speech therapy for children

Lumiere Children’s Therapy: Learning to Talk

Mama, Dada, go, ball, and hi are all common first words you may hear your child say between 12-15 months old. Hearing your child say their first word is not only exciting, but helpful to be able to attend to your child’s wants and needs. Although each child develops language skills at different rates, delayed expressive language skills are usually first noticed by families.

Expressive language is the ability to communicate thoughts through words, gestures, and/or facial expressions. Expressive language allows one to communicate their wants and needs, socialize with others and interact in their environment. In order for a child to begin expressing themselves with words, there are a number of prerequisite skills that need to be mastered.

Prerequisites to talking

  • Exploration of the environment. Children should be constantly reacting to situations in their surroundings such as noises, lights, people, and activities. Reacting to others and new experiences are core features of communication.

    Strategies to try at home: Interact with your child in new ways to encourage exploration. Bang on pots and pans in the kitchen during meal prep, let your child ring the doorbell when walking in the house, or make a light show with flashlights. Be creative while incorporating music, sounds, visuals, and familiar faces!

  • Acknowledges others during play. Communication involves at least two people, so learning how to interact with another person is a necessary component. Children should want to be around others and react to interactions initiated by others.

    • Strategies to try at home: Get on the floor and play with your child! Initiate interactions by taking a turn on a puzzle, bumping your toy car into his, or stacking a block on his tower. Let your child acknowledge your interaction by imitating or responding in their own way. Continue to model interactive play with your child as often as possible.

  • Adequate attention and joint attention. Child should be able to remain on a single toy or activity for at least five minutes. Joint attention is when a child is focused on the same item or activity as the communicator or parent.

    • Strategies to try at home: To increase attention to asks, set a visual timer for two to three minutes on a chosen toy before they are able to pick a new activity. Instead of time increments, set a number of turns before moving to a new activity such as three puzzle pieces, three car races, or three items on Mr. Potato Head. In order to improve joint attention, be sure to sit at your child’s level and in their line of vision.Show your child that you are interacting with the same object by pointing, naming, and interacting with the same toy.

  • Demonstrates age-appropriate play skills. Language skills are most often learned through play in early development. Learning opportunities are frequent during pretend play, and while using interactive toys and early concept toys such as animals and play food. Playing with toys appropriately is required in order to use play to learn language. This may look like a child racing a car, pretending to stir a pot, or placing blocks on top of each other.

    • Strategies to try at home: Play with toys that require the child to interact, instead of watching it do something (i.e. light-up toys, ipads). Examples of good toys include puzzles, blocks, dolls, play kitchen and animal figurines. Model appropriate play with toys and encourage your child to imitate.

  • Understands words and commands. In order to use language to communicate, a child must understand language. This includes following simple requests such as “throw the ball” or “bring me book”, identifying pictures in books, or grabbing a named object in a group of three or more.

    • Strategies to try at home: If your child has difficulty following directions, give a verbal command first and then model the action. During routine activities such as getting dressed, brushing teeth, or leaving the house, give specific and consistent commands such as “put on your coat” or “open the door”.

  • Begins to imitate sounds, gestures, or facial expressions. Mimicking gestures teaches the concept of learning language through imitation without the pressure to use words. A child should learn to copy funny faces, clapping, waving, high-fiving, and other common gestures before being expected to imitate words.

    • Strategies to try at home: Sing nursery rhymes and do the gestures along with it such as Itsy Bitsy Spider, The Wheels on the Bus, and Pat-a-Cake. For facial expression, sit in front of the mirror and make funny faces such as sticking out your tongue. During social activities, encourage your child to wave to people they see and high-five family and friends.

  • Communicates wants and needs with gestures and/or pointing. Children will often learn to point to request objects before using words. Finding ways to express wants and needs by pointing, grabbing, or leading, is a way of nonverbal communication.

    • Strategies to try at home: If your child is wanting food or a toy, hold up two options and give the prompt, “what do you want?” Encourage your child to point by modeling the gesture. Teaching baby signs is a great way to facilitate non-verbal language as well. Start with teaching the signs for more, all done, and eat.

Once your child has developed the prerequisite skills for language develop, they will start to babble, imitate sounds, and use words for communicative purposes. The typical milestones for language develop are listed below. If your child is a late-talking, the months will vary but the hierarchy of skills will be relatively similar.



