Does my child have a phonological disorder?

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What are phonological processes?

Phonological Processes are patterns of sounds that typically developing children use to simplify speech as they are learning to talk. A phonological disorder occurs when the phonological processes persist beyond the age when most typically developing children stop using them or when the processes are used abnormally (or differently than expected).

Why do children have phonological processes?

Children use phonological processes because they do not have the ability to coordinate the lips, jaw, tongue, and cheeks for clear and articulate speech. As a result, children simplify words in predictable ways until the coordination is developed to properly articulate words.

What is a phonological disorder?

A child is considered to have a phonological disorder when the processes persist beyond a “normal” age when other children typically stop using the phonological process. For instance, if your child is 4 years old and he/she still uses reduplication (e.g. wawa for water) that would be considered delayed since deleting the consonant at the beginning part of a word is typically stopped by 3 years of age. The excessive use of phonological processes can also lead to a phonological disorder because when many phonological processes are the child’s intelligibility becomes very poor (the child is hard to understand to the unfamiliar listener).

What is considered typically intelligibility?

  • 19-24 months- a child should be 25-50% intelligible
  • 2-3 years of age- a child should be 50-75% intelligible
  • 4-5 years of age- a child should be 75-90% intelligible
  • 5+ years- 90-100% intelligible

How do I know if my child has a phonological disorders?

Often times articulation disorders are confused for phonological disorders. Since both phonological disorders and articulation disorders are considered speech disorders it can sometimes be tricky (as non-professionals) to tell the difference. Here are a few tips to differentiate the two:

An articulation disorder occurs when:

  1. Speech sound errors persist beyond age appropriate times
  2. A child is mild to moderately unintelligible

A phonological disorder occurs when:

  1. Phonological Processes exist beyond the typical development
  2. Phonological disorders exist that are not seen in typical development
  3. A child is highly unintelligible due to excessive use of phonological processes

How can I help my child who has a phonological disorder?

Remediation for kids with phonological disorders involves targeting phonological processes as determined by a Speech Language Pathologist. Targeting the phonological process instead of targeting each sound error (articulation approach) is common. If you suspect your child may have a phonological disorder contact any one of our offices to set up an evaluation.

Source:

Mommy Speech Therapy. (n.d.). Retrieved February 28, 2015, from http://mommyspeechtherapy.com/?p=2158

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Pragmatic Speech

What is Pragmatic speech?

Definition: Pragmatic speech is language used to communicate and socialize. It involves three major areas.

  1. Using language for a variety of functions such as: greeting (i.e. hello, goodbye), requesting (i.e. I would like a book), demanding (i.e. give me a book), and informing (i.e. this book is about a dog).
  2. Changing Language: This aspect of pragmatics involves changing what you say or are going to say based on the needs of the listener/ or conversation partner. Examples include– speaking differently to an adult than you would to a child, telling background information to a unfamiliar listener, and speaking differently to your boss than you would to your friend.
  3. Following rules: talking turns during conversation, listening when the other person is speaking, commenting appropriately, rephrasing when misunderstood, using facial expressions and eye contact, staying on topic, and ending a conversation when necessary

Some children whether they have the ability to talk may benefit from therapy focused on pragmatic speech.

Since difficulty with social communication is a characteristic of autism spectrum disorders, many children with an autism spectrum disorders diagnosis will need some level of pragmatic speech therapy. According to the American Speech-Language-Hearing Association, people with pragmatic speech issues may:

  • say inappropriate or unrelated things during conversations
  • tell stories in a disorganized way
  • have little variety in language use
  • Pragmatic speech therapy is offered by speech therapists. It is appropriate for    children, but may be equally appropriate for teens and adults.

How can a Speech-Language Pathologist help my child?

