What is Childhood Apraxia of Speech?

Childhood Apraxia of Speech (CAS) is a motor planning disorder that interferes with a child’s ability to plan and execute the precise sounds needed for speech. Children with CAS find it difficult to produce specific sounds on demand, and find even more difficulty in stringing sounds together into words. They may be able to use various sounds when babbling but cannot produce a specific sound when asked to do so. It is often frustrating for the child, as they know what they want to say but struggle to produce the sounds and words needed to communicate their message.

How do I know if my child has CAS?

Initially, CAS may present as a language delay in young children if they are not yet talking by 15-18 months of age (most children say their first word around 12 months of age).  It is difficult to diagnose CAS when the child is not yet talking, so initial speech therapy may focus on verbal imitation of age-appropriate sounds. Children with a speech or language delay can successfully imitate the prompted sound with guided support. Children with CAS, however, will struggle to imitate sounds when prompted because their brain does not send the right coded message to their mouth. Without this message (i.e. the motor plan), they will not know how to use their tongue, lips, and/or teeth to make the correct sound.

Common characteristics of CAS:

  • Reduced babbling during early language development (6-12 months of age)

  • Inconsistency of speech sound productions

  • More errors or changes in errors when producing the same sound or word multiple times

  • Difficulty imitating sounds and sound patterns when prompted

  • Incoordination and/or groping of the mouth when attempting to speak

  • Significant gap between receptive language skills (understanding of language) and expressive language skills (production of sounds/words); receptive language skills tend to be age-appropriate in children with CAS

  • Slow progress in therapy, or a plateau in progress

If you think your child may have CAS, refer to a speech therapist for a speech and language evaluation. The speech therapist will work with you and your child to determine the appropriate diagnosis and to establish therapy goals that will support your child’s communication skills.

Autumn Smith, MS, CCC-SLP

January Community Events

Be Enchanted by Trains That Glide Through Every Season @ Morton Arboretum

The kiddos can watch trains travel through all four seasons with the Enchanted Railroad. They’ll see bright orange pumpkins in the fall display, and they’ll even spy fluffy little daffodils as the trains sweep through spring. This interactive display is specially designed for the kiddos because it’s meant to be viewed from just two feet off the ground.
When: Jan 15 – Feb 21.  Ages: All Ages.  Cost: Free with Admission.

Sing Along with Neeleo at the Farm-in-the-Zoo @ Lincoln Park Zoo

Sing Along with Neeleo delights young audiences with silly songs and tall tales every Wednesday and Friday at 9:15 and 10 a.m. at the Main Barn in Lincoln Park Zoo’s Farm-in-the-Zoo. Join Neeleo as he performs original songs while the wee ones dance and sing along. This joyful jamboree features animal songs and dances for children ages 6 and younger accompanied by a caregiver.
NOTE: Always call ahead, some dates may vary. When: 9:15 and 10am; Cost: FREE
Ages: 0-6

Hansel & Gretel Meet the Swamp Witch @ Museum of Science and Industry

AlphaBet Soup Productions presents another fractured fairy tale that the whole family will enjoy! Join Hansel Jo and Gretel Lou as they journey into the Louisiana bayou in search of the legendary swamp treasure! But beware–deep within the swamp lies the junk food fortress guarded by Badweena the Swamp Witch and her wacky alligator henchmen. This down-home, foot-stompin’ musical comedy is one that will FEED your imagination!
When: Jan. 22 @ 10:30am.  Cost: $8 General Admission, $7 Groups (25+).  Ages: PreK-4th grade

Disney On Ice celebrates 100 Years of Magic @ Allstate Arena

The legacy of Disney is displayed through 14 classic and modern stories in this epic production that features an international team of award-winning figure skaters, high-energy choreography and a breathtaking set. Features more than 30 melodious masterpieces such as “Let It Go!,” “You’ve Got A Friend in Me” and “Hakuna Matata.”
When: January 20, 2016 – January 24, 2016; 7 p.m. Wednesday and Thursday; 10:30 a.m. and 7 p.m.Friday; 11 a.m., 3 and 7 p.m. Saturday and Sunday
Cost: $20 and up

Craft Time: Make your own puffy paint!

