help your child with stuttering

Stuttering-How to Help Your Child at Home

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When you first notice your child stuttering, it can be very worrisome. Will he grow out of it? Should I take him for a speech-language evaluation? Why is it happening? First, let’s look at what is typical versus atypical stuttering in young children.

Typical

  • During language development, young children occasionally repeat syllables or words one to two times. For example, “I, I want to play.”
  • Children may hesitate when speaking and use fillers such as “um”, “er”, “uh”.
  • Disfluencies come and go. Your child may stutter for a week and then it goes away completely. This is an indication that your child is learning to use language in different ways.

Atypical

  • Syllables, words, or sounds are repeated more than once or twice. For example, “I, I, I, I want to play” or “I w-w-w-want to play”.
  • Your child starts their utterances with fillers (“uh”, “um”, “er”) versus using them withing her sentence. For example, “Um, um, uh, I want to play.”
  • You may notice tension in your child’s facial muscles and/or neck.
  • Your child may experience a “block” – this is when your child attempts to say something, though there is no airflow or voice for a few seconds.
  • Disfluencies may continue to come and go; however they are more present than absent.

Whether you feel your child’s stuttering is typical or atypical, there are several strategies that you can use at home to promote fluent speech:

1. Model, reinforce, and praise healthy conversation skills during 2-3 structured times per day. Healthy conversation skills include:

  • Encouraging “thinking time” to increase time needed for language formulation
  • Speaking at normal to slow normal rate to model easy, relaxed speech.  Easy, relaxed speech: elongated vowels in words, smooth transitions between words, and lots of pauses between sentences.

2. Reduce the quantity of talking to ease the pace of communication and allow your child to take his time in formulating what he wants to say.

3. Try not to pressure your child with questions. Instead, comment on what he is doing.

4. During moments of disfluency:

  • Continue to allow your child to finish his thought/idea
  • Rephrase his thought/idea back to him using easy, relaxed speech.

5. Reinforce communication by praising your child’s attempts at communication. For example, “I like the way you told me that!”

6. Avoid commenting on “bumpy” consistency of speech disfluency.  Instead, model more fluent speech and healthy ways to communicate.  Reinforce what is going well.

Click here to download your free stuttering and fluency checklist!

speech and language through reading

How to Use Books to Promote Language Development in Babies and Toddlers

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Books are a fantastic way to stimulate learning and language development with your baby or toddler. Books provide a way to introduce new vocabulary, increase attention spans, inspire their imaginations, and the best part – reading books with your child is a great bonding experience.

Here are some general tips to consider when reading with your baby or toddler:

Match your child’s language level-Simplify or shorten sentences to match what your child can understand and/or produce.

Be animated!

  • Vary your intonation
  • Use facial expressions and gestures
  • Use sound effects (i.e. animal noises, “whee!” “whoosh!”)
  • Stress key words

Show them what you’re talking about by bringing their attention to the page-Point to pictures.

Choose books with fun pictures, animals, numbers, letters, etc.

  • Open flaps, put fingers through holes, press buttons
  • Point to the printed word
  • Demonstrate verbs with actions or gestures

Slow it down.

  • Read at a natural rate
  • Encourage turn-taking – give your child a chance to point, say a word, open the flap, or turn the page

Establish joint attention.

  • Pick books with your child’s interests (i.e. favorite characters, things to do)
  • When your child makes sounds or points, imitate or join in
  • Look at the book and look towards your child when reading to show you’re interested in both the book and them!

Reading is a great time to encourage learning and language development, but also a fantastic time to bond with your child. Remember, make it fun!

Here is a list of books that are some of my personal favorites:

  • Brown Bear, Brown Bear – Eric Carle
  • The Very Hungry Caterpillar – Eric Carle
  • Go Away, Big Green Monster – Ed Emberley
  • Goodnight Moon – Margaret Wise Brown
  • Hippos Go Berserk! – Sandra Boynton
  • Cars and Trucks and Things That Go – Richard Scarry
  • Peek-a-Who? – Nina Laden
  • My First Word Book – Angel Wilkes
  • Don’t Let the Pigeon Drive the Bus – Mo Willems, or any Mo Willems books, they’re very silly!

