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.

How can I help my little guy learn to say both syllables in a new word?

Rather than reinvent the wheel, here’s an excerpt from FUNctional Phonology with the best technique I know to help a child when he’s struggling to include both parts of a word.

However…

there are a couple of skills a child needs to be able to do before this strategy is effective.

First of all, he must be imitating pretty well… as in imitating most of the time when you cue a word. I define most of the time as 7 or 8 times out of 10 tries. If a child can’t do that yet, work on frequent imitating first. (There’s a tip for this at the bottom of this post!)

Secondly, a child must be able to produce two syllables in a word. So… if a child can’t already say words with reduplicated syllables like Mama, Dada, or bye-bye, he won’t be able to produce words with two different sounding syllables. Doesn’t that make sense? Work on those kinds of words first because they are easier and will help a child master what SLPs refer to as syllableness. (It’s actually priority pattern #1 for toddlers who are difficult to understand. Read more about that in FUNctional Phonology.)

If a child can do those two things, THEN (and only then!) are you ready for this next strategy…

A technique called backward chaining can help a child learn to include the second syllable in a word. In this strategy, have him imitate the last syllable of the word several times, and then “chain” the first syllable to produce the entire word. The key to this entire process is speed. Proceed very quickly to build momentum and automaticity so that a child says both syllables.

Using the words “bubble” and “open,” here’s how teaching each word using backward chaining sounds:

Bubble

You: Say “bul.”

Child: “Bul.” (Or “buh” or however he tries to say it, as long as he’s producing some kind of vowel sound.)

You: Say “bul.”

Child: “Bul.”

You: “Bul.”

Child: “Bul.”

You: Bubble.

Child: Bubble. (Or “buh-buh” or any other variation with two syllables.)

Open

You: Say “pen.”

Child: “Pen.” (Or “puh” or however he tries to say it, as long as he’s producing some kind of vowel sound.)

You: Say “pen.”

Child: “Pen.”

You: “Pen.”

Child: “Pen.”

You: “O-pen.”

Child: “Open.”

If a child doesn’t imitate your models after several attempts, back up and work on helping him learn to imitate a single word more easily. Play imitation games with words he already says pretty well and go very quickly. For example, if he already says “ball,” have him imitate that word several times in a row. Play these little games frequently with a few different words to build momentum and success, and then sneak in a two-syllable word to help him move into imitating two-syllable words.

For more fantastic tips like this, check out my therapy manual FUNctional Phonology. It’s LOADED with “tricks” to help toddlers achieve better intelligibility!

Laura

The post Backward Chaining… A Fantastic “Trick” for Helping a Toddler Learn Multisyllabic Words appeared first on teachmetotalk.com.

Here’s a sample from the TREATMENT section of my therapy manual FUNctional Phonology. Final consonants are the 6th priority for improving speech intelligibility in toddlers. (If you want to know the other 5 priorities that come first, check out the manual!)

INITIAL TREATMENT TIPS FOR FINAL CONSONANTS

Get yourself a good starting point to ensure early success! For most toddlers, begin with either nasal sounds /m/ or /n/ or unvoiced consonant sounds /p, t, k/ since those are easier.

Resist working on voiced final sounds like /b, d, g/ because toddlers tend to add an extra vowel such as “bed-uh” as they emphasize the sound. If you wait until a child has mastered voiceless and nasal sounds, many times voiced sounds will emerge without any focused effort from an adult.

1. Target this pattern in the most relaxed, fun way by introducing exclamatory words in context. Don’t just practice a word list if there are other options—remember that toddlers learn best by doing! Include the words in play routines in context. My favorite exclamatory words for this goal are “yum” or “mmmm” as we eat snack foods and “boom,” “beep,” “bam,” “peep,” and “toot” as we play with vehicles and throw balls in a ball pit or against a wall.

2. Select words with the same initial and final consonants to make including final sounds as easy as possible. Introduce familiar words for toddlers in context rather than practicing nonsense syllables that have no functional use in everyday life. Here are some ideas to get you started:

/m/ mom, ma’m

/n/ none, noon, nine, nun

/p/ pop, poop, peep

/t/ tot, toot

/k/ kick, cook, cake, Coke

Granted, some of these words are a little difficult to practice with toddlers because there aren’t as many activity options, but this just means you should focus on the words that are easier to include in everyday activities. Here are my favorites:

“Mom” is a super functional word for toddlers and if you practice it in a new context, it’s even more fun! I like to teach “Mom” to a toddler almost like an eye roll, by having Mom do silly things a toddler will recognize like putting a hat on her knee, putting a shoe on her hand, putting a sock on her head, etc.

“Pop” is another easy word to target as you play with bubbles, popping bubble wrap by stomping on it or by popping with your fingers, and balloons if you can stand the noise as you pop the balloon. Popcorn is always a popular snack for older toddlers and preschoolers with mature chewing patterns and no other feeding issues.

“Poop” is a hysterical word for many toddlers. Potty training is a primary activity for his age group, so parents should have no difficulty including this word during everyday activities.

“Tot” is a great word for establishing this pattern. I’ve had several little friends add tater tots as a new food when we practice this word—albeit not the healthiest choice!

“Toot” is fun for a boat sound. Play with several boats in the water for a longer play routine with toddlers. If a child is stimulable for “toot,” practice with direct imitation until a child is consistent, then start asking, “What does the boat say?” and giving them a boat to reward their production of “toot.”

“Cook” and “Cake” are fun target words for pretend cooking with a toy microwave, another kitchen set, or when you’re playing with Play-Doh.

These ideas work! The word lists work too because they’re selected for 3 factors:

Familiarity – These are words toddlers probably hear often at home.

Functionality – These are words that a toddler needs to be able to say and and use during everyday routines.

Phonetic Complexity – These words are easier for toddlers to pronounce.

Get your own copy of FUNctional Phonology! You’ll find TONS of activity ideas and word lists to help you improve a toddler’s speech!

The post INITIAL TREATMENT TIPS FOR FINAL CONSONANTS appeared first on teachmetotalk.com.

Well… I’ll admit, I tried that too, and then I finally figured out a better way!

In my own clinical practice, I’ve come to rely on seven factors when deciding if it’s appropriate to begin to focus on speech intelligibility with a toddler or preschooler.

Child’s Age

Language Skills – especially receptive language or how a child understands the words he hears.

Social Interaction Skills

Attention Span

Play Skills

Imitation Abilities

And lastly, but most importantly,

The Impact of Intelligibility on a Child’s Everyday Life

In my new therapy manual FUNctional Phonology, I discuss exactly why each of these factors is necessary to consider before we begin to focus on a toddler’s speech intelligibility.

Beyond that, I also provide a general guideline for each factor. If a child meets this guideline, we know that he is probably ready to work on speech intelligibility. If he does not meet the guideline, we should help him get ready! I won’t leave you hanging… suggestions for how to do that are also provided!

Pre-Order your copy today! I know it’s going to make a huge difference for you, just like it has me!

Special pricing at $40. (Regular price $48)

Shipping for this first run begins on November 15.

Don’t miss it… we’re selling out fast!!

Laura

teachmetotalk.com

The post Ready or Not? Targeting Speech Intelligibility in Toddlers appeared first on teachmetotalk.com.

Do you need help working with a late-talking toddler who is also unintelligible?

I have a great tool for you!

It’s my therapy manual Functional Phonology and it’s filled with practical information to help you address speech intelligibility in toddlers.

You can’t address a toddler’s articulation skills with methods recommended for older kids without some tweaks! Let me show you how to modify what you do so that you can be more effective.

If you’re a parent and aren’t sure HOW to cue a child to change the way he pronounces words, then this therapy manual is definitely for you!

For therapists, the best part is learning how to teach parents what to do at home. All this information lines up perfectly with a parent coaching model. You’re telling parents, “This is what you can do during your everyday routines at home to help improve your child’s ability to be understood.” You’ll also get lots of other tools too- checklists for deciding who is and who is not ready to work on articulation (best for helping justify your decision to eager families!), a form to help you prioritize your first therapy goals, cheat sheets for how to cue consonant AND vowel sounds, plus TONS of developmentally appropriate therapy activities that work in clinic, preschool, and home settings.

Order here.

Regular price is $48.

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MY NEW ARTIC THERAPY MANUAL FOR TODDLERS IS READY!

It’s called…

FUNctional Phonology: A Language-Based Approach for Treating Speech Intelligibility Problems in Very Young Children

I’ll be posting additional information in the next few days, but for now, I want to give you a sneak peak.

The subtitle of this therapy manual should really be…

“I don’t like to focus on articulation with toddlers, but when I do, here’s what works best.”

If you’ve followed my work for any length of time, you know that I’m a self-described “language-language-language” therapist. I will ALWAYS believe that WHAT a toddler says is much more important than HOW he says it.

But…

Clearly, there are times when we should address speech intelligibility in toddlers.

That’s what this therapy manual is all about… helping you know who’s ready to work on speech intelligibility, who’s not, what to do to get them ready, and then finally, what to work on and how to work on it. Whew! That’s a mouthful, but it’s the summary of the manual.

This program is based on teaching (correcting!) early phonological patterns – which is how speech develops in toddlers – but it’s also language-based meaning that your target words are completely relevant and functional for toddlers – not random words that fit the speech sound or pattern but provide no “real life” application for 2 and 3 year olds!

You’ll also notice the word FUN capitalized in the title. I won’t do anything with a little friend that’s not fun! Let’s face it… working on changing how a young child says a word can be t.o.r.t.u.r.e for everyone involved. To combat that problem, I’ll give you play-based therapy activities as well as practical ways (and words!) to use during everyday routines for families at home… It’s SUPER FUNCTIONAL.

Here’s the outline from the Table of Contents with a brief description of what you’ll find in each chapter:

Chapter 1… Is There a Problem?

Red Flags That Indicate a Significant Speech Intelligibility Problem in Toddlers

Chapter 2… Guidelines to Determine Readiness… To Treat or Not to Treat?

Learn the 7 factors that tell you when a child is developmentally ready to target speech intelligibility and when he’s not. You’ll also find recommendations for how to proceed when a toddler is not ready yet. I’ve included a great checklist to use with families, especially useful when parents are pushing you to address artic goals when you know there are other things that you should address first.

Chapter 3… Prioritize Your Goals

Read an overview of the 6 Priority Patterns to Increase Speech Intelligibility in Toddlers. I’ve tweaked these patterns based on newer research. You’ll also get another great yes/no checklist to help you informally assess a toddler’s status with each of the priorities so that you can easily determine your goals and share your clinical decision-making process with parents.

Chapter 4… Principles for Designing Sessions for Toddlers

Essential tips for achieving success with toddlers while working on speech intelligibility including how to:

1. Keep it Fun!
2. Keep it Real!
3. Keep it Realistic!
4. Keep it Meaningful!
5. Keep it Moving!
6. Keep it Easy (Enough)!
7. Keep it Going! Involving Families, Teachers, and Other Important People

Chapter 5… Tips for Teaching Toddlers New Sounds, Patterns, and Words

Fantastic “how to” information for parents and for therapists! You can’t use the same methods for treating artic in toddlers as you do with older kids. Learn some tricks that work!

Chapter 6… Treatment Strategies and Activities to Target The 6 Priority Patterns

Here’s the THE MEAT of the MANUAL! You’ll get:

• A description of each of the six patterns you’ll target and why it’s important for improving intelligibility
• A list of my BEST treatment tips to get you started as you begin to teach a toddler the new pattern
• Potential word lists for each priority beginning with a list of First Targets that are the easiest to produce and (hopefully!) the most relevant and functional for a toddler. By easiest, I mean that the word contains sounds in the most facilitative contexts for success. You’ll get next sets of words containing the pattern in more difficult contexts too so that you can “bump up” kids who are ready
• An entire section of activity ideas that have worked well with toddlers over the years in my own practice. Activities are organized into Moving Around and Sitting Down options to help you implement my “Move – Sit – Move – Sit” philosophy. This is a critical piece between success and failure during sessions with toddlers.
• EASY ideas for targeting the pattern during everyday routines at home. Therapists can use these recommendations to share with parents as “homework” between sessions. Parents can get this information directly to work on speech all day, every day.
• To wrap up this chapter, there’s a section on Troubleshooting with ideas to try when the initial recommendations are not working.

Chapter 7… What is This? Diagnostic Information for Speech Intelligibility Issues in Toddlers

Get information related to the 5 main diagnoses that result in unintelligible speech including speech delay, phonological disorder, dysarthria, childhood apraxia of speech, and lastly, some information about autism and speech intelligibility. This section will help clear the murkiness that occurs when we try to sort out a firm diagnosis in a very young child who is not easily understood.

I am thrilled to release this book! I’ve worked on it since 2012 and it’s finally, finally, finally ready to go… woo hoo!

Order here.

Laura

The post My New Artic Book for Toddlers is Finally Here! appeared first on teachmetotalk.com.

What’s Normal and What’s Not for Speech Intelligibility in Toddlers

Even toddlers who are typically developing can be difficult to understand! Almost every child uses sound substitutions or their own pronunciations. Learn what’s normal and what’s not with percentages of intelligibility and when specific sounds emerge in toddlers by age range. For example, a 24-month old with normal speech sound development uses 6 to 8 different consonant sounds in the initial position in single words.

You’ll hear “evidence-based practice” with a list of red flags for articulation skills in toddlers. This information tells us when researchers have found that we should work on speech sounds with very young children.

Listen to the show at this link or on iTunes for FREE!

Want to hear more?

This information is from a section of my course Early Speech-Language Development: Taking Theory to the Floor. CE credit is available for this 12 hour course on DVD.  Right now it’s on sale for 20% off when you use the coupon code 20off. This offer is valid July 2017. If you’re listening after this date and need a current coupon code, email me at Laura@teachmetotalk.com and I can help!

The post #316 Treating Speech Intelligibility in Toddlers 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.

A Cycles Therapy approach exposes young children to speech sounds they don’t currently use in word approximations. Dawn feels that this fast-paced patterns approach (vs. targeting one sound at a time) with non-sense syllables helps even very young children generalize new sounds/patterns more quickly than a traditional articulation approach where a single consonant sound is targeted in isolation, then moved to syllables, then moved to words, etc…

In the show she outlined the assessment and treatment sequence she uses for the early developing consonant sounds and patterns and then ended the show talking about more difficult combinations like /s/ blends and even (get this…) later developing consonants /l/ and /r/. For someone with a name like LAURA, that’s good news : )

Listen here:

Dawn’s website is www.expressionsspeech.com. You’ll find outlines of her treatment approach in the Therapy Documents section. She’s currently tweaking her Modified Cycles for Toddlers, but hopes to add that outline very soon.

