Information ... Articulation Development ... Encouraging Speech ... Language Disabilities ... ؛

Information

• Articulation Development
• Bilingual Children
• Encouraging Speech Development at Home
• Language Disabilities in School aged Children
• Reading Disabilities in School Aged Children
• Speech and Language Delays in Toddlers
• Thumbsucking and Pacifiers in Toddlers
• Is My Child at Risk for a Reading Disability or Dyslexia?

When to Worry About Articulation Development in Children

Children acquire speech sounds in a fairly predictable sequence however the age of onset for these sounds can vary from child to child. Some children acquire a wide variety of sounds early on and are easy to understand from an early age. Other children take longer to acquire their sound system and their speech can be difficult to understand. At what point should a parent become concerned and seek help?

The foundation for speech sound development begins at birth. Newborns learn that crying will help get their needs met. As early as two to three months of age, infants typically begin to make “cooing” sounds and learn to vary pitch and volume. By 4-6 months they should begin to engage in “vocal play” (i.e. they start putting sounds together, making raspberries, squealing, yelling etc.) This helps them gain greater control of their oral structures and they begin to produce sounds that are more like speech. By 6-11 months they should begin to “babble” where they begin repeating consonant syllables. Typically, the consonant sounds made with the lips (p,b,m) are the first to arrive e.g.” ba-ba-ba-ba” or “ma-ma-ma-ma”. All of these skills provide the foundation for the development of speech sounds.

Typically, first words appear around one year of age. To be considered a “word”, it does not necessarily have to be pronounced correctly, just used consistently (e.g. a child may say “du”or “ju” for juice). Simplification of adult forms of words is a normal developmental process at this age. Some children acquire their first words prior to their first birthday, other children a few months after. Children born prematurely require an age adjustment where first words would be expected to appear one year from the planned due date not the actual birth date.

By two years, a child should demonstrate some beginning word combinations (e.g. “Mommy up”, “Daddy car”), and simplification of adult forms of words are to be expected. Between two and three years of age children develop speech rapidly. They begin to use a greater variety of sounds and sound combinations, they begin to produce sentence forms and their vocabulary explodes. At the minimum, a two year old child should use at least 50 words and have some beginning word combinations.

Articulation development follows an orderly sequence and developmental error patterns are to be expected at each stage in development. As sounds become more difficult to pronounce, increased coordination of the muscles in the lips, tongue, jaw and soft palate are required. A child will often delete or substitute sounds to simplify more complex sound combinations.

For example:
A three year old might say “nana” for banana or “tar” for car
A four year old might say “sanwit” for sandwich
A five or six year old might say “wed” for red.

The following demonstrates the age ranges in which the correct production of these sounds should appear:

p,b,d,t,m,n,w,h	By two years*
k,g,f,v,ing,	By four years*
s,z,ch,sh,j, l	By five years*
r,th	By six years*

*These ranges serve as a general guide for parents (sounds within each age range occur at more specific ages than presented). By the end of a child’s seventh year, he/she should have achieved mastery of all sounds.

Delay vs. Disorder
A child is said to have an articulation delay when the sounds are acquired in the expected sequence but the developmental errors persist beyond the age we expect (e.g. when a four year old continues to say “tar” for car or “nake” for snake). A child is said to have an articulation disorder when their error patterns and/or sound acquisition sequence deviate from those seen in most children their age. A phonological disorder occurs when error patterns are more severe and affect an entire group of sounds with similar characteristics. In all cases, a referral to a Speech Language Pathologist is indicated.

A referral is indicated in the presence of the following:

1. Limited production of consonant sounds by two years.
2. Poor sound imitation skills or lack of interest in speech by two years.
3. Child lacks interest in shared or reciprocal play by their first birthday.
4. Difficulty understanding a child’s speech beyond the third birthday.
5. Child has unusual or atypical error patterns in his/her speech
6. Child has typical error patterns but they persist beyond the expected age
7. A child has not mastered all sounds by the end of their sixth year.

