Parent Education

Telegraphic Speech: An Important Milestone

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Telegraphic speech refers to a form of communication commonly used by young children as they are developing their language skills. It involves speaking in short, simple phrases, usually comprised of only the most important words needed to convey a message. These 2-3 word phrases exclude non-essential parts of speech, such as articles, prepositions, and auxiliary verbs. Telegraphic speech sounds like telegrams, where brevity was valued and filler words were left out to save time and cost.

A person typing on a computer keyboard with a speech bubble containing short, fragmented phrases

Telegraphic speech is an important phase in speech development. It emerges once children have progressed past the babbling and single-word stages, typically between 18-24 months. As children’s vocabularies grow and their cognitive abilities become more sophisticated, their sentences gradually become longer and more complex, including a wider range of grammatical structures. Telegraphic speech is a natural and expected stage of language development that signifies a child is learning to communicate their thoughts and needs effectively.

Over the last decade, research has concluded that modeling telegraphic speech with children beyond this phase of language development may hinder them from making grammatical progress. This warrants reflection for therapeutic intervention, especially among autistic populations.

Key Takeaways

  • Telegraphic speech is a typical stage in children’s language development involving short and simple phrases.
  • It is characterized by the omission of non-essential words, mirroring the concise nature of a telegram.
  • The evolution from telegraphic speech to more complex sentences indicates growth in a child’s communication skills.
  • Using telegraphic speech models beyond this phase of development may hinder grammatical progress.

Understanding Telegraphic Speech

A child pointing at simple objects: ball, cat, book

In this section, you’ll learn about the concise form of communication known as telegraphic speech, which is critical in early language development.

Definition and Characteristics

Telegraphic speech refers to the two-word phrases that children begin to use when they start speaking. This form of speech is typically observed in toddlers around the age of 18 to 24 months. It is characterized by the omission of non-essential words, leaving only the most important words to convey a message. The name “telegraphic” draws from the way telegrams were written, omitting unnecessary words to save costs.

Examples of telegraphic speech:

  • “Want cookie” instead of “I want a cookie.”
  • “See dog” rather than “I can see the dog.”
  • “Mommy up” to shorten “Mommy, pick me up.”

Characteristics include:

  • Omission of articles: “a,” “the.”
  • Skipping auxiliary verbs: “is,” “can.”
  • Leaving out prepositions: “to,” “for.”

It is a critical stage that signifies growing comprehension and the ability to express core ideas.

Role in Language Development

Telegraphic speech plays an important role in your child’s language development. This stage demonstrates that they are beginning to understand sentence structure and the concept of grammar. While their sentences are simple and lack the complexity of adult speech, this phase is fundamental for practicing communication and building vocabulary.

Your child’s ability to convey basic needs and thoughts through telegraphic speech serves as the foundation for more complex sentences. Over time, as their cognitive and linguistic abilities advance, they will start incorporating more words into their speech for clarity, eventually developing grammar and fluency that mirrors adult speech.

Progression to Full Sentences

The shift from telegraphic speech to full sentences can be expected to occur between ages two and three. Progression is evidenced by:

  • Sentence Expansion: Telegraphic speech will gradually include more words and vital sentence components.
  • Grammar Introduction: Use of prepositions, conjunctions, and articles starts to become apparent in the child’s speech.
  • Complexity: The sentences grow in complexity, reflecting a better understanding of language structure.

By the age of three, most children are capable of constructing simple, multi-word sentences that adhere to the rules of grammar more closely. In summary, telegraphic speech is essential for enabling children to communicate effectively and serves as a building block for their ongoing language learning journey.

Encouraging Language Growth

A young child pointing at objects, saying single words. Books and toys scattered around. Time passing, child using more words

Supporting language development in children is crucial, especially when they begin to use telegraphic speech, which typically consists of two-word phrases. As you foster this developmental stage, be proactive and patient, providing plenty of opportunities for language use.

Strategies for Parents and Caregivers

Talk to Your Child: Engage in regular conversation with your child using simple sentences. This exposes them to the structure and rhythm of language.

  • Read Together: Shared book reading can introduce new vocabulary and sentence structures. Eliminate non-essential words while reading to reinforce telegraphic speech patterns.
  • Simplify Your Speech: Use clear, concise language when communicating with your 18-24 month old. This makes it easier for them to imitate and learn.

Listen and Respond: When your child uses telegraphic speech, reinforce their efforts by listening and expanding on their phrases. For example, if your child says “more juice,” you might respond with “You want more juice? Here is your juice.”

  • Play Language Games:
    • Matching Games: Connect words to pictures or objects to build vocabulary.
    • Role-Playing: Act out scenes with figures or dolls to practice different scenarios.
    • Seek and Find: Hide mini objects in plastic eggs/ boxes and model an action to go with the object like “car go.”

When to Seek Professional Help

Monitor Development: Keep an eye on your child’s speech milestones. If you notice a significant delay or lack of progress in language development, consider consulting a professional. A speech pathologist can provide a thorough evaluation of your child’s language abilities and create a tailored speech therapy plan if needed.

Recognize Signs: Difficulty in following simple instructions, limited vocabulary, or lack of two-word phrases by a particular age might warrant professional advice.

Early Intervention: The earlier you seek help, the better the outcomes for your child’s language development. Speech therapy often plays a key role in supporting and accelerating language growth.

Research

While telegraphic speech is a typical phase in language development, research suggests that we should not continue modeling this speech when working with children who have language delays.

One study in 2014 by Shelly Bredin-Oja and Mark Fey of the Kansas Medical Center concluded that “providing a telegraphic prompt to imitate does not offer any advantage as an intervention technique.” Another study by Courtney Venker suggested that parents using higher rates of telegraphic speech with their autistic children negatively impacted these children from developing language skills two years later. These findings reveal that using telegraphic speech with children beyond this phase may hinder grammatical language development.

Frequently Asked Questions

Telegraphic speech is a normal phase in linguistic development where children communicate using short and simple constructions. This phase typically excludes unnecessary words, making the speech sound abrupt, much like an old-fashioned telegram.

Do all toddlers use telegraphic speech?

Yes, toddlers often begin to use telegraphic speech when they are between 18 to 24 months old. It marks an important phase in language development.

How does telegraphic speech manifest in children with autism?

In children with autism, telegraphic speech may manifest similarly to their peers but can extend beyond the typical age range. These children may particularly omit function words and might rely on this mode of speech for longer as they develop language skills at different rates.

How is telegraphic speech addressed in a psychological context?

