Language Milestones for Children with Down Syndrome (Birth to Five)

Birth to five years of age is a critical period for language development for all children. Each child progresses at his or her own rate, and each presents with his or her own strengths or weaknesses. The same applies to children with Down syndrome. However, children with Down syndrome tend to develop language skills at a slower rate than their typically developing peers. This blog will aim to answer questions regarding language development in children with Down syndrome by comparing language milestones to those of their typically developing peers.

While the milestones above are based on general trends, it is important to note that language development will vary for both typically developing children and children with Down syndrome. Speech therapy is recommended for children with Down syndrome, starting younger than one year of age to target feeding and oral-motor skills and after 15- to 18-months of age to target speech and language skills. Common early speech and language targets for children with Down syndrome include verbal turn taking, vocabulary acquisition, use of simple signs and gestures, following simple routines-based directions, use of age-appropriate speech sounds, and more.

Questions or concerns?

If you have questions about language development in children with Down syndrome, please contact us at info@playworkschicago.com or 773-332-9439.

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

Reference: Layton, T. (2004). Developmental Scale for Children with Down Syndrome.

Photo Credit: yulia84 via pixabay.com

Let’s Play! The Stepping Stones to Verbal Communicators

If you are a parent of a toddler receiving speech and language therapy, you may have noticed your child’s therapist playing games such as peak-a-boo, and wondered to yourself, “What do these games have to do with learning to talk?” While learning to talk is of course the ultimate goal in speech and language therapy, there are actually many skills a child needs to develop before they are ready to start talking. Some of these skills include joint attention, turn-taking, and responding to people and their environment, among others. One of the best ways to support acquisition of these pre-linguistic skills is to engage in social games with your child.

What are social games and why are the important?

Social games are people-based in that they are interactive games between you and your child rather than the use of toys. Examples include peek-a-boo, songs with corresponding actions, hide and seek, tickles, etc. Engaging in social games with your child will help to develop their interaction, communication, and social skills. Through social games, children learn to pay attention to others, anticipate what will happen next, and imitate actions. Additionally, through these games children learn important skills such as how to take turns and connect with others. These pre-linguistic skills are the foundation of verbal language. For example, a child who has difficulty using joint attention, which is shared attention with another person, will not have as many opportunities to learn about their environment from the people around them. Additionally, a child who is not using turn-taking will have difficulty understanding the back and forth nature of conversation. Through acquisition of these pre-linguistic skills a child becomes ready for communication and verbal language use.

How to play and what to look for?

You will want to engage in social games repeatedly so that your child learns the routine. For example, if you play peak-a-boo with your child play it over and over again and look for your child learning the game. You may notice that they have learned the game once they start to smile or laugh in anticipation of you saying, “boo!” Over time, you might see your child’s initiation skills emerging when they cover their eyes with their hands or cover themselves up with a blanket to request playing a peek-a-boo game with you. Eventually, you can try to pause after “peak-a…” and see if your child can fill in the word, “boo!” Once your child has learned the routine they will be able to anticipate what is going to happen next.

When thinking about your child’s language development it is important to remember that there are many steps that come before talking and children must master pre-linguistic skills before they can be successful with verbal language. So, when think you are just “playing” remember that you are actually teaching your child foundational skills to become an active learner and communicator!

Questions or concerns?

If you have questions or concerns about the importance of social games and your child’s language development, please contact us at info@playworkschicago.com or 773-332-9439.

Claire Hacker MS, CCC-SLP
Speech Language Pathologist

Photo Credit: from Pixabay

Min, Mod, and Max Cues: What does it all mean?

 

When a child begins therapeutic services, long-term and short-term goals or objectives are developed as a way to guide therapy and gauge progress. If your child is already partaking in speech, occupational, physical, or developmental therapy, you’ve probably seen the words “minimal,” “moderate,” or “maximal cues” written in his or her goals. Amongst sometimes “wordy” goals, it can be difficult to interpret meaning of the specific objective, let alone understand what exactly a “cue” means.

What is a cue?
When helping a child reach his or her therapeutic goals, a “cue” is simply something that is going to aid in that child’s success. When I am providing speech therapy to a child, my goal is ALWAYS for that child to be successful; however, the number and type of cues that child needs to be reach his or her goal may vary. Think of a cue as a hint; as a child becomes familiar with the goal, he or she is going to need less “hints” to be successful and, thus, will become more independent. As a child progresses in therapy, the quantity of cues required for a child to effectively complete an objective will decrease. This is one way that therapists gauge a child’s progress.

