Just Playing: The Importance of Play

As a child, I remember playing for hours. I enjoyed riding my bike around the neighborhood, playing at the park, playing tag, hopscotch, jump roping, dress-up, etc. The list is endless. I enjoyed playing dolls and Barbie’s, while my brothers enjoyed playing Legos and building blocks. Play is a child’s work. It is their job. It is their way to express themselves. Play is important in overall childhood development. Play stimulates the body and the brain. It fosters cognitive, fine and gross motor, communication, social-emotional and self-help skills. Play is so important to optimal child development, that it has been recognized by the United Nations High Commission for Human Rights as a RIGHT OF EVERY CHILD.

Spending time playing is establishing and building your child’s self-esteem. Play between children and their parents, creates a bond and let’s your child know they are important. It allows the parent to role-play real life situations and teaches the child how to problem-solve certain social situations. For example, play during recess creates endless social and communication opportunities. Since there have been nation-wide budget cuts; children around the country no longer have recess and/or fewer physical education days. This means, children are playing less at school. Additionally, in today’s age of technology, children are less likely to play, are less likely to go outside and explore and have a decreased imagination. It is important to limit the time your child spends in front of the television.

There are many types and stages of play, and as your child grows, their play evolves. Play begins in infancy. For example, when your child begins playing with a rattle and begins looking around. Simple give-and-take games, such as peek-a-boo and smiling back and forth is encouraging interaction-attachment. Play progresses, where a child takes on different roles, common goals, plays with one to two leaders. It becomes relatively long and complex.

Play parallels language, meaning if your child is playing with one object they should be saying one word. If your child is combining objects into play, he/she should be combing words. Therefore, as your child’s play becomes more sophisticated, his/her language will follow. Play is fun and can be free. It is important to avoid telling your child what to do and try avoiding asking too many questions. Follow your child’s lead by commenting on what he/she is doing. Research has concluded, families who play together have better communication and are more supportive. Play is important in promoting a healthy development and creating child-parent bonds. In our busy worlds it is important to make time to play!

As a parent, ask yourself these questions:

1. When was the last time you played with your child?

2. What games and toy preferences does your child have?

3. How long does your child play for on a daily or weekly basis?

 “When you asked me what I did in school today and I say, 'I just played.' Please don’t misunderstand me. For you see, I am learning as I play. I am learning to enjoy and be successful in my work. Today I am a child and my work is play.”

Anita Wadley, 1974

~Written by Angie

Communication Strategies for Infants and Toddlers

Your baby starts communicating with you before they take their first breath. It's true,  little Johnny and Susie are communicating even before they leave the womb. Sure, early communication seems like a lot of crying and grunting at first, but quickly becomes so much more! As you understand early communication, you will be better equipped to enhance your baby's language from infancy through adulthood.

Communication can be broken down into two fundamental categories: expressive language and receptive language. Expressive language is an individual’s ability to communicate using words, phrases, build sentences, report information, tell stories, have conversations, etc. for means of social, academic and safety needs.  Receptive language is most often a precursor to expressive language, therefore, it is essential to establish before vocalizations begin.

Expressive Language:

Around 10 months of age, your child should begin using variegated babbling, using different consonant+ vowel (CV) syllables and more sounds should begin appearing. Adult-like intonation and prosody (the up and down tones in our voice) emerges. Frequently used consonants include the following sounds /h, d, b, m, t, n, w, p/. Before your child turns one, they should have approximately 2 words in their vocabulary (i.e. mama and dada). Your child should be able to imitate CV combinations and non-speech sounds (i.e. clicks, raspberries, animal sounds). They should also begin imitating the name of familiar objects such as “ball, milk, baby”. Communication continues to grow and expand at an exponential rate. By the age of 15 months, your child should begin saying 8-10 words spontaneously and begin asking to have their needs met.After birth, vocalizations are reflexive, including crying, coughing and sneezing. As your child begins to cry, they are communicating a need (i.e. hungry, tired, dirty diaper). At two months of age, a parent is beginning to distinguish cries for different needs. As your child grows to four to six months of age, he/she is beginning to communicate by laughing, babbling CV and VC syllable sequences and vocalizing feelings through intonation. Reduplicated syllables, such as “baba” begin emerging around 7 months, as do gestures. Gestures are a precursor for verbal language skills. For example, gestures can include reaching towards a rattle, looking at their bottle, smiling when approached and spoken to, establishing eye contact, grabbing for a toy, etc.

