Speech Therapy Archives | Page 2 of 3

The Power of Play

Activities, Educational, General, Speech Therapy | Aug 01, 2023 10 min read

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?

Educational, General, Speech Therapy | May 31, 2023 3 min read

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

Educational, General, Speech Therapy, Therapy | May 01, 2023 3 min read

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 www.meaningfulspeech.com. 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

Educational, Speech Therapy, Therapy | Aug 08, 2022 2 min read

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

Activities, Educational, Speech Therapy, Therapy | Jul 01, 2022 4 min read

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!

Activities, Educational, Speech Therapy, Therapy | Jun 02, 2022 4 min read

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?

Educational, Speech Therapy, Therapy | May 23, 2022 4 min read

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?

Educational, Speech Therapy, Therapy | May 04, 2022 3 min read

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.

References

Fairbanks, G. (1940) Voice and Articulation Drillbookt. New York: Harper and Row.
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
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

What is Pediatric Occupational Therapy and how would I know if my child would benefit?

Educational, Featured, Psychology, Speech Therapy, Therapy | Apr 04, 2022 6 min read

Occupation refers to functional tasks or activities that bring meaning to your life. And our children’s main activity is PLAY. Did you know that kids play to learn and that play requires motor, sensory processing, cognitive, and social skills? All these skills work together for learning. However, when the necessary skills for play are observably difficult, it can make grasping new competencies challenging for kids.

Occupational therapy addresses all the skills needed for play. It works on strength, coordination, and control to support their movement. OT also helps with sensory processing difficulties by identifying the way your toddler receives or responds to sensory input and teaching fun ways for you to support your child. And finally, Occupational Therapy promotes executive function skills building on motor, attention, and regulation foundations for learning.

Though play can look different and vary from child to child, there are general toddler development skill ranges necessary for learning to happen. When these are not progressing or missing, they can inhibit engaging in and learning through play.

The development of sensory processing and motor skills begins immediately at birth. The brain is where all the magic happens. Newborns take in sensations, but their body is unable to organize them—their reflexes are neurological responses to stimulation, including the senses of light, sound, touch, or pressure input such as stroking and vestibular sensory input with sudden movement.

The sensory processing and motor skill development looks random and clumsy at first with the baby’s initial kicking of their legs or trying to find their mouth with their hand. As they continue to be exposed to the sensation and repeat the movement, it becomes more purposeful.

Babies are holding, pulling, pushing, and dropping toys as they learn about cause and effect. More and more skills work together to explore and learn through play.

For your toddler, the years from 1 to 3 are very busy. They are essential years of curiosity, trial and error, and learning about what they can do. At age one, toddlers are very active. Give them a container, and everything comes out; maybe a few things go back inside. Set something on the table, and they pull up to see if they can get it. They make sounds and babble and may tug on your heart with Ma Ma or Da Da words!

Toddlers are in a transition of building more independence. During the terrible twos, a stage that everyone stresses about, they continue to learn about their environment, manipulate things, and communicate their experiences. Their development takes all the work that the baby’s brain and body did and uses it in play to build confidence, control movement, and explore new sensations. Toddlers experience big emotions. They must learn about these feelings and how their body responds to them. How we react and support them is important.

They also learn to transition from one activity to another, even when they don’t want to.
For example, two-year-olds usually can stack a few blocks, string a few large beads on a shoelace, feed themselves with a spoon, drink from an open cup or a straw, remove/pull on clothing, brush teeth, help wash their body at bath time, jump, run, and walk up and down a few steps. They can also throw a small ball toward a target, help clean up, and put toys away. Though the terrible twos try on parents and toddlers, they don’t last long. And both parents and kids learn a great deal!

As we strive to develop more patience during these times, our toddlers are growing far more in their quest for independence. Two-year-olds should be able to attend and learn a new play activity for 4-6 minutes. Some research even suggests that this age group should be able to focus on a task for 10 minutes.

Though many toddlers can sit and play for extended periods of time with preferred toys or activities they have initiated themselves, a better learning opportunity is to give them a new task to work on to develop manipulation skills like using a tool to scoop, fill a container, feed themselves with a spoon or fork, stack or build with blocks, lace beads on a string, or roll a ball back and forth.

