Phonological Processes

As children learn to talk, there are often times that we have difficulty understanding what they say. There are a number of complex steps between thinking a word and saying it clearly. The differences may be hard for parents to recognize, and it could be even more complicated to determine if it is normal speech development or not. Here is some information that may help determine if parents should seek a speech-language evaluation.

What is the difference between articulation and phonology?
Articulation refers to the motor act of a speech sound – all the movements that our articulators (lips, tongue, teeth) need to do to make the right sounds. Phonology refers to the ability to organize speech sounds into the patterns that form words.

Why can my child sometimes produce a sound correctly, and other times get it wrong?
Your child may display the use of sounds within certain words, but seem unable to produce the same sound in a different word. For instance, they say “Go!” but pronounce “doggie” as “doddie”. It is possible he or she is having difficulty with their phonology – or use of sound patterns within words. These difficulties are called phonological processes or patterns. Children display phonological processes in an attempt to simplify adult speech to an achievable level for them. It is not that they have trouble physically producing the sound, but that they are having difficulty organizing the sounds at the phonemic level in their brains.
Most phonological processes are considered to be age-appropriate for a certain amount of time as a part of speech development. Others are never considered typical, and may indicate a phonological disorder. Additionally, if a child continues to demonstrate patterns after a certain age, they are no longer typical and may implicate a need for remediation through speech therapy. Please click the link below for a detailed chart of phonological processes.

Phonological Process Chart

If you are concerned about your child’s speech, or have questions after reviewing this information, please email us at!

Leanne Sherred, M.S., CF-SLP

The Power of Routines

A routine is anything that we do with regularity. For example, a bedtime routine for a young child could include the following: milk, a bath, brush teeth, and read a story. Children thrive on routine and repetition. Routines create patterns that allow children to easily understand and predict their days. Routines are often repeated in a specific sequence, and this repetition builds an understanding of what is happening and what is coming next which often decreases the uncertainty that can cause anxiety and/or tantrums.

In addition, routines are great for creating independence in your toddler. If they know what is happening next, they can begin to initiate the next step. Routines are also great for language development and comprehension of basic sequences! Talk about the actions and objects within each step of your routine. For example, during your bedtime routine you can talk about getting milk and modeling the word and/or sign for “milk.” Encourage your child to sign or say “milk” to request it. Praise all attempts even if they are not accurate! Bath time is another great opportunity for language practice. Label verbs such as “wash” and “dry,” as well as body parts; e.g. nose, eyes, belly button, toes, etc.! You can also have your child point to body parts or imitate these verbs if they are not quite ready for verbal imitation. The more your toddler hears a word connected with a specific object or action the deeper their understanding of that word becomes. A fun addition to routines could be a visual schedule which often includes pictures of your child performing various activities within the routine, providing a visual cue for what comes next.

Adding routines to your day is easy! Include a specific routine, such as the bedtime routine mentioned earlier, or a loose, but consistent, structure to your day; e.g. wake up, eat breakfast, play, eat lunch, take a nap, play, eat dinner, go to bed. Once your child becomes familiar with the sequence routines become more natural, and they are a great opportunity to bond with your toddler and model language!

Still have questions? Please e-mail us at

Jessie Delos Reyes, MA, CF-SLP

Cooking Up Opportunities for Sequential Direction Practice

Many of my clients’ therapy goals include working on multistep sequential directions.

“First, find the game, then find the book.”
“Before you get the game, get the book.”
“After you get the book, get the game, then get the bubbles.”

Frequently, these sequential directions also include early concepts such as spatial, size, temporal and quantitative concepts. Sequential directions are frequently used in the classroom, so they are extremely important to master! While there are many functional ways to practice multistep sequential directions at home, one of my favorite ways is to incorporate kids into cooking! Note: “cooking” can be a term used very loosely for young children, i.e. have them “make” chocolate pudding by mixing milk with an instant pudding pouch or “make” an ice cream sundae in a specific order for a fun, summer treat!

Here is a favorite family recipe that will get your kids cooking and practicing sequential directions. Note: this recipe is made with whole-wheat flour and eggs but could easily be made vegan or gluten-free.

• 1/3 c melted coconut oil (or oil of choice)
• ½ c maple syrup or honey
• 2 eggs
• 2-3 ripe, mashed bananas
• ¼ c milk of choice OR water
• 1 t baking soda
• 1 t vanilla extract
• ½ t salt
• ½ t cinnamon
• 1 ¾ c whole wheat flour

1. Preheat oven to 325F and grease a 9×5 inch baking pan (**this direction for parents only – the rest can be kids or parents!)
2. First, pour the oil and honey into a large bowl, then whisk together.
3. Add the eggs to the bowl and mix well, then mix in bananas and milk.
4. Before you whisk again, add the baking soda, cinnamon, vanilla, and salt.
5. Pour the batter into the loaf pan, then sprinkle with a pinch of additional cinnamon.
6. Bake 55 to 60 minutes or until a toothpick or knife inserted into the center comes out clean.
7. After you let the bread cool for 10 minutes in the pan, transfer to a wire rack to cool for 20 minutes.
8. Slice. Eat. Enjoy!

