Update on my career

I have not posted on this blog since 2016.  I have continued working as a speech/language pathologist.  For the past 5 years I have been full time in a school district while still seeing preschoolers for the county public health department part time after school.  I earned tenure at the end of last school year.  I had intended to post helpful information over time, but I really have become too busy in my work and personal life to keep too active.  I hope some of my previous posts have been helpful. I am hopeful that I will post again in the future. 

Communication Milestones Guide

This is an amazing guide for all areas of speech and language development.  Check to see if your baby or preschooler is on target for development of these skills. Click on the link below to view this free guide!

http://www.slideshare.net/ksfithian/milestonesguide-44505048

A Child Stutterer's Point of View

     In the school district I work, there was a little boy who was extremely intelligent. He graduated high school two years early, after taking college courses. After graduating early he went to an Ivy League college. He was a severe stutterer. He attended speech therapy sessions because of this. I was not his therapist.  While in elementary school he wrote a short piece about his own stuttering. It makes me re-think trying to change someone’s stuttering. It provides great insight that others his age and older might not be able to express:
“I do not mind my stuttering too much. Even if I did, I would not be able to notice the difference. Because I do not mind, I can’t understand why my parents do. Luckily though, I also do not mind the speech “lessons” that I have, allowing me to not become angry or frustrated. In the book I read, I do not understand much why so many kids do care about the stuttering that they have. I know that even if I could hear myself, I would not be the least bit upset over it. To me, it is nothing to worry about, but, to make everyone else happy, I try to stop and relax when talking anyways. Either way, I do not understand why it is bad or important in any way. As you can clearly see, to me, stuttering is no big deal. It is only as bad as a grammar or punctuation error in a set of meaningless sounds our society uses. What is so important about that?”

May is Better Hearing and Speech Month 2012

It has been two years since I have posted to this blog. I apologize to my followers who thought they had found a site to help them with understanding speech and language development and issues. It is my hope that I will again be able to provide some information for you soon.  Please scroll through my previous posts to review or learn about the topics provided.  It is the month to be aware of speech and hearing. Support your school speech therapists as well as those in private clinics, hospitals and the many other settings you can find them. Be aware and tolerant of those children and adults who are faced with challenges due to speech, language and hearing disabilities. The ability to communicate with others is one of the most precious abilities we have. Imagine if your ability to communicate was affected by loss of hearing, speech or the ability to understand and use language.  Help those with problems in these areas any way that you can.

May is Better Hearing and Speech Month!

Check out the American Speech-Language-Hearing Association website for information on all areas of communication.  Slogan for this year's Better Hearing and Speech Month is "Helping People Communicate."

This is an excellent site to learn information about any area related to speech, language or hearing.

Next week, May 10-16 is National Stuttering Awareness Week!

Visit the Stuttering Foundation of America website to get all of the answers to questions you may have about stuttering. It is especially helpful if you are worried that your child may be a stutterer.

Speech Sound Milestones

As a speech pathologist, I often have people asking me questions about their toddlers' and preschoolers' speech sound development. "Articulation" is the formal term for the ability to physically make consonant and vowel sounds that can be used alone and in combination with other sounds for the purpose of speech. All babies babble. This is the early sound play where we hope to hear a true word. It usually sounds like "ah-buh," "muh-muh-muh," and "ah-da." They will babble sounds that are in our language and some sounds that are not speech sounds. If a child doesn't babble, or if they babble and then stop babbling, their hearing should be assessed. For a typical child, speech sounds develop in a similar developmental manner. Although all children vary somewhat, we can hope to have children master the production of certain sounds by certain ages. Some children learn later sounds at a younger age and may sound like they have perfect speech by age 3. Others have sounds that aren't completely mature yet by age 5. Both of these examples are within the range of what is normal. Below are general guidelines for speech sound development. Your child may be a bit ahead or behind these guidelines and that's ok, as long as they continue to go through the stages in a near age approppriate time span. If you have any questions or worries, start with your pediatrician or local public health department and ask for a speech and language evaluation. Early intervention programs will be available to you if your child is delayed.

1-6 months
Vowel sounds are generally heard first. Soon there will be consonants, typically ones like "k" and "g" produced in the back of the mouth. Towards 6 months there may be some combinations of consonants and vowels.

6 months
Makes a lot of different sounds such as laughing, gurgles and coos. Babble when alone and for attention.

8 months
May often use syllables ba, da, ka. They will try to imitate sounds and make four or even more different consonants.

10 months
They may use a syllable or use several in repetition such as "ba-ba-ba-ba." They may start saying "dada" or "mama." They will start using jargon which is babbling with intonation making it sound like a "sentence." They will also shout to gain attention.

12 months
By one year of age they will say two words in addition to "mama" and "dada" on a regular basis. They will try to imitate sounds and familiar words. Will start making sounds of familiar animals and environmental noises like motors. Hears well and can tell the difference between many sounds.

18 months
They will use 10-20 words and start combining 2 words like "all gone," "Mommy up."
Imitates sounds and words more easily and accurately.

24 months
Vocabulary growing fast..around 300 or more words. Sentences of 2-3 words used regularly.
Using many different consonants correctly but may still substitute one sound for another such as
"d" for "g" or "t" for "k." They may be able to make consonant sounds but use them incorrectly at times.

3 years
All vowel sounds can be produced correctly. 90% of 3 year olds can correctly use consonants: m, n, p, h, w.

4 years
90% of 4 year olds can correctly use the consonants: k,t,g,d,b,v,f

5 years
90% of 5 year olds can correctly use: y, ing

6 years
90% of 6 year olds can correctly produce: l, j, sh, wh, ch, zh (treasure)

7 years
90% of 7 year olds correctly use: r, s, z

8 years
90% of 8 year olds can correctly use: th, blends (pr, sl, sp,tr...)

Teaching Letters and Sounds to Preschoolers

When I work with children as young as three years old on correcting error sounds, I am very aware that because they are not yet readers, they do not have the same understanding of sounds and letters that older children have. Some children are aware of letters and may know the alphabet song. The connection between a letter and a sound is not typically something that children learn until they get to pre-k or kindergarten. Letters and sounds are different concepts and I think it's as important to teach the connection between the two as it is to teach the letters themselves.  All parents try to teach their children the alphabet song.  I think this is great.  What could make this even better is to be sure that they pair what the kids are singing to a picture of the letters as they are singing them.  If there is no concrete connection made between the auditory letter and the visual letter, then the children are just learning a random song.  All children should have an alphabet poster or chart of some kind that should be brought out when the ABC song is done.  They should be taught to touch each letter as they are singing it.  This will avoid that single "LMNOP" cluster that they clearly think is one word.  The same chart can be used when teaching the children that each letter makes a sound.  I like to use a song that I heard in the pre-k classroom with all of my kids in speech therapy.  I take the sound that they are targeting and put it in the song.  The song is to the tune of "hot cross buns" and it would go like this: "D says duh, D says duh, every letter makes a sound and D says duh."  This can be used with every sound.  I tend to use the short vowel sounds when doing the vowels, since when vowels are long  they say their own letter name. When doing vowels use short sounds "a" (as), "e" (bed), "i" (in), "o" (on), "u" (up).  These tend to be harder for kids to learn for reading and writing and any jump start is helpful.  The pre-k classroom picks one letter each week to target and then does activities all week with that sound. Art activities, searching for things that start with that sound etc.  I suggest that parents do the same thing.  As the weeks progress, you add to the length of the sound song and mix the letters up so they are not learned only in order.  This work on pairing sounds and letters will give your child a great jump on early reading skills.  We tend to forget that just because a child can sing the alphabet song does not mean that he  knows his sounds and letters.

