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Could My Child Benefit fromSpeech-Language Therapy?

Table of Contents:

About the Author / Introduction Page 2What is speech? Page 3Determining the need for speech therapy Page 3What is language? Page 7The difference between Receptive and Expressive Language… Page 10Determining the need for language therapy Page 11Speech and Language Milestones (6 months through 6 years) Page 12

What to do if you are concerned Page 20

About the Author

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Stephanie Barry received her Bachelor of Science in Education from the University of Nebraska-Lincoln and then went on to receive her Master of Science in Speech-Language Pathology also from the University of Nebraska-Lincoln. She holds a Certificate of Clinical Competence from the American Speech-Language and Hearing Association, a regular license from the Arizona Department of Health Services and a Standard Teaching Certificate (speech-language impaired) from the Arizona Department of Education. She has worked in several school districts, acute care and children’s hospitals and has been in private practice for several years.

Stephanie founded Independent Speech, and online speech therapy private practice to help combat the shortage of speech pathologists. This practice serves school-aged children experiencing a variety of communication disorders using real time video and audio over a secure internet site. The activities are designed by speech pathologists to be engaging and motivating and are tailored to meet each individuals specific needs. It is an exciting alternative to traditional speech therapy. To learn more please visit www.independentspeech.com

IntroductionThis e-book is a general description of speech and language, what they are and what children may experience difficulty with in these areas. It is meant to give you some background information to determine if your child may benefit from speech language therapy.

This e-book is a basic manual and is not meant to diagnose any speech and/or language disorder or delay. If you have concerns about your child’s speech and/or language skills please have an evaluation completed by a certified, licensed Speech Pathologist.

This e-book is not comprehensive. If I were to delve into each and every aspect of speech and language this book could be a thousand pages (or more, who knows). This gives you an overview and hits on the most common errors or areas where children exhibit difficulty. Again, only a Speech Pathologist who is completing the evaluation with your child can give you specifics for your child. This e-book gives you things to look for and pay attention to as your child’s speech and language skills mature.

What is Speech?

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Speech refers to the production of sounds that make up words. All children exhibit some speech errors while they are learning to talk. For example, a two year-old child who says “wabbit” for “rabbit” may not have a speech disorder or delay as this is considered developmentally appropriate due to the difficulty in producing the /r/ sound.

Determining the need for speech therapy There are two types of speech disorders. The first is an articulation disorder or delay. An articulation disorder is when a child is demonstrating errors when producing certain sounds. They may have trouble articulating one sound or several sounds.

You may be wondering what the difference is between a disorder and delay. An articulation delay is when the child is acquiring the sounds in the correct sequence but they are acquiring these sounds at a slower rate than expected. They are not accurately producing sounds that most children their age are able to. An articulation disorder is when children do not acquire the sound in the correct sequence or they are showing sound articulations that are not common, such as a lateral lisp. These two are not completely separate. A child may experience a disorder and a delay together acquiring sounds in the correct order (though at a slower rate) but with some uncommon articulations. This is why most people refer to difficulties with articulation as an “articulation disorder” rather than trying to specify if it is a delay or disorder.

Speech sounds are typically acquired in an orderly sequence. Vowels are typically acquired first as in the first year of life children practice these sounds by saying “ahh” and “ohh” etc. Vowels are less likely to be misarticulated and thus are not included in charts of sound acquisition. It is important to note that some children do experience difficulty correctly articulating vowel sounds which should be mastered before 3 years of age. Below is a chart showing the ages of acquisition of speech sounds. Please note this is only one chart, there are many charts that will show slight or great differences between the ages of acquisition. The main factor to look at when comparing charts is the percentage of children that have mastered the sound. The chart included here shows when 90% of children have mastered this sound whereas some charts show when 50% of children have mastered the sound and thus their ages of acquisition will be earlier. This chart is a great reference if you are having concerns.

