The most common concern that parents express to me as a Speech and Language Pathologist is that their child is not talking yet. In this post, Part 1, I will discuss the different forms of communication that your child might already be using if they are not talking. In my next post, Part 2, I will advise strategies that you can implement to help your child further their language development and start using words.
Children typically start to say their first words at 12 months old, and start to combine two words together by the age of two. However, for some children it may take longer than this which can spark feelings of worry and anxiety among parents. Nevertheless, it is important to point out that communication involves much more than talking. In fact, non-verbal communication is the foundation upon which verbal communication develops. Therefore, as a parent, try to be aware of the different ways that your child communicates with you so that you can respond in a manner which encourages and facilitates communication using words. Some of the different ways your child might already be communicating with you include: 1. Your child may point to objects to draw your attention to them. 2. Your child might use their head (e.g. shake head for “no”) or hands (e.g. wave for “hello”) to convey a message. 3. Your child establishes and maintains eye contact. 4. Your child may bring objects to you. 5. Your child may pull you to objects. 6. Your child might display joint attention by looking at an object, then at you, then back at the object again. 7. Your child might be babbling (e.g. “mama”, “dada”). 8. Your child may try to imitate words you say at times but only produce a sound or a syllable. 9. Your child might make sounds during play. 10. Your child uses facial expressions to show you how they feel. If your child has not started saying their first words yet but is using some of the above forms of communication, you can help them with their language development by using some very simple strategies. These strategies will be discussed in my next article – Part2: My Child Is Not Talking Yet! Importantly, if your child is not using words yet and is also not using most of the different communication methods outlined above, I strongly recommend that you consult with a Speech and Language Pathologist. If you would like to be notified when my next article is released, subscribe to my mailing list and receive a free copy of The Speech & Language Development Table! As always, please leave any comments or questions you may have below. Speak soon, The Expat Speechie
Parents often express concerns to me that their child stutters, yet identifying stuttering is not always simple. While for some children stuttering is resolved naturally over time without intervention, for others, if it is not addressed stuttering tends to increase in severity and continues as they grow older.
So how can you identify if your child is stuttering? Become Aware Of The Different Types There are several types of stutters. Becoming aware of them will help you determine whether your child is stuttering or not. The different types of stutters include: 1. Whole-word repetitions: Your child repeats single words. Example: “I am-am-am going to school.” 2. Sound repetitions: Your child repeats a single sound in words. Example: “W-w-will you go with me?” 3. Syllable repetitions: Your child repeats a syllable in words. Example: “un-un-un-der”. 4. Phrase Repetitions: Your child repeats phrases. Example: “Good thanks - good thanks - good thanks.” 5. Blocks: When your child tries to say a word, it sounds as if the word is ‘stuck’ or being ‘blocked’ from coming out. Blocks usually indicate that your child is stuttering severely. 6. Prolongations: Your child stretches a sound in words for a long period of time. Prolongations also indicate that your child is stuttering severely. Example: “ssssssssssssnake.” 7. Frequent Interjections: Your child constantly says “um” when they speak. Example: “Um I went to um um the shop and there um I um...” 8. Frequent Pauses: Your child pauses frequently between their words. Example: “I (pause) went to the (pause) playground (pause).” Monitor Different Situations: The speech fluency of a child who stutters often varies depending on the situation that they are in. If your child stutters, it is likely that this will become more apparent when they are excited, nervous or frustrated. For instance, your child may speak fluently during dinner time but stutter severely during an argument with their sibling. To help you identify if your child is stuttering, monitor their speech fluency in different situations. Monitor Every Day: You may find that your child’s fluency varies between days, such that, they stuttered severely yesterday, but you did not notice any stutters today. This variability makes it difficult for parents to confirm that their child is in fact stuttering. However, it is important to note that even if you think that your child stutters only on ‘some days’, they are still stuttering. Consider Stuttering Severity: You can use these three indicators to determine stuttering severity: Mild stuttering: Your child stutters slightly. This will usually go unnoticed to all strangers and even some familiar people. Moderate Stuttering: Your child stutters noticeably to both familiar people and strangers. Severe Stuttering: Your child stutters frequently and this greatly interferes with their ability to express themselves. What Next? If you think that your child is stuttering, it would be beneficial to arrange a fluency assessment with a Speech-Language Therapist soon. There is a large body of scientific evidence indicating that early intervention leads to better fluency outcomes in children. As always, if you have any questions or comments you would like to share, feel free to write them below. Also, if you would like to be notified about my next post, subscribe to my mailing list and receive a free copy of The Speech and Language Development Table! Speak soon, The Expat Speechie
These days, technology is unavoidable, and the iPad in particular is just as popular among children as it is with adults. Naturally, parents have concerns about the impact that the use of the iPad has on their child’s speech and language development. In this post, I will address this concern by firstly outlining how the iPad should be used, and secondly, situations when the iPad should be avoided.