This article serves as a general guideline for parents regarding sound development only. Please don’t hesitate to contact us if you have any additional questions regarding your child’s speech or language development. 

Bilingual Language Learners

Kathryn Kohnert, Ph-D, CCC-SLP, both a researcher and associate professor at the University of Minnesota recently presented a seminar at the Children’s Hospital titled “Intervention with Bilingual Children with Primary Language Impairment”. Dr. Kohnert has conducted extensive research in this area and has an upcoming book titled “Language Disorders in Bilingual Children and Adults”.

Many professionals including pediatricians, teachers, psychologists, special educators and speech language pathologists are often confronted with the question of how to know when a child’s speech and or language is delayed when they are raised in bilingual or multi lingual environments. Many parents and adoptive parents also wonder if their child is acquiring English as a second language in a proficient manner. Below are some of the key points from Dr. Kohnert’s presentation that may help answer some questions you may have regarding children learning more than one language.

Children in a bilingual environment (bilingual in this case indicates presence of two languages, not the mastery of two languages) should meet speech and language milestones for their primary language at the same developmental age as monolingual children. “Onset of first words, early core vocabulary, and 2 word combinations are attained at the same age as monolinguals”… in normally developing bilingual children. A delay in reaching these milestones is considered a red flag for language impairment. Typically, by the age of two years, a child should have a minimum of 50 words in their speaking vocabulary and should be starting to combine words into short phrases.

In bilingual children, both languages should be supported in the presence of an identified language delay. It was previously thought that it would be better to support only the dominant language of the community at large to avoid confusion for the child i.e. English. This is no longer the view among the experts. The home language is needed to “maintain and promote family connections, cultural links, and the self identity that are necessary for positive social-emotional development and well-being. English is needed to develop and maintain positive interactions with the majority community to maximize educational and vocational opportunities and success.” Also, it is important not to ignore previously acquired knowledge, rather to continue building on knowledge in both languages.

By age 3-5 years, at least one language should be equivalent to monolingual norms in normally developing bilingual speakers. At some point there will be a shift in dominance from the child’s home language to the language of the majority community. This is a natural shift and should not be artificially encouraged at a younger age than it would normally occur. The timing of this shift is dependent on many variables.

An underlying language impairment will manifest itself in both languages in bilingual children. A bilingual child with language impairment does not have more severe deficits because of the presence of another language as compared to monolingual peers. Bilingual children with language impairment are capable of learning two languages equally as well as their monolingual language impaired peers. Most importantly, there are many ways to support language impaired children with a single minority language, even if the care provider does not have knowledge of that language.

Encouraging Speech Development at Home

1. Increase your expectations for verbal communication. If your child’s current communication system is working for him, he has no motivation to change his means of communication. For example, if your child successfully obtains desired items by pointing, there is little motivation for him to use verbal means of communication as his pointing was successful. Begin to expect your child to try to imitate a word while pointing or signing to obtain the desired item.
2. If your child enjoys familiar songs or stories, leave out key words or phrases and wait to see if your child will try to fill in the blanks. If waiting does not elicit a response, try to have the child imitate the word or phrase before continuing. The reward for verbal communication in this exercise is continuing the song or story.
3. Give your child choices throughout the day. If your child wants a snack give him a choice. E.g. “Do you want apple or cheese?” to encourage a verbal response that is not limited to yes or no.
4. Create scripts for familiar routines at home that create opportunities for lots of repetition and gradually encourage your child to join in. Sometimes using melody or rhythm creates more interest for the child.
   
   E.g. Bath time
   
   “water on”
   “water off”
   “wash hair”
   “wash hands”
   “bubbles please”
   “boat please”
   “all done”

Language Disabilities in the School Aged Child

Many children develop adequate speech skills but continue to have trouble expressing or understanding language. As the child reaches school age, the difficulty may begin to interfere with reading, writing and learning of new material. When should a parent or educator become concerned?