 By 18 months your child should have approximately 50 words in his/her vocabulary and should begin asking questions (“daddy go?”). At 24 months your child should have approximately 250 words and be using new words regularly!! Your child should consistently be combining 2-3 words and should be approximately 50% intelligible (percentage of time your child is understood by an unfamiliar listener). By 36 months, your child should be able to relate recent experiences through words, begin conversing, begin counting and combing 3-4 words and be approximately 75% intelligible.

Receptive Language:

Soon after birth, your child learns to quiet to a familiar voice, shows awareness of a speaker and attends to the speaker’s mouth. Around three months of age, your child searches for you when he/she hears your voice, stops crying when spoken to and is beginning to respond to “no”. At the age of six months, your child is beginning to understand a few words and should beginning to follow simple commands, with gestures. For example, “come up” while holding your hands out. They should begin to recognize family members’ names (i.e. mommy and daddy) and wave in response to “bye-bye”.

Before reaching 12 months of age, your child should be attending to new words, giving objects upon verbal requests (“give me the ball”), understanding simple questions (“where’s sissy?”), and is beginning to identify one to two body parts on self. First early words include: family members, food, body parts, clothing, household objects, animals, toys, action words, etc.

By 18 months, your child should be understanding 200 words, identifying noun and action pictures when named. At 24 months, your child should begin following novel commands and two-step related commands. As receptive language increases, your child should begin understanding basic concepts (i.e. size, quantity concepts “give me one”, colors, qualitative “which one is big?”). By 36 months, your child will begin answering simple “wh” questions (who, what, and where), understand location phrases, answer “yes/no” questions correctly, and follow a two to three-step command.

As your child continues to grow and learn, there are many communication strategies we, as speech-language pathologists, recommend to ensure continued communicative development. I’m briefly going to discuss three communication strategies. These strategies are taken from the book More than Words: Helping Parents Promote Communication and Social Skills in Children with Autism Spectrum Disorder.

First, observe, wait and listen to your child’s body language and notice what they are looking at. Provide your child with enough time to carry out his/her own ideas and communication roles. Personally, wait time, was an extremely difficult strategy for me to use, I literally had to count 1-10 in my head. It is truly amazing how much more a child is capable of saying, when time wait is given. If your child does not respond after waiting, cue him/her through modeling, or hand-over-hand help your child make their request. Listen and pay attention to your child’s sounds and words. Do your best to NOT interrupt. When you are listening, you are letting your child know he/she is important.

During daily routines, talk to your child. Tell them what you are doing (i.e. “I’m washing my hands”). Tell your child what he/she is doing (i.e. “you must be mad, because you are yelling”). Follow your child’s lead, meaning every time your child leads an interaction, respond. Give your child information about the things that interest him/her, join in and play. Imitate, interpret and comment on your child’s play. Play is the most important aspect for a child’s communicative development. Play is how your child learns. Make communication fun and as a result, your child will develop an increase in spontaneous use of language and will also begin to establish the power of language for controlling people and getting their desires met.

The third strategy I use frequently is out of reach. Place highly preferred items in sight, but out of reach. This creates an opportunity for your child to seek out communication partners and it makes a specific request. This can be done easily by storing a specific toy in a clear box with a lid. Below is a quick list of additional tips you can use with your infant or toddler. It is important to seek a speech-language evaluation is you have any concerns with your child’s communicative development.

Infants:

• Encourage your baby to make vowel-like and consonant-vowel sounds such as "ma," "da," and "ba."
• Reinforce attempts by maintaining eye contact, responding with speech, and imitating vocalizations using different patterns and emphasis. For example, raise the pitch of your voice to indicate a question.
• Imitate your baby's laughter and facial expressions.
• Talk as you bathe, feed, and dress your child. Talk about what you are doing, where you are going, what you will do when you arrive, and who and what you will see.