How The iPad Should Be Used: 1. To Reward Give your child access to the iPad as a reward following a positive behaviour or after they have completed a set task. This way, your child will learn the association between their behaviour/performance and receiving the iPad. This is likely to reinforce your child’s positive behaviours and give them an incentive to complete tasks. 2. Limit Daily Exposure It is completely fine for your child to use the iPad for entertainment purposes. After all, we as adults often use it this way. The key is to limit your child’s iPad exposure to one hour per day. By doing so, your child will still have many opportunities to engage in interactions in their environment, which are important for their communicative and social development. 3. Educational Tool The iPad can be used as an additional education tool. In fact, many Speech and Language Therapists, including myself, use Apps on the iPad to support some children’s learning during therapy sessions. There are several Apps which you can download for your child to practice their speech sounds, vocabulary, sentence structure, comprehension, reading skills and so forth. 4. Alternative and Augmentative Communication (AAC) Device I have seen the amazing way that certain iPad Apps can improve the quality of life of children with a disability, who otherwise, would have very limited means to communicate. These Apps can often be customised to include the child’s own vocabulary, allowing them to access these words easily during their daily interactions. Some Apps also act as the voice of a child who has difficulty speaking or being understood by others. Parents are sometimes concerned that the use of these Apps may decrease their child’s verbal output. However, the use of these Apps is actually likely to increase both the frequency and quality of children’s verbal output. When The iPad Should Be Avoided: 1. To Substitute Pretend Play Playing with toys is actually the foundation for language development. When your child plays with toys, they are learning to use symbols for actual objects, which is essentially what we do when we use language (Weitzman and Greenberg, 2002). Try to encourage pretend play at home while you limit iPad exposure. 2. During Mealtimes When a child is given the iPad during mealtimes, they often find it distracting and tend to eat less than usual. Also, when the iPad is constantly given to a child during mealtimes, the child forms an association between the iPad and food. They may start to demand the iPad to participate in eating. Try to engage with your child during mealtimes instead, to teach them the association between eating and social interaction. 3. During Tantrums I know that giving the iPad to your child when they are crying seems like a quick and effective solution. However, by doing so, you are actually rewarding your child’s unwanted behaviours. They will learn that the next time they cry, they will receive the iPad; this makes them likely to repeat these unwanted behaviours. 4. To Substitute Social Interaction There is nothing worse for an adult in a social setting than sitting next to a person who does not look up from their phone. Social engagement is very important for your child’s communicative and social development because it teaches your child how to interact with others. Try to encourage your child to engage with other children. Social interaction should not be substituted by anything, especially the iPad. As always, if you have any questions or comments that you would like to share, feel free to write them in the section below. Also, if you would like to be notified about my next post, simply enter your email address in the subscription box below! Speak soon, The Expat Speechie Reference for this post: Weitzman, E. Greenberg, J. 2002. Learning Language and Loving It: A guide to promoting children's social, language, and literacy development in early childhood settings. Toronto: The Hanen Centre. One of the biggest worries that parents have is that their child finds it hard to understand what is being said. This is important to address because it can greatly impact a child’s ability to follow instructions, respond to questions, learn in class, keep up with their peers, and follow conversations. Here are 10 things you can do to support your child's understanding. 1. Speak Slower: These days, our talking reflects the fast-paced nature of our day. When speaking to your child, try to speak using a slower pace. This will make your speech sound clearer to them and will also give them more time to process what you are saying. 2. Build Vocabulary: When your child comes across a word that they do not know, explain the meaning of this word to them. Then make a plan to use this word in a sentence a few times over the next week. By doing this with a different word each week, you are helping your child to gradually build their vocabulary, and strengthen their overall understanding. 3. Encourage Clarification: As adults, we often ask questions when we do not understand something. You can also encourage your child to ask a question when they do not understand what has been said to them. By doing so, you are teaching your child an important life-skill. 