Below are short summaries of information related to various speech and language topics pertinent to children. For more information on any of these areas or to make a request for a tidbit of information written on a topic of interest please contact us.
More information can be found on many of these topics in my e-Books.
What to expect in speech therapy
Speech therapists work on a variety of areas including sound production, language stimulation, oral motor/feeding skills, social use of language, voice, fluency, and more. Over the years the profession has expanded to include a variety of areas including, but not limited to, reading and phoneme awareness. If it is felt that a child needs speech therapy based on the child's speech/language evaluation, therapy will begin and will focus on the child's areas of need. First and foremost, the therapist needs to establish rapport with the child so that the child is comfortable and so that the therapist and child get to know each other better. The therapy sessions will focus on the areas of need. For younger children, therapy might be implemented more with a "play-based" approach, where toys and games are used to stimulate speech/language production. Note- this is different than just playing with the child. The interactions are aimed specifically at improving the child's goals. For older children therapy might include working on goals using play at times, but often with using more structured activities such as structured games and worksheets. Some children are seen for therapy individually, while other children are seen in groups, depending on the area of need. If the child is receiving speech therapy at school, the therapist often tries to incorporate academic focus and work with the teacher. Your child's speech therapist may also work with other professionals (such as occupational therapists, behavior specialists,etc) since other areas often influence progress. If your child is receiving speech therapy it is recommended to keep in contact with the therapist to both voice concerns and questions, and to be able to carryover at home things focused on in therapy. Parents, children, and therapists working together creates the greatest speech therapy experience!
Ideas to help the non-verbal child
Children that are non-verbal are sometimes highly frustrated due to their difficulty with communication. Many children that don't yet speak need work on earlier skills such as joint attention and a sense of cause and effect. Many children do well with using other systems to communicate while working on increasing their verbal language. Using pictures and sign language can be helpful. There are numerous ways to increase verbal language. Using routines/phrases/books with repeated elements can be helpful (such as "ready, "set", and then the child could be given the opportunity to fill in the "go" part). Imitating the child's own actions , words, and sounds can be helpful. Children often learn to imitate what they have already said before they can imitate something novel. Other ideas to help non-verbal children are to create a core vocabulary (words that are most functional for a child to say) and help the child practice those words. These words can be anything that is of high interest to the child and a book can be made with pictures of these items. Setting up the environment can also be highly helpful to create opportunities for children to communicate, Examples of this might be keeping a favorite toy in a closed box for the child to see (an opportunity for the child to say "help", "open",etc), blowing bubbles and then stopping and waiting for the child to say "more",etc and doing unexpected or incorrect things such as putting the child's sock on their hand instead of their feet,etc (as an opportunity for your child to say "no", "feet',etc)
Improving social skills
Social interaction skills can be difficult for children with language challenges. It is especially difficult for children with Autism Spectrum disorders.If your child has difficulty with social skills and you want them to interact better let them engage in an activity of high interest and also one that is easy for the child. For example, asking a child who has difficulty engaging socially and difficulty with playing sports to interact with others while playing sports could be a "double whammy". The child would have to engage in two very difficult tasks. It will likely be easier for the child to focus on social skills without having to play sports, which is also a difficult task. Have your child interact with a peer who has a welcoming personality and one whom you feel comfortable with. Have your child pick an activity that he/she is good at or has particular interest in. Make sure, however that the interest is not so specific or out of the ordinary that another child might not be interested. For example, another child might not be interested in listening to an hr synopsis on the planets. Help your child chose something that might interest other children, but that your child also has enough comfort with (ex- for a younger child it might be taking turn blowing bubbles, or for an older child maybe playing a simple board game) Again keep in mind that having your child try to interact in an activity that is stressful for them and with other children, which is stressful is putting on double pressure.Also try to practice the game first with your child by demonstrating taking turns, etc so that your child is prepared to do it with another peer.
