Language Disorder or Language Difference/Limited Proficiency?

Language Disorder versus Language Difference

A language disorder is a significant discrepancy in language skills relative to a child’s age or developmental level. A language difference is a rule-governed language style that deviates from standard usage of mainstream culture.

Children from different cultural backgrounds who are English language learners (ELLs) CAN have a language disorder; however, many ELL children who are referred for a speech-language assessment simply have limited English proficiency. These children have average proficiency in their native, primary language as compared to proficiency in English. As a result, many children are misdiagnosed with a language disorder. It is important for professionals to determine at what stage the child is in terms of being fully competent in English.

Basic Interpersonal Communication Skills versus Cognitive Academic Language Proficiency

Children at the Basic Interpersonal Communication Skills (BICS) Stage can use vocabulary that are frequent in the language (English, in this case), produce more or less appropriate grammatical sentences, and can engage in everyday conversations about familiar events and objects. According to Paul and Norbury (2012), it is estimated that it can take a child an average of 2 to 3 years of exposure to and experience with English to achieve BICS. It is important to remember that children at the BICS stage, while appearing to be fluent in English, will present with difficulties succeeding at the academic level and therefore, appear to have a language-learning disorder. Children at the BICS stage will present with difficulties reading higher level texts that require adequate comprehension, producing written discourse (i.e. argumentative and compare/contrast essays), using and understanding subject-specific (i.e. science) vocabulary, and engaging in cognitively demanding communication.

According to Paul and Norbury (2012), it is estimated that to achieve Cognitive Academic Language Proficiency (CALP), it can take at least 5 to 7 years.

Despite what stage your child is at, your child CAN present with a language disorder if it is also present in your child’s native, primary language. If there is a language disorder present in the native, primary language, your child may present with difficulty moving past the limited English proficiency/BICS stage. 

How can I determine if my child has a language difference or a disorder?

With careful assessment, a speech-language pathologist can reveal a language difference or disorder. It is important to reveal whether there is a language disorder present in the child’s native language; therefore, an initial evaluation in the child’s native language is pertinent to determining if it is a lack of proficiency in English or if there is a disorder present.

What are some examples of language differences?

The child (or adult’s) native language can have an influence on English. See below for some general examples:

  • Spanish-Influenced English
    • Verbs
      • May leave off the regular past -ed on verbs
      • Copula may be produced as “have” such as “I have 10 years versus “I am 10 years old”
      • Future tense go + to, such as “I go to have dinner” versus “I am going to have dinner”
    • Nouns/Pronouns
      • Possessive markers substituted by prepositional phrases: “the doll of my sister” versus “My sister’s doll”
      • Possessive markers substituted by articles: “I cut the arm” versus “I cut my arm”
      • Plural s (dogs, cats, hats) omitted
      • Articles (the, a, an) often omitted
      • Subject pronouns may be omitted: “John is sick. Got flu” versus “John is sick, he has the flu”
      • The word “more” is used as a comparative: “He is more tall” versus “He is taller”
    • Negatives
      • “No” replacing “don’t” such as “No go too fast” versus “Don’t go too fast”
      • “No” replacing “not” such as “She no go to work” versus “She is not going to work”
    • Questions
      • “Do” is optional: “You want some?” versus “Do you want some?


  •  Asian Languages and their Influence on English
    • Verbs
      • “to be” verb omitted or improperly used: “I is going” or “I going”
      • Auxiliary “do” may be omitted or improperly used: “He not going” or “He do not go”
      • Regular past tense -ed may be omitted or overgeneralized: “I have eat” or “I have eated”
      • Errors with noun-verb agreement: “You goes” versus “You went”
    • Nouns/Pronouns
      • Plural -s may be omitted or overgeneralized: “two dog” or “the sheeps”
      • Errors with possessive markers: “him book” versus “his book”
      • Errors with comparatives: “he is gooder” versus “he is better”
    • Negatives
      • Double marking: “I didn’t hear nothing” versus “I didn’t hear anything”
      • Simplified marker: “He no want” versus “He doesn’t want”
    • Questions
      • No reversal of auxiliary verb: “You are going?” versus “Are you going?”

(Paul, R. & Norbury, C., 2012)


If you believe your child has a language disorder and does not present with a language difference or simply limited English proficiency, it is important to schedule an evaluation with a speech-language pathologist. 