Speech Development and Ear Fluid

     It is common for infants and toddlers to have ear infections.  It is also common for them to have an excess amount of fluid in their ears that never becomes infected.  Otitis Media is the medical term for inflamation of the middle ear (the part of the ear right behind the eardrum) that is accompanied by a build-up of fluid. (The Otitis Media link above has a great deal of information and is a great supplement to this basic information I am providing). The fluid can be an infection, but this is not always the case. It is more difficult to recognize when a child has only fluid build-up because there is no accompanying pain or other symptoms.  When they have an ear infection, they may cry, pull on their ears or have a fever to tip you off.  You will likely take them to the doctor and they may be put on an antibiotic to clear up the infection.  Once the infection is cleared up, there is still the chance that they have excess fluid. If the child has excess fluid behind the eardrum, but no pain, you may never know this situation is happening. Other children may have excess fluid in their ears for many months or constantly and it may go undetected because there is no infection.
    Think of walking around with your ears plugged or being under water.  The muffled sounds that you hear is how the infant or toddler with an infection or excess fluid will hear their world. This is why many children who have had recurring ear infections or chronic fluid build-up do not develop speech and language skills at a typical rate.  For all of the time they have this fluid or infection, they are missing the models of speech.  In an infant and toddler, a total of six months of not hearing adequately can make a big difference in development.
     At times, a pediatrician will refer children to an Otolaryngologist (ENT) for tubes. These tubes have been called PE tubes meaning pressure-equalizing. They are also known as tympanostomy tubes. These tubes help keep fluid draining and work to prevent infections from recurring.  One possible side effect from tubes is a small amount of scarring on the ear drum that may slightly affect hearing due to making the ear drum a bit more rigid. This is not generally significant enough to worry about, it is just a small result from a procedure that is helpful in the long run.
     Children with known chronic ear infections are usually more closely followed  by their pediatricians for a possible delay in speech and language development skills. This is not always the case.  It is also important for parents to educate themselves in the developmental milestones their children should reach so that if there is ever a concern, they can notify the pediatrician early. The time that it may be realized that a child has non-infected chronic fluid build-up may not be until a scheduled well-baby doctor visit or at a time when the child has been brought to the doctor for an unrelated issue.  Delays in sound production and language skills should be a clue that something with the child's ears may be a concern.
     It is recommended that any child with recurring ear infections or delay in speech and language skills receive a complete hearing assessment.  It is at this time that the reason for the delay may be discovered and addressed. A very common reason for speech delay is chronic ear infections.  Once this issue is cleared up, a child will generally begin to catch up skills.  Speech therapy may be recommended to help the parents and children gain missing skills more quickly. Even if a child has not had known ear infections or fluid, they should get a hearing assessment as soon as it is determined that there is any speech delay.  There are other reasons for hearing loss in children and for speech delays.  It is always important to have hearing tested so the correct treatment can occur.
     I have been asked many times if it is possible to prevent ear infections in babies and toddlers.  Although some children will get them regardless of the steps you take to prevent them (the same way they get the common cold), there are things you should know and do.  A baby's eustachian tube (the tube from the ear to the throat) is smaller and positioned horizontally. Until a persons eustachian tube grows and changes angle to a more downward position, they will be more suseptible to infection and fluid build-up. 
      A baby should never be lying flat to drink a bottle.  If they are held at an angle of  at least 45 degrees, you lessen the chance of any liquid backing up and sitting in the eustachian tube, possibly causing infections. My professional opinion on this tip is also that babies should never be left propped up someplace to drink a bottle. Feeding a baby is one of the best times to bond with them emotionally and provides a perfect time to talk and interact with him.  You can sing to him, look at him, encourage feedback and just bond.  Speech and language skills can be learned in this time by making funny noises, showing various nice emotions in your face, saying strings of consonants-vowel combinations (ba-ba-ba or ma-ma-ma).  The baby has your undivided attention and eye contact during this time. Breastfeeding is also a way to prevent ear infections for two reasons.  Babies generally are not lying flat to breastfeed and they are gaining the benefits to their immune systems that breastfeeding provides. I also like the benefit of having to be with your baby while feeding, increasing the speech time!
     There are several other tips for trying to prevent ear infections. Children should not be exposed to cigarrette smoke. Children who have weakened immune systems or have allergies are more susceptible, so trying to avoid having them get colds will also help. Children in large day care settings may be exposed to more colds and other germs that may increase infection risk. If a child does have a cold with nasal congestion, try to keep his nose clear of fluid to decrease back-up into eustachian tube. Provide your child with a well balanced and healthy diet rich in fruits and vegetables that boost the immune system. 
feel free to ask questions here or to my direct email at beajvw@hotmail.com 

Vocal Abuse in Children

     Many children abuse their voices.  A few children will actually develop serious problems as a result. Children are known to yell, scream, cry, make loud motor sounds, make character noises, growl like animals and make other harsh sounds.  Some children are exposed to smoke.  Some children do not correctly use the muscles in their necks when speaking and may tense their neck muscles. This may be a result of inadequate breath support and supply. Vocal abuse is also seen in older children such as cheerleaders, yelling spectators at a sports event or just in a family that shouts a lot. We have all experienced a bit of laryngitis after cheering a sports event, screaming or singing loudly at a concert or a day of overusing our voice.  This one time abuse does not generally have a long term effect.
     Vocal abuse, also known as vocal misuse can lead to serious problems which can include vocal fold inflamation, chronic laryngitis, vocal nodules, vocal polyps, and contact ulcers.  Children may start to exhibit a hoarse or raspy vocal quality which is a sign that something more serious is happening.
    Vocal nodules are among the most common problem that develops.  Kenny Rogers and Rachel Ray have both been diagnosed with vocal nodules.  Their chronically raspy voice is a symptom of this problem.  Vocal nodules are non-cancerous calluses that form on the soft tissue of the vocal folds, also known as vocal cords.  The voice takes on a raspy quality because the vocal folds can not easily close due to the mass on them.  It also takes more effort to get the vocal folds to touch which adds to the problem.
     A diagnosis of vocal nodules is made by an ear, nose, throat doctor, also known as an otolaryngologist. Although surgery can remove nodules, it is not usually the first plan of attack.  With surgery, the nodules can be removed, but if the behaviors are not changed, the nodules can return. Voice therapy with a Speech Pathologist is usually recommended as a first step.  This therapy will include a vocal abuse reduction plan.  The child must learn new voice behaviors that include new breathing patterns, good vocal hygiene and easy onset of speech.
     Most conditions that result from vocal abuse are reversible.  Without treatment, however, children can become adults with vocal nodules. Since it is easier for children to change speaking patterns early, it is best to address it when the problem first starts. 
     It is recommended that you try to keep your child's vocal abuse behaviors as controlled as possible.  This is often accomplished best through modeling.  It is an interesting phenomenon that if you talk very softly to children, they tend to speak more softly as well. The opposite is also true.  In a household that is loud and the family members must shout to be heard or just tend to be loud in general, the children will follow that lead.  Young children will use their voice in a variety of ways during play and that should not be discouraged completely.  They need to make environmental noises to develop speech and language skills. They just need adult reminders and direction to help them keep it under control. 
     I am opposed to the terms "inside voice" and "outside voice" because the children shouldn't be allowed to abuse their voices just because they are outside.  I prefer that they learn one phrase that reminds them to use their soft voice.  This way, they can be reminded to change their vocal behavior with the same reminder phrase no matter where they are at the time.  It is also more clear to them after you teach them the difference between soft and hard voice.

