Speech-Language Pathology Scope of Service

By: Anne O’Dowd, Pediatric Speech-Language Pathologist, CF-SLP

What does Speech Therapy Include?

Perhaps your child or another child you know is referred to see a speech-language pathologist from their doctor. When you think about the areas a speech-language pathologist treats, it is easy to assume we work only in the areas of speech and language, as our title implies. This is a common misconception.

In fact, our field is much larger than our title offers it to be. To provide a better view of the areas we treat, below is an extensive list of our scope or service delivery areas. A speech pathologist can help a child in nine key development needs. Please note that this list is not exhaustive, not all service delivery areas are offered at Easterseals DuPage & Fox Valley, and individual speech-language pathologists can specialize in one or several areas. Areas in which we practice vary in development, some continuing to evolve (e.g., literacy) and others emerging.

Learn more about our speech services here.

Speech

Speech refers to the production of speech sounds, individually and in words. Children produce several typical speech errors that decrease over the first few years of life, resulting in adult-like speech. Intelligibility, how well an outside listener without context can understand an individual’s speech, is one quick tool we can use to measure speech development. Below are some examples of the service delivery areas we treat regarding speech:

• Articulation: errors in individual speech sounds
• Phonological: errors that follow rule-based, predictable patterns (e.g., phonological processes of stopping, final consonant deletion, or weak syllable deletion)
• Motor planning and execution: developmental or acquired disorders at a motor/neurological level characterized by difficulty producing consistent, predictable speech patterns

Language

Photo by Keira Burton on Pexels.com

Language refers to expressing and comprehending words through multiple modalities, including speech, writing, reading, speech-generating devices, picture symbols, and gestures. We use language for various intents, including sharing ideas and ensuring our needs are met. Below are some examples of the service delivery areas we treat regarding language:

• Phonology: system of speech sounds and how we combine them to make meaningful words
• Morphology: use of word forms to create new words
• Syntax: combining words to create grammatically correct sentence structures
• Semantics: appropriate use and identification of word meanings
• Pragmatics: social aspects of communication and language use
• Literacy: spelling, reading, writing
• Prelinguistic communication: (e.g., intentionality, communicative signaling, joint attention)
• Paralinguistic communication: (e.g., body language, signs, gestures)

Fluency

Fluency refers to the rhythm of our speech. Typical speech is characterized by occasional disfluent moments (e.g., pauses and repetitions), although a higher frequency of these may be a cause for concern. Below are some examples of the service delivery areas we treat regarding fluency:

• Stuttering: disfluencies in speech, including repetitions, blocks, and prolongations
• Cluttering: abnormally fast and/or irregular rate of speech

Voice

Photo by Stan Kedziorski-Carr

Voice refers to the quality, pitch, and volume of an individual’s voice. A voice disorder is present when one or more of these voice qualities are perceived as different or inappropriate for an individual’s gender, age, culture, and geographic location. Causes for variation in voice can be organic (e.g., structural changes due to aging, vocal fold paralysis) or functional (e.g., vocal fatigue). Below are some examples of the service delivery areas we treat regarding voice:

• Pitch: how “high” or “low” one’s voice is
• Loudness: the volume of one’s voice
• Alaryngeal speech: speech production utilizing a substitute for the vocal folds in the larynx

Resonance

Resonance in speech refers to the production of a filtered sound, beginning at the vocal folds. The sound travels through the pharynx and oral and nasal cavity. As it passes through, it is filtered and enhanced based on the shape and/or size of an individual’s vocal tract. Below are some examples of the service delivery areas we treat regarding resonance:

• Hypo- and hypernasality: not enough or too much sound energy in the nasal cavity
• Cul-de-sac resonance: when sound energy is “trapped” in the oral, nasal, or pharyngeal cavity due to an obstruction

Auditory Habilitation

Photo by Christine Carroll

Typically, when discussing the pediatric population, Auditory Habilitation instead of rehabilitation is used as rehabilitation refers to restoring a skill that was lost. Often, a young child who presents with hearing loss or is Deaf has not yet developed age-appropriate auditory skills and therefore is not restoring the skill. Below are some examples of the service delivery areas we treat regarding aural habilitation/rehabilitation:

• Auditory processing: comprehension and interpretation of auditory information
• Speech, language, communication, and listening skills: as affected by deafness, hearing loss

Learn more about our audiology services here.