Children with a history of language delay (late talkers) are at higher risk for a later diagnosis of Specific Language Impairment (SLI). A child with SLI has normal nonverbal intelligence, hearing and motor development, their difficulty is specific to language. SLI affects both comprehension and expression of language. Children with a history of delayed onset of speech and language or language delays that persist beyond the end of a child’s fourth year of age are considered to be at higher risk for a later diagnosis of SLI.

Children with SLI may speak in shorter sentences than their same aged peers. They may use nonspecific words (thing, stuff, it) so it may be difficult to understand what they are talking about. Their speech may lack grammatical markers, such as tense, plural and possessive markers and they may mix up pronouns (he/she, him/his) beyond the developmentally appropriate age. They may have trouble telling a story in a sequential and organized manner. Comprehension problems include difficulty understanding directional terms, prepositions (under, inside, between) and grammatical markers. Sometimes these children appear to be inattentive as they don’t seem to understand or remember what you tell them. They may have trouble paying attention and following along in a group. It is important to rule out language based learning problems prior to diagnosing attention deficit disorders in children.

Often SLI isn’t readily apparent until a child enters grade school. As demands on language increase in an academic setting, children begin to have trouble keeping up with their peers. Difficulty with language can impact self esteem, social development and classroom behavior.

As children with language impairments get older, they may be re-labeled as having a language based learning disability. It is important to identify children at risk for learning disabilities early so they can get the help and accommodations they need to maximize their academic success. Early intervention should begin in preschool to help prepare your child in meeting the demands of an academic environment. A Speech Language Pathologist is skilled in assessing all aspects of language development and can provide recommendations for both home and school.

Reading Disabilities in School Aged Children

For many children, learning to read is a struggle. The child may experience subsequent difficulty with spelling and writing. Difficulty with reading and writing can impede academic success and also impact self esteem. It is important to know how to help your child and when to be concerned about learning or reading disabilities.

Reading disabilities affect close to 20% of the population, the most common being Dyslexia. There are many excellent tools for identifying kindergarten children at risk for reading difficulty. Research has demonstrated that the earlier the intervention for reading disabilities, the better the outcomes in reading performance as children progress academically.

Learning to read follows a developmental sequence. Children in preschool begin to associate printed words with spoken words. They recognize it’s the print, not the pictures in books that tell the words in a story. Soon a child will begin to understand the relationship between letters, sounds and words. A child needs to develop phonemic or sound awareness. Phonemic awareness is the understanding that words are made up of individual sounds. Children with good phonemic awareness understand rhyming, sound blending and sound segmenting. A child must also demonstrate phonological memory in order to be able to store and retrieve this type of information about sounds and letters. Without these fundamental skills, learning to read will be a struggle.

A mastery and sequential approach to phonics is beneficial for beginning readers. There are many books that are accessible to parents for working on these skills at home. One such book is “The Reading Lesson” by Michael Leven, M.D. and Charan Langton, M.S.. It contains twenty structured phonics lessons to help children learn to read. The “Bob Books” series of beginning readers by Scholastic is a great sequential series of books to help reinforce these early phonics skills.

If a child, despite a thorough and sequential instruction in phonemic awareness and phonics continues to struggle, they should be evaluated for a reading disability. A child should be assessed in both cognitive and academic achievement domains using formal standardized testing procedures. Regardless of the ultimate label, learning to read and write is an integral part of learning and academic achievement. A good evaluation will identify both areas of strengths and weaknesses, provide recommendations for intervention as well as identify specific strategies that may help your child learn to read and spell more efficiently.