Reading With Your Child

     I once went to a home where there were two preschool children.  I was there to work with the two year old who was not speaking yet.  The baby would later need services, but I was initially there to help the older boy.  It was at this home that I got a true understanding of the fact that some people are simply not aware of what should be done with children to ensure that they reach developmental milestones of speaking, language, motor skills, feeding etc.  While chatting with the parent and giving ideas of how she can use books with the child in ways other than just reading the stories, she said "We don't have any books for the kids."  I asked if that was because of how expensive they were, because I would be glad to leave some with her.  She answered, "No, we didn't get them any because they can't read yet." This was a very eye opening moment for me.  After this, I knew I would always be sure families of infants and toddlers had books and knew ways to use the books to encourage many skills to develop. The following is just a short list of things that can be learned through books before children learn to actually read the books and some of them are learned even before they are able to speak:
 1.  Visually attending to 2 dimensional pictures as opposed to 3 dimentional objects.
 2.  Isolated pointing with a finger as they touch pictures that are interesting to them or that are named.
 3.  Social time with parent as they spend time with a book.
 4.  Increasing length of attention to an activity.
 5.  Learning labels for pictures which increases receptive vocabulary.
 6.  Learning about things that they can not experience and gaining vocabulary.
 7.  Fine motor skills of opening flaps or turning pages.
 8.  Cognitive skill development as concepts are labeled. For example: "Big dog."
 9.   Develops book orientation, learning how pictures should face and left to right page turning.
10.  Increased listening skills.
11.  Ability to make noises and words that correspond with pictures.
12.  Imitates actions seen in pictures.
13.  Labels pictures or retells words heard in story.
14.  Begins to pretend to read orally.
15.  Begins to anticipate pages or parts of stories.
16.  Following directions such as "Turn the page." of "Point to ___."

     This list of benefits is based on the fact that a parent is using the books with the child.  If the books are available to the children, but not used with them, they will not get any of these same benefits, because there will be no one modeling the words or proper book use.  Babies will not naturally learn what to do with a book without the added interaction of an adult.  They will likely look at them on their own as well, but it can't be stressed enough, how important it is to make it an activity that is also together. 

     Using books with a child does not mean the same thing a reading stories to them.  All children are at different levels of understanding and with different attention spans.   The youngest children will do well with the sturdy cardboard books with bright pictures.  A few large pictures per page make it interesting for them to look at, easy for you to label for them and easy for them to know what you are referring to.  Say "Apple" as you point to the apple.  The babies will soon start imitating the pointing.  Later, you can ask questions such as "Where's the apple?" and they will point.

     As children get older, use books with one sentence per page that refers to the picture.  You can use the sentences and then add to it yourself by looking at the pictures and talking about them in more detail.  For example, if the short poem "Twinkle, twinkle, little star"  is on one page, you can read the poem, and then talk about the picture.  Say things like "I see 5 stars...1-2-3-4-5."  "Stars are up in the sky." 

     Read with your child every day.  Show excitement for reading.  Be enthusiastic and very animated with reading.  Be a great storyteller and it will keep your child's attention. Make it part of the naptime and bedtime routine.  Other times of the day are great too as long as it is a relaxed atmosphere.  Let the child choose the books, let them help hold the book and turn the pages. Let your child point to pictures and talk about things. Let you child fill in the last word of a sentence in a familiar story. There are many ways to use books, be creative. 

     Never worry about the fact that you didn't "Read" the story to them.  It is not the completion of the written words on the pages that matters.  It is the time with you and the time with books that will make the difference.

     Books are expensive, but I encourage everyone to purchase a few.  In addition, I think it is extremely important to introduce young children to the public libraries.  Depending on your area, libraries are now offering many activities for infants and toddlers.  It becomes a nice routine to go once each week to read books there and to bring new ones home.  Attend any story time activities that are offered.  This prepares children for the large group setting of a classroom to listen to stories and enjoy books/stories  told by others.

     It is also good also for your children to see you reading.  Reading the newspaper, magazines and your own books will show children that reading is fun and since they like to copy their parents, they will probably go and get one of their books when they see you reading!  Read with your older children as well.  When they begin to read chapter books on their own, take turns reading the chapters.  At night, even older children enjoy the time you will spend with them reading to them. They will always remember this time with you too.  Have fun and read every day with your child!
    

Parts of Speech Review

     When we are in school we learn the parts of speech and their definitions.  Later, most people can remember things like "A noun is a person, place or thing." or "A verb is an action."  It is all of the other parts of speech that we forget.  It is not until your fourth grader comes home with homework that it all starts to come back to you.  I thought I would do a little review of the definitions of the parts of speech and some other terms we learned in elementary grammar lessons.  In language therapy, if a child is having difficulty with grammar, we will focus on specific areas of weakness.  Some students need to be more descriptive in their writing so we work on adjectives.  Some students have difficulty with irregular plural nouns or verb tense agreement. I will not get into the complications of the language such as when words are sometimes pronouns and sometimes adjectives for example.  Anyone interested in more than the basics can feel free to research this topic. Here is a list of terms with examples. Some you may remember and some may be unfamiliar.