Age 90% have mastered the sound Specific Sound ExamplesBy 3 years of age P, M. N, W, H

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By 4 years of age B, D, K, G, F, Y Y as in YellowBy 6 years of age T, NG, R, L NG as in fishingBy 7 years of age SH, CH, J

Voiceless THJ as in JeepTH as in Think

By 8 years of age V, S, Z, ZHVoiced TH

ZH as in MeasureTH as in Mother

If a child is not able to correctly articulate the sounds shown by their age they may need speech therapy to retrain the way they produce the troublesome sounds.

When assessing articulation errors, a Speech Pathologist will also listen to the child’s connected speech (such as having a conversation with the child) to determine how the sound errors are impacting their intelligibility. Intelligibility is how well we are able to understand the child’s speech. Some children may require speech therapy even if the sounds they are having trouble with are considered developmentally appropriate for their age due to the impact on their intelligibility. For example, if a five year old is having trouble with the sounds shown at 7 and 8 years of age, they may need therapy because their intelligibility is greatly impacted.

The Speech Pathologist will also look at oral-motor skills or how well the child is able to move the articulators (lips, tongue, jaw) to produce sounds. If the child shows decreased strength or range of motion, this will have an impact on their ability to correctly produce the sounds. This would then warrant therapy regardless of the sound errors the child is making as this oral-motor deficits are not considered developmental.

The second type of speech disorder is a phonological process. When a child uses phonological processes, they are demonstrating errors on a class (or type) of sound. These errors are rule based patterns that all children use though most outgrow them as they learn speech and language.

The speech pathologist will be listening for the use of patterns in the child’s speech and if deemed necessary will analyze their utterances not only for the presence of an articulation disorder but the use of phonological processes as well.There are eleven (11) common phonological processes which are listed here. There are others that are rarely exhibited by children but are included in an assessment of the use of phonological processes.

Phonological Process

Description Example

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Final Consonant Deletion

The final consonant sound is left off.

Cat is pronounced “ca”

Stopping A long sound is replaced by a short sound

Funny is pronounced as “punny”

Voicing A voiceless sound is replaced by a voiced sound

Pig is pronounced as “big”

Velar Fronting A sound produced in the back of the mouth is replaced by a sound produced in the front of the mouth

Give is pronounced as “div”

Consonant Harmony The presence of one sound influences the production of the other sounds in the word

Dog is pronounced as “gog”

Syllable Deletion A syllable is omitted from the word

Telephone is pronounced as “teffone”

Cluster Reduction Part of the sound cluster is omitted

Spider is pronounced as “pider”

Palatal Fronting The “sh” and “zh” sounds are replaced by /s/ and /z/

Ship is pronounced as sip

Devoicing A voiced sound is replaced by a voiceless sound

Red is pronounced as “ret”

Gliding The sounds /l/ and /r/ are replaced by /w/ or “y”

Real is pronounced as “weal”

Stridency Deletion The strident sounds (f, v, s, z, “sh”, “zh” “j” and “ch” are replaced by non strident sounds

Brush is pronounced as “bruth”

While these are the most common phonological processes there are several others that are not noted as frequently but may be present such as vowel changes. You may also see some broken down into smaller categories such as rather than using the category of “Devoicing” one may refer to “initial consonant devoicing” or “final consonant devoicing” depending on what specific errors the child is demonstrating.

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It is important that this distinction be made between misarticulations and the use of phonological processes as the therapy process will be different depending on the underlying cause of the errors in the child’s speech. If they are using phonological processes, working to correctly articulate the /r/ sound alone is not going to change the child’s general speech. They need to learn the rules of when to use this sound in speech as well.

What is language?Language is an organized set of symbols that allow us to communicate our thoughts, feelings, ideas, etc. For example, the word “dog” is a symbol as it represents a specific type of animal. Sounds can also be symbols, such as when we make a long “s” sound to represent what a snake says. These symbols are combined according to the rules of our language. Language symbols can be gestures such as in sign language, or written such as using the alphabet to write this e-book. We are going to focus on spoken language in this section. There are three parts to each language, they are form, use and content.