Ideas to decrease drooling
Some of the children that we work with demonstrate oral motor concerns which have an impact on their feeding and speech clarity. One of these concerns is drooling. Awareness is an important factor for a child who drools. Some children need to be able to feel sensation better in and around the oral area. Activities which work on awareness of wet and dry are important. The child has to learn what wet is in order to be able to control the secretions. Some children that constantly drool aren’t even aware when they are wet. The child needs to be made aware of when the lips/face are wet and encouraged to dry the oral area. This can be done by the therapist in a very non-threatening way such as by having the child look in the mirror and saying “oops, wet mouth”, let’s dry, etc. The therapist can also wipe his/her mouth or use a doll. In addition to awareness, the child may need oral motor strengthening. The exercises can be geared to improving awareness and tone of the oral area. Bubble blowing, straw drinking, and horn blowing are good activities. The child can also be encouraged to eat chewy and crunchy foods and shown in the mirror how to clear the food with the tongue. Sometimes using something sour such as lemon ices may help the child learn to swallow. The therapist should be careful though with using sweetened foods, as the sugar may increase the drooling. Overall when working on decreasing drooling, the areas to address are awareness of wet and dry, strengthening, and learning effective swallowing.
A good resource for info on drooling is: How to stop Drooling- Practical Solutions for Home and Therapy by Pam Marshalla
Techniques for articulation:
Many of the children that we work with have articulation difficulties. Some children are able to learn sounds simply by watching your production. Other children need more cuing to help them learn placement, manner,etc. One thing that I have found helpful with young children when working on articulation is to name the sound such as /p/ is the “popping sound”, /m/ is the “yummy sound”, etc. Using visual cues such as hand signals are often helpful. An example of a visual cue I would use for /p/ would be to open and close the fist fast to represent the fast pop of the lips. For an /m/ you can run your finger across your lips to show the child that he/she needs to use his/her lips and that the sound /m/ is continuous (mmmmmmmmmmmm). Some children need tactile cues where you actually need to touch areas to cue sound production. An example of this would be for /m/ actually close the child’s lips together with your fingers (using universal precautions of course). No matter what sound or sound classes you are working on it is important to give the child an awareness of how and where that sound is made by using specific language (“close your lips, “use your tongue”, “put your lip on your teeth”, etc) Using a cue such as running your finger down a child’s arm for a continuous sound (ex,m,f,s) and gently tapping the child’s arm for a sound that stops (ex:p.t.k) can be helpful.
Ideas for carryover
When working on speech and language skills, carryover is very important. The child needs to be able to use the skills that they have learned with many people, and across many different environments, and the parents need to learn how to better stimulate their children’s skills on a regular basis. Working with young children on speech and language skills during play is very important. Through play, children are able to learn many concepts, ideas, and vocabulary and young children also tend to enjoy play activities. Play activities are highly stimulating for language; however, it is often difficult to carryover what is being worked on if the parent is not present for the session. This is especially true when the child is seen for speech therapy in a preschool setting. There are some things, however, that I feel have been helpful for carryover of skills. If you are engaging in play with the child try to write to the parent and tell the parent what toy the child played with and what was being worked on so the parent can have shared context with the child. A good idea is to take photographs of your toys and then to photocopy the photograph and send it home. This way the parent can see the toy that was played with and it can serve as a visual cue to remind the child what he/she played with in speech that day. The same idea can be used for book reading. Since in most cases the child can’t take the book home to show the parent, you could photocopy the cover, pages, pictures, etc of the book to send home. If the book is short enough, you could photocopy the entire book and staple it so that the child has a book of his/her own to take home. You can write to the parent as to how to use the book and the child can color in the pictures if they choose to. It is also a good idea to have a speech notebook. This can be any kind of notebook that the child can bring to speech with him/her. You can use this notebook to place activities in it (such as pictures of animals for the child to label, etc) and also to write notes to the parent. The parent can also use the notebook to write to you regarding any questions and concerns. The activities that you put in the notebook can be worked on at home by the parent. For some children with articulation difficulties I have had the parent use the last few pages of the notebook to keep a list of words that the child was having difficulty saying. You could also make a special sticker page to reinforce the child for doing good work.
