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​The most common question parents ask about children's communication development is - does my child have a language delay? Whether you have noticed some things which made you question this, or something just doesn't seem quite right, your concerns as a parent are valid and are important to address. 

Let's look at early language development, the period from birth to five years. This period is known as the critical learning period, where the brain has capacity to learn skills faster and better than at other ages. During this development period, children mostly learn language by being exposed to it. The more exposure a child has to language during their early development, the more language stimulation they receive, the better their language skills will likely develop.

Sometimes, we are doing everything we can as parents, but language just does not come through the way which we expect it to. If you have these concerns or questions about your child's language development, below are some guidelines for what you can look out for at home:

Birth to 1 year:

• Recognizes names of common objects
• Vocalizes (makes a sound with their voice)
• Babbles (e.g. "mama"... "dada")
• Says first words at around 1 year
• Points to objects of interest

​
1-2 years:

• Follows up to 2 step instructions (e.g. "come here and sit down")
• Vocabulary grows 
• Combines up to 2 words (e.g. "mama go")

2-3 years:

• Vocabulary explosion 
• Asks simple questions 
• Pronouns develop (e.g. you, me)

• Follows up to 3 step instructions (e.g. "bring your shoes, sit down and put them on"

3-4 years:

• Follows multi-step instructions
• Grammar continued to develop (e.g. plurals, verb tenses) 
• Often asks 'why' questions
• Combines 3-4 words, at least
• Can briefly retell events

4-5 years:

• Full sentences form
• ​Can follow conversations of others 
• Can retell stories or events in detail 

If you have ongoing concerns about your child's language development, it is always a great idea to consult with a Speech Language Pathologist. They are specialized to evaluate language development, provide you with recommendations, and support your child through Speech Therapy, if required.

While it is true that each child develops at their own pace, it is important to address parent concerns in this area, to ensure that we are maximizing a child's language stimulation during their critical learning period and that additional support is provided if needed. 

Speak soon,
The Expat Speechie

Being bilingual can be defined as speaking more than one language with medium to high-level proficiency. Currently, more than half of the world's population can speak a second language. This is leading to more interest and research into bilingualism as time goes on.

​There is a lot of research which shows that bilingualism has developmental, educational, socio-cultural and cognitive benefits. But what happens to our brain when we age?

As we age, we typically experience a decline in cognitive functioning and a loss of grey matter (which control our movement, memory and emotions) in our brain. However, being bilingual can slow this process down and can even protect our brain as we age, to some extent. It is thought that this happens due to the constant mental exercise by switching between languages in daily life, leads to bilinguals having better cognitive functions, such as memory, inhibitory control and decision-making, compared to people who speak only one language.

Here is what the evidence has shown (studies below cited in Waldie et al., 2020):

• Bilinguals have better episodic memory; we remember more personal life events as we get older, when compared to people who speak only one language (Libersky et al., 2023)
• Bilingualism can protect against decline in cognitive functioning with age (Borsa et al., 2018)
• Loss of brain grey matter volume, has been shown to be delayed in bilinguals compared to monolingual seniors (Del Maschio et al., 2018)
• There is a 4.5-year delay in Alzheimer’s disease in bilinguals, compared to monolinguals (Woumans et al., 2015)
• There is also a bilingualism advantage in cognitive recovery after stroke (Alladi et al., 2016)      

 
The good news is - it is never too late to learn a new language in life! In fact, continuing to stimulate our brain and learn new things as we get older has been shown to protect our brain as we age, even well into the later years. 

Speak soon,
The Expat Speechie

References:
                     Libersky, E., Crespo, K., Reppe, A., & Kaushanskaya, M. (2023). Effects of bilingualism on autobiographical memory: variation in idea density and retrieval speed. Memory, 31(4), 491–501. 
                Waldie, K. E., Badzakova-Trajkov, G., Park, H. R. P., Zheng, Y., Neumann, D., & Zamani Foroushani, N. (2020). The cognitive and neural correlates of written language: a selective review of bilingualism. Journal of the Royal Society of New Zealand, 51(1), 81–96. 