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Language FormLanguage form is choosing the correct sounds to make the word, the choice of words, the choice of word forms and the choice of word order. There are three subdivisions of language form, the first is phonology or the choosing of the correct sounds. This level may be impacted by a child’s articulation or phonology skills. For example, if they have trouble saying the /c/ sound and are trying to tell you about the “cat” they saw but they keep saying “tat” you may have trouble understanding their story.

Children with disorders of language form; phonology may also use the phonological processes we discussed earlier. They may not be using proper word forms due to these processes. For example, if the child is experiencing final consonant deletion (leaving the end sound off of a word) they may not correctly produce plurals as the ending /s/ sound is what makes the word a plural. A Speech Pathologist is again, going to listen for intelligibility to determine if the errors the child is making is causing other people to misunderstand the child as well as to determine if it is an articulation error such as not being able to correctly produce the /s/ sound or the phonological process of final consonant deletion that is at the root of the errors.

The second part is morphology. Morphology is essentially grammar. This refers to the choice of word forms and endings. Some aspects of morphology include choosing the correct form of the “be” verbs (is, are, was or were, etc), using negatives such as don’t, using past tense words and plurals.

The child may demonstrate grammatical errors such as not developing word forms (plurals, past tense etc) at the age most other children do. For example, the child who continues to use words like “runed” rather than developing the irregular past tense form of “ran” may be displaying a disorder of language form. The Speech Pathologistwill look at all grammatical forms and errors to make the determination if a child is experiencing a disorder of language form or is using developmentally appropriate simplifications such as in the example above.

The last part of language form is syntax. This refers to knowing the rules for putting words together in a sentence. While children usually cannot tell you the rule, they have learned what order the words go in a sentence to convey the meaning they want. For example, they know when to say “The boy hit the ball.” and when to say “The ball hit the boy.” Both are correct sentences but convey very different meanings because of the order of the words. The Speech Pathologist will look at

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a variety of sentences both within formal tests and informal conversations to determine if the child is using correct syntax to convey the message they intend to.

Language ContentLanguage content is the meaning that the child is able to express as well as understand. Some refer to this area as semantics, or word meanings. Semantics is the ability to choose words and arrange them in a way to express their desired message. There are many categories that the content can belong to. These categories include:

1) Existence – the existence of an object2) Nonexistence (disappearance) – the nonexistence of an object

or the disappearance of an object.3) Recurrence – the reappearing of an object4) Denial – negation of identity, state, or event5) Possession – ownership by a different person(s)6) Action – movement7) Locative state – the location of a person or object (in, at,

under)8) Quantity – the number of people or objects (more, less)9) Time – the passage of time (when, first, before, last)10) Quality – the description of a person or object (big, hot,

pretty)11) Causality – cause and effect relationships12) Mood – the attitude of a speaker

Children with disorders of language content have difficulty choosing the words to express their intended meaning. We see a dichotomy between expressive and receptive language in this area as a child may be able to demonstrate understanding of words and sentences as expected of a child their age but is unable to use these words to express their own thoughts. Thus showing their receptive language is more advanced than their expressive language. When showing difficulties with expressive language content, you may hear a child substitute words that have similar meanings or that sounds similar when you say them.

Language UseLanguage use is the reason for talking. There are many functions of language and each time we express ourselves our message falls into one of these categories. These categories are:

1) Requesting an object2) Requesting an action3) Sharing thoughts and feelings4) Expressing one’s personality or asserting one’s self5) Requesting information

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6) Exercising the imagination7) Relating information to the listener

A child with disordered language use may show limited use of these categories. For example, they may be good at requesting objects or actions but struggle to share their thoughts or feelings such as being sad or angry about something. In addition, they may rarely ask questions. Children with disordered language use, tend to answer questions posed by their communication partner but rarely ask questions themselves preferring to let the other person do most of the talking.

Children that show trouble with language use may have difficulty with pragmatic skills or social interaction skills as well. They may have difficulty with turn taking, topic maintenance (staying on one topic), etc. We will discuss this in a different e-book as a disorder of pragmatic skills is its own unique communication disorder.