Click here for a list of toys to develop language skills in babies and toddlers.

 

toys to elicit language

Toys to Elicit Language from Birth to Three

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Your child’s first three years of life are the most intensive period for speech and language development. Children learn through modeling, imitation, and most importantly; through play. Below are some examples of toys that will help elicit language and communication in your child. It’s important to keep in mind that these toys will not teach your child language all on their own; your interaction with your child while using the toys is where the magic happens. Narrate your actions, take turns, label nouns and verbs, and HAVE FUN!

Toys to help elicit language in your 0-3 year old:

Interactive Toys/Turn-taking

  • Drums
  • “Microphones”
  • Slinky
  • Ball Tub
  • Mirror

Toys for Requesting/Joint Attention

  • Puzzles
  • Blacks
  • Wind-up toys/Light-up toys
  • Bubbles
  • Balloons

Toys to Target Sounds, Single Words, and Phrases

  • Books
  • Stuffed animals (think farm animals and animal noises)
  • Barn with animals
  • Baby doll/puppet
  • Hygiene items (e.g., toothbrush, washcloth, etc.)
  • Clothing for doll/puppet
  • Dish set
  • Stroller
  • Doll House
  • Car Wash
  • Basketball + hoop
  • Cooking set + food
  • Grocery cart
  • Train set
  • Cash register
  • Play-doh and accessories
  • Doctor set

Click here for 3 tips for promoting speech and language in your 0-3 year old.

is direct speech therapy necessary

Is Direct Speech-Language Therapy Really Necessary?

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In the wake of recent news articles espousing a position that speech-language therapy can be implemented at home through apps and other forms of technology, many parents may wonder, Do I really need to bring my child to the clinic? The answer is: YES!
Apps and other activities can be helpful to supplement and support individualized intervention. However, they should not be used as a substitute for one-on-one speech-language therapy. Oftentimes speech-language pathologists (SLPs) will incorporate apps into therapy sessions to serve as motivators and to provide new materials.

See below for the top 5 reasons that direct speech-language therapy is best:

1) Individualized approach: Direct intervention conducted by a licensed SLP is tailored specifically to each child’s individual needs. Clinicians determine each child’s goals and create treatment plans to target these goal areas. Apps rely on a “one size fits all” approach, and while that may be helpful for some children, others will continue to struggle. If children, for example, are working on an /r/ sound, apps won’t teach the various ways to make an /r/, they will provide word lists and sentences for practice. A licensed SLP can determine which manner of production works best for an individual child and then use apps to create word lists.
2) Diagnostics: SLPs evaluate every new child prior to starting therapy. This process may assess speech, language, or both, in order to determine areas of need. Parents may not be aware of typical speech and language milestones and at what ages they should be concerned. A thorough evaluation conducted by an SLP can outline a course of treatment and determine goals for therapy sessions.
3) App selection: With millions of apps available, it can be daunting to pick the best apps to target specific goal areas. Incorporating apps out of the clinic to increase carryover of skills can be a great way to practice target words in a fun and motivating manner. In order to ensure that apps are appropriate and target areas of need, an SLP can provide families with suggestions and explicit instructions on how to use them. For example, apps for articulation are often broken down by sound into initial, medial, and final positions. If a child is working on initial /s/ at the word level (e.g., sea, soup, sink, sand, etc.), it may be too challenging to practice /s/ sounds at the sentence level (e.g., Sally sells scissors at the sea).
4) Feedback & cueing: During sessions SLPs are constantly modeling appropriate production or language for clients to imitate. When clients, for example, produce a distorted /s/, SLPs are able to provide verbal, visual or even tactile cueing to help with accurate tongue placement. This feedback ensures that children don’t practice sounds in error, further hindering progress.
5) Expertise: SLPs are master’s-level educated individuals who work with children (and adults) to improve communication. SLPs are licensed both by the state in which they practice and the American Speech-Language-Hearing Association (ASHA). This expertise allows children to receive evidence-based treatment and helps to educate parents throughout the therapy process.
The benefits of combining technology into therapy sessions and supervised home programs are immense. Apps and other technologies can serve to motivate children, track progress, and provide accessible ways for parents to help build skills!