Toddlers:

• Get down at your child’s eye level so he/she can see how you produce sounds clearly
• Sing songs and read books with sound and word repetitions. Music brings language to life. Popular children’s songs and rhymes: “Humpty Dumpty”, “Row, Row, Row Your Boat”, “Head and Shoulders”, “Itsy Bitsy Spider”, “If You’re Happy and You Know It”, etc. Allow for opportunities for your child to fill-in-the blank with sounds/words/phrases. Sing simple songs and recite nursery rhymes to show the rhythm and pattern of speech.
• Use environmental and vehicle noise, this will help your child produce a variety of vocal sounds and patterns
• Interpret the meaning of your child’s vocalizations and gestures into simple phrase/ Respond to your child’s sounds even if she can’t say that actual word/ Repeat mispronounced words correctly for your child to hear
• Expand his/her single words into short phrases
• Talk about the things you are doing, looking at, playing with, eating, etc.
• Respond to your child in a way that encourages further attempts to communicate/ Repeat what your child says indicating that you understand. Build and expand on what was said. "Want juice? I have juice. I have apple juice. Do you want apple juice?"
• Try to read every day. The earlier you begin to read and tell stories to your child, the sooner reading will become an important and enjoyable part of your child’s life.  It allows him/her to build knowledge they will need to learn to read.
• Identify colors/Count items throughout your day.
• Use gestures such as waving goodbye to help convey meaning.
• Acknowledge the attempt to communicate.
• Make a scrapbook of favorite or familiar things by cutting out pictures. Group them into categories, such as things to ride on, things to eat, things for dessert, fruits, things to play etc. Create silly pictures by mixing and matching pictures. Glue a picture of a dog behind the wheel of a car. Talk about what is wrong with the picture and ways to "fix" it. Count items pictured in the book.
• Place familiar objects in a container. Have your child remove the object and tell you what it is called and how to use it. "This is my ball. I bounce it. I play with it."
• Use photographs of familiar people and places, and retell what happened or make up a new story.

When speech and language interventions are implemented during a child’s daily routines, there is an increased likelihood that:

• Your child will become more independent. Teaching your child to communicate with the context of a daily routine such as mealtime will help your child to be able to function more independently
• Your child will increase their use of communication behaviors after the instruction has ended. When communication strategies are embedded within daily routines, your child has an opportunity to be rewarded as a natural consequence of their behavior.
• Your child will generalize their new skills across settings and situations.

Enjoy spending time engaging your child and helping them understand the world around them!

~Angie 

References:

      Lanza, J. R. (2009). Ls guide to communication disorders. (2009 ed.). East Moline, IL:

LinguiSystems, Inc.

      Rossetti, L. The rossetti infant-toddler language scale: A measure of communication and

interaction. LinguiSystems, Inc.

       Sussman, F. (1999). More than words: Helping parents promote communication and social skills

in young children with autism spectrum disorder. (1st ed.). Hanen Center.

"Tongue Tied"

We have probably heard of someone being “tongue tied”. What this really means is the tongue is fused to the floor of the mouth. The lingual frenulum is a mucous membrane that usually recedes after birth. 

With ankyloglossia, the medical term for “tongue tie”, the lingual frenulum stays attached to the tip of the tongue. This can cause restricted tongue movement. It appears that if we had restricted tongue movement, we would not be able to produce a number of our speech sounds; however, there has been no empirical research to indicate that “tongue tie” causes a speech delay/disorder. Wait, I just said it can cause restricted movement, how will one be able to protrude their tongue between their teeth for the productions of “th” and /l/. The “th” production can accurately be produced with limited tongue protrusion. The /l/ can be produced inside the mouth, with the tongue touching the alveolar ridge, decreasing the tongue extension. How is one going to make lingual-alveolar sounds such as /t, d, n, s, z/? In reality, we use such limited movement/elevation of our tongue during these sounds. These sound productions can be produced using compensatory strategies, such as slightly changing the position of the tongue (e.g. moving the tongue tip down instead of elevating it). With practice, little to no distortion should be heard, just practice!

According to the ASHA Leader, the oral cavity changes significantly in size and shape during the first 4 to 5 years of life. In return, the significance of ankyloglossia tends to decrease with oral growth. For example, with time the lingual frenulum can recede, stretch and at times rupture.

Being “tongue tied” can cause other functional difficulties, such as latching, sucking, and feeding. Literature primarily deals with potential difficulty with breast feeding (Nicholson, 1991; Jain, 1995; Fitz-Desorgher, 2003; Ricke et al., 2003). It was reported, that the majority of newborns with ankyloglossia do not have feeding difficulties.