Typical Expressive Language Development


3-6 months

  • Makes pleasure sounds such as cooing and gooing

  • Smiles at familiar faces

  • Vocalizes to express anger

  • Initiates “talking” by playing with new sounds

  • Whines with manipulative purpose or cries for different needs

  • Laughs



4-6 months

  • Babbles with different sounds including p, b, and m

  • Vocalizes excitement and anger

  • Makes raspberries or gurgling sounds



6-9 months

  • Vocalizes four different syllables

  • Vocalizes two-syllable combination, example “uh oh”

  • Makes noises during play

  • Attempts to sings along with familiar song

  • Shouts or vocalizes to gain attention



9-12 months

  • Says mama or dada meaningfully

  • Repeats different consonant and vowel combinations

  • Imitates environment sounds such as car beep, animal sounds, or fire engine siren



12-15 months

  • Says or imitates between eight to 10 words independently

  • Imitates new words frequently

  • Says three animal sounds

  • Combines vocalizations and gestures when asking for an object (pointing and saying “milk”)

  • Babbles with adult-like intonation and occasional words



15-18 months

  • Child produces 15 words consistently

  • Uses words more than gestures

  • Begins to ask questions such as “what’s that?”

  • Child will name objects on request

  • Uses a variety of early consonant sounds like p, b, t, d, n, m, and h


18-21 months

  • Uses words frequently

  • Will imitate two-three word phrases such as “help me” or “want more please”

  • Child will occasionally produce two word phrases on their own


How to Encourage Language Development after First Words

After your child starts saying words, you may feel the progress of new vocabulary is slow. Modeling language, creating opportunities, and setting expectations are important to grow your child’s expressive language vocabulary. Below are a list of strategies to implement at home to improve your child’s use of words.


  • Narrate everything. During play, routines, and daily activities, narrate what you and your child are doing. Use simple, concrete nouns (dog, milk, cookie) and common verbs (go, eat, drink) in short phrases. If your child speaks in one word sentences, use two to three word sentences when narrating.

    • What does it look like? When getting dressed, mom says “Grace zips coat”. During mealtimes, dad says “I cut apple”.



  • Create language opportunities. Provide opportunities by holding toys back during play to encourage your child to request more of activities or specific items.

    • What does it looks like? Play with toys that have multiple parts such as legos, puzzles, blocks, sorting cube, and piggy bank. Parent holds the toy parts and hands each part after your child requests items with a word.  

Parent: “What do you want?”

Child: No response

Parent: “More”

Child: “More”

*Parent gives child one item*

If your child does not imitate word after two attempts, provide the toy so he or she does not become frustrated.


  • Wait. Parents know what their child wants without them having to verbally request with a word. Instead of automatically putting your child’s coat on or giving him the preferred toy, allow a period of wait time. Silently look at what your child wants, and wait for your child to request item. If your child does not say the item, give him a verbal model. If your child still doesn’t say the word after giving a prompt, give the item to your child.


    • What does it look like?

Parent: *silently looking at item”

Child: No response

Parent: “What do you want?”

Child: No response

Parent: “Ball”

Child: “Ball”

*Parent gives ball*



  • Give choices.  Providing two options to children forces them to communicate the object/activity they prefer. During meal times, hold up a preferred food (goldfish) and non-preferred food (carrot) then ask your child which one they want.  During play time, hold up two toys such as puzzle or ball.


    • What does it look like?

Parent: *Holds broccoli and goldfish*

Parent: “Which one do you want?”

Child: *Points to goldfish”

Parent: “Fish”

Child: “Fish”

*Parent gives fish*

  • Make it fun. Most importantly, make language development fun! The best way to do this is play with your child at their level. Teach them unique ways to play with your toys by making forts, pretend play, or setting up a picnic for all the stuffed animals. Children learn by imitating caregivers so continue to model phrases, play, and interaction with others.


Every child develops language at their own pace, but if you feel your child is significantly behind based on the typical milestone chart provided contact Lumiere Children’s Therapy for a language evaluation from one of our speech therapists.





References:

ChildTalk. “Child Talk.” How Many Words Should My Child Be Saying? A Quick Guide To Vocabulary Development, 1 Jan. 1970, www.talkingkids.org/2013/01/using-self-talk-and-parallel-talk-to.html.