Speech and Language Delays in Toddlers

Many parents become concerned when their child isn’t beginning to speak as well or as clearly as their same aged peers. Certainly there is some normal variability in the age at which children acquire speech and language, but when should a parent become concerned and seek further evaluation?
Typically, first words appear around one year of age. To be considered a “word”, it does not necessarily have to be pronounced correctly, just used consistently (e.g. a child may say “du”or “ju” for juice). Simplification of adult forms of words is a normal developmental process at this age. Some children acquire their first words prior to their first birthday, other children a few months after. Children born prematurely require an age adjustment where first words would be expected to appear approximately thirteen months from the planned due date not the actual birth date.
By a child’s second birthday, he/she should have a minimum of 50 words in their speaking vocabulary. At two years, your child should be beginning to combine words into short phrases and sentences e.g. “more juice”, “mommy go”. Between two and three years of age, speech and language skills should show a dramatic increase. By three years of age, a child should have several hundred words in their vocabulary and be speaking in more lengthy sentences and be able to carry on a short conversation with an adult. Your child should be speaking clearly enough so that most people outside of your immediate family can understand what your child is saying when the context is known.
Language is dynamic and a two-three year old child should be using it to communicate a variety of different functions such as to request, tell about an object, share information and refuse/protest. Communication involves turn taking between the speaker and the listener on a shared topic.
A child should be assessed by a speech language pathologist if the child:

1. Has a limited speaking vocabulary by their second birthday.
2. Is not combining words by their second birthday.
3. Uses few consonants and is difficult to understand during their second year
4. Does not seem interested in communicating or playing with others.
5. Does not use pointing and words to regularly draw a parent’s attention to objects in their environment.
6. Shows limited growth in vocabulary or a regression in speech skills.

Note:  This article serves as a general guideline for parents regarding language development only. Please contact us if you have any additional questions regarding your child’s speech or language development.

Thumbsucking and Pacifiers in Toddlers

Many parents dread the day they need to put the pacifier away or discourage thumb-sucking. Certainly all children need to be able to soothe themselves and oral habits are just one of the many ways they are able to accomplish this. When should you extinguish this behavior and how do you accomplish this without turning your life upside down?
Regardless of the oral habit, one needs to consider frequency (how often throughout the day they do they use their oral habit?), intensity (do they create a significant amount of pressure in their mouth when they suck?) and duration (do they aggressively suck all night or does their thumb/pacifier fall out shortly after they fall asleep?). Before the age of two years, parents should be mindful of beginning to wean their toddler from both pacifiers and thumb-sucking. Both of these oral habits can cause some long term problems.

1. Prolonged use can interfere with dentition and result in an open bite.
2. It can interfere with development of a mature swallow pattern--a reverse or tongue thrust swallow pattern persists which results in additional atypical pressure on dentition and also creates articulation problems later on (i.e. lisp etc.).
3. It interferes with development of more refined tongue muscle movement and coordination which can also interfere with later articulation development.
4. It can interfere with your child’s resting mouth posture; your child may develop a weak and pronounced lower lip with a more taut upper lip and begin to exhibit oral breathing instead of nose breathing patterns at rest. Nasal breathing is more healthful than mouth-breathing as it helps to filter, moisten and heat the air before entering the body.

The more mouth breathing becomes a habit, the more the tongue tends to sit low and lax within the mouth.  The tongue should have slight tension and be positioned in upper portion of the mouth. When in the upper portion of the mouth, the tongue helps the developing palate to maintain an optimal wide arch formation. Without the tongue there to create resistance, the palate may begin to narrow. This creates less space in the nasal cavity; the child may not able to get enough air-flow through the nose so they revert to the habit of mouth-breathing. 

5. Social stigmas related to an older child with oral habits--they may be perceived as less mature, shy or insecure by others.
6. Your child’s expressive language ability may be slowed--they simplify and shorten their expressive speech to accommodate being understood with a pacifier or thumb in their mouth.

Resources:  Marshalla, Pamela. “How to Stop Thumb sucking and other Oral Habits”,  2004;  William & Julie Zickefoose, “Techniques of Oro-facial Myo-functional Therapy”, 2003.

