Resource Packet

Assessment of Speech:
Voice
 VOICESEVERITYRATINGSCALE
DeterminationofSpeechImpairment:Voice

Student______________________School________________________Grade______DateofRating_______DOB_______Age___SLT_______________________

Pitch 0 1 3
Pitchiswithinnormallimits. Thereisanoticeabledifference,which Thereisapersistent,noticeable
maybeintermittent. inappropriateraisingorloweringof
pitchforageandsex.
.

Intensity 0 1 3
Intensityiswithinnormallimits. Thereisanoticeabledifferencein Thereispersistent,noticeable,
intensity,whichmaybeintermittent. inappropriateincreaseordecreasein
theintensityofspeechorthepresence
ofaphonia.

0 1 3
Quality Qualityiswithinnormallimits. Thereisanoticeabledifferencein Thereispersistent,noticeable,
quality,whichmaybeintermittent. breathiness,glottaltry,harshness,
hoarseness,tenseness,stridencyor
otherabnormalquality.

Resonance 0 1 3
Nasalityiswithinnormallimits. Thereisanoticeabledifferencein Thereispersistent,noticeableculde
nasality,whichmaybeintermittent. sac,hyperorhyponasality,ormixed
nasality.

Instructions: 1.Donotincluderegionalordialectaldifferenceswhenscoring.
2.Circlethescoreforthemostappropriatedescriptionforeachcategory,i.e.,PitchorIntensity.
3.Computethetotalscoreandrecordbelow.
4.Circlethetotalscoreonthebar/scalebelow.

2 3 4 5 6 7 8 9 10 11 12
Mild Moderate to Severe
TOTALSCORE__________
Basedoncompilationoftheassessmentdata,thisstudentscoresintheMild,ModerateorSevererangeVoiceDisorder. qYes qNo
Thereisdocumentation/supportingevidenceofadverseeffectsoftheVoicedisorderoneducationalperformance. qYes qNo

DeterminationofeligibilityasastudentwithaSpeechand/orLanguageImpairmentismadebytheIEPTeam.

VoiceSeverityRatingScale

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 AssessmentGuidelinesforSpeechVoice

VOICEASSESSMENTCONSIDERATIONS
Therearemultipleaspectstoconsiderwhenevaluatingvoiceimpairments:
pitch,
loudness,and
qualityincludingresonance.

Manydisordersofvoiceorresonancehaveanorganicetiologywitharelatedmedical
history.Otherdisordersarefunctionallybased,causedbyfaultyusageorbehavioral
histories.Forassessmentandinstructionalpurposes,classifyingvoicedisordersby
vocalbehaviorsorsymptomsprovidesthemostusefulinformationfortheSpeech
LanguageTherapist(SLT).BooneandMcFarlane(1988)suggestthatPatientswith
voicequalityandresonanceproblemsgenerallyrequiresomemedicalevaluationofthe
ears,nose,andthroataspartofthetotalvoiceevaluationAlaryngealexamination
mustbemadebeforeapatientcanbeginvoicetherapy forproblemsrelatedtoqualityor
resonanceVoicetherapyeffortsshouldbedeferreduntilamedicalexamination(which
wouldincludelaryngoscopy)isconcluded,becausethereareoccasionallaryngeal
pathologies,suchaspapillomaorcarcinoma,forwhichvoicetherapywouldbestrongly
contraindicated.Insuchcases,thedelayofaccuratediagnosisofthesepathologies
couldbelifethreatening(pp.104105).Nochildshouldbeenrolledforvoicetherapy
withoutpriorotolaryngologicalexamination.However,thepresenceofamedical
condition(e.g.,vocalnodules)doesnotnecessitatetheprovisionofvoicetherapyasa
disabilityrequiringspecialeducationnordoesaprescriptionforvoicetherapyfroma
physician.