Click here for a list of great speech and language apps to supplement your in-clinic therapy service!

speech therapy carryove activities

Speech-Language Carryover Activities

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Speech-language pathologists (SLPs) and other clinicians will often give clients homework to complete before the next session in order to increase carryover. Carryover, or the idea that skills learned in the clinic will be transferred or generalized out of the clinic, is important in a variety of therapeutic disciplines. Increased practice and more time spent focusing on a skill will improve a child’s abilities and rate of mastery.

Carryover activities:

  • Homework: Completing homework sent home by a therapist is a great way to spend structured time practicing a skill. Oftentimes, this homework will include words or sentences with target sounds for children working on articulation. Homework may including writing prompts for older clients, or worksheets to practice goals outside of the clinic.
  • Book reading: Books can be a great way to increase carryover. For children working on language goals, possibly including sentence structure, wh-questions, sequencing, auditory comprehension and a variety of other goals, SLPs may recommend that parents simply read to their children. During book time, parents will be encouraged to stop frequently and ask children questions about characters, events, etc. This can help children improve their language skills and be a fun activity for parents and children!
  • Craft projects: Parents can use craft projects to increase carryover outside of the clinic. Working on crafts can help target following directions, appropriate sentence structure, as well as focus on a specific theme to increase vocabulary.
  • Modeling: Parents simply modeling their own appropriate speech and language for children can help children work toward their goals. If parents, for example, practice using a slow rate, children will learn to copy their parents’ rate of speech which may increase intelligibility.
  • Recasting: Parents can recast their child’s utterance by correcting and emphasizing changes for any errors noted. For example, if a child says, “he walking,” parents can recast by saying, “You’re right! He IS walking.”

Helping children with carryover outside of the clinic will help progress through goals in the clinic. Frequently working on target words/sounds and other areas throughout the week will help children improve faster and meet their goals!




Child speeking

Defining Speech-Language Diagnoses

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Navigating the world of pediatric therapies can be a daunting and overwhelming challenge for many parents. Oftentimes, parents, caregivers, or even pediatricians notice changes in a child resulting in the need for an evaluation by a pediatric therapist. A pediatric speech-language evaluation is comprised of 3 parts: parent interview, assessments, and feedback following assessment.

 

SPEECH-LANGUAGE DIAGNOSES: WHAT DO THEY MEAN?

Following the initial evaluation, your child may receive a diagnosis from a licensed speech-language pathologist. Here’s a breakdown of many common diagnoses:

Language Disorder: A language disorder is characterized by difficulty with one or more aspects of language, including receptive, expressive, and pragmatic language. Children with a language disorder may have difficulty formulating sentences, following directions, using appropriate verb tenses, or asking/answering questions. The language disorder umbrella also can include late-talking toddlers.

Articulation Disorder: An articulation disorder occurs when a child has difficulty with place, manner, or voice of production for a given speech sound. Some errors in articulation are expected, Child speekingdepending on a child’s age and which sound he is trying to produce. For example, between two- and three-years-old, a typical child will master /p, b, m, n, h, d, t/ sounds; the same child, however, would not be expected to accurately produce an /r/ sound until closer to 7 years old. Common articulation errors include a “lisp” or other distortions with /s/ and /z/ sounds.

Phonological Disorder: A phonological disorder also pertains to speech sound production, however, these children substitute one sound for another. This predictable pattern of substitution occurs at different ages for many children, and may include substituting /w/ for /r/ sounds (e.g., “wabbit” for “rabbit”), or /f/ for /th/ sounds (e.g., “fumb” for “thumb”).

Fluency: Fluency disorders or “stuttering” commonly occur when an individual has whole and part-word repetitions (“can, can, can I have the iPad?”), prolongations (“s-s-s-s-s-sister”), or blocks, which are silent stops during connected speech. Some children will also demonstrate secondary behaviors including grimaces or tension in their face and/or neck.

