Valentine’s Day Activities for Speech and OT

As Valentine’s Day approaches, we’re excited to share some heartwarming and therapeutic activities that not only celebrate the season of love but also contribute to the growth and development of our clients. Join us on this journey of combining affection with effective therapy!

Speech and Language Therapy

Valentine’s Day provides a unique opportunity to explore the language of love. Speech and language therapy can be both educational and enjoyable as we engage our clients in activities that focus on expressing emotions, social interactions, and building meaningful connections through communication.

Activity Ideas:

  • Love Letter Writing: Encourage clients to express their feelings by writing or dictating love letters. This activity enhances language skills and emotional expression. 
  • Conversation Hearts Challenge: Use conversation hearts candy with words or phrases related to communication goals. Clients can create sentences or engage in conversations using these sweet treats.

OT- Sensory

Occupational therapy often involves sensory activities that stimulate and enhance sensory processing. This Valentine’s Day, let’s explore sensory-rich experiences that promote engagement and development.

Activity Ideas:

  • Scented Sensory Bins: Create sensory bins with Valentine-themed scents like roses, chocolate, or strawberries. Clients can explore different textures and engage their senses.
  • Heart-shaped Stress Balls: Make heart-shaped stress balls filled with different textures to provide tactile stimulation. This activity is great for hand strength and stress relief.

OT- Fine Motor Fun

Fine motor skills are crucial for daily activities, and what better way to practice than with Valentine-themed fine motor activities?

Activity Ideas:

  • Valentine’s Day Crafts: Engage clients in crafting activities like making heart-shaped cards, cutting out paper hearts, or creating tactile crafts. This enhances fine motor coordination.
  • Cupid’s Arrow Game: Use a bow and arrow game to target various objects. This activity improves hand-eye coordination and fine motor precision.

Valentine’s Day is not just about chocolates and flowers; it’s about fostering growth, connection, and joy through therapeutic activities. We invite you to join us in celebrating the language of love and the development of essential skills that make every day special for our clients. Happy Valentine’s Day!

By Amy Rawlings, MA, CCC-SLP

Tips for Stuttering and the Holidays

For many people, October-December is the most wonderful time of the year filled with good food and company. But for others, this time of the year can be busy and stressful, overfilling our internal buckets. This bucket analogy is frequently used by stuttering specialist, Dr. J. Scott Yaruss, and illustrates the idea that many factors can affect stuttering, including child factors (genetics, temperament), interpersonal stressors (life changes, fast-paced lifestyle), and communicative stressors (competition for talking time, frequent interruptions). We like to encourage families to try to lower the level of the bucket, since we all communicate best under the least amount of stress and pressure.

Here are some practical ways to try to pour out some of the bucket’s contents when it gets filled
with the uncontrollable holiday bustle:

1. Include some space and time for quiet as a family

When our homes are filled with family and friends, especially those we haven’t seen in a while, conversations can be found at every corner. This can take a toll on those who stutter who might not enjoy, and may even anxiously anticipate, constantly conversing. Before a big gathering…

  • Do: Enjoy leisure activities together that don’t require as much talking like coloring, reading, puzzles, legos, play-doh, etc.
  • Try to avoid: Activities that encourage pressure, speed, and are verbally taxing such as competitive board games.

2. Keep the joy, lower the excitement

Children may have a more difficult time speaking when worked up in either a positive or negative way. Still speak about the great time that will be had during the holidays, but try to limit ramping up emotions and building a lot of anticipation.

  • Do: Speak positively “I love getting to try so many different kinds of candy on Halloween.”
  • Try to avoid: Speaking to heighten emotions “Aren’t you excited to show off your new costume?!”

3. Practice stressful areas

You know your child best, and when and where they communicate their best. You know if your child is a perfectionist, and can anticipate that when other children come over, win games and take toys, yours may be very thrown off. Or, you may know your child to be on the shyer side making trick-or-treating a difficult activity. Practicing these scenarios with people that are familiar to the child and in a controlled environment can help transfer readiness and emotional preparedness for the more spontaneous encounters.