Extinguishing oral habits can be very difficult for both the child and everyone else around them. It takes patience and time. Many parents postpone this process simply because they know it will cause turmoil for everyone in their household. A few tips to facilitate the process are:

1. Try to do it when there is some stability in your routine for a period of at least a couple of weeks. Do not try to do it right before a trip or a move.
2. Talk to your child about when it is a good time to use the pacifier or thumb--start by identifying some times during the day as designated quiet time for using it. During “off” times, plan activities that will keep your child’s hands busy (play-dough) versus more passive activities where they may be more inclined to want their thumb/pacifier.
3. Sometimes putting a colorful band-aid on thumb as a reminder for an older child helps. Having the child wear a glove during the night can also help. Using lotions or sprays on their hands may discourage it because of the bad taste (there are products developed specifically for this).
4. Plan a celebration and let your child help in the planning for the day when the thumb sucking or pacifier is officially done.
5. Let your child decorate a special box for disposal or permanent storage of the pacifiers. Having a designated special place for them versus throwing them in the garbage is helpful, after all this was a cherished possession of your child’s.

What to do when it’s gone on too long…consult with your child’s dentist to determine the impact on dentition and bite and get follow up recommendations. If your preschool child appears to push his/her tongue forward when he/she swallows or eats, they should be evaluated for tongue thrust by a Speech and Language Pathologist. Elimination of the oral habits and tongue thrust pattern is necessary to correct dental and bite patterns as well as some articulation errors.

Note: This article serves as a general guideline for parents regarding oral habits and development only. Please contact us if you have any additional questions about your child’s speech or language development.

Is My Child at Risk for a Reading Disability or Dyslexia?

The International Dyslexia Association has adopted the following definition for dyslexia:

Dyslexia is “characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”

Breaking this definition down:

 “Phonological component of language”
The “phonological component” refers to the “sound” component of language or the ability to “hear” that words are composed of individual sounds put together and that these “sounds” can form almost unlimited combinations to create new words, each of which is tied to meaning.  When this is linked to reading, which is the written representation of these “sounds,” the individual with dyslexia struggles even more.  When individuals read, they “sound” out the words in their heads. If there is no “sound” representation for the letters on the page, then the writing becomes an undecipherable code.

”Unexpected difficulty in relation to other cognitive abilities”
In fact, it is not uncommon for individuals with dyslexia to have average or above-average IQ scores. This can be a two-edged sword for them; they can use their high level of cognitive abilities to aid in reading comprehension and thereby mask their difficulties and delay a diagnosis of dyslexia and the necessary intervention that could help them.

What do I look for in determining if my child is at risk for a reading disability/dyslexia?

According to Sally Shaywitz, M.D., the presence of one, some, or all of the following characteristics is consistent with a diagnosis of dyslexia:

• a family history of dyslexia
• delay in speaking (timely milestones are first words around one year and phrases around 18 months to 2 years)
• difficulties in pronouncing words and delayed articulation development
• sound reversals in words - “aminal” for “animal”
• by age three or four, not noticing/remembering nursery rhymes
• difficulty learning the names (by the end of kindergarten) and sounds (by the end of first grade) of the letters of the alphabet
• unexpected difficulty with reading – child is at or above her chronological age expectations for other abilities
• word retrieval difficulties (difficulty using specific words to describe and making frequent related word errors e.g. tornado/volcano)

It is also important to note that dyslexia is NOT a result of the following:

• visual problems
• poor motivation
• anxiety
• poor use of mnemonic (memory aids) strategies
• hearing/auditory problems
• low IQ
• Attention Deficit (Hyperactivity) Disorder (AD(H)D)

Furthermore, although ADHD is present in 12-24% of individuals diagnosed with dyslexia, it is a behavioral diagnosis made separately and through different means than a diagnosis of dyslexia.

Other misconceptions about dyslexia include:

• the belief that reversals in writing, such as writing a “b” for a “d” are common only among dyslexics.  The truth is that reversals are common in developing writers, both dyslexic and nondyslexic. 

• the belief that reading difficulties can be outgrown.  This is absolutely false. Early intervention is critical because the brain is more "plastic" or able to absorb more information and to "flex" in the younger child. In fact, younger, at risk students make progress with 30-40 minutes of remedial or preventative instruction/day. When children are beyond third grade, they require up to 2 hours/day of direct reading instruction time to achieve the same amount of progress in reading development.