Childhood Apraxia of Speech (CAS): This disorder also impacts how a child produces sounds. Children with CAS know what they want to say, but they have difficulty coordinating their muscles and articulators to accurately produce sounds. There is, in other words, a disconnect between a child’s brain and mouth to plan the movements for speech sounds.

Voice Disorder: A voice disorder is characterized by anything that disturbs or alters one’s regular voicing (talking). This may be the result of vocal abuse or misuse, including: yelling, gastro-esophageal reflux, or excessive coughing or throat clearing. Allergies and other environmental factors may also contribute to a voice disorder.

Depending on the severity of difficulties that your child is having, a Speech Language Pathologist might recommend one to two times per week for therapy, or even more.

 

Child with speech bubble

How To Improve Speech Intelligibility

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It can be frustrating for both parents and child when a child’s language is difficult to understand! During preschool and school-age years, a child’s language is expanding and he is using more words to request, exclaim, and to label. Parents will often guess at what their child is saying, and unfamiliar adults may rely on parents to decipher their child’s speech. Many times children will throw tantrums or give up when trying to communicate. See below for some helpful tips to improve your child’s intelligibility and your understanding!

Rate: An increased rate of speech leads to more words blending together and doesn’t always give the listener enough processing time to take in all of the information. If your child has an increased rate of speech, encourage him to slow down and try again. Multisyllabic words may get simplified (e.g., “tephone” for “telephone”), leading to further difficulty for the listener. Modeling your own slow rate will allow your child to match your speech.

Volume: Using appropriate volume depending on a situation may help to improve intelligibility. Oftentimes children’s voices will be too loud or too soft, making them difficult to understand. Contrast different volumes with your own voice (no voice, whisper voice, inside voice, outside voice), and allow your child to pick the appropriate volume based on a situation.

Speech sound substitutions and errors: Sound substitutions, omissions and errors frequently impact a child’s intelligibility. There are set milestones for speech sound acquisition, however substituting one sound for another (e.g., saying “wing” for “ring” or “fumb” for “thumb”) can leave parents guessing at what their child is saying. In these cases, parents can model accurate sound production (based on age), and overcorrect, or emphasize target sounds.

If a child continues to struggle with speech intelligibility and either child or parent is getting frustrated, a licensed speech-language pathologist can help!


 

Child speeking

Childhood Apraxia of Speech: What Is It?

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What is it?

Apraxia of speech is a motor speech disorder caused by a disruption between the planning of muscle coordination in brain and the body parts needed for speech (e.g., lips, tongue, jaw). It is not due to muscle weakness or paralysis. A child with apraxia of speech knows what he wants to say, but their brain has difficulty coordinating the oral movements needed to produce and combine sounds to form syllables and words.

What does it looks like?

Childhood apraxia of speech can look different in each child. Not every child show all of the signs and symptoms of apraxia. The following is a list of potential indicators that your child may have apraxia of speech:

  • Little to no cooing or babbling as an infant
  • Limited imitation of syllables and/or words
  • First words occurring after 18 months of age
  • A two-year old who:

o   is non-verbal

o   uses non-speech sounds without any word approximations

o   uses gestures, rather than words, to communicate

o   becomes frustrated around communication

  • A child who is able to produce single words clearly, though becomes unintelligible in phrases or sentences
  • A child who deletes sounds from words after age three
  • A child who has previously said a word clearly, though cannot imitate it when asked
  • Family members often have to interpret for the child

How is it diagnosed?

An audiologist should complete a comprehensive hearing evaluation to rule out any potential hearing loss.

A certified speech-language pathologist will complete a comprehensive speech-language evaluation. This will assess your child’s oral-motor abilities, speech sound development, and language development.

Childhood apraxia of speech is a differential diagnosis, or a diagnosis that is made by examining all the possible causes for a set of symptoms in order to arrive at a conclusion. Due to this, an official diagnosis of apraxia may not be made right away. It is important to rule out other potential causes for your child’s speech difficulties before coming the apraxia diagnosis, such as phonological disorders. However, it should be noted that with or without a diagnosis your child will still receive effective therapy to improve their overall communication skills.