Cognitive-Communication Disorders

Speech-language pathologists also provide services for individuals with Cognitive-Communication Disorders.  In the pediatric population, the most common etiologies for cognitive-communication disorders are autism spectrum disorder, cerebral palsy, developmental delay, and traumatic brain injury. Below are some examples of the service delivery areas we treat regarding cognitive communication:

• Executive functioning: includes working memory, inhibitory control, and cognitive flexibility
• Attention: ability to attend to someone or something
• Memory: includes episodic, semantic, procedural, short-term and working, sensory, and prospective memory
• Problem–solving: obtaining, processing, and collaborating the information needed to find a solution to a simple or complex issue

Feeding and Swallowing

Photo by AMSW Photography -Alisha Smith Watkins on Pexels.com

Feeding and swallowing refer to how individuals transport food and drink from their environment into their bodies. Speech-language pathologists are involved in the parts of this process that involve the mouth, pharynx, and esophagus. We collaborate with other specialists, such as nutritionists, occupational therapists, and gastroenterologists, to meet each child’s individual feeding and swallowing needs. Below are some examples of the service delivery areas we treat regarding feeding and swallowing:

• Oral, pharyngeal, and esophageal phase of swallow: components of the swallow that occur in the mouth, pharynx, and esophagus; abnormal swallow can occur in one or multiple phases
• Atypical eating: (e.g., food refusal, food sensitivity, negative physiological response)

Learn more about our feeding clinic here.

Augmentative and Assistive Technology

Photo by Michael Vanko

Augmentative and Assistive Communication (AAC) includes all forms of communication that are used to supplement or replace oral speech to express thoughts, needs, wants and ideas. AAC allows children to communicate more easily and, in doing so, reduces frustrations for the individual and his or her family. There are several forms of AAC ranging from light tech to high tech. Below are some examples of the service delivery areas we provide in AT services:

• Diagnostic Therapy – working with a child to explore access methods that are consistent and least restrictive to a robust communication system
• Assistive Tech/ Speech Therapy – building language skills and learning how to operate the communication system to be able to express wants and needs
• Customization of systems – setting up, maintaining, or generalizing communication systems to all environments
• Consultations – may work with other providers/school team members to ensure consistency of aided language partners
• Parent training – provide parents the tools to implement operations of communication systems and to be a language model

Learn more about our Assistive Technology (AT) and Augmentative and Alternative Communication (AAC) services here.

Speech-Language Therapy at Easterseals DuPage & Fox Valley

If you are concerned about your child’s language or other development, take our free online developmental screening tool for children birth to age five. The Ages and Stages Questionnaire (ASQ) will showcase your child’s developmental milestones while uncovering any potential delays. Learn more at askeasterseals.com. 

To learn more about Speech Language services at Easterseals DuPage & Fox Valley, click here or call us at 630.282.2022.

Common Questions About Bilingualism

By: Joanna Nasiadka, M.S., CCC-SLP

Speech-Language Therapy strengthens children’s communication and feeding skills so they can participate fully in daily activities and achieve success. Easterseals DuPage & Fox Valley therapists have numerous years of experience in typical and atypical speech and language development and offer a fun and engaging environment for children to learn and develop their skills. We also have a number of therapists fluent in several language such as Polish (myself), Korean and Tagalog. There are often questions shared about raising a bilingual child and I wanted to discuss the many benefits and what to look for if you suspect a speech delay below.

Q1: Does bilingualism mean my child is equally proficient in two languages?

Being bilingual does not mean that the child has equal proficiency in both languages. It is common for children to have a dominant language. Children can also have a dominant language for specific contexts. For example, a child might speak English at school and communicate most effectively in English when the context is academics but might prefer to talk in their family’s native language while talking about a sport, religion, or while talking to their family members. The dominance of language fluctuates depending on the amount and nature of exposure. There are two types of bilingualism:

Simultaneous Bilingualism:

This type of bilingualism is the acquisition of 2 languages at the same time, typically before age 3.​ Early language milestones are met in typical time and manner in both languages.​

Sequential Bilingualism:

This type of bilingualism occurs when the second language is introduced AFTER 3 years old.

Photo by Stan Kedziorski-Carr

Q2: Will my child be confused if we use two languages at home?

Many studies on bilingualism have shown that using two languages does not confuse a child, even when they are young and learning two languages simultaneously.

Q3: What if my child has a language delay or disorder?

There is no evidence that using two languages confuses a typically developing child OR a child with a disability. Bilingualism can actually be beneficial for children who have disabilities, and it allows them to be active participants in their daily activities. It also allows them to have full social-emotional growth since it will enable them to communicate with family members and friends who have a shared language and culture.

Q4: Will bilingualism cause my child to have a language delay or academic difficulties? Will he or she be behind other kids?

Bilingualism does not cause language delay or disorders in children. It also does not exacerbate delays or disorders that are already present. If a child presents a disorder in one language, they will have the disorder in the second language as well. If the difficulties only arise in one language, this could be a sign of limited language proficiency.

Bilingual children develop language similarly to their monolingual peers. However, bilingual children may have lower proficiency in one of the languages until they catch up to fluent speakers.

• Average time to achieve social proficiency (conversations, social interactions): 2-3 years
• Average time to reach academic proficiency:  5-7 years

Photo by August de Richelieu on Pexels.com

Q5: What are some pros and cons of raising a bilingual speaker?