Combine equal parts white glue and shaving cream. Using a paintbrush or your hands, apply to paper and that’s it! Feel free to add food coloring to make your desired color or keep it white and pretend it’s snow! This activity is great for following directions, allowing children to touch and explore different textures, and makes a cute craft! 

4c1b1db1-3b1a-4146-9f9b-906d427a5777

Ask an Expert: “Joint Attention”

You may hear your therapist emphasize the importance of “joint attention” during their sessions with your child. What does this mean and why is it important?

Joint attention is when yourself and the other engaged parties are all sharing attention or interest on the same toy or activity AND there is a shared understanding that both are interested. When you are stacking blocks with your child and both of you are looking at the tower, that is a “shared gaze”, which is the first step towards joint attention. True joint attention is when you are stacking blocks with your child and you are exchanging eye contact between looking at the tower.

It is so important to share joint attention because it provides an extremely important foundation for communication, language, and cognitive development. Exchanging looks while playing is very basic communication and encourages social interaction. Children learn new skills when imitating the actions of others – which can be extremely difficult if you are not focused on the same object or another person!

Examples of ways you can encourage joint attention while playing:

  • Engage in activities that require turn taking – stacking blocks, rolling the ball back and forth, or completing a puzzle together where you hold the pieces.

  • Pause and wait for your child to communicate (either through eye contact or asking through signs or verbally) before providing the next piece or taking your turn.

  • Provide positive reinforcement – children love to be praised! Give high fives or verbal responses to encourage continued participation

Playing with just your imagination: HOT LAVA

013a2cf8-ebed-44e3-bf85-f592e679eaee

In a living room, play room, or bedroom, pretend that the floor, certain colored tiles, or a carpet/rug is “hot lava” and work together to navigate the room. This is a great opportunity to initiate imaginative play such as creating “bridges” and “tunnels” out of blankets, pillows, stuffed animals or other objects in the room. This activity also addresses balance, coordination and can give proprioceptive sensory input by jumping, leaping and crashing into blankets, pillows and other furniture. (Be careful if placing pillows/blankets on a wood or tile floor!)

January: Toy of the Month

“Fun Crayons”
(a.k.a. short/broken crayons)

1306fc6d-2d0e-4100-b30e-e5dd21c96549Broken crayons are actually a good thing! Coloring with broken crayons helps promote a mature pinch grasp of objects, and it promotes a more mature grasp of writing utensils. Use an easel or an inclined surface for your little artist to also encourage mature wrist movements when drawing and coloring.

Why Symbolic and Pretend Play is Important in a Child’s Cognitive Development

There are many benefits of symbolic play to your child’s cognitive development. For example:

  • Children learn many new skills through imitation. While engaging in symbolic play, they act out behaviors and scenarios they’ve observed in their daily life. While acting out these activities or behaviors, children develop their interests, or likes and dislikes. Given the opportunity to act out adult behaviors, a child may realize that they love tending to a baby but have less interest in driving a racecar (or vice versa!).

  • They gain an understanding of relationships between people and build social skills. When children are young, they may hug, rock, and kiss a baby doll or stuffed animal, demonstrating their understanding of relationships and interactions between adults and babies. As children get older, their symbolic play becomes more in-depth and interactive. They assign roles to others, communicate, and take turns while role-playing. This type of play also encourages children to work out social issues and deal with different emotions while playing with children and adults around them.

  • They problem solve. Acting out different scenarios allows children to be presented with a variety of issues or problems along the way. In a single symbolic play scenario, such as making dinner, a child could face multiple problems or complications:

    • The child may imitate a problem they’ve observed their parent solve, such as burning dinner.

    • They may have an issue finding the right surface or materials to make a “stove”.

