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Sunday, December 6, 2009

TALKING KIDZ: WHAT PARENTS WANT TO KNOW ABOUT WHAT’S NORMAL AT AGE TWO

By The Speech Doc/Bonnie Engel Lee, Ph.D., Speech-Language Pathologist
Do you suspect that your child’s speech delayed? Or just want confirmation that your child’s speech is developing normally. As a parent, you want to make sure your child’s speech and language skills are developing and if not, you want to make sure that you are doing all you can to help your child.

In the next few episodes, we’ll be talking about what typical two, three, four and five year olds understand and express. But before we start talking about what’s normal or typical, it’s important to briefly differentiate between the terms speech and language.

Language includes a system of symbols that are used to communicate thoughts and feelings. While there are many different languages, they all follow a given set of rules that govern how words are combined to express meaning. The rules relate to the sound system, the words and their meaning as well as the grammar, how words are combined. Receptive language refers to what a child understands and expressive language refers to what a child can say or express.


On the other hand, Speech refers to the physical ability to speak. Speech includes saying speech sounds, using your voice at a particular loudness level (loud, soft), pitch level (high, low) voice quality (hoarse, breathy) and with an appropriate rate of delivery (fluency).

The ability to understand words, concepts, sentences, etc. precedes expression and use.

This means that a child may, for example, understand questions that start with “what” as in “What are you doing?” before your child will ask “What” questions on his/her own.

Here’s a summary of what a typical two-year old understands and expresses:

Receptive Language

Understands up to 500 words

Begins to understand whole sentence

Pays attention to word order

Understands yes/no questions

Begins to understand WH questions (what, where, who)


Expressive Language

First word are nouns, actions and modifiers

Uses intonation to change meaning of the same word

Uses names of objects that are familiar

Common words child uses: “no”, mine, good, bad, hot, here, more, etc.

Begin to use 2 word utterances by 18-24 months- Child typically uses 50 single words before putting words together.

Uses 2-3 word sentences (average is 2 words

Expresses up to 300 words

Uses 25 different phonemes-vowels and some consonants

First pronouns appear (“me” and “my” are the first ones)

Uses vowels in mid central and low front part of the mouth. (These include “uh” (as in cup), “eh” (as in bed) and “ae” (as in cat). They do not use “ee”(as in see) or “oo” (as in shoe).

Lips are the most frequent place of articulation. That means your child will be saying words with p, b, m and w (papa, baby, mama, wawa (for water).


Even if you feel your child is delayed, you should be noticing that your child is doing new things with his/her speech and language each month, such as adding new words or using them in new ways.


Perhaps you’ve discussed your concerns with your pediatrician and been instructed to give your child time to develop. Some parents have shared that they feel guilty waiting for their child to develop. Research supports that children who receive early intervention have a better outcome than children who receive services when they are older.


If you still have nagging concerns about your child’s speech and language skills, there are places to go for information and referral.

The American Speech-Language Hearing Association (ASHA) website at asha.org is a great resource. Click on the word “public” on the menu on the left side of the home page for information on various topics including normal development and ideas on how to help your child develop speech and language skills. If you want to talk to someone, you can reach the ASHA Call Center at 800-638-8255 between the hours of 8:30 am and 5:00 pm (Eastern time zone).


If you’d like to have your child evaluated, contact “CHILD FIND”, a comprehensive system for identifying children with disabilities in a variety of areas, including speech and language skills. Child Find is a federally mandated program that is part of the Individuals with Disabilities Education Act (IDEA). For information, contact your state’s Part C Coordinator at http://www.nectac.org/contact/PTcoord.asp for information about services and eligibility in your state. You can also contact your local school district for information.


Sources of Information for this blog include:

American Speech-Language-Hearing Association Website Public Section. www.asha.org

Child Find, www.childfindidea.org

Heavner, Krista. Using Developmental Milestones to Set Goals and Plan Therapy. Therapy Guideposts 2007 Webinar Series. www.bionicear.com

Let’s Talk, Publication of American Speech-Language Hearing Association, 2003


I hope I’ve answered some of your questions about your two year old’s speech and language skills and if you still have concerns, that you have some ideas as to where to go for help.


You can listen to the entire podcast by going to speechdoc.podbean.com. If you would like you’d like to suggest a topic, you can contact The Speech Doc at TalkingKidz@gmail.com

Sunday, November 15, 2009

TALKING KIDZ: WHAT PARENTS WANT TO KNOW ABOUT BEING A GOOD SPEECH MODEL FOR THEIR CHILD

Welcome back to Talking Kidz. In Episode 2, we’ll talk about being a good speech model for your child. First we’ll talk about self talk and parallel talk as ways to provide models in terms of what you are thinking or talking about and also what your child might be thinking or want to say. Then we’ll talk about some research that helps parents identify ways to be effective speech models. Last, we’ll talk about how your child’s interest in a particular topic dramatically impacts his/her acquisition of speech and language and how you can use everyday events in your child’s life to enhance language development.


