My Child Is Stuttering — Should I be Concerned?

Many children in the early language developing years (anywhere from one to five years old) pass in and out of stages of increased disfluency. This is often seen when children go through a time of rapid language growth, where they increase their vocabulary and begin to combine words into short phrases. Children may frequently struggle with word finding in connected speech and repeat sounds and syllable shapes as they ‘look for’ the right word. They also use fillers, such as “uh” or “um,” in conversation.

Young children may repeat the sounds at the beginning of words (“Ka-ka-cookie”) or they may repeat whole words at the beginning of phrases (“My-my turn”). Normal disfluencies are two- to four-repetitions long (“I-I-I want ice cream”) and the child will continue their phrase without pause. The majority of typically developing children are unaware that they are disfluent and show little to no signs of frustration. They often do not follow a pattern of disfluency, but may experience times of increased disfluency when they are excited, tired, upset, or when under stress to talk or answer questions. They may be disfluent for a few days or weeks at a time, and then enter periods of relatively fluent speech. This occurs naturally as children learn how to use language in a new way. These periods of disfluency are considered age-appropriate and usually disappear on their own.

As a parent, you can support your child by allowing him or her to finish their word/phrase on their own before responding. Acknowledge their communication attempt by giving them plenty of time to communicate and use slow, unhurried speech in your response.

Moderate to severe stuttering is characterized by longer repetitions, effortful speech, and tense facial muscles.  Children with atypical disfluencies may experience a ‘block’ in speech, where no airflow or sounds occur for a few seconds. They may become embarrassed about talking or avoid talking altogether.

If you have any concerns about your child’s fluency or communication skills, email info@playworkschicago.com to schedule a speech-language evaluation with one of our experienced clinicians.

Autumn Smith, MS, CCC-SLP
Speech-Language Pathologist

Transitioning to Preschool- Finding the Right School for You and Your Child

The transition to preschool can be an intimidating one for families – every parent wants the very best for their child! Here are some questions to consider when choosing the right school for your child and family:

What is the school’s educational philosophy?

Parents are encouraged to ask schools this question however may be unsure of their own educational philosophy. Here are some things to keep in mind:

  • Is the program play-based? Are the children allowed to explore and discover or do they complete mostly drill work (i.e. worksheets)?
  • What is the school-family relationship like? Are families welcome and/or expected to volunteer? Is there an open door policy or do families need to make appointments to stop in?
  • What curriculum is used in the classroom?

Does the school use a skills based assessment?

It is important to learn how your child’s preschool program will be tracking their progress over time. Are they assessed every 6 months? Once a year? What tool is used to assess their skills? You want to make sure that your child’s cognitive, social-emotional, and physical development is monitored to ensure they are successful in the classroom and getting any support they may need.

What qualifications or educational background do the teachers have?

Qualifications to teach in a preschool classroom can vary from school to school – some require a bachelor’s degree in early childhood education, elementary education, child development, etc. Others may require only a few hours of coursework and complete the rest of their training in-house. You want to make sure that you are comfortable with their educational background and experience, as these are the people who will help your child learn and grow!

What is the school’s discipline policy?

It is essential that a preschool’s and classroom’s rules are clear to both the parents and child. You want to be certain the program is setting children up for success in the classroom. How often are the rules reviewed with the children? Are they posted it the classroom or around the school?

You also want to make sure you agree with the way the school handles discipline, should the situation arise. Do they use the “timeout” method? Do they redirect the child when possible? Do they talk with the child to explain why they are being disciplined and to resolve the situation? Are children rewarded or acknowledged for good behavior?

Does my child need to be potty trained to attend?

Some schools require children to be potty trained in certain classrooms and may not allow a child to move up to the next room until they are using the toilet regularly. Other schools do not require children to be fully potty trained and help out in the practice.

Kimberly Shlaes, MAT, DT

Developmental Therapist

How Do I Teach My Child To Care About Others? Part Two: Practice Kindness

Please refer to part one, Modeling Empathy, of this two-part blog post.

Practice Kindness

The next logical step after empathy is kindness. What is kindness? It’s an attitude of empathy that leads to an action. You model kindness when you act in ways that express empathy. Kindness is a choice to do something or to say something that shows you care.

You can show kindness to your child by offering an alternative to help them overcome their anger at needing to clean up their toys: “After you calm down, you can help me set the table for dinner.” We learn to be kind by receiving kindness. When your child is experiencing a negative emotion, your kindness towards them will be keenly felt. You validate their worth when you show kindness despite a difficult interaction, and your child will learn compassion.

You can also encourage kindness by suggesting appropriate action towards others:
“When do you think you should give Sarah a turn to swing?”, or “Let’s help John pick up all those crayons!”

Try to create opportunities to practice showing kindness to others:
“How about we bring a couple of extra water bottles to the park for someone that doesn’t have one?”, or “I think it would be kind to help somebody today. Shall we look for someone who could use a hand while we are at the store?”

Older children may be encouraged to understand kindness by playing games like charades. Try discussing real or made-up scenarios and compare kind or unkind responses. Talk to your child about kind or unkind actions they may see on TV or read about in their books.

Kindness may also be expressed in words. Teach your children a language of kindness. Speak kindly to your children. Never use harsh words, and tell them how much you appreciate them. Demonstrate speaking kindly to others. Don’t allow your children to insult you or others. Remember that words are powerful, whether positive or negative.

Conclusion
Remember, you are your child’s first and most influential teacher. He or she will emulate your words and actions. When your child learns to identify with the feelings of others and practices kindness towards them, respect for the needs of others is a natural result. When you treat other people like they matter, your child will watch and learn!

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

Bilingual Language Acquisition – Frequently Asked Questions

In the United States, more than 20% of school-aged children speak a language other than English at home. As soon as I learn that a client is exposed to more than one language I always make sure to answer any questions related to bilingual language development. Often times, I encounter families that speak more than one language at home, but they decide to only expose their child to one language in fear that speaking more than one language will confuse their toddler. Other times, I meet families that attribute their child’s language delay solely to the fact that they are exposed to more than one language. Here are a few of the most common questions related to bilingual language development that I have encountered as a speech-language pathologist and an Early Intervention provider.

Question: “Is it okay that I expose my child to more than one language at home?”
Answer: Absolutely. In fact, research states that there is a “critical period” – or, a window of time during early childhood when it is easiest to learn a language.

Question: “My child is 2 years old and is not producing any words. They’re exposed to English and Spanish at home, so it’s okay that they’re not talking yet. Right?”
Answer: Wrong! Though a child who is simultaneously learning more than one language may start talking a little later than monolingual children, they should still begin talking within the normal range. If your toddler is 2 and not producing any words at all, this definitely warrants a speech-language evaluation.

Question: “My child frequently goes back and forth between languages when they’re talking to me. Is this normal?”
Answer: Yes. This is called “code-switching.” “Code-switching” is typical and it is a process that both children and adults who speak more than one language experience. Children might do this when they know a word in one language but not the other. This should not be looked at as a sign of language delay or confusion.

Question: “I want my child to be bilingual. What can I do at home to make sure my child learns both languages successfully?”
Answer: Do what is most natural and comfortable to your child and your family. Some families prefer that one parent speak to their child in one language while the other parent talks exclusively in another. Some families decide to mix languages amongst caregivers. Whatever approach you decide to take, trust that it can lead to bilingualism.

Julie Euyoque MA CCC-SLP

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 info@playworkschicago.com!

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 info@playworkschicago.com.

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.

INGREDIENTS
• 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

INSTRUCTIONS
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 scheduling@playworkschicago.com.

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