How masks get in the way of speech therapy

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Americans have been arguing for two years over pandemic restrictions, and the debate is particularly tense among parents of young children, for good reason. While measures such as masking and isolation mean temporary discomfort or inconvenience for most people, their consequences for young, still-developing children are more mysterious, and perhaps more significant and long-lasting.

Children with speech or language disorders offer perhaps the clearest example of these obscure trade-offs. Pandemic restrictions vary by state, county and school district, but I’ve spoken with parents in California, New York, Massachusetts, Washington, New Jersey, Iowa and Maryland who said their children’s speech therapy was disrupted, first by loss of in-person therapy and then by masking requirements, in settings that have it.

Megan’s son, for example, has Joubert syndrome, a rare genetic condition that often manifests as severe speech delay. At the start of the pandemic, the 4-year-old could relate to a few simple words, like mom and residence, each the hard-earned victory of the intensive speech therapy he had received since the age of 2. But he regressed a lot during remote therapy, and is still struggling now that the therapy is in person, because his therapist is wearing a face mask. (Megan, who lives in California, asked to be identified only by her first name to protect her son’s privacy).

The consequences of not treating speech and language disorders can be profound, told me Diane Paul, director of clinical issues in speech-language pathology at the American Speech-Language-Hearing Association. Children who find it difficult to express themselves can be frustrated, which can behavioral challengesand they may have trouble making friends. Numerous children with speech impairments struggle to learn to read, but “language becomes a medium through which we learn everything later in school,” Alex Levine, speech pathologist at the Child Mind Institute’s Learning and Development Center, told me. And the longer you wait to fix a speech or language problem, it is more difficult to do it.

Many parents I have spoken with are frustrated that they have been asked to compromise their children’s social and academic life in the name of public safety. The first years of a child’s life are important. Anything that threatens to interfere with development, whether it’s COVID-19 or the mitigations put in place to avert it, can feel like rolling the dice on the future of a kid. In one way or another, all parents of young children have been forced to play during the pandemic. Many parents of children with speech delays don’t like their chances.


When the world shut down in the spring of 2020, many speech therapists told me they were quick to adapt. Many practices immediately turned to teletherapy, often with success. But remote therapy is difficult for young children. “He would completely disengage, lay on the floor, start playing with the toys, literally turn his back on the computer, try to shut it down,” says Julia Toof, a parent from Somerville, Massachusetts, of her then. almost 3 years. -years son. “It just didn’t work out.” Teletherapy also typically required significant involvement from parents, many of whom were already overwhelmed with work and homeschooling during the pandemic.

And when in-person therapy resumed, masking requirements made it difficult. Some of the more than a dozen speech therapists I spoke with said the children found the masks distracting. More importantly, the masks hide the mouth, which therapists say disrupts some forms of therapy, especially those that target motor speech and motor planning — “anything to do with actual speech coming out of your mouth,” said Alexandria Zachos, an Illinois-based pathologist. For “this type of therapy, you absolutely have to see the speech therapist’s mouth and they have to see yours,” Zachos said.

When available, therapists have used masks with a transparent panel, with mixed results. “They are a bit uncomfortable to wear. They really heat up,” Zachos said. And while she’s tried a number of tricks to keep them from fogging up, they inevitably do. Aside from fogging, even transparent masks prevent therapists from using tactile cues, such as straws or tongue depressors to nudge patients’ tongues into place, or bite plates to maintain alignment of the tongue. jaw. Therapists have come up with creative alternatives — some use videos to demonstrate tongue placement, for example — but those I consulted agreed that masks aren’t ideal. “There’s just a lot of interference on so many levels that I think there are definitely kids whose care has been negatively affected and whose progress has probably been slowed down,” Levine said.

Problems in speech therapy were exacerbated by problems outside of therapy. Parents have told me that their children are more hesitant to speak with a mask on, which makes it harder for them to feel secure in their ability to communicate. “It is hardly understandable without a mask,” said a mother of a 3-year-old boy in Iowa who asked to remain anonymous. “If he’s not understood, he won’t have the confidence to keep talking.” And in the wake of prolonged school closures, children seem to be more socially anxious; they can take a lot longer to familiarize themselves with therapists, says Craig Selinger, owner of a business which offers speech therapy and tutoring services in New York City. “Their verbal output is more restricted because they feel more uncomfortable,” Selinger told me. It’s a particular concern for children with autism, for whom therapy is often more about nurturing engagement than building vocabulary, says Danielle Lindgrena speech therapist based in Los Angeles.


Many parents and speech-language pathologists have struggled to get any type of accommodation. “She sees no workaround; there is no possibility of going outside or using a transparent face shield,” Megan said of her son’s therapist. “We would do a quick test every day before our speech therapy if we needed to.” Several therapists and parents have told me that their schools or agencies do not provide clear masks.

The CDC does not list speech or language disorders among the acceptable reasons for exemption from school masking guidelines, many schools do not grant one, whether during therapy sessions at school or while children are in class. Even where exemptions might have been available for children with eligible disabilities, some parents said they were afraid to apply for them, fearing their child would be ostracized by classmates as a virus risk.

Under these circumstances, some speech therapists simply ignored the rules. The Iowa mother I spoke with told me that even when the public school where her son receives therapy had a mask mandate, his speech therapist would allow him to remove it during therapy. “She would say things like, ‘It’s our little secret,'” she told me. (The neighborhood has now switched to mask optional). Two therapists I spoke with who work in public schools admitted to removing their masks from time to time to provide visual cues. And where possible, some parents go to great lengths to fill in the gaps in their children’s care, shelling out $100 per session for private therapists willing to practice with just a transparent face shield. Megan has been looking for such a therapist in her area, but they seem impossible to find. So in January, she cut her hours to 20% to help her son learn to speak.


While the circumstances of children with speech delays are not universal, the tricky nature of COVID math for parents of young children is. A lot of very important development occurs in the early years of a child’s life, and it is a key window for catch and tackle developmental delays. That’s why many parents think carefully about seemingly minor issues like screen time, how many words their kids hear per day, and whether it’s okay to put a child in time out. Pandemic restrictions are frightening and experimental for parents of children in the youngest age group because they are. Asking them to believe that they will not interfere with the development of their children is asking a lot.

With proper treatment given at a young age, some children with Joubert syndrome can learn to speak. At the start of 2020, Megan felt her son was close to doing just that. Now she’s not sure he ever will. “The window is closing,” Megan said. It is impossible to know how things would have turned out if his care had not been interrupted. Megan wishes she had never been put in a position to wonder.

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