatrician if you are concerned about other areas of development besides speech. (i.e. behavior, gross/fine motor skills)
Ear infections are the most commonly diagnosed childhood illness in the United States; second only to the common cold. More than 3 in 4 children have had at least one ear infection by the time they reach 3 years of age. When a child has fluid in the middle ear, the fluid reduces sound traveling through the middle ear. Sounds may be muffled or not heard at all. Children with middle ear fluid will generally have a mild or moderate temporary hearing loss. The sound your child hears would be comparable to you plugging your ears with your fingers.
Children develop ear infections more frequently in the first 2 to 4 years of life for several reasons: Their eustachian tubes are shorter and more horizontal than those of adults, which allows bacteria and viruses to find their way into the middle ear more easily. Also, the adenoids, which are gland-like structures located in the back of the throat near the end of the eustachian tubes, are large in children and can block the opening of the tubes and prevent them from functioning properly. Both of these structural differences can effect hearing and as a result, impact speech and language development. Children who have had ear infections should be monitored closely for appropriate speech and language development.
The following are a few things to look for in your child if you suspect your child has an ear infection. Your child may:
- Not respond to soft sounds
- Turn up the television or radio
- Talk louder
- Tug or pull at one or both ears
- Appear to be inattentive at school
Children with persistent otitis media (lasting longer than 3 months) should be reexamined periodically (every 3 to 6 months) by their doctors. Certain children, such as those with persistent hearing loss or speech delay, may require ear tube surgery. In some cases, an ear, nose, and throat doctor will suggest surgically inserting tubes (called tympanostomy tubes) in the eardrum. These tubes allow fluid to drain from the middle ear and help to equalize the pressure in the ear when the Eustachian tube is not functioning properly. (Joel Klein, MD, June 2008, KidsHealth.org)
A speech language pathologist should be consulted if you or your pediatrician feels that your child's speech and/or language development is behind or is compromised due to frequent bouts of otitis media. The following are suggestions for you when interacting with your child at home and can be used to help all children become better listeners.
- Get within three feet of your child before speaking
- Get your child's attention before speaking
- Face your child and speak clearly with a normal tone and normal loudness
- Use visual cues such as moving your hands and showing pictures in addition to using speech
- Seat your child near adults and children who are speaking
- Speak clearly and repeat important words, but use natural speaking tones and pattern
- Check often to make sure your child understands what is said
- Stand still when talking to your child to decrease distractions
(Joanne E. Roberts, Ph.D. & Susan A. Zeisel, Ed. D., Ear Infections and Language Development, Collaborative brochure with American Speech-Language-Hearing Association and the National Center for Early Development & Learning)
Therapists at Achieve are certified in the SOS (Sequential-Oral-Sensory) Approach to Feeding Program. This approach can be beneficial and make mealtimes more pleasant. Children may be considered a 'picky eater' or 'problem feeder' if one or more of the following issues are present:
- Difficulty controlling food in his mouth
- Gags or is unable to tolerate certain foods or textures
- Decreased range or variety of foods
- Eats less than 30 different foods
- Unable to tolerate new foods on plate
- Eats different foods than the rest of the family.
The SOS Approach to Feeding is a Transdisciplinary Program for assessing and treating children with feeding and weight/growth difficulties. It has been developed over the course of 20 years through the clinical work of Dr. Kay Toomey, in conjunction with colleagues from several different disciplines including: Pediatricians, Occupational Therapists, Registered Dietitians, and Speech Pathologists/Therapists. This program integrates motor, oral, behavioral/learning, medical, sensory and nutritional factors and approaches in order to comprehensively evaluate and manage children with feeding/growth problems. It is based on, and grounded philosophically in, the "normal" developmental steps, stages and skills of feeding found in typically developing children. The treatment component of the program utilizes these typical developmental steps towards feeding to create a systematic desensitization hierarchy of skills/behaviors necessary for children to progress with eating various textures, and with growing at an appropriate rate for them. The assessment component of the program makes sure that all physical reasons for atypical feeding development are examined and appropriately treated medically. In addition, the SOS Approach works to identify any nutritional deficits and to develop recommendations as appropriate to each individual child's growth parameters and needs. Skills across all developmental areas are also assessed with regards to feeding, as well as an examination of learning capabilities with regards to using the SOS program.