Psychologists consider telegraphic speech a natural and expected stage in language acquisition. It serves as an indicator of typical cognitive and language development and is not usually a cause for concern unless it persists beyond the expected age range alongside other delays.

Speech Development in Babies: From Babbling to First Words

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Three infants seated at a table with balls

Speech development in babies is a fascinating and vital aspect of their growth, revealing the intricate process in which infants learn to communicate with the world around them from babbling to first words. From the very first coos and babbles to the formation of syllables and first words, this developmental milestone is crucial for social interaction and cognitive development. Comprehension goes hand in hand with speech as babies begin to understand and respond to language, setting the foundation for effective communication. As caregivers, there is much you can do to begin laying the foundation for communication with your little loves.

Babies babble, point, and smile while engaging with caregivers. They respond to sounds, gestures, and facial expressions, building social and communication skills

Social development in infants is characterized by their increasing ability to interact with others and the environment. This includes the capacity for shared attention, turn-taking, and recognizing social cues, which are essential for building relationships and understanding social norms. Interaction and attachment are also key components of a baby’s development. Between 0-3 months, infants are already socializing through brief eye contact while feeding, recognizing varying caregiver tones, and smiling for the first time upon seeing and/ or hearing a caregiver. The attachment formed between a baby and their caregivers, often through consistent and sensitive interactions, fosters a sense of security and trust, which influences their ongoing emotional and social growth.

Key Takeaways

  • Babies’ speech and comprehension advancements are critical for communication and cognitive growth.
  • Social development is characterized by the ability to interact with others and recognize social cues.
  • Secure caregiver attachment is essential for a baby’s emotional and social well-being.

Babbling to First Words

A baby babbles and gestures, while a caregiver listens and responds, creating a nurturing and interactive environment for early speech, comprehension, and social development

In the first year of life, your baby will progress from simple cooing to uttering their first words, beginning with the foundational babbling stage which paves the way to meaningful speech and comprehension.

Cooing: When do Babies Start to Coo?

Babies may start making cooing sounds as early as 6 weeks, leading to the growth of their verbal skills. By 2 months old, you should hear your baby making noises similar to vowels that mimic laughter.

Babbling: When do Babies Start Talking Gibberish?

  • Around 3-6 months, your baby may begin babbling, producing repetitive consonant-vowel combinations, which is a critical precursor to language development.
  • By around 6 months, you may notice your baby laughing and cooing to show happiness, an initial form of social interaction.
  • Sounds progress in variation near 6-9 months making this an opportune time to play early games like peek-a-boo to model, “mama”, “dada”, “baba”.
  • Music is another wonderful way to stimulate early sounds.

First Words: When Should Baby Say “Mama” and “Dada”?

Expect your baby to say their first word between the age of 9 to 12 months. Common first words are “mama” or “dada,” though at this stage, they may not fully grasp the specific parental association. Many babies say “mama” and “dada” by their first birthday with intention.

Sound Play: When do Babies Imitate Sounds?

Comprehension: What do Babies Understand?

  • Early signs of comprehension may be seen in infants between 0-3 months when they cease fussing upon hearing a familiar voice or move limbs when a parent uses a pleasant voice.
  • Understanding gradually develops, with name recognition typically emerging between 3-6 months, followed by consistent responses to commands like “no” and “want up.”
  • From around 9 months old, babies start understanding simple commands like, “give”. They look at objects and familiar people when named and begin to recognize some body parts.
  • Notably, waving usually occurs by 9-12 months, indicating an understanding of gestures associated with language.

Attachment and Social Interaction Milestones

Babies reaching for toys, babbling, and making eye contact with caregivers. Smiling and responding to sounds and gestures

Your baby’s journey through early speech and social development is marked by key milestones. Understanding these benchmarks helps you support and nurture your baby’s communication and bonding skills.

Emotional Engagement

During the first few months, cooing serves as the foundation for your baby’s future social communication. Around 2 months old, when babies start making cooing sounds, marks the beginning of speech development and their interaction with the world. Your baby’s emotional engagement grows alongside their cooing. In addition to cooing, babies cry when hungry and to get attention in their early months, with varied cries indicating different needs.

Social Play and Interaction Development

As babies grow, their interactive abilities gain complexity. They become more responsive in social situations and their sounds start to include babbling, or what is sometimes referred to as “talking gibberish.” This stage is crucial for social play and the progression towards meaningful speech.

Interactive play involving back-and-forth exchanges with caregivers fosters social and language skills. Peek-a-boo, for instance, is not just a game; it teaches your baby about communication, turn-taking, and emotional connections. Beyond playing this game with your infant, you can read books like, Peek-a-Baby by Karen Katz and Peek-a-Who? by Nina Laden.

Recognizing Social Cues and Imitation

Babies can recognize social cues and imitate sounds quite early in their development. Interactions where they engage in mimicking facial expressions or sounds are crucial for their social and communication skills. Play with your infant while looking in a mirror by clicking your tongue or blowing raspberries. Model animal sounds, especially those with make with our lips like, “ba, moo, woof”.

Playing with toys also becomes a form of social interaction where you can see your baby’s comprehension and imitation abilities:

  • As early as 4-6 months, babies may begin to grasp and play with toys, setting the stage for future social play and interaction.
  • Look for toys and objects with various textures that are great for exploring and grasping!
  • Find toys that support engagement between you and your child. Demonstrate, model, and support baby in playing with toys.

Gestures and Physical Expressions

Babies engage in social interaction, using physical expressions and speech to develop comprehension and social skills. They interact with others, showing curiosity and responsiveness

In the journey of your baby’s development, physical expressions serve as the building blocks of social interaction. This section focuses on how these gestures, such as clapping, waving, and pointing, are pivotal for engaging with others and understanding social cues.

When Should Babies Clap?

Your baby will likely start to clap hands around 9 to 12 months of age, which is a joyful way for them to show excitement and communicate. They can sit on their own and have more control over their limbs and hands to communicate with gestures like clapping. 

When do Babies Wave?

As they approach their first birthday, you may observe your child beginning to wave goodbye, which symbolizes their growing awareness of social norms and relationships. Two wonderful books for encouraging gesture and sign development are My First Baby Signs by Linda Acredolo & Susan Goodwyn and If You’re Happy and You Know it by Annie Kubler.

When Should Your Baby Point?

Pointing with one finger often emerges by the end of the first year through 15 months, serving as a non-verbal tool for your baby to express interest or desire towards an object or direction. Books that foster pointing through touch:

Gestures and physical expressions lay the groundwork for a baby’s use and understanding of the social cues that are critical for communication.

