Is Articulation Therapy Appropriate for My Toddler?

My toddler’s speech isn’t 100% clear, and his preschool teachers say that they have a hard time understanding him. Should I be concerned?
Let’s set the scene: Your child walks up to you and says “mohmik peas,” and at first you don’t have a clue what they are trying to tell you! But by using the clues in your environment and by observing their gestures, you eventually figure out that they requested “more milk please.” You were able to meet your child’s needs (getting them more milk) even though they did not produce all of the correct sounds in each word. So are their speech sound (i.e. articulation) skills something to be concerned about?

As your child produces new words and phrases you might be noticing that their speech is not 100% clear. Your child’s speech clarity, also referred to as intelligibility, is your child’s current production of sounds which impacts how others can understand them. Intelligibility for a two year old should be approximately 50% to an unfamiliar person. By three-years of age your child should be approximately 75% intelligible, meaning that you should understand at least seven out of every ten sentences that they produce. It is important to remember that as your child is learning how to talk they may not sound exactly like an adult would, and that’s typical! In general, your child should be using a variety of consonants and vowels at two- to three-years of age but there is variability speech sound development.

Speech sound development: What should I expect?
Not all speech sounds are alike! Some speech sounds are considered early developing sounds, while others might develop when your child is older due to the complexity of oral movements required to make that sound. Early developing sounds include: “p, b, m, n, w, t, d, h.” Later developing sounds include: “sh, s, z, l, r, th.” Later developing sounds may be substituted with a different sound at two- to three-years of age due to their motoric complexity.

“So you’re saying that not all speech sounds need to be mastered by three-years of age?” That’s right! At three-years of age it is possible that your child may be substituting different sounds in real words, such as “wed” for “red,” and this is age-appropriate! At the age of three, a “w” for “r” substitution would be considered a developmental error, or an error that does not require direct therapeutic intervention. The majority of developmental errors will correct themselves as your child’s language and articulation skills develop.

What are phonological processes?
Phonological processes are patterns children use to simplify their speech as they are learning how to speak. For instance, your child may be saying “back” for “black.” Each phonological process is considered age-appropriate until it persists past a set age of elimination (the age in which the majority of children no longer present with that specific error pattern). The majority of children will correct their own speech and no longer use phonological process substitutions as their language and speech sounds develop. (Please see resources listed below to view an age-appropriate phonological processes chart.)

Is your child ready for articulation therapy?
Articulation therapy uses a hierarchical approach to master target speech sounds. For instance, you may first practice the sound “f” in isolation, or by itself, and then progress to practicing “f” with a vowel such as “fee” or “foe.” Articulation therapy requires your child to have the ability to follow directions given by the therapist, tolerate a variety of cues to help support appropriate production of their target speech sound, pay attention to the therapist, and imitate what the therapist is saying. At two years of age, your child’s attention span is shorter than a three- or four-year-old’s attention span, and they may become frustrated by some of the direct cueing provided during traditional articulation therapy. One critical component of articulation therapy is avoiding negative practice, or practicing your child’s target speech sound the incorrect way. Your child’s therapist wants to avoid negative practice because they want to support and encourage the accurate production of the speech sound and not have your child continue to practice incorrectly. A child who is not ready for articulation therapy is a child who is unable to follow directions provided by a therapist, unable to pay attention to a therapist’s face, or is unable to imitate what a therapist is saying.

Should my two-year old be receiving articulation therapy?
If you feel like you understand your child approximately 50% of the time, but notice that there are some sounds that are not the same as an adult’s production they may be using age-appropriate substitutions and/or phonological processes. For instance, if your child is deleting the end of words (final consonant deletion) at two years of age this is considered an age-appropriate phonological process that is typically eliminated around three years of age. In addition, at two years of age children are still learning how to use language and are increasing their phrase length and vocabulary, which are both age-appropriate skills to promote and target with a two-year old. If at two years of age you feel like your child is not using a variety of vowels or consonants, or you feel like producing speech sounds is effortful, your child may be a candidate for a speech and language evaluation.

So what can you do to help support your two-year-old’s speech intelligibility? Your mouth is a great cue for your child! Several early developing speech sounds can be seen on the lips and this visual cue makes it easier for your child to imitate you. For instance, “p” and “b” both require your lips to come together before making sound. Children learn a lot by what they see, so hold objects and toys near your face to encourage them to look at how your mouth is making sounds. You can also talk slowly and prolong different sounds to help your child imitate new sounds they may not be using such as “mmmma-mmmma” for ‘mama.’

Should my three-year old be receiving articulation therapy?
If your child is three years old or older and you feel like their intelligibility is less than 75%, have difficulty producing early developing speech sounds, have a limited variety of vowels, or are using phonological processes that are no longer considered typical for their age, your child may be a candidate for speech and language therapy. If you have concerns regarding your child’s articulation skills, talk to your speech-language pathologist or schedule an appointment for an evaluation.