Here are some simple definitions of these very valuable techniques: Self-Talk is used when a person talks about what they are seeing, doing, hearing or feeling. So if you are making breakfast, you can talk about “crack egg”, “more milk”, “mix eggs”, “put in”, “ cook eggs”, and/or “all done” as models for your child.

Parallel Talk is used when a person talks about what a child is seeing, doing, hearing or feelings. When you do this, you are providing a running commentary about what your child, using short simple phrases or sentences at your child’s language level.


There has been a lot written about these two strategies. If you search the internet, you’ll uncover video’s on Teacher Tube that demonstrate how to use these procedures. Even thought the techniques sound very simple, they are very effective ways to model and promote language development.


A few years ago I worked with a preschooler who had very limited verbal communication. Although he was three years old, he spoke mainly in single words and had only a few two or three word phrases so he had a significant speech delay. During therapy, we played with a dollhouse, a pretend airport or garage set. I didn’t ask him child any questions. I just talked what I was doing with the objects or thinking out loud about what I was doing and kept my speech models to two to three word phrases. If the child participated in the pretend play, I spoke about what he was doing or might be thinking, again using short phrases and leaving out the articles and unimportant words. Within four to six weeks of receiving speech only once a week and of course, teaching his parents to do the same at home, this child was consistently speaking in two to three word phrases.


Another time, I was asked to work with a five year girl whose mother felt she wasn’t ready for kindergarten because her language skills were not well developed. Using a similar procedure, I worked with her in her home environment with her toys, using self talk and parallel talk as we played with her blocks, dolls and puzzles. I spoke in short sentences, which were similar in length to the child’s longest utterances. While I only worked directly with her for a half hour each time, her mother watched our sessions and used the same procedures with her. While my intervention was limited, the child speech and language skills were significantly expanded three months after her mother and I started using parallel talk and self talk procedures with her. We also did some sequential activities that could be safely performed with children. For example, we made popcorn with a hot air popcorn maker, photographed the ingredients and the steps we followed and then printed the photographs for use in story telling. The child’s mother served as the photographer as we gathered and used the ingredients with the child performing as many of the activities as possible such as adding the seeds, stirring the butter, etc. Using the finished photographs, the child was able to put the pictures in order and then retell the story. With practice, she was able to provide more details and retell the story more completely. If she were older, she could have written captions on the bottom of each picture to retell the story in words.


In a research study by Dunst and colleagues published in TOPICS IN EARLY CHILDHOOD SPECIAL EDUCATION (PRO ED) IN 2001 which investigated the characteristics of everyday natural learning opportunities, the authors investigated how different activities (which they referred to as activity settings) and different interaction patterns influenced the performance of children with a range of developmental disabilities. The children represented diverse diagnoses including autism, down syndrome, cerebral palsy hearing or vision impairments, speech delays, epilepsy, etc. Many of the children had significant language and speech delays. The subjects were 63 parents/caregivers and 63 preschool aged children at six different age levels who lived in six different states. Several scales were used to rated students’ play, performance and progress along several domains.


First, the researchers identified everyday activities which would provide language learning opportunities for children. The activities included everyday occurrences that we often take for granted and yet the offer children the opportunity to grow and develop.


These activities included but were not limited to:

Meal times, bath times, caring for pets, dressing and undressing, taking walks, playing in a puddle of water, going on picnics or to the park, planting flowers, bedtime stories, car or bus rides, bookstore or library story hours, amusement rides, play groups, grocery shopping etc.

A total of 10-12 activities were eventually selected as the focus of the intervention. Using these activity settings, the researchers assisted parents in actually scheduling these different activities as opportunities for learning. The learning activities could be planned or unplanned. So for example, the activities were listed vertically on a calendar with the days of the week listed horizontally and then activities were scheduled throughout the week.


Participants were asked to consider each activity and pick those that they thought would be fun and enjoyable for their child.

After the activities were selected, participants identified the behaviors that they wanted their children to produce in each activity.

Then, a researcher visited the participants every other week for a total of 8 visits (over 16 weeks).


Participants were taught how to use a technique called RESPONSIVE TEACHING.