  • Do: Talk about emotions! Encourage losing and still having fun. Talk about how nice it feels when your child shares a toy with you. Practice knocking on bedroom doors and saying “trick or treat!”. Have your child switch roles with you in each scenario to be the winner/loser, sharer/taker, etc.
  • Try to avoid: Rewarding only winning and reacting negatively when things don’t go perfectly.

4. Encourage and advocate

Our children may be meeting visiting guests for the first time, who may bring up that they stutter. This is a great opportunity to advocate for your child and to address the situation head on. Speaking openly and positively about stuttering helps children feel empowered to be themselves, and reduces the chance of children developing avoidance behaviors.

  • Do: Learn about stuttering with your child (myths/facts, famous people who stutter, etc.) to build their confidence and eliminate negative associated feelings about stuttering. Acknowledge the stutter, acknowledge that he/she/they is/are trying to find strategies to speak smoother through therapy, talk about your child’s strengths.
  • Try to avoid: Avoiding the conversation of stuttering and using vocabulary that portrays it as negative such as “fixing” or “correcting” it.

Feel free to reach out to your Speech-Language Pathologist for additional suggestions relevant to your child and their plan of care. For more stuttering related-resources, check out

By Mariel Manuel, MS, CCC-SLP

The Power of Play

How to Use Play to Help Children Learn and Grow

To the untrained eye, it may look like a speech therapist is just playing with your child.  You might wonder when the actual learning is going to start with worksheets, flashcards or drills.  But the reality is that children tend to learn more from play than through structured, adult directed activities.

Play can help to increase:

  • social-emotional skills
  • cognitive skills
  • self-regulation
  • language skills

It can promote:

  • problem solving
  • collaboration
  • creativity

The mutual joy and shared connection during play can decrease stress and increase the bond between the people involved. 

When I meet a child during their first speech session with me, it is my job to get to know that child, build rapport, and figure out the best way to help them meet their speech goals.  If I were to make them sit at a table while I proceeded to lecture them and drill them for 25 minutes, some older children might do okay, but most younger children would probably either protest or not pay attention to me because I am not creating any active engagement.  My top priority during my first few sessions with a child is to create trust and connection.  Without that, it is difficult to teach anything.  I do this by finding an activity that brings them joy:  bubbles, tickles, cause/effect toys, pretend play, board games, etc..  Depending on the child’s age and abilities, there are certain activities I know that child will probably enjoy based on my experience.  I start with those, and if they do not work, I try alternatives until I find something that creates joy and engagement.  It is only then that I begin to integrate the child’s speech goals into the play to facilitate learning and growth.  Let’s talk about the different types of play and how you can use them with your child at home to help expand their language skills. 

Types of Play:

1. Physical/Rough and Tumble Play 

Playing on the playground, tickle or wrestling games, pillow fights, lifting kids in the air, hanging them upside-down, using movement or dancing with music, etc.

I personally find this type of play especially effective with children who are difficult to engage (prefer to play alone doing their own thing) or who are sensory seekers (love climbing, jumping off things, crashing into pillows, etc.).   I only do this with children who enjoy this type of play and pay attention to their body language that indicates whether they are giving me permission to tickle them or hang them upside-down.  If a child is turning away or backing away in a non-playful manner, I stop, making sure to respect their boundaries to keep that aspect of trust.  And of course, I always play these games as safely as possible.   

Examples of using this type of play to facilitate language:

  • Hold your hands out like you are about to tickle the child and wait for them to communicate they want you to proceed either through a gesture such as moving closer to you or a word or phrase such as “tickle” or “get me”.
  • Incorporating music- singing a song where there is a part that you tickle them, squeeze them, hang them upside-down, etc.  One I use while bouncing the child on my knees is “horsy, horsy, go to town.  Better watch out or your horse will fall…… DOWN” then hang the child upside-down.  You can wait for the child to say, “down” or gesture they want you to hang them upside down by leaning back. 
  • On the playground while pushing a child in a swing, you can hold the swing/child up so they are about to swing forward or backward (make sure the child is secure) and say, “ready…set…” and see if they can say “go” (or sign or gesture) to indicate they want you to let go.