What treatments are available?

Research has shown that frequent (3-5 times per week) and intensive speech-language therapy yields more successful results. Furthermore, individual therapy is more successful than group therapy for children with apraxia. Improvement in the planning, sequencing, and coordination of oral muscle movements is the main focus in intervention. Visual and tactile cues, such as tapping on the arm or looking in the mirror, provide multi-sensory feedback which helps to improve the child’s coordination and production. The most important piece in therapy for apraxia is practice; both in therapy and at home. The treatment of apraxia takes time, patience, and commitment. A supportive environment is crucial so your child can feel successful in their communicative interactions.

If you have any questions regarding childhood apraxia of speech, contact one of our speech-language pathologists today!





5 Warning Signs That Your Toddler May Need Speech-Language Therapy

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It is such an exciting time when children are first acquiring words; they can begin to express wants and needs, communicate with parents, and begin to label objects in sight. Most children will begin to speak their first words around 1 year of age, but what happens if they don’t?

Don’t panic—children progress through language milestones at different rates. Some children will start talking before 1 year of age, and others may begin a few months after. There is a typical pattern of development when acquiring speech, but this pattern may vary widely from child to child. See below to identify 5 warning signs that your child may benefit from intervention.

Warning Signs Your Toddler May Need Speech-Language Therapy:

  1. Number of words: If your child is approaching 2 years old and is using fewer than 50 words to communicate, he may benefit from an evaluation to determine the need for speech therapy.
  2. Understanding: By 2 years of age, most children should understand approximately 300 words. Parents can monitor their child’s understanding by giving simple directions, for example: get your shoes, get your coat, want more juice?
  3. Combining words: After your child acquires his first 50 words, he should begin to combine words when making requests. For example, your child may say, “more ball,” and “my truck.”
  4. Frustration: Oftentimes when children are delayed expressively, some will exhibit signs of frustration when communicating, including tantrums and hitting themselves and others.
  5. Play skills: Children showing difficulties with the acquisition of speech and language may also have difficulty with appropriate play skills. By 2 years old, children should begin to play away from their parents, and use most toys for their intended purpose.

If your child is exhibiting any of these warning signs, they may be a late-talking toddler.  A licensed speech-language pathologist can help! Parents may want to “wait and see” if their child will “catch up,” however the most successful intervention begins early, as soon as parents notice a delay. A speech-language pathologist will work both with the child and his family to help boost speech and language skills in order to maximize the child’s potential.

Click here to view our speech and language milestone infographic.

What to Expect from Your Pediatrician during a Speech/Language Checkup

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When parents develop concerns about their child’s speech and language, the first person they typically ask for help is the pediatrician. At the 15 month and 2 year checkups, discussing concerns with your pediatrician is a great way to get more information. Your pediatrician will take a close look at your child’s physical health and the major milestones achieved.

To make this easier, keep track of speech and fine/gross motor milestones and at what age they develop.

As a general rule, here are the ages at which your child should be achieving these steps:

Language

 

Gross Motor

 

Fine Motor
Babbling 6 months Rolling 4 months Objects to midline 4 months
Gesturing to indicate want 9 months Sitting Independently 6 months Raking grasp 7 months
Following 1-step commands 12 months Crawling 8 months Finger feeds 7 months
First words 12 months Standing 9 months Pincer fingers 9 months
Combining words 24 months Walking 12 months Spoon use 15 months
Says name 35 months Running 15 months Cup use 15 months

Additionally, it is important to discuss frequent ear infections with your pediatrician. An ear infection is fluid buildup in the middle ear, essentially muffling all speech/language your child is exposed to. If your child cannot hear clearly, he will have difficultly acquiring new language. If your child is prone to chronic ear infections, discussing PE tubes may be the next step to ensuring your child develops speech and language.

If your pediatrician recommends a speech pathologist or an audiologist, read here for what to expect during a speech screening or evaluation.  If you have immediate concerns, contact a speech pathologist for a screening today.