​​如果您的孩子在曼谷就读国际学校，受到学校的老师建议接受言语治疗的评估，以下这篇文章将会为您介绍言语治疗师能为您的孩子提供的支援。

言语治疗主要是帮助孩子们促进沟通技巧，其中包括理解语言，用语言表达自己，正确的发音，文字上的吸收和运用。一些小朋友更会通过言语治疗，学习利用平板，图片交换(PECS)，手语等方式来沟通。

谁适合接受言语治疗？
如果您在孩子身上观察到以下情况，代表他们适合接受言语治疗师的帮助：
·语言理解迟缓，例如分不清一些同龄孩子普遍认识的词语，指令或问题
·语言表达发展慢，例如还没开始说话或者比同龄的小孩说话明显比较少
·说话顺畅度有问题或者有口吃的表现，断断续续或重复一些字，以致影响他们的表达能力，别人理解他们会比较吃力
·与身边大人或者小孩子社交沟通上有困难，例如常独自玩跟行动，很少互动交流，不懂得在适合的环境讲合适的话等等
·陌生人难以理解他们说的话，字词发音有问题，例如字的开头换成别的音（沙→打），加上多余的音或者漏掉尾音（开→卡, stop →sta_ ），展现出不同种类的错误发音等等
·肌肉控制和协调导致的发音问题，让孩子说话时常出现不同的语音错误，甚至讲话上有困难
·进食上的困难，例如嘴唇的控制或吞咽方面有问题，流口水等。另外他们会有严重的偏食或者不吃固体或需要咀嚼的食物
·控制舌头方面有困难，例如呼吸，计时或讲话的时候，舌头会在口腔外
·声线和用声方面有困难，听起来和其他小朋友的声线有明显的不同，常失声等等

言语治疗如何进行？
言语治疗由受过专业的言语治疗课程，言语治疗系学士，硕士博士等学位的言语治疗师提供。
通常言于治疗依据以下流程：
1. 言语治疗师从家长学校方面收取关于这学生的资料，然后与学生见面进行评估
2. 根据评估结果和家长的需求，为学生定制个人的言语治疗训练目标
3. 为学生建议合适的言语治疗周期和频率进行训练，言语治疗师为学生定期观察进度
4. 为家长定期反馈学生的言语治疗进度，在家里的训练提供建议和方案，于每个训练周期尾声和家长商讨接下来的训练目标。已经达到训练目的的学生可以改为家里训练，由家长持续观察他们的进度

言语治疗的出发点和技巧：
言语治疗师会根据学生的表现和情况，运用自身专业经验，临床研究接受过的专业训练为学生提供定制的训练模式
·通过游戏进行治疗，包括Hanen, DIR Floortime训练方式。从游戏启发小孩互动和沟通的意愿。治疗师会根据孩子的兴趣和专注能力，为孩子设计课堂活动，成为他游戏中沟通的示范和游戏伴侣，同时提供语言训练。这方法普遍适合五岁以下语言发展迟缓或有自闭症的孩子
· 社交技巧：训练孩子社交沟通上的思考能力，目的是让他们能独立的在社交环境中处理不同的情况。相比直接告诉孩子社交的礼仪和规矩，这种方法鼓励孩子们运用思考和把自己代入不同的社交场景中，尝试理解别人的观点，从而获得社交知识和能力
·PROMPT口腔肌肉提示：为有肌肉控制困难发音问题的孩子，运用碰触和轻按脸部肌肉的方式，帮助提醒他们如何正确发音，例如如何收紧不同的发音肌肉
·阶段性发音训练：循序渐进的教导孩子如何正确发音，有听力辨识，单音，和不同声母组合，到字面上句子上的正确发音，配合不同场景上的正确发音：阅读，述说故事，对话等等
·口部肌肉功能性治疗：利用运动训练舌头，以帮助讲话进食和呼吸功能
·S.O.S喂养疗法：帮助儿童克服进食喂养困难和严重挑食的问题，利用循序渐进的方式扩展不同食物质地的接纳程度
·学前和在学儿童的语言刺激治疗活动，包括物件分类，聆听跟从指令能力，造句能力，序述事情和阅读理解能力等

