Social distancing may be challenging for children with speech and language disorders, as it limits decreases their daily opportunities to practice language with others. In addition, having to transition to phone calls and text messaging as opposed to face to face communication may be overwhelming for our kiddos with speech and language disorders.
Never fear! We’ve outlined 5 ways to stay connected and practice pragmatic language while maintaining social distance.
Virtual connectivity. Facetime or Zoom friends, grandparents, and others! Virtual connectivity with a visual, socially interactive interface provides a multi sensory input for kids to socially interact while maintaining physical distance
Physical exercise! There are many free programs offering online classes right now for physical exercise. Try out an aerobics class at home with your child in the house. Turn it into a language opportunity (i.e. sequencing activities you did in the class, how it felt to exercise, etc).
Spring cleaning. Spending more time in the house we have increased opportunities to organize our homes. Have your child put items into groups, sorting, organizing, and sequencing to practice their language skills.
Daily routine and structure. Establish several times a day where everyone in your home will complete an activity together each day to reduce the thoughts and feelings of social isolation (i.e. having one meal together a day, going for a walk at a certain time each day, reading a book together at the same time each night).
Creative activities. Encourage interactive activities that involve interactive social exchanges at home. Turn your living room into a “park” and have a picnic on the floor, build blanket forts, and encourage other creative activities your child may be interested in to promote language and social connection with the family.
NSPT offers services in the Chicagoland Area. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!
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Social distancing proves to be a challenge for families with children who rely heavily on structure and consistency in their daily schedules. That’s why the implementation of parent home programs is essential now more than ever to maintain carry over of learned therapy skills. Here are some tips to make therapy at home fun while providing structure.
Provide correct modeling of speech and language
Turn ordinary conversation into opportunities to practice speech and language goals. Provide correct models whether it be articulation, language and grammar skills, or social pragmatic skills. If your child makes a mistake, (i.e. incorrect usage of speech sound) rather than correcting their error, continue to provide the correct model of the desired speech sound.
Create visual schedules
Many of our kiddos can benefit from visual schedules. Advantages of using a visual schedule include but are not limited to: helping remaining calm/maintaining self regulation, providing the child with a positive routine with predictability of what to expect next, increasing receptive language skills with the use of visuals, increasing language processing skills with the use of both visuals and written text, promoting sequencing skills (first, second, now, later), and providing structure in the child’s day to day life.
Practice verbal routines Using verbal routines for children with language disorders is an excellent way for children to foster language development in their daily lives. Verbal routines are when you use the same words/phrases in an activity every time (i.e 1, 2, 3 or ready, set, go!). These routines are predicable and provide opportunities for the child to enhance their language skills. Verbal routines can be applied in both unstructured and structured tasks such as playing with bubbles, playing catch with a ball, or higher level cognitive tasks such as saying “my turn” before every turn in a family board game night at home.
In addition, functional language routines can be found in nursery rhymes and songs. These songs additionally provide opportunities for labeling, object identification, and sequencing. (i.e. head, shoulders, knees and toes, if you’re happy and you know it clap your hands, row row row your boat).
Provide opportunities for children to ask questions and make comments Set the stage for your child to ask questions during functional tasks that will give them the opportunity to ask questions or make comments. For example, if your child wants to draw or write provide them the piece of paper but leave out the pen or pencil to provide them the opportunity to ask questions in relation to the task.
Read books out loud together! Reading books is a wonderful and fun way to practice language at home. Use books with predictable patterns that can be easily learned and require active participation from the reader.
Whether you are continuing face to face therapy at one of our clinics or beginning telehealth with one of our therapists, we are here to continue to serve you.
NSPT offers services in the Chicagoland Area. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!
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Language development for children diagnosed with Down Syndrome can be challenging and confusing. Factors such as cognitive and motor delays, hearing loss and visual problems can interfere with language acquisition. It’s important that a child’s caregivers provide a variety of opportunities to increase language development.
Using many normal everyday activities can enhance the child’s language and expose them to new concepts. The language you teach to your child will assist them in learning and generalizing new information.
The following are early intervention strategies that can be used to help children with Down Syndrome develop and increase their understanding of language:
Take advantage of language opportunities during daily routines:
Activities such as taking a bath, cooking, grocery shopping, changing a diaper, or driving in the car are a wonderful time for learning. Caregivers can consistently identify actions, label items, expand on their children’s utterances to facilitate vocabulary acquisition and overall language development. It takes a lot of repetition for children to learn and start to use words appropriately. Include a variety of words that include all the senses. “Does the water feel hot?” or “Can you smell the cookies?” When speaking, identify textures, colors, express feelings etc.