Laura. “CHART 11 Skills Toddlers Master Before Words Emerge from Let's Talk About Talking.” Teachmetotalk.com, 28 May 2018, teachmetotalk.com/2018/04/18/chart-11-skills-toddlers-master-before-words-emerge-from-lets-talk-about-talking/.


Mattingly, Rhonda. “Typical Development .” Early Language Development . Early Language Development , 2016, Louisville, University of Louisville .


Mize, Laura. “11 Skils Toddlers Master Before Words Emerge.” Teach Me to Talk , Laura Mize, M.S., CCC-SLP, teachmetotalk.com/wp-content/uploads/2017/11/CHART-of-11-Skills-Toddlers-Master-Before-Words-Emerge-from-Laura-Mize-and-teachmetotalk.com_.pdf.

Rossetti, Louis. Rossetti Infant-Toddler Language Scale a Measure of Communication and Interaction. Pro-Ed, Distributor, 2006.

“The Effectiveness of Language Facilitation.” Leader Live - Happening Now in the Speech-Language-Hearing World, 29 May 2015, blog.asha.org/2014/05/22/the-effectiveness-of-language-facilitation/.


Lumiere Children’s Therapy: Feeding Tubes

For children who are at risk for complications when eating by mouth, feeding tubes can provide necessary nutrition in a safe manner. Problems with swallowing may occur in one of the four stages of the swallow as described in a previous post,  Swallowing Difficulties in Children. There are six types of feeding tubes available to children with swallowing problems. Below explains the advantages and disadvantages of each type of feeding tube, as well as treatment for children with a feeding tube.

Nasal Feeding Tubes

Nasal feeding tubes are tubes that are entered through the nose down the esophagus. There are three types of nasal feeding tubes: nasogastric, nasoduodenal, and nasojejunal. Deciding between the three types depends on whether your child can tolerate feedings into the stomach. Nasoduodenal and/or nasojejunal tubes are recommended if a child demonstrates chronic vomiting, inhaling or aspirating stomach contents into airway, and/or does not empty feedings well since those tubes bypass the stomach.

Nasogastric Tubes (NG)

NG tube enters through the nose feeding into the stomach through the esophagus (connects the throat to the stomach).

  • Advantages

    • No anesthesia is required for insertion of tube

    • Tubes may be replaced at home

    • Feedings are usually quick

    • NG are used for shorter duration cases, usually 1-6 months

    • Stomach provides a larger capacity for feedings

  • Disadvantages

    • NG tube is visible on face

    • NG tube can be irritating so younger children may pull it out

    • Increased risk of aspiration (food or liquid entering airway) from reflux

    • Increased nasal congestion

    • Possibility to cause oral aversions and/or increase amount of reflux

Nasoduodenal Tubes (ND)

ND tubes enter through the nose and extend into the beginning of the small intestine called the duodenum. The small intestine is the location of the majority of digestion in a person’s body, therefore bypassing the stomach.

  • Advantages

    • No anesthesia is required for insertion of tube

    • Can reduce reflux. Reflux is when stomach bile irritates the food pipe by coming back up the esophagus

    • Reduced risk of aspiration (food or liquid entering airway) from reflux

    • ND are used for short term use, usually 1-6 months

  • Disadvantages

    • Feedings are given slowly over 18-24 hours

    • Child may be self-conscious with visible tube coming from nose

    • Tube may be irritating with younger children possibly pulling it out

    • Potential intolerance to feedings entering small intestine causing bloating, cramping, and/or diarrhea

Nasojejunal (NJ)

NJ tubes are similar to ND as they enter through the nose extending into the small intense. NJ tubes extend further into the small intestine called the jejunal. The tube is designed for children who demonstrate difficulty with feedings into their stomach.

  • Advantages

    • No anesthesia is required for insertion of tube

    • Reduces risk of reflux

    • Reduced risk of aspiration (food or liquid entering airway) from reflux

    • Tubes are primarily recommended for short term use (1-6 months)

  • Disadvantages

    • Feedings are given slowly over time

    • Tube is visual, so may be irritating and/or children may feel self-conscious

    • There are potential intolerances to feedings such as bloating, cramping, or diarrhea

Stomach Feeding Tubes

Feeding tubes are entered directly into the stomach instead of through the esophagus. There are three types of stomach feeding tubes: gastrostomy, gastrojejunal, and jejunostomy. The following are common conditions that may require the use of a stomach tube.