— Amanda Hammer, M.A. CF-SLP, TSSLD



  • Paul, R., & Norbury, C. (2012). Language disorders: From infancy through adolescence: listening, speaking, reading, writing, and communicating (Fourth ed.). St. Louis, MO: Elsevier.

Facilitating Pronoun Use

What is a Pronoun?

A pronoun is a word that is used to replace a noun or noun phrase. There are many different types of pronouns:

  • Objective: Receives the action of the verb
    • My father bought me a car.
    • The doctor gave you a shot.
    • The clown gave her a balloon.
    • Take a picture of him.
    • He bought it.
    • My parents bought us a cake.
    • He went to the museum with them.
  • Subjective: Performs the action of the verb.
    • dropped my hat.
    • You jumped on the trampoline.
    • He ate an ice cream cone.
    • She danced in the rain.
    • It fell off the counter.
    • We went to the movies.
    • They went on a school trip.
  • Possessive: Assigns ownership
    • The flowers are mine.
    • The book is yours.
    • The phone is his.
    • The camera is hers.
    • Its petals are falling off.
    • The house is ours.
    • The baby is theirs.

It is important to not confuse possessive pronouns with possessive adjectives (i.e. my house is blue). Possessive pronouns are used to replace the noun, while possessive adjectives are used to describe the noun. 

  • Reflexive: Refers back to the subject
    • I bought myself a camera.
    • You should give yourself some medicine if you’re sick.
    • My brother dressed himself this morning.
    • She smiled to herself.
    • The door locks by itself.
    • We have the house to ourselves this weekend.
    • The children occupied themselves during recess.
  • Demonstrative: Points to something specific in a sentence
    • That is a good idea.
    • This is tasty!
    • Those belong to my father.
    • These are very comfortable.

Estimated Age of Acquisition For Pronouns

  • 12-26 months (1-year to 2-years, 2-months old): I, It, this, that 
  • 27-30 months (2-years, 3-months to 2-years, 6-months): my, me, mine, you
  • 31-34 months (2-years, 7-months to 2-years, 10-months): your, she, he, yours, we
  • 35-40 months (2-years, 11-months to 3-years, 4-months): they, us, hers, his, them, her
  • 41-46 months (3-years, 5-months to 3-years, 10-months): its, our, him, myself, yourself, ours, their, theirs 
  • 47+ months (3-years, 11-months+): herself, himself, itself, ourselves, yourselves, themselves 
  • 5 years old: those, these 

Mastery of pronouns should be achieved by 5-years of age

Activities To Facilitate Pronoun Use At Home

  • I-SPY: The caregiver should go first to model how the game will be played. Bombard the child with the pronouns you want to work on. You can also use a picture scene with various people in the scene if you want to work on the he/she pronouns. To work on the we pronoun, print pictures from various places you and your child go to together (i.e. the movie theater and the grocery store). Example: “We go to this place and buy food” and “We go to this place to see a movie”
    • I spy something black. I wear it on my face. It helps me see. What is it?
    • I spy something red. I like to eat it and it tastes sweet. It is round and it grows on a tree. What is it?”
    • To work on the pronoun “you/your/I”, play I-SPY in your child’s room: “I spy something pink that YOU wear on YOUR feet. I tie the laces for YOU. What is it?”


  • Dollhouse: Using a dollhouse is a great way to facilitate pronoun use, especially if you have multiple dolls. Modeling proper pronoun use through play is a great way to assist your child in carrying the skills learned over into conversation.
    • My doll is the daddy and your doll is the baby girl. Oh no! She is crying! He has a bottle for her. Here you go baby! She is full now and sleepy. Lets put her in the crib now!”
    • “Lets dress the girl doll! She wants to wear a dress and shoes. Oh look! You found a yellow dress, lets put it on her. She looks great! Lets put on her shoes. Now lets dress the boy doll. He wants to wear shorts and a t-shirt. Lets put a blue shirt on him. He really likes the blue shirt and the brown shorts. Wow! He looks great! Lets put on his shoes too! Good! Now, they are ready to go to the store now.”


  •  Tea Party: Play tea/birthday party with your child. Set up a girl and boy doll at the  table. First, model pronoun use by giving your child directions. (i.e. “Give him a slice of cake and give her some tea. I want a piece of cake too! Can you give me a piece of cake please?”) Then, have your child give you directions. Pretend you misheard and give it to the wrong doll so that your child can correct you!


Remember, gestures are important when you are modeling pronouns, especially if this is the first time you’re introducing the pronoun! For example, point to yourself when saying I/me/mine and to the child when saying you/your/yours.



