Tag: speech therapy

A Parent’s Guide to Early Intervention

You’ve heard the words early intervention before, but it seems confusing.

Your pediatrician tells you that they are free services for children aged birth to 3.

Your friend from Gymboree tells you that the only way to qualify is to have your child evaluated right before nap time.

Your aunt tells you that if you do an early intervention evaluation, your child will be “classified” for the rest of his life!

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Let’s Play: A Guide to Language in the First Year

During the first year of life, your new baby will take the journey that brings him from a crying ball of mush to his first words.  It is exciting, breathtaking…and nerve-racking as you ponder whether all this is normal.  As part of my new parenting series, I present to you the speech and language milestones and expectations for your baby’s first year.  I have also included activities that you can incorporate to maximize your child’s development at that stage.

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The OT-Speech Connection

The longer I work as a speech language pathologist, the more I appreciate my work with occupational therapists.  I checked in with my friend Jill Loftus at Honest OT in Denver, Colorado, to find out How Sensory Processing Impacts Speech Development.

 

Photo via PROLoren Kerns via Flickr Creative Commons
Photo via PROLoren Kerns via Flickr Creative Commons

It’s important to realize that the vestibular and auditory systems work together as they process sensations of movement and sound. These sensations are closely intertwined, because they both begin to be processed in the receptors of the ear.

Audition, or hearing, is the ability to receive sounds. We are born with this basic skill. The ability to hear does not guarantee, however, that we understand sounds. We learn about comprehension as we integrate vestibular sensation. Gradually, as we interact purposefully with our environment, we learn to interpret what we hear and to develop mature auditory processing skills.

Language is understanding what words mean and how we use them to communicate. Receptive language is language which we take in by listening and reading. Expressive language is what we put out by speaking or writing. Language and speech are closely related, but they are not the same. Speech is the physical production of sound. Speech skills depend on smoothly functioning muscles in the throat tongue, lips, and jaw.

The vestibular system impacts motor control and motor planning that are necessary to produce intelligible speech. Because the vestibular system is crucial for effective auditory processing, the child with vestibular dysfunction frequently develops problems with language.

How do these problems play out? Here are some common characteristics of children with poor auditory-language processing:

  • May seem unaware of the source of sound and may look all around to locate where the sounds come form.
  • May have trouble identifying voices or discriminating between sounds, such as the difference between “bear” and “bore.”
  • May be unable to pay attention to one voice or sound without being distracted by other sounds.
  • May be distressed by noises that are loud, sudden, metallic, or high – pitched, or by sounds that don’t bother others.
  • May have trouble attending to, understanding, or remembering what she reads or hears.
  • May misinterpret requests, frequently ask for repetition, and be able to follow only one or two instructions in sequence.
  • May look to others before responding.
  • May have trouble putting thoughts into spoken or written words.

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Take that thing out of your mouth!

Our tongue is essential to many of our daily functions, so it’s no surprise that it is the focus of much of our earliest explorations.  Some babies have even been observed to suck their thumb while in their mother’s womb!  In our first months, it is normal to place our fingers, and for a brief time, other objects into our mouth to test out what our mouths our capable of.  New research by University of British Columbia’s School of Audiology and Speech Sciences recently tested the motor theory of speech perception.

What did the study say? Read more

Brain Builders for the Holidays!

The holiday season is here!  It is a busy time for everyone, filled with holiday gatherings, visits from family and friends, and shopping–but it is also the perfect time for you to maximize your child’s language skills.  Here are 3 quick and easy tips for you to incorporate into the next few weeks to make sure your child continues to meet his/her speech/language goals.

1. Guess My Gift

This is a great game for children aged 6-10 and it helps with word retrieval, language processing, auditory memory, and even inferencing skills.  You and your child can take turns giving each other hints about their favorite present desires.  When I play, I tell the child that they will get 3 clues, and I try to give my clues in an organized and predictable way each time (category/function/descriptor). For example:

“I want something that is a pet. It likes to purr. It has whiskers.”

It is then the child’s turn to give you clues.  For an added bonus, you can have the child write the items in the form of a list so that they can practice writing skills as well.

2. Catalog Browse

Somehow, I am on the mailing list for every major catalog ever.  I hate to waste paper, so I like to repurpose my clothing and furniture catalogs.  With younger children (age 3-5), I like to find an assortment of pictures and have the child place into categories (i.e. furniture, clothing, toys). With my 5-6 year olds, we use the catalogs to play a game of “I Spy”.  My 6-8 year olds can use the catalogs to practice their descriptive language use by talking about the characteristics of the clothing/furniture on each page and by comparing different items in the catalog.

3. Cooking Projects

Children love to be helpers in the kitchen. Thanks to Pinterest, there are a million different ideas for every holiday, such as these dreidels or these reindeer.  You can even use cookie cutters to talk about shapes with your little 2-3 year olds!  Cooking is a great way for children to practice their sequencing skills (what comes first, next, and last)…and obviously there is a delicious treat at the end!

