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As therapists well know, it’s can be sooooo h..a..r..d to teach communicative intent to a toddler who is disconnected or isolated and doesn’t seem to know he’s supposed to want to share messages with other people.

There are actually 3 components for teaching a child to use communicative intent. Over the next couple of days, we’ll discuss these. The text is from Teach Me To Talk: The Therapy Manual:

Demonstrate Communicative Intent with Affect, Gestures, and Vocalizations
Once a child is attending and moving along cognitively, we want him to demonstrate
intentionality, even before he’s ready to use true words. Ways that babies and toddlers
first begin to demonstrate their own communicative intentions are through affect,
gestures, and vocalizations.

Affect
As a reminder, affect is visual demonstration of your feelings. According to Dr. Stanley
Greenspan in his book Engaging Autism, affect drives communication. In 2005 a group
of neuroscientists found that words spoken within an emotional context stimulate more
neural activity in infants. So what does this mean for pediatric SLPs and early
interventionists? We have to model emotion, or affect, for our friends so that they are
more likely to attend to and then learn words. How’s that for pressure?

If you’re consistently remembering to be playful, you’re probably already
demonstrating heightened affect with your clients during sessions. For those of you
who are naturally less up-beat, you may have to fake it, or at least remind yourself to
purposefully exaggerate any hint of emotion that you feel during play. As noted in the
previous section, young children with social skill delays may not notice you at all unless
you’re highly animated during play.

We’ve already talked about how important it is to use affect to engage a child, but
using heightened affect to demonstrate communicative intent is a little different. When
we correctly display heightened affect, we’re also modeling non-verbal ways for our
non-verbal friends to communicate with others.
Facial expressions are important ways we can help our clients learn to convey
information before they begin to speak. Many times the toddlers we see appear to be
“flat.” There’s not much deviation in their little faces, and consequently they show little
affect throughout play and daily routines. These children also lack social referencing
meaning they don’t notice your changes in facial expressions. Teach them to notice
faces by making your own face visually appealing during play. Exaggerate emotion with
your own eyes and mouth during play. You want a child to think, I better keep looking
at this crazy lady to see what she’s going to do next!

Using heightened affect is very natural as you’re modeling Exclamatory Words during
play. I’ve used the term Exclamatory Words a couple of times already, but let’s define
those kinds of words and how important those words can be in your treatment of
toddlers with language delays and disorders. Exclamatory Words are those you seem to
“yell” to exclaim your message. These kinds of words are probably prevalent in your
everyday narratives whether it’s intentional or not! I don’t know of any adult who’s
great with kids, who doesn’t instinctively say, “Uh oh,” “Whee,” and make funny noises
during play.

Exclamatory Words not only help children attend and connect with you, but they also
help children heighten their own affect in play and begin to convey meaning. During
these times of elevated arousal in play, a child may even “pop out” words they might
ordinarily not be able to say. Pamela Marshalla included the phrase “Pop Out Word” in
her book Becoming Verbal with Childhood Apraxia to describe when a child says a
word that seemed to come out of nowhere. Exclamatory Words are often the first kinds
of words a non-verbal toddler “pops out” and may be the first kinds of ways they begin
to verbally demonstrate communicative purpose.

It’s true that non-verbal children talk more, perhaps popping out a new or unexpected word,

when they are “mad, scared, or excited.”

We shouldn’t really set out to make kids mad or scared in therapy, so we better go for excited! 

When kids are excited, they’re naturally attending to you and demonstrating increased affect
with smiles, laughter, and other positive facial expressions and body language.
Using heightened affect yourself can also significantly improve a child’s ability to
understand what you mean when language comprehension is a problem. Children with
significant receptive language delays may depend more on your facial expressions and
tone of voice to determine what you’re saying rather than your words.

I’ve reiterated the importance of modeling affect and given you multiple examples of
how to do this in your sessions for a very specific purpose. Children with social skill
disorders can’t begin to imitate affect in order to demonstrate communicative intent
unless he sees you model variations in affect first. In this area, like all other areas of
language development, imitation typically precedes spontaneous use of a new skill.
Because of the inherent differences in children with social/pragmatic concerns, using
affect to demonstrate communicative intent will not emerge without some focused
attention to this goal.

from Teach Me To Talk: The Therapy Manual

I’ll be sharing Part 2 later! We also discussed this in one of our 2 new podcasts last week… #451 Expressive Language Milestones by 12 months… check out that show for more discussion of communicative intent. If a child doesn’t seem to connect with you very often to purposefully communicate, this is what’s missing! Watch the show below for ideas of how to get started working with them.

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Before I talk about my treatment philosophies, let me send out a disclaimer for all of you who are working with SLPs or other early interventionists who may be taking a different approach with your child. There may be very valid reasons she (or he) has chosen to use other specific strategies with your child. There may be reasons that the approach I take may not be the best for your child or your family, (although I can’t think of any). Ask your therapist to have a frank discussion with you about her (or his) decision-making process in choosing techniques. Most therapists welcome this kind of discussion and are happy to talk about it with you, over and over if necessary to make you feel comfortable and empowered as an important member of the team for your child.

For children who are non-verbal or minimally verbal (less than 10 words), I believe that establishing communication and improving both receptive and expressive language skills are the primary focus for treatment. Specific speech sound practice need to be worked into play as a very FUN part of therapy, and are absolutely necessary for kids with apraxia. However, I do not feel that this should be the main focus for children who are non-verbal, even when they are non-verbal because of apraxia, and especially for those who are non-communicative.

By non-communicative, I mean children who lack interaction skills. These kids do not come to you to get the things they need. They do not point or use other gestures to make you understand what they want. He or she does not initiate social games with you. Many of them appear self-absorbed. They focus on their specific likes to the exclusion of more meaningful interaction. If this is your child, it is absolutely essential that you target social interaction and being “connected” to others FIRST, or at least WHILE, you are working on expressive language. Please don’t mislead yourself. If your child has some social interaction issues (difficulty making eye contact, little social referencing which is “checking in” with you while they’re engaged in something else, poor joint attention meaning he doesn’t easily look at something you’re trying to show him, doesn’t consistently respond to his name, has a limited attention span, and doesn’t seem to listen to or understand others when they try to communicate with him, etc.), talking is not the only problem.

If a child is interacting with you socially, but is not yet using gestures consistently to indicate wants and needs, and/or is not initiating interaction with you, this should also be a focus. Children who are social responders, but not social initiators, can be taught to do this. I might use another adult or older sibling to help model these kinds of things. For example, an older sibling can initiate jumping off the couch into my arms by climbing onto the couch and holding out his hands for me to begin the routine. Or I might take the child’s hand and place it on Mommy’s to help pull Mommy over to the counter to get a drink. I might sit behind the child and help him lean into take Mommy’s hands to initiate Peek-A-Boo or Row Row Your Boat.

I model pointing constantly with a child who can’t do this yet. Point to pictures in books, choices in play, clothing items, body parts, everything. I make it a big gesture. I work on pointing by making sure kids reach for things. If he’s not reaching, I hold toys he wants just in front of him to make him lean in. Sometimes I ask Mom to help him reach with hand-over-hand assistance. In play with toys and in books I also have kids pat, tickle, feed, and any other action I can think of to have them touch specific items. If this doesn’t work, I rely on a couple of oldie but goodie OT tricks. Have her practice touching a dot on a cup with her index finger with hand-over-hand assistance. When she perfects this and can do it on her own, pull the cup back just as she is about to touch it. Or practice stuffing a scarf through a hole with your finger. If this doesn’t work, talk to an OT!

Don’t get me wrong. A toddler with apraxia can still have issues with social communication, interacting, and even gesturing. However, in this kind of case, in my opinion, apraxia is not the main reason he’s not talking or communicating. More importantly, if he’s not following directions or doing other kinds of things to indicate that he understands language, direct lots of your efforts to improving language comprehension. Start by teaching him to Do His/Her Part in daily activities. For example, you’ll give him a “job” during each big part of his day like meals, bathtime, playtime, etc.

The thing I do with all kids I see for therapy, and especially those with apraxia is absolutely, in the most fun way possible, REQUIRE them interact and respond. Children do not get to veg out in their own worlds, or direct all the play. (If this sounds like your child, please carefully read the next paragraph.) I do not follow children around simply narrating what they do “hoping” that they may imitate what I say. This kind of language stimulation approach is not successful for children with apraxia. If it were, these children would already be talking, because most good parents talk to their children in this way already. If you are using this approach, or (gasp) you have a therapist using this approach, please read on for what I believe is a better way to do things.

For children with limited social interaction skills or lower functioning cognitive skills, this “requiring a response” may not be achievable for a long time. For those kids we work on interacting during social games and participating with very basic cause/effect toys or foundational cognitive skills like object permanence. I also use Floortime techniques for at least part of the session to be sure we’re working on engaging at whatever level they can achieve. For more information on this technique, read anything by Dr. Stanley Greenspan. This approach is at the core of anything he’s written.

Back to the premise of my treatment philosophy – I require the child to respond. Their attempts can be off-target. If they can’t talk, they can sign, or use any other mode (such as gestures or pictures) they can. But they absolutely, positively MUST communicate. I don’t give any kid who can initiate or respond a turn with any toy, a piece of any snack, or let them do anything else, until he at least tries to ask for it using the highest level of communication he can. I’m not mean about it. In fact, I could possibly the most fun adult many of my little clients know, but I am VERY insistent that they respond.

Like I’ve posted on other sections (What Works / What Doesn’t Work), I play for most of my therapy sessions. For most toddlers I see over 15 months old or so, play means using toys. I like to use a combination of things we sit down to do and alternate them with movement activities.

Strategies for Toddlers with Apraxia

For example, we might start the session with a favorite toy that I know a kid likes. Initially, most children are generally pretty eager to attend and play when I first arrive. I try to make this as upbeat and as fun as possible. You do this with your tone of voice (very animated and bubbly) and your facial expressions. Smile! Laugh! Act like you are having the time of your life!

For parents, this is essential. Begin your own play sessions with toys you know that he or she likes. Then move on to new things or things that are difficult. Lavish your child with affection and attention during this special play time. Let her know how crazy you are about her by how totally focused you can be during play. Don’t answer your ringing phone. Don’t constantly look over her head to watch TV. Those things can wait. Pay attention so she will pay attention!

BUT absolutely withhold or sabotage the activity by keeping the pieces of the toy until the child requests what he needs with words (if he’s verbal) or gestures/signs (if he’s not). Model what he should imitate if he’s not using spontaneous words or signs yet. Say the word or demonstrate the sign and wait.

As I’ve stated before on this site, I always give choices. Ask, “Do you want trains or cars?” Wait for him to pick one, either with a word or sign. If he can talk or sign, model the choice 3 to 5 times before giving in and playing. Take his hands and help him sign if he can’t/won’t do it on his own.

If he resists or becomes too upset, go ahead and play with what you think he wants. I think it’s too mean to hold out beyond this point. I want to keep the toddler engaged and wanting to play with me. I believe that it is counterproductive to have a toddler throw tantrum after tantrum in a session because he’s so upset. It should be the same during playtime with mom and dad too.

When kids are this upset, they don’t learn. Or the lessons he is learning are ones I don’t like. He either feels like, “This woman is so horrible to me that I don’t ever want to play with her again.” Or equally non-constructive, “This tantrum thing is working for me. All I have to do is scream and pitch a fit to get my way.”

When a toddler begins to exhibit these kinds of patterns, I do not use withholding or sabotage as my primary approaches. I still choose the activities so that I can make them fun and target language, but I do lots of modeling in an animated way with occasional withholding when he’s happy and can tolerate it. I use LOTS of praise and then immediately reward (with the toy or snack) when he’s participated in a positive way.