There are many ways a SLP can help your child learn how to use language in a more social and appropriate manner. Some options include:

  1. Role playing: Pretending to talk to different people in different situations. For instance, set up a situation as if you were in a restaurant and have each person take a role. The child can be the person ordering while the SLP can act as the waitress. In this situation, the child will use a variety of appropriate language functions to order his/her food. In addition, the SLP will model how your child should talk to the other conversation partner (i.e. the waitress) in order to get the point across.
  2. Encouraging the use of persuasion: For instance, asking the person what he/she would do in order to convince a friend, family member, or other loved ones to let him/her do something. Discussing different ways to ask such as: polite (saying please, thank you), direct language (shut the window) vs. direct language (It’s cold in here), discussing why some requests may be more persuasive then others.
  3. Helping with conversation and story-telling skills: commenting on a topic (i.e. adding related information to encourage talking more about a particular topic), providing visual cues (i.e. pictures, objects, or graphs to tell the story in a sequence), encouraging rephrasing (i.e. “What do you mean? ”,“Can you explain that again?”), and show the importance of non-verbal signs (i.e. contact, gestures, and facial expression).

To set up an evaluation for your child, call any one of our offices!

Social Language Use (Pragmatics). (n.d.). Retrieved February 24, 2015, from http://www.asha.org/public/speech/development/Pragmatics/

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What is a Lisp?

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What is a Lisp?

This term usually refers to difficulty making the /s/ and /z/ sounds due to incorrect placement of the tongue. The tongue may be sticking out too far between the front teeth, or the sides of the mouth may not be tense or high enough to produce the sound. Both of these errors create a distortion of the sound.

Are there different types of lisps?

Yes, there are two different types of lisps. There are frontal lisps and lateral lisps. An interdental (frontal) lisp is when the tongue sticks out between the teeth. This error makes the /s/ and /z/ sound like /th/ (e.g. yeth/yes). A lateral lisp is when air escapes out of the sides of the mouth. This type of lisp makes the /s/ and /z/ sound wet due to the sound of the saliva.

When is a lisp considered normal?

Lisps are never considered to be part of developmental speech. If you suspect that your child has a type of lisp it would be beneficial to set up an appointment with a Speech-Language Pathologist to assess the suspected lisp. The SLP will determine if the child in fact has a lisp and if they are ready to start services.

What causes of lisp?

Some SLP’s believe that a lisp is cause due to a weakness in the musculature. In some cases, children tongue position is too anterior (far front) in the mouth. This is sometimes referred to as tongue thrust. A tongue thrust creates an abnormal swallow pattern that causes the tongue to move too far front during swallowing. A tongue thrust also effects a child’s articulation.

What can be done to help my child?

Children can come into our center to be evaluated for expressive speech (articulation) and language. The SLP will determine what type of therapy is warranted for the child. Due to the fact, that every child is different and needs personalized individual care the type of therapy varies case to case. Typically, a child can be placed on an expressive speech program or a myofunctional program.

What treatment can be implemented for a lisp?

If the child is determined to need therapy for expressive speech (articulation) many types of techniques can be used depending on the type of lisp. One method is to isolate the sound and work on perfecting the sound in isolation. Then the SLP will continue to work on the sound in varying word positions. Another method is to have the child bite blow and smile working on this will help the child keep the tongue in the mouth. Also having a child say /th-s-th-s-th-s/ will help the child increase his/her awareness of the tongue in the mouth. SLP’s will work on lateral lisps through correcting the airflow.

Sources:

Bowen, C. (1999). Lisping: When /s/ and /z/ are hard to say. Retrieved from http://www.speech-language-therapy.com/lisping.htm on 10-1-2011.

 

The Importance of Pointing

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Why is Pointing so Important?

1. It Makes Us Look What They’re Pointing At

When a toddler points at something it is your first reaction to look at what they are pointing at. This is called initiation of joint attention. Joint attention is an early-developing social-communicative skill in which two people (usually a young child and an adult) use gestures and gaze to share attention with respect to interesting objects or events. This skill plays a critical role in social and language development (Sage Journals). The more a child points the greater the intention to engage in communication.