2. Using Cause/Effect Toys

These toys are simple in that when you push a button, wind them up, etc. they do something fun.  Some examples are wind-up toys, spinning tops, ball poppers, car ramps, bubbles, etc.  These toys are great to capture a child’s attention and increase engagement.  These kinds of toys work better to create engagement when the child needs you to help them operate it.  For example, if they can’t wind up the wind-up toys on their own or they don’t know how to blow the bubbles.  In this case, they will need to communicate with you every time they want you to activate the toy. 

Examples of using this type of play to facilitate speech and language:

  • Using “ready set….” and waiting for the child to say “go” for you to activate the toy, blow the bubbles, etc.  If the child is not saying “go” you can model sign language or model a gesture, then wait for them to use it to communicate they want you to activate the toy.
  • Model describing or action words:  while popping bubbles say, “pop…pop” every time you pop a bubble.  While the top is spinning say, “spin!”.  Always use lots of excitement in your voice to increase attention and engagement.

3. Pretend Play

Pretend play can be done with toys such as people, animal figures/dolls, or vehicles becoming the “characters” in play or the child or adult themselves can be a character such as when playing dress up, playing school, restaurant, etc.  Pretend play creates a safe container for children to explore different situations and emotions and is a great way to learn language.  The first pretend play skills to develop in toddlers usually involve pretending to feed a doll or stuffed animal, or pretending to put them to sleep, or alternatively for the child to pretend to eat pretend food or pretend to sleep.  They might also push a car or fly a plane while making sound effects.  As they gain more vocabulary, they can make the characters talk and have conversations with each other and act out different situations. 

 Examples of using this type of play to facilitate speech and language:

  • As a parent, while engaging in pretend play with your child, it is common to feel the need to ask your child a lot of questions.  For example, “where are they going”, “what are they doing?”, “what color is that?”, etc.  However, questions like this take the child out of the fun and magic they are creating with their pretend world into an interaction where their parent is quizzing or drilling them instead.  It is much more beneficial for the child to have the parent join them in this pretend world by grabbing a toy and also pretending to be a character and interacting with that child’s character.  Modeling language while engaging in pretend play is a great way to teach your child.  For example, if you want to teach your child what to do when you go to someone’s house, you could do this using dolls and a doll house.  Your character could knock on the door, and another character inside the house could say, “who is it?”, and the one outside could say, “it’s Billy”, and then your character inside could open the door and say, “hi!  Come in!”.  Even if your child is not talking yet, you can have your characters talk to their characters to model appropriate language for the situation. 
  • Children also LOVE to experiment with emotions within pretend play.  It almost never fails that when I make my character fall down and cry, the child smiles and indicates they want me to do it again.  Not because they like seeing people cry, but because I am showing them a safe way to play with difficult emotions such as sadness and anger.  In real life, when a child is feeling those emotions, they are in a state of distress which shuts down the logical brain and makes learning pretty much impossible.  By pretending to have characters outside of themselves feeling these emotions, they can play with the cause and effects of emotions, and as a parent you can model ways to deal with them.  For example, when my character falls down and starts crying, I can have another character walk up to them and say, “are you okay?”, and pretend to help them or give them a hug.  This helps with emotional regulation and using appropriate language for emotionally charged real life situations.  These are just a couple examples of the things you can teach children through modeling within pretend play.  The possibilities are as endless as your imagination! 

4. Board Games/Structured Games

These are games that have a set of rules.  It can be a physical game like a sport, or tag, or a board game that comes with a set of written instructions (note:  you do not always have to play with a game according to the given instructions.  You can always tailor these rules to accommodate your child’s abilities and things you want to teach them). 

Examples of using this type of play to facilitate speech and language:

  •  If you want to teach your child cooperation, collaboration, and negotiation skills, you can come up with the rules of the game together.  You can work on skills that these games address directly- such as working on describing skills with games like Guess Who or Headbands in which you must describe a person or noun so the other person can guess who or what you are describing.  Or you can have the child practice a skill before they take a turn in the game (i.e., before you roll the dice, make a sentence about this picture or tell me the opposite of up). 
  • The type of play you choose to engage in with your child should depend on their age and interests.  Watch your child when they play by themselves and see what they tend to gravitate towards and see if you can join them in a playful and fun way to help them learn and grow.