家长在言语治疗中的角色：
由于家长是最理解孩子的重要一员，家长的参与是言语治疗中很重要的一环
·观察孩子的发展过程，留意任何和同龄或和兄弟姐妹的显着能力差别
·与言语治疗师沟通分享您对孩子的观察和顾虑，安排适当的评估和治疗
·和治疗师相议孩子的治疗目标
·参与言语治疗课和跟进孩子在言语治疗课的进度

学校老师的角色：
由于老师在学校和学生相处的时间长，他们能注意到学生在课堂上或群体中的表现，他们可以转介有需要的孩子接受言语治疗或评估，同时学校的老师也会跟言语治疗室合作，共同支持学生的语言发展

如果您的孩子被转介接受言语治疗评估或您发现孩子语言发展上有额外需要，欢迎与合资格的言语治疗师联络，希望能为您和您的孩子提供专业及有帮助的建议和支持。

This article was written by Chiman Estephan, Speech Language Therapist, and translated from English to Chinese by Siu Wai Wong (Leon), Speech Language Therapist.

According to a recent article in The Nation Thailand, language development among Thai children in Thailand is on the decline. The article reported that over 80% of Thai children's development was screened using the Denver ll Developmental Screening tool for children aged 0-5 years. More than 20% of children who were screened were found to have a language delay. A language delay is when a child is delayed to meet language development milestones according to their age. Also, more than half of these children presented with language delay in both their receptive language skills (the ability to understand language) and expressive language skills (the ability to use language). 

This can be seen as an alarming statistic. However, it can also be interpreted as an important wake up call, that we need to be doing more to stimulate the language development of young children. Children learn language by hearing it from their environment. This means that we as parents, caregivers and educators, are the main models of language for children during their early years.

Below are 5 simple strategies you can use today, to stimulate your child's language development:

​1.     Engage In Interactive Play
During play, children are engaged, attentive and motivated, which are the ideal conditions for learning. Try to find 10-15 minutes each day to play with your child. When you do, get down to their level, turn your body to face them with full attention, and let them show you what they are interested in.

2.     Stop Asking So Many Questions!
Try to limit the number of questions you ask a child. Remember that when we ask a child a question (e.g. "what color is this?") we are not teaching them anything, we are testing them instead. Also, if your child is not talking yet and you are asking questions during play, your interactions will be one-sided because they do not have the words to respond.
 
3.     Be Your Child’s Commentator
Imagine that you are a sports commentator and your child is the athlete. Base your comments on what toy your child is playing with and what actions they are performing. When you comment on what your child is doing, they will find play enjoyable and will be likely to want to play with you again. Try to use comments which are slightly above your child's current language level. For example, if your child is not talking yet, keep your comments very simple by using only single words.  If your child is using single words, try to use comments with 2 words, and so on. 
 
4.     Be Your Child’s Interpreter – Not Parrot
Although, your child might not be talking yet, they can still be making sounds or trying to say words. A common mistake we make when a child produces a sound is to repeat this sound back to them. When we do this, we are not teaching the child anything new and thus, missing an opportunity for language stimulation. Instead, when this happens, try to interpret what your child is communicating by using the context you are in to guide you. For example, if your child says, “baa” while holding up a toy bear, avoid repeating “baa” back to them and respond with an interpretation of this sound instead (e.g. say “bear”).
 
5.     Let Your Child Be Captain
When you play with your child, take a step back and let them lead the play interaction. Try not to direct your child’s attention to certain toys by holding toys up to them or placing toys next to them. Instead, let your child choose which toys they want to play with. Also, try not to influence what your child does with the toy or for how long they will play with a toy. Let your child decide the events and duration of the play interaction. Your child will enjoy playing with you much more if they lead. As a result, they will respond better to your language stimulation. They will also be more likely to want to play with you again, which will present more opportunities for language stimulation in the future.