2. It Helps Increase Their Vocabulary

When a child points at something, most of the time it is our natural instinct to label the item for the child. For instance, if your child points to a cookie… you may say, “Look at the yummy cookie.” This is one of the many ways children learn names of common everyday items. It is very beneficial in order to increase their vocabulary.

3. It Makes Us Describe the Item They are Pointing To

Another way to increase your child’s vocabulary is to describe the item that your child is pointing to. You can describe the item by saying (e.g. cookie) by saying “The cookie is in the jar. It is high up, brown, chocolate, and big.” This will allow your child to be exposed to many new words by describing the item that they were originally pointing to.

4. When should we expect a child to be pointing?

By 12 months a baby should be able to point to items they are interested in. The typical range is 9 to 15 months, with some research saying around 18 months. This range includes all forms and gestures, not only pointing. This includes gestures such as clapping, waving, and other gestural communication. If you child is 12 months and not pointing but he/she is using other gestural communication, the pointing should come soon. That said if your child were not pointing by 15 months, it would be a good idea to contact your pediatrician.

5. What can you do to teach your child to point?

The first thing to do is to model! It is very important to model the behavior that you want your child to engage in. Walking around at home and pointing and in stores is a good way to model pointing. Another good way is to incorporate pointing in games. Games such as point to specific body parts, colors, and foods is a good way to help begin to use this skill. When your child does point, reinforce the behavior and show excitement by cheering/clapping etc. It is important to note, that some children with more severe delays such as autism spectrum disorders (ASD), may need more direct help such as hand over hand. A professional such a Speech-Language Pathologist should personalize this type of instruction and then parents can practice the specific skills outside of therapy.

Sources:

The Importance of Pointing. (n.d.). Retrieved February 16, 2015, from http://www.playingwithwords365.com/2012/01/the-importance-of-pointing/

 

 

 

 

Selective Mutism

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What is selective Mutism?

This is a disorder in which children completely avoid speaking in certain situations (e.g. school).

What are the Signs & Symptoms of Selective Mutism?

The problem usually starts between 2 to 3 years of age although help is often sought out around 5 to 6 years of age. According to Dr. Kurtz, “ the lag time is a real problem—the condition is there and continue to get worse.” Help is generally not sought out in time and the child may continue to stop speaking in other situations as time continues to pass. Selective mutism should not be confused for a speech delay or an auditory processing disorder. Children with selective mutism can be right on target with their speech and language skills. Common symptoms include:

  • consistent failure to speak in specific social situations (in which there is an expectation for speaking, such as at school) despite speaking in other situations.
  • lasts at least 1 month (not limited to the first month of school).
  • not due to a communication disorder (e.g., stuttering). It does not occur exclusively during the course of a pervasive developmental disorder (PPD), schizophrenia, or other psychotic disorder. (ASHA.ORG)

What are the Causes of Selective Mutism?

            There is a strong genetic component to selective mutism, with about 75% of children having one parent with an anxiety disorder. The child who feels anxious in a new or unexpected situation may feel as if they are unable to speak. Often, the adult will try to “help” and speak for the child further perpetuating the issue. The child then may make non-speaking a habit.

How is Selective Mutism Diagnosed?

            A child with selective mutism should be diagnosed by a Speech-Language Pathologist (SLP). They will work with a team such as teachers, psychologists, and psychiatrists.

What type of treatment is available for treating Selective Mutism?

            The type of treatment will vary depending on the needs of the person and his/her family. The SLP may create a behavioral program and address speech and language needs accordingly.