To clip or not clip? The clipping of the lingual frenulum is called a frenulectomy. It is a decision solely left up to the parent. If there are feeding concerns, clipping of the tongue can be done. Most speech-language pathologists would rarely recommend a frenulectomy to increase correct sound productions, unless the child presents with a severe articulation or phonological disorder.

In conclusion, many physicians continue to think that ankyloglossia will cause a speech delay, regardless of no evidence found in literature. In the words of Agarwal and Raina (2003): "…there is enough evidence that good speech is still possible with significant tongue-tie and speech problems can be overcome without frenulectomy with speech therapy."

References:

Kummer, A. W. (2005, December 27). Ankyloglossia: To Clip or Not to Clip? That's the Question.. The ASHA Leader.

~Written by Angie

What is Stuttering?

Fluency

What is stuttering?

It is a complex interaction between the child’s inherent abilities and his/her internal/external environment.

There is a lot of new research out there about stuttering and with the age of technology, some information can be overwhelming and some information may be incorrect. New research shows that stuttering does not have an adverse affect on one’s life if it is left untreated. Research has  also shown a link between stuttering and language, stuttering and pragmatics (social use of language), stuttering and phonology (speech sound patterns), and stuttering and language complexity; however there is no consensus on the exact effects stuttering has on these areas. Additionally, research has concluded that the onset of developmental stuttering is usually observed at the same time of their child’s language spurt.  Children who stutter might experience increased anxiety levels and decreased self-esteem. Some physicians might tell you that stuttering is of no concern  and that your child will “grow out of it”. A speech/language referral is the first step to take to help your child.

In every day speech, we all display many types of disfluencies. These disfluencies are considered ‘normal’ because they are heard in normally fluent speakers as well as those who stutter. They are:

     1.       Whole word repetitions 

     2.       Phrase repetitions

     3.       Interjections

     4.       Revisions

9 Types of Disfluencies:

    1.       Sound repetitions ( i-i-it was me)

    2.       Syllable repetitions ( Bi-bi-bicycle)

    3.       Whole word repetitions ( I-I-I want to go too)

    4.       Phrase repetitions ( I don't I don't I don't like it)

    5.       Interjections (um, like, uh)

    6.       Prolongations (W-------------e will play later)

    7.       Blocks (Mmmmmmmmore please)

    8.       Incomplete phrases/revisions "I want mi-mi-mi" (milk), "I want water"

    9.       Broken words

Types of stuttering:

    1.       Developmental-onset between 2-5 years of age

    2.       Neurogenic stuttering associated with acquired neurogenic disorder (e.g. stroke, head trauma)

    3.       Psychogenic stuttering- may occur in people with mental illness or who have experienced mental stress. It is very rare

    4.       Cluttering-fluency disorder that is not stuttering

Fast Facts:

·         More males than females

·         About 1% of the population stutters

·         A large genetic component

Treatment:

An in-depth speech and language evaluation should be conducted. The evaluation is comprised of an interview, assessment, counseling, case history, and audio and video recording. After the evaluation, there are 4 possible situations:

   1.       The child is fine, no stuttering behaviors, no at risk behaviors
   2.       We aren't quite sure, not totally concerned, but more red flags than in situation one. 
   3.      The child is at risk. They aren't actually stuttering yet, but there are red flags, family history, and disfluencies 
   4.       The child stutters

Treatment goals would include:

•      Reducing/eliminating the disfluencies
•      Master modification skills so the child can say what they want, when they want to say it, at any time, any place, and with any listener
•       Teaching self-evaluation skills
•      Teaching modification skills
•     Teaching self-correction skills
•     Building in generalization tasks

According to Bloodstein (1949), stuttering is reduced or eliminated when speaking:

    1.       Alone

    2.       In unison with another speaker 

    3.       To an animal

    4.       To an infant

    5.       In time to a rhythmic stimulus

    6.       When relaxed

    7.       In a different dialect

    8.      While simultaneously writing

If you have a concern about a child in your life who is stuttering, contact a speech-language pathologist in your area.

Additional resources can be found at:

The American Speech-Language-Hearing Association http://www.asha.org

The National Stuttering Association

The Stuttering Foundation of America http://www.stutteringhelp.org

Sensory Processing Disorder: What's That?