Caitlin Brady, M.A., CCC-SLP

Recipe credit:

Healthy Banana Bread!

Do Parents/Caregivers Need to be Present During Therapy Sessions?

Parents often ask the therapists whether they should sit in with their child during therapy sessions or if they should stand back and let the therapist work alone. If the parent(s) are available to be present during the child’s session, the therapists highly encourage them to participate in the activities and ask questions. For example, if the child is learning how to practice using sign language to communicate his/her wants and needs, it would be beneficial for the parent to be present at the sessions. This way the therapist can encourage the parent to take part in learning and modeling the signs in order to help the child work on this goal outside of the session. Knowing that each therapy usually occurs once a week for an hour, it is important for the parent(s) to practice the strategies while the therapist is there so that they can then carry the strategies over into the week, increasing their child’s chances of learning the new skill.

We realize that not all parents can be present during their child’s sessions. In those cases, it’s important for the therapists to talk with the child’s caretakers at the time (teacher, nanny, extended family, etc.) and give them tips on how to help the child work on specific goals in their daily environments. Knowing that it is not always feasible for a parent/caretaker to accompany a child to each session, it is important that the information is communicated to the parent/caretaker at the end of the session – including demonstrations of the skills – so they can expose the child to the skills throughout the week.

Therapists should encourage the parents and caretakers to ask questions during or after a session so they fully understand what they are asked to do and why it will benefit the child. Overall, therapy sessions that include parental and caregiver participation not only teaches the adults how to learn and incorporate the developmental strategies into their child’s routines, but works on continually building a relationship between the parent/caregiver and child.

Brittany Hill, MS, MSW, LSW, DT

Q & A Forum: The Basics of Early Intervention

What is Early Intervention?
o Early Intervention (EI) is a state-funded program that provides services to help babies children birth to three years of age and toddlers with developmental delays or disabilities. Each state has their own EI program system that offers both assessments and ongoing therapeutic services. for children between the ages of zero and three and their families.

What steps do I need to take to enroll my child in EI services?
o You will begin by contacting your local EI office to set up an initial evaluation (please reference additional information below to find your local EI office). Anyone can refer a child to Early Intervention without a doctor referral. As a parent, you can refer your child for services without a doctor referral. You will be assigned a service coordinator who will work with you to schedule an evaluation with a team of EI professionals in order to determine your child’s eligibility. If your child is determined eligible, the EI team will create an ongoing service plan to best meet your child’s needs.

How do I know if my child qualifies for EI services?
o To determine EI eligibility, your child will need to complete an evaluation with a team of therapeutic professionals. The initial evaluation typically consists of assessments by a developmental therapist as well as a speech and language pathologist, an occupational therapist, and and/or a a developmentalphysical therapist. Upon completion of the evaluation, the therapists will inform you of the results including any measurable developmental delays. If your child is found to be at least 30% delayed in one or more areas of development, the EI team in the assessment domains and will provide recommendations for ongoing therapy (frequency and intensity of services, i.e. one1 time per /week for 60 minutes) if applicable. At this time, the service coordinator will work with you and your team to create an Individualized Family Service Plan (IFSP) detailing your child’s current needs and family-centered goals for therapy.
o Your service coordinator will find therapists in your area that have availability for ongoing services. The therapists will then contact you to schedule therapy sessions for your child. If you are interested in working with a therapist from PlayWorks Therapy, you may request one of our providers during the creation of the Individualized Family Service Plan (or at any time during the process). .

What services are provided?
o Early Intervention provides services to support all aspects of your child’s development. These services may include one or more of the following:
-Speech and language therapy
-Occupational therapy
-Developmental therapy
-Physical therapy
-Audiology or hearing services
-Assistive technology
-Counseling and training for a family
-Medical/nursing services
-Nutrition services
-Psychological services

Where are services provided?
o Every effort is made to provide services in your child’s natural environment. This means that therapy typically takes place in your home or at your child’s daycare/education center.