Some ideas for food stuffing
As Speech Language Pathologists we are sometimes faced with children with difficulties with oral motor skills. At times the child’s decreased oral motor skills can impact on their speech clarity, as well as their feeding skills. Some young children stuff their mouth with food just by the nature of them being young and wanting to be done and on to the next thing! Some children’s food stuffing, however, is directly related to decreased oral motor skills and may give you clues as to the child’s oral sensory system. Children generally stuff food due to decreased oral motor awareness, and or to decreased oral motor skills. Children that stuff food generally need more input in their mouth. They may stuff the food to increase the oral input and may not feel the food well with only a little food in the mouth. Food stuffing may also be related to decreased strength. If there is only a little bit of food in the mouth the tongue has to make more precise movements to move the food, whereas if there is more food in the mouth, the movements of the tongue don’t have to be as precise. Some ideas to help children with food stuffing, and with oral motor awareness in general are to increase the input in the child’s mouth by having the child chew very chewy and crunchy foods, brushing in the mouth, increasing the taste or changing the temperature of the food to make the child more aware of the food in the mouth, and to work on tongue movements if the child’s food stuffing seems to be related to decreased strength or movements. Sometimes using cold and sour items with the child (such as lemon ices) is good to help the child become more aware of their mouth. To increase awareness of tongue movements, make sure to brush the sides of the child’s tongue. The parent can be encouraged to brush the child’s lips and tongue during tooth brushing time.
For helpful information on oral motor/feeding skills, look for information from:
Sarah Rosenfeld Johnson
Suzanne Evans Morris
Working with children with word finding difficulty
Some of the children that we work with have difficulty with understanding and expressing themselves with language. Some children’s expressive language abilities are compromised by difficulty with word retrieval. Children with word retrieval difficulties may have an adequate vocabulary, but may have difficulty retrieving the vocabulary they possess. This is different from children that have a limited vocabulary, where they appear unfamiliar with many names of objects, people, etc. Some children have a combination of decreased vocabulary and word finding difficulties. Children with word retrieval difficulty may be able to label harder words such as “alligator” but may have more difficulty naming easier words such as “dog”. I have worked with a few young children who actually stated “I can’t think of it”. Some children with word finding difficulties will label things using words that are close to the target word they are searching for and may be inconsistent in labeling the same object or picture, despite being able to label it before. Some children may be able to label words after a considerable pause time. Word finding difficulties may be evident both in single word vocabulary (such as when asked to name pictures or objects) and in conversational speech, where the child may have difficulty retrieving words to formulate conversation. Sometimes the child may look as if he/she is stuttering, when the child is really searching for words.
In general, children with difficulty with word retrieval need activities aimed at helping them “chunk” information and use the context to retrieve words. Some ideas are to give the child phoneme cues such as the first sound of the word (ex”pi/pig), work on categorization activities to help the child organize in their mind, use sentence fill ins (ex: I like bologna and cheese), and to work on word associations (ex: train goes on a track, salt goes with pepper,etc). Working on describing things is also helpful.
For more information on word finding difficulty feel free to search Dr. Diane German and Caroline Bowen.