Frequently Asked Questions

A group of babies engaging in various activities, such as babbling, listening, and playing together, while caregivers observe and interact with them

Understanding the progress and stages of your baby’s development can provide reassurance and guidance as you assist their growth. The questions below are designed to directly address common concerns related to speech, comprehension, social development, and attachment.

What are the key milestones in speech development for babies?

In the first year, babies typically begin to babble and may say simple words like “mama” or “dada.” By the end of their second year, most children can use about 50 words and start combining them into 2-word phrases. As your baby’s vocabulary expands with both nouns and verbs, you’ll notice these phrases beginning to emerge.

How can parents support their child’s comprehension development in the early years?

You can aid your child’s comprehension by consistently talking to them, reading books, and explaining and naming the environment around them. Encourage their attempts to communicate and participate in these mini conversations. Below are some classic books to foster comprehension:

How does early interaction and attachment influence a baby’s development?

Secure attachment, formed through consistent and responsive caregiving, leads to better emotional regulation and social relationships. Positive early interactions directly support cognitive and language skills, fostering a foundation for healthy development.

At what age should a child typically start forming clear, understandable words?

Most children start to form clear, understandable words between 12 and 18 months. They gradually improve clarity and expand their vocabulary as they approach the age of two.

Bedtime Stories: Great Time For Boosting Speech & Language

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ethnic mother and little kids reading book in bed

Bedtime Tales: Boosting Speech & Language Skills with Stories

a family reading a book on the bed

In today’s digital age, where screens dominate our children’s lives, the power of storytelling remains a timeless tradition. Bedtime stories not only engage and captivate young minds but also offer a unique opportunity to boost speech and language skills. By immersing children in the magical world of stories, parents can help them develop crucial communication skills that will serve them throughout their lives.

Through the art of storytelling, children are exposed to a rich vocabulary, varied sentence structures, and complex characters and plots. Listening to stories stimulates their imagination and enhances their ability to express themselves verbally. While listening to bedtime stories, children naturally enhance their pronunciation and fluency by picking up on the rhythm of language.

Furthermore, bedtime stories provide a safe space for children to explore emotions, solve problems, and develop empathy. By empathizing with storybook characters, children learn to identify and articulate their own feelings, enhancing their emotional literacy.

Discover bedtime story benefits and practical tips for a cherished tradition in this article. So snuggle up, grab a favorite book, and embark on a journey that not only entertains but also nurtures your child’s speech and language skills

How Bedtime Stories Can Enhance Speech and Language Skills

Stimulating speech and language skills through story reading is crucial during early childhood development as it fosters vocabulary expansion and comprehension. Reading stories aloud helps your child better understand and interpret sounds, words, and sentences, boosting their listening skills. Engaging in storytelling activities also strengthens parent-child bonds and encourages a love for reading from an early age.

Bedtime stories offer a fun and engaging way to enhance speech and language skills in children. When children listen to stories, they are exposed to a wide range of vocabulary, sentence structures, and language patterns. This exposure helps them expand their vocabulary and develop a better understanding of how words and sentences are used to convey meaning.

The use of descriptive language in stories also aids in the development of expressive language skills. Children learn to describe characters, settings, and events, using adjectives and adverbs to paint a vivid picture in their minds and express their thoughts and emotions.

Additionally, stories provide opportunities for children to practice listening skills. As they follow the plot and understand the sequence of events, they develop their ability to pay attention, concentrate, and follow instructions. This is especially important for children who may struggle with attention deficits or auditory processing difficulties.

Benefits of Bedtime Stories for Children’s Cognitive Development

ethnic mother and little kids reading book in bed

Bedtime stories not only enhance speech and language skills but also offer numerous cognitive benefits for children. When children engage with stories, their cognitive abilities are put to work as they make connections, analyze information, and develop critical thinking skills.

Story comprehension requires children to make predictions, infer meaning, and draw conclusions. This process stimulates their cognitive development and helps them develop problem-solving skills. As children encounter various characters and situations in stories, they learn to analyze and evaluate different perspectives, fostering their ability to think critically and empathize with others.

Furthermore, the imaginative aspect of storytelling activates children’s creativity and encourages them to think outside the box. By envisioning story settings and characters, children exercise their creative muscles and develop their capacity for imaginative thinking.

Choosing the Right Stories for Speech and Language Development

Selecting appropriate stories for speech and language development is essential to maximize the benefits of bedtime stories. When choosing books, consider the following factors:

1. Age-appropriate content: Select stories that are suitable for your child’s age and developmental stage. Younger children may benefit from simple, repetitive stories with clear illustrations, while older children can handle more complex narratives.

2. Rich vocabulary and varied sentence structures: Look for books that introduce new vocabulary and expose children to different sentence structures. This will help expand their language skills and challenge their cognitive abilities.

3. Engaging and relatable themes: Choose stories that are engaging, relatable, and capture your child’s interest. Children are more likely to stay engaged and actively participate in storytelling sessions when the themes resonate with their experiences and emotions.

4. Interactive elements: Seek out books that encourage participation, such as stories with repeated refrains or interactive elements like lift-the-flap pages. These interactive elements can enhance engagement and make storytelling sessions more enjoyable for children.

By considering these factors, you can ensure that the stories you choose align with your child’s speech and language development goals, making bedtime storytelling an effective tool for nurturing their communication skills.

Incorporating Storytelling Techniques to Engage Children

To make bedtime storytelling sessions even more effective, you can incorporate various storytelling techniques to engage children and enhance their speech and language skills. Here are some techniques to try:

  • Use expressive and animated storytelling: Bring characters to life by using different voices, facial expressions, and gestures. This will captivate your child’s attention and make the story more engaging and memorable.
  • Pause and encourage responses: Pause at key moments in the story and ask questions to encourage your child to participate. This can be as simple as asking them what they think will happen next or how a character might be feeling.
  • Encourage retelling and sequencing: After reading a story, ask your child to retell the main events or sequence them in the correct order. This helps develop their comprehension skills and strengthens their ability to organize information.
  • Explore different perspectives: Prompt your child to consider different perspectives by asking questions about the characters’ motivations or how they would have solved a problem differently. This encourages critical thinking and empathy.

Incorporating these techniques into your storytelling sessions will not only make them more enjoyable but also provide valuable opportunities for your child to practice and develop their speech and language skills.