Q6: What is the best way to support two languages? Should I wait for my child to be proficient in one language before introducing a second one?

Photo by Alex Green on Pexels.com

The best time for a child to learn two languages to be proficient is before 3. Younger children are more likely to develop a natural accent, more likely to become proficient and achieve higher syntax levels in the long run. Therefore, there is no need to wait for your child to learn one language before introducing a new one.

Many families have found success in speaking both languages at home. Other families prefer to speak both languages and spend time reading, writing, or doing activities in each language. A very effective way to help a child learn both languages is to have one caregiver speak one language and a second caregiver speaks the other language. This choice depends on the family dynamic and your preferences.

Q7: My child started to mix the two languages together in the same sentences. Is this normal?

Using both languages or alternating between languages in the same utterance or conversation is very common for bilingual speakers and is called code-switching. Competent bilingual speakers often code-switch for many reasons, including using a word that is not present in the other language, quoting ideas, emphasizing, excluding others from conversation, showing status, or adding authority. Code-switching can happen more in certain cultures and contexts.

Code-switching does require rules to be done appropriately:

1. Must follow the grammatical structure of both languages
2. The word order has to make sense

Photo by Julie Hermes

Q8: How will a speech-language pathologist evaluate and treat my bilingual child with a language disorder or delay?

A speech-language therapist can help determine a speech-language disorder from a limited language proficiency by considering the sound and language rules of both languages that your child speaks. Your therapist will administer evidence-based methods of testing that are adjusted for your child’s needs as a bilingual speaker. These tests include speech-language samples, writing samples, play-based observations and assessments, standardized measures (if appropriate and adjusted), and assessments of ability to learn new skills. If your child benefits from services, treatment will focus on improving speech and language skills while supporting both languages.

Take our Free Developmental Screening

If you are concerned about your child’s language or other development, take our free online developmental screening tool for children birth to age five. The Ages and Stages Questionnaire (ASQ) will showcase your child’s developmental milestones while uncovering any potential delays. Learn more at askeasterseals.com. 

To learn more about Speech Language services at Easterseals DuPage & Fox Valley, call us at 630.282.2022.

Chores and Executive Functioning

By: Jessica Drake-Simmons, M.S. CCC-SLP

People are not leaving their houses right now and you know what that is resulting in?  A need for lots of cleaning and organizing!  This doesn’t have to be a solo effort though!  Maybe we can embrace this unique opportunity, where we are being asked to be our children’s teachers, to show our children some new things we don’t normally have time for in everyday life.

Research has found that one of the best predictors of a young adults’ success was whether one participated in household tasks when they were young.  Chores help kids have a “pitch-in” mindset, which is an invaluable skill throughout the lifetime.  In the book, 50 Tips to Help Students Succeed, Marydee Sklar describes the executive functioning skills that are developed when completing chores including:

• Time management
• Delaying gratification
• Planning
• Prioritizing
• Problem-solving
• Focus and goal-directed behavior

Here is an idea of some of the chores your child might be ready to do by age.  The level of assistance a child may need will vary.

Age 2-3: This is a magical age in which your child is so enthusiastic in their desire to  “help”! The problem is that “help” feels like anything but help!  However, it appears that cultures that embrace and expect children in this age group to participate in household work raise children that are willing and proud contributors to household chores.

• Put toys away
• Throw garbage away
• Put dishes in sink
• Help set the table
• Put dirty clothes in the hamper
• Dust the baseboards
• Fold rags, washcloths and dishcloths

Ages 4-5:

• Make the bed
• Feed the pets
• Pick up toys
• Water the plants
• Wipe cabinets
• Put away dishes they can reach
• Clear and clean table after dinner
• Make easy snacks
• Wipe down doorknobs
• Match socks

Ages 6-7

• Sweep the kitchen floor
• Empty the dishwasher
• Sweep the hallways
• Mop the kitchen floor
• Organize the mudroom storage area
• Make a simple salad

Ages 8-9

• Clean room
• Bring in the empty garbage cans
• Put groceries away
• Clean out the car
• Clean room
• Wipe bathroom sink and counters
• Sweep the porch
• Hang, fold and put away clean clothes
• Make scrambled eggs
• Bake cookies

Ages 10-11

• Clean the toilets (inside and outside)
• Wash your own laundry
• Vacuum
• Sweep the garage and driveway
• Wipe down the counters
• Clean the kitchen
• Make a simple meal

Ages 12+: For this age group, help them be proactive in recognizing what needs to be done and initiating a plan for how and when to do it.  Work side-by-side on house projects with them. 