***Please also note that Dawn’s approach with Modified Cycles for Toddlers may or may not be consistent with other SLPs who study and recommend a similar treatment protocol for young children with phonological disorders. Several SLPs have produced bodies of work with different applications based on the same theory using Dr. Barbara Hodson’s original work in Targeting Unintelligible Speech in Children. ***

The post Podcast for Using a Modified Cycles Approach for Toddlers appeared first on teachmetotalk.com.

If this is your first visit, I’d like to tell you how I recommend “first timers” navigate the site because I have TONS of info on here that may not be apparent to you with your first click!

The site is organized in chronological order with the newest entries listed first here on the home page below the green banner.

However, lots of my best information is in the older articles and most of those articles are listed by category in the BLOG section. Click BLOG for a drop down list and choose the topic that most interests you. Once you’ve clicked on that section, you’ll see articles beginning with the most recent. I started this website in 2008 so there are hundreds of posts. You may want to scroll down to the bottom of the page and hit “next page” until you’re all the way back to the beginning of so that you can read those detailed “how to” posts first. I wrote lots and lots and lots of those kinds of posts in 2008 and 2009. The information is still EXCELLENT for parents as well as professionals. If you’re looking for in-depth information, start there!

Another category I’d like to tell you about is in VIDEOS. I have over 35 short (most are less than 10 to 15 minutes) videos here for free in my Therapy Tip of the Week series. You can also watch those on teachmetotalk.com’s  youtube channel. Most of the videos are ideas for a particular toy or activity. I walk you through how to work with toddlers and young preschoolers with language delays and provide suggestions for goals for each issue you might be working on at home or in therapy.

In 2008 I started a podcast where I host a weekly show about topics related to late talking toddlers. I used to do the show with a co-host and you can still hear those, but now I have guests or it’s just me! The podcast has thousands of listeners, both parents of children with developmental delays and professionals who work with young children with language delays. Scroll through the podcasts until you find show titles that are most applicable for your situation. You may also want to subscribe to the podcast on iTunes and listen from your smart phone or another device.

If you’re looking for resources, I’ve developed a whole line of DVD and therapy manuals to help parents and early intervention therapists. Click here for more information about those products.

If you haven’t signed up for my free eBook, do it now! It’s full of information, particularly for parents who are just beginning to search for answers. You’ll also receive updates and special offers when you subscribe including a coupon code for a nice discount on any teachmetotalk.com product.

Thanks for stopping by, and I hope you find what you’re looking for to help your baby! If not, leave me a comment with your questions, and I’ll try to point you in the right direction.

Laura

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More information about Laura

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Limited consonant sound use results in unintelligible speech and often indicates a motor speech disorder (apraxia) or phonological disorder. Check out these norms and the list of “red flags” which indicate that speech therapy is likely needed to help your child learn to be understood.

By 18 months 

Child produces 3 to 6 different consonant sounds with each child having a little different consonant inventory.

By 24 months 

Initial Sounds – /p, b, m, t, n, d, h, k, g/

Final Sounds – /p, m, n/

Produces Most Vowel Sounds Correctly and at least 6-8 different consonant sounds.

By 28 months 

Initial Sounds  /d, f,  and y/

Final Sounds – /s, d, k, f/ and n /

By 32 months 

Initial Sounds – /w/

Final Sounds – /t, b, r/

By 36 months 

Initial Sounds – /s/

Final Sounds – /l, g/ and /er/ endings

Child uses at least 9-12 different consonant sounds.

By 40 months 

Initial Sounds – /l, r/

Some consonant blends  bl, br, tr

Final Sounds  /v/ and sh

By 44 months 

Initial Sounds sh and ch and fl

Final Sounds ch

By 48 months 

Initial  sp, st, kl

After 48 months 

Initial – /z, v/ and j and th

Final – /z/ and th and j

RED FLAGS for CHILD’S ARTICULATION SKILLS that warrant a referral to a speech-language pathologist for evaluation. (Stoel-Gammon 1994).

Numerous Vowel Errors –

 Most children have mastered nearly all vowel sounds by age 2. Some errors are still acceptable are age 2, but by age 3, all vowels be mastered (with exception of /r/ vowels).

 Widespread Deletion of Initial Consonants

 By 2 a child should use at least 3 to 4 different consonant sounds at the beginnings of words.

 By 3 a child should have a large repertoire of initial consonants.

 Substitution of Back Consonants /k/ and /g/ or /h/ for a variety of Consonants

 This is atypical phonological development and should be targeted even in very young children.

 Deletion of Final Consonants after age 3

 By 24 months in language delayed children some final consonant deletions are expected, but by 36 months, all children should be producing words with ending consonant sounds.

Again there is variation in individual children, but for the most part, parents should understand close to all of what a child says by age 3, and strangers should understand all of what a child says by age 4, even if errors are still present.

For more information about how to treat speech sound disorders, check out my DVD Teach Me To Talk with Apraxia and Phonological Disorders. Here’s the link –

https://teachmetotalk.com/2009/08/21/teach-me-to-talk-with-apraxia-and-phonological-disorders-dvd-now-available/

I also want to share with you a FANTASTIC quick resource for practically all Communication Milestones in young children from Linguisystems. It’s evidence based and a it’s FREE download. I use my hard copy all the time! You have to become a member of Linguisystems first, but you can get the online version here:

Communication Milestones 

The post Speech Sound Development 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.

There’s a whole lot of research in the past few years that tell us that oral motor exercises DON’T work to help children learn to speak more clearly. Before all of you get fired up and start a campaign to write in to tell me how crazy I am, let’s take a look at what science says………..

In his ASHA presentation in November 2006, Dr. Gregory Lof, a PhD level speech-language pathologist from MGH Institute of Health Professions in Boston, titled his work, “Logic, Theory and Evidence Against the Use of Non-Speech Oral Motor Exercises to Change Speech Sound Productions.”

In real words – he’s saying that common sense tells you that these exercises don’t work to make children speak more clearly, and then he cites a whole bunch of scientific studies that back him up.

For those of you who are really confused, he’s defined “non-speech oral motor exercises” as “any technique that does not require the child to produce a speech sound but is used to influence the development of speaking abilities” and “a collection of non-speech methods and procedures that claim to influence tongue, lip, and jaw resting postures, increase strength, improve muscle tone, facilitate range of motion, and develop muscle control.”

Again, but in English please! He’s talking about all of those mouth “exercises” or “games” that SLPs tell you to do including blowing, tongue push ups, pucker-smile, tongue wags, big smile, tongue to nose to chin, cheek puffing, blowing kisses, and tongue curling.

Basically, he’s saying any “game” or “exercise” that you have your child do that DOES NOT INVOLVE him making a speech sound is not going to help him learn to talk. This means that all the blowing, sucking, tongue exercises, and lip games you’ve been doing will not do one bit of good when it comes to helping him produce clearer speech. OUCH!

Now I can’t say that I’m an SLP who has over-relied on this kind of stuff. I’m a talker, and I push functional communication whether it be with signs or words in play practically every minute of the time I provide direct treatment to a child. I hardly spend any time doing oral motor stuff in sessions because, frankly, I feel like my time is better spent doing “REAL” therapy stuff, and in my opinion, that’s language-language-language.

I do not write goals that say, “Johnny will perform 10-15 repetitions of oral motor exercises to improve strength and coordination for intelligible speech.” I do not make claims that these kinds of activities will “improve muscle tone,” but I know lots of SLPs who do and who base their whole treatment plan around these kinds of goals and strategies for non-verbal children and for children who are struggling with speech intelligibility.

I’d like to say that I haven’t done lots of oral motor activities in sessions because it didn’t make sense to me clinically. But the truth is, it’s because I hadn’t found a way to make them fun enough to do on a consistent basis or for any length of time. Because of this, it never really felt right or worth pursuing for me, or especially for a kid.

Besides – have you ever really tried to get a 2 or 3 year old to do these kinds of things for more than a minute or two? You might have an initial novel period where they sit with you and try to do it, but unless you make it super fun and whacky, I’ve found it wasn’t successful for very long. It’s usually pretty hard for them to do, and again, it’s usually pretty boring.

BUT I have routinely recommended, out of some kind of SLP obligation, at least in my initial assessments, that mom and dad do these kinds of things with my little clients as part of “homework.” I have even recommended these kinds of things for kids without low muscle tone or who don’t have sensory issues that are negatively affecting feeding. Why? Because it’s somehow ingrained in how we’ve been trained as SLPs. There are whole catalogues, entire textbooks, countless treatment manuals, and week-end long continuing education courses devoted to telling us how effective these are and how to do these.

As a matter of fact, Dr. Lof cited that 85% of SLPs in America who were surveyed said they use non-speech oral motor exercises to change speech sound production. Results were the same for Canadian SLPs. He cited other interesting statistics including the most frequently used exercises, the reported benefits, and the diagnoses of children when these kinds of exercises were used.

I will tell you that every “diagnosis” for kids I see were on that list including dysarthria (which is unintelligible speech due to low muscle tone), childhood apraxia of speech, structural anomalies (probably cleft lip/palate but not specified), Down Syndrome, enrollment in early intervention, late talker diagnosis, phonological impairment, hearing impairment, and functional misarticulations (meaning sound substitutions). This tells us that MOST SLPs are recommending this kind of task for MOST clients that they see – even toddlers enrolled in early intervention programs.

His conclusion, again based on a number of studies, was that it’s not appropriate for any of them. Double OUCH!

Again, I don’t feel too badly on a personal level since I haven’t used them all that much, but I feel super sad about all of the therapists who have and mostly for the moms they’ve convinced to try to do it.

In this presentation, he also dissected most arguments for using oral motor exercises including that children must first learn to produce isolated movements before they can use a speech sound, that you have to build up articulatory strength when a child has low tone, that these exercises “warm up” the mouth before talking, and that you have to have adequate coordination in non-speech exercises before you talk. He debunked every one of these very persuasive arguments for non-speech exercises with 10 different studies that prove otherwise. His conclusion was that no research supports the use of these for any reason when improving speech is the goal. Triple?OUCH!

His bottom line was this –

“If clinicians want speech to improve, they must work on speech, and not on things that LOOK like they are working on speech.” (GOOD! To learn to talk, you must focus on talking and not blowing, wagging, puffing, etc…!)

“Phonetic placement cues that have been used in traditional speech therapy are NOT the same as non-speech oral motor exercises.” (GOOD! This means you can and should still give your child verbal, visual, and tactile cues about placement of his tongue or lips to help him make a speech sound correctly. The difference here is that you’re actually working on SPEECH and not just a movement.)

“Non-speech Oral Motor Exercises are a procedure and not a goal. The goal of speech therapy is NOT to produce a tongue wag, to have strong articulators, to puff out the cheeks, etc… Rather the goal is to produce intelligible speech.” (GOOD! Goals must have speech and language outcomes. That’s a big duh to me, but again, these never made much sense to me anyway.)

“Speech is special and unlike other motor movements.” (GOOD! He means that using these kinds of exercises to improve feeding do not necessarily correlate to the same movements needed for speech. He cites studies that prove that same function/same structure argument doesn’t hold water. He also means that working on a particular oral exercise like lifting your tongue up and down 10 times in a row may not translate into a kid being able to lift up his tongue to produce a sound like /l/ when saying a word or in a phrase. No kiddin’! I gave up that kind of assumption early into my?2nd year of work when this rarely produced results!)

This last one really gives a kick in the seat of the pants to SLPs who depend on oral motor exercises as a staple in their treatment plans –

“Following the guidelines of evidence-based practice, evidence needs to guild treatment decisions.” (Here’s his parting blow – ) “PARENTS NEED TO BE INFORMED THAT NON-SPEECH ORAL MOTOR EXERCISES HAVE NOT BEEN SHOWN TO BE EFFECTIVE AND THEIR USE MUST BE CONSIDERED EXPERIMENTAL.” (Emphasis was mine, not his.)

My bottom line is this – I won’t be recommending or doing these in therapy anymore for kids whose focus is speech and language, and now not just because young children?don’t like them and won’t do them,?but because science tells me not to bother. Whew! Laura

Here’s the original article’s reference for those of you who want to read it yourself –

http://www.speech-language-therapy.com/Lof-2006-ASHA-06-Handout.pdf

Other articles from experts who’ve looked at the same issues & reached the same conclusion –

Caroline Bowen – http://www.speech-language-therapy.com/cb-oct2005OMT-ACQ.pdf

From the Apraxia Kids Site –

http://www.apraxia-kids.org/site/c.chKMI0PIIsE/b.980831/apps/s/content.asp?ct=464461

In the spirit of fairness, here are?articles that?disagree with Dr. Lof’s findings –

http://www.speech-language-therapy.com/oral-motor-TT-bathel.pdf

http://www.speech-language-therapy.com/williamsetalACQ2006.pdf

One more thing – Another SLP also cited Dr. Lof’s article and arrived at this conclusion which I also agree with –

“Oral Motor therapy does have its uses. While it is ineffective for improving speech production it is effective for treating many issues related to feeding. And that is an important distinction. If your child is drooling, or unable to move food around with his tongue and chew, Oral Motor Therapy can be very effective if provided by a competent therapist.”http://www.speechlanguagefeeding.com/Newsletter.html

The post Oral Motor Exercises to Help Speech in Toddlers and Preschoolers – Why Science Says They Don’t Work appeared first on teachmetotalk.com.

This is a mom who’s poured out her blood, sweat, and tears over the last several months to do anything she can to pull him into interacting with her, and now that he is, she’s elated. But…. she still doesn’t hear that magical word, that word we all wait with baited breath to hear from our sweet, little babies – “Mama.”

On our show today, we gave Annette a couple of different ways to work on how to help him learn to call her Mama, but before we get into that, let’s review what could be going on. (Let me say that I didn’t explore all of these with Annette on air, and I haven’t had the pleasure of meeting her cute little boy, so I don’t know with any certainty why her particular son isn’t doing this yet.) However, it is not uncommon for children with language delays to struggle with learning to say “Mama” for several different reasons. I’m going to discuss the possibilities of why he’s not doing it yet, and hopefully give you some ideas so that you can work on these at home with your child who may not yet be saying this wonderful word.