    • They may have to solve a problem with a peer when both want to be the parent in this play scheme.

What can I provide to encourage symbolic play?

  • Different sized boxes – a single box can be an airplane one minute and a barn the next.

  • Adult clothing – what better way to feel like a grown up than wearing dad’s old dress shirt and tie?

  • Stuffed animals or dolls – this allows children to imitate their own life and explore different feelings and thoughts.

What are some scenarios I can create in my home?

  • Grocery Store: Instead of disposing of your trash, clean out milk jugs, jelly jars, cracker boxes, etc. and provide a few grocery bags. You can even expand the play scheme to create a shopping list or use construction paper to make money to pay for groceries.

  • Post Office: Save your junk mail and your child can be a mailman! Those handy boxes mentioned above can be created into mailboxes. This also provides exposure to numbers and letters.

  • Restaurant: Collect the take-out menus from your favorite restaurants and have a restaurant in your own home. Provide your child with some paper and a crayon and they can take your order (or the other way around!).

Kimberly Shlaes, MAT, DT

How to Incorporate Language-Rich Activities into Your Holiday Routine

Many families go away this time of the year to celebrate the holidays, and this often results in a short break from speech therapy for your child. Luckily, it is easy to incorporate language-rich activities into your normal holiday routine!

Holiday and Winter Songs

It is hard to turn on the radio this time of year without hearing familiar holiday and winter themed tunes! Singing and listening to holiday songs is a beloved tradition in many families, so this year, invite your children to join in the fun! Try slowing down the pace of familiar songs to allow your child the time they need to sing the words along with you. Once your child knows a song well, try pausing at the end of each phrase in order to allow them to fill in the last word.

Travel Activities

Long trips can be challenging with young children. Be sure to bring lots of books and toys in order to keep your child entertained on long road trips or plane rides. Airplanes are a great place to sit and read with your child. Have your child point to objects in pictures and engage with the book while you flip through the pages together. Remember, it is not necessary to read every word. Books with interactive components, such as “lift-the-flap” or “touch-and-feel”, tend to be favorites among young children. There are also lots of mess-free activity books currently available for young children.  Crayola Color Wonder paper and markers, as well as Melissa and Doug Water Wow activity books allow your child to color away while you talk to them about the pictures and objects that they are coloring. These activities also provide a great opportunity to model color vocabulary.

If you have older children, “I Spy” is a great game to play on road trips. This simple game can keep children entertained for long stretches of time while they work on using descriptive vocabulary, and asking and answering “yes” or “no” questions. With younger children it is still possible to point out sights along the road while modeling the use of the simple phrase, “I see a___.”

Baking

Baking sweet treats is a classic holiday activity for many families. This year let your little one join in the fun. While baking, use short, simple phrases to describe what you and your child are doing. Some examples of easy phrases include: “pour milk,” “crack eggs,” and “mix, mix, mix” (while stirring batter). Baking is also a simple way to practice following directions and demonstrating simple spacial concepts like “on the cookie sheet” or “in the pan”. It is also great for size concepts like “big cookie” vs. “small cookie”, and number concepts like count eggs, cups of flour, etc.

Enjoy trying out these activities, and have a very happy holiday season!

Meryl Schnapp M.A., CCC-SLP

Teaching Your Child to Manage Emotions

Many of us have experienced a child’s meltdown, or inability to calm down after an exciting day. It can be frustrating for parents when a child expresses his or her feelings in less than desirable ways, but with a little know-how, these instances can become teachable moments.

One of the greatest coping skills your child can learn is emotional management. As a child develops, they try to make sense of a myriad of feelings, and learn behaviors to deal with them. Emotions are a normal part of life, and they have the potential to influence our choices, actions, and interactions either positively or negatively. So, how can a child learn to positively express feelings such as sadness, anger, frustration, joy, or excitement?  By parental guidance and modeling.