A behavioral treatment may include:

  1. Stimulus fading: involve the child in a relaxed situation with someone they talk to freely, and then very gradually introduce a new person into the room.
  2. Shaping: use a structured approach to reinforce all efforts by the child to communicate, (e.g., gestures, mouthing or whispering) until audible speech is achieved.
  3. Self-modeling technique: have child watch videotapes of himself or herself performing the desired behavior (e.g., communicating effectively at home) to facilitate self-confidence and carry over this behavior into the classroom or setting where mutism occurs. (ASHA.org)

A speech/language program may include:

  1. Targeting issues that are making the language behavior worse.
  2. Using role-play: this will help the child gain confidence in different speaking situations.
  3. Help children who do not speak because their voice sounds different or they are uncomfortable with their voice.

 

Top 10 Toys for Eliciting Speech and Language in Children

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With all the snow and cold weather upon us in the start of February, I thought it would be a good idea to post some toys that are useful in promoting speech and language right at home:

  1. Nesting/Stacking toys: These toys are very useful for infants and toddlers. Not only do these toys last a long time but children are often very interested in these toys because they are highly interactive. Some language, cognitive, and other skills a toddler can learn from these types of toys include:
  • Prepositions concepts such as: in, out, under, above, below, in front, behind, on, off
  • Color concepts
  • Shape concepts
  • Size concepts such as big, bigger, biggest; tall, taller, tallest; small, smaller, smallest
  • Counting skills
  • Concepts of full and empty
  • Fine motor skills
  • Other activity idea: take a different toy such as a teddy bear and hide it under a cup and have your toddler find where the toy went
  1. Wooden Blocks: Every child should own a pair of wooden blocks. Blocks that come in all shapes, colors, and sizes are particularly useful to teach children important concepts. Some blocks come with numbers and letters on them as well and help  teach children the alphabet, and counting. Some language, cognitive, and other skills a toddler can learn by playing with blocks include:
  • Letter and number concepts
  • Number concepts
  • Color concepts
  • Shape Concepts
  • Cause & Effect relationships
  • Early Problem Solving: how to build the blocks in order for them not to fall
  • Cooperation and sharing in school settings
  1. Toy Phone: These toys are EXCELLENT for developing language and are low cost! This toys concept is perfect because as adults we talk on phones and use our language. Therefore, a phone is a great toy to promote these types of skills. Some of the skills that your toddler can learn from a toy phone include:
  • Social skills/ pretend play: You can use the play phone to practice speech and language. It can also be used to pretend to talk to all different people and language will be used during different pretend situations.
  • Turn taking: Often, when speaking on a telephone it is a back and forth conversation. Children will want to model this real life situation. Take advantage of this and have your child speak and then give you the phone to speak. In essence, they are learning turn taking skills.
  • Practice speech sounds/language: Sometimes children do not want to practice their sounds in the traditional articulation manner. Some children will find it more fun and engaging to speak/say their sounds through a phone. It may motivate a child and help them to practice
  1. Balls: Balls come in all different colors, shapes, and sizes. There are associated with sports and may be used to release energy and promote physical activity. Some concepts that can be learning while playing with balls include:
  • Verbs such as throw, roll, bounce, kick, hit, fast, slow etc.
  • Colors concepts (using different balls)
  • Size concepts: Big, medium, small,
  • Adjectives (tactile): such as bumpy, smooth, soft, hard, and rough (using various materials)
  • Gross motor/ motor planning skills
  • Social skills: rolling a ball between two people takes a lot of social skills. A child must be able to watch their friend, read their friends non verbal skills such as if he/she are ready to receive the ball (i.e. Gestures, eye contact, body language), and waiting patiently to receive the ball in return etc.
  1. Farm Set: The farm set is one of my favorite toys to use during therapy. Some concepts the farm set can teach includes:
  • Animal names and animal sounds
