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

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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

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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.

What is an Augmentative and Alternative Communication Evaluation?

By: Laura Van Zandt, MS, OTR/L

Did you know October was National Augmentative and Alternative Communication (AAC) month? AAC is a specialized area of clinical services. Here at Easterseals DuPage & Fox Valley, we are very lucky to have several therapists who specialize in helping individuals find their voice through AAC. We have both Occupational Therapists (OT)  and Speech-Language Pathologists (SLPs) involved in a multidisciplinary team evaluation to determine the best strategies and/or communication systems to help a child learn to communicate.

As an OT, I first became interested in AAC when I was working with a little boy with autism who received a high tech speech output device. It was amazing to see how having his new voice provided so many new opportunities for him. It helped with his overall regulation as he now had a system to share his wants, desires, and needs.

AAC looks different from person to person and varies from low tech options, light/mid tech and high tech systems. If you think your child might benefit from AAC, our team evaluative approach may be helpful. Below is more information on what each team member does to best help your child.

1. Many parents often have questions about whether or not a device will hinder their children’s ability to speak. This is absolutely not the case. Research demonstrates that AAC does not keep children from learning to speak.  In fact, users will make gains in language AND speech because AAC helps a child connect with others, produce successful communication, and provides consistent speech models. The child I described above, went on to learn a ton of new words after he got his device! When we begin to use AAC with toddlers, it doesn’t mean we believe they are never going to talk; instead, it often means, we believe they need a way to have a meaningful connection to others through a common language which helps serve as a bridge to spoken language.
2.  Do try and introduce forms of AAC early. Using AAC can be very helpful for a toddler who is beginning to make gestures, eye contact or sounds to communicate messages, but isn’t yet using spoken language. Often these toddlers are frustrated they can’t communicate certain thoughts and messages. Once they start to see and learn the power of communication through signs, pictures, or more formal AAC apps/devices, they begin to feel a little less frustrated.

3. Model, model, model. When using any type of AAC, we can never model enough. This means that everyone in a child’s life should use AAC too! As with all language learning, AAC is learned because those around the child speak the same language. If you think about it, early communication development (between birth – 12 months) is only modeling – caregivers communicating without any expectation while being connected with their baby using a common language. I love it when my clients bring their devices to therapy. If your child is already receiving therapy services, ask the therapist to use your child’s communication system during sessions to connect and engage with your child. When using AAC, continue to use verbal speech to model and help children understand the pictorial representation of language and develop the words.

4. When you schedule an evaluation, you will see both an occupational therapist and a speech therapist trained in AAC. Both therapists are knowledgeable in a variety of access methods such as hand access, switch scanning, and eye gaze technology. The occupational therapist will specifically look at:

• the child’s overall posture and strength to allow for upper extremity (or any other extremity) use while accessing the communication system
• determine optimal positioning of both the child and the device to ensure the most efficient method of access
• the child’s vision, auditory, and sensory processing needs
• the child’s visual and/or auditory scanning ability
• the child’s visual/auditory tolerance
• any adaptations to engage different sensory systems, as well as monitor for sensory overload and/or assist in sensory regulation for device access.

The speech therapist is extremely knowledgeable in the vast array of AAC communication systems and AAC strategies available. They will help determine the communication system and language page best suited to bridge the gap between the child’s receptive and expressive communication skills. The evaluations are done in a play based manner to help the child feel comfortable. And play is how children learn!

Here at Easterseals we offer a team approach for evaluating children for AAC needs. For children that could additionally benefit from AAC, we will see them for co-treats to help expand their language within play based therapy sessions.

When the child’s specific goal is to assist in overall regulation and play to support device access, then a co-treat can be extremely valuable between Occupational Therapy and Speech Therapy. OTs are trained in setting up sensory rich environments to support regulation and drive play. These activities can be very motivating for your child’s communication. There are endless opportunities to model language depending on your child’s unique development.

To learn more about Assistive Technology at Easterseals DuPage & Fox Valley, click here. 

 

Additional resources: www.speechscience.org

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

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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.

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. 

 

Beyond the Sippy Cup

By: Jennifer Tripoli, M.S., CCC-SLP

I often get asked the question “Should my child use a sippy cup?” It’s a difficult question to answer. Sippy cups were initially invented in the 1980s by a mechanical engineer who was sick and tired of cleaning up his son’s juice mess around the house. He uniquely devised a prototype for the no spill mechanism and just like that problem solved! He eventually sold his patent to Playtex ® and the rest is history as this became the go to type of cup for babies learning to transfer from bottle to cup.