• Clean the garage
• Mow the lawn
• Wash the car
• Mop the floors
• Wash windows
• Clean bathroom
• Help with simple home repairs
• Cook a complete meal

Tips for success:

• Teach the skills- Don’t expect them to learn it on their own.  Break down the task into small steps.
• Help them come up with organizational systems for their belongings that they can maintain with little help from you.  Have written labels or pictures to assist in sorting items in different boxes.
• Take a picture of what their clean room (or other designated) area looks like.  Encourage them to match the picture when their chore is complete.
• Give them some control, even if that means it’s not done the way you would prefer. 
• Assist them in thinking through when they will have time in their schedule to do their chores. 
• Help implement designated chores into daily routines. 
• Schedule work time and break time.
• Help them recognize how long a chore should take to complete in order to maintain their focus to the task and motivation for completing it in a timely manner. 
• Make it fun! 
  • Play music
  • Make it a race or competition
  • Create a chore chart or list which will assist experiencing a sense of accomplishment as they complete their chores
  • Sometimes incentives might help!
  • Have everyone completing chores together

Stay home, stay well, embrace the ones you are socially isolated with and relish in those chores! For more information on Easterseals DuPage & Fox Valley, visit eastersealsdfvr.org.

Tele-therapy at Easterseals

By: Valerie Heneghan, M.A., CCC-SLP/L, Director of Speech-Language, Feeding, and Assistive Technology

Tele-therapy for All! 

Easterseals DuPage & Fox Valley has been at the forefront of serving children and their families in a way that meets their current needs through clinical expertise, a team-based approach and integrating technology to ensure maximum independence. As an organization, we have been offering tele-therapy opportunities for the past 10 years as a service delivery model to those it would serve optimally (i.e., a generalization of skills to home environment, transportation issues, medically fragile or at-risk health, to accommodate busy schedules, etc.). 

In response to COVID-19, all 87 therapists were trained to transition to tele-therapy services within two days with support from experienced tele-therapists within the agency.  

How Does Tele-Therapy Work? 

Once evaluated to determine eligibility for skilled therapy services, your therapist would follow up to plan your child’s tele-therapy session and schedule a time to meet. They will work with you to review treatment plans and establish your priorities. 

Laptops or desktop computers are preferred for best overall experience. But tablets, iPhones and Android phones can work too as long as the device has a working microphone and camera. A stable internet connection is needed via a hard-line/Ethernet cord, WiFi or using your cellular plan (your standard data rates may apply). Screen sharing is available to increase participation, engagement and utilization of resources throughout the session. 

Tips for Making the Most out of Online Therapy

1. Get comfortable with the technology: Immerse yourself in the platform you are using. There are often a lot of features available such as audio adjustments and visual displays, screen sharing, chat features, etc. The more comfortable you are with these features the easier it may be to modify or troubleshoot if a technical problem occurs.
   
2. Make a plan: Plan out a time and a designated space in your home that would work best for your child. Have the computer, phone or other device propped up on books or a stand that has a wide view of the room. If possible, the therapy time should be away from other family members or pets. Work with your therapist ahead of time to prepare a few materials or resources like balls, pillows, mats, or games. 
   • Ex: For a young child, find a space where the child can sit comfortably to view the screen but also has space nearby for movement breaks. Bring your child’s favorite toy to show to their therapist and board game to keep their engagement with the parent between exercises. 
3. Be flexible: When plan A doesn’t go accordingly, be willing to change course.  
   • Take the child’s lead and adapt as necessary. Let the therapist guide you in facilitating therapy strategies through real-life reactions and experiences. 
   • Use items in your home to replicate therapy equipment. Ex: Use couch cushions and pillows to create new surfaces for climbing and crashing. 
4. Make it fun: Be creative and try new things! You may be surprised by new interests and breaking from the same routines. See how much your child can do! 
   
5. Make it matter: Use this as an opportunity for your therapist to see your child in your home to incorporate therapy strategies and techniques in your daily routine. Let your therapist see what is important to your child and how to motivate them to achieve their treatment goals. 
   • Ex: A child is experiencing difficulty with mealtime; let the therapist observe seating and position at the table, mealtime structure, and how you communicate to your child during a typical mealtime. Pick a food that is important to your family and ask about strategies to incorporate it into your child’s diet. 
6. Give your therapist feedback: It may be more difficult to pick up on social cues, be direct about what went well and what could be improved. Share ideas and problem-solve together to plan for the next session.   

COVID Response

As we try to be one step ahead of the COVID-19 crisis and care of your child, we are committed to keeping our programs running. Our tele-therapy services are available to maintain your child’s therapy schedule, help your family navigate this new routine and manage the difficult emotions that may come with it.  We can also help parents that have a concern about their infant or toddler’s development now. There is no need to wait, as the early stages of a child’s life are the most important in their development.

We are pleased that tele-therapy has already helped many children eat a new food, stay active, and improve their regulation and play skills while building a stronger relationship with their caregiver. 

We understand the immense stress of balancing your child’s needs with the demands of work and school while also keeping your family healthy. We are here to ensure that each child and their caregivers have the support they need to adopt this technology and continue therapy progress. 