Who pays for these services?
o Under Part C of the Individuals with Disabilities Act, the following services must be provided at no cost to families:
-Initial evaluation to determine eligibility
-Development and review of the IFSP
-Service coordination
o Ongoing service fees are determined by the policies of your state. In Illinois, if you have public insurance (e.g. All Kids), all fees are waived. If you have private insurance, In Illinois, your family-fee is calculated based on the size of your family and your income. Additionally, you You will may be asked to provide your medical insurance information to determine if your public or private insurance will cover the cost of EI services. If insurance covers the cost of therapy, you will not be assessed a family fee. If services go towards your deductible or are not covered, you will be assessed your family fee. .
o You are not required to provide this information, however, and EI cannot use your insurance without your written consent. If you do not give consent, the program may not limit or deny services to you or your child.

What happens after my child turns three?
o If you and your team believe that your child would continue to benefit from therapeutic services, you can attend an evaluation through the public school system to determine eligibility for the Early Childhood program (3 to -5 years of age). Your EI service coordinator should contact you about three to six months before your child’s birthday to schedule this evaluation and to answer any questions you have about transitioning from Early Intervention to Early Childhood.
o If you do not wish to continue services with your public school system, you can contact a private therapy company, including PlayWorks Therapy, to schedule an evaluation and to discuss ongoing services.
If you are currently seen by a PlayWorks Therapy, please contact our office at (773) 332-9439 and speak with our case coordinator to facilitate a seamless transition.

I am interested in therapy; however, I am not interested in utilizing the Early Intervention program. What are the next steps?
o To schedule a private evaluation through PlayWorks Therapy, please call us at: (773) 332-9439, or email

For more information on the Illinois Early Intervention program, please visit the DHS website.

To determine your local EI office in Illinois, please visit the Provider Connections website.

Autumn Smith MS, CCC-SLP

A Developmental Therapist’s Favorite Toys

As a developmental therapist, parents are always asking me for toy recommendations. Here is are five developmentally-appropriate toys for toddlers that I love to use in therapy sessions:

1. Mr. Potatohead
The classic Mr. Potatohead is a fantastic, battery-free toy that people have enjoyed for decades! With Mr. Potatohead, children learn about body parts and can explore their placement on the potato. Children also work on their fine motor development while placing features on Mr. Potatohead. Parents and caregivers of older children can expand their play with this toy to learn functions of body parts and explore different facial expressions.

2. Playdough
Playdough is a great for symbolic or imaginative play, language development, and sensory exploration! Playdough can be molded into food or animals to encourage symbolic play. For their language development, children can work on color identification or following directions while manipulating the dough. Playdough can be used for imitation of gestures (e.g. rolling, poking, patting, etc.). You can also hide small toys inside playdough for texture or sensory exploration (while supervised, of course!).

And if you’re looking for an easy kitchen activity with your child, you can make the dough yourself!

Homemade Playdough
1.5 cups flour
½ cup salt
2 teaspoons of cream of tarter
2 tablespoons of oil
1 cup of boiling water
Food coloring

Mix all ingredients in a large bowl and then knead until smooth. Store in an airtight container to keep soft.

3. Melissa and Doug Nesting Blocks
These blocks are great, as they can be used for so many different areas of development! Parents and children can work on joint attention (when two parties are engaged in the same activity, sharing attention with a particular toy or activity) by taking turns stacking the blocks. Fine motor skills are developed through the motion of stacking. Children can work on their animal, color, or letter identification, as well as animal sounds, with the colorful pictures on the blocks. And while cleaning up the blocks, children can work on their understanding of size concepts while nesting the blocks.

4. Farm Set
I really like the “Little People” farm set but really any will do! This is a great toy for symbolic play and language development. Children can engage in symbolic play by feeding or putting animals to bed. It is another great toy that can be used for imitation of different play gestures. Children can also work on their receptive language by following directions provided by their caregiver or matching the sounds to each animal (use this toy while singing “Old McDonald”!) For older children, you can discuss the kinds of animals that live on a farm and those who do not.

5. Melissa and Doug Cutting Food
Whether it is the fruit, food, or grill set, children love the Melissa and Doug play food! This toy provides children the opportunity to imitate adult behavior (which we know they love to do!). Not only can you discuss the different types of food, it provides children fine motor practice and is a great symbolic play activity.

Kimberly Shlaes, MAT, DT

How Do I Teach My Child To Care About Others? Part One: Model Empathy

One question parents often ask me is, “How do I teach my child to care about others?” The answer may be simple: show care for the people around you. Your son or daughter is watching you! Children watch your interactions closely and they tend to imitate what they see. When you demonstrate positive interactions with your child and others, they are likely to follow your example.

Here are some ways you can encourage your child to develop the caring characteristics of empathy and kindness.

Model Empathy.

Empathy is the ability to consider the perspective of another person. It’s valuing someone, and trying to understand his or her thoughts and feelings.

