Social communication with others requires a complex integration of skills in three areas:
Pragmatic language skills
A social worker often addresses social interaction skills (e.g., understanding social rules, such as how to be polite) and social cognition skills (e.g., understanding the emotions of oneself and others). A speech-language pathologist often targets pragmatic language skills, which are the verbal and nonverbal behaviors used in social interactions.
A social interaction typically requires the ability to understand and use the following pragmatic language skills:
Expression of a variety of communicative functions. Does the child communicate for a variety of reasons, such as attempting to control the actions of others, asking questions, exchanging facts, or expressing feelings?
Use of appropriate frequency of communication. Does the child use an equal number of messages as his or her communication partner?
Discourse (conversation) skills. Can the child initiate conversation, take turns, maintain and shift topics, and repair communication breakdowns?
Flexible modification of language based on the social situation. Can the child switch between informal vs. formal language based on the setting and listeners?
Narrative storytelling. Can the child tell coherent and informative stories?
Nonverbal language. Can the child understand and use body language, gestures, facial expressions, and eye contact?
Nonliteral language skills. Does the child understand figurative language, jokes, words with multiple meanings, and inferences?
A child with a social communication disorder, also known as a pragmatic language impairment, may present with difficulties using language to participate in conversations. Impairments in pragmatic language can impact a child’s ability to make and keep friends. It is important that social language skills are viewed within the context of an individual child’s cultural background. A speech-language pathologist can identify and treat pragmatic language difficulties in children.
Dyslexia is the most common learning disability in the United States, impacting 20 percent of the country’s population. If a child is not diagnosed by the second grade, there is a significant chance he or she will remain undiagnosed until they reach adulthood. By educating yourself on the red flags of this learning disability, you can avoid misconceptions as well as delayed identification of this disability. Early identification of any disorder correlates with improved outcome and prognosis.
Preschool-Aged Red Flags for Dyslexia:
Difficulties with phonemic awareness or the ability to identify and manipulate individual sounds in words are beginning signs that your child may have dyslexia. Examples of phonemic awareness skills are:
Segmenting syllables (e.g., “how many syllables do you hear in butterfly?”)
Rhyming (e.g., “which word rhymes with mat; star or hat”?)
Phoneme isolation (e.g., “in the word sun, is the /s/ at the beginning, middle or end of the word?”)
Sound deletion (e.g., “say cup without the /k/.”)
Other signs include:
Trouble reading single words
Trouble generating rhyming words or identifying which words don’t belong
Reversing letters and words (e.g., tab/bat)
Difficulty identifying sounds at the beginning or end of a word (e.g., “what word begins with /t/; toad or boat?”)
Elementary-Aged Red Flags for Dyslexia:
Once children enter elementary school, the expectations for reading and writing abilities increase significantly. Children not previously identified as being at-risk may begin to exhibit signs as school work becomes more challenging. These children often have average or above average IQ, but demonstrate below grade-level reading and writing abilities.
Difficulty with word finding (e.g., relying on “stuff,” “things” or other generic words)
Difficulty with organization and studying
Trouble with story telling
Avoidance or dislike of reading
Should an individual demonstrate some of these signs, it is not necessarily indicative of dyslexia. Other reading or language disorders may play a factor. However, if these difficulties persist through childhood, it may negatively impact that child’s academic success.
Through early identification, children with dyslexia can begin treatment in phonics-based programs, such as Orton-Gillingham or Wilson. These programs are unique in that the relationships between sounds and letters are explicitly and systematically taught. With consistent treatment, children with dyslexia can learn to compensate for their disorder, as well as begin to enjoy reading and writing.
Parents are often eager to teach and practice the good old ABCs with their children. However, there are other ways that parents can support pre-literacy development, such as fostering phonological awareness skills, too! Phonological awareness is the understanding that sentences/words are made up of smaller units, as well as the ability to identify and manipulate these units. Research has found that strong phonological awareness skills are predictors of early reading success. One way to understand phonological awareness is to divide it into different levels: word, syllable, and sound. Check out NSPT’s blog Phonemic Awareness Skills to learn more about when these skills are acquired.