Possibility #1 -Conceptually the child has not made the connection between this particular word and his actual mother.

Sometimes it’s because this word has not been presented to him in the same way that he learns all of his other words. Since his mother is likely doing most of the teaching, it’s hard for her to label herself in a way that makes sense to him. When she’s teaching him names for other things, she’s repeating the word many times, holding up the object, or pointing to it so he gets what she’s talking about. She may even have him “ask” for it so that she knows he’s made the connection between the word and the actual object or event. This is kinda’ hard to do with yourself! Even though a mother is likely saying “mama” in context all day long (“Give it to Mama.” “Do you want Mama?” “Where’s Mama – Here I am!”), it’s just not the same for him as when his primary language labeler says it, shows it, and does it in the way that she teaches everything else.

Solution – Use very specific activities to teach him to conceptualize or learn this as your label/name. Ideas you can try at home.

1.Play the “Mama “game.

Just like you’ve tried to teach him “Dada” or any other name by constantly labeling that person, you’re going to have to get someone to play with you to label you as “Mama” and then you’re going to have to reinforce him using “Mama” in the most powerful way you can.

The most success I’ve had with this is by placing the child in a confined area, say the crib, or behind a gate, or in a room with a closed door and me. Mom hides outside the room, behind the door, or bends down below the crib so that the child can’t see her. Then I model calling, “Mama. Mama. Maaaaaaamaaaaaaaaa” several times using an exaggerated, playful, and animated tone of voice.I can’t stress how FUN and ‘over the top’ you need to be when you’re playing this game. Coach the other person to increase their affect if they’re not being as excited as they should be.   Cup your hands on either side of your mouth too so that a child attends to your mouth and the act of “calling.” Sometimes we’ll see a child begin to copy that action before we actually hear the word and that’s great progress! He understands what you’re doing and this tells you the game is working and to keep practicing!

After calling for mom in this way several times, Mama excitedly jumps out from her hiding place with a big smile and shouts,”Mama! Here’s Mama! Mama!” We all laugh and smile and hug and tickle so that it’s very clear that this is a fun game that we all want to play again. Then we play it again. And again. And again, until I think he’s ready to begin to try to imitate “Mama” when I model this. If he even hints that he’s trying to say this on his own, I ask Mom to pop up with the biggest reaction she can muster so that he links his action (saying the word) with her return.

Older siblings are GREAT at playing this game with mom and younger brothers and sisters. The act of having someone else “call” you and label you as “mama” sometimes helps a child solidfy this concept. If you have no other children, then have Dad, grandma, your sitter or even a neighbor come in to help you teach your child this fun game. Don’t try to do it alone. Having another person call you “mama” is what makes this game work.

2. Play the “name” game for everyone at home.

I usually recommend that families do this at dinner or at another time when everyone in your family is seated and isn’t distracted. (Meaning no TV or other playful activity going on!) Start with the “name” your child most easily understands or says and ask, “Where’s ______?” Build up the anticipation by asking it several times. Hold your hands out and look around expectantly. Wait for your child to look at the person, point, say the name himself, or somehow indicate where the person is. Even if he doesn’t, have everyone else excitedly point, look, and shout the person’s name. Have the person named say their name, such as “Dada!” or “Sissy!” That person should also hold up their arms or clap or do something to indicate that he or she is the person named. Laugh, giggle, smile, hug, and make this a total riot for your toddler.Repeat it for every member of your family, but especially have someone else ask, “Where’s Mama!” so he doesn’t hear that label from you.

Possibility #2 – The child is a visual learner and needs a new method of presentation for this word to make sense and “sink in.”

Some kids learn almost everything they know visually, by seeing it, and not auditorily, just from hearing it. That’s what makes it so difficult for kids like this to learn language since language is an auditory communication system. These are the kids who like to look at pictures in books, and these are the kids who LOVE screens (like apps on your phone, a DVD, TV) and videos. Use this to your advantage.

Solution – Teach him “Mama” in the way he learns.

1. Make a”Mama Video.”

Get your husband, partner, boyfriend, a grandparent, an older sibling, your best friend, or ANYONE to come and shoot some footage of you in some very focused and specifc activities I’ll teach you below so your child can learn to label you as “Mama.” This has been a huge success every time I’ve used it. This is so easy now with smart phones!

Try to shoot the beginning shots with as plain a background as possible. Try to look as “normal” as possible too. If you usually wear sweat pants and have your hair in a pony tail, don’t doll up for this movie. Your kid may not recognize you!

Begin by standing right there in living color, looking right into the camera and saying “Mama.” Smile. Pause. Say “Mama” again. Wave. Say “Mama” again. Blow kisses or do any other action your child might associate with you. Say Mama in this way 5 or 6 different times with huge pauses in between so that your child can begin to imitate and say “mama” himself during these pauses. Then have your person behind the camera say it a few times in imitation of you, or after you say “Mama” again several times. This will help your child begin to imitate this word.

After 4 or 5 rounds of saying “Mama” in this way with waving or blowing kisses or some other simple action your child will recognize this, turn the camera off and reposition yourself behind a door or couch or counter. Then have the person who is videoing you turn the camera back on focused on your hiding place. Have that person ask, “Where’s Mama? Where’s Mama? Mama! Mama?” Jump out from behind the obstacle in a very animated and playful way and say, “Mama” with as much warmth and excitement as you can muster. Again have your camera person say, “Mama! Here’s Mama! Mama!” Repeat this several different times in several different locations. Don’t forget to use pauses so that your child can being to imitate the word “mama” at the appropriate times.

Sometimes families have added other statements such as, “There she is!” or “Hi Mama!” But I think it’s most effective to limit the word to “Mama” so that there’s no doubt what you want your child to learn to say.

You can repeat this with other family members too. But again, if saying “Mama” is the goal, don’t make it more complicated than it needs to be!

Once your child can do this, move on to the Mama games listed above in #1 or reenact some of your “hiding” places from the video in real-life too. So if you’ve hidden behind the pantry door in your Mama video, when your child is in the kitchen, hide behind the pantry door and call yourself to play this game in real time.

2. Make a “Mama” album.

If your child likes to scroll through your phone or the iPad, make an album of pictures you so that he sees you. The key is, you MUST scroll through the pictures with him saying, “Mama!” several times for each picture. He can’t just look at the pictures by himself – there’s no language with that activity! He must hear the word “Mama” as he sees the pictures to make this effective. You have to purposefully point too and label the pictures by saying “Mama” over and over again, not just 2 or 3 times. Get an older sibling or your sitter or Dad or other important people to repeat this activity with your child too. Try to use this activity during times when he wants your phone and doesn’t want to do other things such as when you’re waiting in line somewhere or anytime you’re sitting with him and can talk to him in the way I’ve recommended.

For kids who love books, make your very own Mama photo album. Have someone take lots of current pictures of you. You’ll need new ones, not ones from 20 pounds ago, or when your hair was longer or blonder, or any other pre-mom photos since we all know how different you look now that you’re sleep-deprived and exhausted from chasing a toddler! It used to be really hard for moms to come up with several pictures since we are usually the ones behind the camera, but with the invention of “selfies” any mom can take your own picture right now with your phone! Take several new ones, and again in your “normal” everyday Mom attire. If someone else is taking the pictures for you, get close ups of your face with few background distractions.

Print the pictures. Buy a small, cheap album from the Dollar store and place the pictures inside. Don’t spend lots of money on the album or buy a nice one that you’ll use as a keepsake, because my hope is that your child will love it so much that he’s going to want to carry it around with him all of the time. You’ll be less likely to let him do it if it’s expensive or pretty, and you’ll find yourself getting too upset if he tears it, chews it,whirls it at the dog, or flips the pictures with his dirty, little hands. Help him look at it and say “Mama” about 150 times with as few other words as you can force yourself to do. Point to yourself. Say the word “mama” again and wait, wait, wait for him to say it back to you. Introduce the book at times when he is calm and ready to look at it for more than a few seconds. Right before nap or bedtime is a good idea, or when he’s strapped into his car seat, or sitting in the waiting room at the pediatrician’s office when you need a quiet activity. Don’t forget to have the other important people your life look at his book too and label “Mama.” Be sure to teach them not to say very many other words in the beginning since your main goal for this book is teaching him to say, “Mama.”

Possibility #3 -For whatever reason, he can’t say the sound /m/ and/or sequence the /m/ sound with a vowel yet to form the word “Mama.”

This could be a physiological issue – he has low muscle tone so he can’t get his lips consistently closed to form the speech sound /m/. (Look for lip closure at other times. It actually takes very little lip “strength” to close your lips to produce an intelligible /m/ sound, so if he can perform this movement when he’s not talking, low tone is not a significant factor for him.)

Not producing /m/ could be a sensory issue – Some kids don’t like the feeling of their lips being together to vibrate for /m/. These are the kids who may refuse lots of foods, hate having their faces washed, or flip out when you try to brush their teeth. They truly are HYPERSENSITIVE in and around their mouths or possibly all over their bodies.

Then there’s the other extreme. HYPOSENSITIVE – These kids have so little awareness of their mouths that they don’t even know “how” to make an /m/ sound. Usually there are other indicators such as profuse drooling after age 2 since they don’t routinely close their mouths (usually mouth breathers from a sensory perspective OR because they have so many allergy/respiratory issues that they HAVE to mouth breathe!). This may be a kid who constantly places toys or other things in his mouth. Or it may be a kid who over-stuffs his mouth with food to the point that he gags. He lacks the normal sensations in his mouth. For whatever reason, he does not “feel” things normally in his little mouth.

Not saying /m/ could also be a coordination, or motor planning and sound sequencing issue. He may even be able to use an /m/ sound alone, but not necessarily combined with the ‘a’ for Mama.

Solution – Work on the /m/ sound.

My favorite way to get this sound is by saying “mmm, mmm, mmm, mmm, mmm” with foods he loves. Exaggerate this sound! Shake your shoulders when you do it. Make it so silly and captivating that he’s going to want to try to imitate you.

While earlier in my career I may have tried chapstick or lip gloss on your lips and then hers (or his!) and again exaggeratedly rubbing my lips together to increase sensory awareness of his lips, now we know that that’s more likely to promote tongue protrusion since the child will only want to lick that yummy stuff right off his lips! Some SLPs like vibrating toys or textured spoons, but I’ve even stopped doing all of this.

You MAY even try helping him get his lips closed by placing your index finger above his top lip and your thumb below his bottom lip and helping him close his lips, but if he’s negative or over-reactive to this very hands-on approach, stop. Don’t overdo this method because then you’ll ruin it for the both of you!

One little guy I have right now on my caseload is responding very well to the verbal cue, “Hide your lips” to produce an /m/ sound when he watches me model this sound.

When a child can produce an “m” sound, or even if he can’t, keep modeling “mama” in speech often so he begins to imitate it, even if it’s not in context, or purposeful just yet.

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I hope these ideas help your child begin to say this magic word! Pretty soon I hope you’re hearing “Mama! Mama!” all the time. Then you have to promise NOT to complain when she says it so much that it makes you crazy, but that’s a whole different post!!!

Watch the video with these tips.

Laura

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When I’m in a social setting and people find out that I’m a pediatric speech-language pathologist, I get lots of questions about using pacifiers, sippy cups, and if they affect speech development in babies and toddlers.

Let’s tackle the sippy cup?question first. “Sippy cup mouth,” or a huge open bite, is quite common. Don’t mistake the word “common” for “normal.” When children have an open bite they have a gap between their upper and lower teeth when closing the top and bottom teeth together. Many times this dental malocclusion can be linked to prolonged sippy cup use. By prolonged I mean carrying a cup around all day and sleeping with one at night, or using this kind of cup exclusively after age 2 or 3. It can be worse if your child is using a sippy cup AND taking a pacifier because there’s something in his mouth essentially all of the time.

If your child is using a lisp as a toddler or preschooler, it’s likely he has an open bite. An approximation for the sound /s/ is very common in this age group, with or without an open bite. As children get closer to age 5, their/s/ should sound adult-like. If this doesn’t occur by age 5, children may need speech therapy to help learn a more mature production pattern for /s/. This is usually the only negative effect on speech development.

Although it’s messier than a sippy cup, your child should learn to drink from a straw by age 2 and an “open cup”before age 2 1/2 to 3. This takes a commitment from parents because it requires more supervision and clean up than using a no-spill cup. Not too long ago, we didn’t even have sippy cups, besides the slotted top kind from Tupperware. Actually that cup could still be a nice transition between sippy cups and an open cup. The skills to drink from a slotted opening are more mature than the sucking pattern required for the no-spill sippy cups.

Moving to a more complex cup is a great way to work on oral motor coordination than any set of “oral motor exercises.” This drinking practice is very functional, meaning that your child would have built-in opportunities to “practice” many times a day, rather than setting aside time to do special oral motor tasks.

Introduce the new cups (straw, slotted, or open) when he’s seated at a table, outside, or on a tile kitchen floor. Save the sippy cups only for times when making a mess is a big deal such as in the car, when he’s on carpet, or in any other place that would be a major hassle to clean.

Your child should NEVER go to bed with a sippy cup or bottle, no matter how convenient it is to help him to sleep. Leaving the cup or bottle between your teeth while sleeping is what leads to the open space AND tooth decay, especially if you’re using milk or juice. I’ve known several two-year-olds who have had to see a dentist due to a mouth full of greying teeth. Not a pretty site. If you can’t kick this habit just yet, at least switch to water in the cup at bedtime.

Straw drinking is wonderful for oral motor coordination and sensory skill development. Drinking  a cold, thick liquid from a crazy straw is just about the best way to improve tongue, lip, and cheek strength and coordination all in one! Look in the toddler dishes/utensils section of the major retailers for the many version of these cups, or save and use the plastic ones you get at sit-down restaurants. Sports water bottles are also a good option.

Now let’s tackle pacifiers. For some toddlers, pacifiers are not an issue since they never took one in the first place or easily gave it up as an infant. Sometimes not taking a pacifier hasn’t necessarily been a good thing either, since a child may not have found a successful way to self-soothe. Sucking is a very good way to regulate an out-of-control infant and toddler.

Many babies find their thumbs during this phase. While some parents and even experts prefer this habit, I think it’s a lot more difficult to kick, even for 6 and 7 year olds, because you can never truly get rid of it.

