In my last post, I wrote about the benefits of using a play-based therapy approach for children with speech and language delays. In case you missed it, here is the link 'Why Play is The Way'. Play presents endless opportunities for learning and there are many skills which can be stimulated. You may be thinking, ‘where do I start?’
Below are five speech-language related skills to focus on during play:
1. Speech Sounds
Model speech sounds to your child based on what they are playing with. For instance, if your child holds up a toy rabbit, you can model the ‘r’ sound to your child. Using emphasis and repetition to make your child more aware of this sound, as well as its correct production.
Another great way to stimulate speech sounds during play is by making noises which reflect the play situation. For instance, if your child is holding a toy car, you can make a car noise (e.g. “broom broom”) to stimulate the ‘b’, ‘r’ and ‘m’ sounds.
2. Receptive & Expressive Language
Use play as an opportunity to strengthen your child’s understanding of basic concepts. For instance, you can describe what is happening during play or even model actions with toys which demonstrate the meaning of the words ‘in’, ‘out’, ‘under’, ‘big’, ‘small’ and so forth.
Play provides the perfect opportunity to teach your child new vocabulary. This works best when you introduce new words to your child which reflect the play situation. Again, you can use repetition and emphasis over several play sessions with your child. When doing so, your child is likely to start imitating these words, and eventually they will say them spontaneously.
3. Language Foundation:
When children engage in ‘pretend-play’, they learn to use toys as symbols for real objects. Similarly, adults use words as symbols for real objects when we use language. Because of this, play is the foundation of language. To facilitate your child’s language foundation, encourage them to play with toys such as, dolls, cars, tea-sets, toy food, toy animals and so forth.
Show your child that toys can be used as symbols for other real-life objects which they do not necessarily represent. For instance, during play a piece of paper can be used as a ‘blanket’ and a spoon can be used as a ‘hair brush’. By using substitution in play, you are encouraging your child to use their imagination.
5. Sequencing and Expansion:
Try to expand and sustain play so that it is comprised of more than one event. For instance, if your child is playing with a toy truck, the ‘sequence of events’ could include:
1) the truck picking up objects such as blocks
2) the truck driving to a construction site
3) the truck then unloading the objects
4) the objects being used for construction
Other events reflected in play include having a tea party or visiting the doctor. By expanding play into a sequence of events, your child is learning to sustain their attention to a single task for longer time periods as well as developing a greater understanding of the world around them.
Play presents endless opportunities for your child to develop a wide range of skills, such as those discussed in this post. When stimulating your child’s skills during play, remember to keep it fun - because after all, it is play!
A parent of a child who has Autism told me how shocked they were during their child’s first speech therapy session because their child and the therapist just ‘played’ for one hour... I don’t blame them! Watching a play-based therapy session with no background information on what is being done and the reason behind it can look like just regular play. However, there are many strategies which are used during play-based sessions to create an environment which strengthens the interaction between the child and adult as well as stimulates their language development. A therapist should always discuss this with parents before using a play-based approach so that everyone is on the same page.
Play-based therapy has certainly grown in popularity over the past few years. Personally, this is my preferred approach when working with young children. Here are some reasons why:
There are different types of play-based approaches, however, it is important to use one which is evidence based. Evidence-based approaches are made up of strategies which have been scientifically proven to stimulate and improve language development in children. Once these strategies are combined to form an approach, the approach as a whole is then tested again by scientific research. This rigorous scientific process has won me over.
2. Children Love It!
A play-based therapy session is far less structured than, for instance, a session where the therapist repeatedly holds up flashcards to a child (“say cat”). In a play-based session, children usually select the toys they want to play with and therapists can involve the child’s interest in therapy to make learning ‘fun’. As anyone who has children or who works with them knows, when children have fun, they will get more out of the activity and want to do it again.
3. It improves Parent-Child Interactions:
Again, this depends on the specific play-based therapy chosen. However, most play-based therapies focus on developing and strengthening interactions as a foundation for language development. Parents can be trained to apply certain strategies at home. Research evidence has even shown that some play-based therapies are more effective when used by parents than when implemented by therapists- go parents!