Some things you can try at home include:

  • Encourage your child to look at your mouth! Your mouth is a great cue for your child to look at as you model a new sound.
  • Model the word with the correct sound for your child to hear the difference. For instance, if your child says “bid” for “big,” you can model the correct word “big” after your child’s attempt.
  • Tap or clap out syllables to promote the inclusion of all syllables in a word. Tapping or clapping can help your child know the exact number of syllables in the word, which can facilitate inclusion of all syllables within a target word. A word is much easier to understand when all of the syllables are produced clearly and do not run into the next word in a sentence!
  • Give your child two verbal choices to choose from if you’re having a difficult time understanding your child. By providing your child with two verbal choices for them to imitate you know what they are trying to say, even if their sounds don’t come out just right!. Also, it may be easier for your child to imitate one of the two choices you give rather than produce the word on their own.
  • If you notice that their speech sounds are ok in single words, but are incorrect when they try to produce a full sentence, try to decrease the number of words in your child’s sentence and have the imitate it back to you. For instance, your child attempts to produce a four-word phrase such as “puppy drink more water,” however, there are multiple words that are challenging to understand. You can model a shorter, three-word phrase such as “drink more water” to aid with increased intelligibility.

Resources:
Visit Mommy Speech Therapy to download the phonological processes chart!

Questions or concerns?
If you have questions or concerns about your child’s speech and language development, please contact us at info@playworkschicago.com or 773-332-9439.

Samantha Labus, MS, CCC-SLP
Speech-Language Pathologist

Reference:

Fabiano-Smith, L., & Goldstein, B. A. (2010). Early-, Middle-, and Late-Developing Sounds in Monolingual and Bilingual Children: An Exploratory Investigation. American Journal of Speech-Language Pathology,19(1), 66-77. doi:10.1044/1058-0360(2009/08-0036)

Sander, E. K. (1972). When are Speech Sounds Learned? Journal of Speech and Hearing Disorders,37(1), 55-63. doi:10.1044/jshd.3701.55

Photo Credit:Ryan Fields via unsplash.com

Increasing Participation in Daily Routines

Establishing routines in your child’s life are crucial in that they help to create expectations and predictability. However, certain routines can often be difficult to follow when considering a parent’s work schedule and child’s behavior at particular times of the day. Children often feel as though they experience a loss of control when being asked to constantly “do this and that.” Parents-don’t panic! Try implementing these small tricks at home and school, which have been shown to increase your child’s participation and motivation to engage in routines!

How can routines help my child?

Routines are created to help your child understand what he/she should be expected to do throughout the day. Routines are important in a variety of settings, including the home and school. It is the parents’ and teachers’ duties to enforce these routines on a daily basis, which can include specific activities as well as consistent responses that reinforce participation. For example, if a child is expected to sit for circle time and he/she is having difficulties, it is crucial that the teacher responds in a consistent way in order for the child to understand that circle time is the next step and the child is expected to participate.

What if my child has difficulties following routines?

If your child is having difficulties following specific routines at home or school, creating a visual schedule of the specific steps in that routine can help to increase your child’s motivation and control of the situation. For example, if your child demonstrates resistance towards the morning routine, follow these simple steps to create a visual schedule:

  1. Take pictures of your child engaging in each step of the routine (e.g. waking up, getting dressed, eating breakfast, etc.)
  2. Place the pictures vertically on paper, numbering each step to help the child understand what needs to be done first/last.
  3. Allow the child to mark each step once completed. Ask your child how he/she wants to mark the steps (e.g. putting a sticker next to the completed step). Laminating the schedule is a fun way in which your child can “X” off the steps and then erase for the next day.
  4. Use this schedule every day for at least two weeks, which will allow for sufficient time to understand whether it is making an impact or not. It is important that all caregivers use the chart with your child in order to build consistency. 

How do these visual schedules actually help?

Visual schedules serve many purposes for children and caregivers. First, the pictures on the schedules allow children to see themselves in action, which adds an extra fun factor. Secondly, the schedule allows children to have increased control, in that they are able to mark off each completed step. Lastly, the schedule serves as reminders to the caregivers as to what the child has done and what he/she needs to further complete. It is also helpful for caregivers to add in an incentive if the child is able to complete all steps included in a routine (e.g. giving your child extra play time before leaving for school).

Questions or concerns?

If you have questions or concerns about your child’s routines, please contact us at info@playworkschicago.com or 773-332-9439.

