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Why Your Child is Making Progress in Speech Therapy, But Not at Home

An articulation disorder occurs when a child produces a distorted sound, such as a lisp (i.e., incorrect tongue placement during /s, z/ sounds) or an /r/ sound with a “flat” or vowelized quality blog-speech-main-landscape(“spiduh” for “spider”). It is worth noting that an “articulation disorder” has become a generalized label used to also describe patterns of errors in speech, for instance, “tat” for “cat” or “wion” for “lion,” which is a substitution rather than sound distortion. Many therapists will address substitution errors using a “sound-by-sound” approach if there are only a few errors. Nevertheless, it is important to understand that speech altogether is a learned movement pattern, just like walking, for example. A motor pathway of nerves in the brain is developed, established, and practiced, at a very early age.

The “give ‘em some time!” myth

Pediatricians and therapists often advise parents to “give it some time” before they seek out the help of a professional, leaving parents wondering why. Professionally, I am a supporter of the “wait and see” approach if the child demonstrates correct productions in some words, but not all, during their conversational speech. A child’s awareness of their speech increases as their gross and fine motor skills also develop and mature. As a result, common speech distortions may resolve with postural maturity, improved fine oral motor control, or exposure to same-aged peers which increases a child’s awareness. However, at the age of 4-years old, a child should be understood by familiar and unfamiliar listeners 90% of the time. Similarly, children who are typically developing demonstrate rapid growth of speech articulation skills in 6-month increments.

I advise parents to ask themselves the following:

  1. Has my child’s speech become easier to understand or made improvements at any time over a 6-month period?
  2. Can my child make the sound correctly at any time in spontaneous speech?
  3. Can my child make the sound correctly after I make the sound?
  4. Can acquaintances understand my child’s speech?

If any of the above answers are “no,” it may be time to consult with a speech-language pathologist regarding a full speech-language evaluation, especially if your child is approaching kindergarten. During the evaluation, the therapist will determine oral-structural abnormalities, evaluate for substitutions and omissions of sounds, and trial therapy techniques to determine the prognosis. The therapist may also hear the impact of reduced speech-articulation on language skills.  In my experience, children typically respond well to treatment unless structural differences (e.g., tongue tie, high palate, cleft palate) exist that impact their ability to produce the sound physically. In that case, a referral to an orthodontist, otolaryngologist, craniofacial specialist, may be warranted.

So, what does articulation therapy look like? Speech therapy for an articulation disorder is focused on creating a new movement pathway in the brain, “weakening,” or just simply not using the distortion pathway. Therefore, intervention should be repetitive and intensive in nature once the correct sound placement is achieved.

The process of articulation therapy includes producing the sound at specific levels of speech:

  • Establishing awareness of incorrect productions
  • Isolation
  • Syllables
  • Words
  • Phrases
  • Sentences
  • Reading
  • Story re-tell
  • Conversational speech

Many parents ask how long it takes to re-mediate an articulation disorder. Progress depends on consistency regarding the child’s attendance, treatment frequency and productivity/number of repetitions during speech sessions and completion of home practice assignments on a daily basis. I often set a goal to help the child achieve the sound hundreds of times per session. Once a child has established a sound by itself consistently, the therapist will challenge the child to produce it in words, phrases, sentences, etc. Many children will use their sound perfectly while practicing their articulation cards but become completely unaware of errors made as they speak spontaneously. Awareness and self-monitoring spontaneous speech is the most challenging part of articulation therapy. I explain this to kiddos I see to remind them that un-doing the speech distortion takes time! We ultimately want the child to use the new motor pathway without the need to actively self-monitor. Therefore, treatment is most effective when the child makes hundreds of productions per session and engages in daily home practice as directed by the SLP.

This is what you can do to work on speech:

  • Pick a daily routine to coincide with repetitive practice: before brushing teeth at night, during breakfast in the morning, on the way to school, etc.
  • Require your child to use correct speech while talking in the car, during dinner time, or while speaking on the phone.
  • Encourage your child to sing their favorite songs or nursery rhymes using their correct sound. For a challenge, make them start over if you catch an error!
  • Play games like “Guess Who?,” “Connect Four,” or “Sorry” and use a target word or phrase with their sound in it each time they take a turn.
  • Combine homework assignments and speech practice into one activity! Encourage your child to read the directions with correct speech, identify/practice vocabulary words that have the sound, or read stories aloud.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

Meet-With-A-Speech-Pathologist

5 Tips on How to Respond to Articulation Errors

A child who is still developing his or her articulation skills may need some feedback in order to fix speech errors and improve intelligibility. blog-articulation-errors-main-landscape

The following tips will help you respond to a child who produces articulation errors:

  1. Repeat the misarticulated word in your response with a slight emphasis on the target word. For example, if the student says, “I want the wed pencil,” you can respond, “Okay—here is the red
  2. Describe features about the misarticulated sound. For example, “The /s/ is a hissy sound. The air goes sssss like a snake hissing” or “The /v/ is made when our teeth bite down on our lip.”
  3. Give the child a consistent visual cue for the target sound, such as dragging a finger across the lips for /m/ or putting a thumb under the chin for /k/ or /g/.
  4. For a child who can read, contrast sounds that contain the correct sound and the incorrect sound by writing them out. For example, you can write out thin fin and show the child that one is made with a th and the other with an f.
  5. If you know that the child is able to produce the target sound, give him or her feedback on what you heard. You can say, “I heard you say doe, did you mean doe or go?” or feign difficulty understanding, such as, “You want to doe home? What do you mean, doe home?”