The difference between expressive and receptive language...Receptive language is understanding language around us. This is both understanding spoken language and non-verbal language. There are many skills involved in receptive language, such as:

1) The ability to hear the difference between two sounds (/p/ and /b/ are different sounds) and that these sounds create different meanings. For example, knowing the word “Paul” means a boy and “ball” means a thing that can bounce based solely on the different beginning sounds.

2) Being able to remember what they have heard such as following two or three step directions (or longer) or remembering a list of things.

3) Being able to understand the meaning of words. If you ask them to get a pitcher, do they know what a pitcher is?

4) Understanding different grammatical forms. Knowing that “dog” and “dogs” are different as one is singular and one is

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plural or that “walk” and “walked” are different because although it is the same activity it happened at different times, etc.

5) Answering questions appropriately and being able to stay on the current topic.

Expressive language is the ability to use language to express our thoughts and feelings, to answer questions and relating events and carrying on a conversation. There are many skills involved in expressive language, such as:

1) Being able to use the sounds of our language (phonology) to produce the desired words

2) Being able to choose word forms (morphology) and word order (syntax) to express the desired meaning.

3) Being able to use a wide variety of language functions (language use) to get needs met and exchange information.

Determining the need for language therapyA Speech Pathologist looks at all parts of language both receptive and expressive language to determine if a language disorder or delay is present. A language disorder is when a child is not acquiring language skills in the natural order whereas a language delay in when a child is acquiring language skills in the natural order though at a much slower rate.

A Speech Pathologist will complete standardized assessment measures that assess a variety of expressive and receptive language skills so they are able to compare the child’s current skills to those of other child the same age. In addition, they will obtain a language sample, this is an information conversation between the child and clinician to determine how the child uses language within general conversations. The Speech Pathologist may do a variety of things such as having the child make up a story using pictures, tell a personal story (such as what did you do for the 4th of July?) or retell a story they just told. There is a wide variety of tasks the Speech Pathologist may use to

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elicit language from the child. Their intention is to determine how they are able to use their language in everyday conversations.

Finally, the Speech Pathologist will ask the parents and teachers (if appropriate) questions about how the child communicates in everyday situations. When answering these questions, remember to be completely honest and tell what the child typically does. A child may have done something one time but if they are not consistently using this skill it is not a permanent part of their language repertoire at this point. We have all had this experience where we maybe made a single three-point shot but when asked if you can make a three-point shot the true answer would be “no” doing it that one time does not mean it is a skill you currently posses though with practice and coaching you may be able to add that three-point shot to your repertoire. This is where the Speech Pathologist comes in, giving your child the needed instruction, strategies, etc to make these skills a part of their language skills.

Speech and Language Skills6-12 months

At 6 months your child… Makes lots of different, playful sounds (called babbling) Laughs, gurgles, cooes with familiar people Vocalizes attitudes other than crying – joy, anger Reacts to music by cooing Reacts to loud, angry and friendly voices Turns and looks at new sounds Babbles for attention Waves or responds to bye-bye

At 8 months your child… Responds to name and pats image of self in mirror Produces four or more different sounds Frequently uses syllables such as “ba”, “da” and “ka” Babbles with inflection Transfers objects from one hand to another Listens to own vocalizations and those of others

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Tries to imitate sounds

At 10 months your child… May say “mama” and “dada” Shouts to attract attention Repeats sound or gestures if laughed at Babbles in response to human voice Uses jargon (babbling that sounds like speech) Plays peek-a-boo Says a syllable or sequence of sound repeatedly

At 12 months your child… Recognizes name Points to objects for you to get or name Says 2-3 words besides “mama” and “dada” Uses exclamatory expressions such as “oh-oh” or “no-no” Understands simple instructions Recognizes words as symbols for objects (for example, hears “car”

and points to garage

Speech and Language Skills12 to 17 months

From 12 to 17 months of age, your child… Recognizes his or her own name Understands “no” Says “no” meaningfully Uses 10-15 words spontaneously Attempts to sing sounds to music Understands simple instructions Points and gestures to call attention to an event Points and gestures to show wants Uses voice in conjunction with pointing or gesturing Imitates familiar words Waves good-bye and plays pat-a-cake Uses “mama” and “dada” and several other words Practices words Likes to make the “sounds” of familiar things Gives a toy upon request Laughs a great deal Hears and discriminates between sounds Shows a great deal of affection