Each level of phonological awareness is described below, with activities you can do at home!
Word: The concept of a “word” is an important first step in understanding language. Children are constantly building their vocabulary and using these new words in a variety of ways. There are many ways to begin bringing attention to how words work.
Clap out the words of a favorite song (e.g. Old – McDonald – had – a – farm) to help children learn that sentences contain separate words. You can also use musical instruments, tapping on the floor or jumping. This is especially important for “function” words that are more abstract, such as “the,” “and,” “do,” etc.
Enjoy tongue twisters to begin thinking about alliteration (e.g. Peter Piper picked a peck of pickled peppers. What sound do all of these words start with?). Alliteration, or when every word of a sentence starts with the same sound, is another way to bring attention to patterns in words.
Syllable: Words can be broken down into smaller units, one of which is syllables. Children learn to separate these chunks in a similar manner as they do for words in sentences. Knowing how to do this will help when a child is reading and comes across a multi-syllabic word they are unfamiliar with.
Make a bean bag toss in which you provide a multi-syllabic word, and the child has to throw a bean bag into a bucket while saying one syllable at a time.
Write the numbers 1, 2, 3, and 4 on a piece of paper and place them in separate areas of a room. Then give the child a multi-syllabic word and have them run to the number that represents the number of syllables in that word.
Sort objects found around the house into groups by how many syllables they have.
Sound: Words can also be broken down to their individual sounds. There are several ways we can manipulate sounds, including identifying (e.g. what is the first sound in “bat?”), segmenting (e.g. what 3 sounds do you hear in “bat”?), blending (e.g. what do the sounds /b/ /a/ /t/ make?) deleting (e.g. what’s “bat” without the /b/?), and substituting (e.g. if you change the /b/ in “bat” to /m/, what word is it?). Here are a few ways to begin prating these in an interactive, multi-sensory way.
Play “Simon Says.” Give the last word of the direction by segmenting it into sounds. For example, Simon Says touch your /l/ /e/ /g/, or Simon says stand /u/ /p/.
Play “I spy” to bring attention to particular positions of sounds (beginning/middle/end of word). For example, you could say “I spy something that begins with a sssss sound.”
Modify “head shoulders knees and toes” by providing a multi-syllabic word. The child can touch their head, shoulder, knees and toes (one per sound) as they figure out what sounds are in the word. For example, /b/ (touch head), /a/ (touch shoulders), /t/ (touch knees).
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As children begin to develop their speech and language skills, it is important to remember that speech sounds are acquired in specific patterns around approximate age ranges. Therefore, most children go through periods of development where their overall speech intelligibility is reduced.
In order to understand if a lisp is considered normal, one must first understand what a lisp actually is. Lisps can present themselves in a different manner, primarily as lateral and interdental, with misarticulations primarily on /s/ and /z/, though productions of “sh,” “ch,” and “j” are typically impacted as well. In order to accurately produce these speech sounds, airflow needs to be channeled down the middle of the tongue.
A lateral lisp occurs when the airflow passes over the sides of the tongue, which causes significantly distorted production of the targeted speech sounds. The manner of the production will have a “slushy” quality, and lateralized productions of speech sounds can be difficult to correct.
Another common lisp is the interdental lisp, in which the tongue protrudes between the upper and lower teeth distorting the airflow that is forced through the space during speech production. This type of lisp is often heard as a substituted “th” rather than an accurate /s/ or /z/.
In the preschool years, children are expected to have mastery of early speech sounds, and errors on later-developing speech sounds are considered typical. Therefore, distortions of /s/ and /z/ that present themselves as a lisp are often seen in children this age. However, around the age of five when children enter kindergarten, they should be more accurate with their speech sound production skills.