Therapists at Achieve are well-versed in treating developmental delays associated with many genetic disorders including, but not limited to: Down Syndrome, Fragile X, Williams Syndrome, Marfan Syndrome, and any other chromosome deletions causing speech and language issues.
Language Enrichment Around Play (LEAP Program)
The LEAP program is designed to target early speech, language, and learning skills for children of all ages. LEAP classes are offered in small groups to maximize exposure to all concepts. Classes are 1 hour in length, 2 times a week, and are offered each summer. All classes are facilitated by a licensed, certified Speech-Language Pathologist.
The LEAP classes are offered to children with and without speech, language, or learning disabilities. The class is open for any and all children who will benefit from:
- Preschool skills
- Kindergarten readiness skills
- Exposure to structured learning environment
- Maintenance and continued learning throughout summer
- Exposure to peer interactions in small group
The LEAP classes target skills in the following areas:
- Vocabulary Building
- Phonemic Awareness
- Pre-Literacy Skills
- Social Language Skills
- Other basic preschool/kindergarten readiness skills
Language disorders are described as difficulties with the comprehension, production, and use of language. Deficits in language can have a pervasive impact on a child's development, success in school, relationships, and emotional well-being. 5% of preschool children exhibit a significant limitation in language ability not caused by problems with hearing, intelligence, or neurological structure. They are hampered in conveying and receiving information. Children with impaired language skills have a hard time fulfilling their potential unless efforts are made to improve their language skills. Clinical research has documented that children with language disorders benefit from treatment provided by a speech language pathologist.
More than 200 research studies report that language intervention is effective for the majority of those who participate. Language treatment addresses functional communication skills, thereby improving the quality of life for the child, by enhancing social, academic, and vocational situations. Children who struggle in multiple areas of language can learn targeted language skills in those specific areas.
The role of the speech language pathologist is to determine the child's receptive and expressive language skills using standardized or informal assessment. The child's language skills are then compared to other observations or normative data that reflect the typical performance of a child that age or developmental level. This comparison helps to determine the presence or absence of significant deficiencies and exactly where those significant weaknesses exist. The speech language pathologist selects functional treatment goals from the weakness displayed on the assessment and based on their usefulness in home, educational, and community settings. The primary goal of language treatment is to increase the frequency and quality of language the child can use and understand to age-appropriate levels. Other aspects of treatment may be language production, increasing vocabulary, improving interaction skills, or using augmentative/alternative communication systems. (Modified from ASHA Treatment Efficacy Summary, Goldstein, H.)
Achieve therapists have been trained in implementing the Sound Sensible and SPIRE programs in order to directly target reading skills in preschoolers and school-aged children. If a child has a history of learning deficits in the area of reading, these programs are designed to pinpoint areas of growth to strengthen reading and reading comprehension skills. This program is particularly effective if you suspect dyslexia or symptoms of a learning disability. Therapists at Achieve specialize in important phonological awareness skills children may miss in a regular school setting. These include: rhyming, segmenting/blending sounds, isolating/deleting sounds, and decoding.
Oral Function Therapy
Therapists at Achieved are certified in Sara Rosenfeld-Johnson's TalkTools® hierarchies which encourage oral placement therapy techniques and incorporate tools specifically designed to help patients increase awareness, placement, endurance, muscle memory and accurate production of speech. Our therapists utilize a series of user-friendly products to correspond with a hierarchical approach to oral placement therapy. Many of these items, including the original Horn and Straw Hierarchies and Jaw Grading Bite Blocks, are now household names in the oral placement field and are available exclusively through TalkTools Therapy™. Through this program, Achieve therapists provide the absolute best instruction for strengthening and improving respiration, phonation, resonation, articulation, muscle grading and dissociation of movement.
Parents and family members are welcomed and encouraged to attend therapy sessions to gain skills necessary to work on therapy goals outside of the session. We also have an observation room with a two-way mirror so the patient can be observed without actually being present in the therapy room.
Phonological Process Disorder
A phonological process disorder involves patterns of sound errors. For example, substituting all sounds made in the back of the mouth like "k" and "g" for those in the front of the mouth like "t" and "d" (e.g., saying "tup" for "cup" or "das" for "gas").