What types of cues are there?
Generally speaking, many therapists use tactile, visual, or verbal cues in therapy tasks. Each category of cues has several variations:

Tactile cues: Tactile cues are used when a therapist uses physical touch to guide a child towards successful completion of a therapy objective. In speech therapy, this may be demonstrated by gently touching under a child’s chin in an attempt to help produce the /k/ or /g/ sound, or gently tapping a child’s hand to help him or her produce the correct number of syllables in a word. In occupational or physical therapy, the therapist may tap a child’s arm/leg to remind a child to use that specific body part.

Visual cues: Visual cues are used when a therapist provides a visual reminder that helps the child complete his or her task. In speech therapy, this may be as simple as drawing a snake to remind a child to use his “snake” sound to produce /s/; the therapist may tap the picture if the child omits this sound. Gestural cues are a specific type of visual cue; when targeting this same sound, the therapist may run her finger down her arm to demonstrate the long, fluid motion of /s/. Have you ever used a sticky note to remind you to complete a specific task? That’s an everyday example of a visual cue!

Verbal cues: Verbal cues are used when a therapist provides a verbal reminder that helps the child complete his or her task. Using the same /s/ example as outlined above, the therapist may say, “don’t forget your snake sound!” One specific example of a verbal cue is called a phonemic cue. If a child is working on asking for “more,” the therapist may cue the child by vocalizing “mmm.” A carrier phrase is another form of a verbal cue. Instead of using the phonemic cue, “mmm,” the therapist may say, “I want ____” to encourage the child to finish the phrase. A verbal model may be provided if verbal cues are simply not enough at that time; in this example, the therapist may model the word, “more” before handing the child the desired item.

What does “min,” “mod,” “max” mean?
Now that you have a better understanding of the types of cues used in therapy, what does “min,” “mod,” and “max” mean?

“Min,” “mod,” and “max,” stand for minimal, moderate, and maximal. When developing goals, therapists determine how much cuing a child realistically needs to reach his or her goals. Ideally, the level of cuing necessary decreases as a child participates in therapy. While the criteria of minimal, moderate, and maximal is fairly subjective, many therapists determine that minimal cues are used approximately 25 percent of the time, moderate cues are used approximately 50 percent of the time, and maximal cues are used approximately 75 to 100 percent of the time. Therapists may also report using “faded” cues, which means a child may have required moderate cues as the session started, but required minimal cues as the sessions progressed.

Can I “cue” my child at home?
Of course you can! In fact, you’re probably already cuing your child and you may not even realize it. When your child is about to do something undesirable, do you ever catch yourself counting, “one, two, three…?” You just gave your child a verbal cue, which helped him or her to reflect on his or her behavior and (ideally) change it accordingly. If your child is currently receiving therapeutic services, ask his or her therapist for ideas to best cue him or her to reach his or her goals.

Questions or concerns?
If you have questions or concerns about your child’s therapeutic goals, please don’t hesitate to ask his or her clinician for more information. If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9439.

Sarah Lydon, MA, CCC-SLP
Speech-Language Pathologist

Photo Credit: Heriberto Herreravia via freeimages.com

Speech and Language Opportunities on the Road

Looking for some ways to work on your child’s speech and language while in the car?

Stuck in gridlocked traffic is not fun, but you can make it a little more interesting by working on your child’s speech and language skills while in the car! Below are some easy ways to work on your child’s speech and language development that do not require a phone, iPad, or any physical toy. Reduce the noise in the car and tune into your child during your next drive!

12 months to 24 months

-Sing songs! Some great songs to sing include Twinkle Twinkle Little Star, Row, Row, Row your Boat, Old McDonald, Five Little Monkeys Jumping on the Bed, Itsy Bitsy Spider, Wheels on the Bus, BINGO, Baby Bumblebee,If You’re Happy and You Know It, andBaby Shark.” As your child gets older you can leave out words at the end of phrases (“…Twinkle twinkle little _____”) to see if your child can fill them in!

-Model environmental sounds like “wee, woah, uh-oh, vroom, beep-beep” while driving. Make your sounds exaggerated and silly to capture your child’s attention!

-Name things you see during your car ride! Label objects you see as you pass them by.

-Phrase “Ready, set, ____ (go)!” when you start/stop at a red light

-Make silly sounds as you drive to see if your child can imitate you

24 months to 36 months

-Continue to name things you see during your car ride! If your child labels something they see as you are driving you can expand on what they say. For instance, if your child said “truck” you can model “red truck.”