Tips for Parents and Caregivers to Make Bedtime Storytelling Effective

mother and daughter lying on bed while reading a book

To make bedtime storytelling sessions as effective as possible, here are some tips for parents and caregivers:

  • Establish a consistent routine: Set a regular time for bedtime storytelling to create a sense of anticipation and make it an integral part of your child’s bedtime routine. Consistency helps children feel secure and reinforces the importance of storytelling.
  • Create a cozy and comfortable environment: Make the storytelling environment comfortable and inviting. Dim the lights, use soft cushions or blankets, and eliminate distractions to create a calm and focused atmosphere.
  • Be enthusiastic and engaged: Show genuine enthusiasm and interest during storytelling sessions. Your enthusiasm will be contagious and help captivate your child’s attention.
  • Allow for interaction and discussion: Encourage your child to ask questions, make predictions, and share their thoughts and feelings about the story. This interaction promotes active engagement and enhances their speech and language development.
  • Personalize the stories: Relate the stories to your child’s experiences, emotions, or challenges. This personal connection makes the stories more meaningful and encourages your child to actively participate in the storytelling process.

By following these tips, you can create a nurturing and effective bedtime storytelling routine that not only enhances speech and language skills but also strengthens your bond with your child.

Recommended Bedtime Stories & Resources for Boosting Speech and Language Skills

Choosing the right books and resources can greatly enhance the impact of bedtime storytelling on speech and language development. Here are some recommended books and resources:

1. “The Very Hungry Caterpillar” by Eric Carle: This classic picture book introduces children to basic vocabulary and sequencing through a charming story.

2. “Giraffes Can’t Dance” by Giles Andreae: This rhyming story celebrates individuality, self-expression, and the importance of believing in oneself. It promotes expressive language and emotional literacy.

3. “The Gruffalo” by Julia Donaldson: This imaginative story introduces children to descriptive language, rhyming patterns, and creative problem-solving.

4. Speech and language therapy resources: Online platforms and apps such as Speech Blubs, Articulation Station, and Tactus Therapy offer a wide range of interactive games and activities designed to support speech and language development.

These are just a few examples, and there are countless other books and resources available to support speech and language development. Explore different genres, themes, and authors to find the ones that resonate with your child’s interests and developmental needs. Subscribe to our email list below to receive a free ebook! You’ll get 65 stories for bedtime, grouped by theme, every month of the year.

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Speech and Language Therapy Techniques That Can Be Integrated into Storytelling

For children with specific speech and language difficulties, integrating speech and language therapy techniques into storytelling can provide additional support. Here are some techniques that can be incorporated:

1. Articulation practice: Choose stories that include words or sounds your child needs to practice. Encourage them to repeat and pronounce these words correctly during the storytelling session.

2. Vocabulary building: Pause during the story to introduce and explain new vocabulary words. Encourage your child to use these words in sentences or retell the story using the newly learned vocabulary.

3. Sentence expansion: Model and encourage your child to expand on simple sentences used in the story. For example, if the story says, “The cat sat,” prompt your child to say, “The fluffy cat sat on the warm mat.”

4. Narrative skills: Help your child develop narrative skills by discussing story elements such as characters, setting, problem, and solution. Encourage them to retell the story using proper sequencing and descriptive details.

By integrating these techniques into storytelling sessions, you can turn bedtime stories into effective speech and language therapy sessions tailored to your child’s specific needs.

Conclusion: The Power of Bedtime Stories in Nurturing Speech and Language Skills

Bedtime stories offer a wealth of benefits for children’s speech and language development. By exposing children to rich vocabulary, varied sentence structures, and engaging narratives, stories help expand their communication skills and enhance their expressive language abilities. Additionally, storytelling provides a safe space for children to explore emotions, develop empathy, and strengthen their cognitive abilities.

By choosing the right stories, incorporating storytelling techniques, and engaging in interactive activities, parents and caregivers can make bedtime storytelling an effective tool for nurturing speech and language skills. The consistent practice of bedtime stories not only fosters speech and language development but also strengthens the bond between parent and child.

So, snuggle up, grab a favorite book, and embark on a journey that will not only entertain but also nurture your child’s speech and language skills. Storytelling unleashes your child’s communication potential, paving the way for lifelong success.

Why is Mean Length of Utterance (MLU) Important?

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mother and baby girl reading a book

Unlocking the Power of Language: Understanding Mean Length of Utterance (MLU)

kids sitting on green grass field

Language is a powerful tool that allows us to communicate our thoughts, express our emotions, and connect with others on a deeper level. But have you ever wondered how language develops in young children? How do they progress from babbling to forming coherent sentences? One way to measure a child’s language development is by measuring their Mean Length of Utterance (MLU). In this article, we will explore the concept of MLU and its importance in understanding language development.

MLU, or Mean Length of Utterance, measures how many words or parts of words your child typically uses when speaking. It helps track their language development, including vocabulary and grammar growth. By analyzing a child’s MLU, speech pathologists can assess language milestones, identify potential language delays or disorders, and design appropriate interventions.

Understanding MLU is not only crucial for professionals working with children but also for parents who want to support their child’s language development. By unlocking the power of language through MLU, we can foster better communication, enhance social relationships, and open doors to a brighter future for young learners.

Join us as we dive into the fascinating world of MLU and discover how it can unlock the potential of language development in children.

anonymous ethnic tutor helping little multiracial students with task in classroom

How to calculate MLU

Calculating MLU involves analyzing a child’s spoken or written language samples and determining the average number of words or parts of words per utterance. To calculate MLU, follow these steps:

1. Speech pathologists collect a representative language sample from the child. This is typically done during play with the therapist limiting questions and opting for probes to unleash more language. For example, we may say, “Tell me about your favorite toys/ games/ vacation” rather than ask a question that would yield a single word answer.

2. We typically record the language sample to write out sentences later.

3. Next, we count the total number of words or morphemes in the sample. A morpheme is the smallest meaningful unit of language, such as a word or a prefix/suffix. When we calculate MLU, we count morphemes, which are the smallest units of meaning in a word. In “running,” “run” is one morpheme and “-ing” is another, making it two morphemes.

4. Finally, we divide the total number of words or morphemes by the number of utterances (words/phrases/sentences) to obtain the mean length of utterance.

For example, if a child’s language sample consists of 20 utterances with a total of 100 words, the MLU would be 5 (100 words divided by 20 utterances).