Side Note About Media and Electronic Toys:

Some TV shows, YouTube videos, and electronic toys market themselves as educational and lead parents to believe that if you put your child in front of the TV or hand them the toy and go do your own thing, they will learn something.  But the reality is that no television show or fancy toy is a substitute for engagement with a real live person.  Children learn best with adults who are present and give their full attention.  Speech and Language skills are particularly all about communication, human interaction, and connection, which is best achieved through your presence. 

Playing with your child will not only help them to learn and grow but will also increase your connection to your child and increase joy and decrease stress for both of you.  So, find your inner child and have some fun together!!!

By Hilary Dickey, MS, CCC-SLP

What in the World is Childhood Apraxia of Speech?

What is CAS?

Childhood Apraxia of Speech, or CAS for short, is a speech disorder that results in children being unable to form the words they intend to, even though they know what they want to say.  It is associated with very low intelligibility and is arguably one of the most frustrating speech challenges kiddos and their parents face.  CAS is also sometimes also called Developmental Apraxia, but unlike this name suggests, children do not often improve spontaneously; skilled speech therapy is required to treat it.

Origins of CAS

CAS is estimated to occur in only 1 or 2 of every 1,000 children in America.  Unlike acquired apraxia, which is most often seen in adults who have had strokes or traumatic brain injury, the cause of CAS is unknown.  Rarely are there any observable differences in the brain, though CAS can sometimes occur as a symptom of a syndrome, genetic disorder, or metabolic condition (e.g., galactosemia).  CAS is known to exist at higher rates in children who have other neurodevelopmental conditions such as ADHD, Autism, and epilepsy.

Mechanics of CAS

The act of speech is a series of incredibly precise fine motor skills that requires very refined movement of the lips, tongue, and jaw.  If the neurological planning of these movements is disrupted, as in the case of CAS, low intelligibility results.  Recent research indicates that children with CAS may have difficulties with sensory feedback loops required to learn and judge the accuracy of speech. Sensory feedback is important for the subliminal knowledge of proximity between speech structures (e.g., lips, tongue, teeth, palate) during speech, which plays a role in execution of movement.

What CAS is Not

CAS does not involve physical issues with the mouth, such as muscle weakness or muscle coordination difficulties. It also does not involve the brain itself, but rather nerve pathways responsible for planning speech movements.  

CAS vs Phonological Disorder

Many times, parents of children who exhibit very low intelligibility research causes online and conclude that Childhood Apraxia of Speech is to blame for their child’s unintelligible speech.  However, children with severe phonological disorders can be just as unintelligible, or even more so, than children with CAS.  Your speech-language pathologist will need to analyze your child’s speech to discern whether distinct error patterns (e.g., deleting or substituting certain sounds in various word positions) are present, as in a phonological disorder, or whether the errors are inconsistent or random, as in CAS.  CAS and phonological disorders can also coexist.

Errors related to CAS often change as a word is repeated, and these errors cannot be grouped into categories, unlike phonological errors.  Other characteristics of CAS which distinguish it from a severe phonological disorder include errors on vowels, prosodic errors (relating to stress and intonation), increased errors as utterance length increases, and increased errors in spontaneous speech over rehearsed speech.  When your child’s speech is evaluated, your speech-language pathologist will provide an appropriate diagnosis in order to follow with appropriate treatment methods.

By Kathleen Winger MS CCC-SLP

Gestalt Language Processing

Let’s unpack some buzz words that you may have been hearing lately:

“Echolalia” is the repetition of language spoken by others. It can be repeated either immediately or after some delay. With echolalia, language is stored as a “chunk”, or a whole unit.

“Scripting” is another term that refers to echolalia. “To infinity…and beyond!” is an example of a script from media. “See you later alligator” is an example of a script that may be heard in conversation. When children are “scripting”, they may be observed reciting dialogue from a TV show, singing lyrics from a YouTube song, or copying phrases they’ve heard other people use. The message is often identical to the source where they heard it, and has the same melody.