-Model simple location phrases such as “in, on, under.” For instance, “doggie inwater” or “car onroad”

-Target basic concepts:

-Model the words “open/close” and “in/out” as you open and close doors and get into or out of the car

-Model a variety of action words as you drive such as “go, stop, drive, park, turn”

-Look for and identify objects that are “big” vs. “small”

-Work on quantity concepts as you drive, such as onecloud vs. manyclouds in the

-Talk about the colors of cars around you

-Talk about the types of cars you see (e.g., semi-trucks, cars, construction vehicles)

3 years to 4 years+

-Play “I spy” to work on labeling and naming things that you see and drive past

-Model more complex adjectives and more advanced location concepts as you drive.

-Ask your child a variety of wh-questions while driving such as “Where are we going?, What are we doing?, When did we leave?, What are we doing when we reach our destination?, What is mom/dad doing?, What are we making for dinner? Why are we going grocery shopping, etc.” If your child responds with a single word see if you can give them two choices or model a longer phrase. If they use vague and non-descript language such as “this, that, right here, etc.” provide them with two choices to see if you can promote your child’s use of more descriptive language.

-Play the Grocery Storegame: Have an adult start. “…I went to the grocery store and I bought _____ (apples). See if your child can repeat the item just said and add one to it. For instance, “I went to the grocery store and I bought apples and stickers.” You can provide hints if you don’t think your child can recall what was said last. When it’s too hard start again from the beginning!

-If your child is working on speech sounds you can practice their sounds in the car! Pick several words with the target sound and say it every time you stop at a red light or every time you see a certain object or item such as a tree.

-Tell your child that you’re thinking of an object that starts with a certain sound such as “b.” See if your child can think of things as you drive that start with that letter.

-Promote appropriate grammar and sentence structure. If you notice that your child made a grammatical error model their sentence with correct grammar and sentence structure.

-Talk about letters or numbers you see on license plates

-Talk about categories (e.g., types of transportation that you pass, types of weather, types animals you see, etc.)

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

Photo Credit:Sandy Millar via unsplash.com

Is My Child Stuttering? How to Identify Typical Disfluencies Versus Red Flags for Stuttering

As a pediatric speech and language pathologist, I often find myself listening as a child tells me, “my mom – my mom – my mom – my mom – likes green!” You may find yourself in a similar situation, waiting for your child’s response, as they repeat sounds, parts of words, whole words, or even phrases. Now, how much of that is typical? The information below will help you determine whether your child’s fluency is characteristic of their age and stage of development, or if there are red flags for stuttering present.

What is Disfluency

A disfluency is anything that interrupts the forward flow of speech. Within every person’s speech, children and adults alike, there are disfluencies present. As adults, we become acutely aware of these disfluencies during times of increased pressure, such as during an oral presentation or an interview. Even something as simple as taking a big breath, sneezing, or coughing can impact our fluency. Some types of disfluencies are typical, while some may be indicative of something more significant, such as a fluency disorder (i.e. stuttering).

So, what is typical disfluency?  

Typical disfluencies include repetitions of whole words (my – my dog is small) or phrases (can I – can I – can I go outside?). They also include interjections (um, like) and revisions (I went to the – I saw a chicken at the farm). With typical disfluency, the speaker does not demonstrate physical characteristics of difficulty, such as increased tension in their face or body.

Developmental Disfluency

Children may have periods of increased disfluency from two to five years of age, as these are years of significant expressive language development. Between these years, children often transition from using single words and two-word phrases to engaging in adult-like conversations. This is sometimes referred to as “preschool stuttering” and consists largely of the typical disfluencies outlined above. If your child is using mostly typical disfluencies in their speech, does not have negative feelings about their fluency, and does not appear to be physically struggling to complete their sentences, then it is likely typical and not cause for concern at this time.

Stuttering

If a fluency disorder or “stuttering” is present, it can lead to breakdowns in communication, which can impact your child’s participation across settings.

What are the red flags for stuttering?

  1. A family history of stuttering is present
  2. Your child is a male
  3. Your child is repeating sounds (b-b-b-ball) or syllables (break-break-fast) in addition or instead of words and phrases
  4. Your child is prolonging sounds (sssssoup)
  5. Your child has periods of time when they are trying to speak, but no words are coming out
  6. Your child appears to be tense or struggling while talking
  7. There are observable secondary behaviors present (i.e. blinking eyes, changing pitch or volume, grimacing)
  8. Your child has negative feelings regarding their speech
  9. Your child is avoiding speaking in general or speaking in certain situations
  10. Your child has been stuttering for over six months
  11. Your child has other speech and language related concerns
  12. Your child began presenting with significant disfluency after three and a half years of age

What can I do?

If your child is demonstrating some of the behaviors above, consider contacting a speech and language therapist who can provide your family with helpful tips and tricks to encourage fluency, or recommend therapeutic intervention as necessary. In the meantime, visit The Stuttering Foundation’s website for tips for talking with your child.

