A normal speaking voice is clear and has an appropriate amount of pitch, resonance, and loudness.  Many school-aged children shout and scream during active play and sometimes experience hoarseness as a result.  Some children are repeatedly or chronically hoarse.  As children become older and reduce the amount of active vocal abuse, this may spontaneously improve.  If the hoarseness is persistent and severe enough that it interferes with communication, ff there is frequent loss of voice during speech, there may be a voice problem.  There is normal variation across speakers in pitch and resonance characteristics (amount of nasality in the voice).  However, if a pitch or resonance difference is highly noticeable and interferes with normal communcation, there may be cause for concern.  Teachers are advised to be sensitive and to discuss concerns with parents before attempting pre-referral interventions, since voice characterisitics can vary according to cultural and family patterns.  If there is a concern about voice that may result in a referral for a speech/language assessment (if classrom interventions are not successful),  you will need documented evidence of the nature, frequency and length of the classroom interventions tried.  If there is a voice concern and the student's voice does not improve with pre-referral interventions, a referral for a voice assessment may be made,  A medical history is important in these assessments, and a referral for an exam by an ENT specialist may be made by the speech/language clinician.  There may be vocal nodules or other abnormalities of the vocal cords, or there may be structural reasons for a nasality problem.

Prepared by S. Penner  11/1/93