If a child continues to present with difficulty on particular sounds, further assessment may be beneficial. This is particularly true if the child presents with a lateralized lisp, as speech-language therapy is warranted to help re-mediate the place and manner of the errors. Evaluation is also recommended if the child presents with either inconsistent productions of speech sounds, or is significantly difficult to understand, regardless of age.
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I attended a graduate school program that took great pride in a multi-disciplinary approach. They heavily emphasized the importance of working together to obtain the most accurate diagnosis within a medical model that was centered on patient wellness and experience. “It’s the wave of the future!” they said, “Funding in healthcare will be directly related to a patient outcome!”
When I started working at North Shore Pediatric Therapy, I couldn’t believe that the ‘wave of the future’ concept (simply translated to: increased and improved communication between patients and health care providers) was something that had been fundamental to this practice for so many years! They were so ahead of their time because they thought about how they wanted their family, friends, and children to be treated within a healthcare setting. It’s something that I find value in everyday and would like to share more information about in the upcoming paragraphs. *Of note, this blog post is in response to information derived from an article found in The ASHA (the American Speech-Language-Hearing Association) Leader (a monthly publication sent to licensed speech-language pathologists) titledWhat Does the Patient Want? by Sarah W. Blackstone.
This blog post seeks to explain the ways in which the model of care NSPT has implemented for so many years is compliant with the recent changes in health care laws, policies, and regulations for patient-centered, communication-supportive care.
Why has the government recently realized this as a need in healthcare? Because, “Successful patient-provider communication correlates positively with patient safety, patient satisfaction, positive health outcomes, adherence to recommended treatment, self-management of disease and lower costs.”At NSPT, we have been working this way since day 1! We’re familiar with the positives of this model and know how to set up the challenges for success. We use these skills to impact our patients and improve our practice every day!
NSPT EXAMPLE: A colleague of mine had a client with a speech impediment and an upcoming school play. She reached out to the girl’s teacher (with the permission of her mother of course!) and they worked together to obtain a passage that had fewer of the sounds that were difficult for her. After the performance, all 3 parties rated the experience to review how the collaboration worked for everyone!
Participation in interprofessional rounds to generate relevant concerns and questions for our patients!
NSPT Example: I am a speech-language pathologist that works with physical therapists, occupational therapists, behavior therapists, social workers, and family child advocates. Some of our more involved kiddos see more than one therapist to address multiple areas of concern. This is where “rounding” is particularly helpful. It is the process of checking in and making sure that everyone is on the same page regarding the plan of care. Rounds are also a place to problem solve new challenges and talk about a client’s recent progress!
These are only a few of the ways that NSPT has already incorporated novel health care concepts into the foundation of what we do to convey our appreciation for the wonderful families we work with!
Blackstone, S. W. (2016, March). What Does the Patient Want?. The ASHA Leader, 38-44.
As a busy parent, hearing that your child needs help talking can be overwhelming. You already have a to-do list that feels a mile long— When are you supposed to find time to work on teaching language? The good news is there are ways to incorporate language into the routines that you already do every day! One of the tricks to helping your toddler talk is for YOU to do a lot of the talking. Children need to hear words over and over again to understand them. Just like if you’ve ever learned a second language, they want to hear it a lot before trying it out for themselves! The key here is to focus on doing the talking to build up your toddler’s understanding, which will help her to become confident and ready to use the words with less and less help.
Here are a few daily routines that are perfect to work on teaching language:
Describe what you are doing during bath time. Remember to keep the language simple so your toddler can focus on the words. As you do this every day, your toddler will remember the routine, and may begin to fill in the blanks (e.g. Dad: “Shirt on! Socks….” Toddler: “On!”). While doing these actions, tell your child:
“Shirt off! Socks off! Pants off!”
“Diaper on! Socks on! Shirt on! Pants on!”
“Duck in! Boat in!”
“Duck out! Boat out!”
Use action words while playing in the bath tub
A cup can be a great toy for playing. You can show your child how to “pour” the water. If your child is working on requests, she can request for you to “pour,” she can say “my turn” to have a turn pouring (just be careful so she doesn’t try to drink the bath water!), and she can request “all done” when she wants to finish playing with the cup.