Milestones in child language development

MLU milestones indicate the progression of language development in children. As children acquire new language skills and vocabulary, their MLU increases. Here are some general MLU milestones based on age:

  • 12-26 months: At this stage, children typically have an MLU of 1-2 words. They focus on single-word utterances, such as “ball” or “dog.”
  • 27-30 months: MLU expands to 2-3 words as children begin to combine words to form simple phrases or sentences. For example, “want juice” or “big car.”
  • 31-34 months: MLU increases to 3-4 words, and children start using more complex sentence structures. They may use questions like “Where is my toy?” or make statements like “I like ice cream.”
  • 35-40 months: MLU reaches 4-5 words, and children develop more advanced sentence structures. They use conjunctions like “and” or “but” to connect ideas, and their sentences become more grammatically complex.
  • 41-46+ months: MLU continues to grow, and children become more proficient in using complex grammatical structures and expanding their vocabulary.

It is important to note that these milestones are general guidelines, and individual children may progress at different rates. MLU milestones provide a framework for assessing language development but should not be used as the sole indicator of a child’s language skills.

Influential Factors

Several factors can influence a child’s MLU and language development. These factors include:

1. Language exposure and input: The amount and quality of language a child is exposed to can impact their MLU. Children who have rich language environments and frequent interactions with caregivers tend to have higher MLU.

2. Cognitive abilities: Cognitive abilities, such as memory and attention, play a role in language development. Children with stronger cognitive skills may have higher MLU as they can process and produce more complex language.

3. Socioeconomic status (SES): Socioeconomic factors can influence a child’s language development. Children from lower SES backgrounds may experience fewer language-rich environments and have lower MLU compared to their peers.

4. Language disorders or delays: Children with language disorders or delays may have lower MLU compared to typically developing children. MLU can be used as a diagnostic tool to identify potential language difficulties and guide intervention strategies.

5. Bilingualism: Bilingual children may have different MLU patterns depending on their language exposure and proficiency in each language. MLU calculations need to consider both languages when assessing language development in bilingual children.

Understanding these factors can help professionals and caregivers identify potential challenges or areas that require additional support in a child’s language development.

Using MLU as a diagnostic tool for language disorders

MLU is a valuable diagnostic tool for identifying language disorders or delays in children. A lower MLU than expected for a child’s age may indicate potential language difficulties that warrant further assessment and intervention. MLU analysis can help professionals determine if a child is experiencing difficulties with vocabulary acquisition, grammar, or syntactic structures.

MLU, when combined with other language assessments and observations, provides a comprehensive picture of a child’s language skills. It assists in identifying specific areas of language that may require intervention, such as phonological disorders, expressive or receptive language disorders, or pragmatic language difficulties.

Early detection of language disorders is crucial for effective intervention and support. MLU serves as an objective measure that helps professionals make informed decisions and develop targeted intervention strategies to address a child’s specific language needs.

Strategies to promote MLU growth in children

mother and baby girl reading a book
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Promoting MLU growth in children involves creating language-rich environments and providing opportunities for meaningful interactions. Here are some strategies to support MLU development:

  • Engage in interactive conversations: Have frequent conversations with children, encouraging them to respond and express their thoughts. Ask open-ended questions, provide descriptive feedback, and expand on their utterances to model more advanced language structures.
  • Read aloud and encourage storytelling: Reading books aloud and encouraging children to tell stories helps develop vocabulary, sentence structure, and narrative skills. Engage in discussions about the stories, ask questions, and encourage children to express their opinions and ideas.
  • Play language-rich games: Engage children in language-rich games, such as “I Spy” or “Simon Says,” that encourage vocabulary development, turn-taking, and following instructions. Incorporate new words and concepts into the games to expand their language skills.
  • Use visual aids: Visual aids, such as picture cards or drawings, can support language development by providing visual cues and prompting discussions. Use visuals to help children make connections between words, objects, and concepts.
  • Provide opportunities for peer interactions: Encourage children to interact with peers, as peer interactions promote language development and MLU growth. Arrange playdates or group activities where children can engage in conversations, share ideas, and practice using language in social contexts.

By implementing these strategies, caregivers and educators can create language-rich environments that foster MLU growth and support overall language development in children.

Conclusion: Emphasizing the value of MLU in language assessment and intervention

Mean Length of Utterance (MLU) is a powerful measure that unlocks the potential of language development in children. By analyzing MLU, speech pathologists and caregivers can gain valuable insights into a child’s language skills, identify potential language delays or disorders, and design targeted interventions. MLU serves as a diagnostic tool, guiding language therapy and promoting MLU growth through language-rich environments, interactive conversations, and engaging activities.

Understanding MLU empowers us to support children in their language development journey, fostering effective communication, enhancing social relationships, and opening doors to a brighter future. By unlocking the power of language through MLU, we enable young learners to express themselves, connect with others, and thrive in all aspects of life.

Four Qualities to Look for in Toys to Promote Speech

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Baby holding a play phone next to its ear

Embark on a journey to uncover the essential features that make toys the ideal tools for promoting speech development.

One of my primary missions in my speech and language practice is to educate families on the importance of opening the doors to communication.  Speech is so much more than talking.  It is listening, comprehending, taking turns, gesturing, commenting, asking and answering questions, and requesting to name just a few.  The right toy can set the stage for many of these opportunities.

Throughout the year, parents often ask me for advice on toy/ gift ideas, especially near their child’s birthday and holiday season.  Some toys are better than others, as they contain certain features important for supporting speech and language development. The toys that catch my eye typically have four things in common:

They make HARDLY ANY noise

portrait photo of woman with brown curly hair doing the shhh sign

I am probably not the first SLP to make this comment and I surely will not be the last!  Bottom line is that we want the kids to do the talking.  Sometimes that talking is a sound or part of a word and sometimes it is a word/phrase/sentence.  It’s nice to be able to hear these moments without interruptions. Some of my favorite, quiet, interactive toys are: Critter Clinic Toy Vet Set, Fisher Price Farm House, Stacking Blocks, Ring Stacking Toy that Spins, Barnyard Bingo, Melissa and Doug’s Wooden School Bus, Matchbox Cars, and dolls.

While we are on the topic of noise, do not fall into the trap in thinking that an electronic book option is any better than a noise-making toy.  In my opinion, you should always opt for a quiet interactive book like a lift-the-flap or sensory-enriched option with touch and feel textures if you want your child to progress in his speech and language skills.

Now, having said that, a good, old fashioned single, noise making toy never hurt anyone.  For example, the Elefun makes a whirling sound when activated and I’m okay with that because it motivates kids to request “more”, “go”, and “stop.”  I also love a good ball popper for bringing out some laughter and excitement, which in turns fosters speech and language usage.