4. Endless Language Stimulation Opportunities:
Your child is likely to be most interested and attentive while they play. This creates many opportunities to stimulate their language development and know that they are listening. For instance, many children enjoy when people comment on what they are doing during play. This shows them that someone is engaged in what they are doing. So, as a result, children tend to imitate new words during play. If these words are repeated over several play occasions, they are likely to become part of a child’s vocabulary.
5. Play Simultaneously Targets Several Developmental Areas:
Here is how play helps a child develop language – when children play, they learn to use toy objects as symbols for real objects. This is a crucial step for language development which involves learning to use words as symbols for real objects.
Play not only helps a child develop language, but also stimulates their imagination, cognitive abilities, motor skills and social development. I have used pretend play many times when teaching young children to become more independent or to address behavioral problems during mealtimes. For instance, when a child is transitioning from using a bottle to a cup.
6. Wide Applicability:
I often get the question, “what do you possibly work on with a 12-month old child in your sessions?” The great thing about play-based approaches is that they can be used during therapy with children who are very young. They can even be used when working with children who are five-six years old with limited language ability. I have seen many children who have Autism, Down Syndrome or a general language delay respond really well and make significant gains with this approach.
In my opinion, play-based therapy is a fantastic speech therapy approach when working with young children. A therapist should always explain the therapy approach they are using to parents, as well as the research behind it and their reason for using it. As for any parents who are willing to apply this therapy approach at home - a person once told me, “if you don’t feel like laughing at your actions while you play, then you’re not playing well”. Keep that in mind the next time you take out the toys ;)
“We have been looking for a speech therapist to work with our child for over four years now. It’s incredibly frustrating that we can’t find one because of where we live.”
– Anonymous parent living in the outskirts of Bangkok.
In Thailand, as in most countries, there are inequities between children living in rural and urban areas when accessing speech therapy. Even children living in the outskirts of Bangkok often do not have access to speech therapy. This is primarily due to the shortage of speech therapists living in rural areas, or who are willing to travel long distances or in dense traffic to provide services.
I am frequently contacted by parents living in the outskirts of Bangkok or in rural Thailand who have this concern. Many children living in rural Thailand do not receive the therapy they need for several years- and in some cases, not at all. This is a huge problem when scientific research has repeatedly demonstrated the importance of early intervention for the best outcomes. It is also problematic when the evidence has shown that children with speech and language delays are likely to experience educational, social, emotional and employment difficulties.
So, does this mean that only children living within central Bangkok will ever have the opportunity to access speech therapy?
Especially if there is an openness to other forms of therapy which surpass the ‘traditional therapy model’, where the therapist and child are together in the same room during therapy. In fact, there is an increasingly popular solution to overcome these barriers. Let me tell you about ‘Teletherapy’.
What is Teletherapy?
Teletherapy involves the use of communicative technology to provide speech therapy services, such as video-conferencing, email and telephone.
What do parents think?
Most parents are more comfortable and familiar with traditional in-person therapy. However, some parents would prefer that their child receives a non-traditional form of therapy than receive no therapy at all. Undoubtedly, this is better for any child’s development.
Parents might be reluctant to try Teletherapy at first. The common misconception is that Teletherapy will not be as effective as traditional therapy. However, scientific research has proven that this is not the case.
What does the research say?
Teletherapy has been widely used to assess, diagnose, provide treatment and support to children and their families . Scientific research has proven that teletherapy results in similar outcomes for both diagnosis and treatment when compared to traditional in-person therapy .
Teletherapy can also be a sustainable solution on a wider scale, for instance, if it is used in schools located in rural areas in Thailand. A recent Australian study investigated the effectiveness of Teletherapy in school settings . The findings of this study showed that most of the goals outlined for the children receiving teletherapy at school were achieved at the level expected or beyond .
Here are some benefits of Teletherapy:
1. Greater Practice Opportunities:
While traditional in-person therapy emphasizes the interaction between the child and therapist, Teletherapy places a focus on parents as the primary support for speech and language development. Since parents become the focus of the intervention, the opportunities for practice become endless.