  • Problems of the mouth, esophagus, stomach or intestines presented at birth

  • Prematurity, brain injury, developmental delay, and neuromuscular conditions causing sucking and swallowing disorders

  • Failure to thrive, which is when a child is unable to gain adequate weight to grow appropriately

Gastrostomy Tube (G)

The G-tube is inserted through the abdomen directly into the stomach, completely bypassing the throat. If a child requires tube feeding for over 3 months and/or having difficulties with nasal tubes, gastrostomy tubes are usually recommended.

  • Placement of tubes: There are three types of methods for inserting G-tubes: percutaneous endoscopic gastrostomy (PEG), laparoscopic, and open surgical procedure. All procedures take about 30-45 minutes to administer.

    • PEG: most common technique for first placement of G-tube as it does not require surgery. The doctor is able to use a thin, flexible tube with a camera to insert the tube through the mouth and into the stomach

    • Laparoscopic technique: performed by making small incisions into the abdomen and inserting a tiny telescope to help with placement

    • Open surgery: Alternative for cases where a PEG placement is not appropriate

  • Advantages

    • PEG placement does not require surgery

    • Decreased clogging of tube since diameter is larger

    • Larger reservoir in stomach compared to small intestine

    • Child may feel less self-conscious since tube is not visible

    • Decreased chance of tube being pulled out

  • Disadvantages

    • Risk of aspiration due to reflux

    • Family is required to provide extra care to cleaning of tube

    • Surgery may be required depending on placement.

    • Possible skin irritation from leakag

Gastrojejunal (GJ)

A GJ tube is similar to a G-tube as the tube is placed through the skin into the stomach. The difference is a GJ tube has two feeding ports on one tube so that the food enters into the stomach and then down into the small intestine (jejunum portion). G-tubes may be converted into GJ tubes if the child is not tolerating stomach feedings.

  • Advantages

    • Reduced risk of aspiration

    • May reduce reflux

    • Less costly than J-tube placement

    • Tube is hidden, so child may be less self-conscious

  • Disadvantages

    • Potential intolerance of tube

    • Extra care required

    • Potential skin irritation

    • Tube may clog more easily due to smaller diameter

Jejunostomy (J)

A J-tube is placed directly into your child’s small intestine through the skin. This type is not as common for children.

  • Advantages

    • Reduced risk of aspiration and reflux

    • Tube is hidden

  • Disadvantages

    • Potential intolerance to placement of tube

    • Extra care required

    • Potential skin irritation from leakage

    • Tube is small and more likely to clog

    • Surgery is required for placement of jejunostomy

    • Feedings are slow


Treatment of Children with Tube Feedings

Depending on the type of tube and duration of tube feeding, children with tube feedings are at risk for developing oral aversion to food through the mouth. Oral aversion is when a child experiences a fear of eating or drinking and avoids sensation around or in the mouth. Children who are tube-fed often, develop oral aversions because many have learned that food hurts based on a history of medical issues involved with eating (reflux, aspiration, food allergies, and/or motility). In some cases, feeding tubes are used to supplement adequate nutrition but children may be able to eat orally with some limitations on foods, consistencies, textures, and liquids. If your child has been approved to eat some food orally, it is highly encouraged. In order to reduce the risk of developing oral aversion, the following is recommended by speech therapists:

  • Oral sensation. Children with oral aversions will try to avoid sensation around and in the mouth. Children with feeding tubes should continue to experience the same oral sensation in normal routines as children who eat orally, especially oral care. Adequate oral care such as teeth brushing is not only important to reduce aspiration (food getting into the airway) from reflux, but also continues to provide oral sensation. Consider getting a child-proof vibrating toothbrush for extra sensation. During nightly routines, apply lotion to the face while massaging the cheeks, place chapstick on the lips, and make funny faces in the mirror to encourage facial muscle movement.

  • Participate in mealtimes. Children with feeding tubes often miss out on the social, exploratory, playful aspect of eating. Allow your child to continue to experience the fun of eating by helping prep for dinner, setting the table, sitting with the family, and even playing with the food on the table! If your child is able to eat pre-approved food, be sure to have appropriate food available. Most children with oral aversion would prefer not to participate in the act of eating, but continues to benefit from the social aspect of mealtimes.