4. Holiday Cards

With the rise of the internet, the art of letter-writing is a dying trend.  Kids LOVE writing letters, and my students can’t get enough of addressing envelopes!  This is a great way for your school aged child to practice their spelling and writing organization.  I like to give the child a format to follow, rather than just having them write “Happy Holidays, Love Jocelyn”.  Try this one:

Dear Aunt ____________,

Question to the reader

Statement about yourself

Holiday greeting

Love __________________

5. Wrap Presents

This is another great way for children to use crafts and practice sequencing steps of an activity.  Wrapping gifts is a very teachable skill (and a very easy task for small fingers!)  Your child will love being able to help wrap gifts for their aunts, uncles, cousins, and friends. abuse contacts .  You can even have your child design their own wrapping paper!  Start by giving your child one step at a time (i.e. First, measure the paper around the box).  If you see that they can do this, go to 2 or 3 steps at a time (i.e. Next fold each corner in like a triangle and tape upward).

Addressing your child’s speech and language goals doesn’t have to take a pause during busy season.  Happy holidays to all and good luck adding some holiday cheer for your little dear.

Your Adenoids are Showing!

Think of adenoids as little pillows that rest between your nose and your oral cavity.  These little “pillows” are one of your body’s best defenses against germs.  When they become swollen, however, they can cause a variety of issues, including drooling, poor articulation, snoring, sore throats, and ear infections.  As a parent, you never want to see your kid battling constant illness.  The alternative, surgery, is also not very appealing.  It is a difficult decision, and one that my cousin, Gavriella Lerner, and her husband had to make for their 2 year old.  Gavi, awaiting the birth of her second child, agreed to pass on some information to other parents to help make a more informed choice when it comes to your child’s swollen adenoids.

My baby cousin, aged 15 months here, with the author
My baby cousin (aged 15 months here) and me

Jocelyn: Tell me about your child (i.e. milestones, interests).
Gavriella: My 2.5 year old has always been somewhat low tone and has always been late when it came to physical milestones. He is very bright and eager to learn and is into typical toddler boy stuff- trucks, Thomas, Elmo etc. The low tone affects his mouth too- always hanging open, lots of drooling.

 J: When did he say his first words?
G: His first discernible words came right on schedule, at around 12 months.

J: When did “adenoids” first come up in conversation?
G:  The pediatrician mentioned it during a visit to treat what seemed like his gazillionth sinus infection.

J: Is there a family history ?
G: Yes. My husband had his tonsils and adenoids out at about the same age. For context, we’re in our mid-20s, so we’re not talking about the days where just about every kid got them out.

J: How long did you wait before seeking professional guidance?
G: We got a referral to an ENT from the pediatrician during that appointment. However, it is very difficult to get an appointment with a specialist when it’s not an emergency. Even though we called right away, it was about 3 months before we actually saw the ENT. We could not book an earlier appointment. And we tried more than one- they all had waiting lists about that long!

J: Did he get sick often?


G: He didn’t really get ear infections, but the sinus infections were constant. Every little germ he caught eventually morphed into a sinus infection.

J:Was he a noisy sleeper?
G: He was a snorer, but not a noisy one. That’s why we didn’t really notice for awhile. But the snoring definitely affected his sleep. He woke himself up from snoring several times a night, and if it happened past 5 AM, that was it, he was up for the day. Although he didn’t wake us up every time he woke up in the middle of the night, we realized it was a problem because he was not getting adequate sleep.

J: How did you end up treating the adenoids?
G: Surgical removal.

J: Was the surgery invasive?  What was your child like afterwards?
G: Not really- they go in through the mouth. It does require general anesthesia. When he woke up in recovery, it was pretty bad- he was inconsolable, and they had to give him pain medication through the IV which was still in. He calmed down, and we were able to go home about an hour or so later. He was cranky the rest of the day and required a few doses of baby motrin. The next day, however, I had half a mind to call the doctor and ask if he was sure he had operated- my son was pretty much back to himself and needed no painkiller. Just some ice cream as his throat was still a little scratchy from the tube that had been in there. He was begging to go to the park (doctor had said to keep him inside a few days). He did pull at his nose a bit like there was something in there he was trying to get at, but didn’t really complain otherwise. One annoying side effect was really stinky breath (no, brushing teeth could not get rid of it)- but we were warned that would happen. The only other side effect was some constipation from the anesthesia, but even that wasn’t so bad because he was also on antibiotics (to prevent possible infection) which generally has the opposite effect, so it mostly balanced out.

J: Since treating the adenoids, what changes have you noticed?

G: It’s only been 3 weeks, and the doctor said it takes 6-8 for real changes to kick in. I have noticed definite improvements, but only in the last week or so. For instance, he is definitely sleeping better. He is closing his mouth for longer periods of time and using his nose. He caught a cold and it DIDN’T morph into a sinus infection- it just cleared up on its own.