By praise I don’t mean a 5 minute lecture with language that’s over his head before I give him what he wants. Don’t “lose” the kid with this mistake. I do lots of smiling, laughing, tickling, and saying, “Yay!” I try to project sheer and utter delight that they have done what I wanted them to do with my facial expressions and actions as I am giving him what he wants (the real reward).

When we’ve done several sit-down play activities (or even one) and I sense that I may be losing him, I ask him if he’s finished and have him sign/say “All done,” or “Clean up,” or whatever other word or gesture he can use to indicate that he wants to move on. I always insist that kids help me clean up an activity. I am not a therapist who lets a kid drag out 7 or 8 different toys at a time. How in the world can a busy toddler stay focused on what we’re doing in that kind of clutter? Your child needs this kind of environment even during your special play times. It may be one thing to let him play as he pleases on his own, but when you are doing this together, specifically with teaching language in mind, it will help to limit his choices and clean up a bit so that he’s doing one thing at a time.

Several parents of children on my caseload save certain toys to use only when they play together with their child. They put them in bags or baskets and put them away in the closet until Mommy or Daddy can play too. The novelty alone will make your child want to interact. Think of the reaction you’ll get when you bring out the special bag! Playtime!

When my own children were toddlers, there were many kinds of activities that I never let them do alone. For example, play-doh, paint, crayons, markers, sand, etc… Get the messy theme here? If you have a child that continues to mouth toys, you may choose to introduce ones during this time that you’d never let him play with on his own while your attention is solely focused on him.

Back to my point about cleaning up – This cleaning up process does so much to help with transitions. It also prevents them from moving on to something else before you’re ready and keeps them engaged with what you’re doing. I sing the standard “Clean Up Song” from that old Barney show so much that they ought to charge me, but it works. Have your child try to sing this with you. If a kid can say “up,” I sing, “Clean up, clean … ” and then pause for him to finish “up” once he’s learned the song.

If you have a child that hates cleaning up, you could pick up 3 or 4 pieces to his 1 piece. The point isn’t to be a tyrant or a neat freak. The point is that activities have a beginning, a middle, and an end. Children, especially those with short attention spans or transition issues such as wanting to play with a few preferred things exclusively and who freak out when an adult tries to move on, need practice with this concept.

Additional Tips for Toddlers with Apraxia

Other tips to make the clean up process work are using giant zip-lock bags for most of your toys. I use the 2.5 gallon size since almost anything can fit in there. At home try baskets or bins. If your child won’t help you, try making it more fun by “throwing” the pieces in. Practice saying, “Bye-bye” to each piece. If you’re just beginning to work on sequencing phrases, by all means, use this “Bye-bye ____” during clean up time because the child is usually so focused on this process that the phrases are easier to produce.

I always alternate sit-down play with movement activities, especially with energetic little boys (and girls) who thrive on heavy work and deep pressure. These terms are borrowed from occupational therapy. This applies to the kid who is constantly moving or who needs to jump, crash, or in any other way “feel” his body in space to regulate. Kids who have systems like this usually display sensory integration differences.

My favorite movement activities for toddlers are bubbles, balloons, social games with movements like swinging in a blanket, chase, and jumping off furniture or on the bed. I will “hide” and let them find me or vice versa, to be sure we can run around the house. Many children have plastic slides or swings in their homes, and I never neglect an opportunity to use those kinds of things.

For older 2’s, I might use games with movement such as bowling with plastic pins or Elefun, a game with an elephant that blows butterflies out of his trunk that we catch with nets. I routinely use puzzles and turn this into a running game or obstacle course. Put the pieces at one end of the room and the board at the other. Have the kid ask for each piece and then run, climb, crawl, etc… to place the piece in the puzzle. (This also works better for kids who can’t/won’t sit for a puzzle.) Do the same thing to retrieve the pieces and target language comprehension. Ask him to “Run and get the _______.” Run, crawl, or jump along with him to get the pieces and increase the fun. Toddlers LOVE to see their parents act in unexpected ways.

I might also use other movement activities a child’s OT or PT recommend such as swinging in a blanket or Lycra with help from Mom or bouncing on a therapy ball if Mom mentions that these help a child to regulate. However, if a child associates this with “therapy” time, I avoid it like the plague and stick to more “playful” movement activities.

During the movement tasks, I require them to talk or sign to request more turns to continue. Words I routinely use for this are “more” or “please,” or better yet what they are really doing, “Jump,” or “Go,” or “Swing.” Don’t let this turn into a “break” from talking or signing! I hear and read about therapists who use this kind of play as the reward with no therapeutic focus (aka – talking). I think that they are missing “prime time” for communicating.

Once I think we’ve moved enough or read a toddler’s signals that he is ready, I go back to a sit-down play task. For many toddlers and even preschoolers, these movement breaks are absolutely essential. I cringe when I hear of therapists who make a 2 year old “perform” with several flashcards and then “reward” them with one turn from a toy or a lick from a sucker. BORING! Or more likely – FRUSTRATING!

A Word about Books with Toddlers with Apraxia

I only use cards and even books when it’s one of a toddler’s preferred activities. Otherwise, I don’t use them at all. You will NEVER catch me with a worksheet. Therapy is not as efficient as if I used cards or books, but what good is it anyway if a kid hates it? I do not see the value in this. It takes much more creativity on my part, and I may only get 5 productions of a word or sound vs. 10 attempts in the same amount of time, but again, what good is it if the child is miserable? In my experience, miserable children do not talk. When they do, it’s usually to scream, “No.” I will never see the point with making a child that upset. I do not get my kicks from having power struggles with toddlers. I may win the battle, but not the war. It’s just not worth it to me.

Again, I believe that specific sound practice is necessary for children with apraxia (or phonological disorders or whatever else you want to call it), but I rarely work on sounds without having a functional target. The way I work sound practice in is by seeing what sounds they do have and then getting them in words as quickly as possible. I practice new sounds vowels or consonants alone in isolation only in the context of play. For example, if a kid doesn’t have an/m/, we do “mmm” when we eat snacks, pretend to feed babies, let the toy animals eat, etc… Then I move to a word with an /m/ such as “more” or “mine.” I set up situations so that he has to imitate the word to get what he wants for the next turn/snack.

I use lots of phonemic cues when we start to pay more attention to specific sounds. For example, I call a /p/ sound a “popper sound.” When I want to teach or practice this sound, I use an activity when saying this sound makes sense, such as bubbles with “pop.” Or we might play baby dolls for a child who is starting to potty-train, and we practice words like “pee” and “poo-poo.”

I work in oral motor practice, or for children with apraxia, oral sequencing practice, into play activities. I exaggerate facial expressions constantly in play and encourage children to imitate me. I do this with WORDS ONLY. If something is exciting or huge, I exaggerate, “Wooooow!” We’re beginning that word with a relatively closed mouth and opening up to a huge vowel sound. I use lots of “oooh’s” and “aaaah’s” when we’re playing. I do animal sounds, and my favorite is the monkey so we can practice “oo oo ee ee,” which really is practice sequencing vowels and alternating mouth movements. When we’re playing with play food, I lick my lips and say, “Yummy!” When we’re playing with farm animals, I ask my little friends if they can wag their tongues like the doggie’s tail. You get the drift. Put everything into play.

As I stated before, as soon as I hear a new sound in isolation or alone, I try to get it in a word as quickly as possible. When a child is good at imitating a word, I set up situations for him to use the word spontaneously, or on his own. We keep it at the single word level until he’s ready for phrases. (By ready for phrases I mean 50+ word vocabulary that he says spontaneously.)

One thing I emphasize with all children I see, and especially those with apraxia, is to set up play when I have to get multiple repetitions of the same word. Repetition is how children establish the motor planning necessary for and make the brain connections that result in intelligible and consistent speech. Don’t settle for one production of a word. I always play the “my turn/your turn” routines with toys, so that kids expect me to get even a favorite toy back, and they have to request. If you have to, steal the toy (playfully) and make them ask for it again (and again)! I never let a kid get something and then silently play for even 30 seconds before I’m prompting that word again, or another one. Join in. Make it communicative, and more importantly, keep it fun!

For vocabulary selection, I try to teach words that toddlers can use and ones that represent things they love. Generally, I teach more nouns/names for people, toys, foods, and other objects first. I always begin using verbs/actions during play soon after, and I especially want to focus on these when a child’s vocabulary is near the 50 word level, so that he or she can have some words to combine with their nouns to make phrases. I work on prepositions/location words at that same time too.

Many therapists make the mistake of teaching parents the wrong way to “expand” a child’s from single words to phrases by emphasizing word classes out of sequence from the way typically developing children learn phrases. I sigh when I sit in meetings and hear SLPs suggest that parents expand their children’s vocabularies by offering “blue car” or “big truck” when their children say “car” or “truck.” This is not how typically developing children expand to phrases. For specific ideas for phrase practice (and ones that work!), please look for a new article on this topic in the next few days.

I do NOT target intelligibility or articulation as the primary focus of therapy until expressive (and certainly receptive) language is close to an age-appropriate level. For most of the children I see for early intervention, this doesn’t happen before they are discharged to school-based or private services at age 3. I focus on what they are saying (what they mean) and why they say it (their intent).

I don’t focus on how they say words, with specific sounds, unless they are really, really, really unintelligible and no one, including mom, dad, regular babysitter, or me, can understand them. Nothing is more humiliating to a new talker than a parent who overcorrects first word attempts. I can see this in their little faces. They look at me as if to say, “Why bother? My mom never thinks it’s good enough.”

What you can do is restate the word they intended to say correctly. But please, I am begging you here, don’t say, “No. You said it wrong. It’s ____. Watch my mouth. ______.” Please, for the sake of your little one’s self-esteem, avoid the temptation to overcorrect. This places too much pressure on your child. When I suspect this is happening too much at home, and especially for a child with apraxia, I put the parents on a strict “NO SPEECH” vacation. They are not allowed to prompt, cue, question, or correct anything their toddler says. They are only allowed to model and shower their children with praise. Most of the time a couple of week break is all everyone needs to restore balance and order again.

This post is terribly long, but I hope you’ve hung in there to read it all. I believe that this approach works for all children with expressive language delays, but especially children with apraxia, because you are making speech practice functional by teaching words he can use, integrating specific sound practice into play activities to make it age-appropriate, targeting vocabulary and utterance length in a logical and sequential order, and helping his sensory and alerting systems stay regulated and focused with regular movement activities so that he can pay attention and learn.

Whew! That’s a lot of information! If you have questions or need me to expand or give more ideas, please don’t hesitate to leave a comment below. This site is for you. Laura

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Get my DVD specifically for parents of toddlers who are suspected to have apraxia. More info here!

The post Successful Speech Therapy Strategies for Working with Toddlers with Apraxia and Other Speech-Language Difficulties appeared first on teachmetotalk.com.

We’re continuing our series with the 11 skills toddlers must master before words emerge.

Today we’re talking about skill #8 – Vocalizes Purposefully. When I explain this to parents I describe this as “becoming noisy.”

This skill is necessary for EVERY child. None of us can talk unless we know how to produce sound purposefully! Some late talkers will already be doing this, but some may not, so let’s talk about how to help move a nonverbal toddler toward becoming more noisy.

I also spent a little time discussing reasons (or diagnoses) associated with limited vocalizing in case you need that background too.

Listen to the show below or at this link.