Brittany Hill, MS, MSW, LCSW, DT
Assistant Director of Social Work Services
Licensed Clinical Social Worker

Photo Credit: Openclipart-Vectors via Pixabay

Reducing Screen Time in the Home

Tablets, smartphones, computers, televisions, and more…our world today often seems to be dominated by screens. Yet, one of the most common warnings heard by parents everywhere is:

“Don’t let your child have too much screen time!”

This warning may instantly lead many parents to wonder, “How much is too much?” And once that is determined, “What can I do to set limits on screen time in my home?” Let’s take a look at these common thoughts and questions!

Why is too much screen time a bad thing?

Recent research has produced a variety of results on the potential negative outcomes for children who spend too much time each day watching or using screens. Dr. Cara Booker and colleagues discovered that children who use screens heavily tend to be less happy and suffer from more social/emotional problems than their peers. The content of what is behind many screens can often encourage feelings of discouragement and low self-esteem.  Children who spend a large amount of time “tuned-in” to a screen also tend to miss out on learning and practicing important social skills, such as maintaining conversation and managing social conflict. Additional studies report that children who spend more time watching and using screens also spend less time sleeping at night. Screens can cause physical stimulation within your child’s brain, causing excitement that makes it more difficult to calm down and get ready fro sleep. Too much screen time is also linked to a higher risk for obesity, one reason being that screen time while eating can distract a child’s body from understanding when it is full, which may lead to over-eating. Overall, children who are exposed to increased screen time tend to present with increased cognitive, language, and social/emotional delays.

How much is too much?

With significant potential harms noted, it is important to ask, how much screen time is too much? To answer this question, The American Academy of Pediatrics created age-based guidelines on screen time for children. The exact numbers, as well as additional useful tips on appropriate media usage for children, can be found on their website:The American Academy of Pediatrics Age-Based Guidelines.

Helpful Tip: The American Academy of Pediatrics also offers online tools for families to create a unique “Family Media Plan” or to use a “Media Time Calculator.” Find both tools here.

Remember, these guidelines are just that – a GUIDE – and every family will run into days where screen time exceeds the recommended amount. That is okay!You may find that during a particularly stressful day at home, or over a long weekend spent mostly in the car, your child’s screen time total adds up to much more than the number stated in these guidelines. As long as these “excess” days are limited, and not the norm, they will not have the same negative effects on your child.

Steps to Reducing Screen Time

Once you begin to notice that excessive screen time is the norm in your home, it is time to consider taking action! Here are seven steps to get you started:

  1. Eat all meals without a screen
  • Allow meals to be a time to interact with one another. Share a favorite story from the day, or something you hope to see happen that day!
  1. Set up “technology-free” zones
  • Choose one area of your home. This is a great opportunity to get your child’s input. If they contribute to creating the technology-free zone, they will be more likely to actually utilize the technology-free zone! *NOTE: Be sure all beds are zoned to be “TECH-FREE”
  1. Set a timer when using screens
  • Sand timers, kitchen timers, and digital alarm clocks all work well! Before screen time begins, have your child set the timer with you (to the pre-determined time allowed) and review what happens when the timer goes off.
  1. Schedule specific times each day to “un-plug”
  • As a family, decide on a period of time during the day when you will collectively “un-plug.” This means parents too! Together you will put all phones, tablets and computers away. Turn off the TV and tune into your environment instead. *NOTE: Timers can be used to track your un-plugged time too!
  1. Use parental controls
  • Most devices offer an option for parental controls. Using this setting will allow you to set time limits and make sure that your child is only exposed to parent-approved content.
  1. Model limited screen use
  • Your children learn from watching you! Practice limiting your own screen time so that your child will see it can be done (and hopefully see the benefits as well).
  1. Replace screen-time with a different engaging activity
  • Have a plan ready for what your child can do with the time he/she used to spend with a screen. Below are just a few of many options available for activities that can replace screen-time, and better promote your child’s health and development!

Examples of Alternative Activities

Questions or concerns?

If you have questions or concerns about your child’s development or the effects of screen time in your home, please contact us at info@playworkschicago.com or at (773) 332-9439.

Stephanie Wroblewski, LCSW
Licensed Clinical Social Worker

References:

Grant, Sheena. “Do Children Have Too Much Screen Time and Does It Matter How Much Time They Spend on IPads, Smartphones and Laptops?” East Anglian Daily Times, 17 Oct. 2015, www.eadt.co.uk/ea-life/do-children-have-too-much-screen-time-and-does-it-matter-how-much-time-they-spend-on-ipads-smartphones-and-laptops

The American Academy of Pediatrics Website, (Itasca, IL, USA). American Academy of Pediatrics Announces New Recommendations for Children’s Media Use. Retrieved from: https://www.aap.org

The American Academy of Pediatrics Website, (Itasca, IL, USA). Family Media Plan. Retrieved from: https://www.healthychildren.org

Photo credit: Photo by Hal Gatewood on Unsplash

More Than Words: Building Social Communication Skills

Does your child have difficulty playing with other children? Do they prefer to play alone or demonstrate challenges in making friends? This blog will discuss what pragmatic (social) communication is, review the signs of a pragmatic language delay or disorder, and provide strategies for encouraging pragmatic language development in your child.