Articulation- working on fronting
Many preschoolers that we work with demonstrate various phonological processes which interfere with intelligibility. Many of the unintelligible young children that I have worked with have demonstrated the process of fronting. Difficulty with production of /k/ and /g/ sounds may be related to oral motor issues, phonological issues, or a combination. When a child is fronting I often look at a variety of things. First, can the child discriminate front sound production from back sound production? If the child needs work in this area, I do a lot of discrimination work, and often use minimal pairs (tea/key, tar/car, etc) to help build awareness. The children can also try to produce the minimal pairs to help them see the difference in the production. Some children need oral motor work to help them with retraction of the tongue if the tongue is too far forward. Progressive horn blowing and drinking thickened liquids through straws to get better tongue retraction is recommended by Sara Rosenfeld Johnson. Some children need to be touched on different parts of the tongue to actually help them discriminate the back of the tongue from the front. If a child is very sensitive with touch on the tongue, you may need to work on oral motor touch inside the mouth. Some actual techniques that I have found helpful to achieve the back sounds are to have the child lie down to help gravity pull the tongue back, use a tongue depressor or lollipop to push the tongue down , and to try keeping the mouth wide open the entire time when producing the /k/ and /g/. I have also found it helpful to have the child use a cue to “touch his throat” (neck) to remember to make the sound in back of the mouth. Have the child watch how your tongue “jumps” in back of your mouth when you say the back sounds. I often also name the sounds as the “throat sound” or “back sound”. Sometimes working on /k/ sounds at the end of words is easier than in the initial position. When initially working with the back sounds in words, it is important not to use words that contain front and back sounds (ex”cat”, “take” ,etc) as this may make it difficult for the child. These words can be targeted at a later time. For some children, production of /k/ and /g/ is extremely difficult. If you have tried many techniques, and the child is still having significant difficulty with production you may want to abandon the focus on fronting and work on something that the child is able to get more easily. This will both help the child become intelligible faster, and decrease the frustration level. You can always reintroduce the back sounds at a later time.
Working with young children with Apraxia
Working with young children with motor planning difficulties can be quite challenging. I have found that many children with Apraxia are very frustrated with their difficulty in communicating. This can lead to a low frustration tolerance. It is important for the therapist to try his/her best to work on the child’s speech, while at the same time, boosting the child’s self esteem. Some children may need alternative or augmentative forms of communication such as sign language or use of pictures to supplement their communication. The child can be encouraged to communicate using multi-modalities. Verbal speech should be expected if the child is able to say the word fairly clearly. If the child is not able to clearly articulate, then the child should be encouraged to use sign or pictures to communicate, while working on building the verbal skills. Children with motor planning difficulties need to be taught progressively longer sequences of sounds and I have found it helpful for children to work on words that are most functional for the child. You can work with the parent to devise a list of words that would most help the child communicate his/her wants/needs. Then try to work with the child at getting to the closest approximation of the word that he/she can. When working with children with motor planning difficulties it is important to work on sound combinations vs. isolated sounds. As stated, I often find it important to work on functional words vs. nonsense ones. Once the child is able to produce various cv combinations (ex:”ma”), you can then have the child produce cvcv combinations to make words (ex: mommy (ma,me)). Use of visual cues and hand signals (ex: opening and closing your hand for a p sound) has been found to be helpful for Apraxia. Some resources for Apraxia that have been helpful to me are as follows:
-Nancy Kaufman- I attended her conference on Apraxia- was very informative!!
“Becoming Verbal and Intelligible” by Dauer, Irwin, and Schippits
Some ideas for working with early intervention
Working with children who are very young can be challenging. Toddlers often have decreased attention spans and can be active. If you are in a home setting it may be difficult to contain a young child. If you are unlucky the child may try running all over the house. I have had this before!!! Some therapists will do some, or all of the session with the child sitting in his/her highchair. This works for some children because it could keep them in one spot. Other children may be very unhappy with this. I had one child who screamed “down” for most of a session. The child felt too confined this way. Another idea is to work with the child on the floor, but to designate a specific area for playing games, activities, etc. An example could be a blanket or mat that is placed on the floor. This then becomes the area that you “play” with the child in. The child may begin to learn that they need to stay in that area if they want to do fun things with you. The mat or blanket could give the child a sense of a boundary. Children’s attention spans are short at young ages, so plan to have a variety of toys available and things involving movement may be great such as action games (“Ring around the Rosy”,etc), finger plays, etc. If you have access to the child’s toys, you can use them in therapy as well. Some children are more willing to engage in therapy when using their own toys. Also, you can make almost any activity language stimulating. I had a child once who had a very difficult time cooperating during sessions, but imitated so much language when I went out with her on her playground. Be creative with the little ones and things may become easier!!