The bottom line is: I steer clear of those toys that kids get trigger happy with and all you hear are a million sounds and words all at once.  Not fun.  Personally, I avoided noisy, talkative toys when my son was little and I have lived quite happily in my SLP world for a couple decades without all the noise.

They fit right in with my theme

Christmas decorations

Herein lies my year-round shopping problem.  I’m always looking to add materials to my theme units.  I cannot help myself.  I have to admit that I love bringing out the Fisher Price Thanksgiving sets and Holiday train, Learning Resources camp fire sets, and Super Duper magnetic fish.

One toy that can be used for birthday, Valentine’s Day, and Christmas themes is Mini presents by Learning Resources. First, the client opens a mini box; takes out the object; and then I label it several times while placing it down on a picture of number one.  This continues until we get to three total choices.  Finally, I ask clients to “get/give me” a targeted object.  This super cute set has been fun for my 4-6 year old clients.  You can even target pronouns by using a baby doll and practicing, “She wants a purple gift.”

When seasonal toys are only available for a short amount of time, I think you get more bang for your buck from them.  It’s the same concept of rotating toys in your home so the old ones feel like new when you cycle through them.  For more details on some of my favorite, summer toys, visit my post on seven of my favorites!

They stand the test of time

Baby holding a play phone next to its ear

This rationale is two part: durability and traditional.  I like a toy that can take a beating and clean easily, so I reach for the plastic Velcro foods and walk right by felt food.  If I cannot clean them fast with a Clorox wipe, then I cannot have them in my therapy closet.  While there are always cute, new toys being released, I stick with traditional themes like Mr. Potato heads to work on learning about body parts.  Another great option is any toy that is alphabet-related.  Two of my favorite hits for kids aged 2-8 years old are ABC puzzles and alphabet toys.  What better way to work on letter-sound recognition than with toys?!

You can perform a few different functions with them

baby in a chef hat playing with a toy kitchen in a chef hat

Your child’s speech and language development builds alongside play.  The more opportunities you can create to further communication with your child, the better.  For example, I prefer a small collection Velcro foods over a 100 piece set of foods that are static. 

Having something to do with the object helps you model and teach a functional sequence.  In this case, you can gather all the Velcro foods and sort them to make a salad.  Then, you “cut” each item and put them in a strainer for rinsing.  Finally, you “dry” the slices and transfer them to a bowl.  Modeling these real-life events supports teaching your child to make connections with a sequence he has seen before, which in turns strengthens memory skills.

In conclusion, when it comes to selecting toys for speech development, prioritizing those that make hardly any noise, fit the session’s theme, endure over time, and offer versatility is key. These criteria ensure engagement, continuity, and diverse learning opportunities, laying the foundation for effective speech therapy sessions. By choosing toys thoughtfully, you empower your child to thrive in their language journey while making learning enjoyable and effective.

Why Did My Child Qualify For Articulation Therapy?

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Woman holding the letter S with child imitating a touch cue in speech therapy
Bowl of pastel colored alphabet letters

ARTICULATION

Why is understanding the journey of speech sound development crucial, and what is the basis for evaluation and treatment in articulation therapy? Making progress in speech development starts with understanding the evaluation and treatment process for articulation delays, as discussed in this post.

In this comprehensive guide, we will navigate the journey of speech sound development and discuss the basis for evaluation and treatment in articulation therapy. Understanding the milestones and stages of speech sound acquisition is crucial for identifying potential delays and designing effective intervention plans. Articulation therapy, distinct from phonological and childhood apraxia of speech therapies, targets specific speech sound errors to enhance clarity and pronunciation. We’ll explore the various assessment methods used to evaluate speech sound production and discuss evidence-based treatment approaches.

Additionally, we’ll highlight the pivotal role of home programming in reinforcing therapeutic gains and supporting speech progress beyond the therapy room. Join us as we navigate through the fundamentals of speech therapy and empower caregivers with practical strategies for facilitating speech development in children.

Milestones and the Evaluation Process:

Speech pathologists assess speech sound development using a test battery containing all consonant sound targets. Most of the time, a child with an articulation delay can produce vowels accurately, but not consonant sounds.  If your child hasn’t mastered age-expected sounds, their score may indicate therapy is necessary. The chart pictured below is my all-time favorite speech development reference tool from 1972 for parents.  I particularly like how it displays the wide range for development of each sound target.

Speech Sound Development Chart

Some children need more time to master sounds with any number of factors influencing that timeline. Ear infections, fluid buildup, wax, growth, attention issues can delay sound mastery for months or years in some children.

In 2018, McLeod and Crowe published a study updating developmental expectations for speech sound development. Note that these researchers suggest that all speech sounds are acquired by six years. Under these guidelines, more children may qualify for speech services.

McLeod-Crowe-2018-English-consonants-Treehouse-A4

After the Evaluation:

You just learned that your child is eligible for speech services due to an articulation delay.  If you are in early intervention, then you likely will not see specific sound targets in your treatment plan, but that all changes in an IEP- Individualized Education Plan.

Let’s walk through the meetings that lead to an IEP in the school system. First, attend a brief referral meeting at the school to determine testing needs with the team. A couple months later, you will reconvene and review all test results.  If your child qualifies for speech, then you will create an IEP at that eligibility meeting.  Listen carefully to the goals for speech articulation, which are written to be met in one year.  Given that these goals must be achieved in a year, they should be concise, measurable, and appropriate for your child’s age.

Here is an example of an achievable objective, focusing on an early sound production: Increase accuracy of /b/ in all positions (i.e., ball, cowboy, web) of words with 85% accuracy.

Here is an example of a lofty goal which should be divided into smaller components as there are 18 objectives in this one example: Increase accuracy of /p, m, h, n, w, b/ in all positions at the word level with 85% accuracy.

In summary, you have the right to ask questions during any meeting, be it for eligibility or treatment planning. If goals seem unattainable, express concerns during IEP meetings. Parents are one of the most important team members because you know your child best!

Therapy:

Woman holding the letter S with child imitating a touch cue in speech therapy

Your child needs articulation therapy when he substitutes or distorts one or more sounds.  For example, he may substitute the /w/ for /r/ in the word rabbit or distort the /l/ in the word ladybug such that the /l/ does not sound clear and crisp. In articulation therapy, we teach lip and/or tongue placement for target sounds. Here, we progress from isolated sounds to sentences and practice sounds in all word positions: initial, medial, and final. So, someone working on the /s/ sound may practice “sun”, “glasses”, and “cats.”  Typically, we look at mastery in one position before moving onto another.  We target developmentally appropriate sounds and increase the level as the child progresses.