Common Noun: A word used to label a person, place, thing or idea such as ball, home, or happiness.
Proper Noun: Names a particular person, place or thing and is capitalized, such as Bob, Chicago, or  the Declaration of Independence.
Pronoun: A word that takes the place of  one or more nouns such as he, she, it, both, you.
Adjective: A word used to modify a noun or pronoun. It will often be a word that will answer the questions What kind? Which one? How many? or How much?  Examples : tall, last, many.
Article:  The most frequently used adjectives: a, an, the.
Proper Adjective: An adjective formed from a proper noun which will also be capitalized such as:  American flag.
Action Verb: A word that expresses a physical or mental action such as run, or imagine.
Linking Verb:  A word that helps to make a statement by linking the subject and predicate. The most common are the forms of the verb be: am, is , are, was, were, been, be, being, been.  Other common linking verbs are: seem, taste, become.
Helping Verb: A word that accompanies other verbs to make a verb phrase. Some examples are will, have been.  She will walk.  They have been wondering.
Adverb: A word used to modify an adjective, verb or another adverb.  Usually answers questions When? Where? How? and To what extent? Examples: It started here. He threw the ball far.
Preposition: A word that combines with a noun or a pronoun to make a phrase. Examples: in, on, under, from, off, through, against.
Conjunction:  A word that joins words or groups of words. 
      Coordinating Conjunction:  and, but, or, nor, yet
      Correlative Conjunction:  Found in pairs with other words between them: either...or, neither...nor,
             not only...but also.
      Subordinating Conjunction: A word that introduces an adverb clause such as since, as, because, or 
             if .
Interjection: A word that expresses emotion and is not related to other words in the sentence grammatically.  Examples: Oh! Wow! Well, 

Bubble Play for Early Sound Development

   One of my most favorite activities to do with infants, toddlers and preschoolers is to play with bubbles.  The kids absolutely love bubbles and I often bring them out for the last few minutes of a session.  The older kids think it's a reward and will work well with the promise of bubbles. I love them for several reasons.  If the child is old enough, I have them practice blowing the bubbles as part of the activity.  This works on oral motor strength and coordination.  I use bubbles to encourage sign and gesture usage for "more," "please," "done," "bye," "yes," etc.  I use related words to encourage all early developing sounds such as /h,p,b,d,m,n,w/.  Some bubble play related words are: bubble, more, up, bye-bye, pop, done, please, wet, gone, blow, wow, uh-oh, high, yes, no.
   When blowing bubbles with the child...use the key words repeatedly. For example: "Look....bubble..up-up-up...bye-bye bubble....pop-pop-pop...."  "More bubble...pop-pop-pop....all gone..."  "More bubble...uh-oh...pop-pop-pop...."  "Bubble...wow!....up-up-up... uh-oh...pop!"   "Wow...high bubble....bye-bye." This is also a chance to ask questions of your child and encourage responses either verbally or with gestures.   Ask child "Do you want more?"  Encourage them to use head gesture for "Yes," sign for "More" or use words if they are able to say "more" or "more bubble."
     This bubble activity is done regularly and the children begin to respond to the repetiveness of the words modeled and the activity of blowing and popping (popping the bubbles with a pointer finger encourages fine motor skills as well). They will often imitate the repeated words like "pop-pop-pop" after a few sessions.  Soon they start to use some of the phrases spontaneously!   Parents in my sessions usually love this activity as well.  I encourage them to get bubbles and use them as often as possible when the children are learning these early sounds..  I recommend the spill proof type of bubble containers that are available now.
     I will also work on body parts and object recognition with bubbles. I will catch the bubble on the wand and pop it on a body part or toy while I label it.  "I'm going to pop this bubble on your foot."  "Pop on block."  You are then modeling speech sounds and vocabulary.
     So get those bubbles out and have fun!  The learning opportunities are endless.

Keep A First Words Journal

  When I first go into a home to start therapy with a toddler that is delayed in their speech I always ask the parents how many words the child currently uses.  At first, parents usually do not know exactly how many words their child has.  They may then start remembering that their child has said "mama" or "baba" or "dada."  There are situations where this is actually the number of words the child has. More often, however, the child may actually have ten to twenty words in their expressive vocabulary.  Parents can forget easily, even though at the time they think they will remember every word the child uses.

   One of the first things I do is to have the parents start a "First Words Journal" in the form of a piece of paper placed on the refrigerator. I find this is the best method for ensuring that the parents use it.  They see it and are reminded of it often.  Whenever their child uses a word, they are to write it down as soon after they hear it as possible. The date should be added so it can be determined how often new words are added. If they hear the word again, they are to put a tally mark next to the word that had been written previously.  This helps to see the number of times the child uses specific words and which words may have just been a one time production.

     Parents aren't expected to keep a perfect record, but in one week an impressive log is often compiled.  Through the course of therapy, I have parents continue to keep the journal as the child uses more words.  Before long, there are often two word phrases added to the list!  This is a great way to see the child's progress and have the parents be more aware of their child's speech attempts.  Parents tend to get  more involved trying to encourage new words to be able to add them to the list.

     This is a great way to document any child's first words and phrases and becomes a keepsake for memory books.  I especially encourage parents to use this if they suspect a delay.  Be sure to date the new words the first time they are used.

A Day in the Life of a Speech Pathologist

      Today was my first day back to work following the Christmas Vacation.  I thought I'd share with you a little timeline of my day.  Every day is so different, I'll share one of my totally different sort of days another time.

     I dropped my son off at the high school at 7:15.  I arrived at the Intermediate School by 7:30 after stopping for a large coffee.  Our school building has 4th and 5th graders only.  I turned on the computer and logged on to the Online IEP site. An IEP is an Individualized Education Plan and it is the document that contains the test results, goals and other relevant information about the students.

  I spent the next hour on the computer.  I first entered the attendance for the month of December for my Medicaid eligible students into the related service log of each student's online IEP.   Next, I realized that it was January and the second quarter progress codes needed to be entered  on each goal for all 26 of my kids with IEP's. This online program takes at least half of the time off of "paperwork" like this.  I only work at this school 17 hours a week, so 26 kids is quite a few.  I also have 8 kids that receive "speech improvement" and do not have an IEP. 

I had finished entering the progress codes (NP for no progress, SP for some progress, PS for progressing satisfactorily etc...) and had enough time to check school emails like the Principal's weekly newsletter and general requests from teachers for things.  I then wrote an email to all of the teachers that had my students in their classes.  I told them that I had to get started on annual review testing because I had half of my kids with early meetings this year.  They are scheduled for February 24 &25th which is much earlier than we are used to.  A change in Committee for Special Education scheduling caused this change for us.  Onced I hit send, the 8:30 bell rang.  This bell releases kids to their classrooms and to breakfast.  I take a Breakfast Club group of speech improvement kids to work on sounds 'r' 's' and 'th' during this first half hour of the day before morning announcements and the school day technically begins.  These kids do not have an IEP, so I don't feel right seeing them during the school day.  Kids with an IEP have a documented time out of regular education slated for their therapy sessions. 

The day is broken into half hour intervals for most pathologists. From 8:30 am until 2 pm were my 10 time slots for today.  This is my longest day at the school.  Other days I am only here about 3 hours.  Here is how the rest of my day played out.