4. Emphasize: When talking to your child, try to emphasize the key words in what you are saying by increasing your volume or putting more stress on certain words. This will direct your child’s attention to what they should focus on. 5. Reword: I was once assessing a five-year-old child who could not follow my simple instruction, “point to the ball”. Eventually, I realized that the child did not understand the words “point to”. I then changed the instruction to begin with “show me” instead, and after doing so, the child correctly followed the instruction. If your child has difficulty understanding what is being said, try saying it again using different words. 6. Break Things Down: Simplify your instructions by breaking them down, rather than saying them all at once. For instance, instead of saying, “put your toys away, then brush your teeth and wear your pajamas,” you can first say, “put your toys away”. Then, once your child has completed this, you can move to the next part of the instruction, “brush your teeth”, and so on. 7. Repeat: If your child does not understand something that you have said, say it again. You can also encourage your child to ask for repetition from you and from other people when they did not hear something the first time. 8. Use Gestures: Try using your hands to make gestures when talking to your child to help them understand what you are saying. 9. Use Visual Supports: Many children who have difficulty understanding what is being verbally said to them, can usually understand much better if the same information is visually presented. If your child responds well to the latter, you can build on your child's strengths by using signs and pictures at home. 10. Model: If you ask your child to do something for the first time and your child does not understand what you mean, show them- after all, children learn from watching others around them. Speak soon, The Expat Speechie
This post will address a question that I am often asked by parents, “how can I help my child with their speech sounds?”
Firstly, it is important to mention that in some cases children do not produce speech sounds correctly because they have difficulty hearing them. Before you can help your child with their sounds, you need to be sure that your child does not have a hearing impairment. If you are concerned about this, it would be beneficial to arrange a hearing test. So how can you help your child with their speech sounds? 1. Speak using Your Strongest Language: When you speak to your child in your strongest language (or a second language that you are almost equally fluent in), you are modelling the correct way to produce sounds in that language. By speaking to your child in your second or third language, you are likely to expose them to speech sound errors, perhaps even to ones that you are unaware of. 2. Increase Your Awareness: It is very common for parents to be unaware of the speech sound errors that their child makes. Several times after I have first raised a child’s speech sound error to their parent’s attention, they have responded by saying, “I don’t know why I never noticed that they were doing that.” This is very common because you become accustomed to your child’s way of talking over time. 3. Increase their Awareness: Most of the time when children produce a speech sound incorrectly, they are unaware of the difference between their production and the actual sound. Often this is because the people they communicate with daily have come to understand their speech, despite their speech sound errors, and so there is no apparent breakdown in communication. Making your child aware of the difference is crucial, and is actually the first step in most speech therapy sessions. You can make your child more aware by using volume, stress and repetition to emphasise the difference between their production and the actual sound. Example: If your child says ‘dood’ instead of ‘good’, you can say, “the word is good… good… good starts with the g sound (make the sound) g...g… good, not dood… good ... g ...g… good.” 4. Binary Choices: When your child says a sound incorrectly in a word, ask them to evaluate this by offering them two choices – one with the correct sound and the other with the incorrect sound. Often when children are presented with a choice, they will say the word that they heard last. You should offer the choices by saying the word containing the correct sound production first, followed by your child’s incorrect production. This way you will know if your child can actually identify the correct word. Importantly, this strategy will only work if your child can already produce the target sound, otherwise they will not be able to provide you with the correct response, even if they know it. Example: If your child says ‘dood’ instead of ‘good’, you can offer binary choices by asking, “good or dood?” 5. Contextual Cues: Provide your child with a context-related cue to the target sound. For instance, the ‘s’ sound is often associated with a ‘snake’ and the ‘ch’ sound with a ‘choo-choo’ train. Eventually, your child will establish the association between the target sound and the contextual cue. Example: “Say that word again with your snake sound this time.” 6. Articulatory Cues: Many speech sound errors are due to functional reasons; often the incorrect placement of the lips, tongue or teeth. You can help your child produce a speech sound correctly by showing them how. As you say the target sound, draw their attention to your lips, tongue and teeth. You can watch them produce the sound and focus on what they are doing incorrectly with their mouth. Do not be discouraged if they are unable to respond to your cues immediately, as with all habits, it will take some time to change. 