What is pragmatic language and why is it important?

Pragmatic language or social communication refers to the appropriate use of language in social situations. It is not only what we say, but also how we say it. This includes being able to understand and use nonverbal cues such as body language and facial expressions. Pragmatic language is comprised of various important skills for successful communication, including eye contact, turn-taking, initiating and maintaining conversation, and understanding and using humor, among others. Children may have difficulty with one or more of these skills. It is important to support the development of your child’s pragmatic language skills so that they can learn to express themselves, understand others, and build relationships with family and peers.

Signs of a pragmatic language delay or disorder:

  • Preferring to play alone for an extended period of time
  • Limited eye contact while talking and/or playing
  • Difficulty taking turns
  • Limited initiation of conversation or play
  • Difficulty maintaining a topic of conversation
  • Difficulty participating in pretend play activities
  • Difficulty understanding or expressing emotions
  • Difficulty understanding another’s point of view
  • Difficulty interpreting tone of voice or body language
  • Difficulty making inferences
  • Difficulty using appropriate greetings
  • Difficulty adapting language to different listeners (i.e. talking to a friend the same way as to an adult)
  • Difficulty adapting language based on environment (i.e. talking the same way on the playground as in the classroom)
  • Not providing background information when appropriate

Strategies for building pragmatic language skills:

  • Pretend play:Engage in pretend play activities with your child, such as playing house, pretending to bake cookies, or pretending to be a veterinarian. Pretend play facilitates growth in cooperative back and forth play, ability to act out social situations, and ability to understand another’s perspective.
  • Turn-taking games:Turn-taking is a fundamental skill of communication as it teaches the basic back-and-forth exchange of a conversation. Through turn-taking games children learn to wait when it is someone else’s turn and they learn how to identify when it is their turn. Turn-taking games could be as simple as rolling a ball back and forth or taking turns blowing bubbles. You could also play simple turn-taking board games with your child to support development of this skill.
  • Story time:When reading a book with your child, try to make it interactive. Based on their age and language skills you could ask them to describe the pictures and what they see. For older children you can ask questions such as, “How do you think he feels?” or “What do you think she will do?” Prompting your child to answer these types of questions will help your child to make inferences, learn to understand another person’s perspective, and have a better understanding of emotions.
  • Be a good role model: You are your child’s best teacher. Model appropriate social communication skills such as making appropriate eye contact, using appropriate greetings, asking on-topic follow up questions, etc. Help your child to use these social communication skills when talking to family, teachers, and peers.
  • Facilitating peer interactions:Children need practice in order to learn to share, take turns, and play cooperatively with others. Setting up play-dates that you can be present for is a great way to facilitate peer interactions and relationships. You can encourage your child to communicate with their peer by prompting them to initiate conversation and play ideas. In addition you can encourage them to maintain play and communication with their peer by prompting them to ask on topic questions and make on topic comments.

Questions or concerns?

If you have questions or concerns about your child’s pragmatic language skills, please contact us at info@playworkschicago.com or 773-332-9439.

Claire Kakenmaster, MS, CCC-SLP
Speech Language Pathologist

Photo Credit: Image by HaiRobe on Pixabay

Picture Exchange Communication System: Is PECS appropriate for my child?

When people think of communication, they often think of verbal communication. However, communication is not limited to one modality. In fact, communication can occur through a variety of modalities: verbal exchanges, written exchanges, facial expressions, gestures, sign language, etc. Picture exchange is another modality through which people can communicate. To capitalize upon this modality, Picture Exchange Communication System, or PECS, was created as a leading therapeutic technique for children who cannot yet verbally communicate.

As a pediatric speech-language pathologist, I often come across the question from parents, “Is PECS appropriate for my child?” Let’s dive into what PECS is, how it works, and for whom it may be appropriate.

What is PECS?

Picture Exchange Communication System (PECS) is a form of augmentative and alternative communication (AAC) that allows people to communicate using pictures. Although PECS contains a formal protocol that systematically moves through six phases of communicative exchanges, the method of picture exchange can be modified to meet the needs and skill level of the child.

How does PECS work?

  • Children using PECS are first taught a cause-effect relationship between pictures and communication. In other words, they learn that when you give a picture, you receive something in exchange.
  • Children are then taught to use pictures to communicate with different people across a variety of environments.
  • After the basic communicative exchange is established, the child learns to discriminate between multiple pictures in order to request specific objects or activities.
  • Pictures can then be combined to communicate phrases and sentences of increasing complexity, such as “I want ___.”