“GLP” stands for Gestalt Language Processing. This is a form of language development where children learn the meaning of language in chunks first, then over time learn to break the chunks down and formulate their own original language.

Let’s bust some myths:

Are most autistic children GLPs? YES!

Does being a GLP automatically mean a child is on the Autism Spectrum? NO! Some neurotypical children learn language via chunks as well. 

Unsure if your child may be a “GLP”? Here are some common signs:

1. They echo back what you say or the last part of phrases you say, without appearing to process the language.

2. They have difficulty answering questions in conversation.

3. They like to hum or sing songs rhythmically. 

4. They have a preference for intonation-rich sound input, such as music or videos.

5. They replay certain portions of video clips over and over.

6. They like to repeat play scenes in the same way over and over.

7. They like to play with the WHOLE set – if a figurine is missing, they are not pleased. They are seeing the world in a “gestalt” way.

8. They like to label objects they see around them and can recite their ABCs or count 1-2-3, though have trouble using their language to ask for help or communicate other important functions. 

I think my child is a GLP… Now what?

1. Find a Speech-Language Pathologist near you that has been trained in Gestalt Language Processing. They can help determine which stage of the Natural Language Acquisition framework your child is in and give tailored advice on how to support your child’s language development at home. 

2. Follow social media accounts such as @meaningfulspeech and @bohospeechie, which provide brief, useful posts related to GLP.

3. Take a look at free resources on the website If you have extra time, consider taking Meaningful Speech’s parent friendly course. 

4. Check out Marge Blanc’s book, “Natural Language Acquisition on the Autism Spectrum. The Journey from Echolalia to Self-Generated Language.”

Things to Keep in Mind:

  • Echolalia is not just a “stimming behavior” that should be ignored, decreased or extinguished… Echolalia communicates. 
  • We should acknowledge children’s scripts by nodding our heads or repeating back what they say, even if we are unsure what they mean.
  • Speech therapists are here to help! 

By Julia Navarra MA CCC-SLP

Comparing/contrasting occupational therapy school vs. clinic based services

Happy August! I hope that our families are currently enjoying this home stretch of summer, perhaps taking in a few more beach days or afternoons at the park, going on fun trips out of town, having play dates with friends, and simply indulging in this time before our thoughts turn to autumn. No doubt, many of us are already planning for returning to the “school routine” of classes, schedules, and services, including keeping up therapies in school and in-clinic. It can be a lot to juggle!

In case you are wondering what the similarities and differences are (or would be) between your child’s occupational therapy (OT) services at school vs. in the clinic, here is a basic principle: outpatient OT can address any deficit area within our scope of practice, as long as funding sources allow, and school-based OT addresses deficit areas that directly impact the student’s access to their education. In the latter case, the student must have an IEP (Individualized Education Program).

In our outpatient clinic setting, we may directly address areas of need such as:

  • Fine motor / visual-motor skills
  • Gross motor skills
  • Overall coordination, core strength, balance
  • Sensory processing
  • Self-regulation / emotional regulation
  • Activities of Daily Living (ADLs): dressing, hygiene, grooming, etc.
  • Feeding and oral-motor skills
  • Executive functioning
  • … plus others!

School-based OT services also address the above areas, however, the goals must be related to deficits seen within the student’s educational setting. For example:

  • Fine motor and visual-motor skills related to writing, typing, completing assignments and homework
  • ADLs within the school day: changing into gym clothes, independence at lunch time, etc.
  • Executive functioning skills for organization, attention, planning, time management, getting through a routine schedule
  • Sensory processing challenges that affects the student’s ability to participate in their school day
  • Core strength, affecting the student’s ability to maintain appropriate posture for attending to and completing school tasks

Of course there are many more differences between these two OT settings, and the best advice is to consult with your child’s physician, clinic Occupational therapist, and/or educational team to determine which kind of services are appropriate and necessary.

Lastly, if your child already receives both clinic and school-based OT, we’ve found that it’s often beneficial for both therapists to sometimes consult and be aware of what the other is working on, for an even more harmonious OT experience for your child!