Summary of strategies I shared during the show to help a late talker learn to vocalize:

1. Get moving! Children are more likely to vocalize when their little bodies are active!! Run, swing, bounce a kid on your lap, jump on the bed or couch. Try anything like this to elicit any kind of sound your child might make as he’s moving. Do anything you can to get some sounds!
2. While the child is moving, you (the adult) should model more sounds and early vocalizations rather than real words.  So… how does that sound? This means that rather than talking, you scream, squeal, say single syllables (like “Oooooooooooh!” or “Duh” or “Yah”), and model play sounds (such as car noises, animal sounds). Think in terms of using sound effects, rather than words.
3. Try vocalizing in a large space that echoes. I like to go in to a family’s empty garage or a large, open gym. Remember to model more sounds and less words! Yell. Laugh. Run around like a crazy person making all kinds of noise. Set the stage for a child to try to make noise too.
4. Simulate “crowd noise.” This means having everyone talk, laugh or sing all at the same time when your child is present. Often times this helps a child “let loose” and begin to make noise, just like everybody else.
5. Play with toys that amplify sound. Try those cheap $1 microphones, a paper towel roll, a funnel, pot or pan. Listen to the show for ideas and how to use this easy technique.
6. Introduce games and songs that include easy, early vocalizations like yelling or a simple word like “Yay!” I sang my favorite version of this kind of song in today’s show : )

Remember… a child has to become noisy BEFORE she begins to talk!

Ready for the next show? Click here!

Laura

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If you’re a therapist and need more specific ideas like this to use in sessions and share with families, check out my best resource for you – Teach Me To Talk: The Therapy Manual. It’s filled with recommendations that match the goals/milestones for children developmentally under 12 months all the way to 48 months.

If you’re working with a child who isn’t talking and need a step-by-step guide for helping him learn to say words, I highly recommend my book Building Verbal Imitation in Toddlers. If you’re an SLP or another therapist and would rather take a full course on DVD (with continuing education credit!) outlining these strategies so that you can SEE how this looks with toddlers and preschoolers, I have one for you with this information Steps to Building Verbal Imitation Skills in Toddlers. 

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If you’ve missed the earlier shows in this series, check them out below:

#275 Introduction Show – Why These Skills are Important

#276 Overview of Skills 1 – 5

#277 Overview of Skills 6 – 11

#278 Responds to Things in the Environment

#279 Responds to People

#280 Building an Attention Span

#281 Developing Joint Attention

#282 –  Developing Early Play Skills (part one)

#283 – Early Play  Skills (part two)

#284 Understands Gestures

#285 Understands What Words Mean (Follows Simple Directions!)

The post #286 – 11 Skills Toddlers Use Before Words Emerge – #8 Vocalizes Purposefully appeared first on teachmetotalk.com.

Here’s part of her original question… Hi Laura. I have a 3 year old diagnosed with autism and is suspected to have apraxia. He doesn’t have much of a problem in the receptive language department, as he understands the majority of what is being asked of him. When he communicates, he usually uses some gestures or words/approximations. He has a little over 50 different words/approximations…but he has yet to say the majority of them accurately. He will verbally communicate what he wants on his own by pointing and naming objects, saying “opo” when he wants something open or “uhpah” for up if he wants to be held or get something out of reach. He does like to label objects, but knows their functions. For example, if he sees a crayon, he will point and say “cay” and if I ask what we do with crayon, he will say “dah” for draw. He will often say the first two letter sounds of words that are usually CV and VC. (ba – ball; pehpeh – pretzel; opo – open; ow – out). He also often deletes the final consonant….

I replied to her questions down the thread in this post: Have A Question? I’m Here to Help!

But today I’m giving her an “on air” consult, especially with models of how to do backward chaining with a toddler. Don’t miss it!

#260 Should I Focus on Artic or Not with My 3 Year Old with Autism?

The post #260 Should I Focus on Artic or Not with my 3 year old with Autism? A Mom Calls appeared first on teachmetotalk.com.

PARENTS, ARE YOU FRUSTRATED TRYING TO TEACH YOUR TODDLER TO TALK?
ARE OTHER CHILDREN HIS AGE ASKING FOR WHAT THEY WANT AND NEED  WHILE HE CAN ONLY CRY?

Find help for toddlers with speech delay…

Maybe the experts tell you everything’s fine. But you can’t get past that nagging feeling that things should be getting better. And they just aren’t.

As a parent, there’s nothing more frustrating than watching your precious baby struggle to learn to communicate. While friends’ and relatives’ toddlers are all saying “Mama” and “ball” and even forming simple sentences, your child can only cry in frustration, locked away from the world of words that should to be opening up for her.

You can’t help feeling embarrassed, or jealous, or even angry. Why YOUR child? Why does it have to be so hard?

You would give anything for your baby to be able to ask for help when he needs it, or tell you he loves you when he snuggles close.

Everyone tells you, “Oh, she’ll talk when she’s ready.”

Even the pediatrician insists there’s nothing seriously wrong. But you KNOW your child. You know she WANTS to communicate. You see her trying. You know she’s ready now.

But no matter how hard you try to help her, the words don’t come.

Maybe your child is seeing a speech therapist. But it’s hard when the techniques the therapist tells you to use at home are too hard and too complicated for you , let alone your toddler!

I want to tell you right now, the problem is not you.

And it’s not your child.

The problem is simply that you don’t have the simple, easy to understand tools you need to help your child communicate.

Until now.

Right now, TODAY, there IS something you can do. Without letting another painful, frustrating, heartbreaking day go by.

BECAUSE FINALLY, THERE’S AN EASY, FUN, NO-TEARS METHOD THAT’S PROVEN TO HELP TEACH YOUR TODDLER TO TALK.

It’s called Teach Me To Talk, and take it from a mother who’s been there! And it’s just amazing.

The Teach Me To Talk DVD is packed with strategies that will unlock that beautiful voice your child has locked away inside. And best of all, these strategies are PROVEN to be simple to learn, easy to apply, and best of all, successful in teaching young children to talk.

Order here.

Interested in seeing the Teach Me To Talk techniques in action? Here’s a quick preview of the Six Essential Strategies you’ll learn — and a glimpse of the first technique you’ll see:

What makes Teach Me To Talk different?

It was developed by Laura Mize, a pediatric speech-language pathologist who has literally spent thousands of hours and 20 years on the floor, helping toddlers just like yours and mine learn to communicate.

Laura has read stacks and stacks of research on the subject of delayed speech in children. She’s attended more professional courses than you can count. She’s taken the best of the best from all the ‘experts’ in language development.

And she’s condensed all those years of learning and experience and trial and error into a single DVD, with the six most simple, most practical, MOST EFFECTIVE strategies to get your child talking. And best of all, you can start using them the minute you start watching the DVD.

“Thank you so much for this DVD! Our 3 and a half year old son has apraxia and only has 10-12 clear words. When I first started watching this DVD, I wondered if I could ever be that animated. About 5 minutes into the DVD, my son walked into the room and was instantly fascinated. He sat with me and watched the rest with me! His reaction was truly amazing, and our speech therapy will never be the same again! The most amazing thing to me, though, was how my son interacted with you! During the 90 minute video he  got two new words: choo choo and boom. He also tried to say pull and barn, and learned the sign for fish. Twice he signed ‘give me’ and then touched a toy you were playing with, and every time you tried to get a child to say a word he knows, he would say it with you.” Robyn, mother from Wyoming

Order here.

How wonderful would it feel to hear your child say “Mama?”

You’ve been waiting for that moment since he was born and you first held him in your arms. But as the months have dragged by, you may have started to lose hope that you will ever communicate with your baby, to hear what he wants, what he needs, what he feels.

And even if your toddler can say a few words, is it taking longer for her to communicate than other children her age? Are you constantly trying to interpret what you think she might be saying, or asking for?

Maybe both of you are ending up in tears.

“When I watched the DVD, I felt like I was reliving my son’s life for the past 1 1/2 years now. It was a little sad in some ways, but on the other hand, if I concentrate on where he is now and how far he’s come, it’s positive!..” Holly, a mother from New Hampshire

Order here.

The Secret is Simple- Change Your Approach!

Of course, you’ve been trying to teach your child to talk. It’s what parents do. But if what you’re doing hasn’t been working, the solution is simple.

Change your approach.

If you’re like me, you’re probably wondering what that can possibly mean when you’ve tried EVERYTHING. The problem is, you’ve probably tried without really knowing what to do, or how to do it.

This DVD will change everything. Because a lot of the time, it’s not what you do, but HOW you do it. Teach Me To Talk will lay out step by step, in easy-to-follow terms, exactly what you can and should be doing to help your baby learn to talk.

“I know for a fact that Laura’s approach really does work because I’ve been using it for years myself! Don’t be afraid to copy exactly what she says, how and when she says it! It is not hard and can become second nature to you, just as it has to me. By implementing her approach, you will set the stage for both you and your child to be successful!”  Kate, Developmental Interventionist, Kentucky

If your child has a language delay, no doubt you’ve heard it all. There’s always the well-meaning friend who tells you, “Boys talk later than girls.” Or the mother-in-law who tells you to “Wait and see” (while you worry what she’s saying about your parenting skills behind your back).

The fact is, the most critical time for language development in a child is from birth through age three. So if you feel in your heart that something’s not right, you’re probably on to something. You know your child.

Most parents of children with language delays regret that they waited to do something. The good news is, YOU DON’T HAVE TO WAIT ANY LONGER.

Teach Me To Talk will show you a better, easier way to do things. Things you can do RIGHT NOW, at home, that will help your child learn to talk. It’s all about learning a new and better way of working with your child.

After all, as a parent, you are the most important teacher your child will ever have.

“Just wanted to let you know how thrilled I am with your video. I just received it five days ago and I’ve watched it every morning to gear up for working with my daughter each day and I have to tell you what a difference it has made! My daughter has been in therapy for a year and a half (she’s 31 months) and she would often run from me during our ‘play’ sessions. Finally, after only five days, she is starting to think that her mommy is fun during playtime! Thank you for giving me a way to really connect with my daughter on a new level. This video is priceless.” Helen

“I do think the video will be very helpful for parents with late talkers. The ideas are great, and you really do show them how to do the things you are talking about which is very important!..” Holly, mother from New Hampshire

Secrets Your Speech Therapist Hasn’t Told You (or might not even know!!!!)

“Even when weekly therapy reports indicated a great deal of progress, we weren’t always seeing that progress at home. The Teach Me To Talk DVD has dramatically changed the number of words we hear. Seeing the techniques you use, and seeing how easy they are to incorporate in to our daily routines has been a blessing. I can get so many words and even phrases out of my both my toddlers by incorporating playfulness in to our daily activities. As a working mom, I’ve always felt as if I’m not as active in my children’s therapy as I should be. You DVD is finally helping me make that connection. Thank you so much for such a fantastic tool!” Stephanie, Mother from Kentucky

Speech therapy is a specialized skill, that’s why speech therapists charge hundreds — even thousands — of dollars for their services. But the very same techniques they use can be SIMPLIFIED, so that you can use them at home.

Teach Me To Talk will teach YOU how to use the very best, most effective techniques speech therapists charge hundreds of dollars for. Watch and learn as these techniques are explained in plain language so that you can use them at home. Then, see each technique in action.

And you won’t just see how it works with one child, but with 20 different toddlers, all with different personalities and challenges. You’ll be amazed and inspired by their progress as each and every one of them learns to talk, just like your child can with the Teach Me To Talk DVD.

“The DVD brought tears to my eyes (not your goal I’m sure, but there you go!). Each strategy you used – reminded me of my child. It is amazing how simple techniques (most of which we take for granted) can help a non-verbal child become verbal. Another thing I learned from my experience with being a mom, a pediatrician, having your guidance and the DVD – is that language, talking, speech, and articulation involve SO many other aspects of development.” Ranjana, pediatrician and mom from Ohio

If your child is a late talker, you’ve probably read dozens of parenting books and looked for advice on the internet. But when you apply it to YOUR child, it doesn’t always make sense.

Do you try to do what the “experts” say, but find it just doesn’t work with your child?

The secret isn’t just knowing WHAT to do, but WHY you need to do it, and better yet, seeing exactly HOW to do it. Teach Me To Talk unlocks those secrets.

“The DVD was quite different from what I expected – in a good way. I hardly expected to see so much one-on-one with the kids, and it was great!” Kristyn, mother from New Hampshire

“The DVD is great! I wish I had had this when we first started down the path with Gabe who has been diagnosed with apraxia.” Julie, mother from Illinois

View It — Then Do It!