Read, read, read:
It can never be said enough how important reading is to children. When reading a book, it’s important to not only read the words on the page, but to talk about what is on the page, what the characters are doing or how they might be feeling. Make reading a book an interactive experience.
Incorporate play time with other kids:
Children can learn a lot just by interacting with other children as they are interested in and motivated by their peers. They imitate each other’s actions and will learn from them. Play time with other children will also help them develop social skills. Concepts such as sharing, taking turns, pretend play, creating, etc. can all be increased.
Play with them:
Children don’t know how to play with toys and games on their own, we need to show them. Get on the floor and play with blocks, balls, bubbles, sing a song, etc. During this time talk about what you and the child are doing (Ex: stack up the blocks, let’s blow more bubbles, it’s my turn) and expand on their utterances. Play time is critical for children to develop their ability to focus and attend to a task. When you are engaged together in a task, you are developing a special bond with your child and they are learning!
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A school speech-language screening allows a speech-language pathologist to observe the child’s language understanding and use, production of speech sounds, vocal and nasal quality, and social language skills. The screening typically follows a checklist that a speech-language pathologist administers in approximately 15-20 minutes.
Most screening tools yield a “pass” or “did not pass”. If a child did not pass the screening, then a comprehensive full speech-language evaluation is recommended. Following this process, an intervention plan is created and proposed if needed.
A hearing screening is equally important and recommended upon entering kindergarten. The screening is typically a hand raising game an audiologist administers in approximately 10 minutes. If a child did not pass the screening, a comprehensive full hearing test is typically recommended. Normal hearing in children is important for normal language development. If a child has hearing problems, it can cause problems with their ability to learn, speak or understand language.
Speech and language skills are used in every part of learning and communicating with other children in school. In kindergarten, children learn the routine and structure of a typical school day and need to be able to follow directions, understand ideas learned in class, communicate well with their peers and teachers, practice early literacy skills and use appropriate social skills within the classroom and during play.
Screenings can be a great tool to determine if a child warrants a full speech-language or hearing evaluation. A screening alone is not diagnostically reliable and should only be used as a tool to decide if an evaluation is necessary.
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Parents often worry when their child reaches 18 months or 2 years of age and does not talk much or at all. Some children exhibit late language emergence, also known as late talking or a language delay. Approximately 10-20% of 2-year-old children exhibit late language emergence. A late-talking toddler is typically defined as a 24 month old who is using fewer than 50 words and no two-word combinations. While research shows that late talkers catch up to peers by elementary school, approximately one in five late talkers will continue to have a language impairment at age 7. For some children, the late emergence of language may indicate a persistent language disorder, also called a specific language impairment. For other children, late language emergence may indicate a related disorder such as a cognitive impairment, a sensory impairment, or an autism spectrum disorder. Many parents wonder if their late-talking toddler will catch up naturally or whether speech-language therapy is recommended.
The following signs may indicate that a child will not naturally “catch up” in language and therefore may require therapeutic intervention:
Language production: The child has a small vocabulary and a less diverse vocabulary than peers. A child who uses fewer verbs and uses primarily general verbs, such as make, go, get, and do is at risk for a persistent language disorder.
Language comprehension: The child has deficits in understanding language. The child may be unable to follow simple directions or show difficulty identifying objects labeled by adults.
Speech sound production: The child exhibits few vocalizations. The child has limited and inaccurate consonant sounds and makes errors when producing vowel sounds. The child has a limited number of syllable structures (e.g., the child uses words with two sounds, such as go, up, and bye instead of words with three to four sounds, such as down, come, puppy,black, or spin).
Imitation: The child does not spontaneously imitate words. The child may rely on direct modeling and/or prompting to imitate (e.g., an adult must prompt with, “Say ‘dog,’ Mary” instead of a child spontaneously imitating “dog” when a parent says “There’s a dog”).
Play: The child’s play consists mostly of manipulating or grouping toys. The child uses little combination or symbolic play, such as using two different items in one play scheme or pretending that one item represents another.