The great thing about these strategies above, is that they can be incorporated into your usual routines and interactions with your child. You can further stimulate your child's language development by following these simple, yet effective steps, today! 

Speak soon,
The Expat Speechie
​
Statistics Reference:
The Nation Thailand: https://www.nationthailand.com/health-wellness/40043135

Artificial Intelligence (AI) is attracting more buzz in the healthcare service sector, which often leads to misunderstanding and misconceptions. This post aims to touch on some of the common myths around AI in Speech Language Therapy and explores how AI can be beneficial when providing Speech Language Therapy services to clients. 

So, what is AI? AI often involves algorithms, computer programs and systems which enable machines to do tasks which usually / previously required human intelligence. This may include explaining concepts, drawing comparisons, creating and generating content, translating language, and so forth. Since AI mainly delivers outcomes in some form of language (written, symbolic, spoken, etc.), it can be particularly useful for Speech Language Therapy services. 

Here are some of the common misconceptions about AI and Speech Therapy:
Myth #1 - Your child no longer needs to see a Speech Therapist, which can be replaced with AI instead.
Myth #2 - AI can do the same functions of a Speech Therapist.
Myth #3 - AI can do the job of a Speech Therapist better and with more accuracy. 

It is important to emphasize that the above myths are factually not true. While AI is developing at a speedy and impressive rate, it does have several limitations. One of the main limitations is that AI cannot replicate or replace human critical thinking, collegial and multi-disciplinary collaboration and fact-checking. 

In saying this, AI can be used to supplement current Speech Therapy service delivery. It is already showing to be extremely useful in this regard, including with the below and beyond:

• formulating individualized stories for clients, involving their interests, preferences or imaginative characters
• making comparisons in grammatical rules between 2 languages 
• translating messages or videos from one language to another
• generating lists of words with specific sounds in certain word positions for clients to practice

The key take away here is that AI can be an incredibly powerful tool for further enhancing current Speech Language Therapy service delivery. However, it is not without limitations. It is critical for Speech Therapists who use AI to continue to apply their critical thinking skills, to do ongoing training related to AI, continue to collaborate with peers, seek multi-disciplinary consultation and to fact-check. Speech language Therapists can also seek feedback from each other and from their clients, to give to AI developers on how their products can improve to better serve client populations. 

AI in Speech Therapy is a topic with growing popularity and questions. There will be more posts to come on this topic shortly. 

Speak Soon,
The Expat Speechie 

If you are a parent of a child who has been recommended to have Speech Therapy or you a teacher of a student who needs more support with their communication skills, here is everything you need to know to become familiar with Speech Therapy.

Speech Therapy aims to support children with their communication skills. This involves working on listening, understanding language, using language to express themselves, speaking skills and writing skills. It can also involve working on communication using a device such as an ipad, picture exchange and sign language.

              Who will benefit from Speech Therapy? 
              If your child or student has any of the below, they would likely benefit from Speech Therapy:

• Is delayed in their receptive language skills (understanding language). For example, has difficulty understanding age-appropriate concepts, vocabulary, instructions and questions. 
• Is delayed in their expressive language skills (using language). For example, your child is not speaking yet, or is speaking considerably less than what is expected for their age. 
• Stutters (repeats syllables, words, phrases), where this interferes with their ability to be understood, or takes away from the message which they are trying to communicate. 
• Struggles with social communication skills. For example, their body is constantly out of the group, they have difficulty with turn-taking, say inappropriate things in context, etc. 
• Has difficulty being understood by others or has unclear speech. For example, they substitute sounds, leave sounds out of words, add sounds to words, inconsistent ways of saying sounds and are difficult to understand by unfamiliar listeners.
• Has motor-speech difficulties, which is the difficulty coordinating the brain with muscles of the mouth for speaking, speech is often inconsistent and hard to understand. Sometimes a child cannot speak at all. 
• Has feeding difficulties. For example, keeping lips closed or swallowing. Also, they may be a picky eater and have a strong avoidance of certain textures.
• Has their tongue outside their mouth when breathing, eating or speaking 
• Loses their voice often or has a voice which draws attention to itself 
  
  How does a Speech Therapy work? 

