Some guiding principles in emerging models of voice therapy for children.

Voice disorders are the most common communication disorder across the life span, affecting more than five million school-aged children annually in the United States alone. Although such disorders are commonly associated with benign pathology, medically malicious conditions cannot be ruled out without proper medical examination by an otolaryngologist. Many children with voice disorders are otherwise healthy. However, some are not. Moreover, children with voice problems of any origin often experience distinctly negative consequences in quality of life and academic participation as a result of them. Regrettably, this population is badly underserved by speech-language pathology. In this article, possible reasons are suggested, among them the relative unattractiveness of traditional therapy that emphasizes voice conservation using a Skinnerian paradigm. Alternatives are presented in terms of foundational principles of biomechanics, biology, and learning and factors affecting children's compliance with health care directives, which may help to shape the next generation of pediatric voice therapies. The article concludes with discussion of challenges surrounding voice therapy in the school setting and possible solutions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.