9-9:30 I pushed into a reading class that I have 5 language students in.  A typical lesson in here is reading a chapter in a book and answering comprehension questions.  Today we also worked on combining sentences such as The girl is running.  The boy is running.  The girl and boy are running.  OR They are running. 
9:30-10 I typically push into a reading class with a boy with Asperger's.  Today I pulled him out for a little testing.  He has trouble with things like use of idioms, metaphors, similies etc.
10-11 I pushed into a collaborative teaching classroom during English/Language Arts time.  Mondays is the beginning of a spelling list week.  They get a list of words, write these words into sentences, practice writing them in cursive, alphabetize them and copy them onto a list to study at home.  During the rest of this time I provide lessons that directly address the goals of the students in there that are on my caseload.  There are 7 in this particular group. 
11-11:30 I pulled a student from his classroom for testing.
11:30-12 I see a small group of three kids in my therapy room.  They are working on a variety of things, but the group works well together.  One student leaves off all plural and possessive "s" markers and used the wrong tense in his spoken and written expression.  The other boy in the group needs work on social skills involving conversation rules and socially appropriate topics and skills.  The girl in this group needs to speak more loudly, provide longer and more complete answers and learn to use more descriptive words in her speaking and writing.  Today was a conversation about vacation and Christmas presents.
12-12:30 I had a break.  I spent this time going through all of my files to find information for a parent I met on twitter that has a child in need of speech therapy. I was unable to make any copies for her though since the copy machine ran out of toner with all the teachers using it this morning. Grabbed a cereal bar while I looked through files.
12:30-1 I pulled another student for some testing.
1-1:30  Yet more testing. 
1:30-2 Back on the computer to go into the IEP site again.  This time I had to sign off on two therapists' attendance.  In our district there are two therapists and two pathologists.  I am the supervisor of the two therapists and I have to sign off on all of their testing, therapy, attendance, etc. 
2-2:30 Worked with two students who have Aspergers.  Great session on idioms.  One of them has caught on a bit that they are not meaning what they sound like.   The other student is so literal, he can not yet get past it. It was fun though.
2:30 I left the school...but I was not done working yet!
2:45-3:15 I worked in a home with a 4 year old who has recently had his tongue clipped.  He needs retraining in saying many words now that he has more tongue mobility.  We are working on 't' and 'd' as well as 's'  He previously made these sounds way in the back of his mouth...uses g for d for example.
3:30-4 I worked with a 2 year old boy in his home.  He is just starting to use words and we are noticing that he leaves off all initial consonants.  We are addressing this as well as increasing vocabulary and having him be able to follow more directions. 
4:00....Headed home to make dinner. Evening activities begin.

This was my first day back after a very relaxing vacation.  I honestly do not have any brain power left to write an in depth, educational post today.  Hopefully tomorrow I will be back in the swing of things! 

Phonological Processing Delay vs. Articulation Delay

 Many children have difficulty producing sounds correctly. This is referred to as an Articulation delay or even sometimes as a Phonological delay.  In previous posts I have discussed speech sound development and given some information about delayed speech production skills.  Today I will discuss the difference between an articulation delay and a phonological processing delay.  There is great information on the ASHA Website on this topic as well.

An Articulation or a Phonological delay is a delay in the ability to produce sounds correctly.  Children may be late to speak in general or not master sounds at the times that other children do.  These sounds are usually substitutions of an easier sound for a more difficult sound.  An example is a child saying a /f/ for a /th/ in the word "bath."

A Phonological Processing delay is a sub-group of Articulation Delays where children have difficulty with a pattern(Process) of speech sound productions.  Children all use phonological processes in their developing speech.  A child's speech becomes phonologically delayed  when they continue to use these normal processes past the typical age of use. I will  give you one example of a typical phonological process.
The one phonological process that I work with most often is called Final Consonant Deletion also called Deletion of Final Consonants.  This is very common as children learn speech. It is a normal pattern.  They will say "da" before they say "dad" they will say "kuh" before they say "cup."  As children approach age 3 to 3 1/2, they have generally stopped using this process.  They will now use final consonants on a regular basis. If children are still using these processes past the general age of elimination, they may need to address it directly in therapy. 

   Once in a while a child will use a phonological process (pattern) that is not typical. This is identified as a phonological disorder rather than just a delay. I currently have one child using Deletion of Initial Consonants.  This is not a typical pattern, it is challenging to address, but I am seeing progress.  He is able to produce all age appropriate sounds in isolation and at the end of single syllables. Our therapy has focused on encouraging initial consonant production by taking him through the sounds developmentally.  Since /m, b, p, d/ are typically early mastered sounds and since he could produce them well in the final position, we started encouraging production of these sounds before a vowel such as "ba," "be," "boo."  Once he mastered this, we added a final consonant to see if he could maintain the ability to produce it in the initial position.  He is showing progress with this method and now has some spontaneous words that begin with /m, b, and d/.

Speech Sound Development Guidelines

     Children develop at different rates in all areas.  There is a general guideline for when children reach developmental milestones, but there is a wide range of what is considered normal development.  This is also true in the development of speech sounds in children. This may be referred to as Articulation Skills as well. The guidelines below are just that, they are only meant as a guide, not a definite rule. Different sources may place sounds at different age mastery, so you may read a source with slight variations to what I have here. The ages at which children master sounds, means that they are able to use the sound correctly in all word positions on a consistent basis.  Children are always working on some sounds and can use them correctly in some word positions.  We call those sounds emerging.

     The earliest sounds that are generally mastered by children are /m,p,b,h,w,n/. Most children have these sounds mastered by the time they turn 3.  While they are reaching mastery on these sounds, they are working on perfecting the following sounds: /k,g,d,t,v,f, y/.  These sounds have generally been mastered by age 4.  By age 6, children should now be able to use /ing, l, j, sh, ch, zh/.  The sounds that are generally the latest to be mastered are/r, s, z, th/.  Children at age 7 and 8 could still be working toward mastering these sounds. 

     Children generally use substitutions for sounds that they have not yet mastered.  You will likely hear a three year old use many words, but not use the sounds of these words correctly.  They may say "I wub ew" instead of "I love you." because they may still be working on mastery of /l, v, y/ sounds.  We know what they are trying to say, but there are sound errors. Parents can usually fill in the blanks of their child's speech.  They often do not even consciously notice the errors. 

     You may have a child that is making some later sounds, but not yet some early ones.  This is possible.  In this case,  be sure to model these early sounds and do things that exaggerate the sounds they are missing.  It is fine for parents to notice that a child is not making the /d/ sound, for example, and try to boost the development of this sound by doing activities that incorporate it.  When you are rolling a ball down a slide say "down, down, down"  Have child imitate.  It is fine to have them look at you and tell them to listen to how you say it.  Exaggerate the "d" while they see how you make it. 