Describe cleaning actions to your child. Tell her “Wash,” “Rinse,” and “Wipe” while you are giving her a bath. These words are especially important as your little one may be working on washing her hands more independently soon.
Bringing in the groceries:
Talk to your child about what you are doing while putting groceries away. This is a great opportunity for your child to practice following directions and to learn food and action vocabulary.
“Carry the bag”
“Beans! Put the beans in” (while putting a can of beans in the cabinet)
“Apples! Put apples in” (while putting apples in a basket)
After you have exposed your child to food vocabulary, you can have him identify foods for you. Take out an apple, a banana, and a carrot. Ask your child “Can I have the apple?” He has to find the food and follow directions to give it to you. As your child learns more, you can give him more items to choose from and ask for two items. When he begins naming foods (e.g. “Nana” for “banana”) smile and encourage him. You can expand his language by telling him “Banana! You found the yellow banana!” You may be surprised by how motivating this can be! Children love to be included and help you.
Have your toddler request which clothes to put on first. You can give him choices to assist with language production. Showing him one item at a time, ask “Do you want PANTS? (show the pants in one hand) or Do you want SHIRT?” (show the shirt with the other hand). Remember to hold the clothes out of your child’s reach so that he has to communicate to you by pointing or talking. Your child can pick which one to put on first. Watch what he points to and, if he points to shirt, encourage him to say “Shirt.” If your child does not repeat the word, honor his choice and say the word “shirt” for him while putting the shirt on him.
Once your child is more familiar with clothing vocabulary, have him find the clothing. Put a shirt, pants, and socks on the floor for him to find. Tell him, “Give me the socks,” and wait for him to find the socks and bring them to you. Remember to say the direction the same way and slowly so that your child can focus on your words. If your child prefers to be more independent, you can lay out two outfits so that he can choose which pants and shirt to put together.
Tips & Tricks:
Keep your language simple
Talk for them instead of asking questions (e.g. “It’s a duck! Quack quack.” instead of “What is it? Do you see it? What color is it? What does it say?” –Questions can be overwhelming, and asking too many makes your child unsure of what to answer).
WAIT for your child to respond
Accept their attempts at saying a word, such as “dah” for “dog”
Model the word for them & expand on what they say: “Dog! You see a dog.”
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A /k/ is produced with the back of the tongue raised, creating a complete blockage of the outward airflow in the back of the mouth. The build-up of air pressure occurs until the tongue moves away from the top of the mouth and releases the air.
Types of Misarticulations & Pronunciation Suggestions
The most common misarticulation of a /k/ is substituting it for a /t/. Ex: “tat” for “cat”
To try and elicit a /k/ you can use a tongue depressor to hold down the front half of the tongue during production or try gargling with the head tilted backward before trying to produce the /k/ sound.
Once you have achieved /k/ in isolation, try pronouncing it by combining the /k/ with back vowels. These vowels best facilitate the pronunciation of /k/.
Did you know?
/k/ is among the top 10 most frequently occurring consonants!
/k/ can occur at the beginning or end of a word.
Consonant clusters with /ks/ at the end can signal plurality
Bauman-Waengler, J. (2012). Articulatory and phonological impairments: A clinical focus. (4th ed.). Upper Saddle River, New Jersey: Pearson Education, Inc.
Taking your child in for a speech-language evaluation and receiving the initial report can be a confusing and overwhelming process. As a parent or caregiver, you are entering a new health care field, which comes with new terminology and jargon. In order to best understand your child’s needs, it is helpful to have a good foundation of what speech-language pathology is. Here are eight terms that you will likely come across when reading your child’s report or when talking with your child’s speech-language pathologist. Reference this list to get the most out of the information that you are given from your speech-language pathologist.