In a recent Australian study, when speaking about traditional in-person therapy, one parent reported, “I would often end up in a room with speech therapists, occupational therapists or teachers …I don’t think there’s a lot aimed at being a parent and supporting your child .” Teletherapy overcomes this concern by putting the parent at the centre of the intervention process and empowering them to support their child.
2. Flexible Consultation Time:
When using Teletherapy, parents have the flexibility to attend consultations while their children are at school. They are no longer limited to the short window between their child finishing school and the therapy centre closing, as is often the case with traditional in-person consultations.
3. Reduced Travel Time:
Children and parents can become extremely tired after traveling long-distances- or being stuck in traffic over short distances such as in Bangkok. Similarly, therapists also can become tired when traveling long distances, which may impact on the frequency of the visits arranged . Teletherapy eliminates the need for parents, children and therapists to travel for consultations.
4. Reduced Cost:
As travel is no longer necessary, Teletherapy removes travel costs for families and therapists.
5. Wide Applicability:
Teletherapy is now being used in the assessment and treatment of many areas of speech and language delays and communication disorders . These include articulation, Autism, cognitive-communication disorders such as after traumatic brain injury, language delay, stuttering, voice disorders and swallowing difficulties.
Teletherapy is an excellent solution to increase the accessibility of speech therapy, regardless of geographical location. The outcomes of Teletherapy have been proven similar to those of traditional in-person therapy. I hope that moving forward, more parents living in the outskirts of Bangkok or in rural Thailand will consider this option for their child.
Acknowledgement and thanks to the following sources whereby the above information was obtained:
 Reynolds, A. L., Vick, J., & Haak, N. J. (2009). Tele-health applications in speech-language pathology: Journal of Telemedicine and Telecare, 15, 310-316.
 Edwards, M., Stredler-Brown, A., & Todd, K. (2012). Expanding use of tele-practice in speech-language pathology and audiology. The Volta Review, 112, 227.
 Fearweather, C., Lincoln, M., & Ramsden, R. (2016). Speech-language pathology teletherapy in rural and remote educational settings: Decreasing service inequities. International Journal of Speech-Language Pathology, 18, 592-602.
 Anderson, K. L., Balandin, S., & Stancliffe, R. J. (2015). Alternative service delivery models for families with a new speech-generating device: Perspectives for parents and therapist. International Journal of Speech Language Pathology, 17, 185-195.
 Dew, A., Vietch, C., Lincoln, M., Brentnall, J., Bulkeley, K., Gallego, G., et al. (2012). The need for new models for delivery of therapy interventions to people with a disability in rural and remote areas of Australia. Journal of Developmental Disability, 37, 50-53.
One night, a fifteen-year-old boy stole a car. He drove away at high speed and wasn’t wearing a seatbelt. Suddenly, he lost control of the steering wheel and crashed into a tree. ‘Tom’ (whose real name has been changed to keep his identity confidential) acquired a traumatic brain injury, commonly referred to as TBI. He experienced a lot of changes after that night. Tom thought the changes would go away. But they didn’t. Tom was the first child I ever worked with who had TBI. He inspired this post.
What causes Traumatic Brain Injury (TBI)?
TBI is caused by sudden damage to the brain by an external object. This may occur from impact during a car accident collision, sport injury, violence (such as a blow to the head or gunshot) or fall. Falls are the most common cause of TBI, particularly in young children and older adults .
Who is at risk for TBI?
There are three age groups who are most at risk:
1. Children up to the age of 4.
2. Individuals (mostly males) aged between 15-24. This is because young males are more likely to engage in high-risk work or behaviour.
3. Adults above the age of 70.
What are the problems associated with TBI?
TBI can be easy to miss when first meeting someone. This is because individuals with TBI look just like you and I. However, 80-100% of individuals with TBI experience some form of communication impairment, mainly cognitive-communication disorder  which impacts the way they think and interact with others. The problems associated with TBI include :
What are the long-term consequences of TBI?
Scientific research has shown that individuals with TBI are likely to experience difficulty in several areas of their life. These areas include overall independence, employment, academic, maintaining relationships, and social integration .
What can be done to prevent TBI?
Here are some steps which can help:
1. Always wear a seatbelt in a car.
2. Wear a helmet when riding a bicycle or a motorbike.
3. Ensure rugs inside your home are secure to prevent slipping.
4. Clear stairways of objects which may cause tripping.
5. Install stair gates at home.
How can a speech therapist help an individual with TBI?