Another rule of speech is that some words start with two consonants (consonant clusters), such as "broken" or "spoon". When children don't follow this rule and say only one of the sounds ("boken" for "broken" or "poon" for "spoon"), it is more difficult for the listener to understand the child. While it is common for young children learning speech to leave one of the sounds out of the word, it is not expected as a child gets older. If a child continues to demonstrate such cluster reduction, he or she may have a phonological process disorder. The following is a list of phonological processes and when they should discontinue:
By the age of 3, the following should discontinue:
- Voicing: pig/big, pig/pick
- Final consonant deletion: comb=coe
- Stopping /f/ & /s/: fish=tish, soap=dope
By the age of 3 ½, the following should discontinue:
- Fronting: car=tar, ship=sip
- Assimilation (consonant harmony) mine=mime, kittycat=tittytat
- Stopping /v/ & /z/: very=berry, zoo=doo
By the age of 4, the following should discontinue:
- Weak syllable deletion: potato=tato, banana=nana
- Custer reduction: spoon=poon, clean=keen
- Stopping sh, j, & ch: shop=dop, jump=dump, chair=tare
By the age of 5, the following should discontinue:
- Gliding of Liquids: run=one, leg=weg
- Stopping th: thing=ting, them=dem
Achieve is highly trained and experienced in handling infants and toddlers in an approach conducive to their learning styles. Children's favorite games and activities are incorporated into therapy sessions in order to maintain motivation and excitement for learning.
All therapists at Achieve frequently attend continuing education courses to stay current in this ever-evolving field. We use the most current and up-to-date evaluation and therapy procedures to ensure rapid progress and generalization in therapy.
Social Language Programs
Achieve offers social language groups for children and young adults needing help with conversational skills, peer relationships, topic maintenance, and general pragmatic skills. These programs are usually offered in the summer but may be available upon request at other times of the year.
Achieve therapists are highly trained and certified in the Lidcombe program to treat preschool stuttering. In addition, therapists at Achieve are well-versed in the most current therapy approached for school age children as well as adults. There are typically three key factors we look for when discerning probability that stuttering will persist. If the patient exhibits any two of the three a referral is warranted at any age.
- Family history of stuttering
- Stuttering has persisted more than 6 months
- Heightened awareness or frustration surrounding the stuttering moments
The most important factor is related to signs of heightened awareness. If unfavorable reactions and emotional responses such as shame, embarrassment, anxiety, or refusal to talk are present, an immediate referral for a speech and language evaluation is appropriate.
Tongue-tie or ankyloglossia is caused when the membrane under the tongue (the frenulum) extends excessively toward the tip of tongue. This extended attachement of the frenulum limits the mobility of the tongue, often giving it a characteristic heart shape when extended. When it comes to whether or not clipping the frenulum is necessary you should consult your doctor as well as a speech language pathologist. There are clearly some babies who have significant difficulty breastfeeding because of tongue-tie. These infants may actually have trouble gaining weight and cause the mother a good deal of breast tenderness from a disorganized suck due to tongue-tie. If your child is older, having a restricted frenulum may affect development of certain speech sounds and cause articulation disorders as their speech develops. Many times, as the child gets older, the frenulum stretches such that speech problems do not occur. You may find conflicting answers from different doctors and books because there simply is no consensus on this issue. That being the case, many physicians deal with this issue on a case-by-case basis and recommend clipping only when problems are being caused by the tongue-tie rather than clipping it on the assumption that the tongue-tie might cause problems in the future.
Trainings and Seminars
Achieve therapists are happy to provide trainings to surrounding private schools, early learning schools, public schools, and/or any agency interested in continuing education. Seminars include any information on speech and/or language pertinent to the interested group.
Achieve therapists are experienced with treating symptoms in adults and children consistent with hoarse, harsh or breathy vocal quality. Problems with voice include, but are not limited to, vocal nodules, polyps, vocal cord dysfunction, paralyzed vocal cords, velopharyngeal dysfunction, dysphonia, aphonia, and chronic hoarseness. A referral to an ENT must be made prior to any treatment to rule out any structural deviations and aid in appropriate treatment planning. Other symptoms include:
- Volume level consistently or intermittently too loud or too soft
- Pitch inappropriate for an individual's age and gender
- Soreness or pain in neck, sensation of something in throat
- Complaints of vocal fatigue and a need to increase vocal effort to speak
- Presence of vocal tremor
- Inappropriate resonance
ACHIEVE Speech and Language Services accepts insurance, Medicaid and all major credit cards. We follow all national HIPAA guidelines to protect your privacy. For more information about Speech-Language Pathology and communication disorders, please visit www.ASHA.org.