Who benefits from PECS?

PECS is often recommended for children who do not yet have a means of verbal communication. For PECS to be effective, however, the child must be motivated to communicate, as PECS relies upon the child initiating communication exchanges by giving pictures to another person. PECS also requires that child must have the cognitive skills to understand the cause-effect relationship between giving a picture and getting something in return. Therefore, a child who does not yet understand the cause-effect nature of a basic communicative exchange would be an inappropriate candidate for PECS until this skill emerges.

Myths Debunked

  • PECS is only for people who won’t learn to talk: The use of PECS does not imply that the child will never learn to use verbal language. In fact, the use of PECS can facilitate verbal communication by providing children with an outlet to reduce frustration and establish early communication skills.
  • PECS is only for people with Autism: PECS is frequently recommended for children with Autism Spectrum Disorder due to deficits in expressive language and social communication. However, recommendations of PECS should be child-specific and may or may not be appropriate for any child who does not have a means of verbal communication.
  • PECS only targets requesting: As a child moves through the PECS hierarchy, they can learn to use pictures for different functions, including requesting, answering questions, and ultimately, commenting independently. PECS involves high priority vocabulary to teach children that they can expand their expressive vocabulary to meet their wants and needs.

Questions or concerns?

If you have questions or concerns about whether PECS is appropriate for your child, please contact us at info@playworkschicago.com or 773-332-9439.

Jill Teitelbaum, MS, CF-SLP
Speech-Language Pathologist

References:

Bondy, A. (2001). PECS: Potential benefits and risks. The Behavior Analyst Today2(2), 127.

Vicker, B. (2002). What is the Picture Exchange communication System or PECS?.

Photo Credit: sitemaker.umich.edu

Teaching Play Skills to Children with ASD

Pretend play can often be very difficult for children with autism spectrum disorder (ASD) because it directly impacts their ability to develop and understand social skills along with communication skills. Play skills are necessary for children to establish and create meaningful relationships with peers and understand the world around them. This blog will help provide some information to help engage your child with ASD while learning new foundational and essential play skills.

Where do I start?

Just like every child is different, every child with autism is different. It is important to understand your child’s strengths and weaknesses. Before introducing new unfamiliar activities with your child, make sure your child is at a ready-to-learn and regulated state. This means your child is demonstrating a calm body and is ready to play. It is important to reinforce eye contact and joint attention while playing with your child to help increase their engagement skills. Your child’s skill level, attention span, and interests will determine and help guide you in the right direction to begin introducing new unfamiliar play. Begin where your child is at and remember to slowly build on their current level of understanding and skill. If your child resists the new play, begin new play schemes with some of your child’s favorite games or toys. Remember, all children learn by repetition and benefit from having a model or demonstration with how to the use objects appropriately.

Sensory Play

Sensory activities include activities that stimulate our senses, whether in a positive way or a negative way using all our senses: taste, sound, visual, tactile, and smell. These different textures, colors, smells, taste, and experiences impact the way you experience the world around you. Sensory-based activities help children become engaged and focus on the activity presented. These activities can improve attention span, increase flexibility and exposure to new items, and help self-regulation. Please use caution when implementing new sensory items with your child and notice for any aversive or negative reactions.

  • Music is a great way to engage any child! Fingerplays (e.g. “Wheels on the bus”) and dancing improve your child’s attention span, imitation skills, and gross-motor coordination.
  • Water, whether it’s outside when weather appropriate or in the bathtub all year round.
  • Play-Doh (roll, squish, animal shapes)
  • Waterbeads (fill and dump, have animals swim)
  • Sand

Functional Play

Functional play is the child’s ability to use objects as they are intended and expected (e.g. block to build). Use cups to fill up and dump the water/waterbeads in the bathtub or a car to drive across the sand. Use the blocks to build a tower and crash them. Provide hands-on assistance and a demonstration if your child does not use the object functionally.

Pretend Play

Pretend play or symbolic play is when a child uses a realistic item or non-realistic item as something else (i.e. using play food or a spoon as a toothbrush). Use animals in the bathtub to walk across the tub and use the sounds associated with each animal. Once your child has mastered the play imitation skills, expand upon this play and encourage your child to have the animals go down the slide in the bathtub. Use their favorite stuffed animal during meal times and encourage your child to “feed” their animal. Continue the child’s bedtime routine with their favorite animal, while you demonstrate and explain what you are doing with your child and their animal.

Questions or concerns?

If you have questions or concerns about your child’s play skills, please contact us at info@playworkschicago.com or 773-332-9439.

Kelly Scafidi, MSW, LCSW, DT
Licensed Clinical Social Worker
Developmental Therapist

Reference: The Australian Parenting Website (2017). Play and children with autism spectrum disorder.