CONDUCTINGASPEECHEVALUATIONFORVOICE
Conducthearingandvisionscreenings.
Obtainrelevantinformationfromtheparents(i.e.,concernsaboutcommunication
skills,developmentalhistory,etc).
Informationmustbegatheredfromtwoeducatorsthestudentsclassroomteacher
aswellasanotherprofessional.Forpreschoolers,obtaininformationfromchildcare
providersandotheradultswhoseethechildoutsidethefamilystructure.
Obtaininformationfromteachersrelatedtoprogressinthegeneralcurriculum,
communicationskills,behavior,andsocialinteractions.Generalcurriculumfor
preschoolersisdevelopmentallyappropriateactivities.
Reviewschoolrecords(e.g.,grades,testscores,specialeducationfile,
documentationofprereferralstrategies/interventions,anddisciplineandattendance
records).
Completeanoralperipheralexamination.
ObtainmedicalreportfromanOtolaryngologist.
Collectarepresentativesampleofthestudentsspeech.
Analyzevoice,pitch,intensityandquality.

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 Document how the students voice impairment adversely affects the students
educational performance in the general education classroom or the learning
environment. For preschoolers, document how the voice dysfunction adversely
affectstheirabilitytoparticipateindevelopmentallyappropriateactivities.
CompletetheVoiceSeverityRatingScale.
FinalizeandsubmittotheIEPteamaSpeechandLanguageEvaluationReport.

INTERPRETINGANDREPORTINGEVALUATIONRESULTS
Severalchecklistsareavailabletoreportfindings.Formoredetailedinformation
regardingproceduresforassessingfundamentalfrequency/habitualpitch,breathing
patternsandbreathsupport,andthes/zratioforrespiratory/phonatoryefficiency,refer
toAssessmentinSpeechLanguagePathology:AResourceManual(Shipleyand
McAffee,1998).Proceduresfortheidentificationofresonanceproblemsincluding
hypernasality,hyponasalityandassimilationnasality,andassessmentofvelopharyngeal
functioningcanbefoundinthisresourcepacketaswell.Theimpairmentmustnotbe
relatedtounresolvedupperrespiratoryinfectionorallergiesthatarenotbeingactively
treatedbyaphysician.

USINGTHEVOICESEVERITYRATINGSCALE
TheVoiceSeverityRatingScaleistobeusedasatoolafterconductingacomplete
assessmentofthestudentsvoice.Thescaleisdesignedtoassisttheexaminerwith
interpretationanddocumentationoftheresultsofvoiceassessmentfindingsintermsof
severity(pitch,intensity,qualityandresonance).Thisscaleisnotadiagnostic
instrumentandshouldnotbeusedintheabsenceofassessmentdata.

InordertobeidentifiedasastudentwithaSpeechImpairmentwithvoicedifficulties,the
severityofvoicedysfunctionmustbedeterminedtohaveanadverseeffecton
educationalperformance.Theratingscaleservesthreepurposes:
1) todocumentthepresenceofvoicedysfunctionandtowhatextent(Mild,Moderate,Severe),
2) toindicatetheabsenceorpresenceofadverseeffectsoneducationalperformance,and
3) todeterminewhetherornotthestudentmeetseligibilitystandardsforaspeechimpairmentin
voice.

Educationalperformancereferstothestudentsabilitytoparticipateintheeducational
processandmustincludeconsiderationofthestudentssocial,emotional,academic,
andvocationalperformance.Thepresenceofvoicedysfunctiondoesnotautomatically
indicateanadverseeffectonthestudentsabilitytofunctionwithintheeducational
setting.Thevoicedysfunctionmustbeshowntointerferewiththestudentsabilityto
performintheeducationalsettingbeforeadisabilityisdetermined.Theeffecton
educationalperformanceis,therefore,bestdeterminedthroughclassroomobservation,
consultationwithclassroomteachersandotherspecialeducators,andinterviewswith
parentsandthestudent.Teacherchecklistsareusefulfordetermininghowthevoice
dysfunctionaffectseducationalperformance.