As a child, I hated walking in the grass. It felt like needles on my feet, my legs, my hands. Today, I can tolerate it. It still hurts; but I tolerate it. All of us have "quirks" that bother and annoy us. Maybe its a loud toilet flushing or the feel of chalk. Some children feel, smell, taste, hear, and see everything WAY too much.

This month, Parent's magazine has done it again with a comprehensive article, "Kids Who Feel Too Much"; an article featuring Sensory Processing Disorder (SPD). Although SPD is not recognized as a medical diagnosis, ask any parent of a child experiencing SPD and they will tell you just how real it is.

Sensory Processing Disorder affects the way a child's brain processes messages sent to his body. This causes signals to be very severely misinterpreted or just slightly. A child may be tapped on the shoulder and his brain could tell him that he was hit, or not even register the touch at all. Many children with SPD have times of both over and under sensitivity; therefore, behaviors are hard to predict.

One of the biggest markers of SPD manifests as extreme behaviors; therefore,  many children suffering from SPD are mis-diagnoised with Autism. Another mis-diagnosis, Attention Deficit Disorder, stems from a continual need to stimulate the sensory system by moving muscles. The child looks too busy and over-reactive. 

Children with SPD typically have strong transitioning objections. It takes the child much longer to become comfortable in a new task so they’d just assume continue with the task they have already learned to handle. When asked to move to a new task, with new people, the child feels out of control and demonstrates objective behaviors. 

Children with SPD may appear clumsy, aggressive, hyperactive, or anti-social. They may love swinging, but hate the feel of squishy play bugs, etc.. However, it is important for these children to learn fine motor tasks in order to develop the coordination it takes to cut, hold a pencil, and eventually write.

Symptoms:

1)Sincerely bothered by certain sensations (hair cutting, loud noises, messy hands, walking barefoot on grass/sand, hugs, tags on clothing, etc…).

2) Does not seem to notice being touched. Prefers “quiet” play, may not seem to feel heat/cold/pain/hunger.

3) Uses too much or too little force with a pencil or when touching someone.

4) Passive, quiet, to respond to directions

5) Overly careful and fearful of new activities/group activities

6) May love spinning or swinging (more than typical)

7) Accident prone; may not be coordinated with learning new motor skills.

9) May have significant eating difficulties or aversions to certain “types” of foods (mushy, crunchy, etc.).

10) May have a language delay (generally will avoid contact with other kids due to unpredictability and dislike of being touched).

Treatment consists of practicing a variety of sensory activities at once to train the sensory system to handle sensory input and build positive neural connections with appropriate responses to the information coming in.

The goal is for the connections to become automatic.

Unfortunately, many insurances do not recognize SPD as a medical diagnosis; therefore, the child will need to receive related services (feeding, ADHD, etc.). Children with SPD may also need to be accommodated in school (wiggle seats, something to feel or fidget with at seat).

If you have a concern about a child in your life who may be suffering from SPD,  contact a child development specialist in your area. 

Age for Speech Sounds

I've had several parents wondering what age that their child should have certain sounds. Here is a general chart demonstrating the age range that of 90% children master the sounds by! 

*Smit (1990), Shriberg (1993) and Grunwell (1997)

Keep it simple

During my time serving on our district's Child Find team, I had the joy of "experimenting" with  variety of therapy techniques and tools.

One of the greatest things I picked up on while working with so many disabilities and individualism was to  teach children language the way that we naturally learn language. Seems simple; just like Rosetta Stone...right? *note the sarcasm

Children always learn best in their natural environment with engaging toys and activities. If you've ever tried to sit down with a one year old and practice flashcards with the goal of them sitting with an attention span of a three year old; than you can picture how a three year old with a developmental level of a one year old would responds to this same task.

The point is, we must always keep in mind where the child is it in their development and shift our therapy/play to their level.

Multiple research studies have proven that therapy tasks that don't account for developmental learning are useless. Practices including non-speech oral motor exercises, weighted vests, auditory integration therapy, and other developmentally inadequate approaches.

Follow the child's lead. If the want to play cars, play cars. If they want to rock a baby, rock a baby and shower that child with pretend play, natural language, and engaging therapy.


SarahV