Written by: Pam Verde, MOT, OTR/L

Incorporating basic concepts into america’s holidays

Happy Birthday month to our beautiful country, America! To many families, Fourth of July means fireworks, family reunions, concerts, barbecues, picnics, parades, and baseball games. For our speech therapists, holidays are a great opportunity to target several different language goals such as temporal, spatial, and quantitative concepts. It is important to remember that before a child can use the concept in their speech (expressive language), we must first be sure they have a full understanding (receptive language).

Temporal concepts

Temporal concepts (before, after, during, first, next, last) are words that are used to describe time. Celebrating special days that occur at the same time every year help provide children with a sense of time that passes in the duration of a year. We can converse with our kids about the upcoming holiday and model using temporal concepts. We may also show them a calendar and allow them to flip through and visualize the temporal order.

Verbal model examples: “Before the Fourth of July, we celebrate Valentine’s Day. After the Fourth of July, we celebrate Christmas. First is Valentine’s Day, next is Fourth of July, and last is Christmas. During the Fourth of July, we will have a cookout and watch fireworks.”

Visual examples: Try showing your child a calendar with pictures on each holiday. Allow them to flip through and visualize the temporal order. Start with two holidays and discuss before and after. You can also try three holidays using first, next, and last. For the children that are new to learning the concept, see if they can use their receptive language and flip to the first holiday! To target expressive language, ask your child a question such as “Which holiday comes first?”

Spatial concepts

Spatial concepts (in/out, up/down, on/off, over/under, behind/in front, next to/in between) or prepositions describe an object’s location in relation to another object. Understanding spatial concepts is critical for following directions and describing objects. Just like temporal concepts, we can use spatial concepts in conversation with our children as well as incorporating visuals to aid in understanding.

Verbal model examples: “Let’s shoot the fireworks up in the sky”, “Should we put the flag on the pole?”, “The float is in front of the dancers!”

Visual examples: Grab a cup and any mini object at home. First, see if your child can follow simple directions such as, “Put the eraser under the cup”. Once your child has mastered this, now you can move the object and ask the child “Where is the eraser?”. If you notice that the open task becomes too difficult, you can also provide your child with two options such as “Is it on top or under?”, changing it to a closed question that will be easier to answer while still prompting the child to use expressive language.

Quantitative concepts

Quantitative concepts (a little/a lot, all/none, more/less, most/least) can describe the size and amount of an object. Similar to spatial concepts, understanding quantitative concepts is important for following directions and describing objects.

Verbal model examples: “I hope we receive a lot of candy at the parade!”, “Do you think this is more candy than last year?”, “I wonder who found the most candy”.

Visual examples: Beginning with receptive language, pull out a large quantity of something such as legos, blocks, or marbles. Ask your child to give you all of the blocks, a little bit of legos, and a lot of marbles. You can also try this while cooking with your child; asking for more chocolate chips, a little bit of sugar, and less flour.

Holidays are a great way to organize our year with temporal concepts and use themes to make language concepts more fun for everyone!

Written by: Alexa Murman, MS CCC-SLP

Let’s play outside!

Summer is here and what better way to spend it than playing outside! Studies have shown that being outdoors promotes mental wellness; therefore, not only will your child benefit from being outdoors, but so can the whole family. Outdoor play can be anywhere from the backyard, your neighborhood park, the beach or a hiking trail. Summer also means school is out and your child might have some extra energy to burn. This is the perfect time to plan an activity incorporating all of the eight senses that your child may be working on during their occupational therapy sessions.

Eight senses:

  • Auditory: how we process sounds
  • Gustatory: how we process taste
  • Interoception: how we process what we feel within our body (hunger, toileting, stomach ache)
  • Olfactory: how we process smell
  • Proprioception: how we process where our body is in space
  • Tactile: how we process touch
  • Vestibular: how we process movement and balance
  • Visual: how we process what we see

Let’s go to the beach:

  • Tactile play/fine motor skills – Building a sand castle
  • Hand strength/grading of force – carrying a bucket of water, digging a hole in the sand
  • Visual scanning – Looking for seashells or rocks
  • Proprioceptive Input – Getting buried in the sand or running with the waves
  • Body/Safety awareness – Being aware of their surroundings and not wandering too far
  • Auditory – listening to the sounds of the waves