First, model empathy towards your children. Be considerate of their perspective by listening and seeking to understand how they feel. For example, if you help your child to name an emotion they are feeling, it can show that you value and understand them: “I see you are mad because it’s time to clean up your toys. I know how much you love playing with your trains, but now it’s time to have dinner.” By validating your child’s feelings, and voicing understanding, you are teaching them to consider someone else’s perspective. (Please see my previous blog post on Teaching Your Child to Manage Emotions)

Next, demonstrate the same thoughtful behavior towards other people. Talking to your child about your concern for others, and sharing some of your own feelings will help them to develop compassion for others:

“I think Sarah is feeling sad because you got to the swing first. Sometimes I feel sad when someone else is first.”

“Did you see the smile on Sarah’s face when you gave her a turn on the swing? I think she felt happy.”

You can also use pretend play to teach your child, by making up stories:

“Oh no! The cow isn’t sharing the ball!  The horse is feeling left out.”

As your child grows, discussions about empathy should become more natural and you may be pleased to discover that they remind you to consider the other’s feelings!

Please check back for Part Two: Practicing Kindness.

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

Laura Mauriello, MS, LCSW, DT

Spring has Sprung!

Warmer weather is finally here (or so we’re told). Along with spring weather comes new opportunities to learn language while getting outside and having fun.

Go for a walk
A simple walk around the block can include many opportunities to help your child expand his/her vocabulary.  As we all know, spring in Chicago means construction. Children love watching the construction vehicles and talking about what they see. Name the vehicles and their actions as your child watches in awe.  You can also talk about airplanes, bicycles, and animals as they pass. Try skipping, jumping, or clapping as you walk, and see if your child will imitate your actions. Building gross motor imitation skills is very helpful for language learning.

Go to the park
The playground is a great place for children to learn to interact with their peers. When it is nice outside it is almost a guarantee that you will run into other young children who can act as language models for your child. This may also provide a great opportunity for your child to work on early social skills like turn-taking.

Take a trip to the zoo
Did you know that admission to the Lincoln Park Zoo is completely free? A trip to the zoo will provide a great opportunity to talk to your child about animals, and animal sounds. The Lincoln Park Zoo also has a great sing-a-long for young children every Wednesday and Friday morning at 9:15 and 10:00 a.m. at the Main Barn in the zoo’s Farm-in-the-Zoo.

Meryl Schnapp M.A., CCC-SLP

Picky Eater vs. Problem Feeder

It’s true that lots of children can be described as “picky eaters.” Many children refuse to eat their vegetables at dinner and would prefer to eat chocolate for breakfast. For other children, being in the same room as a food that they don’t like can trigger a meltdown. These same children may avoid complete food groups or certain food textures.

For some children, this “picky” phase will be one that they outgrow. Other children may require therapeutic intervention to broaden the number of foods that they tolerate and will willingly accept.

“Picky eaters” and “problem feeders” may present similar characteristics. So, how do you decide if your child would benefit from feeding therapy? Below is a list of general differences between “picky eaters” and “problem feeders.”

 Picky Eaters vs Problem Feeders

Ultimately, if you have any feeding concerns, always consult with your pediatrician. If your doctor agree that your child is not just a “picky eater”, he or she can refer you to a certified speech-language pathologist. It can be helpful to keep a food log detailing foods that your child accepts and rejects to bring with you to your doctor visit and feeding evaluation. A speech-language pathologist can help your “problem feeder” discover new foods, and can help to create happy and healthy mealtimes!

Julie Euyoque, M.A., CCC – SLP



What You Need to Know About Sensory Processing Disorder

What is Sensory Processing Disorder?

Sensory processing disorder refers to the way the nervous system receives messages from the senses and turns them into appropriate behavioral or motor responses. It is a condition in which the brain has trouble receiving and responding to information that comes in through the senses. Sensory Processing Disorder exists when sensory signals don’t get organized into appropriate responses. Someone with Sensory Processing Disorder may find it difficult to process and act upon information that they receive from the senses, which can make it difficult to complete various every-day tasks.

What does Sensory Processing Disorder look like?

A child with SPD may exhibit clumsiness, behavioral problems, anxiety, or have trouble in school. SPD can look very different from one person to another. One child may over-respond to sensation and find physical contact, clothing, light, food, or other sensory input to be unbearable. On the other hand, one child might be under-responsive to sensory input and show little reaction to stimulation. Some “red flags” in preschoolers include:

  • Over-sensitive to touch, noises, smells, and other people.

  • Difficulty making friends.

  • Difficulty dressing, eating, sleeping, and/or toilet training.

  • Clumsy; poor motor skills; weak.

  • In constant motion; in everyone else’s face and personal space.

  • Frequent or long temper-tantrums.

If you suspect your child may have difficulty with sensory processing, contact a pediatric occupational therapist at PlayWorks Therapy to complete an evaluation.

Caitlin Cassidy, OTR/L