–Amanda Hammer, M.A. CF-SLP, TSSLD


  • Owens, R. E. (2008). Language development: An Introduction (Seventh ed.). Boston, MA: Pearson Education.

Early Verb Acquisition and What to Expect Before Kindergarten

What is a Verb?

A verb is a word that shows:

  • Action: What the person, place, or thing (noun) is doing
    • Examples: jump, swim, dance, hike

action verbs

  • State of being 
    • Examples: is, are, am, appear, become

What Types of Verbs Should You Expect Your Preschooler to Have before Kindergarten?

1.  Present Progressive:

  • Indicates an activity that is currently or was recently in progress. The present progressive adds an -ing to the end of verbs. Remember though, it can only be used with action verbs!
  • Age of Mastery: 19-28 months old
  • Examples: eating, jumping, dancing, skating
  • Activities to Promote Acquisition:
    • Charades: Act out an action (jumping, swimming, dancing, brushing teeth, sleeping), and ask, “What am I doing?” Have your child then act out an action and you guess! Make it fun by giving your child a token/star/block each time he/she guesses the right action!
    • Through Play:  While playing with your child, comment on what he/she is doing (i.e., while playing with a dollhouse, “Oh the mommy is cooking dinner and the baby is sleeping.)
    • Picture Cards with Scenes: Use a scene picture card (see below) and have your child describe what each character is doing.


  • Watching television: While your child is watching his/her favorite television show, comment on the actions of the characters (i.e. “Look! Dora is running!”)

2.   Irregular Past-Tense:

  • An action or state of being that happened in the past. Unlike regular past-tense verbs, irregular past-tense verbs do not use the -ed ending.
  • Age of Mastery:
    • 3-4 years old: hit, hurt, went
    • 4 -5 years old: saw, gave, ate
  • Activities to Promote Acquisition:
    • Always teach functional irregular verbs first (see above age of acquisition)
    • Model: At night, tell your child about your day. (i.e., “I went to the bagel store and ate an egg sandwich. What did you eat?”)
    • During Play: Comment on what happened while you and your child play (i.e., while your child is playing with a toy kitchen, “Oh! You made cookies? Can I have one?” or “Can I have a cookie now? I already ate my dinner and drank all my juice!”)
    • Games: If your child is school-age, you can take a ball (basketball, soccer ball, etc.) and a worksheet with irregular verbs. You can call out a verb, throw the ball to your child, and he/she can call out the irregular form of that verb. If he/she gets it correct, he/she can try to get the basketball into the hoop or kick the soccer ball. Make it fun!

3.  The Verb “to be”:

  • Can be used as the main verb (“I am sick”), or helping verb (“She is singing”). The different forms include: am, is, are, was, and were. Additionally, forms of the verb “to be” are contractible (“I’m going” or “Mommy’s tall”)
  • Age of Mastery:
    • Main verb 27-39 months old
    • Helping verb: 4 years of age
    • Contractible: 4 years of age or later
  • Activities to Promote Acquisition:
    • During Play and Conversation: modeling is important! (i.e., “I am so hungry! Are you hungry? I was not before but now I am! I am going to make dinner! What do you want to eat?”)
    • Picture Books: Using literature is a great way to promote vocabulary growth (including verbs!) While reading, point out what the characters in the story are doing and comment on what they did previously (“Oh look! The hungry caterpillar is eating an apple! He was eating an orange.”)
    • Games: You can also do charades for this verb type! Using picture cards of various animals, pick one out and act out the animal. The child will have to guess using the verb “to be” (i.e. “You are a dog!” “No! I am a cat!)

4.    Regular Past Tense -ed

  • Using a verb to describe something that already happened. It is important to note that this is overgeneralized to previously learned irregular past-tense verbs (i.e., “eated” and “falled”)
  • Examples: jumped, danced, hiked
  • Age of Mastery: 26-48 months old
  • Activities to Promote Acquisition:
    • Games: Simon Says (“Simon says touch your nose — “Great! You listened! You touched your nose! — “Simon says jump up and down” — “Great! You listened! You jumped up and down.” Let the child be Simon after you have modeled and have them comment on what you or did not do) and Red light Green light (“Oh! You moved!”)
    • Picture Books: Comment on what a character has done in the book, or find a book that can allow repetitive use of a verb/verbs, such as “The Mitten” by Jan Brett. You can model for the child, “Oh look! A rabbit climbed into the mitten, a skunk crawled into the mitten, and a bear climbed into the mitten!”
    • Modeling in Play/Conversation: comment on what the child did after playtime/an activity/the day is finished! (i.e., “Oh wow! We washed the car, played a game, and cooked dinner!”)