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 ParentReleaseofInformation
Name: _______________________
DateofBirth: _______________________
School: _______________________
DateSent: _______________________

DearParentorGuardian:

Yourchildsteacherhasexpressedconcernsabouthis/hervoice.Accordingto
TennesseeStateRulesandRegulationsforSpecialEducationprograms,avoice
assessmentshallincludeanexaminationbyanOtolaryngologist.Wefeelthats/he
shouldbeseenbyanOtolaryngologist.

Pleasetaketheenclosedformsandinformationtothedoctorwithyour

1. copyofthisletter,and

2. medicalresponseformwiththeattachedenvelopeaddressedtotheschool
system.

Themedicalformistobefilledoutbythedoctorandreturnedtoussothatwemay
determineappropriatefollowupservices.Inordertocomplywithfederallaw,your
writtenpermissionisrequiredsothattheschoolsystemcanreceiveinformation
fromyourdoctor.Pleasesignonthelineindicatedbelowandgivethisformtoyour
childsdoctor.

___________________________________
ParentsSignature

I,________________________________________,permitmyphysicianto
releaseinformationaboutmychildsvoicemechanismexaminationtothe
_____________________schoolsystem.

Sincerely,

____________________________________
Speech/LanguageTherapist

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 PhysicianSignatureForm
Name_________________________________________DateSent____________________
Address_________________________________________BirthDate__________________
Parents______________________________________Telephone______________________
School______________________________________________________________________
DearPhysician:
Theabovenamedstudentissuspectedtohaveavoiceproblem.Inaccordancewith
TennesseesEligibilityStandardsforSpeech/LanguageImpairments,avoice
assessmentshallincludeanexaminationbyanOtolaryngologist.Afteryourexamination,
pleasefillinthefollowinginformationtoassistindeterminingifvoicetherapywouldbe
beneficial.

Medicaldiagnosis:_____________________________________________________________

I. Nose:Obstruction?__________Ifso,explain__________________________________

II. Palate: Structuralabnormalities?_______________________________________________

Functionalabnormalities?_______________________________________________
Adequatevelopharyngealportclosure?____________________________________

III. Pharynx:Asymmetryofmusclecontraction?________________________________________
Growth(s)orotherabnormalities?_________________________________________

IV. Larynx:Sizenormalforageandsex?_____________________
Dovocalfoldsapproximateproperlyduringphonation?________________
Evidenceofmuscletensionduringphonation?_______________________
Colorofvocalfoldsnormal?____________________
Visiblescars?__________________Growths?____________________
Otherpathologies?____________________________________________

Doespatienthaveallergies,sinusinfections,orotherchronicconditions,whichmightcontributeto
abnormalvocalquality?_________________________________________________________________

Couldpatientsmisuseofvoicehavecontributedtoabnormalstructureorfunction?__________________
____________________________________________________________________________________

Doyourfindingsexplaintheabnormalvocalquality?__________________________________________

Doyourecommendsurgery?___________________Medication?_____________________

Doyourecommendvoicetherapywithatrainedspeechlanguagepathologist?______________________

Otherrecommendations:________________________________________________________________
____________________________________________________________________________________

Pleasereturnto: _________________________________
_________________________________
_________________________________

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 VoiceEvaluation
(forOtolaryngologist)

STUDENTNAME_______________________________DATEOFBIRTH_____________
DATEOFREPORT________________DATESENT_________________AGE_________