Gestures: The child uses very few communicative gestures, especially symbolic gestures. The child may use pointing, reaching, and giving gestures more than symbolic gestures such as waving or flapping the arms to represent a bird.
Social skills: The child has a reduced rate of communication, rarely initiates conversations, interacts with adults more than peers, and is reluctant to participate in conversations with peers.
The following risk factors exist for long-term language disorders:
Otitis media (middle ear infection) that is untreated and prolonged
Family history of persistent language/learning disabilities
Parent characteristics including less maternal education, lower socioeconomic status, use of a more directive instead of responsive interactive style, high parental concern, and less frequent parent responses to child’s language productions
For children displaying any of the above signs or risk factors, a comprehensive speech-language evaluation is recommended.
Paul, R. (2007). Language Disorders from Infancy through Adolescence: Assessment & Intervention. Elsevier Health Sciences.
Motor speech disorders are neurologically-based speech disorders that affect the planning, programming, control or execution of speech. In order to produce speech, every person must coordinate a range of muscles and muscle groups, including those controlling the vocal cords, the lips, the tongue, the jaw and the respiratory system. Movements must be planned and sequenced by the brain and then carried out accurately to create speech! A child with a motor speech disorder may be learning to understand and use language, but is constrained in the ability to plan, sequence and/or control movements of muscle groups that are used to generate speech due to neurological and/or neuromuscular impairment. Motor speech disorders include apraxia of speech and dysarthia.
What is apraxia of speech?
Apraxia of speech (AOS) is a neurogenic speech disorder in which an individual has difficultly moving his/her lips or tongue in order to say sounds correctly, despite no presence of muscle weakness. This may be due to a disruption in the message form the brain to the mouth when speech is produced.
Two main types of apraxia of speech include acquired and developmental. Acquired apraxia of speech (AoS) is caused by damage to the parts of the brain involved in speech production and involves loss or impairment in existing speech skills. AoS may include co-occurring muscle weakness that negatively affects speech production, as well as language difficulties that result from brain damage. Causes of AoS include stroke, head injury, tumor or illnesses affecting the brain.
Developmental apraxia of speech, or childhood apraxia of speech (CAS), is present from birth and occurs in the absence of muscle weakness or paralysis. There is no known cause for CAS, however, some researchers suggest it is related to overall language development, some say it is neurologically based and others reference a genetic component.
What is dysarthria?
Dysarthria is a neurologically based motor speech disorder, caused by damage to the central or peripheral nervous system that results in impaired muscular control of the speech mechanism. These disturbances of control and execution are due to abnormalities in the muscles used for speech that can include weakness, spasticity, incoordination, involuntary movements or excessive, reduced or variable muscle tone. Dysarthria specifically affects face muscles, vocal quality and breath control. Causes of dysarthria include stroke, brain injury, brain tumors, conditions that cause facial paralysis, as well as tongue or throat muscle weakness. There are five categories of dysarthria that include flaccid, spastic, hypokinetic, hyperkinetic and ataxic.
Children with motor speech disorder demonstrate neuroplasticity for speech learning. Neuroplasticity is the ability of the brain to form and reorganize synaptic connections, especially in response to learning, experience or following injury. Therefore, early intervention for treatment of motor speech disorders in children is critical. Consistent treatment frequency and opportunities for repetition are important to fully develop the child’s neural connections in order to change speech sound input (from the brain) into actions of the speech mechanism in order to create meaningful speech!
If you believe that your child shows signs of a motor speech disorder, do not hesitate to consult with a speech-language pathologist.
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Auditory processing refers to what we do with the messages we hear. An auditory processing disorder occurs due to an auditory deficit that is not the result of other cognitive, language, or related disorders. However, children with an auditory processing disorder may also experience other difficulties in the central nervous system, including learning disabilities, speech-language disorders, and other developmental disorders. Auditory processing disorder may also co-exist with other diagnoses, such as ADHD or Autism.
10 Signs of Auditory Processing Disorder
Difficulty understanding speech in noisy environments
Inability to consistently and accurately follow verbal directions
Difficulty discriminating between similar-sounding speech sounds (i.e., /d/ versus /t/)
Frequently asking for repetition or clarification of verbally presented information
Poor performance with spelling or understanding verbally presented information
Child typically performs better on tasks that don’t require or rely on listening
Child may not speak clearly and may drop ends of words or syllables that aren’t emphasized
Difficulty telling stories and jokes; the child may avoid conversations with peers because it’s hard for them to process what’s being said and think of an appropriate response
Easily distracted or unusually bothered by loud or sudden noises
Child’s behavior and performance improve in quieter settings
How is Auditory Processing Disorder Diagnosed?