They were taught three basic skills. The skills were:

  1. to respond to their child’s communication in different ways, depending upon what their child said
  2. to support and guiding their child
  3. to facilitate variety in their child’s communication and to help their child elaborate what was said.

Participants kept weekly logs of the activities that their child had been exposed to each day.


Each activity was rated in terms of:

  • If it was interesting to the child
  • If the child was engaged in the activity
  • If the child displayed the behaviors expected
  • If the child displayed new or emerging competence
  • if the activity afforded opportunities for exploration

There were several outcome scales, which involved self reporting that related tO Child and parent experiences and Parent and Child Play- There were six rating scales in all.


Here’s what they found:

Parents who used responsive teaching methods interacted more often with their children. And the frequency of participation in activities had a positive impact.

  • Children participating in a larger number of activities were the same children
  • Whose parents reported providing them with more learning activities
  • More rapid rates of child learning activities and parent/child play opportunities were associated with the presence of more favorable activities.


ON THE TOPIC OF PARENT/CHILD PLAY OPPORTUNITIES……

Children who participated in larger number of activities also had A more rapid rate of increase in the number of child learning activities.

Also, children were more socially responsive.


In other words, they learned more, faster and were more socially responsive.


The findings supported the researcher’s hypothesis that:

1. Children’s interests, their engagement in an activity, their exploration and mastery would be the best prediction of variations in the outcomes of everyday learning opportunities.

If they are interested in something, they will explore it and learn from it

2. The findings of this study replicate those of other research studies which demonstrated that different activities that occur in everyday life are IMPORTANT natural learning environments for promoting child development.


And here’s a crucial point:

Learning opportunities that were:

  • Interesting
  • Engaging and
  • Provided children with contexts for exploring, practicing and perfecting competence

Proved to be characteristics that promoted increased learning and development.


TO BE EFFECTIVE IN MAKING DEVELOPMENTAL CHANGES, THE ACTIVITY MUST TAKE PLACE ON A REGULAR BASIS OVER AN EXTENDED PERIOD OF TIME.


An anecdotal experience that I can share about this study relates to a preschool student I worked with about a few years ago. The student smiled frequently, seemed to comprehend directions but did not initiate verbalization very often… that is, until his family took him to Disney World. While shopping during the summer after the student had visited Mickey Mouse and Minnie Mouse, I saw the student and his mother at a grocery store. The student initiated a conversation about his visit and made several comments about his experience. When asked additional questions about who went with him, he took his turn in the conversation and shared additional information. It seemed that after this experience, which was not an “everyday experience as defined by Dunst, et al, this student’s communication skills seemed to “take-off” and by the end of his second year in preschool, he was evaluated and no longer required language therapy.


An example of how our interest level can impact our desire to communicate, just think for a moment about your own communication. What do you like to talk about? When you are passionate about a particular topic, you enjoy talking about it. The same is true of your children. So, if we can find out what our children are interested in, they will be more likely to communicate. When we’re thinking about how to help our children’s communication skills grow, the research shows that we should be thinking about their interests.


An article by Susan Lederer and Esther Kogan called, Collaborating with Parents of Young Children with Language Delays to Identify and Nurture Communication-Enhancing Activities appeared in speechpathology.com, a subscriber professional development site. The article reported on a pilot study conducted at Adelphi University’s Center for Communication Disorders in Garden City, NY. Using the Dunst research as a starting point, the researchers assumed that participating in a favored activity, provides opportunities and motivation for a child to practice communication skills.


So, they developed a program designed to identify favored activities.

The Kid Talk, a ten week program, was developed as a language enrichment program for three year olds with delayed speech and language skills.

First, parents were given a tool to collect information on their child’s interests.


The Child Interest Survey was an open ended survey and it collected information about:

  1. What a child likes to do on a regular basis,
  2. what he/she may not have been exposed to yet
  3. what the child did not seem to enjoy


The survey represented different domains that represent typical an early childhood classroom curriculum such as math, science, gross and fine motor skills, language/literacy, music and art.


Each week as the children participated in activities related to EACH of above curricula. They were observed and rated on several scales using a 3 point scale. The areas included the child’s:

  • participation
  • enjoyment
  • child’s level of communication


Parents also used a form (The Activity-Communication Rating/Reflection form) to rate activities in the home or community.


By paying attention to the child’s interests, parents were able to foster those interests and as a result, their child’s communication skills as well.

The researchers measured the success of their program by changes in parent knowledge, skills and attitudes.

Some of the comments of the parents in the pilot program were revealing and quite valuable. One parent said that she now asks her son what he wants to do. She also takes more time to expose her son to more things. Just because he doesn’t talk, doesn’t mean that he can’t learn from experiences.