7. Verbal Cues: This is similar to ‘articulatory cues’ above, but involves you telling your child what to do with their lips, tongue and teeth. You can hold up a mirror in front of your child so they can see what they are doing in response to your verbal cues. Example: If your child says a word with a frontal-lisp, by protruding their tongue between their front teeth, you can say, “try that word again, this time keep your tongue inside your mouth.” 8. Model: When your child produces a sound incorrectly in a word, model the correct production of that sound to them. If your child is attentive during that time, encourage them to try to imitate your production. If they do not produce this correctly after three attempts, let it go to avoid frustration, and then try again the next day. 9. Praise: Children love receiving praise for their performance, especially when it comes from their parents. When you praise your child, be specific about what you are praising them for. Example: “I love how you said that great ‘s’ sound.” If you have any questions or comments that you would like to share, feel free to write in the section below. Speak soon, The Expat Speechie
Communicating with bilingual children is a topic which parents frequently raise during therapy sessions. In this post, I have chosen to address five common concerns that parents have voiced to me regarding this issue.
Common Concern 1: “What language should I use when I speak to my child?” Answer: Speak your child in your strongest language. You are your child’s primary language model. Children learn language from their environment, and much of this is attributed to their parents, who they are around most of the time. It is important to speak to your child in the language that you are most fluent in and feel the most comfortable using. When you speak to your child in your strongest language, you are providing them with a correct language model. If you speak to your child in a language that you are not fluent in, you are likely to be providing them with an inaccurate language model (e.g. exposing them to incorrect grammar) which they will also start using. Common Concern 2: “We speak more than one language at home and I am worried about the impact that this will have on my child's language development.” Answer: It is completely fine for your child to be exposed to more than one language. It is common for children to be exposed to more than one language at home (growing up, I was exposed to three languages). However, when communicating with your child, you should avoid mixing two languages in the same sentence. I know that this is easier said than done, and most people (including myself) are guilty of doing this. If you constantly struggle to find words in the language that you are using to communicate with your child, then you should consider using a different language. By using one language consistently within a sentence, you are modelling to your child the correct and grammatically appropriate way to combine words together. Common Concern 3: “I prefer to use a different language than my spouse does to communicate with my child.” Answer: Keep language person-specific. If your child is exposed to more than one language at home, try to keep each language specific to a particular person. For instance, you should consistently speak to your child in your strongest language, whereas your spouse on the other hand, should consistently speak to your child in their strongest language. It is important that you both do this consistently when communicating with your child so that your child makes the association between the person and the language to be used when communicating with them. Common Concern 4: “I tend to use different languages at different times. I’m afraid that I am confusing my child by doing this...” Answer: Keep language situation-specific. If you are fluent in two languages, you can use both of them to communicate with your child. The key is to keep each language specific to certain situations so that your child can make the association between a situation and the language that they should be using. For instance, you may want to speak to your child in one language when you are outside of your home, but in another language when you are at home. Common Concern 5: “I am worried that if I speak to my child in my native language, they will fall behind in English.” Response: It is completely fine to