Let’s go on a nature walk:

  • Proprioceptive/vestibular input – walking up a hill or steep incline, safely balancing on a tree stump
  • Visual scanning – I spy a/some….
  • Tactile play – picking up different leaves and flowers
  • Auditory – listening to the sound of birds
  • Olfactory – smelling flowers

Let’s go to the park:

  • Vestibular input – Going down the slide and swinging
  • Proprioceptive input/motor planning – climbing up the play structure
  • Visual scanning – I spy a/some…
  • Tactile: playing in the sand box

Let’s play in the backyard:

  • Tactile/fine motor skills – water play: filling up containers to pour and scoop water
  • Vestibular input – Setting up a little obstacle course to climb, crawl, and jump to get from one end to another
  • Proprioceptive input/motor planning: animal walks around the backyard
  • Visual motor skills – drawing on the sidewalk with chalk

All of these examples will not only target the eight senses but it can also work on core and upper body strengthening, motor coordination, sequencing, endurance, self-regulation, social skills and building your child’s confidence to navigate their natural environment. Children learn more about themselves via play and can become more aware of their surroundings when playing outside. Studies have shown that there has been a decrease in outside play due to screen time and busy school schedules with extracurricular activities. Being around green plants and play yards reduce children’s stress levels; the natural space and surroundings can stimulate a child’s imagination and creativity. While playing outside, children can also benefit from natural sunlight, fresh and natural elements that contribute to bone development, a stronger immune system and physical activity. Green outdoor environments also promote improved attention and mental well-being.

June is safety awareness month and with outdoor play, it is important that your child also learns to be aware of their surroundings and their peers. You can practice having your child safely navigate their environment and provide verbal cues to stay within safe boundaries. You can initiate outdoor play in a smaller space before moving into a large space to practice safety. Although you want your child to engage in free play outside, it is important to create rules, safe zones and buddy systems. Remember to explore, have fun, let your child get dirty and enjoy the outdoors!

Monica Kem, M.S. OTR/L, SWC

What is a tongue-tie and how can it impact my child’s speech?

Tongue-tie (medically known as ankyloglossia) occurs when the lingual frenulum – the membrane beneath the tongue which attaches the tongue to the mouth base – is too large and restricts tongue movement. This anatomical change restricts the tongue from reaching certain points in the mouth, often necessary for producing certain speech sounds. A tongue that lacks a full range of motion may fall short of the target placement required to make certain speech sounds, causing an articulation disorder. Tongue-tie may also impact feeding and oral hygiene.

Doctors typically recommend Lingual frenectomies when infants exhibit difficulty latching or suckling during nursing. In older children, their tongue may protrude out when drinking from a cup or eating from a utensil, increasing the chance of choking and resulting in messy eating.

Visually, the tongue may appear fattened due to the inability to completely extend to its full length without great effort. In more severe cases, it may appear heart-shaped with a cleft in the center from being pulled back.

How does a tongue-tie impact speech?

Because many speech sounds require the lifting or retraction of the tongue to produce, there is evidence that in many cases, a tongue-tie may contribute to speech sound errors. Sometimes, sounds impacted are “l” and “r .” In other instances, tongue-tie may contribute to a lisp. For example, since the production of “s” and “z” requires the tongue tip to lift up to the alveolar ridge, they may not be able to be produced if the tongue is anchored down.

To compensate for this inability, the jaw and tongue body is often thrust forward, causing the tongue tip to emerge between the teeth in a lisp. As a result, single words, phrases, or short sentences may be produced without errors. Still, the demands made on the tongue during conversation (i.e., fast rate and a variety of surrounding speech sounds requiring complex movements) become too great for the anchored tongue, resulting in disordered speech.

Why should my child get a frenectomy?

Scheduling a lingual frenectomy to correct tongue-tie is recommended for those with resulting speech and feeding issues as these issues will likely persist without treatment. While children with untreated tongue-tie can improve their speech through skilled therapy, progress may be slow or limited by the anatomical restriction. While many parents are concerned about their child’s short-term discomfort, surgery is fast – often performed with a laser by a pediatric dentist – and the incision heals quickly.