Working with preschoolers on fluency
It is sometimes difficult to determine whether a child’s stuttering is developmental or more of a problem. It is typical for some children to stutter during the preschool ages. This is a time for much language development, which can influence children’s smoothness of speech. Some factors to consider are how long the child has been stuttering, if the child is aware of it, are there any secondary characteristics such as eye blinking or body tension?, and is there any family history of stuttering. Some children need direct therapy and many need environmental modifications. Therapists should encourage the child’s parents and teachers to speak in an easier, calmer manner and to provide a slower speech model rather than interrupting the child or telling the child to slow down. The environment needs to allow for turn taking for all children so that the child does not feel that he/she is rushed in speaking. Siblings need to be encouraged to take turns speaking. The parents need to be encouraged to create as calm of an environment as possible, though the therapist has to understand that this isn’t always easy. If you work on therapy directly with the child, therapists need to encourage easy talking by possibly equating talking easier like a turtle or snail while comparing talking faster like a rabbit. Children need to learn to use their speech helpers (lips, tongue,etc) in easier ways. Therapists can equate this to talking like a “marshmallow”, where everything is loose, compared to talking like a rubber band, where the speech helpers are tight. Therapists can emphasize that the child’s stuttering is “no big deal” and should react calmly when the child stutters and try to rephrase what the child was trying to say calmly. Therapists are encouraged to obtain more information on dysfluency and young children, and conferences are available on this topic.
For more information on fluency search for Kristin Chmela.
Working with children on augmentative communication:
Acquiring verbal speech is the ultimate goal for all children. For some children, however, becoming verbal may either not be possible, or might be a very slow process. These children often need alternative or augmentative forms of communication to help them communicate. Augmentative communication can take various forms including communication devices, use of picture systems, use of sign language, and, or, use of a gestural or written system. Each of these systems come with advantages and disadvantages, and one system may be right for one child and not for another. It is important that therapists and parents work together on developing a system of communication that will allow the child to achieve their fullest potential. Many parents express fear of using alternative systems, worrying that these systems will inhibit speech production. The opposite is actually true. Research has shown that using other systems actually enhance the development of spoken language. Every child will develop verbal language at their own rate. What is most important is to give the child a way to communicate, and therefore decrease the child's frustration.
To briefly summarize these systems:
Sign language- sign language is the use of a gestural/sign system where the child communicates messages with their hands/body. The advantages to this system are that the child does not need any extraneous device or pictures to carry around with them and some children learn signs more easily than others. The difficulties of using sign language are that the communication partners need to be trained in the signs, and also some children with motor planning issues with their body have more difficulty using signed systems.
Augmentative devices- these devices come in varied forms such as voice output, use of picture overlays,etc. The child may be able to communicate a variety of messages with a computerized device, therefore, many devices have opportunities for the child to learn a vast amount of language. Difficulties with these devices might be cost, training, and portability. It is recommended that another form of communication is used as backup, should the device not be available, not working properly,etc
Picture Communication- picture systems can be taught to children in various ways. Some children can learn to communicate by pointing to pictures of what he/ she wants,etc. Other children are encouraged to exchange pictures for desired objects/items (Picture Exchange System by Frost and Bondy). Many children are able to use picture systems as either an alternative, or a supplement to their development of verbal language. The difficulties with these systems can be training. and having many pictures readily available.
*** note- some children with unintelligible speech can also be trained to use augmentative systems while they work on improving their speech clarity.