8 Terms to Know to Understand a Speech Language Evaluation:
1. Language is the system that you use to communicate your thoughts and feelings. The use of language can happen through several different modalities, using your voice, writing, or gesturing. There are three main components of language: Receptive Language, Expressive Language, and Pragmatics.
2. Receptive Language refers to your ability to understand language. Activities where you use your receptive language are when you follow directions, listen to a story, or when categorizing/grouping items. Learn about receptive language delay here.
3. Expressive Language refers to your ability to use language through speaking or writing. Activities where you use your expressive language include when you tell a story, answer a question or describe an item. Learn about expressive language disorder here.
4. Pragmatics is the last component of language and includes the social rules of communicating or how language is used within certain situations. An example of a pragmatic language skill is your ability to greet an unfamiliar person and learn their name.
5. Speech can also be thought of as vocal communication. It is the ability of the human voice to create a variety of sounds to form the words and sentences that we use when communicating. Speech itself is only a series of sounds, it is the language system that it is used with that gives your speech meaning.
6. Standardized Tests are used during speech and language evaluations due to the standard procedures laid out for the administration and scoring of these tests. The standardization of these tests eliminate environmental and clinician factors that could influence a child’s performance.
After standardized testing is completed a child will receive various scores. Two important scores to pay attention to are: Standard Score and Percentile Ranking.
7. Standard Score is calculated by standardizing a child’s raw score based on indicated method for that test. When standardizing a raw score, the child’s gender and age are often taken into account. Once a score has been standardized it can be compared to the continuum of scores of the typical population.
8. Percentile Rank also compares a standard score to the typical population by identifying the percentage of people who received the same or lower score than your own. For example, receiving a percentile ranking of 50 indicated that 50% of people who also took the same standardized test received the same score or a score lower than your own score.
The results from standardized and informal testing will guide your child’s speech-language pathologist recommendations for services. If services are warranted, these test scores and observations are used to identify areas of need and the child’s therapeutic goals. Every 3 to 6 months, re-evaluations are completed to assess your child’s progress through therapy.
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Does your child ever communicate without using words? Multimodal communication is simply communication through “modes”. Multiwhata? What did you say? Some examples of modes may be verbal, pictures, gestures, sign language, etc. Multimodal communicators use more than one “mode” to communicate.
In the high technology world we live in, we use many modes of communicating daily. Next time you have a chance, ask your cell phone provider how many text messages you send per month. Sometimes, verbally communicating is not the easiest way for us to communicate. A quick, “I forgot eggs for my recipe, can you get them on the way home?” text message is much more efficient than a phone call. The same concept holds true for children who are struggling to speak verbally. Sometimes, other forms of communicating are more efficient at meeting their needs.
“Wait a minute”, you say to yourself. “I want my child to communicate verbally, I don’t want my therapist to stop working on that and I’m afraid if they use one of these ways to communicate they’ll stop wanting to talk”. That’s a common fear of parents, but let me tell you it is a myth. Study after study continues to show that utilizing varying ways to communicate does NOT (I repeat does NOT) hinder or interfere with the development of speech. So why is your therapist talking about introducing all of these non-verbal ways of communicating? Your therapist only wants to alleviate your child’s frustration. The goal of your speech therapist is giving your child a way to communicate their needs and wants in a more efficient way. By teaching your child more than one mode of communicating in a systematic way, you are giving them a greater opportunity to express themselves.
Multimodal Communication and How They Can Help:
Signs: The use of specific hand gestures representing true words can help children to communicate what they want across environments. Signs are typically introduced first to children who are struggling to produce spoken language. Spoken words are a symbolic system, and when we speak we are exchanging “symbols” or words. This can help teach children how to exchange “symbols” or words in the absence of verbal language.