  • Playing with food. In many feeding therapy approaches, the first step to consuming food orally is accepting food using the other senses: touching, smelling, and licking. Create artwork using edible food by painting with pureed food, making edible play dough, and building structures with variety of food. Show children that food can be fun and non-threatening.

If your child currently has a feeding tube or is planning to receive one, feeding therapy is highly recommended to ensure your child is receiving adequate nutrition and quantity from oral feedings. Speech therapists can provide systematic feeding approaches, including but not limited to mealtime focus, S.O.S. (Sequential Oral Sensory), ABA (Applied Behavior Analysis), baby or child-led weaning, and hunger-based cues. Lumiere Children’s Therapy can provide feeding therapy for your child as well as a home exercise program to assist with carryover into the home environment.

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References

“Addressing Oral Aversions.” Feeding Tube Awareness Foundation, www.feedingtubeawareness.org/navigating-life/oral-eating/feeding-therapy-oral-aversions/.



“ARK's Y-Chew® Oral Motor Chew.” ARK Therapeutic, www.arktherapeutic.com/arks-y-chew-oral-motor-chew/.



“Enteral Tube Program | Home Care Instructions after Placement of a Gastro-Jejunal (G-J) Tube | Boston Children's Hospital.” Boston Childrens Hospital, www.childrenshospital.org/centers-and-services/programs/a-_-e/enteral-tube-program/family-education/giving.



“Feeding Therapy.” Feeding Tube Awareness Foundation, www.feedingtubeawareness.org/navigating-life/oral-eating/feeding-therapy-oral-aversions-2/.



“Gastrostomy Tube (G-Tube).” Edited by Steven Dowshen, KidsHealth, The Nemours Foundation, Jan. 2018, kidshealth.org/en/parents/g-tube.html.


Mattingly , Rhonda. “Management of Pediatric Feeding Disorders.” U of L Pediatric Feeding. U of L Pediatric Feeding, 2017, Louisville , University of Louisville .


“Tube Types.” Feeding Tube Awareness Foundation, www.feedingtubeawareness.org/tube-feeding-basics/tubetypes/.


VanDahm, Kelly. “Chapter 9: The Nutritional Foundation.” Pediatric Feeding Disorders Evaluation and Treatment, Therapro, Inc, 2012, pp. 227–227.

Child Speech Therapy: Expressive Language Skills

Hearing your child’s voice for the first time is an exciting, monumental part of parenthood. As the first babbles turn into words, and eventually sentences, your child’s expressive language is developing. Receptive language is the ability to understand language, as expressive language is the ability to use words, sentences, gestures, and writing to communicate with others.

What is expressive language and why is it important?

Expressive language allows a person to communicate wants, needs, thoughts and opinions. Expressive language is the ability to request objects, make choices, ask questions, answer, and describe events. Speaking, gesturing (waving, pointing), writing (texting, emailing), facial expressions (crying, smiling), and vocalizations (crying, yelling) are all variations of expressive language. Children with poor expressive language skills may become frustrated when they cannot communicate their wants and needs. Temper tantrums may occur when they feel tired, sick or hungry and cannot express their current needs.

How do expressive language skills develop?

Expressive language is developed within the first few days after birth. Babies learn to communicate when they are hungry, uncomfortable or tired through crying and facial expressions. They learn to laugh when they are enjoying an interaction with a parent or caregiver, and smile when they are happy. These are all forms of communication. In order for expressive language skills to develop, a child also needs to have strong receptive language, attention, play, social pragmatics and motivation.

  • Receptive language skills is the comprehension of language which is an underlying skill to label objects, answer questions appropriately, and use language in the intended way.

  • Adequate attention skills is an underlying skill for all developmental tasks. The ability to sustain attention is important in order to finish one’s thought and effectively communicate to others.

  • Play skills encourage children to explore their surroundings. Play can be an intrinsic motivator for young children to communicate by requesting, interacting, and labeling toys.

  • Pragmatic skills is the way language is used day to day in social situations. Adequate pragmatic skills allows a person to participate in conversation appropriately.

Expressive Language Milestones & Activities:

The following, outlines expressive language milestones from birth to 7 years old in three categories: birth, preschool, and school age. Learn about the typical developmental stages as well as activities to try at home.