Working on behaviors and attention and sensory problems:
Working with children in general can be a challenge, but speech and language intervention becomes particularly challenging with children with behavior and attention issues. The therapist often has to work on these areas before doing more structured activities. When the child is more focused and has less interfering behaviors they are more readily available for learning. Strategies aimed at increasing attention and improving behaviors and sensory functioning can help children significantly. If the child is experiencing severe behavior issues, which are felt to be beyond what the therapist or parent is able to deal with comfortably, consulting with a behavior person, psychologist is recommended. If the child is experiencing issues which appear to be sensory related (examples: difficulty with touch, being very under or overstimulated), consult with an occupational therapist who deals with sensory issues is recommended. (Sometimes it is difficult to determine whether something is related to a behavior issue or to something sensory therefore, these professionals can help to determine what is causing a particular behavior and treat it accordingly). Some ideas to help the child function better and be more readily able to take a more active part in therapy are as follows:
-give the child warning time so they know what is happening next, how much time they have until they are done,etc- can use a picture board, a timer,etc,or a counting system- (5. 4. 3. 2. 1. finished,etc)
-mix hard tasks with easier ones so that the child gains success at easy things and is more willing to attempt harder ones
-mix quiet sitting with times of moving around, jumping, etc to give the child opportunities to get out energy
-use a reward system where the child knows what they are working for- anything can be used that motivates the child
-write stories with the child (at their level) that discuss behaviors and provide the child with an idea of what they SHOULD DO vs what they shouldnt do. (see Carol Gray social stories)
-provide the child with a schedule of activities that they can see visually so that they know what they are doing now, what is coming next, and when they are finished.
-provide a box or something similar for the child to put items in when they are finished (labeled with a picture or with the word "finished" or "done")
-positively reinforce any good behavior by being specific and giving much praise for even the little things!! (ex- "wow you sat so nicely today", "wow you got 3 baskets in- you are the best basketball player!",etc)
Working with children with Autism Spectrum Disorders:
Working with children with Autism spectrum disorders can be quite challenging. I personally find it one of the most challenging, yet at the same time rewarding experiences. I have a particular passion for this population!! All of the areas discussed in the tidbit of info "Working on attention and behaviors and sensory problems" can be used with children on the Autism spectrum. Children with Autism or related pervasive developmental disorders may need significant help with behaviors, attention, and sensory challenges, and working with a team of professionals to address all of these issues is most valuable. What might differ with children on the spectrum, vs children with more typical speech and language difficulties is the intensity of needs in the above areas. Children with Autism Spectrum disorders often need significant help in the areas of language and social skills. The following are some ideas to improve these areas:
- the child with Autism may demonstrate echolalia (repeat what is said to them either immediately or after a period of time) Some children demonstrate more echolalia as a means to take a turn in a conversation when they are unsure of how to do so, or as a response when they don't comprehend what is asked of them. It is recommended to provide a language rich environment, but to decrease any unnecessary verbalization. One thing that is helpful is to repeat back what the child just did successfully rather than saying "good job" (the child may repeat "good job" back to you) Example- if the child just labeled a dog correctly reinforce by saying - "dog" ( in a voice of praise) so that the child might repeat the word dog. If you say "good job" the child may then repeat back "good job" numerous times
- the child with Autism often needs visual cues for activities and behaviors. Many children benefit from using pictures and written words but children with Autism seem to benefit hightly. Examples of using visual cues include picture or written schedules, use of tokens (happy faces,etc) to work toward desired goals, and written or picture rules of what the child SHOULD be doing (ex: sit down (with a picture of a person sitting), "quiet"- with a picture of someone being quiet,etc) The directive should always be phrased as what the child SHOULD be doing vs: "DO NOT get up", etc.
- the child with Autism may demonstrate behaviors that can be either disruptive or viewed as "strange" or "peculiar". Some behaviors which are considered self stimulatory (hand flapping, clapping, spinning,etc) may be necessary for the child and may be able to be shaped into more appropriate behaviors. For example, a child who continually claps or snaps might be able to transfer those skills to using musical instruments, etc. A child obessed with playing with strings might be able to transfer that behavior to playing with a doll with "stringy" hair,etc.