Retrieved from: raisingchildren.net.au/autism/school-play-work/play-learning/play-asd.

Photo Credit: rawpixel via Unsplash.com

Gender Differences in Autism Spectrum Disorder (ASD)

Are girls with autism being missed?

A growing body of evidence supports the hypotheses that autism spectrum disorder (ASD) is being underdiagnosed or misdiagnosed in girls. Why might that be? And how could that affect your child? We will delve into a few of these issues in this blog post.

First, an overview of autism spectrum disorder.

What is ASD?

ASD is a biologically based, neurodevelopmental disorder. Meaning, autism is a disorder present at birth that affects how the brain develops. Individuals with ASD often display behaviors that are repetitive in nature and have difficulties participating in social situations. Autism is characterized as a “spectrum disorder” because it presents differently in each individual, causing the symptoms to vary in type and intensity. The current prevalence of autism is 1 in 68 children. Autism is more prevalent in boys, presenting with a ratio of four boys to every one girl with autism spectrum disorder.

Red Flags:

Potential signs of ASD that you might notice in your child are outlined below.

  • Your child does not use gestures to communicate, such as pointing, clapping, or nodding their head
  • Your child does not use a combination of eye contact, gestures, sounds, and words to communicate
  • Your child has a delay in speech and language skills
  • Your child does not imitate actions, sounds, or words that they overhear
  • Your child does not respond when you say their name
  • Your child has sensory differences, including over- or under-sensitivity to certain sounds, textures, smells, etc.
  • Your child has unusual ways of moving their hands or bodies
  • Your child has significant difficulty with transitions
  • Your child does not play with, or similarly to, other children their own age

The red flags outlined above may indicate a difference in your child’s development. If your child exhibits one or more of the red flags mentioned above, it does not necessarily mean that they have autism spectrum disorder. For example, not responding to their name could be due to a potential hearing loss. It is recommended that you discuss any concerns regarding red flags with your child’s medical team, including their pediatrician and therapists.

So, Girls:

Why are they being missed?

As mentioned above, professionals in the field have begun to discuss this issue of underdiagnosis or misdiagnosis of ASD in girls. One potential area of difficulty is that assessments commonly used to diagnose ASD are based on data collected from the general population of children with autism, which consists of more boys than girls. That means the tests are less sensitive to detecting girls with ASD. Girls with well-known or easily understood symptoms will likely not be missed, but those that present with less obvious red flags may be. As ASD is less common in girls it might not be the first diagnosis that comes to mind, especially if symptoms are less severe. Although girls may and do exhibit some of the red flags outlined above, it can present differently or less obviously in girls. It is also common that girls are intrinsically more socially motivated, so symptoms of social communication difficulties may be less obvious.

What does it look like?

A few more specific signs of ASD that you might notice in girls are outlined below.

  • Your child has interests that are age-appropriate but very intense
  • Your child plays with toys in a “pretend” but repetitive manner
  • Your child displays sensory differences, but might begin to hide these as they get older
  • Your child has extreme reactions to change or transitions
  • Your child is exhausted after social interactions
  • Your child has difficulty making or keeping friends
  • Your child has difficulty with conversational skills, such as topic maintenance and turn taking
  • Your child may internalize their emotions, resulting in anxiety

How does this affect your child?

The slight variation in type or intensity of red flags in girls may cause them to be diagnosed with something other than autism spectrum disorder, such as an anxiety disorder or a language disorder. The misdiagnosis results in recommendations that may be less appropriate or encompassing of symptoms and may result in your child missing out on early intervention strategies to support their development.

What can I do? 

If your child is demonstrating the behaviors above, or any general red flags for autism spectrum disorder, consider following up with your child’s therapist or pediatrician. Although individual speech-language therapists cannot provide a diagnosis of autism spectrum disorder, they can make appropriate referrals for testing and possible diagnosis.

Questions or concerns?

If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9439.

Ana Thrall Burgoon, M.S., CCC – SLP 
Speech-Language Pathologist

References:

Bartley, Janine. “Autism Spectrum Disorder.” Grand Valley State University, 4 Dec. 2018, Grand Rapids. Lecture.

Rudy, L. (2018, December 4). Symptoms of Autism in Girls . In VeryWell Health .

Volkers, N. (2018, April). Invisible Girls. The ASHA Leader23(4), 48-55.