Birth- 3 years old

  • 0-1 years old:

    • Produces pleasure sounds (cooing and gooing)

    • Makes noises when talked to

    • Protests or rejects through gestures or vocalizations

    • Cries differently for different intentions

    • Attempts to imitate facial expressions and movements of caregivers

    • Laughs during parent interaction

    • Between 7-12 months, child will start to babble sounds together (mama, dada)

    • Uses a representational gesture (such as waves bye-bye, claps hands, moves body)

  • Activities to Try at Home:

    • Talk to your child. When your child is developing language, they learn through role models. Talk to your child about your day, what you are doing, and what they can see. It may feel strange at first to talk to your baby without them responding, but the more you talk, the more they learn.

    • Read. It is never too early to start reading books to your child. Point out familiar pictures in the books. If you are reading about animals, make the animal sounds associated with each animal.  

    • Imitate. Imitate all sounds, gestures, and facial expressions your child makes. Repeat a noise they make, and wait for a response. Encouraging imitation can help your child participate in social turn-taking and start to imitate your words.


1-2 years old

  • First words develop around 12 -14 months (hi, mama, dad)

  • Takes turns vocalizing with another person

  • Uses at least two different consonant sounds (early signs include p, b, t, d, m)

  • Around 18-24 months, child begins putting 2 words together (“more cookie,” “no book,” “all done”)

  • Uses one-to-two word questions such as  “go bye bye?” or “where mommy?”

  • Uses a variety of nouns (e.g. mom, dog) and verbs (e.g. eat, sleep)


2-3 years old

  • Participates in play with another person for 1 minute while using appropriate eye contact

  • Repeats words spoken by others

  • Has a word for almost everything

  • Speaks in two-three word sentences

  • Asks what or where questions (e.g. “what’s that?”)

  • Ask yes and no questions

  • Will add “no” in front of verbs to refuse activities (e.g. “no go”)

  • Imitates turn-taking in games or social routines

Activities to Try at Home:

  • Games. Simple turn-taking games help children learn how to wait and take turns which is a necessary skill in conversations. Fun toddler games include Let’s Go Fishin’, Seek-a-boo, and Hi Ho Cherry-O.

  • Expand sentences. Imitate your child’s speech and add on extra words to make it grammatically correct. For instance, if you child says “more juice”, you can repeat “I want more juice”.


Preschool

  • 3-4 years old

    • Names objects in photographs

    • Uses words for a variety of reasons (requests, labels, repetition, help, answers yes/no, attention)

    • Around 3 years, child combines 3-4 words in speech

    • Answers simple who, what, and where questions

    • Uses about 4 sentences at a time

    • Child’s speech can be understood by most adults

    • Asks how, why, and when questions

  • Activities to Try at Home

    • Yes/no game. Make a game out of yes/no questions by asking your child funny questions such as “Is your name Bob?”, “Can you eat dirt?”, “Do you like ice cream?” Then have your child make up silly questions to try to trick you!

    • Ask questions. While running errands, ask your child questions about the community. For instance, “where do we buy food?”, “who helps you when you are sick?”, or “what do you do if it’s raining?”


  • 4-5 years old

    • When given a description, child can name the described object. For example, “What is round and bounces?”

    • Answers questions logically. For example, “what do you do if you are tired?”

    • Uses possessives (the girl’s, the boy’s)

    • Tells a short story

    • Keeps a conversation going

    • Talks in different ways depending on the place or listener


  • Activities to Try at Home

    • I-spy. Describe common objects around the house by giving descriptive clues such as what it looks like, what you do with it, where you would find it, etc. Have your child guess what you are talking about! Include objects out of sight to encourage your child to determine objects on their own, and then have them go on a scavenger hunt to find it.

    • Make up stories. Build a blanket fort, grab a flashlight, and create fairy tale stories. Toys may be used as prompts to help make up a story. Incorporate each part of a story including setting, characters, beginning, middle, and end.


School age

  • 5-6 years old

    • Child can tell you what object is and what it’s used for

    • Answers questions about hypothetical events. For example, “What do you do if you get lost?”

    • Uses prepositions (in, on, under, next to, in front of) in sentences

    • Uses the possessives pronouns her and his

    • Names categories of objects such as food, transportation, animals, clothing, and furniture

    • Asks grammatically correct questions

    • Completes analogies. For instance, you sleep in a bed, you sit on a chair

    • Uses qualitative concepts short and long


  • Activities to Try at Home

    • Category games. Name 5, Scattergories, and Hedbanz are fun and engaging games to work on naming categories.