You don’t have to read another book. You don’t have to make time for a class. All you need is a TV and a DVD player  or your computer, and you can watch and learn at your own pace, in your own time, in your own home.

And your child can be right there with you while you learn!

“I recently watched a DVD that has been advertised on this site called Teach Me to Talk, by Laura Mize, Pediatric Speech-Language Pathologist. The DVD was 90 minutes long and taught six strategies to teach your child to talk.

It is aimed at toddlers who are delayed in speech…..which is how I will use it. It has tons of video of the speech therapist actually working with children! This was so informative. Laura Mize explains what she is doing while showing actual video of her working with children with delays! These are things you can incorporate in every day interaction with your child. I finished watching the video feeling like I could really teach my child to talk!

From the time I first learned Sophie had autism, I have wanted to see what a speech therapist actually did while working with a child. I desperately want to homeschool Sophie, but until now I have been in the dark about what the experts do to get children to talk. Now I have video examples to work with.

I watch this video with my 3 children in the room, and my daughter Sophie, was actually playing along with the video! I highly recommend this video for anyone who has a child with delayed speech. It is worth every penny.” Sarah, mother and author of the website www.wakingsophie.com

Teach Me To Talk takes the camera INSIDE therapy sessions with children just like yours. Whatever stage your child is at, if you’re just wondering if there’s a problem, if you’ve already seen a professional or if your child is currently in speech therapy, you’ll see all kinds of children in all kinds of situations.

So you’ll discover the very best techniques to use with YOUR child.

“Seeing these tips in action was very beneficial. When you have a child that is language delayed, you want to do as much at home as you can – after all, our children are at home most of all! And this DVD helped me do that.”  Kristyn, mother from New Hampshire

All of this for only $39.99???

It can be expensive teaching your child to communicate.

Conferences that teach parents and therapists cost hundreds of dollars  and take up hours and hours of time.

But the Teach Me To Talk DVD has all the information you need for only $39.99. That’s less than 1/3 the cost of a typical one-day training conference.

And the Teach Me To Talk DVD is packed full of ideas and tips you can use all day, every day as your child learns to communicate. Plus, it’s yours to keep and watch over and over again until you master the techniques.

“I have worked with quite a few speech therapists in my practice as a developmental interventionist. In ten years, I’ve only worked with one that was universally appreciated by parents and young children alike! Thanks to this DVD, you no longer have to live in our county to benefit from Laura Mize’s unique and effective approach. For a minimal investment, she comes live to your living room to demonstrate her highly successful approach to speech and language therapy.” Kate, Developmental Interventionist, Kentucky

To order, click this link.

Teach Me To Talk the DVD is now available for $39.99 plus shipping. Order yours now!

“A lot of the therapy techniques that you use, some and or all of his therapists have used EXCEPT for a few things. First, your enthusiasm, it’s AWESOME!!!!! I have never seen any of my son’s therapists be so upbeat and fun as you were in your video. I wish they had been because I know my son would respond so well to that in therapy. Any time I play with him at home and do some of the things you do with your kids, like tickling them and just being ‘silly,’ his whole frame of mind changes and I can usually get him to try whatever it is again at least one more time.” Holly, mother from New Hampshire

Watch how you can learn sign language to help teach your child to communicate.

“I also like the emphasis put on signing with your child. I was very hesitant to do this with my son at first, I was afraid it would hurt his speech development, but it helped him learn that he has to do something to get something, now anytime I hear someone say they are hesitant about signing, I pipe up and tell them to please consider it. What a great DVD! It will be a huge help to other parents like me!” Julie, mother from Illinois

Teach Me To Talk the DVD is now available for $39.99 plus shipping. Order yours now!

Get The Must-Have Speech Therapy DVD Recommended For Both Parents and Professionals!

The Teach Me To Talk DVD was especially designed for parents. But the techniques used are equally beneficial for professionals. Anyone who works with young children can learn from these PROVEN, EFFECTIVE techniques, including speech-language pathologists, developmental interventionists and therapists, occupational therapists, service coordinators, family therapists, and preschool teachers.

“I think this DVD is a tremendous & invaluable guidance tool for parents, preschool teachers, caregivers, and other therapists (speech, occupational, developmental, etc) and should be used as an accessory aid for anyone involved in early childhood development.” Ranjana, pediatrician and mother, Ohio

“Teach Me to Talk is an easy to watch DVD that empowers parents and caregivers with the ‘how to’ skills to not only promote speech development, but also PLAY. As an occupational therapist, I believe that play is an important ‘job’ for a child, but it requires more interaction from a parent than just watching a child play. Finally, parents have a visual tool that teaches them how to interact and play with their child so that he or she will not only learn to talk but will be on the road to reaching their optimal potential! The techniques are easy to implement, and you will discover playing with your child is actually fun!” Carey White, OTR/L, Occupational Therapist

The Teach Me To Talk program is so effective, university speech pathology programs all over the world have ordered this DVD to train their new grad students! Several state early intervention agencies have purchased Teach Me To Talk for their loan libraries to make these proven techniques available to parents and therapists.

Why? Because the experts know,Teach Me To Talk does exactly what it says it does.

“This is an excellent training DVD for parents of late talkers. The strategies that Laura teaches are the same ones she used when working with my son, who has apraxia of speech. My son made incredible progress working with Laura. These strategies are very effective and easy to apply to a variety of speech and Ianguage disorders. I wish all speech therapists possessed this level of knowledge and skill. As a Speech-Language Pathologist, I would recommend this DVD to my parents of late talkers. As a Mom of a late talker, I would recommend this DVD to all speech therapists working with children.” Laurie Felty, Speech-Language Pathologist

“I just finished your DVD. It was great! I really got into it and actually found myself taking notes! As a PSC (early intervention service coordinator) it was helpful to see the speech therapy in motion so I can answer some questions from parents. As an OT is was refreshing to see some OT techniques embedded into the speech therapy activities.” Cindy, Louisville, KY

“Thank you so much for allowing me to preview your DVD! I will put these techniques into practice myself on Monday morning with my clients! They’re not going to recognize me anymore! I learned so much from watching you provide therapy, and I will never use those same approaches again. This DVD has rekindled my excitement for pediatric speech therapy. I can?t wait for next week to come so I can try them out! One more thing – Why didn’t they teach me this in grad school? Thanks again!” Penelope, Speech-Language Pathologist, Kansas

Another Mom’s Testimonial

Even experienced therapists struggle with the challenge of providing therapy that’s developmentally-appropriate for toddlers.

One on hand, it needs to be entertaining enough to hold their attention. But on the other hand, it needs to provide real growth and learning opportunities in order to be “therapeutic.” Teach Me To Talk effortlessly combines the two, illustrating WHAT to do and HOW to do it in a wide range of situations.

“What I especially loved was that it wasn’t just clips of the PERFECT session; you showed us what to do when a kid turned away, or lost interest, or was more difficult to engage (for instance, touching the child or changing their position). Let’s face it, sometimes kids have their own agenda!” Kristyn, mother of a child with apraxia, New Hampshire

The 1 hour Teach Me To Talk DVD is packed with plenty of “HOW TO” examples you can begin using right away with clients in your practice. Learn how to make therapy FUN, how to keep a busy toddler’s attention, and how to select successful and age-appropriate techniques that will lead to SUCCESS for you and your clients.

You’ll see toys that are “winners” with children at various developmental levels from 12-36 months old, watching the kids in action and seeing how the toys work.

“Just watching how my son interacted with the DVD made me a believer in how engaged he will become once it stops being ‘work’ and begins being fun.” Robyn, mother of a 3 year old with a language delay and apraxia, Wyoming

You’ll learn how to use play and food as THE focus for therapy — not just the reward at the end of the session!

“The whole idea of using food during speech is awesome. I will usually reward him with something after therapy especially if his self esteem is a little low that day or he’s just having an off day, but I never thought of buying something to use when working with him, nor have any of his therapists used food .” Holly, mother of a 3 year old with apraxia, New Hampshire

Teach Me To Talk is packed with essential, must-have tips to make your sessions more natural, more kid-friendly, and most importantly, more effective.

“If you are the parent of a young child who has been in speech therapy, you may have already learned the hard way that children don’t necessarily respond to all speech therapists efforts to ‘teach them to talk.’ Despite being well intentioned, far too many speech therapists attempt to implement the same strategies that they use with school- age children or mistakenly believe that young children ‘choose’ not to talk. As a result, young children are frequently frustrated by inappropriate techniques or by speech therapists who aren’t using developmentally appropriate techniques.” Kate, Developmental Interventionist, Kentucky

Of course, there are plenty of things that just DON’T work with toddlers, and you’ll learn what those are too! Watch here as Teach Me To Talk illustrates a classic example of one of the most common mistakes parents and professionals make when trying to teach a toddler to communicate:

Teach Me To Talk the DVD is now available for an introductory offer of $39.99 plus shipping and handling. This is for a limited time only! Click here to order.

More feedback….

“I also liked the tips in the ‘withholding’ section. A lot of times, we Moms are instructed to do so (by putting toys out of reach and such), but sometimes it is difficult to judge just how much is too much or how long is too long. You gave easy to understand tip to follow. How to push just far enough to elicit a response, but not so far as to discourage language, or cause too much frustration.” Kristyn, mom from New Hampshire

“I love the part about not ruining the interaction and to keep it going with humor, this is SO important. I can’t tell you how many times I probably lost Gabe in the process of working with him because it was too drill like. The withholding concept is explained perfectly. It was never explained to me as well as you did, I failed to keep it playful and as a result totally killed the communication with Gabe. As you say in the DVD, you will miss the effectiveness and the child won’t learn anything! I plan on trying to keep things much more playful with him from now on when it comes to withholding.” Julie, Mom from Illinois

If you’ve been struggling to help a late talker learn to communicate, there’s no need to wait another day to hear those precious words. Order Teach Me To Talk today, and you’ll be on your way to a healthier, happier relationship with your child tomorrow.

Teach Me To Talk the DVD is available NOW for an introductory offer of $39.99 plus shipping. This is for a limited time only! Order yours now! Click here.

Read more feedback from parents and SLPs alike –

“As members of the medical community and parents of two toddlers who experienced speech delay, we can personally attest to the value and effectiveness of Laura’s instructional video, Teach Me to Talk.The teaching points reinforced throughout the DVD are parent friendly, reproducible, and easy to follow.Laura repeatedly demonstrates simple and effective techniques that promote language skills, while at the same time emphasizing a fun and engaging environment for both parent and child.Jane Rice, RN and Michael Rice, MD

“Hi Laura. I just finished watching your DVD and am so impressed You really did a terrific job putting everything into “parent-friendly” language, and your examples are super. Thanks so much for doing this. I look forward to sharing it with the parents in our practice. By the way, I am working on a 3rd edition for my “Childhood Speech, Language & Listening Problems: What Every Parent Should Know” book, and I will definitely include your DVD and website. You have so much great information on there.” Patti Hamaguchi, Speech-Language Pathologist and Director, Hamaguchi & Associates, Cupertino, CA 

“I have been a Speech and Language Pathologist for 12 years, and I have worked in the early intervention for the last 2 years.In my quest to provide the best services I could for the children I worked with, I scoured the internet looking for therapy tips.I hit a gold mine when I found Laura Mize’s Teach Me to Talk website.Her website has wonderfully informative articles, but being the visual person that I am, it was even more helpful to see her therapy techniques in action.The Teach Me to Talk DVD is a valuable tool for anyone looking for hands on ideas to help develop speech and language skills for toddlers, and it is an especially valuable tool for those in the profession. No matter if you are a seasoned pro or a grad student; you will surely find many helpful tips and ideas to make the most of your therapy sessions with toddlers. he DVD does a great job of putting the information into very simple and easy to understand steps.I also found it helpful that Laura did not just show the sessions where ‘everything’ goes perfect, because in the real therapy world it often does not.Her DVD includes several clips that show you how to playfully re-direct those ‘little angels’ when they might not be at their ‘toddler best.’This is really a wonderful tool, and I will be recommending the DVD not only to my early intervention parents, but also to the other early intervention speech therapist I know.” —Yvonne Smith, Speech and Language Pathologist MS, CCC-SLP, Sacramento, California

To order and see other products from teachmetotalk.com, click here.