– Amanda Hammer, MA, CF-SLP, TSSLD


  • Owens, R. E. (2008). Language development: An Introduction (Seventh ed.). Boston, MA: Pearson Education.
  • Paul, R., & Norbury, C. (2012). Language disorders: From infancy through adolescence: listening, speaking, reading, writing, and communicating (Fourth ed.). St. Louis, MO: Elsevier.


The Role of Phonemic Awareness in Early Reading Development

What is Phonemic Awareness?

Phonemic Awareness is the ability to hear and manipulate the sounds in spoken words, and the understanding that spoken words and syllables are made up of sequences of speech sounds. Primarily, phonemic awareness involves understanding language at the phonemic level. A phoneme is the smallest unit of sound in a language that holds meaning. Phonemic awareness skills include blending, segmenting, deleting, and manipulating phonemes. Phonemic awareness is encompassed in a broader, umbrella term otherwise known as phonological awareness.

What is Phonological Awareness?

Phonological awareness is the explicit understanding of a word’s sound structure (Gillon, G., 2002). As a child develops phonological awareness, the child will not only come to understand that words are made up of phonemes, but also she/he will learn that phonemes can be “put together” to form syllables. Additionally, the child will begin to learn that words have an “onset” (sounds before the vowel in a word) and “rime” (the vowel-consonant combination of a word). Phonological awareness skills include the following: rhyming, alliteration, sentence segmentation, syllables, and onset-rimes.

Phonological Awareness Skills and How to Promote Them With Your Child:

  1. Rhyming:
    1. Discrimination: recognizing when two words rhyme (“Do bat and hat rhyme?” or “Do man and foot rhyme?”)
    2. Production: ability produce a rhyming word (“What word rhymes with log?”)
    3. How to promote this skill with your child: reading rhyming stories (i.e. Dr Seuss books, “Brown Bear”, “Frog on a Log”, “Moose on the Loose”) and sing nursery rhymes (i.e. “Hickory Dickory Dock”, “Its Raining, Its Pouring”, “Jack and Jill”)


  1. Alliteration:
    1. Discrimination: recognizing when two words begin with the same sound (“Do pop and pat start with the same sound?”)
    2. Production: ability to produce a word that starts with the same initial sound as a given word.
    3. How to promote this skill with your child: reading children’s books with alliteration (“Silly Sally” or “Pigs in Pajamas”) and tongue twisters (“Sally sells seashells by the seashore”)


  1. Segmentation of Words in Sentences:
    1. Identifying the words in a sentence
    2. How to promote this skill with your child: The parent can model clapping/tapping each word out as saying a sentence/song aloud. Next, the parent and the child can clap/tap out each word together for a new sentence/song. Lastly, have the child attempt it alone. Blocks can be used as well (i.e. each word represents a block and the child can build a “word tower”) or tokens.

segmenting sentences

  1. Syllables:
    1. Blending Syllables: “I am going to say parts of a word. Tell me what the word is: bas-ket-ball”).
    2. Segmenting Syllables: Counting the number of syllables in a word (i.e. “clap for each syllable you hear in the word basketball“)
    3. Deletion of Syllables: “Say basketball. Now say it without ball”
    4. How to promote this skill with your child: clapping out the syllables in bisyllabic/multisyllabic words, sliding beads on a string for each syllable, or using blocks (each representing a syllable) to build a “word” tower.


  1. Onset-Rime:
    1. The onset is the initial sound of a word and the rime is the vowel+ending of word.
    2. Examples: S-un, S-unshine, p-ig, b-ear
    3. How to promote this skill with your child: use visuals! Fold an image in half, and write the onset on the left side and the rime on the other. Tap the left side while saying the onset, and tap the right side while saying the rime.