     In an earlier post I told how learning speech sounds involves some trial and error.  If a child is of an age that should be mastering a particular sound and he is not, it is fine to point out this sound and focus on it in play and activities. They will not know they are using sounds incorrectly if it is not addressed either directly or indirectly through modeling.  I will do a later post on some activities to work on  single sounds.  If you feel that your child's overall speech sound development is delayed, contact your pediatrician who can refer you to a  Speech Pathologist for an evaluation and therapy.  If they do qualify for therapy, parents will still need to be involved in modifying the child's sound by doing activities and modeling suggested by the therapist.

Feel free to ask me questions if you are a little unsure about your child's current sound development. 
 

The Difference Between Speech and Language

     The difference between "speech" and "language" has been a confusing point for many people. I have been called a Speech Therapist, Speech Teacher, Teacher, or Speech-Language Pathologist depending on who is saying it.  Some people think I teach others how to give speeches, some think I teach kids how to speak and some think I am an English or reading teacher.  One of the biggest confusions in public schools is when kids "go to speech" but we work completely on language goals. Some kids, as well as teachers and other adults, are confused by this contradiction. To alleviate this confusion just a bit, I will provide some definitions and explanation to help differentiate. This is just the quick explanation.

SPEECH (ARTICULATION):  In the context of my profession, speech is the physical process by which we verbalize language.  It is a method of communication that uses voice and coordinated movements of the speech articulators (tongue, lips, jaw, teeth etc.).  When I am addressing "speech" in therapy, I am working on the person's ability to have adequate strength and coordination of the speech musculature through oral-motor exercises.  I am working on teaching them correct articulation or placement of articulators for production of specific consonant and vowel sounds.  For example, when a child produces an "f" instead of a "th" sound I first make them aware that they need to place their tongue between their top and bottom teeth, and blow gently rather than gently biting their bottom lip with their top teeth for making an "f."  Once they learn the correct placement, we practice the sound alone, then we practice it at the syllable level, we practice it in all positions of short words, we progress to multi-syllable words, then phrases, sentences, and finally conversation.  It is a lengthy process to correct an error sound because there is conscious effort needed on the person's part.  Eventually, with practice, there is muscle memory and a change from voluntary concentration on the sound to an involuntary carry over of correct production to all contexts. It can be compared to anyone attempting to change a habit.

 LANGUAGE: The understanding and use of our language is the focus of language therapy.  A few of the things I might address are concepts, grammar, use of language in social settings (pragmatics),  morphology (plural markers, possessive markers, irregular verb tense...), word finding, vocabulary, synonyms, homonyms, and written expression.  This is not a complete list, but it gives you an idea of the category.
When children are evaluated for their language abilities, there are assessments done in receptive and expressive language areas separately.  Children generally have better receptive skills than expressive skills since they can understand things before they can express the same things. Testing for specific areas of weakness helps to guide the development of goals for each child.
     Receptive Language:  The general definition of receptive language is the processing and understanding of language.
    Expressive Language: Expressive language is the use of the language. This can be in any form such as oral or written.

Techniques to Encourage Language Development

     If a child is not told the name of an object, he can not learn to say it. If an action is never labeled, a child can not follow a direction to do it. Think about what it would be like if you were suddenly placed in a foreign country with absolutely no idea of the language.  If people are constantly talking but not helping you learn to place meaning on words, you will not ever be able to understand or use their language.  It does not come naturally for all people to think of this with a baby or toddler.  All babies will naturally make sounds and try to communicate, but it takes specific methods of interaction to reinforce their attempts and encourage more from them.  Children can have delayed speech and language skills for many reasons.  Parents can help be sure that their child's  language environment is as rich as possible to avoid lack of stimulation as a reason for any delay. 

     Most parents use the following techniques while interacting with their babies and toddlers without realizing that what they are doing has a name.  Some of these techniques are indirect methods of stimulating language.  By indirect, I mean that there is no specific requesting of a response from the child. The parent or therapist will perform these methods in a natural way during the child's day.  Direct methods of encouraging language are requesting that the child try to imitate words and phrases or answer questions that we ask.  These are important to do in combination with the indirect methods in order to check for understanding and encourage the use of words that the children are learning. It is not always natural to focus on one of these methods at a time, use them together and in various combinations to provide the most well-rounded language stimulation experiences.

INDIRECT TECHNIQUES:

     Self Talk:  This  method is just what it says. YOU talk out loud about what YOU are seeing, doing, or hearing as you do it.  The child should be nearby or at least in hearing range when you are talking so that he can make connections between what you say and what is happening. Use single words and short simple phrases.  A running commentary of non-stop talking in long sentences will not provide the same effect. An example of a natural activity to use this method is folding laundry.  With the child playing nearby or involved in the activity, some of the self talk might go like this:  "Mommy's folding clothes....shirt....fold shirt...sock....one...two...two  socks."  "Big shirt...Daddy's shirt....fold Daddy's shirt." "Pants....blue pants...fold blue pants...." 

     Parallel Talk:  With this method, YOU talk out loud about what your CHILD is seeing, doing or hearing. A great way, but not the only way, to use this method is to sit near your child while he is playing with something.  In this example, a child is playing with a toy farm set. "Cow....cow eat....yum, yum, yum.....cow says moo...moo cow...uh-oh...cow fall down.  You picked cow up...walk, walk, walk..."   This parallel talk can happen throughout the day as the child is doing all activities:  "Roll ball...weee....get ball...you got ball....bounce, bounce...you gave Mommy ball..."

     Description: This method is partly used in the above methods as well.  This method uses words and statements to describe, label and explain objects.  This introduces adjectives in addition to the noun and verb labels you started with.  Examples are "Big ball"  "Hot coffee" "My blue shirt."  "The juice is cold."

     Repetition: To use this technique, your child must now be talking in single words and some phrases but will still have sounds that they can not say correctly.  Although it is developmentally expected that they will make errors on sounds, learning them is partly trial and error. If their productions are always accepted and never modeled differently, their brain will register this as being correct. With this method, you repeat what they say but produce your words with correct sound production as a model for them to hear how you say it.  Do not expect them to repeat yours back or correct it the next time they say it.  An example might be if he says "Boo Baw" you say "Blue ball"  just the way he said the phrase, but with a model of correct sound.  Another example of the child's phrase may be "mow gink" Repeat what he says correctly: "More drink."

     Expansion: With this technique, you repeat the child's phrase, but in an adult form.  This reinforces that you understand what they said, but it models the more advanced forms of their early language.  They may say "Moo eat." You would reply back "Yes, the cow is eating."  If your child says "Shoe"  You say "I'm putting your shoe on."

     Expansion Plus: This method uses the above Expansion method plus an additional comment that is related. Expand the child's sentence to an adult form, then add something that will enhance the meaning of this to add concepts to what they relate to this sentence.  An example would be if the child said  "Car go" You would say "Yes, the car goes. It's going fast."   Another example is if the child says "Go out." You could say "You are going outside.  We can play ball."