Homework:

Your speech pathologist will want your child to practice sound targets at home once progress is noted in treatment sessions. Waiting for accuracy is crucial; clients who practice at home generalize skills, reducing therapy time and ensuring error-free practice.

Conclusion

In summary, understanding speech sound development lays the foundation for effective evaluation and treatment of articulation disorders. By incorporating home programming into therapy plans, caregivers can play a crucial role in reinforcing progress outside of sessions. Consistent practice in natural environments enhances therapy outcomes and promotes long-term speech proficiency.

Childhood Apraxia of Speech CAS: Why it’s Treated Differently

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Boy whispering into a girls' ear

Parents with young child holding book

Childhood Apraxia of Speech (CAS) is distinctly different than articulation and phonological delays with regards to evaluation, diagnosis, and treatment. If you’re confused about your child’s speech delay, it’s best to consult an experienced speech pathologist in a timely manner. At the end of this post, I share some resources for finding that speech pathologist in your area.

The late Pam Marshalla, a renowned Speech Pathologist, said it best in the opening to her book, Apraxia Uncovered- Seven Stages of Phoneme Development, “Children with apraxia and dysarthria do not respond well to traditional speech therapy methods and procedures, rather they need a therapy that actually teaches them how to make their speech mechanism function correctly.”  Explore causes, theories, and defining characteristics of apraxia and how it differentiates from speech delays.

What is Apraxia?

Apraxia of speech is a condition that impacts one’s ability to plan sequential movements for speech productions.  According to a well-known researcher and diagnostician, Dr. Edythe A. Strand, “Apraxia is due to deficits in the planning and programming of movement gestures for speech production.”  Like dysarthria, apraxia can be acquired or developmental.  Probably the most frustrating thing about a developmental apraxia diagnosis for some families is that it’s cause is unknown.

In cases with unknown causes, experts theorize about issues like motor planning or breakdowns in language processing, but definitive answers are lacking. These theories suggest problems with language frameworks or sensory-motor integration affecting speech. Effective therapy targets individual needs.

Common Characteristics of Apraxia

In the video clip below, a young child with CAS uses vowel distortions and has difficulty producing multiple syllable words.

Below is a list of characteristics common to many clients with apraxia of speech. This information was adapted from an informative website, www.apraxia-kids.org:

  •  Errors on vowel productions
  •  Variety of errors for one sound target (For example, may produce “mat”, “sat” or “hat” for the word “cat”)
  •  Awkward speech movements, sometimes with groping that makes speech look difficult
  •  Productions that are difficult to understand or distorted
  •  Increase in errors as length or complexity of words increases
  • They may correctly say a target sound once but struggle to repeat it
  •  More success with producing a word in a conversation, but cannot imitate the same  word when asked
  • Slower rates/speeds when talking because sequencing sounds/words is such a struggle
  • Awkward prosody with limited to no use of stress on words, making speech sound robotic
  • Significant difficulty with repetitions
  • Age appropriate receptive/comprehension ability.  Your child knows what he or she wants to say, but can’t sequence the complicated stages necessary for speech

How does CAS Differ from Dysarthria?

Dysarthria is an impairment in muscle movements for speech caused by damage in the central or peripheral nervous system. In many cases, dysarthria has a clear medical diagnosis, affecting muscle tone. Speech might sound weak, strained, or slurred, making it hard to understand. Therapy sessions focus on individual needs and may include oral motor exercises.

The common thread between dysarthria and apraxia is that both significantly impact a child’s ability to tell his articulators (lips, tongue, palate) how to move and sequence sounds. This delay is markedly different than that of an articulation or phonological impairment and it all comes down to movement. Therefore, it is imperative that speech therapy for motor speech disorders follow some kind of protocol that teaches muscle movements for speech. Research and my own personal experience have taught me that delivering therapy early and frequently is the most effective form.

What is the Difference Between CAS and Phonological Disorders?

Boy whispering into a girls' ear

A phonological delay happens when your child leaves out, swaps, or changes sounds in words. It’s common in kids but usually gets better by preschool. These mistakes happen because a child’s mouth muscles aren’t fully developed yet.

There are eight, phonological processes that we typically encounter in speech therapy: syllable reduction, syllable structure, cluster reduction, final consonant deletion, stopping, fronting, backing, and gliding. For more information and examples of each of these, you can read my article: What are Phonological Disorders and Processes?

The Child Apraxia Treatment- Once Upon a Time Foundation has parent friendly videos with examples of a child talking with a phonological disorder and some children who have dysarthria of speech. Be sure to look at the video titled: Childhood Apraxia of Speech: How CAS is Different from other Disorders.

Who can Diagnose Apraxia?

As speech pathologists we need to seek specialized training in diagnosing and treating apraxia, otherwise, we cannot ethically work with children with motor speech disorders.  These trainings require that we learn how to effectively use evaluation tools and therapy programs. Not all speech pathologists treat motor speech disorders. Parents have the right to seek professionals with appropriate credentials for their child. Rather than administer an articulation assessment, clinicians record children during play tasks to analyze speech motor movements.

Dynamic Assessment

Speech therapists use dynamic assessment as a specialized approach to evaluate and understand childhood apraxia of speech (CAS), a motor speech disorder in children. It’s designed to provide insights into a child’s speech abilities by observing how they respond to various prompts and cues during assessment. Unlike traditional assessments that simply measure what a child can or cannot do, dynamic assessment actively engages the child in tasks that gradually increase in complexity.

Dynamic assessment can be likened to a problem-solving session. Imagine your child is presented with different speech tasks, starting with simple ones like producing single sounds or syllables, and progressing to more complex tasks like forming words or sentences. Throughout this process, the assessor observes how the child approaches each task, noting strengths, weaknesses, and any patterns of difficulty.

What makes dynamic assessment valuable is its interactive nature. It allows the assessor to provide support and feedback tailored to the child’s responses. For instance, if a child struggles with a task, the assessor might offer additional cues or modeling to help them succeed. By observing how the child responds to these supports, the assessor gains insights into the underlying nature of the speech difficulties.

The Dynamic Evaluation of Motor Speech Skill (DEMSS)

The Dynamic Evaluation of Motor Speech Skill (DEMSS) assessment for apraxia provides a comprehensive evaluation framework that considers various dimensions of speech motor planning and execution. What sets the DEMSS assessment apart is its emphasis on providing tailored support and feedback. If your child struggles with a task, the SLP will offer cues, prompts, or modeling to help them succeed. By observing how your child responds to these supports, the SLP gains valuable insights into the underlying nature of the speech difficulties.