Phonemic Awareness Skills and How to Promote Them With Your Child

  1. Blending Sounds: “What word is made up of the sounds b-a-t?”
  2. Segmenting Sounds: “What sounds make up the word bat?”
  3. Deleting Sounds: “What is bat without the /b/ sound?” or “What is bat without the /t/ sound?”
  4. Adding Sounds: “What word do you have if you add a /b/ to the word at?”
  5. Manipulation of Sounds: “What word would you have if you changed the /b/ in bat to a /s/?”
  • How to promote these skills with your child: Games, toys, crafts and songs!

make learning fun with this playdough phonemic awareness kids activityphonemicshark phoneme.jpg

The Importance of Phonemic/Phonological Awareness for Early Reading Development


  • Phonemic Awareness prepares children to learn the alphabetic principle.
  • Fundamental to mapping speech to print
  • Helps children read (decode) new/unfamiliar words
  • Promotes spelling skills


If your child struggles with reading fluency and comprehension, he/she may not have a solid basic understanding of phonemic/phonological awareness, and may need the assistance of a speech-language pathologist to address these deficits.


– Amanda Hammer MA CF-SLP TSSLD


  • Gillon, G. (2002). Phonological Awareness Intervention for Children: From the Research Laboratory to the Clinic. The ASHA Leader, 7(22), 4-17. doi: 10.1044/leader.FTR2.07222002.4.
  • “Bringing Letter Sounds to Life: Merging Phonemic Awareness and Phonics” by Marianne Nice (M.S. CCC-SLP) and Amy Leone (M.S.T. CCC-SLP)
  • Adams, M. J., Foorman, B. R., Lundberg, I., & Beeler, T. (1998). The elusive phoneme: Why phonemic awareness is so important and how to help children develop it. American Educator, 22(1-2), 18-29.
  • Smith S. B., Simmons, D. C., & Kame’enui, E. J. (1998). Phonological awareness: Instructional and curricular basics and implications. In D. C. Simmons & E. J. Kame’enui (eds.), What reading research tells us about children with diverse learning needs: Bases and basics. Mahwah, NJ: Lawrence Erlbaum Associates.


Executive Function Disorders

“Difficulty with the process of coordinating, prioritizing, and/or managing information needed to perform tasks successfully may be indicative of a disorder of a child’s executive functioning abilities.”

A child with an executive function disorder may be highly intelligent, but they may also struggle to complete seemingly simple tasks, such as remembering to hand in their homework.

What are Executive Functioning Skills?

Executive functioning skills are cognitive based skills that help individuals plan, direct, and execute actions in their daily lives.

Lower-Level Executive Functioning Skills impact regulation of behaviors.

Higher-Level Executive Functioning Skills are meta-cognitive based.

Some executive functions include…

  • Planning and Prioritizing

This refers to the ability to “see and create” order, related to the individual’s life. Deficits in this area are evidenced by disorganization of materials and home/work spaces, as well as memory deficits.

  • Starting a Task (aka “initiation”)

This refers to the ability to begin actions in regards to activities or tasks. Deficits in this area are evidenced by difficulties “getting started” –even with help. Individuals who struggle in knowing where/when to “start” or those who cannot “get going” without extensive support from others could be experiencing an executive function disorder.

  • Controlling Impulses (aka “inhibition”)

Inhibition refers to the ability to control impulsivity and stop inappropriate actions and/or thoughts at the appropriate time. Delays in this area are evidenced by inappropriate comments and actions. Individuals who struggle with inhibition often “act before they think” or “lack a filter” for the things they say to others.

  • Shifting (aka “transitions”)

Deficits in this area may inhibit a child from switching focus between tasks fluidly or showing “flexibility” in thoughts, words, and actions. Individuals who struggle with transitions may become stuck on certain problems, topics, or activities. (See previous post “Trouble with Transitions”)

  • Controlling Emotions (aka “regulation”)

Deficits in this area are evidenced by mood swings and “dramatic” reactions to seemingly small problems. Individuals who struggle with regulation cannot change their reaction based on facts and may assume information or “jump to conclusions”, which supports their inappropriate reactions.

  • Using Working Memory

This refers to the ability to hold onto information while doing something with it. Deficits in this area are evidenced by difficulty in completing tasks. Individuals who struggle with working memory may start tasks but “lose-track” midway through.

  • Organizing Materials

This refers to the ability to plan and organize tasks related to projects. Individuals who struggle with this area may begin a task at a midway point rather than the beginning, start a task too late, or not have everything they need to complete a task upon starting.

  • Self-Monitoring

This refers to the ability to evaluate and monitor one’s own time and attention. Poor attention, poor timing, and an irregular pace at which to meet the demands of tasks/environment are common features associated with deficits in this area of executive function.


Some children with executive functioning deficits may develop these skills later than their peers (delay) or experience ongoing weaknesses (deficit).

All of these skills develop differently and vary depending on a child’s age, degree of difficulties, and strengths in other areas.