1. Assessment 
A speech therapist will first assess a person’s orientation (their awareness of who they are, where they are and what date it is) and their cognitive-communication skills. Once these have been determined, the speech therapist will form a treatment plan. The goals of this plan will depend on each person’s needs, with the focus of increasing their independence in daily life.
Early Stages 
In the early stages of a person’s recovery, for instance, during coma, a speech therapist will work on obtaining a response from the person to sensory stimulation. As the person becomes more aware, the speech therapist will focus on improving their orientation and gaining their attention for basic tasks.
Once a person has regained their orientation and awareness, the speech therapist will work with them to improve their cognitive-communication skills using scientifically proven methods . In many teenage and adult cases (unless in the case of severe intellectual impairment or severe receptive aphasia), the individual can be involved in selecting what areas they want to prioritise in therapy.
Now, let’s revisit the story of Tom. Initially, Tom was very reluctant to participate in therapy. However, by being involved in his own goal-setting, Tom realised the relevance of therapy. Eventually, Tom chose to work on these three areas in therapy:
Finally, there are several negative impacts of the cognitive-communication disorders experienced by individuals with TBI. Speech therapy can greatly improve the areas where an individual with TBI is experiencing difficulty through the use of scientifically proven methods. In my opinion, it is important to involve the individual in the goal-setting process whenever possible.
The Expat Speechie
Acknowledgement and thanks to the following sources whereby some of the above information was obtained:
 Freund , J. , Hayter , C. , MacDonald , S. , Neary , M. , & WisemanHakes , C. (1994). Cognitive-communication disorders following traumatic brain Injury: A practical guide. Tucson, AZ: Communication Skill Builders .
 MacDonald , S. , & Wiseman-Hakes , C. (2010) . Knowledge translation in ABI rehabilitation: A model for consolidating and applying the evidence for cognitive-communication interventions . Brain Injury, 24, 486 – 508 .
Last Friday, I started the monthly parent communication empowerment training at the Rainbow Room, a special needs awareness centre here in Bangkok. Below is a summary of what was discussed:
Below is the translation in Thai:
Come and join me for the next parent communication empowerment session on Friday 10th of February, 2017, at the Rainbow Room. All parents are welcome!
The Expat Speechie
It always fascinates me just how similar speech sound errors are among bilingual children who speak the same languages. Every day, I hear common speech sound errors among children who speak both Thai and English. However, before I delve deeper into this post, it is important to note that not all children who speak Thai and English have speech sound errors. This post will be focusing on the errors noted in the speech of those children who do.
The most common speech sound errors I have noticed among children who speak both Thai and English are:
1. Replacing the ‘ch’ sound with the ‘sh’ sound.
For instance, saying ‘shilli’ instead of the word ‘chilli’.
2. Interchanging the ‘v’ and ‘w’ sounds.
For instance, saying ‘wery’ instead of the word ‘very’, or saying ‘ving’ instead of the word ‘wing’.
3. Replacing the ‘r’ sound with the ‘l’ sound.
For instance, saying ‘labbit’ instead of the word ‘rabbit’.
This occurs because of incorrect tongue placement when making sounds such as 's' and 'z'. You can read more about lisps in my previous post 'Let's Talk About Lisps.'
So, if these speech sound errors are so common, are they ever a problem?
The speech errors above are problematic when they impact a child’s ability to be understood by others. Between the ages of four and five years, 90-100% of what a child says should be understood by others. It is usually the case that parents understand their child’s speech the most, even if they have speech sound errors. This is because parents eventually become accustomed to these speech sound errors. However, if a child’s teacher, relative or friend is finding it difficult to understand what they are saying, then it is likely that these speech sound errors are hindering a child’s ability to be understood.
Importantly, speech sound errors should always be addressed if they are impacting on a child’s self-esteem or interfering with their ability to speak confidently. They should also be addressed if a child experiences bullying or teasing because of their speech.
Can these speech sound errors be resolved in bilingual children?