Visuals:Visuals are typically used for quick and easy communication for a specific purpose. For example, your therapist might introduce a YES or NO board to your child. This way, your child can easily communicate their response by pointing to their answer. Before your flags go off, this is a great way to teach the difference between yes and no before it can be used verbally. For children with difficulty communicating verbally, they often misuse the words yes or no. Some other quick visuals can be, “bathroom” or “break”. Another easy way to implement visuals at home is having pictures of items placed on or next to their corresponding real life representations. For example, in the kitchen have a picture of “food” posted on the refrigerator. These pictures are typically placed in an easily accessible place within a specific environment. These visuals can immediately alleviate frustration for children.
PECS: The Picture Exchange Communication System is form of communication where your child will exchange pictures for their desired items (hence the name). This is different from visuals. PECS is intended for use when communicating for a wide variety of items or actions and carried with the child across all environments. PECS is taught in many phases, by a trained PECS speech therapist, each one encouraging your child to become more and more independent with communicating. For children, this is often how they learn their communication and language is meaningful. Over time, this mode of communicating can alleviate frustration and teach children how to use communication to express themselves versus a meltdown.
Speech Generating Devices: These devices are typically in tablet form with a variety of “buttons” that have picture representations embedded within them. A child will then press their desired “button” for their desired object, and the device will produce the verbal output. There are many common misconceptions when talking about SGDs or assistive and augmentative communication devices. However, these devices that generate speech are specifically formatted for your child and can improve or increase verbal language output. Not only do these devices model language constantly, they can also continue to teach children how to use language.
I know that all of these alternative ways of communicating can seem overwhelming. Just remember, your child’s therapist is only trying to immediately alleviate the frustration your child feels in not being able to communicate needs and wants. It is okay for your child to use sign language and PECS, or visuals and an SGD, or any other combination of modes of communication. Studies show that when therapists introduce these modes of communicating early, children can increase vocalizations and improve overall speech abilities. Your child’s therapist will continue to model spoken word when using multimodal communication. Remember, spoken word will still be the target and utilized when teaching and using these alternative modes of communication.
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Building up a child’s self-esteem is important for all children within typical development, however this may require special attention for children with speech and language disorders. Self-esteem is important as it affects how a person feels about themselves and ultimately how they behave and act.
For a child with a speech or language disorder, maintaining a high self-esteem may be difficult.
In a study completed by Jerome, Fujiki, Brinton and James, it was found that children with specific language impairments have a significantly lower perception of themselves than their typically developing peers by the age of 10 (2002). This difference in self-esteem was especially evident in the areas of academic competence, social acceptance and behavioral skills. Being aware of a child’s vision of their own self-worth is important for all adults in a child’s life – parents, teachers, clinicians, etc. Low self-esteem could have a negative impact on a child’s social relationships, mental health and academic performance.
The classroom offers a unique and accessible environment to provide a child with positive interactions to improve his or her self – esteem.
Here are some simple tips to implement during your daily classroom life which may have a positive effect on a child’s self-esteem:
Make time for one on one interactions with the child. Demonstrate that you are actively listening. Maintain eye contact and acknowledge what the child says. These are important components of listening.
Provide positive praise for things the child does, whether the actions or big or small.
Educate other students on speech and language disorders. As a teacher, you could hold a peer educational day in order to increase children’s understanding of their peers.
Be a role model for other students by demonstrating how to communicate with someone who at times may be difficult to understand. Try to concentrate and be patient with the child. Set up positive social interactions between the child and an appropriate peer.
When possible try to decrease frustrations for the child by eliminating distractions and giving the child enough time to communicate. Speak with his or her speech-language pathologist to better understand the errors the child typically makes when communicating. Importantly, try not to finish the child’s sentences, rather than letting the child speak for him or herself.
If a child’s low self-esteem is judged to be significantly interfering with a child’s ability to perform in academic and social situations, additional steps should be taken. Observing a speech-language pathologist interact with the child may provide further suggestions for successful communication. Contact a social worker through North Shore Pediatric Therapy for additional support.
Reference: Jerome, A. C., Fujiki, M., Brinton, B., & James, S. L. (2002). Self-esteem in children with specific language impairment. Journal of Speech, Language, and Hearing Research, 45, 700 – 714.
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