Executive Function & The Brain:

“It is theorized that, although executive functions use multiple areas of the brain, these skills are based in the frontal lobe, acting as part of the executive system. It is a higher order process that involves connecting past experiences to present novel experiences to control and regulate one’s abilities and behaviors. This allows one to anticipate outcomes and adapt to changing situations in order to manage oneself and one’s resources to complete a task and/or achieve a goal.”

Executive Function Development:

  • Executive functions begin developing in infancy and continue to develop through adulthood.
  • In childhood, executive functioning delays are often seen in individuals with diagnoses such as ADHD, ASD, or other learning disabled.
  • Executive functioning skills may also be infiltrated by strokes, traumatic brain injuries, and the on-set of neurodegenerative disorders in older populations.

Assessment and Treatment:

An SLP’s intervention for executive functioning skills focuses primarily around the language aspects of the disorder. As previously mentioned, higher-level executive functioning skills involve meta-cognition, which is the process of “thinking about thinking”. These skills are language based because they involve self-talk and language processing in order to monitor, plan, and execute actions.

The assessment of executive functioning delays may be completed via formal assessments, informal testing, and observations.


“Formal assessments identify delays in an isolated and structured testing environment, while informal testing and observations take into consideration the impact of the delays across a person’s day in a variety of settings.”


A combination of assessment styles ensures the SLP or team of professionals working a case have full insight on the individual, and can create an effective and functional therapeutic intervention plan.



A speech-language pathologist plays a vital role in the identification, evaluation, and management of executive functioning delays and disorders, especially those involving higher-level metacognition and the language-based needs of the individual. A full assessment of the child/adult involves a dynamic assessment as well as observations to help ensure therapy is functional and generalizes across environments. While executive functioning skills impact every aspect of daily living, a solid treatment plan can immediately begin improving an individual’s quality of life.


Ashley DiGregorio M.A., CF-SLP, TSSLD

SLP’s, We Need to Talk…

Six years of school equals more than just a bunch of letters after our names…


It is obvious that becoming a speech-language pathologist enriches our minds as much as it does our hearts.


It is important to remember that while we know what we’re talking about, many parents, teachers, and other healthcare professionals do not know our lingo!

While SLP’s have lots of big words and long answers to describe the ins and outs of our field, it is important to alter our language based on our audience.

The same way we simplify explanations on-the-spot for our kids, we can alter the way we explain things to parents, teachers, and other professionals involved in the treatment and care of our clients/patients/students. 

THINK ABOUT IT:  How can a parent help their child with carryover assignments if they, themselves, don’t even understand the goals or objectives? We cannot assume that every parent is proactive enough to ask questions when they’re unsure of what we mean (and we shouldn’t leave it up to Google to give them an answer!). We should be providing explanations or descriptions for everything we are doing. We should remember that these parents, teachers, and professionals don’t all have degrees in speech-language pathology.

The following is a “dictionary” for some of the lingo we frequently use

(and infrequently explain):

Articulation: Articulation is the physical ability to move the tongue, lips, jaw, and other oral motor musculature (known as the articulators) to produce individual speech sounds, which are also called phonemes.

Articulation Delay/Disorder:  An articulation delay/disorder is when a child has not mastered age-appropriate sounds in the typical time frame. This is characterized by the child substituting, omitting, adding, or distorting speech sounds.

Augmentative and Alternative Communication (AAC): Augmentative and Alternative Communication, also known as AAC, refers to “…all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write” (ASHA).

Babbling: Babbling refers to sounds and syllables an infant begins stringing together between 4-12 months of age. Babbling is referred to as a pre-linguistic skill: meaning it occurs prior to the development of speech/language.

Childhood Apraxia of Speech: CAS is a motor speech disorder. Children with CAS have difficulty producing sounds, syllables, and words due to difficulty with planning and executing the fine motor movements needed for speech. The child knows what he/she wants to say, but the brain is having difficulty coordinating the parts of the body that are used to produce these speech sounds (i.e., the vocal folds, lips, jaw, and tongue).

Choking: Choking occurs when food (or a foreign object) becomes lodged in the throat or windpipe, blocking the flow of air. Choking cuts off oxygen to the brain and consequently makes it difficult to breathe, resulting in the inability to cough and loss of consciousness.

Delay: a delay refers to development that is following the “typical or normal patterns” but is developing at a slower rate than age-matched peers.