This DVD is now available for ASHA CEUs for SLPs! Order the DVD and then click here for CEU information and to purchase!

The post “Discover The Best Approach To Teach Your Toddler To Talk” appeared first on teachmetotalk.com.

Check out this post for guidelines to let you know when you should be concerned about speech sound development in toddlers.

The post Speech Sound Development in Toddlers appeared first on teachmetotalk.com.

Check out the review here, and register for the DVD giveaway on her blog!

The post “Apraxia Mom” Blog Giveaway appeared first on teachmetotalk.com.

I rarely…no make that NEVER, think that a child doesn’t talk because he’s stubborn or lazy. I get so frustrated when parents tell me this, or worse, when I hear another therapist say this.  If you have thought this about your child, or if a teacher, a physician, or a speech-language pathologist (GASP!) is telling you this, please re-evaluate your situation.

The truth is…

When kids can talk, they do talk.

It makes life so much easier for them, and for you!

Once they figure that out and come together cognitively (understand language), neurologically (can plan and send the message they want to convey), and physiologically (perform the complex processes that are physically required to produce sound), they do learn to speak.

Sometimes parents think that because a child can say a few words, he can say any word. They think he is somehow “holding out on them” when he’s “refusing” to say new words.

Children at age 2 or even 3 are not capable of the advanced cognitive reasoning that must occur for this kind of mental manipulation. Please don’t convince yourself otherwise.

Some parents would rather see their children as “bad” vs. realizing that they have a true developmental problem, and I am always confused by this approach.

Most children who don’t talk have no choice in the matter. If they could talk, but actually have made the choice not to talk, they would be diagnosed with selective mutism, and this diagnosis is very, very rare. Selective mutism requires that a child use language that is typical for his age in at least one setting. If a child has used a couple of words occasionally or even pops out a phrase now and then, but otherwise doesn’t talk, she still does not meet the criteria for this diagnosis.

When a kid defaults to the same word over and over in lieu of using new ones, motor planning problems (apraxia) may be the underlying reason. The child is neurologically “looping” a word he can say. “Default” is an accurate choice of words here, because that’s what’s happened. He can’t say the new word. This is very different from he won’t say it.

The problem could be due to cognition. The child doesn’t understand very many words, so she hangs on to the word or words she can say and uses them over and over instead of saying new words. Teach her to understand new words, and she will begin to say those too.

The problem may be related to issues we see with a child who may eventually be diagnosed with ASD or autism spectrum disorders. A particular word may feel good to say or sound appealing to him, so he says the same word repetitively. Or a child may hum nonstop. Because he’s somewhat verbal, a parent assumes he can talk and is purposefully not saying something else. This is a very specific issue, usually attributed to echolalia, rather than “choosing” not to say other words.

I’ve seen other scenarios too. No matter what’s going on with a particular child, the bottom line is this:

Making a distinction between can’t and won’t is very important, and I BEG moms of children that I see as clients to change the way they think about late talking. Without even meaning to, we often treat children differently when we view developmental issues as behavioral (“He just won’t say it!”) vs. a true challenge (“He can’t say it!)

When we look at late talking as something a child can’t do (YET!), we try to help him and search for a solution. We uncover the reasons he’s not yet talking and more importantly, we find strategies that are successful.

If we think a child’s speech delay is because he won’t do it, we may throw up our hands and walk away. We may give up thinking, “He’ll talk when he’s ready,” or “I’m helpless. I’ve run out of ideas.”

Or we may push and push and push to get OUR way so that talking and communicating become a power struggle. Nobody wins those battles.

When I work with a toddler like this on my caseload, I keep things super fun so they WANT to participate and actually, so irresistible they can’t help but play with me. I model, model, model lots of play sounds and exclamatory words like animal sounds and fun words like “Wow!” and “Whee!” and “Uh oh.”

When a child is ready, we bump it up to include tons of single words without adding too much pressure to “perform.”

When a child is a little further along, I offer a variety of choices for motivating items (such as their favorite things to eat, play, and d0) so that they are somewhat forced to respond to get what they really, really, really want.

Even before moving forward with those good ideas, I always teach another way to communicate, whether it is with simple gestures, signs, or pictures.

Along with changing a parents’ mindset when it comes to the reasons behind late talking, these strategies can make the difference with a kid who seems like he won’t talk.

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For more about this topic and to find ways to help your child, please see the full listing of my products from teachmetotalk.com here.

The post Can’t vs. Won’t appeared first on teachmetotalk.com.

Are you scared and confused by what you’re finding on the internet? ?

Then I’d like to introduce you to a DVD that’s made especially for parents to help you understand this complex diagnosis.

It’s called Teach Me To Talk with Apraxia and Phonological Disorders, and it was developed by pediatric speech-language pathologist Laura Mize, author of the website teachmetotalk.com.

In the last few years, Laura’s best-selling DVDs Teach Me To Talk and Teach Me To Listen and Obey have helped thousands of families in the United States and around the world understand expressive and receptive language delays. Now she’s using her parent-friendly, easy-to-understand approach to explain speech disorders.

Watch Laura as she not only explains the characteristics of apraxia, but shows you many, many examples of toddlers and young preschoolers who exhibit verbal motor planning difficulties. You’ll learn exactly how speech-language pathologists distinguish apraxia from other speech and language delays such as phonological disorders.

More importantly, this DVD goes well beyond the diagnosis phase and explains all of the therapy techniques recommended by experts in the field. This DVD isn’t just a video-taped conference with a few clips of speech therapy.

In this comprehensive 3 hour, 2 DVD set, you’ll see dozens of real-life therapy sessions so that you can learn to understand and use these techniques at home with your young child diagnosed with apraxia. You’ll hear Laura explain the techniques and then see multiple demonstrations of each strategy with different children so that you can not only understand exactly what to do, but can be confident in implementing the same successful strategies with your own young child.

This DVD covers every important phase of speech-language development in young children. You’ll see techniques to use with toddlers who are non-verbal. Then you’ll watch children progress and find strategies to help them learn to use single words. Children with apraxia and phonological disorders also have difficulty using speech sounds correctly in words. They leave off or substitute consonant, and even, vowel sounds. You’ll learn several ways to help them learn new sounds. You’ll also see strategies to help children learn to make the leap from single words to phrases, and then finally, move on to using sentences.

If your child struggles to be understood and has been diagnosed with apraxia or phonological disorder, this DVD will clearly outline steps that you, as a parent, can use at home to help supplement the speech therapy your child is receiving. Children with parents who are involved in their child’s therapy have much better outcomes than children whose parents don’t participate. If you’ve been left wondering exactly HOW to work with your child with apraxia at home between speech therapy sessions, this DVD will teach you.

Additionally in each section Laura shares her best therapy resources so that you can locate and use the best treatment materials recommended for children with apraxia of speech. No more searching on the internet or pouring over catalogues to decide what will be appropriate and useful for your child as you work at home. You’ll receive many quality references for reputable and reliable information, all based on cutting-edge research and best practices in treating young children with apraxia and phonological disorders.

If you’re a pediatric speech-language pathologist or another early interventionist working with young children with speech disorders, this must-have resource will become a favorite resource in your library of treatment materials as you share information with families, train students, or offer clinical supervision to CFYs. SLPs love Laura’s down-to-earth and practical advice which will help you take your intervention from theory “to the floor.”

“I wanted to thank you for the new Phonological/Apraxia DVDs!!! As usual, you have put together a super video, chock-full of terrific ideas for parents! I also showed a bit of that one, as well as the other ones at our recent seminars….The response from the SLPs in the audience is universally great, and they all comment how much something like this is so needed. You’ve done all the work for them, so what a treat to have these available to loan the parents on our caseloads! -Patti Hamaguchi, M.A., CCC-SLP

“I just love your playful manner with the kids, and the way you break down the suggested strategies and show how you implement them with actual children. Everyone also comments how they love the fact that you show real kids who don’t always cooperate, and how you handle it. So fabulous!! Thanks again.” Diane Moss, SLP

“This is an excellent training DVD for parents of late talkers. The strategies that Laura teaches are the same ones she used when working with my son, who has apraxia of speech. My son made incredible progress working with Laura. These strategies are very effective and easy to apply to a variety of speech and language disorders. I wish all speech therapists possessed this level of knowledge and skill. As a Speech-Language Pathologist, I would recommend this DVD to my parents of late talkers and especially those diagnosed with apraxia. As a Mom of a late talker, I would recommend this DVD to all speech therapists working with children.”
-Laurie Felty, Speech-Language Pathologist

Click here to be redirected to our store to order your 2 DVD set for Teach Me To Talk with Apraxia and Phonological Disorders today!

If you’ve not yet ordered Laura’s first DVD Teach Me To Talk, it’s strongly recommended that you begin with techniques in that DVD first, before implementing the more advanced strategies in Teach Me To Talk with Apraxia and Phonological Disorders. With this special order you can order Teach Me To Talk for only $29.99 with the purchase of Teach Me To Talk with Apraxia and Phonological Disorders – that’s $10 off the regular price. 

Order the set Teach Me To Talk AND Teach Me To Talk with Apraxia.

Order Teach Me To Talk with Apraxia.

The post DVD to Treat Apraxia in Toddlers and Young Preschoolers appeared first on teachmetotalk.com.

Apraxia and phonological disorders are among the most common speech disorders diagnosed in young children. These diagnoses can be difficult for parents to understand. In this comprehensive 2 DVD set, you’ll learn the diagnostic characteristics and view many examples of young children with motor planning difficulties and speech sound disorder during real therapy sessions.

More importantly, you’ll learn how you can help your child at home. Like my previous DVDs, the focus for Teach Me To Talk with Apraxia and Phonological Disorders is on INTERVENTION. You’ll SEE demonstrations and explanations of the latest techniques experts recommend to help non-verbal toddlers first learn to imitate sounds and then begin to use words, phrases, and sentences.

If you’re having difficulty understanding what your young child is saying to you, this 3 hour DVD set will teach you step-by-step techniques to help your child learn to use speech you can understand. This will be invaluable information for parents with children who have been newly diagnosed with a speech delay or disorder including apraxia and phonological disorders.

This set will also be a great resource for any pediatric speech-language pathologist or developmental therapist providing early intervention services. You’ll see techniques used with a variety of toddlers and young preschoolers. Many clinicians use my DVDs as a resource for parent education and as a training tool for grad students and CFYs. If you’re working with very young children, this set will be a welcomed reference for your practice.

Throughout the 2 DVD set, I’ll share my recommendations for the resources I use for treating children with apraxia and phonological disorders. You’ll also learn what DOESN’T work and isn’t recommended for working with young children with speech sound disorders.

This set is HIGHLY recommended by both parents and professionals. Order your copy today!

If this is your initial visit to teachmetotalk.com or your child is newly diagnosed and just beginning therapy, it’s a good idea to implement a play-based approach to target expressive language. The DVD Teach Me To Talk is an ideal initial resource for parents in this situation. To save $$ and bundle Teach Me To Talk with Teach Me To Talk with Apraxia and Phonological Disorder, click here.

For even more treatment ideas and an extremely comprehensive treatment approach to use at home or in therapy sessions, order this DVD along with my book Building Verbal Imitation in Toddlers and my initial DVD Teach Me To Talk. This set is called the Apraxia Resource Set and can be ordered here.

The post Teach Me To Talk with Apraxia and Phonological Disorders NOW SHIPPING appeared first on teachmetotalk.com.