_________________________________issuspectedtohaveavoiceproblem.
AccordingtoTennesseeStateRulesandRegulationsforSpecialEducationprograms,a
voiceassessmentshallincludeanexaminationbyanOtolaryngologist.Theinformation
youprovideonthisformisarequiredcomponentfortheassessmentofvoiceimpairment.
1. Arethereanystructuralorfunctionalabnormalitiespresentforthefollowing?(Checkand
describebriefly.)
q Nose__________________________________________________________________
q Lips__________________________________________________________________
q Jaw __________________________________________________________________
q Tongue_________________________________________________________________
q Palate__________________________________________________________________
q Pharynx________________________________________________________________
q Ears__________________________________________________________________
q Teeth__________________________________________________________________
q Other__________________________________________________________________
q Nostructuralorfunctionalabnormalitiespresent
2. Describetheappearanceofthevocalcords.(Checkthosethatapply.)
q Normal
q Thickened
q Edematous
q Inflamed
q Malformed
q Other___________________________________________________________________
________________________________________________________________________
3. Istherepresenceofvocalpathology?
q Vocalnodules
q Polyps
q Ulcers
q None
4. Arethereanymedicalrecommendations:_____________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
5. Somechildrencanbehelpedtoeliminateormodifyvoiceproblemsthroughspeechtherapy.Do
youseeanylimitationsontheamountorkindofspeechtherapy?
qNo qYes______________________________________________________________
6.Comments:____________________________________________________________
______________________________________________________________________
______________________________________________________________________

OtolaryngologistsName(Print)__________________________ Date__________
OtolaryngologistsSignature____________________________

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 TeacherInputVoice
Student ___________________________________________Date___________________
Teacher _______________________________Grade/Program______________________

Yourobservationsoftheabovestudentsspeechwillhelpdetermineifs/hehasavoiceproblemwhichadverselyaffects
educationalperformance.Pleaseanswerallquestionsandreturnthisformto________________________________.
Yes No
1. Isthisstudentabletoprojectloudlyenoughtobeadequatelyheard
inyourclassroomduringrecitations? _______

2. Doesthisstudentavoidreadingoutloudinclass? _______

3. Doesthisstudentappeargenerallytoavoidtalkinginyourclassroom? _______

4. Doesthisstudenteverlosehisorhervoicebytheendoftheschoolday? _______

5. Doesthisstudentuseanunusuallyloudvoiceorshoutagreatdealin
yourclassroom? _______

6. Doesthisstudentengageinanexcessiveamountofthroatclearingor
coughing?Ifso,which?______________________________________ _______
Ifso,howdoesitappeartodisturbtheotherstudents,(e.g.,their
concentration,listening)?_____________________________________ _______

7. Isthisstudentsvoicequalityworseduringanyparticulartimeof
theday?Ifso,when?_______________________________________ _______

8. Doesthisstudentsvoicequalitymakeitdifficulttounderstandthe
contentofhisorherspeech? _______

9. Doesthisstudentsvoicequalityinitselfdistractyoufromwhat
s/heissaying? _______

10. Hasthisstudentevermentionedtoyouthats/hethinkss/hehasavoiceproblem? _______

11. Haveyoueverheardanyofhis/herpeersmentionhis/hervoicesounds
funnyoractuallymakefunofthisstudentbecauseofhis/hervoiceproblem? ___ ____

12. Ifthisstudenthasapitchthatistoolowortoohigh,doeshis/herpitch
makeitdifficulttoidentifyhim/herasmaleorfemalejustbylistening? _______

13. Duringspeaking,doesthisstudentsvoicebreakupordowninpitchtothe
extentthats/heappearstobeembarrassedbythis? _______

qYES qNO Itismyopinionthatthesebehaviorsadverselyaffectthestudentseducationalperformance.

Ifyes,provideexplanation:_______________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

TeachersSignature________________________________________Date_______________
AdaptedfromSpeechandLanguageServicesinMichigan:SuggestionsforIdentification,DeliveryofServiceandExit
Criteria,editedbyElizabethLoringLockwoodandKathleenPistano.EastLansing:TheMichiganSpeechLanguage
HearingAssociation,1991.

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 VoicePage1of3

VoiceEvaluationWorksheets

Child___________________DOB________Date_______SLT___________________

School________________________Teacher______________________Grade______

Recordareasassessed.Theassessmentshouldreflectareasofconcerndescribedinthereferralandthose
thatariseduringtheevaluation.AreasnotassessedshouldbemarkedN/A.