If you are unable to determine what word the child is trying to say, refer to this article for more tips: https://nspt4kids.com/parenting/helping-your-child-with-articulation-difficulties/.

As a parent or a teacher, it is important to acknowledge attempts at communication while providing feedback on speech sound production. If your child continues to demonstrate speech sound errors or is frustrated with his or her speech, seek out the advice of a speech-language pathologist.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

Meet-With-A-Speech-Pathologist

What Exactly is ASHA?

As a parent, do you ever wonder what all those letters mean after your therapist’s name? To a speech-language pathologist, these letters represent years and years of hard work and ultimately they confirm certification to the American Speech-Language Hearing Association (ASHA). blog-asha-main-landscape

So, what exactly is ASHA?

ASHA is the national organization and governing body for speech-language pathologists, audiologists and speech/language/hearing scientists. In 1926, ASHA became the first organization to initiate the development of national standards for these two professions. Today, ASHA represents more than 181,000+ professionals; 148,105 of which are certified speech-language pathologists (SLP’s), 31,964 of which are certified audiologists and 931 of which hold dual certification as both audiologists and SLPs. These two rewarding professions have shown immense growth over the years and continue to require a governing body to further detail professional standards.

ASHA has been certifying both speech-language pathologists and audiologists since 1952. These standards are established by audiologists and speech-language pathologists, respectively, who are members of ASHA’s Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC). ASHA’s certification standards are based on assessment of academic knowledge, professional and clinical skills by professors, employers and leaders in the discipline of communication sciences and disorders. This certification requires graduate level coursework and clinical practicum within a variety of settings and populations.

These populations span the lifetime and can include:

  • Early Childhood
  • School-Aged Children
  • Adolescents
  • Adults
  • Geriatrics/Elderly

Clinical Practicum explores various settings for an SLP to work including:

  • Schools
  • Private clinics
  • Outpatient Facilities
  • Skilled Nursing Facilities
  • Hospitals

In addition, ASHA collaborates with the Educational Testing Service (ETS) in developing national examinations for both professions. Both speech-language pathologists and audiologists must obtain a passing score on the Praxis examination.

Now, back to the letters after your child’s therapist’s name. Being “certified” from ASHA means holding a Certificate of Clinical Competence (CCC). This is a nationally recognized professional credential that represents a level of excellence in the field of Audiology (CCC-A) or Speech-Language Pathology (CCC-SLP). Individuals who have achieved the CCC-ASHA certification have voluntarily met academic and professional standards, typically going beyond the minimum requirements for state licensure. In order to maintain their knowledge, skills and expertise to provide high quality clinical service, individuals who are certified with ASHA are required to engage in ongoing professional development courses.

North Shore Pediatric Therapy requires all speech-language pathologists to hold and maintain ASHA’s CCC Certification. This is a crucial aspect of ensuring that all our therapists continue to uphold high standards of clinical service to the clients we serve.

As an organization, ASHA provides an abundant amount of resources. Each year, ASHA holds a nationwide convention and invites professionals to come, attend lectures, network and earn CEU course hours. In addition, the ASHA website contains insightful resources, such as the Practice Portal. This online resource offers one-stop access to guide evidence-based decision-making on a variety of both clinical and professional issues. This resource contains direct research articles and resources on a variety of clinical topics and disorders, as well as professional practice issues.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

Meet-With-A-Speech-Pathologist

Play Based Therapy – 5 Things to Consider When Playing at Home

  1. Choose toys and activities a child likes.blog-play-therapy-main-landscape
    • Use toys or objects the child enjoys to increase the likelihood that they will pay attention.
    • Read the child’s cues to determine when or if the attention is waning and provide them with options of other preferred items.
    • It is okay to have them complete “one more turn” before having them clean up.
    • Create a regular clean up routine after play time. Create or use a fun clean up song!
  2. Allow a child to take the lead in choosing toys- but this doesn’t mean you need to give them free rein all the time!
    • Offer acceptable choices- this is a happy medium between letting the child do what they want all the time and the adult determining what the child plays.
    • By providing choices, it gives an opportunity for the child to respond and communicate (and they feel like they are in control!).
    • If possible, choose activities that the child is able to move and does not have to sit still or at a table the whole time moving helps the child to be more attentive or focused!
  3. Imitate a child’s actions and use specific labels to address what the child is doing or attending to at the moment.
    • Over time, it is hoped that the child enjoys the repetition of the words and actions, then will begin to repeat an action he sees you complete (i.e. “Jump, Jump!” “You are jumping!)- Make sure you are face-to-face with the child, so that they know that you are talking about exactly what they are doing.
    • Simply state an object or an event name during the child’s play (i.e. “Ball” or “You found a ball”).
    • Try to stay away from talking too much or narrating too much information (i.e. It looks like you found something. What are you going to do with it? Are you going to bounce or throw it?) Depending on the child’s age, this kind of narration is likely above the language-level for the child.
    • Try to avoid asking the child questions!
  4. Use prompts to elicit attention with verbal visual cues (i.e. Look!)
    • Point to where you want the child to attend or focus.
    • Gaining the child’s attention is the first thing that needs to occur before they are expected to learn anything.
  5. Reinforce attention either naturally or artificially.
    • Pick reinforcements that are motivating for your child!
    • Reinforcing a child’s communicative attempts may include allowing them to play with a toy or finish eating a snack that he/she requested.
    • Depending on the child, stickers or suckers may be just the perfect reinforcement as well!