So, to summarize what we’ve learned today about modeling for our children, here are some key points:

  1. Find out what your child is interested in by observing, rating interest level, engagement and communication skills
  2. Use words, phrases or sentences that communicate what your child might be saying or thinking as he/she plays and/or what you are thinking or saying as you do various activities with your child. We referred to this as self talk and parallel talk.
  3. Use a model that’s appropriate in length and complexity. Speak in phrases or sentences that are slightly longer or slightly more complex than your child’s speech.
  4. Use Responsive Teaching Techniques- Respond to your child in different ways, depending upon what he/she says and elaborate what your child says, which gives your child a model from which to learn.
  5. Make a concerted effort to use everyday experiences to facilitate your child’s language skills. It takes effort to talk to your child while you are helping him/her get dressed, making meals and just going through your daily routine.
  6. When your points or grunts, it’s easy just to give your child what you know your child wants. However, you can turn the situation into a “teaching opportunity” if you take the time to provide your child with a situation-specific verbal model.


I hope you’ve been inspired to use self talk and parallel talk and to observe your child’s interests so that you can foster his/her communication skills.

You can listen to the entire podcast by going to http://speechdoc.podbean.com. If you would like you’d like to suggest a topic, you can contact me at TalkingKidz@gmail.com

Monday, November 9, 2009

TALKING KIDZ: WHAT PARENTS WANT TO KNOW ABOUT IMITATION AND LANGUAGE DEVELOPMENT

By The Speech Doc/Bonnie Engel Lee, Ph. D., CCC-SLP

Speech Language Pathologist

If you are a new parent, you might be wondering what you can do to help your child learn to speak.

If you have an older child, you might be asking yourself, “Is my child’s speech developing normally? Or is my child’s speech delayed?

Whether you are a parent of a baby or older child, you’ve come to the right place.

In this blog, you’ll learn about how speech develops normally and what you can do to help. You’ll also have the opportunity to suggest topics and ask questions. In this blog, we are going to start at the very beginning, and talk about how speech develops from birth. If your child is older, I think you’ll still find some tips that apply to you.

When we think about the early sounds that babies make, we usually think about the cooing sounds, the babbling and so on. Some of these sounds occur by accident as a child is sucking and swallowing. As a child sucks, the tongue comes forward touching the lips and sounds are produced like this……. However, have you ever thought about the role of imitation in learning how to speak?

Pam Marshala, an accomplished speech/language pathologist, in her book, Becoming Verbal with Childhood Apraxia, which was published in 2001, talks about the stages of speech and language development as being fairly predictable. While children hit the developmental milestones within certain age ranges, there is a lot of flexibility and overlapping among the stages. One thing is clear, according to Marshalla, and that is, that the development of words is dependent upon your child’s ability to imitate.

Jean Piaget, a well known psychologist, in the text “Piaget’s Theory of Intellectual Development by Ginsburg and Opper (1969) stated that children learn to imitate others in four distinct stages.

Let’s talk about how imitation develops and how it coordinates with speech and language development.

During the first stage called the Vocal Contagion Stage, which takes place from birth through approximately 5 months of age, children make sounds for themselves. It’s a form of “self” entertainment. We tend to hear the lip sounds at this time such as bah, wah or mah. First, you’ll hear your child say the same consonant sound repeatedly (bah, bah, bah) and then you’ll hear a variety of consonants (bah, wah, mah) and also, you’ll also hear a variety of vowel sounds produced. (Bah, bee, boh, boo)

Piaget describes these sounds as purposeful and repetitious sound play. An interesting feature of this stage is that when you and your family are talking, your baby will make sounds more often, as if the sounds you are making are “contagious”. However, there is no real imitation or taking of turns going on.

Here’s an experiment you can try. Pick up the phone and pretend to talk to someone. If your baby begins to vocalize, he/she may be going through this stage, That’s why this stage of imitation is called “Vocal Contagion”, because “talking is contagious.”

Here are some things you can do if you child is going through the Vocal Contagion stage.

You can do a variety of motor activities to encourage your child to vocalize. For example, you can tickle your child, toss a ball, blow out and make your lips vibrate, make animal sounds (barking or meowing), laugh, sing, babble like a baby, etc. You can also make sounds with some of the whistles and horns that are party favors. You’re child might be making sounds at the end of sucking. You can make those sounds, too.

If your child says something or perform a motor activity, such as tapping on his/her high chair, you can imitate your child’s movements or sounds as a way of establishing that you are taking turns with your child. Turntaking is an essential feature of carrying on a conversation. It doesn’t matter what your child says because your goal during this time period is to respond to your child movements or sounds.