An initial diagnosis of auditory processing disorder is made following a comprehensive audiological evaluation, which is completed by a licensed and ASHA accredited audiologist. Following the diagnosis, the speech-language pathologists at NSPT work closely with the audiologist and collaborate on an ongoing basis. Children with an auditory processing disorder benefit from working closely with both speech-language pathologists, as well as occupational therapists. Professionals at NSPT can collaborate with teachers and other professionals to provide recommendations to help set up a successful learning environment for your child. Therapy will include activities to increase auditory closure skills, vocabulary building, discrimination skills, grammatical rules, and auditory perceptual training.
Bellis, Teri James. Understanding Auditory Processing Disorders in Children. American Speech-Language-Hearing Association.Retrieved from http://www.asha.org.
What is a Picture Exchange Communication System (PECS)? PECS is a form of Augmentative and Alternative Communication (AAC) which uses a picture/symbol system to teach initiation of
functional communication. PECS was developed by Lori Frost and Andy Bondy in 1985 to be used with preschool children on the autism spectrum who demonstrated little to no socially-related communication. Examples include: children who avoided interactions with others, did not approach others to communicate, and/or only communicated when prompted to do so.
Myth #1: The Picture Exchange Communication System is strictly used for nonverbal children or children on the autism spectrum.
A common misconception about the Picture Exchange Communication System (PECS) is that it is strictly used with nonverbal children. While PECS and other forms of AAC have proven very useful and successful with nonverbal children, the system services many other populations with the purpose of eliciting and initiating functional communication.
To fully understand the meaning of functional communication, a distinction must be made between actions directed to the environment vs. actions directed toward a person. A child may climb on a step stool to reach a toy car on a shelf. From this action, we could infer that the child wants to play with the car. However, this is not communicative. If this same child looks from the car to his mother, or leads his mother over to the car, this is considered communication. Neither interaction involved speaking, however the distinction is that communication occurs when an action is directed towards someone else to achieve a certain outcome.
Therefore, Picture Exchange Communication System is appropriate, not just with children or adults that are not verbally communicating, but with those who are verbal, yet lack person-directed communication.
Other populations where PECS might be appropriate (to name a few):
-late-talking children (research is showing benefits for the introduction of AAC as early as 12 months)
-adults with aphasia
-Childhood Apraxia of Speech (CAS)
-children with reduced speech intelligibility
-verbal children with reduced social language and initiating
Myth #2: Using PECS will deter my child from communicating verbally
For some children, verbal communication can be a challenge; speech and language are not developing as quickly as would be anticipated and, accordingly, result in accompanying frustration and associated behaviors. Introduction of an augmentative and alternative communication system like PECS can help bridge the gap for children who are not yet verbally communicating but need an accessible means of communication as speech and language develop. Without an effective means of communication, these children are at risk for social, emotional, and behavior problems, including feelings of frustration and isolation.
Often, parents are concerned that using an augmentative or alternative form of communication will replace or deter verbal communication. In fact, research has shown just the opposite:
“Research over the past 25 years has shown not only that use of augmentative communication systems (aided or unaided) does not inhibit speech development but that use of these systems enhances the likelihood of the development or improvement of speech.” (Bondy & Frost, 2004)
The PECS program mirrors the acquisition of typical language development; children are taught one-word labels for frequently requested items before transitioning to formulation of two-word utterances. Verbally requesting and labeling can be targeted in conjunction with the program. The PECS program also details modality transitioning (i.e., transitioning from PECS to verbal communication), if and when it is appropriate.
If your child is using PECS now, this does not mean that you are “giving up on speech”. It is a system that is being utilized to give your child a means of communicating and interacting with others while speech is developing.
Myth #3: PECS cannot be used with children who have visual impairments, fine motor, or gross motor difficulties.
PECS can be used with a wide range of age-groups and disabilities. Accommodations can be made for children and adults with visual impairments, fine motor, or gross motor difficulties, to name a few.
Pictures can be made in various sizes to accommodate visual impairments. Additionally, you or your child’s speech language pathologist can select and modify pictures to suit your child’s needs; photographs can be used instead of clipart or Boardmaker pictures, and images can be modified to create more contrast.