speak to your child consistently in your native language. Often parents voice concerns about their child’s English language development if they are speaking to them in their native language. You should not be concerned in this case because children will learn English at school and from exposure to other children. Also, because of their young age and their ability to learn, children tend to pick up English quite quickly. In fact, I often see that children whose first language was not English, eventually prefer to use English in their daily interactions. If you have any questions about this topic, or anything that you would like to share, please do not hesitate to comment below. Speak soon, The Expat Speechie Speech and Language Pathology (SLP) is an emerging profession here in Bangkok. Even though there is a growing demand for this service as more parents come to understand its value, obtaining SLP here is not always simple. This post outlines where you can access SLP in Bangkok, some challenges associated with this, and reasons why you are the best person to help your child. Where You Can Obtain SLP For Your Child 1. Schools During recent years, some schools began outsourcing SLP services. This involves a Speech and Language Therapist travelling to schools regularly (as I currently do). At present, only very few schools in Bangkok have a full-time therapist on staff. However, it is exciting that some international schools are planning to expand their Special Education Needs Program and employ full-time therapists to meet the recently growing demand. 2. Private Centres You can also obtain SLP services for your child in private child development centres (as where I am currently employed). These centres are often comprised of a multi-disciplinary team consisting of Occupational Therapists, Psychologists, Physiotherapists, Social Workers and other professionals as well as Speech and Language Therapists. 3. Hospitals Some of the larger hospitals in Bangkok have SLP services which you can access for your child in their pediatric ward. Challenges Associated with Obtaining SLP 1. Access “We just moved here and are trying to establish ourselves, we can’t afford this right now…” (anonymous parent). In Bangkok, SLP is a private service which is not funded by the government. It is also quite expensive relative to the earnings in Thai Baht. 2. Availability “We couldn’t find a therapist for three years because of where we live…when we finally found one, they went abroad to continue their studies” (anonymous parent). The number of therapists does not meet the growing demand for SLP here in Bangkok; with availability being a particularly issue for families living on the outskirts of Bangkok. Moreover, at present, there is only one SLP university course (a Masters Program) which is being taught in English here in Bangkok. 3. Awareness “I wish someone would have told me that my child has a problem earlier…” (anonymous parent). As SLP is quite a new profession here in Bangkok, there is a need for much greater awareness in the community for identifying children presenting with red flags. Also, parents are often unaware of how GREAT their impact on their child’s speech and language development can be. This is the primary reason why I chose to start this blog. Why You Are The Best Person To Help Your Child 1. You Are There - At The Right Place & The Right Time Practice is most effective when a child is alert, motivated and attentive. Though, therapists only see a snapshot of your child's ability during a specific time of the day. They also usually see your child outside of their natural environment, even though the ultimate goal of therapy is to generalise skills to daily environments. However, you have the opportunity to select the optimal practice time for your child during the day and to practice in their daily environment. 2. Your Recognition Counts Most I use a range of rewards to maintain a child’s cooperation and motivation during therapy sessions. Though, I have noticed that when a parent is in the room, the child is usually no longer concerned with rewards, but only with their parent's recognition and praise. This type of intrinsic motivation, that only you can give your child, is far more effective than anything tangible. 3. You Can Help Consistently Scientific evidence has demonstrated that therapy itself is not nearly as effective in improving a child’s speech and language skills when compared to therapy with consistent home practice. It is unrealistic for most parents to take their child to therapy five days per week due to financial and time constraints. However, you see your child every day, and so, each day is an opportunity for home practice! Consistency will result in better and quicker outcomes for your child. If you would like to see what communication skills your child should have at their age, subscribe to my blog to receive your own free copy of the Speech and Language Development Table I have compiled. If you subscribe, you will also be notified upon the release of my upcoming blog posts including:
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