Reference

Mize, L. (2011). Teach Me To Talk! Shelbyville, KY: Teachmetotalk.com

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

Meet-With-A-Speech-Pathologist

help for a speech and language disorder in the classroom

Improving the Self-Esteem of Children with Speech and Language Disorders in the Classroom

Building up a child’s self-esteem is important for all children within typical development, however this may require special attention for children with speech and language disorders. Self-esteem is important as it affects how a person feels about themselves and ultimately how they behave and act.

For a child with a speech or language disorder, maintaining a high self-esteem may be difficult.help for a speech and language disorder in the classroom

In a study completed by Jerome, Fujiki, Brinton and James, it was found that children with specific language impairments have a significantly lower perception of themselves than their typically developing peers by the age of 10 (2002). This difference in self-esteem was especially evident in the areas of academic competence, social acceptance and behavioral skills. Being aware of a child’s vision of their own self-worth is important for all adults in a child’s life – parents, teachers, clinicians, etc. Low self-esteem could have a negative impact on a child’s social relationships, mental health and academic performance.

The classroom offers a unique and accessible environment to provide a child with positive interactions to improve his or her self – esteem.

Here are some simple tips to implement during your daily classroom life which may have a positive effect on a child’s self-esteem:

  • Make time for one on one interactions with the child. Demonstrate that you are actively listening. Maintain eye contact and acknowledge what the child says. These are important components of listening.
  • Provide positive praise for things the child does, whether the actions or big or small.
  • Educate other students on speech and language disorders. As a teacher, you could hold a peer educational day in order to increase children’s understanding of their peers.
  • Be a role model for other students by demonstrating how to communicate with someone who at times may be difficult to understand. Try to concentrate and be patient with the child. Set up positive social interactions between the child and an appropriate peer.
  • When possible try to decrease frustrations for the child by eliminating distractions and giving the child enough time to communicate. Speak with his or her speech-language pathologist to better understand the errors the child typically makes when communicating. Importantly, try not to finish the child’s sentences, rather than letting the child speak for him or herself.

If a child’s low self-esteem is judged to be significantly interfering with a child’s ability to perform in academic and social situations, additional steps should be taken. Observing a speech-language pathologist interact with the child may provide further suggestions for successful communication. Contact a social worker through North Shore Pediatric Therapy for additional support.



Reference: Jerome, A. C., Fujiki, M., Brinton, B., & James, S. L. (2002). Self-esteem in children with specific language impairment. Journal of Speech, Language, and Hearing Research, 45, 700 – 714.

Child with speech bubble

What is Pragmatic Language?

How do you know where to stand when having a conversation? Who taught you to change your voice when talking to a principal or a baby? When did you learn about conversational turn-taking? These innate skills come naturally to some; however, others struggle with what is commonly referred to as pragmatic language. Pragmatics, expressive (or spoken) language, and receptive (or the understanding of) language comprise the three tiers of language. Pragmatic language can be thought of as the “rules of language,” and it is a group of skills some children need to learn, much like reading and writing.

WHAT ARE THE RULES OF LANGUAGE?

  • Child with speech bubbleUsing Language: We use language to greet one another (e.g., “Hi, how was your day?”), to inform or explain important facts (e.g., “I’m hungry”), and to request or make wants/needs known (e.g., “Can I have the iPad?”). Children will quickly learn that using language can be helpful to get wants/needs met, while yelling/screaming will not produce the same results.
  • Changing Language: It is important to alter our language depending on environment and audience. Children will adjust their message depending on their needs, the needs of their communicative partner, the age of their partner (e.g., talking to a baby differently than talking to your principal), and based on their environment (e.g., yelling on the playground is acceptable, but yelling in the classroom is not).
  • Following the Rules: Understanding the rules of conversation can be just as important as the message itself. Children will learn that we take turns in conversation and that it is important to wait for the right time to ask questions/make comments. During conversations it is important to stay on topic, read both verbal and non-verbal cues, and to understand personal space boundaries.

Children struggling with the rules of language may benefit from direct instruction on how to engage others in a social setting or how to participate in a conversation. The extent to which children follow the rules will relate to their success in a social setting. With so many things to think about during social interactions, it’s no wonder that some children struggle! If any of the aforementioned components sound like your child, a licensed speech-language pathologist can help!