For some babies and toddlers (and their parents!), pacifiers are essential and even recommended. For babies with significant oral motor issues, learning to suck a pacifier and keep it in their mouths is a milestone. For cranky babies and toddlers with sensory integration differences, using a pacifier to soothe is the only thing that helps them calm.

Most children should be able to give up the pacifier between age 2 1/2 to 3, or at least relegate this for sleeping or calming only. Walking around all day with a pacifier in your mouth is not recommended as kids move closer to age 3, but not because it keeps you from talking. It makes you look like a big ol’ baby, but that’s another issue in and of itself, and one I’m not going to tackle today!

I think it’s a myth that pacifiers prevent children from talking. Most kids try to talk with it in their mouths and then take it out if their parents insist that they don’t understand them. If your toddler is not talking, is over age 2, and is addicted to his pacifier, try to limit the pacifier to naps, bedtime, and when he really needs it to calm down. You can monitor to see if having an open mouth during waking hours will help him vocalize more. In nearly every child I’ve seen in my whole career, the lack of language is the reason the kid isn’t talking, not because he takes a pacifier.

Some SLPs disagree with this and insist that a toddler be weaned as soon as they begin therapy. I usually advise parents to keep the pacifier until we find other ways to help a kid self-soothe. I think taking away the only method some kids have for calming down is too traumatic when they are also struggling to learn to communicate. I am not into torture, not for the kids I see, and especially not for their parents!

I will add that I don’t let children keep pacifiers in when I’m in their homes seeing them for therapy unless they are falling apart without it. Many children I see work so hard during treatment that they need it to calm down after we’re finished, and I think this is alright.

Parents of children with sensory issues tell me that they need the pacifier for times when no other option works to wind down a jacked-up toddler or end a tantrum. If your toddler, even at 3, still needs the pacifier to help calm his sensory system, keep it and don’t feel guilty. As a mom, I’m just fine with that. As a therapist, I’m fine with it too, but I’d like to see them learn to self-soothe in other more mature ways as they turn 3, and especially by 4, if at all possible.

Options that I’ve seen work are finding a special blanket, stuffed animal, or doll. You are still transferring dependence to an object, but usually one that won’t hurt your teeth, or cause grandma and the neighbors to raise an eyebrow or make those nasty, condescending comments that cause us all to cringe.

Kicking these habits aren’t easy, but it’s all part of growing up, for your baby and you!

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However, your child’s ability to hear can become compromised during infancy and toddlerhood by the presence of fluid in his or her middle ear. Fluid is most often present during an ear infection, but fluid can also be present without any other symptoms.

When a toddler has fluid in his ears, he does not hear words and sounds normally. Speech sounds muffled, like he’s swimming underwater. He may know that someone is talking to him, but have no clue what they are saying. Can you imagine the challenge that presents when a toddler is trying to follow your verbal directions, much less learn to talk?

Maintaining the ability to hear consistently is the key to learning how to understand and use words. Parents should judiciously monitor hearing ability in children, especially those with frequent ear infections. I am not one to overuse antibiotics, but if your child’s pediatrician is very laid back about the presence of fluid and treating ear infections AND your child is not learning language, you should consider taking a more aggressive approach. Begin by asking for a referral to have your child’s hearing tested.

The professional who is best qualified to test hearing in babies, toddlers, and preschoolers is a pediatric audiologist. This person has at minimum a masters degree, but most often a doctorate in audiology. You can usually find them in private practice in the yellow pages, at an ENT’s office, or in a children’s hospital.

Many parents wonder how a toddler’s hearing can be accurately assessed. Listed below are very basic explanations of the procedures that are most often used:

1. Tympanograms – This test is performed by inserting probes that are like ear plugs into the ear test to measure middle ear function and detect the presence of any fluid in the middle ear. Some kids hate it, especially those who are touch-defensive or who’ve had bad experiences with doctors checking their chronically infected ears. Most don’t mind. Parent holds you while audiologist does the test one ear at a time.2.  Sound Field/Booth Testing – Toddler sits with mom or dad inside a dark “booth” or room. When the audiologist plays the tone, the baby looks toward the speaker and an animal/light/some kind of visual spectacle lights up to “train” a kid to look toward what he hears. It works remarkably well for alert and responsive children. I have had lots of children on my caseload “fail” the test because they weren’t reliably responsive. When that happens, the audiologist recommends . 3. An ABR – Auditory Brain Stem Response Test – This test is usually performed in a hospital setting because it requires anesthesia so that the brain’s response to sound can be measured. It’s scary for parents because of their child being “put to sleep,” but the test is accurate because the kid doesn’t have to “participate.”4. Referral to?an ENT (Ear Nose & Throat Doctor) – If your child has had chronic ear infections, he may need tubes put in his ears to keep the fluid from staying lodged in his middle ear. This procedure is done as an outpatient in a children’s hospital and does require anesthesia since it is surgery. Most parents reports that it’s a very quick process with their children back home and playing within a couple of hours. Most of the time tubes stay in place for a year or two and then fall out on their own. You’ll know when the tubes are working because you’ll sometimes notice the drainage leaking out, but this is a good thing because it’s not keeping him from hearing. This is the best treatment for a language or speech delayed child with chronically infected ears. If he can hear, there’s a much better chance he’s going to learn to understand, talk, and be understood. Hearing loss should always be ruled out as a reason for speech-language delay. Most of the time, it’s not the problem, but I’d hate to be the parent or therapist that missed hearing loss! For many children with mild to moderate losses and no other issues, pop the hearing aids in and go! I’m not minimizing the plight of hearing impaired children, but it’s sometimes easier to treat (relatively speaking of course) than lots of other things that could be a reason for a language delay or disorder, particularly if the loss is not severe, and there are no other issues. I must also add that even minimal hearing loss that goes untreated can end up to be a “big deal.” Children with even mild hearing losses at high frequencies have difficulty learning the high frequency consonants such as”/s/.” In English the sound /s/ carries so much meaning. It changes verb tenses, makes nouns plurals, and adds possessives. Make sure your child can hear consistently! Aggressively monitor his or hear ability to hear by being aware of middle ear fluid. Many times fluid remains in a child’s ear after a cold or allergy episode. Be consistent with your follow-up appointments at the pediatrician and ENT.

Bottom line – If a child can’t hear or understand, he is not going to talk.

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“Now that my baby is finally talking, I can’t understand a word he’s saying!” First we want them to talk, but once that happens, we complain that we can’t understand them. This is a big concern among parents of toddlers, especially when you’ve waited longer than you expected for those first words.

“Isn’t it normal not to understand what my two year-old is saying?” The answer to that is, “both yes and no.” Here are the norms:

Parents should understand at least 50% of what a toddler is saying by their second birthday. By age three, parents should understand most (90%) of what a child is saying. By age 4, strangers should understand most (90%) of what a child says.

For those of you who aren’t familiar with typical speech sound development, let’s begin with a quick review of the basics.

Babies begin to use vowel sounds to coo during the first months of life. Then babies begin to add consonant sounds and combine them with vowels to begin babbling between 7-9 months. Babbling is using a string of consonant-vowel syllables. Most early babbling includes reduplicated or repeated syllables (“mamamama”). Near the end of the first year or shortly after, many babies begin to use approximate real words. They also become more sophisticated in their babbling and can sequence syllables with different consonant-vowel combinations.

Bilabials, or lips sounds, /p, b, m/, are usually the first consonants to emerge. (FYI – This is the reason that “Mama” and “Papa” are universal parent names!) Other consonant sounds such as /n, h, w/ are also “early” developing consonant sounds. Most children, or 75%, have mastered using these consonant sounds and all vowel sounds in words by their second birthdays. Consonant sounds that generally emerge before and around age two-and-a-half are /t, d, k, g/ and “ng” and /s/ at the ends of words. Some sources report that /f/ also emerges aroundtwo-and-a-half; some cite between three and four years. Later developing consonant sounds that emerge during the preschool years are /r, l, z, v/ and “ch, sh, j.” The sound “th” is usually the last consonant sound, mastered after age five.

Jargon emerges in most children between 12-18 months. Jargon is defined as unintelligible strings of sounds that mimic adult speech. Some parents refer to this as “gibberish.” Sometimes parents get upset when they hear their children using lots of jargon. Actually jargon is an indicator that a child is learning to sequence sounds and is trying to copy conversational speech. However, in the absence of other “real” words, it can be unsettling for some parents.

Many parents ask, “How should I respond if I don’t know what he’s saying?” My advice is to reword what you think he intended to say to ask for clarification. Hopefully, he’ll try to correct you if your guess was wrong. Other advice is to encourage your child to SHOW you what he wants or is talking about. If your child becomes overly frustrated when you don’t understand, you may be able to slide by with nodding or offering a general comment such as, “Oh!” However, if your child is adamant about telling you something or asking you for things you don’t understand, “faking it” may not work.

This is one reason I love signs or even pictures, especially for difficult words your child asks for routinely that you never get on his first (or seventh) attempt. If he keeps asking you for something and you finally “get it,” store a mental “audio clip” of the word, or take a picture of the object so you can use it to help the next time.

Being understood is an important part of communicating. Let me interject a word of caution: Until a child’s language skills (the number of words he’s using and how he combines those words into phrases and sentences) are at or near an age-appropriate level, intelligibility should not be the sole focus for speech-language therapy OR for parents at home. Overcorrecting a one- or two-year-old child’s speech errors can lead to frustration and a shut-down of progress faster than anything else you can do to a new talker.

What should you do when your child mispronounces a word? Model the word correctly and move on. Your child asks, “Tootie?” You say, “Cookie? You want a cookie? Here you go!”

Actually, before you start to work on specific consonant sound errors, there are other more important factors you should consider to make your child easier to understand.

First Targets for Speech Intelligibility in Toddlers

1. Is my child using the correct number of syllables in a word?

Consider the child who says “ba” for ball, balloon, and blanket. You’re going to be able to understand him better if he is able to use “ba” for ball, “ba oo” for balloon, or “bwa ee” for blanket. Even though these words aren’t “perfect,” you’ll probably be able to figure out what he wants more easily than if all the words sounded the same.

If he’s leaving off syllables (not just individual sounds, but entire syllables), start here first:

Tips for working on syllables – clap or pat the floor as you say the word to help him hear and feel the difference. Try words with repetitive patterns (reduplicated syllables) such as bye-bye, Mama, Dada, boo-boo, Bubu (for bubble or brother), and nana (for banana or grandma). Some kids get so into this that they “double” everything – dog-dog, car-car, etc.  It’s cute at first.  Be careful, though, or you’ll have to fix that later!

2. Is my child using correct vowel sounds in words?

As stated previously, most children with typically developing communication skills use vowel sounds correctly by age two. If your child is substituting vowel sounds or leaving off vowel sounds in words, this can be an indicator of motor planning problems, or apraxia.

Work on vowel sounds by exaggerating them in words, and using new ones alone as “sound effects” in play. For example, if your child can’t say an “ee” such as “green,” “baby,” or “whee,” pretend to be scared during play and let out a big “eeeeeeeeeeeee.” This is also one of the vowel sounds that you can “help” him learn by pulling out both corners of his mouth into a smile. “Cheese” is usually an effective cue not only for picture taking, but learning this vowel sound.

Other vowel sounds you can provide a tactile (touch) cue are “ah” by pulling his chin down with your finger and “oo” by pulling in her cheeks to help her round her lips.

I use lots of animal sounds to work on vowels and really exaggerate the vowel sound.  Think: mooooo, baaa-baaa, meee-ooooow, woooof-wooof, etc.

3. Can my child use two different vowel sounds in words, or does he always copy the first sound for the next syllable?

Learning to “change” the vowel sound for a new syllable in a word is especially difficult for some toddlers. You may continue to hear him say “Coo coo” for cookie, “o po” for open, or “ca ca” for cracker. Work to help him hear and say those differences. Again modeling exaggerated vowels is the best way to do this.

Your child’s SLP may be able to help you come up with “modifications” of particular words that may not be completely correct, but sound “closer” to the intended word. For example, for a child who can’t say “cracker,” you may teach “ca uh” as an in-between more intelligible version of the word. (Some children have difficulty using different consonant sounds in words until age two-and-a-half, but most have mastered this by age three.)

4. Is my child learning consonant sounds in the beginnings of words and syllables?

Usually, beginning consonant sounds come first, but in some children, they continue to omit beginning sounds while adding some ending consonant sounds. It is very difficult to understand children who use words and phrases with predominantly vowel sounds. I have several children doing this at any given time on my caseload. Children who are using mostly vowels absolutely need speech therapy to help them learn to use more consonant sounds.

Your SLP will be able to teach you and your child “cues” to help him learn additional sounds. If you’re working on this at home, you can try the following “tricks:”

Many experts “name” the sounds for young children rather than calling them by the letter. For example, /m/ can be called a “motor” sound, or a “yummy” sound. A /p/ can be called a “popper” sound or “lip” sound. These names can be found in many early articulation books.  Better yet, talk with your child’s speech pathologist.

If you’ve heard your child use consonant sounds at the beginning of one word, or even in a word you couldn’t understand, using these sounds that he can already produce in at least one context is generally easier than teaching new sounds.

5. Is my child using ending consonant sounds?

This is the question about articulation that I’m asked the most. Final consonant deletion occurs in many children until two-and-a-half to three years of age. The easiest ones to work on include /p/ and /t/, both unvoiced consonants. If your child is producing /k/, you may also try this sound. The voiced consonant sounds /b, d, g/ should not be early final sound targets because your child may end up adding a vowel sound at the ends of words such as “bug-u” or “bed-a” in an effort to produce this sound. Once your child is using unvoiced sounds, the voiced sounds should emerge on their own.

I also work on /s/ since this final sound carries so much grammatical information. For example, children need final /s/ to make words plural such as “cats” and “books.” Using plurals is a language concept that emerges around age two-and-a-half, so /s/ is an important sound.

Many children begin using /s/ as a lisp. Although it’s an incorrect way to produce /s/, it’s very common until age 4 or so. You can target this by telling your child to “hide your tongue behind your teeth,” or to say “smile and hide your tongue.”

Other Hot Topics Related to Speech Intelligibility in Toddlers

Oral Motor and Articulation Issues – Pacifiers and Sippy Cups

If your child is using a lisp, it may also be an indicator that he’s developing an “open bite.”  That means there’s a gap between his upper and lower teeth. This can be attributed to prolonged use of sippy cups or pacifiers. Although it’s messy, your child should switch to an open cup or straw when he’s at the table or in another place that you can clean up easily. Save the sippy cups for the car.