J: Is his articulation improving? Have you noticed changing in his drooling?

G: His articulation is getting better every day. A lot of people thought he was speaking jargon- turns out, he had plenty of real words, and we’re only now just starting to figure most of them out. There is still work to be done, but the difference is there. The drooling actually got worse the first week- since we weren’t going anywhere that first week, I kept him in just a diaper because he was soaking through his shirts. The second week, he was drooling in pre-surgery amounts (which was a lot, but better than that first week). Now, this third week, we are seeing less than his usual amounts, so there is improvement, and we expect it continue.

J: Will you seek speech therapy?
G: The ENT told us he would need it, so we got evaluated and were approved for free services through the NYC Early Intervention Program. We were actually able to start before the surgery. We expect to continue for at least the next 6 months.

J: Any final thoughts to share with our readers?

G: A lot of things make sense in retrospect. For instance, he never took a pacifier as a baby, and now it makes sense- he couldn’t close his mouth! Oddly enough, this never interfered with breastfeeding or eating solid foods- he’s always been an excellent eater. We knew he was cognitively very bright and when he was evaluated for speech therapy, it was pretty clear his issues were with articulation and not language. However, I do think his language acquisition was  somewhat hampered because people couldn’t understand him. I definitely spoke to him at probably a lower level than I should have simply because I didn’t understand him so well, and I suspect I wasn’t the only one. Chronic sleep deprivation probably also hindered him. He definitely takes more of an interest in his surroundings now that he’s well-rested. I just wish we could have figured this all out sooner than we did.

If this sounds like your child, make sure to get a referral to a pediatric ENT.
For more information on adenoids as they relate to speech and language development, send me an e-mail!

Tongue-Ties across the Ages

babyboy-thumb

Yes, tongue tie is a real thing, and for some, it is very painful.  The scientific term for a tongue tie is ankyloglossia, or restricted movement of the tongue.  A tie can occur in the anterior (front) or posterior (back) of the tongue. You may be surprised to learn that 10-20% of the population born in the United States have a tongue tie.    If you suspect a tongue tie, you should consult with a professional (speech language pathologist, dentist, ENT, pediatrician) to assess and determine the need for intervention.  There are many consequences of an untreated tongue tie that effect a person differently across the lifespan.

BABIES

Very often, I will do a speech and language consultation and the parent will tell me “Johnny had a difficult time latching when I tried to breastfeed him”.  Breastfeeding is very difficult for a baby with tongue tie.  Due to the restrictions of the child’s frenum, the tongue is unable to make the necessary movements, such as cupping, to latch and breast feed.  This causes stress not just for the baby, but also for the mother, who was looking forward to this important bonding experience for her child.  At this stage, it is very important to receive input from a lactation consultant, speech language pathologist, or a pediatric ENT or Dentist trained in tongue-tie detection.  For a list of trusted providers, you can consult the resources provided by the International Association of Tongue Tie Professionals.

TODDLERS

Now your baby is a toddler.  Either no one has picked up on the tongue tie, or you have decided not to have surgical intervention.  At this point, your child is learning to speak.  Due to restricted movements, you may find that your toddler is having difficulty forming a lot of sounds, or that what he is saying does not sound clear (although you know what he is saying!) Other issues may include difficulty accepting a wide variety of foods.  Having a tongue tie means that it is more troublesome for the tongue to move food back and forth in the mouth, a necessary movement for handling more complicated textures (i.e. meats, some vegetables). Now that your child is more receptive, it may be possible to do certain exercises to help lengthen the frenum and allow for more movement.  However, if the child does not respond to this type of intervention, it is important to consult with a professional about possible surgical intervention to prevent further difficulties from occurring.

 

SCHOOL-AGED CHILDREN

Your child has now figured out to eat and speak and it is time to go to school.  Although your child is bright and has a large vocabulary, he may have difficulty producing some sounds (/ch, sh, j, s, z/) because the restricted tongue is unable to make consistent contact with the upper portion of the mouth.  Speech therapy can be done at this point to correct the production of the sound, but the child may continue to have a “functional lisp” because the tongue is not reaching exactly where it needs to be.  Further, a restricted frenum may cause your tongue to block your airway, causing sleep disturbances and attention issues (see my previous post for more information on how sleep effects attention.  It is important to speak to your speech language pathologist at this time for a referral to further assess for ankyloglossia.

YOUNG ADULTS/ADULTS

At this point, you have no doubt learned to live with your tongue tie and the thought of having a piece of your tongue snipped is scary.  Did you know, however, that a restricted frenum may make you a bad kisser?!  This information is always helpful in convincing my more reluctant teen clients to go through with the procedure.

Check back next week for more information on Tongue Tie, and an interview with my client who had a frenectomy (tongue tie surgery) 2 months ago and is already reaping the benefits! Sign up for the mailing list so that you can see it first.

For more information on assessment and treatment of ankyloglossia (tongue-tie), contact me!

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