You can listen live on Thursday, August 20 at 12 pm Eastern Time using this icon. 

If you can’t join us live, you can always listen later anytime using the blogtalkradio icon in the right hand column or on the home page.

Our show is also available for FREE download on itunes. Visit the itunes store and search “Teach Me to Talk with Laura and Kate.” For you itunes novices, choose subscribe, and the show will download so you can listen later with your ipod.

Hope you’ll join us! Laura

The post Special Time for “Teach Me To Talk with Laura and Kate” on Thursday, August 20, 2009 appeared first on teachmetotalk.com.

Dear Laura,

You were nice enough to answer some questions a while back and I have a few follow up ones. My daughter was delayed in her expressive language and not combining words at age 2. With ST through the regional center she is now within “normal” range at almost 3 years of age and will probably not qualify for services through the school district. You mentioned to me before that catching up in expressive language by age 3 can mean the delay was just a case of late talking. We are hoping that is the case with our daughter (I was also a late talker) but now I have come to discover that she has some fine motor delays. She cannot cut with scissors or hold a pen properly (still grips it with a fist). Given that she had a speech delay & now a fine motor delay should I be concerned about an underlying cause? Would there be other symptoms or signs of some thing like mental retardation?

The SLP did both the preschool assessment scale & Rosetti and said she was within normal guidelines. Her receptive language has always been age appropriate & even ahead. Her strengths have always been her social skills. She is very engaging, empathetic (always concerned about others feelings),and affectionate. She loves playing with other children and adults. As far as the fine motor delays, I am wondering if lack of opportunity can contribute to this? I have to admit that she is not interested in doing these things and I never force her to practice. We do a mommy & me preschool two days a week and I noticed that many of her peers can write, cut, etc and I can hardly ever get her to cooperate with me. All she wants to do is play. Any suggestions?

We canceled the evaluation with the school district because her SLP was very confident that she would not qualify for speech services but I never discussed the fine motor concern with her. Also, my daughter has largnomalacia and I still feel that this caused early feeding issues and played a role in the speech delay. Any chance it can be related to fine motor as well? Why are fine motor & speech delay connected?

You gave some great details about what a 3 year old should be doing and I think my daughter is there. She can string 5-7 words together (but not every sentence has that many), she asks a ton of questions (repetitively), and can follow 4 step commands. I can understand 80-90% of what she says but strangers can not (maybe closer to 65-75%). I hope this is enough background for you to comment.I have to say you are such a great source of info and I really value the service you provide to the public. Sincerely, Kathy

Kathy – Although I can’t say for sure exactly what’s going on with her since I can’t see her, I’ll be glad to give it my best shot.

First of all, it’s great that she’s now within the normal range with language – Hooray for you!!! Pat yourself on the back since all your hard work as paid off!

Secondly, fine motor delays do sometimes accompany late talking, BUT this does NOT equate with mental retardation. She would not have language skills within the normal range and have huge cognitive issues – that doesn’t happen and really doesn’t make sense clinically since cognition is the underlying foundation for language. If cognition is hugely impacted, language is too. Now if they were telling you that her language is commiserate with her cogntition, that’s a whole different story, but you didn’t say that’s the case, and certainly from how you’ve described her, she’s functioning in the normal range. Again – good for you!!!

Has she been assessed by an OT? Occupational therapists are the professionals that can help you address the fine motor skills. However, your SLP may be able to give you some ideas BEFORE she’s discharged from speech before she turns 3. If the fine motor delays are mild and related to not enough opportunities to practice, these should come along pretty well with increased focus from you. This could really be the case since her language has responded so beautifully to treatment. The initial diagnosis she received, the laryngeal dx – can’t remember how to spell it – is likely NOT the cause of the fine motor delay.

My advice for the fine motor skills are to start to practice these skills in a “no pressure” kind of way. Sit on the floor or at the table and cut, then ask her to join in. To entice her, you should cut fun stuff like hearts and snowmen and circles, but help her to cut straight lines at first. Some children (and adults!) do become very frustrated with activities when they’re not good at it, so it may take some time to encourage her to want to do it. Praise, praise, praise her efforts if this seems to help her want to try more.

For writing utensil grip, I always use the cue, “Hold it like a big girl,” then help her do it with her fingers on the crayon or pencil. Another trick is to break a crayon so it’s in a pretty small piece so that she can’t grab it with her fist. Then she’s forced to hold it with the 3-point grasp using her thumb and 2 fingers. Model this for her too so that she sees you having a ball coloring. Coloring on giant pieces of paper, or even on some big surface like a paper grocery bag or a cardboard box, also makes toddlers more likely to want to color. When her grip is better, switch to markers – usually a guaranteed hit! Again, get your SLP’s advice for more ideas since she may be able to pinpoint a cue or piece of advice that will really help you based on what she can SEE your daughter doing.

Have you read the book The Late Talker? I believe that it talks about fine motor delays or other subtle motor planning issues that can accompany late talking when it’s due to apraxia. Since your SLP has not mentioned this to you, this is likely not the case diagnostically, BUT if I remember correctly, the book has some good ideas for fine motor stuff too. I have loaned out my copy, so I cannot check this for you – sorry!!

Think those were all of your questions and concerns, but if I missed any, let me know! Laura

The post Questions about Fine Motor Skill Delays After Language is Now Age-appropriate appeared first on teachmetotalk.com.

Laura,

Hope this helps.

So? What does this mean for you if your child has been diagnosed with apraxia? Children have to practice SPEECH, not movements without any sound or movements with just a sound (such as “p” for /p/)?to be able to learn to talk.

Dr. Lof’s mention of working at the syllable level means that sounds aren’t practiced alone, or in isolation, as your SLP might say. Most early interventionists and pediatric SLPs use this approach since we work on WORDS in the context of daily activities or play. Sometimes SLPs (myself included) will cue the sound?in isolation, or by itself, to be sure the child is capable of producing the sound as well as to heighten a child’s awareness of the sound.

Your SLP might also use verbal, visual, or tactile sound cues such saying “Use your popper sound” for /p/ while pointing to her lips, or your “throaty” sound for /k/ while touching under your child’s neck. Again, this kind of practice should be very limited (no more than a couple of repetitions) and shouldn’t be the focus of the session since we’re talking about toddlers and young preschoolers here! Individual speech sounds should be placed in words pretty quickly so that the sounds make sense AND so that you don’t lose a child’s attention in this process. Cognitively, most children aren’t ready for intensely focused sound production practice until after 3.

Sound practice for children with apraxia isn’t recommended since it’s the SEQUENCING of sounds that usually causes the problems with intelligibility. He or she may be able to say the sound alone perfectly, but then it falls apart in the word or phrase. Practicing the individual sound over and over is often pointless since this is not the real problem. Let me also reiterate one more HUGE principle that I’ll emphasize yet again. If your child is really young and his LANGUAGE skills (vocabulary size, phrase length, using words to ask for things and respond to you, etc…) are?NOT age-appropriate, all of these speech or sound issues should take a back seat to helping him learn to be an effective communicator.  The time to address all of the specific sound errors is AFTER his language skills are well on their way to matching those of his same-age peers. Focus on WORDS and COMMUNICATION. Intelligibility will come, but it won’t matter anyway if he has nothing to say! Laura

The post Oral Motor Exercises and Childhood Apraxia of Speech appeared first on teachmetotalk.com.

This morning I was in a huge hurry to get ready to go see one darling little girl for speech therapy and then pursue my other passion, being a mom, for the rest of the day.  I usually check the website and my e-mail every morning for comments from readers and respond to any that I can adequately answer before dashing out the door to see my first client.

Today started no differently. I checked the comments section to see if I’d received any questions overnight.  The comments section was extra-full today (14 spam messages from porn sites!) and then a comment from a parent who is facing the challenge of getting her SLP to appropriately treat her 25 month old son who was previously diagnosed with apraxia.  (If you’re intrigued, see the comment from Luz.)

I was so irritated with this SLP in question when I read the comment that I knew I wouldn’t be able to generate a thoughtful, responsible reply, so I posted the comment and then left for work.  I literally could not quit thinking about this situation. It bugged me so much on my drive in that I had to force myself to switch gears and start to mentally prepare for my first and only client today.

After a great hour, I returned home to start my second-shift job as mom. Before I went to chaperone the back-to-school swim party for my daughter’s middle school cheerleading team, I asked my husband if he’d take a quick ride with me to McDonalds to grab lunch. While we were sitting in the loooong drive -thru line, I asked him if he’d read the comment already.

Now for those of you who don’t regularly read this blog, this really is a two-person show.  While I do all of the clinical stuff, my husband is the “techie” one who routinely figures out what I want to do and can’t, and more importantly, fixes all the things I mess up on here! He actually “runs” the site and reads most comments and e-mails before I do, so I knew he’d probably already seen the post.

As he drove me to McDonalds so I could grab our daughter some lunch (very picky and very sensitive tummy – but that’s a whole ‘nother post!), he listened to my rant about the comment I received this morning.  Again, if you’re a regular reader, you know is an everyday occurrence for me. I can get pretty worked up about children who aren’t receiving optimal therapy.

While I paused to take a breath, he posed this great question to me, “Is bad speech therapy better than no speech therapy?”

Hmmmmmm. After a very brief pause, I jumped in and said, “Yes. Bad speech therapy is better than no speech therapy.” I supported my initial argument with justifications such as, “At least the child is focusing on learning language during the visit when they might not otherwise be.” I continued with, “At least the parents are getting advice about how to target improving language at home.”

As I was yelling across him to order the only chicken sandwich our daughter will eat, I glanced at the look on my husband’s face. Why was he smirking?

Then it began to dawn on me too. I started to hedge on my previously “correct” answer. I questioned aloud what he had to be thinking.

“But, what if the advice that parents get is the WRONG advice? What if the SLP is using the WRONG approach?What if the parents end up feeling more helpless and confused than ever before? Would this really be better than nothing?”

Hmmmmm……Then I arrived at my next conclusion. Bad speech therapy is not better than no speech therapy.

Actually, it could be (gulp) worse. When parents are counting on sound advice from the person they view as a “professional” and that person does not deliver, for whatever reason, be it lack of experience, or education, or in some cases, plain ole’ common sense, it may actually cause harm to the family and child.

Not harm in the way that the child is physically injured, but harm in the sense that his parents believe that they are doing “the best” job they can by seeing that he gets “the best” treatment possible. If parents don’t know any better and keep doing the same unproductive things week after week, session after session, precious months could fly by without a hint of measurable progress or even a glimmer of hope. In my opinion, contributing to lost time during this critical window of development is harm.

Then my husband asked another question. “What if the SLP herself doesn’t realize that she’s not helping a child?”

That opened up a whole new line of questions for me.

“What if she doesn’t question why her clients don’t make progress? What if she thinks it’s normal for kids to run away from her and cry? What if she gets fired and doesn’t even think it’s her fault? What if her area is so short of speech therapists that she never gets fired because nobody knows any better? What if she truly doesn’t know she’s bad?”

Hmmmmmm…… I don’t even know how to address this issue other than to tell parents, you’ve got to do what’s best for your child. If you think therapy is not going well, if you feel a pit in the bottom of your stomach during yet another horrible session, if you think there’s a problem, there is.

That’s where you parents come in. That’s where therapy supervisors come in. That’s where team members in multidisciplinary models come in. You have to have a voice. You have to speak up. You have to say to that unsuccessful therapist – there’s got to be a better way!

The answer may be helping an inexperienced therapist begin the process of self-analysis. Ask her, “Do the children on your caseload make progress?” “What expert’s material do you read?” “What would that expert recommend for my child?”  “What could we do differently to make this better?”  “Is there any other approach we can try?”

If your SLP can’t answer these questions, I hate to say it, but you and your child are in big trouble. The answer in this case is to find someone else to help you work with your child.