  • Basic concepts: using the animals and the barn, prepositional concepts (in, out, on, under, behind), first/second/last, colors, and size concepts (big/bigger/biggest etc.).
  • Answering WH questions: Answering who, what, where, when, and how while playing with the animals. An example of this includes: “Who is eating?” and “What sound does the pig make?”
  • Pragmatic skills: Turn taking can be used with the barn and animals. For instance, “ Can I play with the barn now?” or “May I have the sheep please?”
  1. Mr. Potato Head: Mr. Potato Head is a classic toy that can help teach endless speech and language skills. You can use Mr. Potato Head with toddlers and elementary school children in a variety of ways. Some concepts that Mr. Potato Head teaches include:
  • Body Parts: This is the most obvious skills because he comes with basic facial and body parts to help teach children. Also, it is important to teach a child that they have those facial/body parts as well. Point out to your child where a specific body part is on them and then use Mr. Potato Head to facilitate this concept
  • Clothing Items: Mr. Potato Head also comes with different clothing items and accessories. This is a good way to teach a child different articles of clothing such as pants, shirt, hat, earrings, and glasses etc.
  • Basic Concepts: In/out, colors, first/second/last, right/left, and over/under/bottom/top
  1. Cars/Trucks: This toy is one that all children should encounter and use despite their gender. Girls can use trains, cars, and trucks as well. Concepts that can be learned through cars and trucks include:
  • Basic Concepts: you can use cars to work on almost all basic concepts such as numbers, colors, counting, sizes, and propositional concepts such as in/on, under/over, up/down, and top/bottom etc.
  • Part whole relationships: Cars are great for teaching part whole relationships. You can work with your child on teaching parts of cars such as: wheels, window, doors etc.
  • Verbs and Adjectives: Cars are great for describing and actions words. Some examples include: Go, stop, fast, and slow
  • Social/Pragmatics Skills: Turn taking with friends while playing with cars. Practice saying “My turn” and “Can I have that car please?”
  1. Kitchen Set: There are an extensive amount of fake foods and kitchen items that help to facilitate tons of language. Some concepts that kitchen sets can teach include:
  • Vocabulary/labels: Foods, parts of a kitchen (microwave, stove, oven), and kitchenware (pot, spoon, knife, fork, plate)
  • Verbs: Actions words including cook, eat, drink, make, stir, and blend delicious
  • Adjectives: Descriptive words including hot, cold, sweet, sour, and delicious etc.
  1. Doll House: This toy is good for both genders. Children love to manipulate the dolls and compare them to spaces and rooms in their own homes. Some concepts that doll houses help to facilitate for speech and language include:
  • Functional objects: this includes all items in the home such as toilet, shower, bed, stove, microwave, couch etc.
  • Verbs: Action words such as sit, stand, run, walk, skip, go, and sleep etc.
  • Part/whole relationships: You can use the house and talk about the parts of the house in many different ways (e.g. walls, roof, floors, ceiling, windows etc.).
  • Basic concepts: almost all basic concepts can be used when playing with dollhouses. Concepts such as colors, prepositions (on, off, over under, behind, in front of, size concepts (big, small), counting, and shapes (windows, doors etc.)
  • Following directions: This can be used with varying levels of directions. You can start with simple 1-step commands and then as the child advances continue with 2-step commands.
  • Answering “Wh” questions: You can use any WH question and target vocabulary related to the home.
  • Social Skills/ Pragmatics: topic maintenance, eye contact, topic initiation, topic closure, sharing, and asking questions.
  1. Doctor Set: This kit is good because all children need to go to the doctor. This kit helps to make the doctor experience more fun and relatable. They are helpful to open up the creative mind and increase vocabulary. The doctor set can help teach children:
  • Vocabulary/ labels: Parents can target all the vocabulary that comes in a set such as band aids, shots, thermometer, and scrubs etc.
  • Basic Concepts: Prepositional concepts like up, off, down, and up
  • Feelings: You can target feelings such as sick and healthy.
  • Answering WH questions: “How do you give a shot?” and “Where do you put the stethoscope?” etc.
  • Social/Pragmatic Skills: Topic maintenance, asking questions, eye contact, sensing the other persons feelings

Sources:

Top Toys & How They Can Support Speech & Language Development (Part One). (n.d.). Retrieved February 11, 2015, from http://www.playingwithwords365.com/2012/02/top-toys-how-they-can-support-speech-language-development-part-one/

 

 

 

 

Echolalia

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What is Echolalia? Echolalia, if you aren’t familiar with the term, is when an individual repeats what he/she has heard. It is often associated with ASD (Autism Spectrum Disorder). There are two types of echolalia: immediate and delayed. Immediate echolalia is when the child repeats what you just said or what he/she just heard. Delayed echolalia is when the child repeated things heard in the past— this is typically when individuals are repeating scripts from movies/shows. Echolalia can be appropriate or inappropriate for the situation but involves sentences or phrases of language with the same intonation (pitch) that occurred when the child originally heard it.

What Causes Echolalia? Certain forms of ASD (autism spectrum disorder) can cause echolalia. Some people will experience it when they are stressed or anxious while others experience it on a consistent basis. Echolalia is a natural part of learning but it subsides after a certain age. Many children are able to develop their own thoughts as they continue to grow up, while others will continue to use echolalia.

What are Symptoms of Echolalia? The main symptom of echolalia is repetitions and imitation of language/noises. For instance, a child with echolalia will repeat a question instead of answering it. Other signs of echolalia include depression, muteness, and frustration during conversations.

What are the different communicative purposes for a child with echolalia

1. Conversational and turn taking: The child realizes that a conversation requires a response in return. Therefore, he is aware that he must answer after his conversational partner has spoken. The child generally lacks the expressive language to communicate and will therefore use echolalic speech in order to respond.

2. Initiation of communicative interactions: The child is starting to recognize and notice others in his surroundings. Due to the fact that he/ she lacks the language to comment he/she will use echolalic language.

3. Requesting: A child may use echolalic utterances to requests a need, want, or desire. This is usually in the form of a question such as “Do you want to watch television?” This may indicate that he/she wants television.

4.To respond Yes to a question: A child may use echolalic language to respond affirmatively to a question. For instance, a person asks “Do you want a cookie?” The child responds with “Do you want a cookie?” This indicates that he does in fact desire the cookie.

How is Echolalia Diagnosed? Echolalia can be diagnosed through conversation. If a child continuously repeats what he/she has heard this could be have echolalia. In addition, echolalia can range from mild to severe.

 How is Echolalia prevented? Echolalia cannot be completely prevented although providing children with a repertoire of words and phrases can help them decrease their echolalia. Echolalia is a part of the natural learning process. Parents can also expose children to other forms of communication during episodes of echolalia.

Tips to use with child who exhibits echolalia?

  1. Model language from your child’s viewpoint. Model words that your child can understand and use in conversation. For instance, narrating play with your child is very effective because he/she will use it while playing independently and will generalize this modeling to other play situations.
  2. Do not ask the child questions such as “Do you want…?” since he/she will likely respond with repetition of the question. For this situation, use a verbal model for what you know he/she wants. For instance, “ I want a cookie!” is a good way to provide a verbal model for the child.
  3. When provided choices for your child do not use questions such as “Do you ______ or _________ that?” It is important to model the choices without using the intonation (pitch) of a question. Also make sure to present both the choices and hold the desired item forward while providing a verbal model.
  4. Model for a child what he/she might need if he/she needs help. Do not say, “Do you need help with that?” rather use the phrase “Help me!”
  5. Avoid uses common phrases such as “good boy” or “good job with the child’s name since he/she will often imitate it. A better alternative is smiling, hugging, and varied positive reinforcement to promote good behavior/responses.

Lastly, it is important to note that when a child is using echolalia they are attempting to communicate. Remember, an attempt to communicate it better than no attempt to communicate at all. They are positive qualities with echolalia such as strong memory and learning from repeated patterns. Use these suggestions provided above with your child and ask your speech-language pathologist to help you figure out personal ways to help your child!