Absolutely! I have worked with many children who have made immense progress with regards to their speech in English, even when English is not their dominant language. As with monolingual children, this process takes consistent practice. I usually recommend 10 minutes of daily speech sound practice.
How are bilingual children taught to produce sounds correctly?
Bilingual children are given speech sound instruction the exact way as monolingual children. The first step is always to make the child aware of their speech, because after all, they can’t change what they are not aware of. This involves drawing attention to the tongue and lip placement necessary to correctly produce a sound. Children generally become quickly aware after this is explained to them. Even after they can differentiate between the correct and incorrect way to produce a sound, they might still find it difficult to correctly produce the sound themselves. This step usually requires much practice.
Once the child can correctly make the sound themselves, they then practice producing this sound in different vowel-consonant combinations, across different word positions, phrases, sentences, short-stories, and eventually, in conversation.
The important thing to remember is that it is always possible to improve a child’s speech, helping them to be better understood by others and boosting their self-esteem.
The Expat Speechie
As a parent, there are many ways which you can support your child with Autism. It all starts with one critical underlying fact- you are the best person to help your child. You know your child better than anyone else ever will and you spend the most time with them. These two factors provide the best conditions for learning.
Below are some strategies and approaches which you can use:
1. Make a Visual Timetable:
Children with Autism tend to have difficulty transitioning between activities or events. One practical way to address this, is by making a visual timetable to hang up at home. This can be made up of pictures showing different parts of their day in chronological order. For instance, you can have pictures for ‘breakfast’, ‘getting dressed’, ‘brushing teeth’, ‘play time’, ‘learning time’ as well as pictures of places you will go to together when you leave the house. Once your child completes an activity, they can then remove the corresponding picture from the timetable and place it in a ‘finish’ box. A visual timetable will help align your child’s expectations, making transitions easier. It will also allow your child to understand sequencing and that activities eventually come to an end.
2. Decrease Recreational Screen Time:
I have worked with children who are allowed many hours of exposure to recreational iPad games daily. Let’s consider a child who plays games on the iPad for five hours a day, this is FIVE HOURS a day whereby the opportunity to learn new things is foregone. Multiply that by a year and you can start to see the significant impact this can have on development.
Recreational screen time can be gradually decreased until it is limited to one hour per day. For more information on iPad use to best support your child, I have included the link to my previous post 'Your Child & The iPad'.
Meanwhile, try to increase your child’s exposure to programs and toys at home which will stimulate their development. For instance, there are many iPad Apps which can stimulate your child’s speech and language skills. Also, increasing your child’s exposure to pretend play toys is another great way to stimulate their language and cognitive development at home. Pretend play toys include pretend tea sets, food, dolls, action toys, cars and so forth.
3. Watch Your Language!
Children with Autism find abstract concepts and figurative language difficult. To support your child’s understanding during daily interactions, avoid using language which is unclear or requires interpretation. For instance, instead of saying things like, “it’s raining cats and dogs”, try to use literal and straightforward language such as, “it’s raining a lot.”
4. Use Language to Teach, Not Test
Be mindful of whether your language is ‘teaching’ your child or making them feel like they are being ‘tested’. Asking questions such as “what’s this?” or “how many do you see?” do not provide your child with any new learning material and will make them feel like they are being tested. Try to reduce the amount of questions you ask your child. For instance, if your child is holding a toy, use this opportunity to make comments about the object (e.g. “that’s a big blue car!”). This will introduce new words into their vocabulary, without them feeling like they are being tested.
As mentioned in my previous post, children with Autism often have echolalia. This can actually be used as a strength to teach them new words. For instance, after you say “that’s a big, blue car!” it is likely that your child will repeat this. Avoid using directive language to encourage your child to talk, such as, “say big blue car”. Chances are that your child is more likely to repeat these words spontaneously than when they are directed to say them.
5. Show Interest in Their Interests
Parents will often say things to me like “my child just doesn’t interact with me.” One way to address this is to show interest in your child’s interests. For instance, if your child is interested in trains, try to involve toy trains or the topic of trains in your interactions. Try to avoid redirecting their attention to a different toy or changing the topic, instead sustain the interaction until your child initiates the change. By involving your child’s interests in your interactions, your child will be likely to interact with you more often, creating more opportunities for learning.