Photo Credit: Photo by Jens Johnsson on Unsplash

Speech Sound Development: What Sounds to Expect and When

One of the most exciting stages in child development is when little ones use words to communicate for the first time; however, this excitement is frequently followed by parent concerns regarding their child’s ability to say certain letter sounds and be understood by others. As speech therapists working with young children, we are often approached by parents with questions about their child’s articulation development. Many times, parents are surprised to find that a variety of speech sounds are not usually acquired until a later age. For example, a typically developing four-year-old child may be pronouncing “r” as a “w” (I see the “wabbit”), or “th” as a “d” (give me “dat”). One easy way to determine if your child is developing his or her articulation skills appropriately is by referencing the ages at which most, but not all, children master certain speech sounds.

What is considered “typical” speech sound development?
Similar to other developmental milestones, such as crawling and walking, speech sounds are usually learned and mastered within a specific timeframe. The bullets below may provide a great frame of reference as to where your child should be in terms of speech sound development, as about ~85% of children will develop sounds at the following ages:

By two-to-three years of age:

• “p” as in “pop”
• “b” as in “ball”
• “m” as in “mama”
• “d” as in “daddy”
• “n” as in “no”
• “h” as in “hat”
• “t” as in “take”
• “k” as in “cat”
• “g” as “go”
• “w” as in “we”
• “ng” as in “talking”
• “f” as in “fish”
• “y” as in “yes

By four years of age:

• “l” as in “like”
• “j” as in “jump”
• “ch” as in “chew”
• “s” as in “see”
• “v” as in “van”
• “sh” as in “shoe”
• “z” as in “zebra”

By five years of age:

• “r” as in “rat
• “zh” as in “measure”
• “th” (voiced) as in “that”

By six years of age:

• “th” (voiceless) as in “think”

As mentioned above, it is important to remember that not ALL children will develop speech sounds at these listed ages; however, this information may provide some insight into when the majority of children will develop certain sounds.

When are my concerns justified, and what can I do?
With the information provided above, you may consider informally monitoring whether your child appears to be producing age-appropriate sounds or not. If you continue to have concerns regarding your child’s speech sound development, we recommend that you contact a speech therapist to further discuss your child’s articulation skills.

Questions or concerns?
If you have questions or concerns about your child’s speech sound development, please contact us at info@playworkschicago.com or 773-332-9439

Kelsey Martin, MS, CF-SLP
Speech-Language Pathologist

Reference: McLeod, S. & Crowe, K. (2018). Children’s consonant acquisition in 27 languages: A cross-linguistic review. American Journal of Speech-Language Pathology. doi:10.1044/2018_AJSLP-17-0100.

Photo Credit: Thiago Cerqueira via Unsplash

Home Bodies: Gross Motor Activities You Can Do at Home

What are gross motor skills?

Your child’s gross motor skills allow them take their first steps, play their favorite sports, and sit upright in their chair at school. Gross motor skills involve stabilization of our large muscle groups and active movement of our whole body to carry out these meaningful activities. In order to develop age-appropriate gross motor skills your child will utilize the following body mechanisms: muscle strength, muscle tone, activity tolerance, motor planning, postural control, body awareness, balance, coordination, and proprioception (our sense our body position and body movement).  If your child is having difficulty with their gross motor skills, they may appear to be clumsy, have difficulty completing activities of daily living such as dressing, or avoid physical activity.

Laying the Foundation

In order to develop more refined skills, such as fine motor skills, your child will need to build a foundation of age-appropriate gross motor skills. For example, in order to complete fine motor tasks at school, your child must first demonstrate appropriate trunk strength and postural control in order to sit upright in their chair. Once your child develops appropriate trunk strength and postural control, he/she will need to develop gross motor shoulder stability in order to prevent his/her shoulder from moving when engaged in writing activities. It is when these gross motor abilities of trunk strength, postural control, and shoulder stability are present when your child is able to develop more refined skills. Our gross motor skills lay the foundation for the more sophisticated and intricate small muscle movements.

Home Work

In a literature review of fundamental movement skills conducted, researchers found a positive relationship between children’s development of gross motor skills and health benefits such as increased physical activity and decreased sedentary behavior*.

At-home gross motor activities are just a jump, skip, and a hop away:

  • Obstacle Course: indoor obstacle courses are a wonderful way to get your child crawling through tunnels, jumping over “lava,” and running to the finish line. This also provides additional opportunities for supplemental sensory input for increasing overall regulation!
  • Yoga: yoga is excellent for incorporating whole body movements, core strengthening, and increasing our sense of proprioception. In order to further develop our body awareness, have your child imitate yoga poses in front of a mirror in order to increase his/her understanding of how his/her body is positioned in space. Yogarilla cards are a great resource for various yoga poses in a fun format for your child.
  • Dance Party: join in on the fun with your child and throw a dance party! Choose action-based songs, such as “I’m Going on a Bear Hunt.” Incorporate action-based songs that involve activities requiring the use of both the upper and lower extremities to utilize your child’s motor planning and coordination skills.
  • Play Catch: a simple back and forth game of catch with either a ball, balloon, or bean bag can facilitate development of motor planning, body awareness, and bilateral coordination. Additionally, with the balloon allowing more time to move throughout space, encourage your child to keep it off the floor utilizing different body parts, such as their feet or even their elbows.
  • Simon Says: have your child participate in a gross motor version of Simon Says. For example, you can state, “Simon says jump up and down. Simon says touch your toes. Simon says stand on one leg.”
  • Animal Walks: completing animal walks such as bear walks, frog jumps, crab walks, etc. Your child might even want to create their own kind of animal walk!
  • Bubbles: blow bubbles and have your child pop them with a body part that you designate. Try to blow the bubbles on each side of his/her body in order to promote crossing their body.
  • Tummy Time: If your child is not yet walking, encouraging him/her to spend time on his/her stomach will allow him/her to bear weight onto their arms. For example, you can place your infant’s desired toys around them in a circle so he/she has to bear weight onto his/her arms to reach out for them. If your child is walking, increasing the amount of time your child is bearing weight on his/her arms such as in a crawling position or lying on his/her stomach strengthens his/her shoulders, arms, and hands for the development of more precise fine motor skills. This can be done by playing games or completing puzzles in an all-fours position or army crawling during transitions.
  • Clapping Games: using both hands in coordination to complete clapping games such as patty cake are a material-free way to practice gross motor skills such as bilateral coordination and motor planning.
  • Stand Up: create a vertical surface for your child’s arts and crafts activities. When standing and using a work station in front of him/her (such as a piece of paper taped on the wall) instead of below them, your child is actively engaging and strengthening the muscles in his/her shoulders, arms, and wrists to promote gross motor development.

Questions or concerns?

If you have questions or concerns about your child’s gross motor abilities, please contact us at info@playworkschicago.com or 773-332-9439.

Reagan Lockwood, MS, OTR/L
Occupational Therapist

*Reference: Lubans, D.R., Morgan, P.J., Cliff, D.P. et al. Sports Med (2010) 40: 1019. https://doi.org/10.2165/11536850-000000000-00000

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Aspiration: What Is It and What to Look Out For

Have you ever had the feeling that something went down the “wrong pipe?” This is a common sensation that people feel when food or liquid accidently enters their airway instead of traveling to their stomach. Most of us are able to protect our airways by coughing up any material that goes down the wrong way. However, some children are unable to cough up material that enters their airway, putting them at greater risk for material entering their lungs, otherwise known as aspiration. Feeding your child can already be a stressful experience, especially when it comes to their safety. Therefore, it is important to understand the signs, symptoms, and risk factors that are associated with aspiration to identify when it is appropriate to seek medical attention.

What is aspiration?

Aspiration is when food, liquid, saliva, or any other foreign item enters the airway or lungs. Aspiration can occur in infants, children, and adults, and can vary from mild to severe. If persistent and untreated, aspiration can lead to serious health issues, such as pneumonia.

What are the risk factors for aspiration in infants and children?

Aspiration is most commonly caused by a swallowing disorder, otherwise known as dysphagia. Other risk factors for aspiration include, but are not limited to:

  • Abnormal anatomy, such as cleft palate, paralyzed vocal folds, or esophageal atresia
  • Premature birth and related complications
  • Reflux disorders
  • Neurological disorders
  • Other medical diagnoses, such as Down Syndrome

What are the signs and symptoms of aspiration in infants and children?

Aspiration can result in overt signs/symptoms, such as:

  • Coughing or choking during feeds
  • Wheezing and/or breathing problems (stop breathing or fast breathing)
  • Voice sounds wet or gurgly after feeding
  • Signs of distress, including facial grimacing, tearing of the eyes, arching back, or redness in the face
  • Repeated lung or airway infections
  • Slight fever after meals

Aspiration can also occur withoutovert signs of swallowing difficulty, meaning that the child does not cough or show symptoms when material goes into their lungs. This is known as silent aspirationand is best detected by a formal video-swallow study, as it cannot be observed by the naked eye.

What can I do?

If your child is demonstrating ANY signs or symptoms of aspiration, notify your speech-language pathologist or contact your medical provider to discuss the need for a formal swallow evaluation. After a swallowing evaluation, your medical team will be able to determine which consistencies are safest for your child to eat and drink, as well as create a plan of care to improve your child’s swallow function.

Questions or concerns?

If you have questions or concerns about the safety of your child’s swallow, please contact us at info@playworkschicago.com or 773-332-9439.

Jill Teitelbaum, MS, CF-SLP
Speech-Language Pathologist

Reference: Aspiration in Babies and Children. (2018). Retrieved from https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/a/aspiration-in-babies-and-children.html

Photo Credit: Jens Johnsson via unsplash.com