First, teach your child to verbally identify feelings. For example, angry and happy may be easily identifiable, but does your child know a simple word for feeling embarrassed, or worried? Build your child’s vocabulary of feeling words slowly. Start with simple words like sad, mad, or happy, and then expand to more specific words like frustrated, scared, excited, calm, bored, nervous, shy, or overwhelmed. Here are some ways you can help your child’s understanding:

  • Talk about emotions during everyday routines. Narrate what you’re feeling, what your child might be feeling, and what others might be feeling.

  • Read books about emotions and point out the various faces the characters are making.

  • Create a “feelings chart” with pictures to refer to.

  • Act out emotions. Make angry faces, sad faces, and happy faces.

As your child learns to label feelings, their emotional vocabulary will help them navigate through their days.

Second, teach your child to communicate and act on feelings appropriately. When a child feels frustration, he or she may act out in negative ways, such as hitting, throwing, or screaming. But if the parent has both empathized and helped the child to identify feelings, they can also help the child discover more positive ways of expressing frustration. Let your child know that it is always appropriate to use words and positive actions to show how they are feeling. Teach your child to ask two questions:

1. What can I say?

Teach your child to use “feeling” words. Make it a goal to talk about feelings before acting out in response to them. Your child must feel confident that it is always okay to talk about feelings. Always listen to your child; as you empathize, you will validate what they are experiencing and your child will feel secure in expressing emotions to you.

2. What can I do?

Help your children discover creative ways to respond to their emotions. When they feel frustrated, they may ask someone for help. If they are angry, they might squeeze their fists or stomp their feet. When they’re sad, they may ask for a hug. And if they feel tense, they might step away to a quiet spot and take a deep breath. The possibilities are endless. Let your children come up with fun, appropriate ways to soothe themselves.

Finally, it’s important that you practice these skills when your child is calm. In the midst of a meltdown or tantrum, your child might not be able to access the necessary words to express how they are feeling. But once calm, they may be ready to discuss what happened and how the situation could have been handled differently. Eventually, your child will be able to express how they are feeling before a meltdown escalates.

You are your child’s best support and teacher of positive emotional responses. Your child will need your listening ear, your patience, and your example to learn these skills. If you stay the course, your child will begin to internalize healthy emotional behaviors.

If you have questions related to supporting your child’s development in this area, please contact one of our pediatric social workers.

Laura Mauriello, MS, LCSW, DT

Make Reading Fun For Every Child

As speech language pathologists, we are always encouraging parents to read more with their children. Some children are naturally more interested in books than others, but by making a book more than just a book, you can use them to help develop your child’s language, and encourage them to explore the world. By bringing more books into your home and exposing your child to the printed word, you are also helping them develop early literacy skills.

Make A Book Fun!

A book can be so much more than pictures and words on a page. In fact, you don’t even have to read the exact words to make it a meaningful experience. Pediatric speech therapists use books to introduce new concepts or ideas, and then extend the book into other activities. When you extend the book beyond its’ pages, your child learns through the words they hear, the pictures they see, and the objects they touch. All of this reinforces the story and makes the content of the book more meaningful for your toddler.

As you may have noticed, many children’s books have repetitive, predictable language (think Brown Bear, Brown Bear by Eric Carle). Children benefit from the repetition of the same language and, for children, the anticipation of the repeated phrase is fun every time! Here is a strategy to make books more than just a 5-minute activity.

1. Pick a book that you are interested in, and read it to your children when they are awake and alert.

2. Do more with it! Depending on your child’s age and attention span, find a way to make the book more engaging. If you have a 1 year old, they can turn the pages on your cue, or you can have them point out objects as you say them. For a 2 year old, have your child hunt around the house for objects mentioned in the book. For a 3 year old, consider a home craft project to replicate a character. Use simple objects from around your house; for example you can make faces out of paper plates, create cereal sculptures, or cut out pictures from magazines!

3. Talk about the book later in the day, or better yet, read it again. This helps remind children what they learned. And remember, repetition is key!

Sarah Pifkin Ruger, MS, CF-SLP