Questions or concerns?

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

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

Reference:

Coleman, Craig. “How Can You Tell if Childhood Stuttering is the Real Deal?” LeaderLive, ASHA, 26 Sept. 2013.

Photo Credit:Limor Zellermayer via Unsplash

Parent Question: How does developmental therapy support speech and communication skills?

“The initial evaluation team recommended developmental therapy for my child but my concerns are with her speech. How can developmental therapy help support her speech? I thought that it focused on preschool readiness skills?” — Concerned Parent

Developmental therapy (DT) focuses on the whole child and often addresses different areas of development, including speech and communication. DT can often be used to complement and support speech therapy by helping your child learn pre-communication skills. These skills include sharing joint attention, attention span, imitation of gestures and play ideas, and general play skills and are essential in learning how to speak! This blog will explain these skills and how you as a parent can help your child with their pre-communication skills.

Pre-communication skills
Joint attention: Joint attention is when two people share attention with an object or activity. This can be demonstrated by sharing eye contact, using gestures, and/or other non-verbal and verbal communication. While children can learn some skills from toys and objects independently, they absolutely need to be able to share joint attention with another person to learn language and how to communicate with others.

Attention span: In order to learn any new skill, one must have the attention span to attend to an activity. On average, a child is expected to attend to a single activity for – at minimum – one to one-and-a-half minutes per year of age. And as they age, a child should be able to attend to several activities in a row.

Imitation of gestures: Imitation of gestures always comes before imitation of words. It is important for your child to learn that they can imitate what other people are doing! Once your child is consistently imitating familiar gestures (such as waving or clapping), novel or play gestures (feeding the baby a bottle, for example), and “invisible” gestures (this is a gesture that you can do but not see yourself do, such as sticking out your tongue or tugging your ear), we know that your child is on track to using sounds and words to communicate.

Play skills: A child’s “work” is play! It is important for your child to engage in functional play with toys to learn the concept the toys are targeting. Engaging in functional play provides your child opportunities to use language to communicate. Play is also a great measure of a child’s cognition!

How can parents support pre-communication skills?
Joint attention: Engage in a preferred activity that your child has mastered – we want to make sure they can focus on learning the skill of joint attention and not forcing too many cognitive demands at once. For example, if your child does not yet match, you would not use a puzzle for this activity. Activities with lower cognitive demands – such as popping bubbles – is much more appropriate for a joint attention activity (but if your child has mastered matching, feel free to use a puzzle!) After blowing bubbles a few times for your child, pause the activity. Give him or her the opportunity to come to you and show you that they want “more” by using eye contact or gesturing to you what they want. If they only look at or touch the bubbles, bring the bubbles near your face to encourage eye contact. Once they look to you, provide praise and blow more bubbles! Continue this routine as long as your child will tolerate.

Attention span: Toddlers are notorious for having a decreased attention span! Everything is so new and interesting to them, no wonder they want to bop around the room and get into everything! Make sure you create a learning and play space that is conducive to attending to activities. Having a large number of toys available at all times or always having the television can create many distractions for your child.

When starting to work on increasing your child’s attention span, your goal should be to complete one activity – that’s it! An activity with a clear beginning and end, such as a puzzle or book, are great activities to start with. Engaging in symbolic play with a baby doll, for example, would be considered an open-ended activity that can be finished after one minute or ten. And again, you want to choose something that they have mastered so they are not expected to complete an activity that is new or particularly challenging.

Imitation: To work on a child’s imitation skills, you can start by imitating them! If they bang a toy on their highchair, you do the same. Encourage your child to do the gesture again before imitating it again. Once you go back and forth a few times, change the gesture – rub an object on the highchair instead for example. If your child does not imitate this gesture, do it again. If they continue to not imitate this gesture, provide hand over hand assistance to show them exactly how to imitate this gesture.

Play skills: Sometimes, children need to be taught how to play functionally with objects! Just like any other skill, play needs to supported and taught and it is up to the child’s first teacher – their parents – to show them just that. Parents should be modeling appropriate play with toys and encouraging the child to do the same (this is also where those imitation skills come in handy!) Help your child master functional play by setting aside a few minutes every day to provide your child your undivided attention and PLAY!

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

Kimberly Shlaes, MAT, DT
Director of Developmental Therapy Services

Reference:

Teach Me to Talk. (July 30, 2018). Sorting Out the 11 Prelinguistic Skills… Retrieved April 25, 2019 from http://teachmetotalk.com/2018/07/30/sorting-out-the-11-prelinguistic-skills/

Photo Credit: PublicDomainPictures from Pixabay

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

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

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