Your child should NEVER go to bed with a sippy cup or bottle, no matter how convenient it is to help him to sleep. Leaving the cup or bottle between your teeth while sleeping is what leads to the open space AND tooth decay, especially if you’re using milk or juice. I’ve known several two-year-olds who have gone to see a dentist before age three with a mouth full of little black teeth. It’s not a pretty site! If you can’t kick this habit just yet, at least switch to water.

Straw drinking is great for oral motor and sensory skill development. Look in the toddler dishes/utensils section of the major retailers for many options for these cups. Sports water bottles are also a good option.

I think it’s okay to use a pacifier for sleeping until age two-and-a-half to three, but excessive use during the day is not recommended if your child can calm down without it. If your child has sensory issues and using sucking to help him regulate, keep the pacy without feeling guilty.

It’s a myth that pacifiers prevent children from talking. Most kids try to talk with it in their mouths and then take it out if their parents insist that they don’t understand them. If your toddler is addicted, try to limit it to naps, bedtime, and when he really needs it to see if having an open mouth will help him vocalize more. I don’t let children keep pacifiers in when I’m in their homes seeing them for therapy unless they are falling apart without it. Many children I see work so hard during treatment that they need it to calm down after we’re finished. Many parents of children I see need them to have it for times when no other option works to wind down a jacked-up toddler and end a tantrum. As a mom, I’m just fine with that.

If you have other questions, please feel free to post a comment.

Laura

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Need some help understanding those first words?

My DVD Teach Me To Talk with Apraxia and Phonological Disorders is an excellent resource for both parents and professionals!

The post Working Toward Intelligible Speech in Toddlers appeared first on teachmetotalk.com.

Apraxia is a neurological speech disorder that affects a child’s ability to plan, program, execute, and sequence the precise movements of his tongue, lips, jaw, and palate that are necessary for intelligible speech. Characteristics that help make the diagnosis of apraxia:

-Limited babbling as an infant
-Few or no first words
-First word attempts don’t develop into understandable words by 2
-Poor ability to imitate words
-Understands much more than he can say
-Makes errors with vowel and consonant sounds

Apraxia can be called developmental apraxia of speech, developmental verbal apraxia, or dyspraxia. The root word ‘praxis’ means movement. ‘A’ means without, so apraxia is supposed to mean a more severe form of the disorder, but in reality, most speech-language pathologists use the terms interchangeably.

Apraxia can exist alone and be the child’s main developmental challenge, or it can be part of a larger issue. Many children with autism or PDD, Down Syndrome, Cerebral Palsy, children who were premature, or those with other developmental delays can also exhibit symptoms of apraxia. Children with apraxia may often have sensory integration differences as well and seem to be at greater risk for future educational issues such as reading challenges (dyslexia), auditory processing disorder, or ADD.

Now for how I explain this to my clients’ families. I think about apraxia as short circuitry in the brain. A child with apraxia knows the word he wants to say, but then it gets lost somehow between planning and saying it.

Real-life Signs of Apraxia in a Child:

-A baby doesn’t babble very much at all. She may only make noise regularly when she cries. She may even laugh without making much of a sound.

-When a toddler does begin to try to talk, he may say the same sound such as “da” for everything.

-You might notice that he’s moving his mouth to talk, but no words come out. Or he watches your mouth intently and then struggles or gropes trying to say the same word, but it still comes out off-target.

-She can’t usually imitate words, even words that you’ve heard her say on her own.

-He says a word perfectly one time and then never again.

-A child says a word fairly often and then one day, it seems to be gone.

-She makes errors with her vowel sounds too, which is unlike other speech problems. For example, she says “bu” for boat.

-A toddler may say words with a “g” or “k” sound which are later-developing consonant sounds, and not be able to say words with “m, p, or b” which are early developing sounds.

-He may use only a single sound for a word, such as “c” for car. Or she may reduce all words to one syllable such as “ma” for Mama or “bu” for bubble.

-A child may say “Dada” correctly one time, then pronounce it two minutes later as “Gaga.”

-She may become “stuck” on a word. She repeats a word she previously said by mistake, or she says the same word over and over.

-A kid uses his mouth fine for eating, but then when you ask him, he can’t stick his tongue out, lick his lips, or copy other movements

-A toddler may not try to talk very much and resort to communicating by pointing, grunting, and leading, because on some level, he knows he can?t say the word, and even if he tried, nobody would understand him anyway.

-Once a child has lots of words, it’s difficult for him to sequence them into phrases.

-There may be a family history of speech problems. For example, all boys don’t talk until after 3. Granddad can’t pronounce difficult words like statistician, Episcopalian, or medical terms.

The good news is that children with apraxia can get better with speech therapy. Many children with mild or even moderate apraxia progress to the point that no one (except for maybe an over-analytic, picky speech therapist) would even notice a problem as they get older. Children with severe apraxia may take a long time, but then they do make progress. My best advice is,  Don’t give up! Make yourself a parent-expert on apraxia. Be an advocate for your child and insist that he get every minute of service he can qualify for. Read everything you can get your hands on about apraxia and implement those suggestions at home.

My best resources on apraxia for parents:

Becoming Verbal with Childhood Apraxia is a book by speech-language pathologist and expert Pamela Marshalla. This only costs about $15 and can be ordered from www.superduperinc.com. It’s a thin book and an easy-read filled with great ideas for little guys.

For older children – Easy Does It Approach for Apraxia. This is a standard for treating preschool-aged children.

I also recommend the book The Late Talker by Seng and Agin. (I hope I spelled their names correctly. I have loaned out my well-worn copy!)

The best resource on the Internet is www.apraxia-kids.org. There’s a whole section for parents starting with a newly diagnosed section.

There’s my best “short” answer about apraxia. Please look for additional upcoming posts because I’m working on a feature-length article with more therapy tips for parents working with children with apraxia at home.

My own DVD for treating apraxia is Teach Me To Talk with Apraxia and Phonological Disorders. Parents and professionals PRAISE this valuable resource as the tool that got them headed in the right direction for easy and effective strategies with toddlers.

The post Is My Child Apraxic? Answers to a Parent’s Questions appeared first on teachmetotalk.com.

There are between three and six million children in the United States with speech or language disorders. As a pediatric speech-language pathologist specializing in early intervention, I work with children between birth and three years of age. When I evaluate a child, after confirming parents’ suspicions that there is a definitive problem, the next question is usually some version of, “Why?”

Sometimes we don’t know exactly why a child isn’t talking yet at two or three. Many professionals err on the side of caution and label all children they evaluate as “delayed,” when in fact they aren’t yet sure what the exact problem is. It is often difficult to pinpoint an exact diagnosis during the first visit or two (or 10!) with a toddler, but there are many common communication difficulties in this age group.

Let’s also clarify the difference between the terms “delay” and “disorder.” A delay means there’s just a problem with the rate of development. Skills are coming in as expected, but it’s just slower than when other children acquire the milestones. Most of the time (unless a professional is misusing terminology) a “delay” implies that there’s a reasonable expectation that a child can “catch up.” Intervention, whether it’s more informal at home with parents who are committed to implementing new strategies, or whether it’s more formal with enrolling a child in therapy services, certainly helps increase the likelihood of improvement.

When there’s a disorder, it means that development is somehow atypical. The rate may also be slow, but there abnormalities present that are not seen in children with typically developing skills. Disorders, by their nature, are more serious than delays and always warrant professional intervention. For example, autism is not a developmental delay, but a developmental disorder.

Below is a list of the most common types of speech disorders and diagnoses associated with pediatric speech-language problems with a basic explanation for each. Please remember that this is a listing of specific speech-language diagnoses and not necessarily a medical or educational label. For example, a child diagnosed with autism may exhibit characteristics of apraxia, a child with Down syndrome may have dysarthria, a child with dyslexia may also have an auditory processing disorder, etc…

The speech-language diagnosis may be just a part of a condition that affects a child’s overall developmental picture, or it could be the only issue a child faces. I have often evaluated children whose parents referred them for what they thought was a speech or language delay, when in fact their children were exhibiting delays in other developmental domains as well. This also happens with other disciplines too. My colleagues who are physical and occupational therapists often end up referring children for communication assessments when parents initially sought their help for what they assumed was just “late walking” or “difficulty with feeding,” not realizing that their child was behind in other areas too. Many children with developmental difficulties have issues that overlap the motor, social, cognitive, adaptive, and communication domains.

When in doubt, get an evaluation. Be sure to ask the professional if there are other developmental concerns as well. You’d rather know, and the sooner, the better. All of the current research tells us that early intervention gives a child the best chance of minimizing long-term difficulties. Waiting until your child is school-age to see if he will “outgrow” a problem puts him at a serious disadvantage, especially when it comes to communication difficulties.

Types of Communication Delays and Disorders in Toddlers

Apraxia

Apraxia is a neurological speech disorder that affects a child’s ability to plan, execute, and sequence the movements of the mouth necessary for intelligible speech. Apraxia can also be referred to as developmental verbal apraxia, childhood apraxia of speech, or verbal dyspraxia. Most SLPs use the terms interchangeably. Characteristics of apraxia include:

• Limited babbling during infancy… these are quiet babies.
• Few or no words when other babies are talking by age two.
• Poor ability to imitate sounds and words.
• Child substitutes and/or omits vowel and consonant sounds in words. Errors with vowel sounds are not common with other speech disorders.
• His word attempts are “off-target” and may not be understood even by parents.
• He may use a sound (such as “da”) for everything.
• Often his errors are inconsistent, or he may be able to say a word once and then never again.
• The child understands much more than he can say.
• There is sometimes (but not always) a family history of communication difficulty. (i.e. “All the boys in our family talk late,” or “My husband’s grandfather still has trouble pronouncing some hard words.”)

There has been controversy in the field of speech-language pathology in giving this diagnosis to children under three. However, the kinds of therapy useful for children with apraxia are often not introduced if the clinician does not suspect this as the root cause for a child’s communication difficulty. If you suspect this is your child’s problem, initiate a conversation with your child’s pediatrician and begin speech therapy with an SLP with experience treating apraxia. If your therapist says that he/she does not believe that this can be considered before age three, look for a new therapist!

An excellent resource for parents and professionals working with children with apraxia is www.apraxia-kids.org. Another comprehensive resource for an explanation of apraxia can be found here.

Many children with apraxia also have difficulty with sensory integration, or how he processes information from all his senses including visual, auditory, tactile, and proprioceptive (or movement) skills.

Feeding issues are sometimes present because of the sensory issues that a child exhibits. For example, he may have poor awareness in his mouth so that he overstuffs to “feel” the food, or to the other extreme, he is so sensitive that he gags when new textures are introduced.

For more answers to a parent’s questions about apraxia on this site, look at posts in the Apraxia section.

Phonological Disorders

A phonological disorder is a difficulty with the “rules” or “patterns” for combining sounds intelligibly. For example, phonological process patterns include prevocalic consonant deletion (leaving off consonant sounds that precede a vowel such as “at” for hat), syllable reduction (producing only one syllable in a multisyllabic word such as “bay” for baby), or reduplication (simplifying a multisyllabic word to a duplicated pattern such as saying “bubu” for bubble or even “dog dog” for doggie.)

There are many patterns for analyzing a child’s speech according to a phonological processes model. All of these processes are common in typically developing children as well. It becomes a problem when a child is not maturing in their patterns of production when most other children are.  For example, final consonant deletion (leaving off ending consonant sounds in words) typically disappears between two and one-half to three years of age. If a child is not including final consonants by the time he reaches 3, it would be considered “disordered” or “atypical,” since most of his same-age peers are now using a more mature pattern.

A child with just a phonological disorder exhibits typically developing language, meaning that his vocabulary and utterance length are the same as his peers, but he continues to exhibit patterns that are consistent with a younger child’s speech errors. He sounds younger than he is. A child with a phonological disorder needs speech therapy to learn new patterns. The most popular approach for therapy for this disorder is the Hodson Cycles Approach. A pattern is targeted in therapy for a certain number of sessions, and then a new pattern is initiated. Once all of the patterns are addressed, the cycle starts over. Your child’s speech sounds begin to improve, even if it’s not “perfect” through the first few cycles. This approach has lots of research to support it. It’s generally used for highly unintelligible kids over three. For more information on this approach, ask your child’s SLP if it’s right for your child because even the veterans know and use this technique.

Articulation Disorders

An articulation disorder is a difficulty with the production or pronunciation of speech sounds. This difficulty may be present with an isolated sound such as substituting /w/ for /r/, difficulty with blends such as “st,”or with distortion of sounds such as a lisp. Sometimes clinicians speak of phonological disorders and articulation disorders interchangeably. I use the term “phonological disorder” when there seems to be a difficulty with attaining a “pattern” of sounds and the term “articulation disorder” when a child has difficulty with only a couple of sounds rather than an identifiable pattern. If a child is still exhibiting errors with even a few sounds after most of his peers can correctly use the sound, he needs therapy to help him. For a list of ages when children acquire certain sounds, try this chart.

Language Processing or Auditory Processing Disorder

A language processing or auditory processing disorder is difficulty listening to, receiving, analyzing, organizing, storing, and retrieving information. It can also be called “central auditory processing disorder” (CAPD). In young children, this often looks like the child cannot understand what’s been said to him, even when his hearing and language comprehension skills are within normal limits. A child may have difficulty paying attention to what someone is saying to him or have difficulty following directions in the presence of background noise, or when he’s more focused on something else. This might be the kid that won’t look away from his favorite TV program when a bomb goes off, much less when you’re calling his name.

This is commonly included as a receptive language disorder in children under three, with an official diagnosis of auditory processing disorder coming later in the preschool or early school-age years since there are no tests for this condition with younger children. Children with sensory integration differences also exhibit auditory processing disorders. It’s very common for children with autism and other learning disabilities, such as dyslexia and attention deficit disorder, to exhibit these characteristics as well. I could not find a site for information for very young children with an auditory processing disorder, but this is receiving lots of attention in the field of early intervention right now, so maybe we should have a good resource soon.

Dysarthria

Dysarthria is a neurological speech disorder that affects a child’s muscle tone. Weakness is noted in the muscles used for speech – lips, tongue, soft palate, and cheeks – so that his speech sounds slurred. Dysarthria is present in kids with Down syndrome, cerebral palsy, or any other condition that causes “low tone.” Dysarthria may also affect a child’s vocal and respiratory quality so that he sounds hoarse or breathy.