    • Simon says. Play a game of simon says using prepositions. For instance, Simon says put the book on the table. Once your child is familiar with the game, have them be Simon and give directions using prepositions.


  • 6-7 years old

    • Child is able to names letters

    • Answers why questions with a reason

    • Able to rhymes words

    • Repeats longer sentences

    • Able to retell a story

    • Describes similarities between two objects

  • Activities at Home

    • Read rhyming books. Dr. Seuss books are great to teach rhyming. Read a page and have your child identify the words that rhyme.

    • Movies. After watching a movie, have your child summarize the plot. Guide your child by breaking it up into beginning, middle, and end.


If you feel your child is developmentally delayed in his or her expressive language skills, contact Lumiere Children’s Therapy for a speech-language evaluation. Our speech therapists can formally assess your child’s expressive language skills, create age-appropriate goals, and develop a therapeutic program unique to your child’s needs.

Resources:

“Baby Talk: Communicating With Your Baby.” WebMD, WebMD, www.webmd.com/parenting/baby/baby-talk#2.

Expressive Language (Using Words and Language). (n.d.). Retrieved from https://childdevelopment.com.au/areas-of-concern/using-speech/expressive-language-using-words-and-language/

“How to Support Your Child's Communication Skills.” ZERO TO THREE, www.zerotothree.org/resources/302-how-to-support-your-child-s-communication-skills.

Mattingly, R. (2018, September 13). Typical Development. Lecture presented in University of Louisville, Louisville.

Zimmerman, Irla Lee., et al. PLS-5 Preschool Language Scales: Fifth Edition. NCS Pearson, 2011.

Child Speech Therapy: Making Social Stories

Last week on the blog, we discussed the benefits of social stories for children with autism and/or language disorders. Social stories, developed by Carol Gray, provide an easy to follow visual for appropriate behavior and conversation during social situations. They can be used for a variety of purposes including transitions, inappropriate behavior, social interactions, and new experiences. 

Shawn Rossi

Shawn Rossi

Writing a social story

The most effective social stories relate to the child’s current routine or situation. Writing your own story allows one to directly target a desired skill. There are a few points to consider when writing a social story:

·     Intent of message: What is the main idea or point of the story? The intent may be for self-regulation, self-esteem, social skills, or productive behavior.  Instead of explaining what a child should not do, create positive messages to encourage appropriate behaviors. For instance, instead of saying “do not hit when upset”,reword to a more positive behavior, such as: “we use our words when we are upset”. 

·     Complexity of language: Using simple, direct language, increases comprehension and implementation of the message. Choose age-appropriate vocabulary that the child understands.  

·     Step-by-step: Social stories are effective because they take the guesswork out of a social situation. Be sure to include each mundane step so children can effectively implement the message without having to make their own inferences.   

·     Sentence types: There are four types of sentences that are used in a social story: descriptive, directive, perspective, and control. All four sentences should be included in the story. Below are examples for each type in regard to a social story about personal space:

o  Descriptive sentences: Explain what people do in a certain social situation from a third person perspective. “It is not polite to stand too close to people. It is polite to respect others’ personal space”. 

o  Directive sentences: Positively elicit a specific response or behavior. “When I talk to other people, I need to step back and give them some space”. 

o  Perspective sentences: Explain another person’s feelings or opinions in a social situation. “My friend feels uncomfortable when I stand too close. She is happy if I give her space”. 

o  The control sentence: Is the message intent of the story. The child constructs the sentence to help them recall the targeted skills. “I remember to keep an arms’ length between my friend and I when we talk”. 

 

How to use social stories?

Create an easy to access plan for the social story. Would it be best to keep on the desk, near the door, or in their folder? Next, determine who will be the facilitators of the social story. For non-readers, a caregiver can read the story out loud, record on a device, or program the story into an assistive device and/or ipad. For readers, the teacher or caregiver may be able to simply reference the story by pointing and bringing attention to it during specific situations. As mentioned in last week’s post, social stories are only one component of therapy. For the story to be successful, the child must practice the desired skill in appropriate situations with the help of parents, caregivers, and/or therapists. As the child practices and uses the skills more often, the story is slowly faded out. Eventually the skill will be engraved in long-term memory, and the visual of the social story is no longer necessary. 