• the belief that delaying the start of kindergarten because of a suspected or real difficulty with reading will help the child “mature.” To the contrary, doing this will only delay reading instruction; the child will have missed a year of critical direct reading instruction and will have the same difficulty reading that he/she had before being.

• the belief that the diagnosis of dyslexia is “black and white” with a determined cutoff point. In fact, dyslexia severity is on a continuum, and there is no stringent cutoff point to determine that someone is dyslexic.

• the belief that holding children back a grade once he/she is in school will help him/her mature. To the contrary, re-teaching using the same methods will not help, and holding a child back just puts him/her at risk for more problems with self-esteem.

I think my child may be at risk for a reading problem or develop dyslexia.  Now what?

First, it is important to know that brain-imaging studies have revealed a difference between the nerve pathways in brains of individuals with dyslexia and those without dyslexia.  Furthermore, brain-imaging studies have shown that scientifically-based interventions can successfully change the brain pathways in a dyslexic child to be similar to those of a “normal” reader. The key is early intervention. As stated earlier, as a child matures, the brain becomes less flexible; the nerve pathways continue to be solidified over time. By beginning earlier, you are taking advantage of the brain’s flexibility. Furthermore, if a child who is struggling does not receive the proper intervention, the effects spread to other areas including stunted vocabulary growth, decreased reading comprehension and increased time requirements to complete assignments. As a child ages, much more time is spent trying to get through the assignments, often at the expense of fun activities such as sports, music, drama, art and playing with friends. These extracurricular activities provide a much needed outlet for dyslexic students, not to mention, helping to build self esteem in other areas that they excel in.

For your preschool and kindergarten child:

• according to Sally Shaywitz, M.D.,“It is critical to identify a child’s reading problem before he fails.” (p.196). Testing for early signs of dyslexia can be done as early as four- to five-years of age.
• read stories aloud that have rhythm and rhyme in them
• incorporate nursery rhymes into his/her daily life, such as “Twinkle, Twinkle Little Star”
• read with your child daily to facilitate vocabulary development and  increased interest in reading
• encourage your child to make predictions when reading
• encourage your child to engage in sound play and rhyming games

For your kindergarten or older child:

• there is no single test that diagnoses dyslexia - tests of reading (accuracy, fluency, and comprehension), spelling, and language form the basis for diagnosing dyslexia.
• IQ tests are not helpful in predicting reading difficulties because as stated earlier, IQ is not related to dyslexia.
• it is important to distinguish dyslexia from a language-learning disability, in which all aspects of language are affected including reading decoding and comprehension. Speech-language pathologists are trained in language development and the diagnosis of language-learning delays and disabilities.

As you try to determine the best route to take for officially diagnosing your late preschool and kindergarten child with dyslexia, it is important to note that therapies targeted at treating peripheral sensory problems, such as supposed or real deficits in vision or hearing, have not been proven to improve dyslexia.  Again, dyslexia is a specific difficulty translating written symbols into sounds that are understood by the language processing areas of the brain. 

For your older child:
Ask for accommodations for your child, including:

• more time on tests
• shortened reading assignments
• supplemental use of audio taped material so that time spent reading is kept within reason

Important points to remember:

• Early intervention is critical
• Many individuals with dyslexia have average to above-average IQs. Many dyslexics, having overcome adversity, develop extraordinary strengths in problem solving, creativity and oral communication skills. These individuals often excel professionally including countless doctors, lawyers, CEO’s, financiers and entrepreneurs.

Where can I find more information?
Informational Websites:

• The International Dyslexia Association:  www.interdys.org
• Rocky Mountain Branch of the International Dyslexia Association: http://www.dyslexiarmbida.org/

Activity Websites:

• http://www.getreadytoread.org/
• http://www.readingrockets.org/
• http://www.starfall.com/

References:
Shaywitz, S., (2003) Overcoming Dyslexia: A New and Complete Science-Based Program for Reading Problems at Any Level. New York:  Random House.

Moats, L.C., and Dakin, K.E. (2008) Basic Facts About Dyslexia and Other Reading Problems.  Baltimore: The International Dyslexia Association.