6. Use Their Strongest Mode of Communication:
Remember that communication involves much more than just talking. Communication also includes using hand signs or pictures to convey messages. Some children with Autism are more comfortable communicating using methods other than talking. Once you know what your child’s strongest communication method is, use this as a tool to communicate with them.
Even though you can offer the best support for your child, you can’t do it alone! There are many professionals who can help your child further their skills in different areas. Below are a few:
Doctors: Children with Autism often experience seizures, allergies, digestive problems and sleeping problems. If your child experiences any of these, voice them to your child’s doctor. By addressing these health factors, you are helping to increase your child’s comfort levels and mood.
Speech Language Therapists: Many children with Autism have a speech and language delay. Most of them can learn to improve their verbal communication skills. However, some children with Autism are non-verbal and unfortunately, remain that way their entire lives. If a child is non-verbal, they can still learn to communicate through hand-sign or pictures. By learning to communicate their needs and wants effectively, children tend to show less self-harm behaviours and tantrums. A Speech Language Therapist can also help to support the development of their social communication skills.
Occupational Therapists: As mentioned in my previous post, children with Autism process sensory information differently to typically developing children. An Occupational Therapist can address this in several different ways. For instance, they can help your child to increase their awareness of when they are experiencing ‘sensory overload’ and teach them effective strategies to regulate their reactions to this.
Play Therapists: A Play Therapist can support your child’s language, cognitive and social development in a fun and engaging way.
Psychotherapist:s Children with Autism often experience anxiety. A Psychotherapist can help to address the anxiety as well as to increase your child’s awareness of their own emotions and teach them to apply effective strategies for dealing with heightened emotions.
Teachers: It is important to adapt your child’s school environment to support their learning needs. For instance, if your child requires high-level support at school, consider employing a full-time shadow teacher to provide one-to-one support. Also, children with Autism often learn best when information is presented visually, by text or by doing things. Once you know what way your child learns best, their classroom teacher can use this approach to support their learning. Teachers can also use a visual timetable in class to support your child’s understanding of the daily sequence and transition between tasks.
There are many ways which you can support your child with Autism. I hope that this post has given you some practical ideas to do so. Remember, you don’t have to do it all alone, there are many people who can help!
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The Expat Speechie
As some of you may already know, I recently travelled to Singapore to become certified as an Autism Specialist. There, I was fortunate enough to meet many professionals from different countries working with children who have Autism, which inspired me to write this post.
As in any other country, Autism is a reality that many families in Thailand live through each day. While awareness is growing here in Thailand, the understanding of what Autism is and the resources available to support individuals with Autism are still limited. This ‘A’ word lingers on the mind of so many parents, though, not all can bring themselves to talk about it.
This post will address some common questions about Autism.
What is Autism?
Autism is a neurodevelopmental disorder. This means that for children with Autism, the brain does not develop typically.
Children with Autism show these two main features below:
1. Social Communication Deficit: Children with Autism have difficulty with the verbal and non-verbal aspects of social communication or the ‘unspoken rules’ of social interactions.
· These verbal aspects include difficulty with back-and forth conversations, initiating conversations, maintaining conversations or ending conversations. For instance, I have worked with a child with Autism who would not give others a chance to speak during conversations.
· The non-verbal aspects which children find difficult include interpreting emotions, making eye-contact, engaging in imaginative play, understanding 'personal space' and the use of gestures.
2. Repetitive and Restricted Routines: This includes verbal and non-verbal repetitions.
· Children with Autism may repeat things over and over again verbally, which is referred to as ‘echolalia.’ For instance, I have worked with a child who recited the same YouTube video repeatedly.
· They usually display repetitive movements such as hand-flapping and rocking.
· They tend to become very upset and have very low tolerance for a disruption or change in their routine.
· They are either much more sensitive to sensory stimulus around them, or they do not seem to respond to sensory stimulus. For example, I once worked with a child who repeatedly walked around the room to run his hands across all the furniture.
· They might seem ‘obsessed’ with a certain topic of interest which they insist to keep bringing up and talking about.