 

Examples of Social Stories

To learn how to make your own template, Autism Speaksoutlines the steps using Microsoft PowerPoint here. Below are some free, pre-made stories to try out! 

·      I Will Not Hit

·     Playing with Friends(from headstartinclusion.org)

·     How to Talk to my Friends(from Watson Institute) 

·     Seat Work(from esc20.net) 

Check out more on ABA Education Resources.  

 

LUMIERE THERAPY TEAM🖐️

 

Resources: 

Cosgrave, Gavin. “Social Stories.” Token Economy - Educate Autismwww.educateautism.com/social-stories.html.

“Social Stories for Autism, ADHD and PDD-NOS.” Epidemic Answers, 17 Apr. 2014, epidemicanswers.org/social-stories-for-autism-adhd-pddnos/.

“Social Stories.” PBIS World RSSwww.pbisworld.com/tier-2/social-stories/.

“Social Stories.” Social Stories : ABA Resources, www.abaresources.com/social-stories/.

Vicker, Beverly. “Indiana University Bloomington.” IIDC - The Indiana Institute on Disability and Community at Indiana University

www.iidc.indiana.edu/pages/Behavioral-Issues-and-the-Use-of-Social-Stories.

 

Child Speech Therapy: Social Stories

Temper tantrums during transitions? Hitting during recess? Inappropriate topics during conversation? 

Social stories provide an educational visual to address specific social situations. Verbal explanation of social interactions may be difficult for children to fully comprehend, so visuals can provide additional information.

John Morgan

John Morgan

What are Social Stories?

            Social stories were first introduced and described by Carol Gray as an intervention strategy to teach appropriate social interactions through the elements of a simple story. Social stories outline social concepts and skills in an easy step-by-step manner. They were originally developed for children with autism, but can be beneficial for any child with pragmatic and language disorders.

            Social stories can be a proactive or reactive strategy. Implementing social stories as a proactive measure involves presenting the story before an upcoming social event or situation. If a child is going on a fieldtrip, a social story can outline the new schedule for the day in order to prepare the child for the change in routine. For upcoming play dates, it can give examples on polite ways to share toys. 

            They may also be used for reactive measures, specifically for negative behaviors. For instance, if a child is hitting other kids on the playground, a social story can explain why this behavior is not appropriate while offering new, positive behaviors. They should not be the only source of intervention, especially for negative behaviors. Social stories can provided the child with positive alternatives for negative behaviors in a direct, simple fashion. After the child has been presented with the information, speech-language pathologists, teachers, and/or caregivers can help the child develop the appropriate behavior skills.   

Why do social stories work? 

            Theory of mindis the ability to understand another person’s feelings, perspective, and beliefs. Children with autism often struggle with understanding theory of mind. They can only see their perspective of the story. Consider a child grabbing a toy out of another person’s hand. The child wanted that toy and decided to take it. For a child with autism, that may be the only perspective they understand.   It may be challenging to realize that the classmate was sad when the toy was taken away. 

            Lacking theory of mind creates problems in social situations and can make social society rules seem confusing and difficult. Social stories allow children the opportunity to learn about the other person’s perspective. The stories will outline how the other child feels and why it was hurtful. It takes the guesswork out of social situations and provides strategies or skills to implement in a given situation. 

When should you use social stories?

            Social stories can be implemented in a variety of opportunities. Below are a few examples. 

·     Establish rules and expectations

·     Address negative behaviors

·     Present new social situations (birthday parties, play dates, social groups)

·     Address personal hygiene

·     Address personal space

·     Describe feelings

·     Selecting appropriate social topics

Social stories are intended for specific situations and events in the child’s life. Create or implement social stories that are relevant and meaningful in the child’s everyday activities. 

Next week on the blog, we will discuss how to create a social story. In the meantime, explore these, here.

 

LUMIERE THERAPY TEAM🖐️

 

References:

Cosgrave, Gavin. “Social Stories.” Token Economy - Educate Autismwww.educateautism.com/social-stories.html.

“Social Stories.” PBIS World RSSwww.pbisworld.com/tier-2/social-stories/.

Vicker, Beverly. “Indiana University Bloomington.” IIDC - The Indiana Institute on Disability and Community at Indiana University

www.iidc.indiana.edu/pages/Behavioral-Issues-and-the-Use-of-Social-Stories.