As I’ve said often on this site, most children with language delays and disorders need high quality speech therapy to make progress. Sometimes maturation kicks in and kids get better on their own or with a little help from mom and dad, but for children who have a diagnosis as a “reason” for their delay at 2 or 3, you’re going to need a professional, and a good one at that.

Many children who are just thought to be “developmentally delayed” must also have speech therapy in order to make enough progress with language to catch up to their peers. Good therapy can make a HUGE difference.

But what if there’s no “good” therapy? What if you just aren’t sure? Keep reading, keep watching, keep asking questions, and keep trusting your gut.

Sometimes bad speech therapy may be better than no speech therapy, but then again, doesn’t your child deserve better?

The post Is Bad Speech Therapy Better Than No Speech Therapy? appeared first on teachmetotalk.com.

Many young children need another way to communicate before they learn to talk. Speech-language pathologists often recommend that parents introduce pictures to help give a child an additional way to express his wants and needs. The most popular method for beginning to teach children to communicate with pictures is The Picture Exchange Communication System, commonly called PECS.

There are lots of myths and misconceptions concerning PECS. First of all, just because you’re using pictures doesn’t necessarily mean you’re using PECS. PECS is a very specific and systematic protocol for teaching a child to request items that he wants using pictures. This program was authored by Bundy, an applied behavioral analysis psychologist, and Frost, a speech-language pathologist in 1985. This program began as a way to teach autistic children to communicate, but it’s been expanded and used in a wide variety of populations and ages.

PECS consists of 6 very distinct phases based on the principles from the fields of applied behavioral analysis (ABA) and speech-language pathology.

If you’re just placing pictures out in front of your child and letting him choose which one he wants, you’re not using PECS. If your SLP is encouraging you to take digital pictures and hang them on the fridge in hopes that your child will point to what he wants, you’re not using PECS. If you are showing him a picture to help him understand what comes next in his day, you’re not using PECS. These are all very valid methods for using pictures to communicate and process language, but they are not PECS.

PECS is a very specific program outlined in its latest version in 2002 in a training manual that’s helpful for both clinicians and parents. You can get more information on ordering this system at the website at www.pecs.com. I highly recommend that parents who want to begin to use PECS with their children should order the manual and read it from cover to cover. It’s an easy read and very parent-friendly. Don’t depend on your SLP to teach you or to implement the program in the way it was intended. Read it yourself so that you know exactly how to introduce each phase. Using the phases just as they were intended is the quickest and easiest way to successfully implement this sytem for your child. Don’t cheat! Do it correctly, the first time!

(Just a quick note – I have also purchased additional used copies from e-bay. It’s cheaper than new, but you may get a highlighted, dog-earred, or stained copy, but that’s usually okay for me and the parents of children on my caseload!)

This information about PECS is directly from their website –

“PECS begins with teaching a student to exchange a picture of a desired item with a communicative partner, who immediately honors the request (a mand within Skinner’s terminology). Rather than verbal prompts we use our unique 2-Person Prompting Procedure, building immediate initiation while avoiding prompt dependency. The system goes on to teach discrimination of symbols and the development of simple sentences. In the most advanced Phases, individuals learn to respond to statements and questions (i.e., intraverbals) as well as learn to comment about common items and activities (i.e., tacts). Many preschoolers using PECS also begin developing speech.”

In real-life parent language, this means that you first select items that you KNOW your kid is going to want and take pictures of these. Things I always use with kids are snacks (think junk foods not green beans) or highly preferred toys. You can use PECS or Boardmaker pictures (colored drawings similar to cartoons), but I do usually take pictures witha phone or a digital camera, print them, and then laminate them so they are EXACT visual representations of what the child wants and can stand up to attempts to throw, tear, and eat them! Kinkos laminates pictures cheaply, or you can go the really cheap route and use clear shelf-liner paper or clear packing tape to cover your pictures. If you think you are going to use PECS for a while, go ahead and invest in a $30 laminator from an office supply place or WalMart. It’s worth the money.

Initially I don’t enourage parents to spend lots of money on supplies other than the a way to take and laminate the pictures. If a parents doesn’t own a smart phone, get a digital camera (which most people have or can borrow).  Places like WalMart and Walgreens are cheap alternatives for printing pictures if a family doesn’t already have a decent printer. Don’t rush out and buy the velcro or a special notebook until you know you’re going to be using this system for a while.

I actually also loan parents my copy of the PECS manual to read initially, then they buy their own when we decide this is a method we’re going to use for a while. But again, if your SLP isn’t providing you a copy of the real thing, go ahead and purchase the manual yourself. You may have to end up letting her (or him) borrow your copy to learn how to do it correctly!

Also remember that PECS takes two adults to implement. One adult is the one who “prompts” the child to by holding the item the child wants to entice him to trade his picture for the item and then holding out the other hand to accept the picture. The second adult is the “helper” who sits behind or beside the child and physically helps him pick up the picture and give it to the other adult. You MUST have 2 adults to use PECS initially. This is a deal breaker if you don’t. Wait to practice until Dad comes home, Grandma is there, or during therapy time. I have trained older siblings as young as 6 or 7 to help too.

One other word of caution – This is supposed to be mostly a nonverbal cueing system, meaning that children are supposed to learn to trade pictures for items they want WITHOUT LOTS OF VERBAL INSTRUCTION. This is HARD for some parents. If you are saying too much during the initial phases, you’re defeating the whole purpose of PECS. I have had parents who repeatedly say, “Give me the card! Where’s your picture? You have to give it to me. I’m not giving you this until you pick up the card, etc…..” Don’t do this! Prompt in just the way the PECS manual says!

Another misconception about PECS is that it is only for nonverbal children. While it can be used it this way, it can also be used to teach interacting/social skills for a child who is verbal but doesn’t communicate very well. For example, some children talk, such as labeling pictures or quoting from their favorite movies, but they don’t understand how to initiate a request to ask for that they want. PECS teaches children how to approach another person and begin interaction by systematically training these skills using pictures.

Initially requesting is targeted in PECS, but later phases also work on responding to questions and commenting (I see, I hear, etc….)

In the middle phases of PECS you’re also going to be teaching picture discrimination so that you can be sure your child can tell the difference between pictures. This is helpful because sometimes children select pictures with no real communicative intent. PECS eliminates this because you’ll be using a picture of an item your child doesn’t want. What a lesson to learn! If you give mommy the wrong picture, you get the wrong item! It’s a very tough lesson to learn, but how else can you be sure your child is really choosing? Many parents want to skip this phase and begin to offer choices for pictures too soon. They give two pictures for things their child may really want, so he never learns to look at the pictures and “choose.” This approach teaches this important skill like no other method I’ve ever used. When children master this phase, they are purposefully choosing and discriminating between pictures for items. That’s communicating!

One other great skill PECS teaches is helping kids learn to seek out other people to communicate. It requires that children lean across a distance or walk across the room  to trade a picture for an item they want. Again, this approach teaches this skill in a very concrete way. Once children learn to do this, they almost always begin to “lead” their parents to what they want (if they haven’t done this already!).

Some parents are afraid that using pictures to teach their child to communicate may mean that their child will never learn to talk. Let me beg you to change your mind! Using PECS (or another alternative method like sign language) actually INCREASES the likelihood that a child will become a verbal communicator! Research has confirmed this with PECS. For more information on these studies visit the PECS site. In my opinion, a child who isn’t going to talk for a long time absolutely needs to learn another way to communicate. As his parent, you should want that for him to save yourself some frustration and heartache!

The post Using PECS for Language Delayed Toddlers appeared first on teachmetotalk.com.

Echolalia is repeating or “echoing” what another person has said. Children who are echolalic imitate what they have heard someone say in everyday life, lines they’ve listened to from a book, lyrics to a song, or a script from a show or movie. Professionals most often characterize children as “echolalic” when many of the words or phrases a child uses seem to be repetitions from a previous activity rather than new utterances a child comes up with on their own.

Children with echolalia use what many parents describe as “more advanced language” than they can typically generate. For example, a toddler who is exhibiting echolalia can quote long segments from a favorite TV show or sing an entire song word for word, but he can’t ask for milk when he needs it or answer a question his dad asks him. Even though this child “talks,” since he can technically say lots of words, he doesn’t seem to completely understand what he’s saying. In essence, he’s just repeating words without really being able to “use” them.

Echolalia is one of the characteristics sometimes noted in children with autism. In fact, researchers have found that up to 85% of people with autism who are verbal exhibit echolalia in some form. The silver lining in this is that echolalia is actually a positive sign that children with autism may eventually be able to learn to use language to communicate.

Echolalia is also a part of normal language development. This phase begins around 18 months of age when a child has mastered imitating words and is just beginning to imitate phrases. Experts tell us that echolalia peaks around 30 months of age, and declines significantly by the time a toddler turns three. This coincides with a child becoming conversational and truly beginning to talk on his own, generating his own original thoughts, asking new questions, and responding to questions appropriately.

In children with autism, echolalia occurs with greater frequency and lasts for a longer period of time than it does in children with typically developing language. For example, a child with typically developing language may be able to quote a few phrases from a favorite TV show, sing a song, or learn to count to ten by rote. However, he doesn’t do this repetitively several times a day, and when he does do this, it seems to “fit” what’s happened rather than leaving adults or other children around him wondering, “Okay…what’s that about?”

Children with motor planning issues, or apraxia, also can “get stuck” in this phase for a couple of different reasons. First of all, children with apraxia begin speech therapy with very poor imitation skills. Once they learn how to repeat what they’ve heard, they seem to want to hang onto this phase for a very long time. Secondly, repeating may become the “motor plan” they learn best, and it may be easier for some of these children to map a previously rehearsed message than to come up with a new one. (Although it is true with apraxia that children can come up with spontaneous utterances better than imitated ones, this is not usually the case once they have been in therapy for a while. It may be easier to pull out a tried-and-true phrase or sentence than learn a whole new one.)

Echolalia is classified as immediate echolalia or delayed echolalia.

Immediate echolalia is the repetition of words or phrases that occur immediately or very soon after the original words are spoken. An example of immediate echolalia is the child who repeats a question such as, “Do you want some juice?” rather than responding yes or no.

Delayed echolalia is the repetition of words or phrases that are echoed after the fact, even hours, days, weeks, or months later. An example of delayed echolalia is a child who might sing, “Happy Birthday” when someone new enters her home.

Echolalia can also include not only the words spoken, but the exact imitation of a person’s inflection, tone of voice, and volume.

Professionals used to view echolalia as something that should be eliminated. However, current researchers tell us that many times echolalic speech can serve a purpose for children with autism. For example, a child who wants to go outside may say to his mother, “Let’s put your shoes on,” as his way of requesting this activity since he’s heard his mother say this many times just before he gets to leave the house. A child may say, “Want me to hold you?” when he’s crying or “It’s okay, Ben,” when he’s upset since his parents have said this to him in this context over and over again.

I’ll give you another real-life example. A darling little boy on my caseload last Christmas called Santa Claus “It’s Santa,” all season long because the first time his mother taught him this word, she declared enthusiastically, “It’s Santa!” He lifted the whole phrase and his mother’s elevated and joyful tone of voice as this character’s name. When his teacher at preschool asked him, “Who’s that?” it was appropriate for him to respond in this way, but during a speech therapy session when I gave him a choice for play by asking, “Do you want Santa or this reindeer?” and he replied, “It’s Santa,” it didn’t make much sense.

In these cases echolalia is representative of the way these children process information. They learn in “chunks” without processing meanings of individual words. This learning style is called a “gestalt” style of language acquisition. Children who learn this way also process the sensory and emotional components of the event. In the previous example with Santa, the little boy processed “It’s” as a part of Santa’s name, along with the enthusiasm in his mother’s voice. Every time he said this, he repeated it in just the way she originally said it to him, beginning shortly after Thanksgiving and lasting well into January.