DIRECT TECHNIQUES:
 
     Questioning:  Ask you child questions such as "What's this?" "What is the boy doing?" "Where's the ball?"  If the child is unable to answer or does not yet have the vocabulary to answer, you tell him the answer right away.  An example is :"What's this? (brief pause)  It's a monkey. Can you say monkey?" Try to encourage imitation of the answer in this method.  This method works well when looking at books with a child. Ask your child what people in the book are doing, ask where something is on the page for them to point to. Combine this method with the above methods to make looking at a book a great language enhancing activity.

     Imitation Requesting: If your child is in an imitation phase of language development, you will see more participation with this method.  If they are not yet imitating on a reqular basis, this method will help to encourage more imitation.  An example of this would be if the child says "more" but holds out cup instead of saying "drink"  You would say to him "Tell me more drink"  If the child has the ability to say drink and you have heard it before, it is fine to require that he say it before you give him the drink.  If he has not used it before, simply request it...model it and then provide drink.  

     Reinforcing:  One of the best ways to encourage children to communicate is to respond to their communication attempts. Reinforcement encourages a behavior to continue.Responding to their communication encourages them to do it more.  If a baby babbles you should babble and chat back to them.  If a child tries to tell you something, take the time to try to figure it out.  If a child is incorrect with speech or language production...model the correct form.  Be sure to acknowledge their communication attempts and  provide time for communication with them.

Who Can Speech Pathologists Help?

     Many people do not realize how many disorders and conditions a speech pathologist can treat.  I will provide a list of general categories and some specific conditions that can benefit from therapy. I am mixing the medical conditions as well as the things they cause in the same categories at times. Some conditions fit in more than one category. This is not a complete list, but it should give you a good idea of the many people that can be helped by a speech pathologist.  The links on the terms will take you to the American Speech and Hearing Association Website (ASHA ) for definitions and specific ways a Speech Pathologist can be involved with each disorder. Feel free to go to this site to look up any disorders that I did not include links for. I know I am forgetting many conditions, but this is quite a few!

VOICE DISORDERS:
     These conditions affect the sound of the Voice in either pitch, volume or quality.  Speech Pathologists never treat voice disorders until a person has been evaluated by an ENT. Voice therapy alone or in combination with surgical treatment may be recommended for the following:
     Vocal Nodules, Cysts or Polyps; Laryngeal Cancer/Laryngectomee; Spasmodic Dysphonia; Vocal Fold (cord) Paralysis; Voice Quality Disorder (pitch, volume, nasal quality);Vocal fold nodules; Vocal Hyperfunction (misuse); ALS; Laryngeal Papillomas; Vocal Fold Scarring; Glottic (vocal fold) and Subglottic Web;

SPEECH DISORDERS:
     Speech disorders affect the ability to produce speech through the correct placement and movement of the articulators. 
     Apraxia; Childhood Apraxia of Speech; Sound Disorders; Dysarthria; Oral Cancer; Huntington's, Down Syndrome; Stroke; Accent Modification; Cleft Lip and Palate; Selective Mutism; Stuttering (dysfluency); Cerebral Palsy...

LANGUAGE DISORDERS:
     Disorders of language affect a person's ability to understand or express words, ideas, vocabulary, grammar, directions.
     Developmental Language Delay; Aphasia; Traumatic Brain Injury; Stroke; English as a Second Language; Auditory Processing Disorder; Down syndrome; Autism...

COMMUNICATION DISORDERS: 
     This category includes people who require augmentative or alternative methods of communication due to inability to use speech. Often uses low and high tech methods in combination. 
     Hearing Impairment;  Cerebral Palsy;  ALS; Ventilator & Tracheostomies; Stroke;

SWALLOWING DISORDERS:
   This category includes people who have difficulty swallowing or eating orally for a variety of reasons. Dysphagia is the term for a disorder with swallowing.
     Infant feeding delays; Stroke;  ALS;

Using Toys in the Home vs. Bringing My Own

     When I first started doing home based speech therapy for children birth-age 5,  I always brought my  own bag of toys and "therapy materials" into the homes with me.  My large L.L.Bean Tote made a great bag to hold books, puzzles, farm sets, preschool toys and games. I brought things that I could use to encourage speech and language production.  The children loved seeing my bag and they couldn't wait to see what was in it each week.  They often had favorites and I made sure to bring those each time.  I was sure to search for toys that could be used to teach concepts and vocabulary. I found toys and books with current TV characters and  things that looked fun to even the parents. For the longest time, I thought this was the best way to run my therapy sessions.  What could be better?  I had the knowledge, the techniques to model and the best toys to do it with.
     The first time a child cried because I had to take the toy away with me I started to question this method.  I started to let kids borrow toys until the next time I came, in order to prevent meltdowns.  Parents started to go out and buy the same toys that were in my bag so their child didn't have to be sad when I would leave.  I also started thinking about how I was demonstrating great techniques with the toys I brought, but I could not be sure that the parents could take what they saw and generalize that to the toys and things they had available in their home already.  A new theory started spreading among therapists that connected with the natural language environment concept.  Since we would be providing therapy in the child's natural environment, we should also use only what is in that environment to do our sessions.  There is no better way to be sure the parents are able to carry over what I do in the sessions to their child's everyday life.
     It was around this time that I attended a workshop that asked the question "How comfortable would you be if you had to leave your bag behind?"  The workshop talked about using things in the child's home, even if they had no toys.  The idea of a child having no toys is not surprising to me.  I have been in many homes that had only a few infant toys for toddlers.  We were given grocery bags full of random household items and asked if we could plan a session around these items.  We were all more creative than we thought and we were able to work on just as many concepts with these everyday items as we were with our bag of the best toys. I was in complete agreement with this theory.
     Now the questions started popping into my head.  How could I now do this with families that were already used to me bringing my bag?  What will a parent think of a therapist who brings nothing to work with?  How open will a parent be with having me use their things?   I didn't think I could quit bringing my bag "cold turkey."  I would probably have to wean myself and my families slowly.  I wondered if I would be able to do this with 100% commitment.
     I was able to start this method with one family I started seeing the very next week.  This was easy to do because during the first session I explained the theory to the mom and she thought it was very logical.  The second benefit in this particular case was that I was not bringing in any toys that other children had played with and may contain germs.  This particular child had a compromised immune system due to chemotherapy.  So, I was on my way to trying this method in a very willing family.  This family also had more toys than any family I had ever worked with, so I was not being tested on my creativity too much yet.  This was going very well.
     My next challenge was to sell this idea to families and children that were used to my bag full of toys.  I started slowly with families that I knew would be willing.  I surprised them with the method one day by telling them that I had left my bag of toys home accidentally. I took the opportunity to explain the theory and they generally said that it was not a problem and we used toys and books that were in the home.  This also had a bonus benefit of the fact that I was no longer tied down to providing therapy in one little spot in the house.  We went to the child's room, a play room, outside etc. This made it easy to talk more about actions and different vocabulary.
     The hardest situations were in the families that had few toys and lived in homes that did not provide much in the way of space or opportunity to do a variety of activities. I used the shopping bag method I learned at the workshop.  A asked that each time I arrived, they would have chosen at least 10 items from around the house and placed them in a bag for us to use during the therapy session.  I was surprised at how this also encouraged the parents to think about finding things that could teach concepts. In these homes, we sat at the table and used all of the things in the bag. Some of these sessions turned out to be the most educational for parents.  They used creativity and realized that even if they could not afford the newest and best toys, they could still help their child with what they did have and with what they could do. 
     Today, I admit that I do use a combination of these methods.  In some situations, when I am confident that the parents understand the techniques I use, I will occasionally bring items that may introduce concepts that I could not do with their items.  I also bring things as examples for parents when they have asked what things they should try to get for their child.  I sometimes bring things to assess how a child is doing in an area and to see where we should focus next.  I think the best method is to use what is in the home, but there is still a place for us to bring in things that make therapy most beneficial to the child.      