I am sure you probably see tons and tons of children walking around the mall, playing at the park, and in the car with their sippy cups. This is the era of “to go” cups. Everyone, including adults bring their drinks (coffee, tea, water) to their next destination. I understand the convenience of sippy cups for parents and quite frankly I get it, but hopefully I can convince you to try out some other convenient cups that will support your child’s oral motor and speech development.

So why are they really SO bad?

• Promote immature tongue movement pattern or suckle
  • Sippy cups promote an anterior-posterior tongue movement pattern, similar to the way an infant extracts liquid from a bottle or breast (suckle pattern). We want to begin to promote a more upward and backward swallow pattern for infants and toddlers by way of an open cup or straw cup. Sippy cups promote a suckle pattern especially with continued use.
• Promote inappropriate tongue position for swallowing
  • The spout on the sippy cup can anchor the tongue tip down during swallowing. The only way for the tongue to move is forward. During a mature swallow pattern the tongue tip elevates to the area behind the upper teeth (alveolar ridge) as the tongue moves upward and backward.
• Promote speech sound errors
  • Continued and overuse of sippy cups (and pacifiers!) promote the tongue to rest forward in the mouth. This inappropriate resting tongue position can directly impact your child’s ability to produce certain sounds. For example, a child may produce the ‘th’ sound (a frontal produced sound) in for an ‘s’ sound (‘tho’ for ‘so’). It is important to note that not all children who use sippy cups will have speech sound errors. My thought is though let’s set our children up for success by using developmentally appropriate cups!
• Poor dental development and Dental Caries
  • Sippy cups can cause cavities and tooth decay. If your child is sipping on fruit drinks, milk, or any other sugary drinks, sugar can be left on their teeth which will cause the enamel to erode away. Sippy cups (and pacifiers!) can also cause misshaped oral cavities and affect resting tongue position.
• Risk of Injury
  • In my research on sippy cups, I came across a study proving sippy cups can be dangerous?! Who would have thought?! A study conducted in 2012 by Dr. Sarah Keim at Nationwide’s Children Hospital in Columbus, Ohio stated every 4 hours a child in the U.S. is rushed to the hospital due to an injury from a sippy cup, bottle, or pacifier. Dr. Keim stated this likely occurs due to the child learning to walk. As they are learning to walk, they trip and fall often. If they have a bottle, pacifier, or sippy cup in their mouth they can injure themselves.

So what’s the alternative?

• Open cups
  • Many parents think I am crazy when I suggest an open cup for a young child. Yes, it may seem a bit ambitious, but an important step in the development of good oral motor and feeding skills! When children drink from an open cup they are developing a more mature swallow pattern. A smaller open cup (with a smaller rim) will allow your child to have better motor control of the liquid. You can first try giving your child an open cup to practice without liquid (place a preferred pureed on the rim of the cup) or you can use thickened liquid in the cup for a slower flow.
• Straw Cups
  • It may take your child some time to learn how to extract liquid from a straw, but be patient and the skill should develop! When choosing a straw cup choose a straw that is thin versus thick. Also make sure the straw is not too long. It is possible for young children to drink from a straw cup with a suckle pattern. Some children are able to extract liquid from the straw by placing the straw under their tongue. To avoid this, you can slowly cut the straw ¼ inch at a time until the straw is short enough that the child cannot place his/her tongue underneath it.

Here are a few of my favorite open cups and straw cups!

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To learn more about development milestones and speech-language therapy services, visit eastersealsdfvr.org.

 

 

 

 

 

 

Communicative Temptation: Arranging Your Environment Can Get Your Child Talking!

By: Jennifer Tripoli, M.S., CCC-SLP

Communicative temptation is a speech therapy technique I use consistently during my sessions with children who are late to talk. It is an easy strategy that can be implemented across environments, not just in therapy! Communicative temptation was coined in 1989 by Wetherby and Prizant in order to use a creatively engineered environment to facilitate communication in young children.

In short, communicative temptations are what they sound like. You are going to tempt or entice your child to communicate by setting up your environment in a specific way. Sometimes we do not give late talkers a chance or an opportunity to learn/use communication. Not because we do not want them to talk, but more so because we anticipate their needs way too frequently.

Is your child ever struggling to open a container full of a preferred food and you jump in and open it for them? Do you ever anticipate the type of snack your child would like without allowing them to tell you? Are all of your child’s preferred toys in reach? Here are a few examples of ways you can tempt your child to communicate! 