It is important to understand that the above features differ to varying degrees for each child with Autism. This is because Autism ranges on a wide spectrum. While many children with Autism require significant support, there are also several children with Autism who are high-functioning.
How Common Is Autism?
Based on statistics from the Centers for Disease Control and Prevention in 2014, approximately 1 in 68 children have Autism. There has recently been an increase in the reporting of children with Autism. This can be partly explained by greater awareness and the availability of better diagnostic assessments.
Autism is also five times more common in boys than girls. Moreover, it is more common in families who have a history of Autism.
What Causes Autism?
Unfortunately, little is known about what causes Autism. However, recent scientific research suggests that the cause is a combination of genetic and environmental factors.
There has been much controversy around the topic of vaccines causing Autism. It is important to know that there is no scientific evidence to support this.
Can Children with Autism Learn?
Children with Autism can learn so many different things. The extent to which they can learn depends on each child. Children with Autism often learn best through the use of pictures, when things are written down or by physically doing things.
Sadly, there are many children with Autism who do not reach their full potential because they do not receive specialised support. In my next post, I will outline certain strategies and approaches which can be used to support the learning of children with Autism.
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The Expat Speechie
I would like to acknowledge and thank the following sources below where the information for this post was obtained:
1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.
2. Autism Speaks. www.autismspeaks.org
3. Baio, EdS, J. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Invesitgators (2014, March 28). Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010., from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6302a1.
This week’s post is a little different. It was inspired when I was asked to give a talk to a group of parents about why speech and language therapy is so important. In the last decade, the amount of research evidence outlining the negative consequences of speech and language delays has been quite shocking. I understand that for a parent, this information can be overwhelming. However, it is important for parents to understand the consequences of speech and language delays, so that they can make a well-informed decision about therapy.
Over the years, there have been many research studies that have looked at the implications of speech and language delays. Here is what was found:
Learning [1, 2]
Children with speech and language delays are likely to experience difficulty learning during their school years, especially with regards to reading and writing. In fact, children with speech and language delays are 4-5 times more likely to experience reading difficulty compared to their peers.
Academic Achievement 
Because of the difficulties in learning outlined above, these children tend to have lower academic achievement compared to other children.
Children with language delays are more likely to display behavioural problems. These children are also more likely to show aggression compared to their peers. This is often a result of their frustration, due to difficulty they have expressing themselves or understanding what others are saying to them.
Scientific evidence shows that children with language delays are more likely to have lower self-esteem when compared to their peers.
Social Adaptation 
Children with speech and language delays often experience difficulties making friends and forming attachments with others. As a result, they feel socially isolated and are less able to adapt to social situations compared to their peers. This is likely to transfer into adulthood.
Emotional Outcomes [5-7]
Everyone wants their child to grow up to be a happy person. However, speech and language delays have been linked to difficulties with emotional stability in adulthood. Research evidence has found that children who had a receptive language delay at the age of 5, were more likely to experience depression at the age of 34. This finding was more profound for men than women.
Evidence has shown that children with persistent language delays are more likely to hold lower-skilled jobs and are more likely to experience long-term unemployment in the future.
How Can I Minimise The Impact Of A Speech Language Delay On My Child’s Life?
As a parent, there are certain steps you can take to reduce the impact of a speech language delay on your child’s life. These steps are:
Step 1 Identification.
If you are concerned about your child’s speech and language development, consult with a speech therapist. An assessment will help to determine if your child requires therapy and to identify the areas where they require further support.
Step 2 Early Intervention.
It has been scientifically proven that the earlier that children receive therapy to support their speech and language needs, the better the outcomes are likely to be.
Step 3 Consistency.
Parents often underestimate their influence on their child’s speech and language development. However, evidence has shown that when certain strategies are used by parents, the gains are even greater than when they are implemented by therapists.
Finally, research has shown that there are many negative implications of speech and language delays. Unfortunately, this issue often receives less attention than necessary, and as a result many parents do not know the potentially serious implications of these delays on their child. Moreover, many parents also do not know that there are scientifically proven strategies available to them to support their child overcome these delays.
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1. Raitano, N.A., Pennington, B.F., Tunick, R.A., Boada, R., & Shriberg, L.D. (2004). Pre-literacy skills of subgroups of children with speech sound disorders. J Child Psychol Psychiatry, 45(4):821–835.