VoiceArea Impairment Evidence AdverseEffectson

Educational
Performance
PHONATION

Isolation
TotalPitchRange

OptimumPitch

PitchAppropriatenessforAge

PitchAppropriatenessforSex

LoudnessRange

Aphonia

Breathiness

Diplophonia

GlottalFry

Hoarseness

Harshness

Tremor

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 VoicePage2of3
Child_____________________________________________Date_________________

VoiceArea Impairment Evidence AdverseEffectson

Educational
Performance
PHONATION(contd)

ConnectedSpeech

VoiceOnset

VoicelesstoVoiced

AppropriatenessofLoudness

PitchBreaks

PitchRange

HabitualPitch

Aphonia

Breathiness

Diplophonia

GlottalFry

Hoarseness

Harshness

Tremor

RESONANCEIN
CONNECTEDSPEECH
Hypernasality

Hyponasality

Throatiness/CulDeSac

NasalEmission

AssimilationNasality

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 VoicePage3of3
Child_____________________________________________Date_________________

VoiceArea Impairment Evidence AdverseEffectson

Educational
Performance
PROSODYINCONNECTED
SPEECH
Stress

Intonation

RESPIRATION

TypeofBreathingPattern

Atrest

InConnectedSpeech

BreathSupportforSpeech

Posture

Tension

ASSOCIATEDFACTORS

VocalAbuseBehaviors

PersonalityFactors

ORALMECHANISM

Structure

Function/Tension

OTLEXAMINATION
RESULTS

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 VocalCharacteristicsChecklist1

Name: Age: Date:

Examiner:
Instructions: Checkeachcharacteristicyourstudentexhibitsandindicateseverity.Make
additionalcommentsontherighthandsideofthepage.

1=mild 2=moderate 3=severe

Comments
Pitch

___toohigh
___toolow
___monotone
___limitedvariation
___excessivevariation
___pitchbreaks
___diplophonia

Loudness
___tooloud
___toosoftorquiet
___monoloudness
___limitedvariation
___excessivevariation

PhonatoryBasedQuality
___breathyvoice
___shrillvoice
___stridentvoice

1
AssessmentinSpeechLanguagePathology1998bySingularPublishingGroup.

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
PhonatoryBasedQuality(continued)
Comments
___harshvoice
___hoarsevoice
___quiveringvoice
___tremorinthevoice
___weakvoice
___lossofvoice
___glottalfry

NasalResonance
___hypernasal
___nasalemission
___assimilationnasality
___hypernasal(denasal)

OralResonance
___culdesac
___chesty
___thin,babyishvoice

Other
___reversephonation
___progressivelyweakeningvoice
___aggressivepersonalityfactors
___breathingthroughthemouth
___hardglottalattacks
___inadequatebreathsupport
___throatclearing
___disorderedintonationalpatterns
___disorderedstresspatterns

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 VocallyAbusiveBehaviorsChecklist1
Name: Age: Date:
Examiner:

Instructions: Havethestudentevaluateeachbehavioraccordingtotheratingscale.Usethe
commentscolumnontherighthandsidetoaddanyadditional,relevantinformation.