While much has changed, our commitment to you remains. If you have any needs, we are actively monitoring our main phone number, 630.620.4433 and info@eastersealsdfvr.org. Contact us at any time (please include your full name, child’s name, phone number and email) and a member of our team will return the response within one business day. 

What is Tongue-Tie and How is it Treated?

By: Valerie Heneghan, M.A. CCC-SLP/L

The topic of tethered oral tissues or tongue/lip tie is evolving and controversial among professionals in the medical field.  The controversy often stems from first diagnosis. Is it truly a tethered oral tissue? And second the remediation. Is surgery necessary or is the child able to compensate without intervention? 

As a parent, I know it is a difficult decision as you want the best for your children.  You want to support your child’s development without unnecessary medical procedures.  My suggestion is to work with a professional who has experience in this area who can discuss these considerations and how they impact your child specifically. 

When discussing considerations regarding tethered oral tissues (e.g., tongue, lip, and cheek) it is important to include these 4 components:  

1. Symptoms of mother/infant
2. Mobility
3. Function
4. Location

The conversation on whether to move forward with medical intervention should include symptomology, structures, and function.  One child upon visual inspection may look to have a tethered oral tissue without any symptoms. While another child may have a tethered oral tissue that is not as visually apparent, however may have several symptoms impacting activities of daily living.

Below are interdisciplinary symptoms that could potentially be attributed to tethered oral tissues that you may want to consider:

• Breastfeeding issues: Nipple pain, difficulty latching, inefficient nursing (e.g., feeding until becomes fatigued rather than full, nursing around the clock, etc.)
• Lack of weight gain or growth
• Difficulty moving to solid foods or won’t tolerate a variety of foods
• Difficulty with cup, straw or bottle drinking
• Delayed production of single words or imprecise articulation
• Dentition (e.g., gap in front teeth) or malocclusion
• Open mouth posture or congestion
• Asymmetrical motor skills (e.g., preference for one side at young age) or Torticollis
• Issues with sensory regulation, fine motor skills or vision
• Coordination or balance issues
• Gut Health issues or GERD
• Sleep apnea

What are the next steps? 

It is important to find a medical professional who has experience in this area. A Pediatrician, ENT, or Dentist can diagnose a tethered oral tissue.  Often a Speech-Language Pathologist or Lactation Consultant may be referred, as these professionals work closely with oral motor skills therapeutically.

If a frenectomy (i.e., surgical cut to release the frenulum) is warranted, seek a medical professional (e.g., ENT or Dentist) who has experience in the following:

• Has knowledge and expertise in releasing tethered oral tissues  
• Recommends post-surgical program (i.e., stretches, therapeutic feedings, etc.)
• Procedural experience using both scissor and laser for best possible outcome.

For more information on Easterseals DuPage & Fox Valley Speech-Language services, including those that treat children with Tongue Tie conditions, visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/speech-language-therapy.html

March is Cerebral Palsy Awareness Month

By: Jack McGraw, Easterseals DuPage & Fox Valley client

While many wear green on St. Patrick’s Day, you can wear green all month long to honor Cerebral Palsy Awareness Month. Why green? The color was chosen to reflect youthfulness and new growth, as well as hope for advancements in treatment and acceptance.

Cerebral Palsy is a disability that is caused by damage to the brain before or at birth. It mostly affects movement and fine motor skills but can have a large range of severity for children. Some children with cerebral palsy can walk or talk, while some may use a wheelchair or assistive technology device to speak like me.

Honestly, living life with a disability can be very challenging but I don’t let it stop me from having an awesome life! I have a lot of friends, a great family and have been a successful student. I graduated from St. Charles North High School in 2017 and am now a proud honors student at Elgin Community College. My communication device uses eye gaze technology and helps me type up essays and lecture notes.

I also love sports. I really, really love sports. While my disability has kept me from participating on teams with my friends, it hasn’t stopped me from being a huge fan. I had the privilege  of being a team manager for football, basketball and volleyball while in school and those were very special experiences. I really felt like a part of the team and got close to some of my teammates.

I have been going to Easterseals since I was a little boy. I have done Physical, Occupational and Speech therapies. Easter Seals has helped me to be as independent as I can be and my therapists have always listened to me and asked me what I want to be working towards in therapy. They have been a great support to me and an asset in my life.

People with disabilities aren’t really very different from people that don’t have disabilities. We enjoy a lot of the same things and want to be treated fairly like everyone else! Having a disability is hard, but I haven’t let it stop me yet! Life is good!

Editor’s Note: Easterseals DuPage & Fox Valley offers many resources for children with spastic and non-spastic cerebral palsy and their families including physical therapy, occupation therapy, speech-language therapy, assistive technology, inclusive day care and parent-to-parent support.