Speech and Language Therapy in Natural Environments

     I have provided speech therapy for preschoolers in a variety of settings.  I have seen them in their pre-schools, in their homes and in clinic settings.  Of these settings, the clinic does not meet the criteria of natural environment. I no longer work in that setting with any child.  A natural environment is defined in IDEA Part C Regulations at 34 CFR Part 303 as: "To the maximum extent appropriate to the needs of the child, early intervention services must be provided in natural environments, including the home and community settings in which children without disabilities participate." (34 CFR 303.12 (b)). See the IDEA Regulations for Natural Environment for details.       All of my early intervention (birth-3 yrs) therapy sessions currently occur in the child's home.  The therapy in this setting allows the most opportunity for progress for several reasons.  In this setting I can include parents, siblings, friends and other caregivers in the sessions. I require at least one person to be an active participant during each session. I am not there to give the parents a break. I can provide support and models in the context of typical relationships and play.  I can adapt my plan to accomodate activities and routines to support full participation and learning. 
     As I tell parents, I am only in their home for a total of about 1 hour each week.  My job is not to provide therapy to the child to catch them up developmentally all by myself.  They will make minimal progress and may not catch up with only my effort one hour per week.  My job is to educate the family through explaining and modeling, so that they can provide the same quality speech and language stimulation techniques throughout the child's day when I am not there. I am a resource for them.  I am available to them for the hour each week to share my knowledge and help them provide the best interactions they can.  I have them be active participants in the sessions and demonstrate to me that they have an understanding of the techniques that I use.
     Another benefit to this natural environment setting is that I can help parents learn how to teach vocabulary that is relevant to their child.  We use toys and activities that are in the home. I teach basic signs to the parents as I teach them to the child. We use a variety of items in several ways to stimulate speech and language development. I provide ideas and activities for parents to use. I make suggestions to them of experiences to try to encorporate into their child's life. There are times that I bring some of my own materials although it is usually best to use what is in the home.  I will address this in my next post since this topic deserves its own space. 
     At the ages of 3-5, I feel it is still most beneficial to see the child in the home with parents present to provide consistency in the way cues and models  are presented to the child.  At this age, they are often working on speech sound development and correction as well as language skill development.  I see many children at this age in their preschool classrooms.  I see the most progress from these children if there is also parent and teacher involvement.  Since the teachers are with these children for large parts of their day, I am sure to share what I am doing with these day care providers as well as progress reports and home activities sent to parents. I provide homework for children working on speech sounds so that the parents learn to help remind them of their sounds.
     Parent involvement is necessary and crucial in order for children with delayed speech and language skills to make consistent and substantial progress in the shortest time possible. This can be most effectively accomplished through provision of therapy in natural environments.

Using Sign Language With All Babies and Toddlers

   Think about the natural gestures we all use. We wave to say "Hi" and "Bye," nod our head for "Yes," shake our head for "No," shrug our shoulders for "I don't know," and clap or high-five when we like something.  These are a few of the universally understood natural gestures we use and even teach our babies. The reason we naturally teach these gestures to our babies is because we know they can imitate and attach meaning to these gestures before they are able to use the words. We are so proud when they wave or shake their head "Yes" for the first time around 9-12 months of age. The babies eventually learn the words that go with these gestures, but they are able to communicate with these gestures much earlier. This is the concept behind teaching your babies and toddlers sign language.  They can imitate hand gestures for patty-cake, peek-a-boo and the words mentioned above. If they can do this, let's give them even more words they can communicate with as they are learning speech. Trust me, a normally developing baby will not use signs learned instead of the spoken word. They will generally use the signs, pair them with the words as they are learning to speak, and eventually only use the signs when they can not be understood or when they are exaggerating their message. Wouldn't it be great and less frustrating to know what your baby wants  before he has the words to verbally express himself?
     You will not be trying to teach your baby to speak in fluent sign language using a sign for every word.  The idea is to choose words you are naturally teaching your baby as he grows.  Some of the first signs would be for the following words: eat, drink, wet, dry, nite-nite, mommy, daddy, help, more, done, out, ball, cookie, etc.  These are the words that have meaning to them and should be helpful to you if they can express it.  Other signs to teach would be for objects that are in your baby's world.  Favorite toys, people, pets, and activities are good ones to teach. Use books and label the pictures verbally and with a sign. As you expand your child's sign language vocabulary, you are naturally helping to develop their speech and language skills.  You are always using the spoken word at the same time you are teaching them a sign, using the sign yourself, or reinforcing their commuinication attempt when they sign by saying something like..."Oh, you want your ball...here's your ball," while you also sign "ball."
     The use of sign language and the spoken label at the same time is part of an approach often called Total Communication.  This approach is often used with hearing impaired children and children with special needs such as Down Syndrome, autism and other conditions that may include a delayed speech and language component.  It allows children to increase expressive communication as they grow and learn faster than their speech and expressive language can keep up.  It is also a way to provide children with a way to hear and see a message you are trying to get them to understand.  Some children learn more visually and may miss the message if it is only spoken to them. Some children with early delays will continue to use signs and speech in combination to make their communication more effective. These children will usually be receiving speech-language therapy if they have been identified with a delay as a preschooler.
   In the case of a normally developing child, they can understand things much earlier than they can express them verbally.  They express by crying, gestures, sounds,touching what they want or having a tantrum when they can't make you figure out their message.
   It is fine if you and your immediate family are the only people who understand your baby's signs.  It would be wise to let any babysitters know the basic signs the baby may use as well.  The general public may not understand what you baby is doing, but you will understand him and, after all, isn't that the goal?
     There are many books and programs for getting started teaching your baby sign language such as this one: Teach Your Baby to Sign: An Illustrated Guide to Simple Sign Language for Babies. I have included many of them  in the Communication Corner Store on this site.  Click on the banner above and go to the category titled Sign Language to check out ways to get you started.  You can learn along with them!