A child may also have feeding problems due to muscle tone issues:   difficulty sucking from a bottle because his tongue isn’t strong enough, keeping foods or liquids in his mouth because his lips aren’t strong, or chewing because of overall weakness in his jaws and cheeks. A child may also drool because she can’t close her mouth consistently.

A child with muscle tone issues may also have difficulty with gross and fine motor skills. Physical and occupational therapy may be necessary to help meet milestones. Low muscle tone never truly “goes away,” and there’s a difference between strength and tone. All of us have varying degrees of muscle tone ranging from high to low, and kids with even very low muscle tone can learn to walk and talk.

For a list of signs/symptoms, go to the link here.

Dysfluency

Dysfluency is the more professional term for stuttering. It is the repetition of individual speech sounds, usually at the beginning of words or phrases. Many children with typically developing language “stutter” when they move from using single words and short phrases to longer sentences, and/or when they are under pressure to speak and can’t encode their words quickly enough. Typical dysfluency can occur anywhere from ages two to four. If it lasts for more than six months, seek a professional evaluation.

Many times there’s a family history of stuttering, and this is going to be a chronic challenge. Kids who repeat individual sounds at the beginnings of words with facial grimaces or tremors, tense their muscles, blink their eyes repeatedly, or tap their feet are at greater risk for true difficulty with fluency than those who repeat whole words and who don’t seem to be phased physically by this.

The best advice for parents when your child starts to stutter is to ignore it. Do not tell him to slow down, stop and think, or any other comment that you feel might be helpful. Relax his environment and do not put pressure on him to “perform” verbally.  This includes asking too many questions in a row, demanding that he answer silly questions such as, “Did you hit your sister?” when you know he did, or insisting that he sing his new song from preschool for Grandma, Grandpa, and all of your long-lost relatives at Thanksgiving. Don’t interrupt him when he’s talking, even when he’s struggling. This may be hard, but it is important!

Our oldest son had a terrible several- month bout with stuttering while I was in grad school taking the class on dysfluency. It was horrible for me!! My professor’s advice was simple -“Ignore it and it will (probably) go away.” Another piece of advice is to make sure his teachers at preschool, sitters, or even family members are on board with the “ignore it” method so that no one calls attention to this issue. The unnecessary pressure will make it worse, not better, so tell all of your well-meaning friends and family that you are doing this one your way.

Expressive Language Disorder

An expressive language disorder is present when a child is not meeting milestones in the area of language usually involving vocabulary, combining words into phrases, and beginning to use the early markings of grammar. A child with only an expressive language disorder doesn’t have difficulty pronouncing the words per se, but he has difficulty learning or retrieving new words and putting sentences together. A child may rely on non-specific words such as “that” and “there” rather than learning specific names for objects. She may have difficulty learning verb tenses (such as the “ing” for walking and “ed” for jumped) or have difficulty learning word classes such as prepositions or pronouns.

An expressive language disorder can, and often do, co-exist with a speech disorder such as apraxia. I have treated kids like this with only expressive language delays/disorders, but more often than not, late talkers exhibit a speech AND a language disorder. Sometimes, children exhibit receptive language disorders as well, so it’s not uncommon to have several speech-language diagnoses at the same time.

An expressive language delay would be a child who is acquiring vocabulary, combing words, and learning early grammar with the same sequence as his peers, but at a slower rate. If there are atypical characteristics present, such as your child having some skills at a higher age level but still missing many lower age-range skills, it’s called a disorder. Delays are typically easier to overcome, and most kids with delays eventually catch up. A disorder is generally something a child will struggle with for a while, perhaps his entire life.

Receptive Language Disorder

A receptive language disorder is a difficulty understanding language. This is also called an auditory comprehension disorder. Kids who have receptive language disorders don’t follow directions – not because they’re being disobedient, but because they don’t understand what’s being said. They seem to ignore language because words don’t mean anything to them yet. They often hate reading books unless mommy lets them flip through the pictures because it’s all about listening to words which may not make very much sense.

When a kid gets a little better and understands a little more, signs of a receptive language disorder may be that he repeats a question rather than answering it or gives an incorrect response. For example, if you ask a child with a receptive language disorder who has been learning his colors, “What are you drinking?” he’s likely to respond with “Red!” because that’s the color of his cup. If you ask a question such as, “Do you want milk?” she might answer “No,” but then she’ll still get upset when you don’t give her the cup. She doesn’t understand that answering “No” means she doesn’t want it.

I have seen many kids whose parents or daycare teachers label them as “difficult” or a “behavior problem,” when really there’s a major receptive language delay that no one recognizes. Parents often overestimate what their language delayed/disordered child truly understands. This is so sad to me. When everyone decides to work on teaching and helping him understand language BEFORE we expect him to talk and BEFORE we expect him to “obey,” then everyone benefits.  This is especially true for the kid who doesn’t understand why in the world he’s in trouble in the first place, even though his mother says “I told him not to do it!”

Make sure your child’s receptive language skills are addressed or the other speech-language problems are not going to significantly improve. A child who doesn’t understand much really shouldn’t be saying much either. To expect more is simply wrong, and well above what he’s able to realistically accomplish. Most SLPs think of working on receptive language as going hand-in-hand with working on expressive language, and this is absolutely the right way to go. When parents get on board with this approach, wonderful things happen.

I have written many posts about improving receptive language; check out the best one for parents here.

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If you would like specific recommendations for teachmetotalk.com products based on your child’s diagnosis or suspected diagnosis, take a look at this post.

The post Why Can’t My Child Talk? Common Types of Speech and Language Disorders appeared first on teachmetotalk.com.

Teach a Child to Imitate

Teaching a child to imitate words often begins with teaching him HOW to imitate. Sometimes it’s easier to start with movements of your body rather than with words or even sounds. You can begin by modeling easy movements you know he can do such as banging on his high chair tray, smacking at a window when he’s looking outside or clapping. If your child is already waving bye-bye or playing interactive games such as Peek-a-Boo or So Big, he already knows how to do this since “copying” you is how he’s learned the game in the first place. If you need more help with remembering how to play these kinds of games, check out my manual Teach Me To Play WITH You.

For kids who don’t catch on and try to repeat what you’ve done, I always back up and start to imitate their movements. Pick a time when your child is in a happy, playful mood to do this. It might also help to be in a confined space, such as inside a playhouse or under a blanket or table, so that her attention is focused on you. Wait until she does something, and repeat her movement. Stare back at her expectantly and wait for her to do it again. If she doesn’t, wait for her next big movement, then try again. When she notices and repeats the same or another movement, copy her again. Make this a game over the next several days or weeks so she expects you to imitate her. I also try to not to talk too much during these interactions so that the focus is on imitation, not on what I’ve said. Too much talking takes the focus off imitating, and this is the skill you need to teach. If I talk at all during this kind of exchange, it’s usually to say a funny novel word such as Bang, Bang, Bang or making a silly noise.

Once your child understands this game, try to take the lead by initiating movements you’ve seen her do in your last few play sessions. If she doesn’t do this on her own, try to take her hands and gently perform the action after you’ve done it. Some of these are performed with your mouth (blowing, fake coughing/sneezing, smacking, etc..) so they are particularly useful for helping kids move toward imitating vocally.

Additional ideas for other movements to have your child imitate –

Touching various body parts

Jumping

Pointing

Shaking his head

Smacking lips/kissing

Opening & closing your mouth

Clicking your tongue

Waving

Yawning

Give me 5

Touching the floor

Holding arms up

Patting your head

Stomping Feet

Fake Cough

Fake Sneeze

Blowing

Moving on to Imitating Sounds

When your child can imitate these movements pretty well, but still doesn’t seem to be able to make the leap to imitating words, I add silly sounds to the imitation games to accompany movements he can already imitate. For example, when I’m clapping, I say, “Yay!” If I shake my head, I say, “No, no, no” (in a silly, playful way), or I might add “sound effects” with popping my lips, or saying, “Do Do Do” as a I jump up and down. One silly sound that works well is saying, “Mmmmmm” when you’re eating a yummy snack. I add a little side-to-side shoulder action as I model this one to give them a motor movement to copy. These silly words, often called Exclamatory Words, are often among the first words that babies try to repeat and say on their own. Try some of the following:

Other Exclamatory Words

uh-oh, oops, whee, wow, ouch, oh, Oh man!, Oh no!, yuck, icky, yum-yum, boo, an audible inhalation or exhalation (think a surprised noise)

Fun With Noises

Some children are able to produce animal sounds before they begin to imitate words. I try these often during play with a farm set. A good first one to try is panting like a dog. I particularly do this if I know the child can imitate opening his mouth. Don’t forget other animal sounds like a bark, meow, neigh, oink, quack, moo, baa, roar, ssss for a snake, etc… I sometimes ask a child, “What does the ____ say?” before I do it, but most of the time, I grab the animal, hold it up by my face as if I’m pretending to be the animal, and model the sound. Exaggerate your facial expressions too. This nearly always generates a laugh, even if I don’t get them to try to repeat the animal sound just yet. Model the sound in play with the animals and barn too, but holding the toy animal by your face while you emphasize the sound and darn near make a fool out of yourself works really well! If they don’t try to imitate this, I might hold it next to their mouths and say, “You do it. You’re the ____!” If you need to take the pressure off of vocalizing, pretend to kiss the animal using an exaggerated smacking sound, then have them try. This also works well with puzzle pieces using animals. Don’t forget zoo animals either, but you may have to be more creative with their noises.

I also try noises to accompany whatever action we’re using in play with the farm animals or even dolls. Have them eat, drink (I do a loud slurpy noise), and everyone’s favorite, snore. When characters walk I either say, “Walk Walk Walk” or “Up Up Up” as they climb. You might also try to model a new consonant sound that they can’t usually produce in a word attempt. My friend who is a DI uses a little chant, “Doo dee doo dee doo” when characters walk, and she’s gotten several children to produce a /d/ in this context when I haven’t been able to get it in a real word. Other sounds I use routinely in play include fake crying, sneezing, laughing, yawning, and shivering for cold or scared.

I always play using vehicle noises. Don’t forget about vroom, zoom, boom, crash, honk-honk, beep-beep, choo-choo (or woo woo), siren noises, etc…. Try these in the middle of play. One of my favorites to do is to get the vehicle stuck when I model “stuuuuuuuuck” and then make lots of effortful noise while I try to pull the vehicle out.  Again try the by the face method, especially for the honk, beep, choo-choo, etc… I also do these with puzzle pieces of vehicles if a kid is too “busy” with a toy vehicle to notice all of my vocal efforts during play.

Another good thing to try is having a child vocalize into a bucket or can since this produces an echo-like noise. I had one little girl with Down syndrome who would not imitate any sound or word unless we first tried it this way. Babbling syllables is a good way to start with this. Try to use the same sounds you know your baby can do such as mamamama, bububububu, or dadadadada. If you can’t get a babble with consonant and vowel syllables, start with vowel sounds such as “ah,” “uh,” or “oh.”  Then I move to vowels that sound like words like “i” for “Hi” or “ay” for “Hey.”

If a child is pretty quiet and I don’t hear much noise at all during play, my goal is always to make him noisy, even before we begin to work on words. One thing I try to is to imitate any noise he happens to make whether it’s accidental or on purpose. Tickling or chasing is a good way to elicit squeals or laughter, then I make a big deal out of matching the child’s laugh or squeal with mine aiming for the same sounds, length, volume, and pitch as him.

If you’d like more information about this approach, I can help you! Get my book Building Verbal Imitation in Toddlers.  You’ll learn the 8 levels of imitation necessary for helping a late talker learn to imitate and talk!!

The post Help! My Child Won’t Imitate Words …. Begin with Imitating Movements & Sounds in Play appeared first on teachmetotalk.com.

1. The adult interacting with the child is (yawn) boring.

As even two-year-olds know, interacting with a boring person is at best a waste of time and at worst, well, just plain boring. Who can get worked up about that?? Certainly not a curious toddler who wants to see what’s making that cool noise outside the window or see if he can really get his toe into and out of air conditioning vent over and over. Get fired up! Act silly! Join in the fun and PLAY! You have to make yourself interesting, make that more interesting, than anything else in your babies’ world routinely for him to want to be with you and hopefully learn from you. When you can’t get a kid to interact, up the FUN FACTOR, and he’ll usually want to play. If you would not be embarrassed by having a neighbor or your boss suddenly drop by and see you playing with your kids, then you’re probably not doing it right.

2. The adult interacting with the child is too (YIKES!) strict.

I actually heard this complaint last week. A wonderful friend of mine who is a developmental interventionist (For those of you who don’t know, this is a preschool teacher with a master’s degree in early childhood education.) told me that the speech pathologist who is also seeing one of her clients actually bragged to a mom that she’s “strict.” Hmmmm. There’s an interesting choice of words. I’m not sure that kind of attitude would ever entice a communicatively-challenged kid to play.  This goes back to the fun factor. Strict and fun do not usually co-exist. Granted I do not allow children to do anything to repeatedly hurt me, injure themselves or another person, or purposefully damage property, but other than that, I don’t really have “rules.” I have heard of therapists who “refuse to chase kids.” They don’t know what fun and opportunities they’re missing! Some days my 41-year-old back and knees don’t particularly feel like chasing kids, but once I’ve used all my other tricks and realize that this kid needs to move, I am up off the floor and ready to play the game. (Besides, my 41-year- old thighs could use the exercise!)

Before all of you disciplinarian moms start firing off retaliatory comments to me about maintaining order and control in your homes, let me interject a quick note. I said “too” strict. This means establishing unrealistic expectations for your child. Let me give you an example. While I was listening to a radio talk show the other day, the speaker told an account of a mom who in an effort to make sure her “non-compliant child did not willfully disobey again” (that was the direct quote), she really “gave him one.” Although the speaker relaying this story did not come out and say “spanking,” I assumed that’s what was meant. I eagerly listened for the report of the “crime” since this punishment seemed harsh. Turns out this was a mom talking about spanking her ten-month old for looking at her (the “willfully disobedient part”) as she told him “no” while he continued to pull books off the shelf. Pulling books off a shelf is a developmentally appropriate activity for a ten-month-old! While a ten-month-old should be in the process of learning to understand and obey “no,” is continued persistence in this activity hardly signified willful disobedience. Actually even the most “advanced” ten-month-old is incapable of the purposeful cognitive manipulation of his mother. Anybody who tells you that he is needs to revisit the topic of Piaget and other “cognitive development” researchers and experts.