Diastemas: Spacing between the teeth can cause difficulty producing certain speech sounds as it will allow for air to escape through the lateral portions of the oral cavity.

Dissociation: the separation of movement in two or more muscle groups based on adequate strength and stability.

Disorder: A disorder is classified as development that is NOT following the “typical or normal” patterns (i.e., abnormally).

Dysarthria: Dysarthria is a motor speech disorder resulting in weakness, paralysis, and/or incoordination in the muscles needed for producing speech (i.e., jaw, lips, tongue, palate, and respiratory system).

Dysfluency: speech with an irregular flow. Certain sounds may be improperly elongated, airflow may be interrupted, and sounds, words, or phrases may be improperly repeated.

Echolalia: a repetition of words that occur without meaning and in imitation. For example, a child might repeat a phrase they overheard. The imitation may occur immediately after the stimulus or long after.

Expansions: This is a strategy that can be used to help children learn language. Expansions are when you take the words your child says about what they see and do and repeat them while adding in missing words/grammar. By doing this, you are expanding your child’s language without directly “correcting” him/her.

Fluency: speech that flows smoothly and is clearly understood. Fluent speech is without irregularities like abnormal repetitions.

Frenum: a narrow fold of mucous membrane connecting a moveable part to a fixed part. Its purpose is to stabilize and check undue movement of that part. The lingual frenum is generally under the mid-portion of the tongue. It can help to stabilize the base of the tongue but does not interfere with tongue tip movement. With a short frenum, however, the lingual frenum may have anterior attachment near the tip of the tongue and may also be unusually short. This causes a virtual adhesion of the tongue tip to the floor of the mouth and can result in restricted tongue tip movement (Kummer, A., 2005).

Language: While speech involves the physical motor ability to talk, language is a symbolic, rule governed system used to convey a message. Language can be expressive (what we say) or receptive (what we understand).

Lisp: A lisp refers to an articulation disorder in which a child is having difficulty producing the phonemes /s/ and /z/. The most common are identified by interdental productions, or lateral air escape.

Morpheme: a morpheme is a meaningful part of language that cannot be broken down further. For example, “dog.” A bound morpheme is part of a larger word. For example, the “ing” on “singing.”

Motor Speech Disorders:  Motor speech disorders are a group of speech disorders characterized by difficulty with the motor aspects of speech. They can involve difficulty with the coordination and planning of movements needed for speech (Apraxia) or difficulties with the strength of the articulatory and respiratory system (Dysarthria).

Phonological Processes: the typical patterns of how a child simplifies his/her speech. For example, a young child will simplify the word “bottle” to something like “baba.” A young child may also say “goggie” for “doggie,” “sue” for “shoe,” or “nail” for “snail.” Phonological processes are the normal patterns of simplification all children use as they are learning to speak.

Phonological Delay/Disorder: A phonological delay refers to the prolonged use of phonological processes (sound simplifications) in a child’s speech.

Phonology: Phonology is the study of how speech sounds (phonemes) are organized and used in a language. This includes the study of the individual sounds of a language (phonemes), their patterns (processes), how they are learned (phonological development) and how they work and go together (phonation).

Pica: the persistent craving and compulsive eating of nonfood substances. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, classifies it as a feeding and eating disorder of childhood.

Pragmatic language: this is the social aspect of language that refers to the way an individual uses language to communicate. It may involve using language to communicate in different ways (like greeting others, requesting, protesting, asking questions to gain information, etc.), changing language according to the people or place it is being used (i.e., audience, setting, etc.), and following the rules for conversation (taking turns in conversation, staying on topic, using and understanding verbal and nonverbal cues, etc.).

Semantics: the meaning of words and language.

Syntax: the rules that govern how words and phrases fit together to create coherent sentences (grammar).

Speech: this refers to articulation/phonological skills, speech fluency, and voice. This looks at a child’s ability to physically produce the individual sounds and sound patterns of his/her language (articulation), produce speech with appropriate rhythm (suprasegmental features, inflection, prosody, timing, etc.), and produce fluid speech with an appropriate vocal quality.

Stuttering: a communication disorder that effects speech fluency. It is characterized by breaks in the flow of speech. Some dysfluencies are developmental (you outgrow them) but having too many can actually significantly affect one’s ability to communicate. Stuttering may include repetitions, prolongations, interjections, and blocks. Often stuttering is compounded by secondary behaviors such as tension in the neck, shoulders, face, jaw, chest, eye blinks, nose flaring, other odd facial movements, clenched fists, stomping of feet, jerking, and/or other unusual extraneous motor movements.