2. Peterson, R.L., Pennington, B.F., Shriberg, L.D., & Boada, R. (2009). What influences literacy outcome in children with speech sound disorder? J Speech Lang Hear Res, 52(5):1175–1188.
3. Young, A.R., Beitchman, J.H., Johnson, C., et al. (2002). Young adult academic outcomes in a longitudinal sample of early identified language impaired and control children. J Child Psychol Psychiatry, 43(5):635–645.
4. Schoon, I., Parsons, S., Rush, R., & Law, J. (2010). Children’s Language Ability and Psychosocial Development: A 29-Year Follow-up Study. Pediatrics, 126(1).
5. Law, J., Rush, R., Schoon, I., & Parsons, S. (2009). Modeling developmental language difficulties from school entry into adulthood: literacy, mental health, and employment outcomes. J Speech Lang Hear Res. 52(6):1401–1416.
6. Cohen, N.J., Barwick, M.A., Horodezky, N.B., Vallance, D.D., & Im, N. (1998). Language, achievement, and cognitive processing in psychiatrically disturbed children with previously identified and unsuspected language impairments. J Child Psychol Psychiatry, 39(6):865–877.
7. Cohen, N.J., Menna, R., Vallance, D.D., Barwick, M.A., Im, N., & Horodezky, N.B. (1998). Language, social cognitive processing, and behavioral characteristics of psychiatrically disturbed children with previously identified and unsuspected language impairments. J Child Psychol Psychiatry, 39(6):853–864.
Children will typically develop each speech sound at a specific age. For instance, the ‘m sound’ is one of the first sounds to develop at around the age of one. Whereas, the ‘r sound’ is one of the latest sounds to develop, and may take until the age of seven. Therefore, when a child has not yet developed certain speech sounds, they will show speech sound errors. These errors are considered a ‘normal’ part of speech development.
The speech sound errors below are all considered ‘normal’ if you child is below the age of five:
1. Replacing the ‘r sound’ with the ‘w sound’.
For instance, your child says ‘wun’ instead of ‘run’.
2. Omitting the ‘r sound’ from ‘r clusters’.
For instance, your child says ‘tee’ instead of ‘tree’.
3. A Frontal Lisp: Your child protrudes their tongue between their top and bottom front teeth when producing sounds such as ‘s’ and ‘z’.
4. Omitting the ‘s sound’ from ‘s clusters’.
For instance, your child says ‘top’ instead of ‘stop’.
5. Replacing the voiceless ‘th sound’ with the ‘f sound’.
For instance, your child says ‘fing’ instead of ‘thing’.
6. Replacing the voiced ‘th sound’ with the ‘d sound’.
For instance, your child says ‘dat’ instead of ‘that’.
7. Replacing the ‘ch sound’ with the ‘t sound’.
For instance, your child says ‘tip’ instead of ‘chip.’
8. Replacing the ‘j sound’ with the ‘d sound’.
For instance, your child says ‘duice’ instead of ‘juice’.
9. Replacing the ‘l sound’ with the ‘w sound’.
For instance, your child says ‘wate’ instead of ‘late’.
10. Replacing the ‘l sound’ with the ‘y sound’.
For instance, your child says ‘yip’ instead of ‘lip’.
It is important to note however, that not all speech sound errors below the age of five are considered age-appropriate or a normal part of speech development. If your child has speech errors which are not mentioned above, consult with a speech-language therapist.
The Expat Speechie
© COPYRIGHT 2016. ALL RIGHTS RESERVED.
I would like to acknowledge and thank the following source:
Bowen, C. (2011). Table 2: Phonological Processes. Retrieved from http://www.speech-language-therapy.com/ on 22/8/2016.
Welcome to my blog! I am a wife, a Speech Language Pathologist with a background in Psychology, an expat and a blogger from Sydney, Australia who is permanently living and working in Bangkok.
Read about ways that you can help your child with their speech and language development right here on my blog.
Come and join me for parent communication empowerment training- every second Friday of the month at the Rainbow Room Special Needs Awareness Centre. All parents are welcome!
The Expat Speechie
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