Speech (expressive language) comes quite naturally to most children and adults, but the skills to do so are very complex and take many years to master. These skills, at times, can be overwhelmed by other factors such as anxiety.nnThink of a musician who can play an instrument at a very high level in their studio but, once faced with the stress of a live audience, the musician may freeze up and not be able to play well. When this occurs, it is often referred to as stage fright.nnA similar event can happen with adults who must speak in front of a gathering of people. If adults are anxious enough, they can have difficulty speaking clearly and fluidly. We often refer to this as being tongue-tied of “speechless” to describe their sudden lack of speaking skills.nnChildren with expressive language delay will go through a similar phase where fluctuations of external stressors (anger, low brain blood pressure, poor focus, emotional stress, anxiety, etc.) may make it difficult for them to access their newly developed speaking skills. The fluctuations in the child’s ability to speak are often due to the same stage fright phenomenon as musicians.nnWith more progress on the protocol, speaking skills will become more deeply embedded, and interfering issues such as anxiety or aggression will lessen, allowing the child to speak more consistently and clearly.