By creating a running document of common words, phrases, and areas of deficit, SLP’s can bridge the gap of misunderstanding, and help parents and children understand the nature of their deficits. With a greater understanding, we may achieve  better carryover of goals.

One Last Thing…

After every session try to review with your client/student/patient:

  1. Why do I come to speech?
  2. What did I learn today?
  3. How can I practice at home?



Ashley DiGregorio M.A., CF-SLP, TSSLD

How To: Manage Self-Stimulatory (“stimming”) Behaviors

Self-stimulatory behavior is commonly exhibited by children with Autism Spectrum Disorder (ASD), however, this population is not the only time that SLP’s and parents may encounter a behavior that a child has developed to stimulate or calm their senses.

Think about it…

  • Babies are soothed when rocked.
  • Adults fan themselves to cool off.
  • People hug to give and receive comfort.

When an individual wants to increase or arouse their senses, they engage in an activity directly involving their senses such as:

  • Listening to music.
  • Eating food.
  • Watching a video or movie.
  • Scratching an itch/rubbing a bruise.

Think about it…

  • Most of these repetitive behaviors are seen as appropriate if carried out at the proper time and in the proper place.

What makes “stimming” different?

  • This phrase is one that portrays a more negative image.
  • The term refers to a repetitive body movement, such as hand flapping, that is hypothesized to stimulate one or more senses”.
  • In the world of ASD, this is known as any type of repetitive, stereotypical behavior engaged in to alleviate or increase sensory input.
  • Children will engage in this type of behavior to get a response, make someone interested, or achieve a more alert state of being.
  • “Stimming” is highlighted by patterns of self-regulatory behavior that are deemed unacceptable.
  • Depending what form the behavior takes and how often it occurs it could be seen as normal – a way to help a person function, or abnormal – a pattern of obsession.
  • Every child and adult, regardless diagnosis, will attempt to modulate his/ her sensory experience as they interact with their world.
  • In fact, only 10% of children with ASD actually engage in exaggerated self-stimulation, such as hand flapping, spinning, toe-walking, licking objects, tracking hand movements or sniffing foods, items, or people.

So you notice these behaviors, now what? 

  • There’s a fine line between behavior management (as a teacher, SLP, and even parent), and seeking professional help for a child’s sensory needs.
  • A qualified occupational therapist (OT) can create a customized sensory diet for every child, which can help reduce “stimming” behaviors.

Some other tips in assessing and managing these behaviors are as follows:

Conduct a Detailed Review: It is important to begin with a thorough assessment of the behaviors. Do the behaviors interfere with daily living, such as the ability to pay attention? Are there any behaviors that negatively impact socialization? Are any of the behaviors obsessive? Do they have a negative impact on the child?

Seek to Understand: What is the function of these behaviors? Most “stimming” behaviors occur involuntarily to some degree, especially in the beginning. However, once a child realizes the relief it brings to their sensory system it then becomes more intentional, and easily gets reinforced into a habit. If it is deemed appropriate it can become a functional way to self-regulate one’s sensory experience, but if it is seen as dysfunctional it can easily get out of control.

Gather Information: If the child is verbal it may prove beneficial to engage in conversation about the behaviors.

For example: If a child stares excessively at an object, consider asking them, “Are you trying to do something with your eyes? Tell me what you see.” If the child is able to verbalize an answer, you may gather extremely useful information to address the behavior with.

Make lists: Most “stimming” behaviors are functional; they serve a purpose for meeting a sensory need, but they may not necessarily be appropriate. Adults may make a list categorizing the behavior(s) as functional and appropriate vs. functional and inappropriate. This will help to determine which behaviors need to be addressed and in what order.

Regulate vs. Eradicate: Once a list is established, it is important to consider the impact that trying to ban the behavior will have on the person. Eradicating the behavior may not be realistic and may make things worse in the short term.  Sometimes regulating the behavior may be all we can do in some cases.

Be Positive: It is important to positively reinforce appropriate behaviors.

For example: “I like the way your hands are being quiet. It makes it easier for you to pay attention to what is going on around you.”

Keep Calm: Children often engage in these behaviors when they are stressed or as a means to manage emotions such as fear, anger and anxiety; therefore, maintaining an atmosphere that is as tranquil, predictable, and appeasing to the senses as possible will prevent many of these behaviors from surfacing.


Ashley DiGregorio M.A., CF-SLP, TSSLD