1=never 3=occasionally 5=always

2=infrequently 4=frequently

Comments
_____alcoholconsumption

_____arcadetalking

_____arguingwithpeers,siblings,others

_____athleticactivityinvolvingyelling

_____breathingthroughthemouth

_____caffeineproductsused(coffee,chocolate,etc.)

_____callingothersfromadistance

_____cheerleadingorpepsquadparticipation

_____coughingorsneezingloudly

_____crying

_____dairyproductsused

_____debateteamparticipation

_____environmentalirritantsexposure

_____gruntingduringexerciseorlifting

_____inhalantsusedfrequently

_____laughinghardandabusively

_____nightclubsocialtalking

1
AssessmentinSpeechLanguagePathology1998bySingularPublishingGroup.

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 Comments

_____participationinplays

_____singinginanabusivemanner

_____smoking

_____speechespresented

_____talkingloudlyduringmenstrualperiods

_____talkingloudlyduringrespiratoryinfections

_____talkingforextendedperiodsoftime

_____talkinginnoisyenvironments

_____talkinginsmokyenvironments

_____talkingwhileinthecar

_____teachingorinstructing

_____telephoneusedfrequently

_____vocalizingtoyoranimalnoises

_____vocalizingundermusculartension

_____yellingorscreaming

_____other

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 VocalSelfPerception:AttitudinalQuestionnaire
1. Doyoueverthinkaboutyourvoice? Yes No NoOpinion

2. Haveyoueverheardyourvoiceontapeplayback(e.g.,on Yes No NoOpinion

cassetterecorder,answeringmachine)?

3. Didyoulikeyourvoiceontapeplayback? Yes No NoOpinion

4. Hasanyoneevercommentedonyourvoice? Yes No NoOpinion

IfYes,whatwassaid?_______________________________
__________________________________________________
5. Doyouthinkyourvoicerepresentsyourimageofyourself Yes No NoOpinion
(masculine,feminine,intelligent,educated,friendly,etc.)?
IfYesorNo,inwhatway?_____________________________
__________________________________________________
6. Doanyofyourfriends,maleorfemale,havevoicesthatyou Yes No NoOpinion
especiallylike?
IfYes,explain.______________________________________
___________________________________________________
7. Doanyofyourfriends,maleorfemale,havevoicesthatyou Yes No NoOpinion
especiallydislike?
IfYes,explain.______________________________________
__________________________________________________
8. Doesyourvoicesoundlikethatofanyothermemberofyour Yes No NoOpinion
family?
IfYes,explain.______________________________________
_________________________________________________.
9. Circleanywordsbelowthatdescribeyourvoiceandtheway
youspeakingeneral(eitherontapereplayorwhileactually
talking).
pleasant toosoft tooloud Addanyothertermsthatmay
describeyourvoice.
sexy highpitched strong _________________________
raspy lowpitched thin _________________________
hoarse grow whiney _________________________
_________________________
harsh toofast interesting
_________________________
shrill tooslow resonant _________________________
squeaky weak masculine _________________________
monotonous breathy feminine _________________________
_________________________
nasal weak resonant
_________________________
mumble clear expressive _________________________
husky average _________________________
_________________________

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation
 VoiceConservationIndexforChildren1

CHILDSINITIALS___________AGE_______ SEX______ DATE__________

Pleasecircletheanswerthatisbest.

1. WhenIgetacold,myvoicegetshoarse.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
2. Aftercheeringataballgame,Igethoarse.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
3. WhenIminanoisysituation,IstoptalkingbecauseIthinkIwontbeheard.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
4. WhenIminanoisysituation,Ispeakveryloudly.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
5. WhenImathomeoratschool,Ispendalotoftimetalkingeveryday.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
6. Iliketotalktopeoplewhoarefarawayfromme.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
7. WhenIplayoutsidewithmyfriends,Iyellalot.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
8. IlosemyvoicewhenIdonthaveacold.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
9. PeopletellmeItalktooloudly.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
10. PeopletellmeIneverstoptalking.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
11. Iliketotalk.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
12. Italkonthephone.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
13. Athome,Italktopeoplewhoareinanotherroom.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
14. IliketomakecarorothernoiseswhenIplay.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
15. Iliketosing.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
16. PeopledontlistentomeunlessItalkloudly.
Allthetime Mostofthetime Halfthetime OnceinawhileNever
Source: Saniga,R.D.andCarlin,M.F.VocalAbuseBehaviorsinYoungChildren.Language,Speech,and
HearingServicesinSchools,1993:24(2),p.83.ReprintedbyASHAwithpermissionofauthors..

1
SanigaandCarlin(1991)

ED4070/Rev.07.09 Speech:VoiceResourcePacket
DepartmentofEducation