Treatments and therapies can benefit a child with cerebral palsy by helping him or her gain the strength and mobility needed to take first steps, speak first words and maximize their independence.

For more information on cerebral palsy and therapy service at Easterseals DuPage & Fox Valley, visit http://www.easterseals.com/dfv/our-programs/cerebralpalsy.html.

How Speech-Language and Occupational Therapies Work Together

By: Danielle Maglinte, MAT, MS, CCC-SLP

Young children go through many developmental stages before they begin talking. One of the first stages of development is shared attention. In a baby, shared attention looks like the baby turning her head toward mom when she hears mom’s voice or a baby looking into dad’s eyes when dad talks to the baby. As children get a little older, shared attention looks like mom holding up a toy, the child looking at the toy, then looking back at mom and smiling. The next step in developing shared attention is dad looking at or pointing to a toy, the child looks where dad looks or points, then he looks back to dad. These steps towards developing shared attention typically happen within the first 12 months of a child’s life.

When a young child reaches a stage of shared attention where they can follow a caregiver’s point and they can shift their gaze between the caregiver and the object, they start to develop back-and-forth communication. At first, this looks like a child reaching for an object to tell the caregiver “I want that.”

As back-and-forth communication with gestures continues to develop, the child starts to vocalize. In the beginning, these vocalizations are mostly babbling. As parents talk back when the child babbles, these vocalizations turn into jargon where a child sounds like they are speaking in sentences but not actually saying words. Some parents comment that it sounds like the child is speaking in another language. Over time, the child’s vocalizations are shaped into short, simple words, such as mama, dada, and baba for bottle. Children with speech delays often demonstrate limited shared attention. Working to develop strong shared attention will help a child learning to communicate.

One challenge for some children with speech delays is that they need to maintain a calm, regulated state so that they are available for interactions and can share attention with another person. Read more about self-regulation from OT Maureen here.

If a child is focused on seeking sensory input, they may not have the ability to focus on social interactions, developing shared attention and speech with caregivers. Occupational therapy can help figure out activities and ways we can include these activities in everyday life so that a child can remain in a calm, regulated state so that she is available for social interactions. This may look like a child with limited eye contact running away and looking back to see if you are chasing him or a child who is quiet asking for “more” when you stop pushing the swing.

When a child stays regulated for longer periods of time, she will be available for interactions so that she can continue to develop strong shared attention, and move on to using gestures and speech to communicate. By working together, speech-language therapists and occupational therapists can help a family find activities, such as climbing, playing chase, swinging, and swimming  or others that help a child with speech delays stay regulated and available to develop shared attention and communication skills.

To learn more about speech-language and multi-discipline therapy at Easterseals DuPage & Fox Valley visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/speech-language-therapy.html. 

Comparing School & Clinic Speech Services

By: Valerie Heneghan, M.A. CCC-SLP/L
Speech Department Manager

 As a speech-language pathologist who has worked both in school-based and clinical settings, I am often asked questions about the difference between these two settings. Overall, they work together! I’ll explain more.

School-based setting

Qualifications

Photo by Pixabay on Pexels.com

Schools have entrance and exit criteria for qualifying children for speech services derived by their district or state. Using formal assessment protocols, children may need to demonstrate a deficit of a pre-set standard deviation before they are eligible for services.  There is usually a wide range of differences from district to district, so it is difficult to predict qualification criteria prior to the evaluation.

Services:

School services can treat children with language, articulation, pragmatic (i.e., social), and voice/fluency disorders to make educational progress. These services may be delivered in a variety of ways including one-on-one, group setting, or push-in to the classroom.

A Clinic-based setting (like at Easterseals DuPage & Fox Valley)

Qualifications

Clinics typically do not have pre-set qualification criteria as they are not regulated by state or governing bodies.  Clinicians will qualify children for services based on clinical judgement using both formal and informal assessment procedures. Coverage for these services however may be dependent on the child’s insurance and/or may be an out of pocket expense.

Services

Clinics may be able to provide more specialized, intensive, or varied skilled services based on functional and/or medical necessity. Often these services are delivered on a one-on-one setting in the clinic, however additional options may be available.

Easterseals

At Easterseals DuPage & Fox Valley , we offer a variety of service delivery models including: one-on-one therapy, community base therapy (groups), co-treatment with multiple services, tele-therapy services in addition to providing services in our clinic, homes, and through our daycare setting.

We deliver a wide range of speech-language services cultivated by upholding ongoing continued education/ certifications, state of the art equipment, and collaboration with multidisciplinary teams.  Our speech-language services work to strengthen children’s communication and feeding skills so that they can participate fully in daily activities and achieve success.