• Placing a highly preferred toy or food item out of reach for the child. Key is in sight but out of reach!
• Placing highly preferred objects inside a clear plastic container that the child cannot open on their own
• Placing a lock on a cabinet door where a preferred object is located
• Eat a desired object in front of the child but don’t offer it to them
• Take the batteries out of a preferred toy and wait for the child to communicate the toy is not working properly
• Initiate a reciprocal interaction game such as “peekaboo”, then stop and wait
• Blow bubbles with the child a few times then place the bubbles out of reach or hand the child the bubbles container without the wand
• Push the child on the swing a few times and then stop
• Block the entrance of the slide they want to go down
• Change a familiar routine

Hopefully these examples, will allow you to think of other creative ways to engineer your home, daycare, toy room, etc. to allow for more communicative opportunities! The outcome is not always “talking”, it can be ANY type of communication! A gesture (e.g.

Photo by: Christine Carroll

pointing or reaching), a facial expression, a word, a phrase, etc.! The key here is WAITING. Often times, we do not give children who are learning language enough time to communicate. We jump in quickly and eliminate that opportunity to communicate independently.

Depending on your child’s language level you may need to model what is expected first (a gesture, a word, etc.). For example, if a child is attempting to open a locked cabinet you may first need to model the word “open” and then slowly fade this model. You eventually hope that the child will independently use the word after they are “tempted.”

Take a quick look at your home today. How can you make a few small changes to facilitate communication in your environment? How you can change how you interact with your child to increase communicative opportunity?

For more information about our speech services and other programs at Easter Seals DuPage & Fox Valley, click here.

7 Tips for Learning and Loving it!

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

Does helping your child with their homework ever feel like a laborious task?  These learning strategies will help you teach your child in a way that increases their understanding and retention.  Above all, these tips are meant to make the learning journey an enjoyable experience for all of those involved!

1. Relate new information to known information.  Our brains are pattern-seeking devices.  They are always searching for associations between information being received and information already stored.  Linking new information with familiar information creates a connection that your brain will hold on to.

2. Multi-Sensory involvement: the more varied experiences a child has with a new concept, the more neural pathways will be developed.  Whenever possible, teach the concept in a way that the child can experience.  If your child is learning about volcanoes, you can have them:

Role play being a volcano OR create a visual Venn Diagram comparing it to something they already know about.

3. Active learning-the more a child is involved with the information, the more efficiently he will consolidate and recall it.  When a child passively receives information, he will understand and remember less.  Passively receiving information would be listening to a lecture or passing your eyes over the print from beginning to end in a chapter. Active learning would involve making predictions about the chapter, taking notes and discussing what was read or learned.

4. Rhythm and Music: Rhythm and music stimulates both sides of the brain.  It activates our attention system and multiple neural pathways which facilitates memory and retrieval.   Create a song, set to a familiar tune that reviews key concepts in a curricular area.  Memorizing the 50 states, days of the week, or spelling words can all be easier when taught within a song or chant.
5. Movement: Adding movement to an activity provides extra-sensory input and enhances attention.  Movement helps increase cognitive function while also helping children get rid of “the wiggles”.

It is also beneficial for children to have downtime for movement built into their days. Many studies have found that students who exercise do better in school.   Exercise triggers the release of a substance that enhances cognition by boosting the ability of neurons to communicate with each other. Below are some ideas to incorporate movement into learning:

• Air writing letters
• Playing charades to act out a history lesson
• If the answer is correct, make a sign like a referee
•  Jumping on the trampoline while doing math facts
• Playing catch while reviewing information

6. Humor– Humor wakes up the brain cells!  It also encourages attention and relieves stress.  Humor keeps learning an enjoyable experience for teachers, parents and children.  Using humor lets students have an increased feeling of safety in making an error or getting an answer wrong.  Make time for laugh breaks to keep your child alert and attentive while learning
7. Reflection– Downtime is important to help the brain process new information and strengthen neural connections.  Have your child learn and study in small chunks of time.  Implement breaks for movement, listening to music, doodling or having a snack.

For more information on strategies for learning and about Easter Seals DuPage & Fox Valley, visit: eastersealsdfvr.org.

Childhood Apraxia of Speech: Signs and Symptoms

By: Jennifer Tripoli M.S, CCC-SLP

You may have heard the term “apraxia” before but wondered, what exactly does this mean? According to the American Speech Language Hearing Association (ASHA),

“Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.”

Childhood Apraxia of Speech (CAS) is not a black and white diagnosis and can be difficult for speech language pathologists to diagnose especially in very young children (under the age of 2). Children with CAS may have coexisting conditions such as Down Syndrome, Cerebral Palsy, or some other neurological disease. Some children with CAS though do not have any other known neurological deficit.