On the opposite side of this argument, I will also say that you must use developmentally -appropriate disciplinary strategies beginning at a very young age. For a typically developing ten-month old in the situation above, the mother should shake her head and say, “No No” while physically moving the child away to another location (A disciplinary strategy known as redirection), and/or showed him a more acceptable and interesting alternative (Another technique called distraction). The mom may also want to place the books she doesn’t want destroyed on a shelf out of reach. (A technique called using your common sense!). The same disciplinary techniques should also be used for the 2 1/2 year old who is delayed and functioning at a 12-month-old level. While some parents would try to use time-out, a recommended technique for a typically developing two-year-old, it would not be appropriate for this guy since he doesn’t understand things at a 2 1/2 year old level. Make sense to you?

I have seen too many well-meaning parents embrace the role of disciplinarian to such a degree that they forget the most important thing. You have to love your child! Don’t get so caught up in “making him mind” that you lose sight of enjoying him every day, even on the hard days. This connection with your kid is what will drive his motivation to communicate with you. His concept of you needs to include how much you adore him and how you light up every time he comes into the room, not just how you take care of him, and especially not how you constantly tell him “no.” Fall in love with your kid (if you’re not already) and be sure to act like it every day!

3. The adult follows the kid around narrating what he or the adult are doing without any sense that the kid knows, or cares for that matter, what you’re talking about.

This also includes other practices that are equally unproductive and don’t challenge that particular kid’s attention or motivation to interact and communicate. This could mean that an adult sits in a chair across the room and repeatedly calls in a monotone voice a kid who won’t sit still for 10 seconds, let alone a whole book. “Brandon. Come over here and sit down so we can read Alexander and the Terrible, Horrible, No Good, Very Bad Day.” Do you think Brandon is going to stop his preferred activity of climbing onto the back of the couch and jumping off for that?? Even if the adult switched gears a little and narrated, “Brandon is climbing on the couch. Brandon is jumping off the couch. Brandon is climbing on the couch. Blah. Blah. Blah.” Does this capture his attention? Even if it did, don’t you think his likely response would be, “I’ll tell you where to jump!”

This kind of behavior, talking on and on incessantly when your child is not paying attention, is another version of boring. Lots of speech pathologists and well-meaning parents do this. Many of them simply talk, talk, talk all day long about everything without any regard for the child’s processing abilities. We all know that kids need to hear language in order to learn to talk, but we need to give kids language at an appropriate level, one they can understand. If a kid isn’t able to follow one-step directions pretty consistently, a parent should not continue to talk in paragraph-length utterances all day. Boil it down. Use lots of single words and short phrases. Give him small narratives for his familiar routines, but don’t address your language-delayed child in the same language you use to talk to your best friend or your 11 year old. He’s going to tune you out. In his mind you sound like the teacher from Charlie Brown. “Wah – Wah – Wah- Wah.” I hear you talking, but I have no idea what you’re saying!

Narrating your and his actions is good advice for homes where parents are not by nature “talkers” themselves, but for most families, and especially ones like you who would go to the trouble of investigating this web-site, they’ve been there, done that. If just hearing enough language were all it takes for a child to learn to talk, chances are he would have already picked it up. You need a new strategy (and likely a new therapist if this is the best or only advice you’ve received!).

4. The adult allows the child to get stuck in negative, unproductive routines to the exclusion of more meaningful play and interaction.

This includes repetitive behaviors such as pushing lights and toys on and off repeatedly, excessive TV watching, repetitively opening/closing doors, excessively spinning objects, or even physical movements like hand-wringing and arm-flapping. These are often called stereotypic and/or self-stimulatory behaviors, and often times these are characteristics of children with autism and other sensory processing disorders. While all of these behaviors can’t totally be eliminated in some children, you should make an effort to try to redirect them to more purposeful play. If that doesn’t work many experts recommend to get them to let you join in their play to make it interactive.

Our oldest son started to flap his arms when he became upset or excited at age two. Rather than let this persist into a habit, we chose to treat this behaviorally by redirecting him to clap. Again his sensory issues were not serious or this need so great that he continued much longer after our efforts to intervene, but I am certainly glad we didn’t wait until he had done this for months or years before we decided to take action. Know that this is sometimes a serious battle for children since their sensory system needs may be getting met in a way that is “better” for them with this than any other behavior/activity you can come up with to replace the undesirable one. An occupational therapy assessment may be warranted with a therapist who is trained in assessing and managing sensory integration differences.

5. The adult provides no constructive routines for the child.

If you think this happens only in uneducated families, you’re wrong. I actually see this mistake more often in families with demanding schedules. Baby gets lost in the shuffle. Mom may own a business and work from home. She’s there, and she’s managing to feed and change her toddler throughout the day, but there’s not much interaction between customer calls and e-mails. Dad may work nights and sleep during the day, but the family can’t afford daycare on their already stretched income, so the baby is at home doing “nothing” or sleeping most of the day while Dad sleeps. The same can be said for many daycare situations. This ranges from the family home provider who is taking care of too many kids to the fancy-named daycare with women barely out of their teens who are proclaimed “teachers” and left to manage in a room full of under (and over) stimulated children with a couple of baskets of broken toys. Don’t kid yourself. Your child is not going to learn if there’s no opportunity. He needs predictable and interesting events throughout his day most every day. Spending three hours a day in front of the TV, two hours napping, one hour driving in the van for carpool, and another hour roaming around the house while Mommy “has her time” and talks on the phone doesn’t cut it. Set a schedule with several slots for one-on-one Mommy and baby time when you plan to be engaged in stimulating activities with your baby. The phone can ring. The dishes can wait.

6. The adult in charge of most of the child’s day has expectations that are too low.

This also happens for many children involved in daycare, either in or out of the home. (Believe me when I say that I am not knocking working moms since I too belong to this category.) I have worked with many families whose parents are gravely concerned about their child’s lack of ability to communicate, only to be told by the grandmother or nanny when a parent isn’t there during my visit that they don’t understand what all the fuss is about. Many people honestly believe that children don’t talk until they are 3. So even when mom and dad are doing a pretty good job of following through at night and on weekends, the person who is responsible for the baby for most of his waking hours, still doesn’t get it. Consequently, neither does the kid. Judiciously monitor your child’s activities when you are not there. Take the time to painstakingly explain to your child’s daycare provider your concerns and rally their commitment to your child’s development. If your attempts are not met with cooperation, please explore other childcare options. It’s that important.

7. Adults are more concerned about “how” a child talks than what he says.

There is nothing more frustrating for me as a clinician as when a child says a new word and his mother (or another significant other) chimes in to “correct” his pronunciation of the word. “Not nilt, it’s MMMMILLKKKKK. Now watch my mouth. It’s mmmmilllkkkk.” I’ll look over at the kid, and especially if he’s smart, he and I both get a look like someone has just burst our bubble. Over-correcting a kid’s articulation, or the way he says a word, is unnecessary and unwelcomed in the new talker phase. His efforts to communicate should be recognized and appreciated.  You can of course model the correct word, but in a non-confrontational way. “Yes! Here’s milk.” There will be plenty of time to teach new speech sounds and correct his errors, but a late talker’s first word attempts are not it. Many mothers worry that if we don’t correct the mistakes that “He’ll learn to say it that way.” Chances are greater that the child is going to correct those early sound errors much more quickly if his initial efforts to talk are met with enthusiasm rather than correction. He’s going to be more motivated to continue to try with adults who reward his attempts, even if they are off-target. Use the carrot, not the stick.

One word of caution – don’t repeat the child’s errors to him and begin to label something incorrectly unless you’re prepared to work really hard to “undo” this later. You’ll not only have to correct how he says it, but in a way, how he “thinks” it since you’ll have reinforced the mistake by having him hear it over and over. (When our children were toddlers, they all three had such cute misarticulations for words that they “stuck,” at least for a while, in our family. Our most memorable ones were Jonathan combining his favorite character from a song and favorite restaurant to proclaim “Mc O’Donalds,” calling my face cream “Earl of Oohlay,” and “Santoe” for Santa. Tyler called his older brother Jonathan “Nah-Nah.” My all time favorite was Macy’s very original version of shampoo, “hairshpoo.”I still write it that way occasionally on my shopping lists just for laughs. Do as I say, not as I do!)

8. Adults are too focused on pre-academic concepts such as colors words, numbers, and letters.

So many times when I start therapy with a new kid, I notice that mom and dad spend lots of time getting him to try to say names of letters, count, or identify colors. It always makes me think, “What about the really important words – milk, cookie, shoe, bye-bye, ball, Mama, Dada?” What about the words he really needs to say in the course of a day to communicate his wants and needs? The toy industry is partly to blame for this misinformation since so many infant toys focus on these skills. All of those concepts are things your child will need to learn during his preschool years, but not at 1 or 2, and certainly not before he learns to understand and say words that are more important.

After I give this lecture to some parents, they balk and exclaim that that’s what their child is interested in, sometimes the only thing he’s interested in. This might be true for some children, but it’s usually not a sign that the baby is going to be a child prodigy, whether it be an artist for those kids who only say color words, a writer for the ABC-obsessed, or a math teacher for the kid who can recognize the number at the bottom of a page in a book, but is still not able to point to the picture of the car or dog when asked. Actually an obsessive fascination with letters or numbers or anything that’s highly visual in nature is characteristic of children with autism. The professional term for this is called “hyperlexia.” So when a parent proudly exclaims that their kid must be a genius because he can read and recognize signs (like the Golden Arches of “McDonald’s” or “Stop”), but then an early intervention team is called in because he still can’t communicate his basic needs and isn’t talking very much other than identifying letters and counting, it makes me suspect that there’s much more going on than a language delay.

My advice to you is to emphasize and teach words that are meaningful for everyday life and leave the alphabet and counting for preschool. There will be plenty of time for this later, after your child has learned to ask for things he needs and can carry on a real conversation.

9. The adult enrolls a child in daycare, a play group, or a mother’s day out program thinking that exposure to other children will help a child learn to talk.

Being around other children does not make a child magically begin to say words. Children talk to adults first, not other children. This is especially true for children with social communication issues. If your child is not noticing other children or seeking out interaction with them or other adults, putting him in a daycare situation is likely to make things WORSE, not better.  The only exception would be a special preschool program where the staff are teachers and therapists specifically trained to teach children with language delays. A mother’s day out program staffed by volunteer mothers or paid workers (even the friendly “grandmother” types) should be used for childcare purposes only. If parents need a break or need time to run errands, by all means use these programs, but don’t kid yourself. Being in a room full of same age peers is not conducive to learning language when it’s not happened yet at home during 1:1 time with Mom and Dad.

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So there’s my top list of unproductive strategies for teaching kids to talk. Avoid these mistakes and counter them with strategies from the What Works section. If you have found other detrimental techniques, please feel free to let us know in the comments section.

The post What Doesn’t Work – Unproductive Strategies For Helping Toddlers Learn To Talk appeared first on teachmetotalk.com.

1. Play, play, play, and when you’re tired of all that, play some more!

You absolutely, positively have to get down on the floor and play with your kid. You can narrate his and your actions all day long, but until you put yourself in the thick of things in his world, you may not get much of a response to anything you try. For infants, this means holding them in your laps and playing early social games. Try old standards like So Big, Peek-a-boo, and Patty Cake. Or make up your own such as leaning them backwards or down from your lap and then pulling them up saying, “Down” then “Up.” For older babies, it means being down on the floor on the blanket and using developmentally-appropriate toys (more about that in another post!) and singing simple songs with hand motions led by you (not the CD or the DVD player!) For toddlers it means moving around with them and using their budding interests to determine your next activity.  For preschoolers, it means interjecting yourself into theirpretend games. For children who are not routinely social, YOU MUST become their favorite playmate at least some of the time instead of letting them remain self-absorded in their own spinning, button-pushing, TV-obsessed world.

2. Exude warmth and joy when you interact with your child.

Now I know that this is a stretch for most parents 100% of the time, but as a parent, or even a professional working with a child, you have to act excited and happy to be with them at least some, if not most, of the time. This change in attitude alone can make children who previously seemed antisocial begin to respond. For the kids who areare interested in playing, but not quite interacting, it causes them to want to sit and play WITH someone as opposed to hoarding the toys or continuously running around the room. Don’t get me started on what it does to kids who are already little social butterflies!  They are drawn to you like magnets, and so much so that they sob hysterically when you leave their homes.

For those of you who don’t know what this looks like or haven’t experienced being this “connected” to a child, try to imagine yourself “lighting up,” when your child walks into the room or looks at you. For the really clueless, it may help to start to notice it in other adults who interact well with children. Look for twinkly eyes and sincere expressions of affection. Sometimes I notice this in a Dad who walks into a room and immediately swoops a kid off his feet and then falls down on the floor in fits of tickles and riotous laughter. I also notice it in grandmothers who snuggle kids on their laps and talk sweetly and softly. It can come in all shapes and sizes, but the experience is the same. The kid who is on the receiving end of this usually responds in some positive way, although it may not be exactly what we’d want in the beginning. Even kids who don’t routinely initiate affection can learn to respond by allowing them to be hugged, or tickled, or caught as they run if a fun, caring adult persists in trying to woo them. If you’re not sure how you’re doing with this one, ask a friend or family member if you ACT like you love to play when you’re with your kid. (Not if you love them, but if you act like you love to play.) Watch yourself on videotape actually playing with your child. If you are not so mesmerized by your performance that you want to send it in to me as a great example for this post, try harder. It does get easier with practice.

3. Talk at and just above your child’s current language level most of the time during direct interactions.

Usually children understand at least a little more than they can say. (There are exceptions to this rule. For example, the child with autism who can recite lines from a movie, but she cannot ask for something she wants.) The theory here is that you want to challenge a child’s comprehension, support his ability to interact, and facilitate his ability to respond, all at the same time. Easier said than done, right?? Actually it is pretty simple when you think about the purpose of why you’re interacting with your child. For most of you reading this blog, your concern is that you want to teach your nonverbal child to talk. This means that you need to say most of what you say to them in the same way they could actually respond.