Our speech-language therapy services address functional communication, language expression/comprehension, pragmatics, speech-sound production, voice, fluency, oral motor, and feeding skills. Areas of specialization include but are not limited to the following:

1. The Voice Box: A Motor Speech Lab, focuses on improving articulation, voice and resonance skills through cutting edge and innovative technology.
2. Oralfacial Myology addresses disorders of the muscles and functions of the mouth and face. These may address tongue thrust, dental malocclusions, breathing, speech, swallowing, and chewing.
3. Feeding services seek to ensure safety and adequate consumption of a varied diet. Treatment may address feeding issues related towards chronic diseases or syndromes, disorders of oral motor structure or development, growth disorders, failure to thrive or obesity, tube feedings, food allergies and sensitivities, gastrointestinal disorders, neurological conditions, constipation, diarrhea, sensory-related or Autism Spectrum Disorder-related feeding difficulties.

Our services continue to expand to meet the needs of the current populations that we serve.  Additional initiatives that we have been growing this year include: tongue/lip ties, auditory processing, and Spell-Links for improving spelling and reading comprehension.

I see value in both school and clinical settings!  I often encourage families that I work with, to consider both options based on the needs of the child.  Our therapists work with other disciplines like our Occupational Therapy, Physical Therapy, Audiology or Nutrition teams. We make sure to consult and involve all medical professionals and school therapists that work with a child, to  review goals and achieve maximal outcomes. To learn more about Speech-Language services at Easterseals DuPage & Fox Valley visit http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/speech-language-therapy.html.

Communication Breakdown

By: Courtney Leonard, MS, CCC-SLP/L

Editor’s Note: Please welcome, Speech-Language Pathologist, Courtney, to the blog. She is a big fan of music and has sprinkled references to a number of songs below. See if you can spot them all!

The road to verbal communication is a long and winding road. This road is often met with many roadblocks (i.e., mismatches in communication) or “communication breakdowns” as well as many repairs which can then “lead you to the door” of effective and efficient verbal communication. Each breakdown affords us another opportunity to broaden and engage in a wider variety of communication opportunities.

Communication is happening all around you every minute of the day. From a baby cooing in response to a loved one’s verbalizations, a toddler pointing and grunting to his favorite snack, a teenager expressing frustration with the boys her age, to adults imparting wisdom on the next generation- communication is something we do day in and day out. We communicate for a wide variety of purposes including expressing wants, needs, thoughts and emotions. We communicate to build relationships, repair relationships, and grow relationships. We communicate to advocate for ourselves, to forgive, and to make promises. Communication often, becomes such a natural part of our day that we often forget just how complex communication is.

Communication comes in a variety of forms both verbal and non-verbal. The term “communication” often brings pictures of spoken words and conversation to mind; however, communication is so much more.

Before we reach our destination of verbal communication, we have to learn how to be effective non-verbal communicators. We begin growing our non-verbal skills as infants and young babies by learning to regulate our bodies with loved ones, learning to attend to faces, maintain attention to faces, and responding to faces to which we are attending (e.g., smiling when smiled at, frowning when frowned at, cooing when talked to, etc.). As we continue our road to verbal communication, we learn to initiate engagement with our caregivers using our voices and smiles and learn to continue engagement with our caregivers by continually responding or initiating to maintain attention. As these circles become more frequent, natural, and smooth, purposeful non-verbal communication begins starting with gaze shifting (i.e., moving eyes toward preferred activity/toy), and joint attention (i.e., making eye contact with caregiver, shifting gaze to preferred toy/thing to comment on, and shifting gaze back to caregiver). I like to refer to “joint attention” as the skill we acquire so we can say “Did you see that cute guy!?” to a friend without having to use words. As gaze shifting and joint attention strengthen reaching, pointing, and gesturing begin to emerge. Once these skills are strongly in place, then we begin to see first words.

The crazy thing is all of this development happens within the first year of life! These skills often develop without much thought or ado and as parents, therapists, and caregivers, we are hardwired to receive and foster these very sophisticated communication opportunities just as children are hardwired to develop them.

There are times, however, that these skills don’t appear to have developed in children. This may happen for a variety of reasons including: physical limitations, sensory difficulties, early trauma, neuro difficulties, etc. Whatever the reason for the delay in developing these early communication skills, there are a few things you can do in order to begin working on developing these skills.

1. Find times when your child is calm and regulated before interacting. This may be while you are swinging them in your arms, during diaper changes, bath times, laying on the floor or on the couch, or any other time your child is calm. Having calm and regulated bodies provides the foundation for meaningful interactions.
2. Be silly! Use big facial expressions and lots of intonation in your voice to catch your child’s eye. You can sing songs, blow raspberries, play peek-a-boo, or just talk with your child. When you notice they are attending to you, stick with the thing you are doing. Your child may need a break from the interaction at some point (i.e., they may look away or walk away) but you can use the same intonation and facial expressions to try and woo them back into the interaction. This takes a lot of practice and attempts to find what will work. Don’t give up, keep trying new things until you find what works best for you and your child.
3. Move slower. Many times I find that kids need a slower pace in order to engage and maintain interactions. You can still use fun, giant intonation and facial expressions but use them more slowly and more exaggerated. This will give the child a chance to keep up with you and an opportunity to maintain engagement for longer periods.