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Places a block in a cup on command Scribbles imitatively with a crayon Attempts to communicate by mixing jargon with real words Vocalizes for enjoyment

Speech and Language Skills18 months

At 18 months of age, your child… Uses 15-20 different words Recognizes pictures of familiar persons and objects Names 2 pictures Starts to combine 2 words such as “all gone” Imitates two word phrases Uses own name to refer to self Imitates words and sounds more accurately Imitates environmental sounds Practices words and word combinations Points and gestures to call attention to an event Points and gestures to show wants Uses words to make wants known such as “more” Points to own toes, eyes and nose Brings familiar objects from another room when asked Turns pages of a book a few at a time Follows simple commands Makes a tower of 3 to 4 blocks Knows and says the names of 5 things Hums and may sing simple tunes Attempts to sing songs with words

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Mixes real words with jargon, on occasion Uses jargon with good inflection and rate Develops a play routine

Speech and Language Skills2 years old

At 2 years of age, your child… Understands simple questions and commands Indentifies body parts Carries on a “conversation” with self and dolls Asks “What’s that?”, “What’s this?”, and “Where’s my?” Answers simple questions Sentence length is composed of 2-3 words Refers to self by name Uses self-centered pronouns Names pictures and actions Uses 2-word negative phrases such as “no want” Forms some plurals by adding “s” Has between 50 and 200 words in speaking vocabulary Builds and 8 block tower Asks for drink, toilet, food Listens to stories and points to pictures when asked Stays with one activity for 6-7 minutes Names five pictures Imitates spontaneously or requests new words Shows frustration when not understood Relates experiences Enjoys tactile books Identifies rooms in house

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Engages in simple make-believe activities

Speech and Language Skills3 years of age

At 3 years of age, your child… Matches primary colors, names one color Knows the words night and day Uses contractions such as it’s Begins to obey instructions with prepositional phrases

o “Put the block under the chair” Verbalizes two prepositions Uses words to relate observations, concepts ideas and relationships Vocalizes for all needs Practices new words by talking to self Knows his or her name, gender and street name Knows several nursery rhymes Tells simple stories and can convey ideas Uses sentences 3-4 words in length Uses nearly 1,000 words Can produce consistently the following sounds

o M, N, P, F, H, B and W May repeat sounds, words and phrases Can draw a circle and vertical line San sing songs Participates in storytelling Expresses fatigue verbally Can stay with one activity for 8-9 minutes Asks “what” questions frequently

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Speech and Language Skills4 years of age

At 4 years of age, your child… Points to colors, red, blue, yellow and green Identifies crosses, triangles, circles and squares Follows commands even though objects are not present Can speak of imaginary conditions such as “I hope…” Asks may questions but is more interested in how answers fit his or

her own thoughts than in the explanation Uses sentences of 4 to 5 words Asks “who” and “why” questions Begins to combine sentences with “and” Uses past tense correctly Copies a line and a circle Stays with one activity for 11 to 12 minutes Uses the following sounds correctly

o M, N, NG, P, F, H, W, Y (as in Yes), K, B, D, G,

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Speech and Language Skills5 years of age

At 5 years of age, your child… Defines objects by their uses (you eat with a fork) Can tell you what objects are made of Knows words for spatial relationships (over, far, behind) Knows his or her address Identifies a penny, nickel and dime Uses sentences of 5 to 6 words Uses all speech sounds correctly

o Exceptions of V, L, TH, CH, J, S, Z, ZH (as in measure) & Knows common opposites such as big and little Counts 10 objects Tells a story with a simple plot Uses future, present and tenses Asks questions to get information Distinguishes own but not other people’s left and right hand Uses all types of sentences some of which may be complex

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Speech and Language Skills6 years of age