Sometimes echolalia does not serve an identifiable purpose. For example, consider the child who repeats every line from the book “Go Dog Go” for no apparent reason while in the grocery store. There’s no dog in sight and no link to associating this book, but she recites it while riding in the cart while her mother selects food.

I try to teach parents with children who seem to be stuck in echolalia to look at this as an opportunity for us to know exactly what he or she is having difficulty learning. Echolalia can serve a purpose for us. For example, the child who is walking around aimlessly quoting a movie or book may need help in finding an appropriate activity, or he may be feeling stressed or anxious and use this routine to calm himself. A child who asks her mother, “Do you want a cookie?” needs help in learning to initiate requests in a more appropriate way. A child who repeats a question needs help learning the meaning of the words so he can accurately process the question, or he may need specific cues to learn exactly how to answer. A child who repeats, “Good job (her own name)” needs to learn a declarative phrase such as, “I did it!” A child who repeats his brother’s words may just be trying to take a turn in conversation and doesn’t know what else to say.

By taking a moment to determine if the echolalic utterance serves a purpose, discovering what the child’s intent is, and then finding ways to teach your child what he should say in this context, you’ll be much more effective than trying to eliminate echolalia.

Look for a follow-up article this week for more specific ideas to work on functional language for children with echolalia at home and during speech therapy sessions. Laura

If you’d like more information about echolalia, you can find it in my course Is It Autism? Recognizing and Treating Toddlers and Preschoolers with Red Flags for ASD.

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One Mother’s Experience….Quality Speech Therapy or Not?

By Laurie Felty, M.S., CCC-SLP

Since the time my son, Jack, began speech therapy almost 2 years ago for apraxia of speech, he has had four different therapists with four different styles of therapy. Some of those styles were successful and some were not.

As a speech therapist myself, with 15 years of experience, I feel that I have the qualifications to judge the level of skill and quality of services that a therapist delivers. Not only can I speak from my own experiences as a therapist, but also from my experiences of working alongside other speech therapists and having the opportunity to observe more than one successful style of therapy. Based on all of this, I have very specific ideas about what I expect from my son’s speech therapy sessions.

I feel that we were very fortunate to have had Laura Mize, the creator of this website, as Jack’s first speech therapist. Our service coordinator through our state’s early intervention program recommended her because she knew that Laura had experience with apraxia of speech. She treated Jack until he turned 3 and was no longer eligible for early intervention.

From the moment Laura walked through our front door, she exuded warmth, friendliness and enthusiasm that immediately captured Jack’s attention and gained my respect. She came in and briefly introduced herself, kicked her shoes off and in the sunniest, brightest voice, invited Jack to “play toys” with her. Jack was absolutely mesmerized by her bag of toys, and she never missed a beat transitioning from one activity to another as Jack’s interest would shift, as a toddler’s interest so frequently does. Just like that, therapy had begun and Jack had a new best friend!

Laura’s method of therapy was completely play based. If you’ve read any of Laura’s articles on this website, then you have a pretty good idea about her style of therapy. Laura honestly uses every strategy and technique that she has described in her articles in her therapy sessions every day. Jack was continually engaged in expressive speech tasks with multiple, multiple repetitions of sounds and words during the entire therapy session. Of course, Jack thought he was just playing because Laura made it so fun.

Another key factor that made Laura’s approach to therapy a success was that she worked directly with us, as parents, to deliver therapy services. There was a continuous exchange of information, and Laura welcomed us to not only observe, but to actually be a part of Jack’s therapy. I feel that this is especially important because parents are with their children 7 days a week to carryover strategies and techniques learned from the therapist, who is, at most, with the child only 1 to 2 ?hours a week. Doesn’t it make sense that parents need to be involved in their child’s therapy sessions in some way?

Now, I will not go so far as to say that the unsuccessful styles of the speech therapists that treated my son were “wrong,” but they were definitely not “right” for my son, and they did not meet my expectations as a mother or as a speech therapist.

For example, the second therapist that treated my son was at a pediatric rehabilitation center, through our private insurance, that only provided 20 therapy sessions per year. With only so many visits allowed, it was important that each one be the most productive possible.

This therapist took the first 30 minutes of a 1 hour session to “establish rapport” with Jack by allowing him to play on indoor playground equipment while she followed him around occasionally commenting on Jack’s movements. Jack did not say and wasn’t asked to say one single sound or word during this entire time.

Once in the therapy room, which was filled with toys, she chose to look at books with Jack. Again, not requiring or asking Jack to say anything. Jack, of course, wanted to play with all the toys. However, the therapist made him sit there and look at books until she decided it was enough because she said she was working on increasing his attention to task. It is important to know that Jack has an expressive speech disorder with age-appropriate receptive language and attention skills.

Only after I asked her if she had any therapy strategies for working with apraxia of speech did she ask Jack to imitate some vowel sounds. This was in the last 5 minutes of the 1 hour session. Needless to say, that was the one and only time Jack saw that therapist. I also called and complained to her supervisor.

Our next therapist was slightly better. She did engage Jack in play therapy but only while seated at a table. With apraxia of speech, it is important to elicit as many repetitions of sounds/words as possible to improve motor planning. Although this therapist encouraged Jack to talk, the speech tasks were very non-specific with no multiple repetitions.

Also, one of his “speech goals” was to attend therapy sessions with no parent present. What? He wasn’t even 3 years old yet. How could that be a “speech goal” and what did it have to do with apraxia of speech?  Where was the partnership between parent and therapist? Plus, after our last experience, that was never going to happen.

We stayed with this therapist only for a few sessions until Jack transitioned to the public school system for speech therapy. I was prepared for a disappointment, yet again. However, I was pleasantly surprised by our new therapist’s style of therapy. It was play based with lots of expressive speech tasks and repetitions of target sounds and words. Jack often brings his own toys to therapy, and his therapist uses them in his sessions. She also welcomes parents to observe therapy. Once again, Jack is making progress and enjoys speech therapy.

I hope, through these examples, that parents will be able to recognize if their child is receiving quality services. A few of the things that I’ve learned from this experience are: Not all speech therapists are qualified to treat all disorders of speech and language; there is a huge difference between play and play therapy; and it is absolutely the parent’s responsibility to monitor, be a part of, and demand the best possible services for their child.

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I love the beginning quote so much that I’d like to share it here:

“Not all children with delayed speech are “little Einsteins” or garden variety “late bloomers.” Some have a speech-language disorder that will persist unless warning signs are recognized and intervention comes early.”

She also includes a set of risk factors for pediatricians (and parents) to look for which might also inhibit language development:

• Family history, such as a strong heritability factor. There’s a higher risk of continued delay if one of a toddler’s parents or siblings had long-term language and learning difficulties.
• Otitis media with effusion causing a fluctuating hearing loss during the period of speech development. (This means frequent ear infections. If your child has had several, and?especially if he’s had to have tubes during infancy or toddlerhood, this could be a major contributing factor to his speech-language delay.)
• Low socioeconomic status and educational level. These families are more likely to have a child with a poor outcome.
• Parental characteristics that may inhibit speech, including the way parents interact with the child. Parents need to follow a child’s lead and provide a language model using simplified speech. Use of “parentese,” the way that many parents instinctively talk to infants in a high-pitched, sing-song voice, actually fosters language development by attracting the infant’s attention and resembling the pitch of the sounds he makes.
• Missed language explosion. Most children experience a vocabulary spurt around the age of 18 months, but late talkers don’t. Some late talkers have an “explosion” of speech later between 24 and 30 months. If a child has not had a vocabulary spurt by 30 months, he is at considerable risk of continued language delay.

She also includes information I’ve cited in other places on the site with the signs that a child should get an early speech-language assessment including:

One major review in the speech pathology literature paints a profile of toddlers 18 to 24 months old who are at risk of persistence of language impairment at 36 to 48 months and who should receive early intervention.⁶ The greater the number of warning signs a child exhibits (especially the closer he gets to 3 years of age), the greater the need for early assessment. Those signs include⁶:

• little sound play or babbling as an infant, with limited number of consonant sounds and, possibly, vowel distortions as a toddler
• poor verbal imitation skills; reliance on direct model and prompting
• immature play skills; little pretend play
• interactions with adults more than peers
• few communicative gestures (the late bloomer who caught up with his peers within a year used significantly more gestures than the child who had persistent delay)
• impaired social skills or behavior problems
• small vocabulary for age; less diverse verb repertoires
• comprehension delay of six months or greater relative to chronologic age

This might also be a great resource for your pediatrician, especially if he or she is of the “wait and see” variety. Printing this article and taking it with you to an appointment might be a great?way to start (or re-start) a conversation about your concern with your child’s language skills.

You can read the full article at this link.

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Part of advocating for your child is to find out all the research and all the therapies possible for their disability, analyze them, and try to implement those that you feel would be beneficial to your child. One treatment that has been brought up on this blog is supplementing the diets of children with apraxia with fish oil.? Since I am a HUGE proponent of this type of treatment, Laura asked me to write a blog entry on its use. I’ve adapted a post I have on the Speech Disorders board on Ivillage http:/messageboards.ivillage.com/iv-ppspeechdel on fish oil basics.? Here it is:

Anecdotally, giving fish oil supplements (plus vitamin E supplements) to children with apraxia has resulted in a dramatic improvement in speech ability within a very short period of time (days) to a very high percentage of children. I first learned of this treatment at the Yahoo group childrensapraxianet, and I would encourage you to join there if your child has apraxia and/or you are interested in more information about fish oil, or any other, supplements that may be beneficial for children with apraxia. After starting fish oil with my son with apraxia, I saw an amazing improvement in my son, both in his articulation and his attention span. The improvement in his attention span was a pleasant surprise, and it helped make his therapy sessions more productive.

As a result, my PROMPT trained SLP has gotten all of her clients on fish oil, and has seen improvement in all. Interestingly enough, if I ever get lazy and forget to give him his morning dosage for a few days, I see a regression in the clarity of his speech. So I know, without doubt, that it’s the fish oil that’s clearing up his articulation.Anyway, on to the basics. Most people using the supplements use Nordic Naturals brand, as the oil is taken from a safe, clean, part of the fish, and it is lemon flavored, so not so offensive to our children.

It also seems to have the combination of essential fats that are most effective in children with apraxia. They use the Complete Omega 3-6-9 (adult strength), and start with 1 capsule a day (you pierce the capsule with something sharp and squeeze the oil out), mixed into pudding or yogurt or applesauce or something the child will eat. Expect to see some improvement within 3 days, and then more gradual improvement over the next few weeks. I personally recommend you not increase the dose until 4 weeks has passed, as it oftentimes takes that period of time to see the full effects of the oil.

Keep in mind that some children do have temporary side effects to the oil, which will appear at each increase. One is loose stools — if this occurs, introduce the oil as gradually as you can. You child’s body should be able to adjust within a week. The other side effect is irritability, restlessness, sleeplessness. This too should go away within a week if you just stick it out, although it’s important to note that for some children, it doesn’t.

It was also discovered that giving one 400 IU Vitamin E capsule a day increased the absorption of the Omegas. Make sure it’s natural vitamin E, and not synthetic — you can tell the difference by reading the label: d-alpha tocopherols is natural; dl-alpha tocopherols is not. So that is also recommended along with the fish oil.

The Yahoo group has much more information on the fish oil and vitamin E, including more specifics about the particular kind of Vitamin E you might want to look for. Please feel free to join there and browse their archives.

Please keep in mind that while fish oil “works” for a high percentage of children with apraxia, it doesn’t work for all. But in my opinion, as well as my pediatrician’s, it doesn’t hurt to try it. But as with most things, please talk with your pediatrician before starting any supplements.

Edited to add another great resource at this link:

http://www.cafemom.com/journals/read/1219104/Fish_Oil_Journeys_Our_Experience_and_My_Research_into_DHA_Omega_3

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