After a lingual frenectomy has been completed, the tongue is typically still weak from being anchored down, so skilled speech therapy is still needed in most cases. The degree of success in speech outcomes following a frenectomy will also be affected by individual factors such as the size of the oral cavity and the tongue’s posture. The child’s age also plays a significant role; Children typically undergo frenectomies before the age of 3. Speech outcomes are best when frenectomies occur at this young age because children over the age of 3 have passed the age of orofacial development. As a result, more skilled therapy will still be necessary to instruct jaw and tongue positioning after age 3.

Research has long shown a correlation between tongue-tie and articulation disorders. Increasing the tongue’s range of motion allows for less effortful lingual placement during speech. In light of this science, the long-term benefits of a lingual frenectomy on articulation far outweigh short-term discomfort.

If your child is experiencing speech sound distortions and has a tongue-tie, to maximize speech therapy outcomes, talk with your ENT or pediatric dentist about scheduling a lingual frenectomy as soon as possible. It may be critical for your child’s success in speech.

Kat Winger, M.S. CCC-SLP

Can speech therapy correct a lisp?

What is a lisp?

Lisping is one of the most common and most well-known articulation disorders resulting from abnormal tongue positioning, which causes a perceived sound distortion. It is estimated that 90% of speakers who have some kind of articulation difficulty exhibit some degree of lisping behavior1. While lisping most frequently impacts “s” and “z,” it can affect other sounds as well, such as “th” and “sh.”

Lisping is considered a mechanical issue that may be either structural, from an overbite or underbite, or behavioral, from a tongue thrust. Factors that impact it includes tongue weakness or jaw instability, as a lowered jaw impacts the ability of the tongue to lift. Typically, jaw instability and tongue weakness coexist when a lisp is present. However, causes are nearly always behavioral and can be treated with skilled therapy.

What are some common types of lisps?

The most common and well-known variety is a “frontal lisp” or “interdental lisp.” Most people think of a frontal lisp as a “th” substitution, as in the production of “thun” for “sun .” However, this is not the case. The tongue does not protrude as far out as during a “th” production. Instead, it may not even protrude, positioned on or between the teeth, and is frequently visible during “s” production. Frontal lisps are nearly always behavioral in nature, not often resulting from structural issues. As a result, they are not a concern for children below 5. Following age 5, it is considered disordered and requires skilled therapy to treat.

Another common type of lisp is known as a “lateral lisp.” This is never developmentally appropriate, meaning that it is disordered in a child of any age and must always be treated with skilled therapy. It results from a flattened tongue so that airflow, rather than moving in a forward trajectory, emits out the sides of the mouth, causing a “slushy” sound. Treatment of lateral lisps involves an emphasis on lifting the tongue to streamline airflow. Ensuring the child’s self-awareness and ability to monitor their speech is also essential during treatment.

Why should a lisp be treated in speech therapy?

While overall intelligibility is not as significantly impacted as with other articulation disorders, the effects of a lisp often have social-emotional ramifications. One study by Ellen-Marie Silverman indicated that lisps draw negative attention and impact perceptions relating to intelligence, personality, and likability.2 The phenomenon of lisping impacts the perceptions of others and the self. In a study by Veríssimo et al., participants who presented with lisps felt insecure and that their speech disorder negatively impacted their social life or work.3

Many parents first seek out speech therapy in elementary school when their child begins to feel shame or experiences bullying related to their speech. Then, the child, parent, and speech therapist can work together to resolve the issue. Following articulation therapy, children are proud of their speech and confident in their ability to communicate with their peers.


  1. Fairbanks, G. (1940) Voice and Articulation Drillbookt. New York: Harper and Row.
  2. Silverman, E. (1976). Listeners’ impressions of speakers with lateral lisps. Journal of Speech and Hearing Disorders, 41(4), 547-552. doi: 10.1044/jshd.4104.547
  3. Veríssimo, A., Van Borsel, J., & de Britto Pereira, M. (2012). Residual /s/ and /r/ distortions: The perspective of the speaker. International Journal of Speech-Language Pathology, 14(2), 183–186.

Kat Winger, M.S. CCC-SLP

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