Children with CAS may present the following key characteristics:

• Limited vowels produced, lack of differentiation between vowels, and/or vowel distortions
• Inconsistency or variability in productions
• Groping of oral structures or physical struggle to produce sounds
• More difficulty with multisyllabic words or more complex productions (longer phrases/sentences)
• Difficulty with imitation, better productions observed with spontaneous, learned, or automatic productions
• Choppy or monotone speech (equal stress patterns on multisyllabic words)
• Slow rate of speech
• Difficulty with non-speech oral movements such as sticking tongue out, pursing lips, etc. (oral apraxia)

Listed below are other common signs present in children with CAS, though are not exclusive to CAS:

• Decreased babbling or vocal play as an infant
• Lack of imitation skills in infancy
• Delayed speech production or expressive language skills
• Poor speech intelligibility (ability to be understood)
• Decreased sound inventory for his/her age
• Words used once and never used again

Children with CAS may not present with all of the above characteristics. There is currently no “rule” regarding how many characteristics a child must have to qualify for a CAS diagnosis.  If your child presents any of the above key characteristics, an evaluation by a speech language pathologist who specializes in CAS is recommended in order to differentially diagnosis your child.  Children with the above characteristics may present CAS or another speech sound disorder.

Visit Easter Seals DuPage & Fox Valley at EasterSealsDFVR.org to learn more about speech-language services and evaluation. And to learn more about CAS and access parent friendly resources, visit Apraxia Kids.

5 Reasons To Enroll Your Child in Private Therapy

By: Jennifer Tripoli, M.S., CCC-SLP

A question I am often asked is about working at a private, non-profit pediatric therapy center. What makes us different?! Well some unique qualities that compliment other services! Below are the top five reasons to enroll a child in private therapy (primarily from a speech-language perspective!).

1. Enhancing School Services

Many children have significant issues that require more frequent, intense services in order to progress. Unfortunately, the public school districts are limited by the hours in the school day. Participating in outside therapy services allows for a child to work on similar goals or additional goals.

For some children, the repetition of school goals helps them progress faster and allows them more time to understand concepts. For other children, the school therapist may be working on one area of need where the private therapist is targeting another area of need. We are happy to collaborate with school therapists. I find that this is the best recipe for success!

2. Your child did not qualify for Early Intervention Services (EI)

Currently, the Early Intervention Program for the state of Illinois requires a child (0-3 years of age) to have a 30% or more delay in 1 area of development in order to qualify for services, have a qualifying underling medical diagnosis (e.g. Down Syndrome), or have 3 or more risk factors for delayed development. In many cases, children do not meet the criteria as listed above for services through the Early Intervention system, but still present with developmental delays.

For example, a child may be evaluated for speech and language delay

Photo by: Nancy Kerner

through the early intervention system and only found to have a 20% delay in expressive language. In most cases, a child with a 20% delay would not receive services through EI, but may benefit from private therapy in order to improve their expressive language skills to a more age appropriate level. Just because your child has not qualified for EI does not mean they will catch up to their peers without assistance. A private speech and language evaluation may be warranted to determine if your child would benefit from speech therapy services.

3. Your child has feeding or oral motor issues

Often, feeding and oral motor skills are not addressed in the school system as these skills may not be considered as educationally relevant as other skills. It can also be difficult to find a Speech Pathologist who has experience in working with children with oral motor and feeding deficits. Private speech therapy services can address your child’s feeding and oral motor deficits as these skills are extremely important. Here at Easter Seals DuPage & Fox Valley our speech pathologists have an extensive knowledge of oral motor and feeding deficits in pediatrics.

4. Your child can participate in co-treat Sessions

When appropriate, co-treat sessions may be of benefit for your child. A co-treat session is when 2 therapies are rendered simultaneously. Often children may be receiving speech therapy along with occupational therapy or occasionally physical therapy. This allows both therapists to work together in order to improve different skills.

For example, the occupational therapist can assist with improving sensory regulation so the child is better able to attend and understand speech and language concepts. The physical therapist can assist the speech pathologist with body positioning/posture to achieve the best speech/voice possible for a child with motor deficits. This is a strength at Easter Seals DuPage & Fox Valley. We often have multiple disciplines work together to get a holistic picture of a child’s needs. 

5. Your child has minor speech/language deficits that are not addressed by the school

Some children may present mild articulation issues that may impact their ability to communicate, but are not severe enough for a child to qualify for school therapy. Private speech therapy can address these issues if found developmentally inappropriate through a private speech and language evaluation.

If you feel your child would benefit from private speech and language intervention, please visit our website here. Let me know in the comments if you have additional questions!