Pictures can also be put on objects (e.g., bottle tops) to make them easier to grasp and pick up from a table or book for children with fine motor difficulties.
Step 2 of PECS involves ‘distance and persistence’, meaning a child is taught to move across a room, multiple rooms, etc. to select a picture from his book and persist when giving it to his communication partner. Students that are non-ambulatory can use a voice switch or a button to request his communication partner in order to perform the exchange.
If you have questions about PECS and if it would be appropriate for your child, please consult with a licensed speech language pathologist.
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A digital doll house that lets your child use everything inside. You can fry an egg, feed the family pizza, pour drinks, feed the pets, and more! This app does not specifically target speech
and language skills; however, there are many ways it can be used to work on speech/language at home. While playing with the doll house, you can work with your child on pronouns, identifying actions (e.g., cooking, sitting), present progressive –ing (e.g., drinking), plurals (e.g., two apples), vocabulary (around the house), formulating complete sentences, etc. I also like to use this app as a motivating activity for children working on speech sounds. For example, I will say, “Tell me what the doll is doing with your good ‘r’ sounds.” There is also My PlayHome Hospital, My PlayHome School, and My PlayHome Stores.
Articulation Station by Little Bee Speech
This app is fantastic for children working on speech production skills. The whole app is pricey, but beneficial for a child working on more than one speech sound. It is also possible to download individual speech sounds to target a specific sound at home. This app is motivating and excellent for home practice!
Following Directions by Speecharoo Apps
Excellent app for working on following directions. Choose from simple 1-step directions, 2-step directions, or more advanced 3-step directions. These funny directions will have your child laughing and wanting to practice more.
Peek-A-Boo Barn by Night & Day Studios, Inc.
My favorite app for toddlers working on expressive language skills. First, the barn shakes and an animal makes a noise. Have your child say “open” or “open door” before pressing on the door. You can also have your child guess which animal it is or imitate the animal noises. When the animal appears, have your child imitate the name of the animal.
Open-Ended Articulation by Erik X. Raj
This app contains over 500 open-ended questions to use with a child having difficulty producing the following speech sounds: s, z, r, l, s/r/l blends, “sh”, “ch”, and “th”. It is great for working on speech sounds in conversation. Have your child read aloud the question and take turns answering. The open-ended questions are about silly scenarios that will facilitate interesting conversations.
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If you are a parent or a professional who has had experience with a child diagnosed with autism, you know that they are all as different as the colors under the sun. Speech therapy services are typically recommended and necessary for kids diagnosed with autism, as they may have difficulty communicating effectively. These services will be tailored to the individual to ensure the child is making progress and achieving developmental milestones. No two speech therapy sessions are the same, as will be the case for your child. However, there are overarching goals that you can expect your child to be working towards.
Here are factors you should expect to be consistent for a child diagnosed with autism that is receiving speech therapy services:
Speech therapy will be individualized.
The speech language pathologist will complete an evaluation of the child’s current speech and language skills. Based on the results of the evaluation and any observations made, goals will be formulated to target areas to improve.
Speech therapy will target functional communication.
This may mean different things depending on the level of the child. Whether the child is verbal or nonverbal, therapy will address making sure the child is effectively communicating their needs and wants. If the child is nonverbal or has significant difficulty utilizing verbal language, Augmentative and Alternative Communication (e.g., pictures, sign language, iPad, etc.) may be implemented. Therapy may also target talking about events, telling stories, answering questions, asking questions, commenting, expressing opinions, and participating in conversations.
Speech therapy will target social language.
Social language is also known as pragmatic language and includes using language for a variety of purposes (i.e., greetings, informing, demanding, etc.), changing language according to the needs of the listener or situation, and following rules for conversation and storytelling. In order to warrant a diagnosis of autism, the child has already been determined to have a deficit in social communication and interaction. Treatment goals may include maintaining eye contact, initiating and terminating conversations, maintaining topics of conversation, identifying emotions, and utilizing appropriate body language.
The above goals are targeted in a variety of ways, again dependent on your child. Sometimes direct education is provided prior to practicing skills in activities, role-play scenarios, or structured real-life situations. Other times, skills are targeted during play and motivating activities for the child. No matter the skill level of your child with autism, speech therapy is an integral piece to their progress and successful functioning.
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