If your kid is nonverbal, or that is basically quiet except for a grunt or babble here and there, you generally are going to want to try to elicit sounds at first rather than words. Why?? (I can read your mind, and I’ve had so many parents react in such a shocked way when I say this that I naturally expect this response.) Because in babies whose language is developing in a more typical way, sounds precede true words. This doesn’t mean that you aren’t going to continue to talk to them using real words every day; it just means that you are going to model and wait for sounds at least some of the time during play, rather than modeling and expecting words. Sounds can be anything from a true belly laugh in kids who don’t even make a sound when they are being tickled, to animal and car sounds during play with toys, to giddy sounds such as “wheeeeeeee” on the swing and slide, or “ooh yucky” when she dislikes something, or “ooops” when you pretend to drop her during roughhousing. Almost all nonverbal, quiet children first begin to imitate and produce these kinds of sounds before words are heard. If your child can say a few of these kinds of sounds, try to expand to other sound effect words during play and daily routines. Usually a kid needs to be noisy before he can talk.

If your child can already produce a variety of sounds, then start to model simple, familiar, single words. Target “power” words so that he can immediately use them to make something happen in his world. Model names for favorite foods, toys, and people over and over and over again so that he can hear the word many, many, many times in the course of the day. Again, if he’s not saying many words, you need to keep most of the things you say to him at the single word level. For example, when you’re playing ball, don’t say, “Do you want to play soccer with me? Mommy is going to kick this soccer ball to you right now. You better get yourself ready to kick it back! Are you ready?” Try saying, “Ball. Kick ball. Ooooh – Ball.” See the difference??

On the flip side of this, when your child is using mostly words and phrases to communicate, stop with the “gitchee, gitchee, goo” and stick to real words most of the time, except for the endearing little rituals you’ll want to persist in doing until they roll their eyes and tell you frankly, “Enough of that already!”

4. Repetition is the mother of skill. Or as your mother would have said, “Practice makes perfect.”

Not to bore you with a discussion of neuroscience, but a baby’s brain must “practice” how to say something many times before the pathway is truly activated and it becomes easy. Think back to learning how to drive a car. In the beginning you had to concentrate on each little movement. You had to think almost out-loud: Adjust the seat, put your seat-belt on, put the key it, turn the ignition, put the car in reverse, No Wait – look in the mirror behind me, etc… Now you can drive, talk on your phone, and scarf down what’s left of your toddler’s chicken nuggets all at the same time. It became automatic. Until your little one has said any word several times and truly “learned it,” he has to rehearse. This is why some kids, especially late talkers, and especially in the initial phases of learning to talk, are overheard babbling or saying a new word again and again in their cribs or car-seats when no one is listening or there’s no real purpose in the repetition. (I must interject a cute story here. I have one little guy on my caseload who is just beginning to try to produce 2-word phrases.  I always carry snacks in my therapy bag to entice my little friends to ask me for things they really want, and let’s face it, food works better than anything with most of us, not just two-year-olds! This particular little friend loves my cheese balls. His mother is a pediatrician and quite naturally does not routinely offer her children vile foods such as this. He, however, has become obsessed. His mother told me that she has heard him on the monitor practicing, “Ball ball.” Then a pause as if he’s thinking, No, that’s not it. “Ball cheese.” Another pause… No, that’s not it either. And then he said, “Cheese ball!”)

New talkers, particularly those with verbal motor planning problems, or apraxia, can sometimes pop out a word once and then never again.  This is because the “pathway” for the word has not yet been established in their little brains. To help this process along, try to get them to repeat new words several times; don’t just settle for once! This works best when a toddler actually has to “use” the word in a functional way, and not just repeat it because Mommy asks him. Chances are if you are reading this, your child can’t imitate words well anyway, so stick to the purposeful activity. For example, if his new word is car, collect every Hot Wheels car you can get your hands on, devise a long ramp with a piece of wood on the side of a table, and then have him ask you for “car” one at a time to roll down the track. If his new word is cookie, don’t hand him 3 or 4 cookies on a plate for snack time. Break each cookie and make him ask you for each little piece. This kind of technique works because it creates opportunities for repetitive practice.

5. Imitation really is the sincerest form of flattery, and it’s the only way most of us learn anything.

If your child is not able to repeat or imitate sounds or words, you need to begin with having him try to imitate actions. Try to copy his actions and then wait for him to respond. When he slaps the tray on the high chair, smack it back. If he holds a ball in each hand and bangs them together, you do the same. If he jumps, jump. If he yawns, yawn. When he laughs, laugh. Repeat. Repeat. Repeat.

Set aside several short times every day to imitate all of your child’s vocalizations, even if he can’t yet imitate yours. Match your pitch, loudness, volume, and sounds to his as closely as you can. This technique, called vocal synchrony, can be found in Pamela Marshalla’s short and easy to read book “Becoming Verbal with Childhood Apraxia.”

Learning to imitate is absolutely essential to learning to talk. Another way to work on this is to model words or sounds you’ve heard your child say in order to teach him to imitate you. In all of my initial assessments I ask mom and dad for a list of words or sounds their toddler says. Sometimes it’s none, but usually a toddler has a couple of words he tries to say. I model these words in the session; usually by giving him a choice during play since this kind of request is best to facilitate a response. Since he or she can already say these words, the theory is that it’s easier for him to be able to imitate what he can already do rather than a new word. Once your child can consistently imitate words he already says, he can usually make the jump to imitating new words more easily than if you started with new ones.

(Since writing this post in 2008, I’ve written a whole book about teaching a child to imitate! Check that out – Building Verbal Imitation Skills in Toddlers. If you’re an SLP or therapist and you want a more academic discussion, the information is available in a course format on DVD with CEUs at this link Steps to Building Verbal Imitation in Toddlers on DVD.)

6. Use a sing-song voice, or parentese, when modeling words for your child to imitate.

Since I’m from the deep South and am a bit musical and dramatic most of the time, this is not a stretch for me at all. Most of us southern girls have that melodic drawl naturally. (This has been a little scary for some parents when I meet them for the first time. The really bold ones who have transferred in from states far away from Kentucky will even ask, “She’s not going to end up sounding like you, is she???”) Research tells us that parents around the world use this kind of speech pattern with their young babies. We all raise our voices several octaves when speaking to a newborn. This practice is still very effective for toddlers who aren’t yet speaking. Again researchers would tell us it’s because little brains like patterns and rhythmicity. Don’t feel like you have to speak this way all day. My own children, now 11, 16, and 18, ask me not to talk in my “therapy voice.” However, when you are modeling a word for your baby to try to imitate, overemphasize the vowels and exaggerate the syllables. For Mommy, try “Mooooo-mmyyyyyy” with your voice going up then falling down.

This is also a very effective technique when children are beginning to learn to combine words into two-word phrases. Again use the up-down intonation.

7. Balance the lead during interactions.

Since many language experts have suggested that adults follow a child’s lead during interactions, some parents and therapists have mistakenly believed that an adult should never choose an activity. This is simply not the best strategy to employ all the time because once again you may find yourself doing nothing but running around and chasing a kid without accomplishing much of anything. (I know of one therapist who spent several weeks during sessions just following a kid around the perimeter of a room and imitated him tapping furniture. Imitating him for a few minutes is one thing, but spending the majority of a session like this for several weeks in a row without accomplishing a role shift so that he imitated her or at least became more interested in her?? This kind of following a kid’s lead is ineffective.) I usually follow a child’s interest during therapy sessions by offering two acceptable choices and then letting him pick what we do. For example, I might hold a toy in each hand and ask, “Choo-choo or bubbles?” If a child can’t verbally tell me which one he needs, I might prompt him with a sign (more about that later in this post), or let him gesture by pointing, looking, or in some cases, wrestling it away from me, to indicate his choice. If a kid routinely obsesses about a certain toy and doesn’t want to give it up or won’t let me join in, I don’t offer that choice at all or I save it until the end of a session when I want to talk to mom. This way he still gets to play with his preferred toy, but I dictate when.

When a child begins to tire with an activity, even if it’s just after a couple of minutes, I start to transition to a new activity by singing Barney’s infamous “Clean Up Song.” It would be better to move on before I’m quite ready than to lose him altogether. If I know that a child hates books, I don’t insist that we look at more than a page or two (Or more often than not, none!) during a session. In my mind, this is what the experts mean by following a child’s lead. Don’t risk accomplishing nothing by following, or even leading, the entire time.

8. Withhold pieces of a toy, a snack, or anything else a kid needs to complete a preferred task, and wait.

This technique is similar to environmental sabotage. When you are trying to set up a situation to entice a kid to talk, never, ever, ever give him all the pieces of anything at once. For example, if your kid likes to complete puzzles, don’t place all the pieces on the floor and let him put them in on his terms. Place the puzzle board and all of the pieces in a large zip-lock bag (I buy the 2.5 gallon size in bulk!). Have him first choose between doing the puzzle or another toy. Then have him tell you how to get the puzzle out by saying “zip” or “open.” Then let him indicate which piece he wants in his most sophisticated response possible by either telling you, signing, or pointing. When he’s finished the puzzle, don’t just let him walk away. Have him help you put away the pieces, again one at a time. If you are working on comprehension, ask him, “Where’s the _____?” and have him place the piece in the bag. Again, don’t settle for simply finding the correct piece. Have him tell you what’s he’s found or at least say “Bye bye” to each piece as it’s placed in the bag. When you are finished, have him zip the bag again saying ”zip” or “close” and then finally, “All done.”

9. Use signs, gestures, or pictures to introduce him to the power of communication.

There are lots of programs on the market today to teach parents how to use sign language with their babies. Research supports this technique and has proven that some children may learn to speak more quickly by using signs than if they had not. The reasons are two-fold. First of all, speech is a motor movement, and pairing another gesture with a word is a powerful combination. This aids in motor planning, or helping his little brain establish the neural pathway for the word. Secondly, it reduces the frustration level for everyone involved. Let’s face it, with a late talker in the house, everyone is more than a little frustrated. Signing gives a way for your child to communicate his basic wants and needs in an acceptable way rather than the alternatives, namely grunting, whining, or screaming.

Here comes the part I just love about signs. We can’t make a kid talk (Goodness knows I’ve tried!), but we can make him, or at least help him, use signs. Many parents tell me that they have tried sign language with their kids unsuccessfully. By this they mean that they have modeled the signs many times, but their baby hasn’t attempted to use the sign himself. Once I show them my solution, they wonder, “Why didn’t I think of that?” Take your child’s hands and help him perform the sign. Some tactile sensitive and defensive toddlers may balk at first, but if you keep trying this in a happy, upbeat way, and then immediately reward him with the thing he’s requested with signs, he usually quits resisting and catches on pretty quickly.

There are some children who don’t have the motor or cognitive skills to be able to sign. There are some kids who just plain hate it. There are some children who just don’t get it because they don’t understand the symbolic nature of signs (or speech for that matter). For those kids I try pictures. There’s a specific program I use called the Picture Exchange Communication System (PECS) that teaches children to trade pictures for objects they want. It’s a very systematic program, and it should be implemented in exactly the way it was designed to be most effective. Look for a later post about this, search the Internet for it, or ask your speech-language pathologist to help determine if this is a good match for your child. Initially it was designed for kids with autism, but now it’s widely used for kids with all kinds of reasons for a language delay. The point is to teach a child to learn to initiate requests so they learn that through communication, they control their worlds. This is powerful stuff no matter what method you’re using.

Some parents are afraid that their children won’t learn to talk if they are given the option of signing or using a picture. I have never seen this happen in all of my career. Children are not born “stubborn,” “lazy,” or simply “choose” not to talk. Most of the time, there’s a reason we can suspect is the cause for a language delay, and although we may never know for sure, I am very certain that it’s not that a child is choosing to subject himself to the pain of not being able to communicate. When kids can talk, they do talk. When they can learn whatever skill has been missing, the words do come. Until then, doesn’t it make sense to give them another way to let you know what they want?? I have had a few families initially hesitate in teaching signs or using pictures, and thankfully I have always been able to talk them into it after a few more exhausting weeks with a frustrated toddler. There are certainly some favorite signs that a child may hold onto for months after he has begun to say words, but signs usually disappear pretty quickly when a kid finally discovers his voice. There are other ways a talented therapist can help you and/or your kid kick the habit once he and you are ready, but this is rarely needed.

On the other hand, I will occasionally have a mother who wholeheartedly embraces signing and might say to me, “He is saying the word, but he won’t sign it.” After I stare at her for a minute or two, they usually grin and say, “Oh. I get it.” We teach the sign to get the word. Talking is the overall objective.

10. Establish verbal rituals and repeat them at the same times every day.

Remember the earlier advice about repetition? This is the same concept  When you create little games or say the same things at the same time over and over, day after day, your little one’s brain begins to expect it as part of a routine. Sometimes your toddler will even “pop out” a word you normally would say without even meaning to do this. That’s when we know that language is in there, and we just have to get it out. You can help this happen by purposefully planning to use the same words and phrases in your daily routines. Try to also stick with the same intonation (sing-song) patterns so again his brain picks up on the rhythm and timing. If you’re not too creative, try using the same songs and reading the same short books every day. When you have used the phrase or song for a long time, start to pause and wait for your child to fill in the last word of a line. For example, try singing “Twinkle, Twinkle Little Star” every night as you look out the window as part of your night-time routine. After several weeks, pause after singing, “Twinkle, twinkle little …….” and look expectantly toward your child for him to fill-in “star” or his own version of this word. Or you might practice waving bye-bye to all the people, pets, and whatever else you choose in your home as you leave. Be sure to build the routine by saying, “Say bye-bye to ________. Pause. Bye-bye (as you wave). Say bye-bye to ________. Pause. Bye-bye. Say bye-bye to ______. Pause and wait for him to fill-in his own “bye bye.”

Some parents like to try counting items as a routine. This is fine, but I usually prefer to label things instead of saying number for new talkers. Instead of counting a row of puppies in a book, I say, “Dog, dog, dog, dog,” as I point to each picture. Help your child begin to point as you label the items. After several days or a couple of weeks doing this, don’t label the last one and wait for him to say it. This would also be good to use when sorting socks, setting the table, or any kind of repetitive household activity. Look the patterns and use them.

While I have other tricks up my sleeve to help toddlers talk, these are the most effective ones and easiest ones for parents to implement. I welcome your comments as you try these with your children at home.

Listen to my podcasts about this post!

Part 1

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Here’s the “What Doesn’t Work” post!

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