In stage two, called Mutual Imitation, which typically takes place between 5 and 7 months of age, you child begins to imitate himself or herself. Even if you vocalize and take turns with your child, your child will only imitate himself. Turntaking is establishing but your child still does not imitate others. By the end of the Mutual Imitation stage, your child begins to understand how what he/she does is related to what you are doing.

Here are some things you can do during the Mutual Imitation Stage:

Try to catch your child talking and imitate what your child says. Pam Marshalla suggests three ways to help your child develop words. Echo your child, Echo and then correct your child or Echo and then expand what your child says. In the following example, assume that your child is looking at an apple and naming it. When you Echo your child, you say exactly what your child says. If your child says “ball”, then you say ‘ball”. When you Echo correct your child, if your child says, “ball”, you say “ball- apple”. When you use Echo expansion, you imitate what you child says and expand what your child says to include more information. An example would be where your child says “ball” and you say, “That apple looks like a ball.”

A rule of thumb to keep in mind is that the speech you model should be only slightly longer and/or slightly more complex than your child’s speech. If you child says, “cookie”, then a response such as, “I love those chocolate chip cookies we baked at grandma’s house” would be way too long and too complex to say to a child at the single word stage. A more appropriate model would be “good cookie” or “yummy cookie”.

You can also model correct pronunciation by echoing your child exactly or by repeating what your child says and then saying the word with the correct pronunciation. For example, if your child calls a puppy, “buh-bee”, you can repeat what your child says and then provide the correct word as in “buh-bee, puppy” and you can expand your child’s speech further as in “Buh-bee, puppy, what a nice puppy.”

It’s important to focus more on the process of learning to imitate rather than the accuracy of your child’s pronunciation. It takes eight years for all of the speech sounds to be fully acquired. Keeping that in mind will help to keep the learning process in perspective.

In stage three, referred to as Spontaneous Imitation of Old Repertoire, children will repeat words “on demand” but only if the words imitated were previously spoken by the child and in his/her repertoire. If you ask your child to say a word he/she hasn’t said before, your child typically will not imitate it. This stage is typically observed between six and ten months of age.

Here are some things you can do during this stage of Spontaneous Imitation of Familiar Words:

  1. Keep a log of words your child has said so you know which words you can model for your child. Say those words in an appropriate context so that your child can associate the word with an object or an event to which the word is related.
  2. You can vary the way you talk to your child. You can ask, “What’s this?” (A book) or use sentence completion, “I read a _____”.
  3. Acknowledge what your child says by commenting “Oh, you said book again”.

During the fourth and final stage of imitation, called Spontaneous Imitation of New Repertoire, children spontaneously imitate words that were not previously in their repertoire. According to Piaget, this stage typically occurs between 10 and 14 months of age. While the imitation may not be perfect, your child understands what he/she is expected to do and if your child is in the “right mood”, he/she should be able to imitate new words that you say.

During the fourth stage of imitation, you can:

  1. Model new words. Try to talk about the words within the appropriate context to help your child understand the meaning. Some words are more powerful than others. For example, words such as “more” and “want” enable a child to get something. And don’t we just love it when our child learns to say the word, “no”.
  2. You can also model new sounds in the words you say, but don’t expect your child to be able to say them correctly. As noted previously, speech sounds are learned in a developmental progression which is not complete until eight years of age.

This blog addressed how children learn to imitate and how the ability to imitate directly relates to a child’s ability to learn to speak, a topic originally presented by Pam Marshalla in an inspiring lecture on Speech Pathology.com, an on line professional development site.

The four stages discussed take place during the first year of life in typically developing children and they include:

Stage one, the Vocal Contagion Stage, where a child is more vocal when others are talking.

Stage two, the Mutual Imitation Stage, where turn taking is established with you imitating your child and your child taking a turn, but not yet imitating your speech.

Stage three, Spontaneous Imitation of Familiar Words, where a child spontaneously imitates words within his old repertoire and finally,

Stage four, the Spontaneous Imitation of Unfamiliar words, which is true imitation in that your child is able to imitate words that are new.

Keep in mind that your child may be older than a year of age and may not have reached the final stage of imitation. If you find that your two, three or even four year old child does not imitate familiar or unfamiliar words and has language or speech delays, you can still follow the suggestions included in this podcast to help your child’s speech and language skills develop.

I hope you’ve found today’s topic of interest and relevant to your child. If you’d like to suggest a topic, feel free to email your suggestion to TalkingKidz@gmail.com

I’d love to hear from you and I welcome your suggestions.