Many things can impact a child’s development of his non-verbal and verbal skills. At times, it may be appropriate for a child to receive an occupational therapy or physical therapy evaluation and start a treatment plan to work on their sensory systems and/or strengthening of their bodies in conjunction with working on increasing their language skills.

Take our free screening tool, the Ages & Stages Questionnaire , to help measure and keep track of your child’s growth and development.

By detecting developmental delays early, you have the power to change lives and educational outcomes for children! If delays are identified, Easter Seals DuPage & Fox Valley can offer the support needed to be school-ready and build a foundation for a lifetime of learning. Learn more at eastersealsdfvr.org. 

How to Talk to Your Baby: Tips for Parents Expanding Speech/Language Skills

By: Valerie Heneghan, CCC-SLP/L

Each baby’s development is unique and magnificent! However, parents will often ask us these questions:

• How do I know if I am doing enough to foster speech and language development to keep my baby on track?
• What communication milestones should I be looking for?

In general, these are a few communication milestones that you should be looking for in the first year of life from the American Speech-Language Hearing Association (ASHA). 

Birth-3 Months

• Seems to recognize your voice and quiets if crying
• Makes pleasure sounds (cooing, gooing)
• Cries differently for different needs
• Smiles when sees you

4-6 Months

• Moves eyes in direction of sounds
• Babbling sounds more speech-like with many different sounds, including p, b and m
• Vocalizes excitement and displeasure

7 Months – 1 Year

• Begins to respond to requests (e.g. “Come here” or “Want more?”)
• Babbling has both long and short groups of sounds such as “tata upup bibibibi”
• Uses gestures to communicate (waving, holding arms to be picked up)
• Has one or two words (hi, dog, dada, mama) around first birthday, although sounds may not be clear

Here are 8 tips to help meet these milestones, engage, and expand your child’s ability to communicate.

• Child-directed communication. The amount and quality of language has a huge impact on your child’s communication development. Research has shown that babies benefit greater from child-directed communication rather than language that is overheard (e.g., asking your child a question vs. listening to the TV in the background) Take the time to smile and enjoy your child through communication exchanges.

 

• Imitate your child’s sounds and actions. Imitation is a very important skill for your child to learn.  Imitating your baby encourages him/her to notice you and even imitate your actions and/or words. This skill is vital for expanding babbling to initiating first words (e.g., “Mamama”, “babo”, etc.).

 

• Put the child’s message into words.  When your child sends you a message by reaching, pointing, looking, or making a sound; put into words what you think he is trying to tell you.  Be repetitive, children learn through repeated exposure to target words. (e.g., Do you see the ball? Ball, Here is the ball.).

 

• Talk with your child during every day routines and activities. When your child hears familiar words and sentences in the same contexts every day, it helps to build his understanding of language.  This is one of the best ways to learn more difficult concepts as well such as verbs, prepositions, etc. (e.g., Look the dog is running. He is running so fast!)

• Be face to face. When playing with your child, get down to his/her eye level.  Sit facing him/her when he is in his high chair or while playing on the floor.  This way, your child can see and hear you better fostering communication and imitation attempts. During this time, use gestures such as pointing, and imitating daily routines (e.g., washing hands, stirring spoon, kissing babies, etc.)

 

• Offer your child choices. Hold up two objects and show each object as you name it.  You can ask, “Do you want crackers or bananas?”  Observe how your child communicates his/her choice-looking at the one he/she wants, reaching toward it, pointing to it, making a sound or saying the word.  As soon as your child lets you know what he/she wants, give it to him/her which will allow him/her to experience the power of communication!

 

• Pause during a familiar routine to tell your child it’s his turn. When you and your child are doing something repeatedly (e.g., swinging, tickling).  Pause during the activity from time to time.  For example, after you have tickled your child, stop the game and WAIT for him/her to let you know that he/she wants more.  Don’t say anything-just look expectantly.  See if your child will tell you to continue in anticipation for that desired activity.

 

• Sign Language. Sign language is the use of a gestural system to communicate. Signs can be used to reduce frustration and give the child a way to communicate his wants and needs while he/she is still coordinating their speech production system. (My personal favorites are “more”, “all done”, “milk”, and “up”).

  

  From babysignlanguage.com

 

In summary, the best way to foster speech-language development with your child in their first year of life is to: TALK, PLAY, READ, and SING!  If you have any questions or need additional support, please contact a speech-language pathologist for more information.

If you are concerned about your child’s language or other development, take our free online developmental screening tool for children birth to age five. The Ages and Stages Questionnaire (ASQ) will showcase your child’s developmental milestones while uncovering any potential delays. Learn more at askeasterseals.org.