             Speech Therapy is done by a Speech Therapist, who has studied Speech and Language                        
             Pathology  in University, at a Bachelor, Masters or PhD level. Speech Therapists usually follow                   this process below.

1.  The Speech Therapist will collect information about the child by speaking with parents and teachers, or through a questionnaire. The Speech Therapist will then meet the child to evaluate their communication skills.
2. Based on the evaluation findings and parent priorities, the Speech Therapist will formulate goals for the child to work on.
3. The child works on their goals in consistent Speech Therapy sessions and the Speech Therapist collects data each session to track goal progress.
4. The Speech Therapist reports on the child's progress to parents. They may either adjust their plan moving forward or dismiss the child from Speech Therapy if they meet their goals and there are no further areas to work on. 
   
   
   What approaches and techniques are used?
   Speech Therapists use a variety of techniques  from evidence-based approached. This depends on the child's areas of need, as well as, their specific training and specialty area. Here are some approaches below.

• Play-based Approaches, such as, Hanen or Floortime. These involve drawing the child into the social world to let them see the value in communicating. They are child-lead approaches and involve following the child's interests. The role of the Speech Therapist is not to instruct, but to be a play partner, while stimulating language. These approaches are suitable for children who are below 5 years who have a language delay or children who have Autism.
• Social Thinking: teaching children to think about social situations, so that they become independent problem solvers in social situations. Instead of just teaching children rules (e.g. "no touching others"), with this approach, children are presented with and encouraged to think about different social situations (personal space and the impacts on others' thoughts and feelings when we invade it), to develop a deeper understanding of social situations. 
• PROMPT: for children who have motor-speech disorders. This involves applying light touch and pressure to a child’s face, to support them with making sounds in words. The tactile prompts cue their muscles to contract for certain sounds.  
• Articulation hierarchy: this involves a step-by-step process to teaching children to say sounds correctly. The steps often involve: auditory discrimination, isolation, CV, words, phrases, sentences, reading, story retell, narrative, conversation.
• OroMyofunctional Therapy: involves exercises for correcting tongue placement in the mouth when speaking, eating and breathing. For example, using an elastic band and raising it to a point at the top of the mouth repeatedly. 
• SOS Feeding Approach: involves a systematic desensitization to food textures. For example, having the child tolerate food on the table, then their plate, then on their lips, then a bite and spit it out and finally swallow a bite. 
• Range of activities for pre school and school aged language stimulation. For example, sorting objects into categories, practicing following instructions of increased length and complexity, formulating sentences, writing a narrative, reading comprehension, etc.
  
  What is my role as a parent in Speech Therapy? Parents are encouraged to take an active role in Speech Therapy, after all, you know your child best.
• Your role may be to identify that your child is not meeting milestones, or perhaps they do not have the same level communication skills as other children their age. 
• To arrange an evaluation with a Speech Therapist, also, express your concerns and observations
• Express your priority communication areas you would like your child to work on or goals you wish for your child
• Either attend the Speech Therapy sessions or be involved with follow up about these skills with your child between their sessions 

             
             What is the role of a teacher? Teachers spend a considerable amount of time with students,                       they often know their students well and bring important information to the Speech Therapy                       process. 

• Your role may be to identify that your student is not meeting milestones, or perhaps they do not have the same level communication skills as their peers.
• To express your concerns and observations to the student's parents and discuss referring the student for a Speech Screening. The purpose of this is to determine whether or not Speech Therapy is required. 
• Collaborate with the Speech Therapist who is working with your student and follow up about these skills with your child between their sessions ​

As a parent or teacher, there are many things which you can do to support a child with their communication skills. The first step, is identifying that further support may be needed. Speech Therapists can lead the path, however, your role is invaluable in the process too. 

Speak soon,
Expat Speechie