At 6 years of age, your child… Has correct articulation of most speech sounds May still have difficulties with clusters such as “spl” or “tr” Uses adult-like grammar in sentences and conversations Understands the meaning of most sentences Names days of week in order Counts to 30 Predicts what comes next in a sequence of events Tells a 4 to 5 part story Tells month and day of birthday Tells name and address Distinguishes left and right Knows most opposites Knows the meaning of today, tomorrow and yesterday Asks lots of “why”, “what” and “how” questions Is beginning to read simple words like cat and ball Is starting to recognize that individual letters in words represent

different sounds that form words when put together (for example c-a-t for “cat”)

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What to do if you are concerned.If you have concerns about your child’s speech and/or language skills you should have a speech evaluation completed. This is the best way to determine if your child would benefit from therapy. When choosing where to get the evaluation completed, please make sure the person is a certified, licensed Speech Pathologist. They have the training needed to competently assess your child and provide you with a wealth of information about your child’s current speech/language skills.

Please, do not wait. You may have asked your pediatrician or your friends who also have young children and they may tell you to wait because they will learn it on their own. You may even hear stories about how their child didn’t talk until he/she was three and is a straight “A” student now. Remember that everyone’s perception is different. To this person “talking” may mean sentences (simple sentences like “no go bye-bye”) while to the next person “talking” begins with the first babble the child made and this leads them to say that their child began talking at 6 months (they may be taking the “ba” the baby babbled and saying they said “ball”) and therefore your child is significantly delayed. Pediatricians, while a wealth of medical knowledge, have no (or very little) training in the speech-language development of children. So again I say, if you have concerns at all please get an evaluation. If it turns out that they do not need therapy at this time, you have at least put your mind at east. If they do need therapy, the earlier you start the better.

There are three main options for completing a speech-language evaluation. The first is through your school district. They are required to provide an evaluation for any child that is (will or should be) attending a school within the district. I say should as your child maybe attending private school rather than the local public school. If your child is of preschool age and not enrolled in preschool at the local public school they are still required to provide a comprehensive evaluation for your child. You may contact the specific school your child should be attending and make a request for an evaluation. You may also contact the school’s district office if you are unsure what

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school to contact. For preschoolers, some districts offer a “Child Find” service where they provide a screening for all children getting ready to enter preschool (approximately 2.9 years and older) and if concerns are raised during the screening process they will schedule a comprehensive evaluation. Check your school district’s website to see if they offer this service.

The second option is going through your state. There are typically two programs; one for early intervention (under three years of age) and one for school-age children and older (to adult) they will provide an evaluation and therapy if needed. Typically, you must apply for services and meet their requirements, though these vary state to state. These programs are paid for by the state, thus are at no cost to you. You can usually find these programs by searching for “(your state) division of developmental disabilities”.

The final option is going through a private practice. There are four types of private practice available to you. The first is center-based therapy where you take your child to the clinic for the evaluation and/or therapy. The second is home-based therapy where the Speech Pathologist comes to your home for the evaluation and/or therapy. Third, is out-patient services provided at your local hospital. They are able to provide an evaluation and/or therapy at the hospital. You do not need to have been in the hospital to receive speech services there. Finally, is online speech therapy, such as that provided by Independent Speech. It is most like home-based therapy as you are at home though therapy is completed via a secure internet site and a web-cam though offers more flexibility than traditional therapy.

Following the completion of the evaluation you will receive a written report detailing the findings of the Speech Pathologist. This report will include the results of the standardized assessment measures, usually reported as standard scores and/or percentile ranks. It will also include narratives by the Speech Pathologist describing the child during the evaluation. This portion is interspersed throughout the report and will mention things like the child’s behavior, interaction skills, and any information obtained through informal assessments. This report will also outline what the Speech Pathologist recommends based on the child’s overall performance. After the evaluation, you will move to on-going therapy, if needed, to address the areas outlined by the Speech Pathologist. Remember to ask as many questions as needed to make sure you fully understand what the report says and the recommendations of the Speech Pathologist. You are your child’s advocate and your understanding and participation are key to your child’s success!

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