Notice how your child works through activities. When development is not smooth, there will be clues in how your child moves, plays, speaks, or acts. See if you observe any of these challenges:

unable to manipulate toys in play, they continue to dump, empty containers, or throw them around the room
difficulty using tools to scoop, squeeze, hammer, draw
unable to demonstrate repetitive play activities. May run around, only roll the car back and forth
moves between many play activities quickly, not engaging in any of them
requiring or demanding your attention and unable to initiate or engage in play by themselves for short periods
difficulty imitating actions in movement, imitating mouth or tongue movements, silly faces, or being unable to throw a ball at a target. Difficulty moving from sitting to moving under structures, crawling through a tunnel
unable or very clumsy with jumping, climbing, moving between different level surfaces, climbing ladder to slide
unable to take turns in play activities such as rolling ball back to you, stacking blocks
seems fixated on the television, tablet, or phone and unable to engage with other toys in play
difficulty putting things together such as connecting blocks, lacing, and beads
unable to tolerate play on a swing, on a slide
unable to play near or with other children
unable to tolerate tactile messy play or engagement with media like play-doh, finger paint, or shaving cream
difficulty removing pull on clothing from dress-up activities

Play is one of the most significant areas that can provide clues about your toddler’s development. As we’ve outlined, there is so much growth happening during this time. If you see your child struggling in any of the areas we mentioned, occupational therapy can help develop and strengthen the skills needed for learning.

Occupational therapists are experienced experts and can help identify the areas inhibiting your child’s primary occupation and introduce fun activities for successful skill development.

Children are tiny individual humans with varied interests and gifts. We embrace and work together with parents to help children reach their greatest potential.

Come in and check us out in April for Occupational Therapy month!

Author: Pamela Vasiloff, OT

How to help children on the spectrum develop friendships

Clinic, Educational, Speech Therapy, Stories | Mar 07, 2022 5 min read

In my high school, a peer known for his social awkwardness greeted me in a monotone voice, “Pratt, do you have anything to say to me?” I replied, “Yes, good morning. How are you doing today?” Satisfied with the exchange, he nodded and walked to class. He did not return the greeting, nor did I expect him to. He also never asked me how I was doing.

There is an expression that “the only way to have a friend is to be one.” But what if you struggle to read facial expressions, body language, and tone of voice? For children on the autism spectrum, making friends can be challenging. From the young child who sits alone on the playground to the high schooler who chooses to stay in the computer lab rather than interacting with their classmates at lunch, it may appear that these children have no interest in pursuing friendships. Unfortunately, this is a common misconception held by neurotypical people (not on the autism spectrum).

The child on the playground and the teenager in the computer lab may be overwhelmed by the noise and chaos of the children around them or the location where social interaction occurs. Other behaviors of children on the spectrum include lack of eye contact, fidgeting, and repetitive movements (arms flapping, rocking, etc.). Many of these actions help limit overstimulation, manage anxiety or help with focus, but they can be perceived as a lack of interest by their neurotypical peers. Neurotypical children may conclude that their counterparts with autism are disinterested. But appearances can be misleading.

Children on the spectrum often long for friendships but do not know how to develop them. The importance of peer relationships is well understood. Friendships can provide opportunities to learn important social and emotional skills, including empathy, cooperation, problem-solving, and similar prosocial skills. Unfortunately, the opposite is also true; negative peer relationships involving bullying, rejection, and manipulation result in feelings of isolation, anxiety, depression, and confusion about relating to others.

Luckily, there are many ways to support children on the spectrum. Here are some steps you can take to support your child in making a new friend:

1. Explain what a friend is:

For young children, keep things simple. For example, explain to them that “a friend is someone who is nice to you and likes to spend time with you.” Understanding abstract concepts can be difficult for young kids on the spectrum. It helps to discuss characters in a movie or tv show that the child enjoys. Ask questions such as, “Is Character X being nice to Character Y? Do they like playing together?”

2. Social Stories

Children with autism often learn better when they are provided with visual support. Social stories lead a child through specific situations using pictures and words. Each story can be tailored to the child. For example, writing a script or drawing out the course of a conversation can help children understand the basics of how to talk to a friend. ***Carol Gray is a good resource.

3. Practice is Key

The best way to try something new is to explore it first in a safe and familiar environment. Have your child practice social skills (greeting others, asking and answering questions, self-advocating, suggesting ideas for play) among people the child already knows and is comfortable with (siblings, cousins, neighbors, and other adults). Through practice and repetition, you and your child can problem solve challenges he might have before encountering them at school or on the playground.

4. Finding Your Tribe

To build friendships, children must first share common interests. Find what your child is good at or enjoys, and then find a community based on that interest. For example, if your child loves board games, find a gaming group. If your child plays an instrument, get them into the band at school. Finding a shared activity is key, and it provides the groundwork for children to further grow friendships by sharing their feelings or by sharing a positive emotional experience.

Sometimes, however, it’s not about what groups children with autism join; it’s about getting other children to join them. Some schools implement a playground ambassadorship program, where neurotypical students are tasked with engaging students who tend to remain on the periphery of the playground. These children look for peers who are not engaged and reach out to them/ask them to play. Parents may want to ask their schools if this program is already in place or can be implemented. You are your child’s best advocate.

SmallTalk wants your children to “find their tribe” and make long-lasting connections with peers. Therefore, SmallTalk offers small social skills group sessions at each clinic location to help teach your children the foundations of social skills and offer guided practice of engaging in different social scenarios with peers. If you are interested, please call us at (619) 647-6157 to schedule an appointment.