We may need to collect additional information, such as vocabulary, language, and social interaction assessments, depending on the child’s needs.  In addition to speech interventions, it is best practice to teach other effective means for communication, determine if there are comprehension needs, address social communicative concerns, and work at your child’s level.

Treatments

In severe to profound motor speech disorders, speech pathologists support functional, effective communication for a child by finding the appropriate augmentative communication (i.e., PECS, SGD) that assist in making a child’s needs known. Once identified, therapy involves teaching the child and caregivers effective communication with the new support system.

PROMPT and DTTC therapy are evidence-based options that may suitable for your child. A speech pathologist must have rigorous clinical training in these approaches and pass competency assessments before providing either. You can search for a speech pathologist who specializes in evaluating and treating children with motor speech disorders at the apraxia kids website and/or PROMPT Institute.

Navigating childhood apraxia of speech (CAS) requires a structured strategy, such as utilizing the Kaufman Speech to Language Protocol, to prioritize motor planning and language development. Using Kaufman materials for CAS involves a systematic approach that emphasizes motor planning, syllable shapes, and functional vocabulary.

Conclusions

In conclusion, understanding childhood apraxia of speech (CAS) is crucial for effective intervention. By recognizing its characteristics, diagnosing accurately, and exploring treatment options such as PROMPT, DTTC, Kaufman Programming, and others, we equip ourselves to provide the best support for children with CAS. Early identification and intervention are key, offering hope for improved communication and quality of life for these individuals. Let’s continue to raise awareness and advocate for resources that empower both professionals and families in addressing CAS effectively.

PROMPT- Useful for Childhood Apraxia of Speech (CAS)

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Nanette Cote Providing Tactile PROMPT to Toddler

What is PROMPT?

PROMPT is an acronym for:

Prompts for Restructuring Oral Muscular Phonetic Targets.  This is a dynamic, hands-on program for children with apraxia of speech in which the trained clinician shapes the movement of a child’s jaw, tongue, and lips using our hands in support of sound production.  Although the use of touch and movement is an integral component, PROMPT is more than just executing tactile support.  It is a program that incorporates all aspects of a child’s processing, understanding, and interaction.

These areas of development, or domains, are known individually as: The Cognitive-Linguistic, (ability & language), Social-Emotional (socialization), and Physical-Sensory (muscle tone & senses) Domains.  Together, these domains function in unison and influence each other to the extent that challenges in one area directly impact progress in another.  This video for families on the PROMPT website visually explains the domains and PROMPT’s multifaceted treatment approach.  Some children that may benefit from PROMPT include those diagnosed with motor speech disorders like apraxia and dysarthria, cerebral palsy, and autism.  To determine if PROMPT is appropriate for your child, your clinician will begin with an observation and comprehensive evaluation.

Evaluation:

PROMPT is rooted in a Dynamic Systems Theory, meaning that clinicians must factor in cognitive, social, behavioral, sensory-motor, and physical influences on communication.  Let us break these down into some specific questions that we as clinicians ask ourselves during a comprehensive assessment process:

  • Cognitive: What is the child’s ability to process sensory information and comprehend language?  Does the child need visual schedules and/or other modifications and cues to learn new information?  How should clinicians and parents’ scaffold, cue, and elicit language with the child?
  • Social: Do we need to work on establishing trust before diving into PROMPT?  How does the child express his wants and needs (i.e., pointing, gestures, sounds?)  How is the child’s non-verbal communication?  What communicative intents does the child relay (i.e., greeting, requesting, commenting, responding to questions?)  Is the child interested in engaging in communication and interactions with others?
  • Physical: What is the child’s skeletal system and muscle tone like?  Do we need to provide additional supports in the environment to support skeletal and/or musculature issues?  Does the child have difficulty with vision, hearing, tactile/touch?

System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH):

In addition to collecting information from a parent interview, a PROMPT evaluation also includes analyzing the movements necessary for speech. These yes/no questions are based on typical speech development. Next, the clinician transfers the results to a visual representation to rate the severity of the speech disorder.  The System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH) provide us with practical information to develop a treatment plan.

Well-Built House

house lights turned on

Marcus Neal, a PROMPT instructor, describes the Motor Speech Hierarchy as a well-built house with a strong foundation (jaw) necessary for sustaining the other structures (lips, tongue.)  The jaw is the first articulator to develop, so we need to make sure that this foundation is ready to support sophisticated lip and tongue movements.  Jaw stability and the ability to open our mouths in four graded levels (minimal to wide) helps us sequence movements for speech.  In PROMPT, we incorporate vowels into a child’s practice because vowels shape jaw movements.

After completing a SAO, clinicians calculate percentages for each of these areas:  tone, phonatory, mandibular (jaw), labial-facial (lips-face), lingual (tongue), sequenced movements, and prosody (inflections/intonation.)  Next, we shade in the boxes for each of these areas on the MSH to help identify points of intervention.  Given the fluid interaction between these Stages, we need to address three areas to work on immediately.  While we cannot change a child’s tone, it is important to note limitations and consult with OTs and PTs for suggestions on improving posture.

After selecting three areas to prioritize, we develop goals and vocabulary lists to practice words/ phrases during functional activities.  This list will include a variety of vowels, consonants, and blends with emphasis on core vocabulary.  From the start, we blend words into phrases to work on prosody (intonation).  So, we model and support with PROMPTs, “ma more!” or “go ma?”  The reason for working on prosody early on is to help make speech movements fluid and vary communication intentions.

Service Delivery:

crop woman filling calendar for month

Typically, young children with apraxia of speech benefit from at least two, 30-minute sessions.  Depending on the degree of severity, services may range anywhere from a few months to several years.  Other contributing factors that can impact longevity of services are medical conditions, cognition, social/pragmatic skills, sensory/tactile defensiveness, and comprehension delays.

Typical PROMPT Therapy Session:

If a child with apraxia of speech has limited verbal skills, then sessions will initially focus on using vowel sounds.  As vocalizations increase, then PROMPT support shifts to productions of consonant sounds/words/phrases/sentences.

A typical 30-40 minute PROMPT session for apraxia of speech would proceed as follows:

  1. Greeting and set up (5-10 minutes)
  2. Motor phoneme warm-up reviewing the targeted words embedded in the session’s activities with 3-5 PROMPT supported repetitions per target. (5-10 minutes)
  3. Most sessions have 2-3 activities, each lasting 5-10 minutes.  These activities incorporate pertinent aspects from the Domains reviewed above factoring in picture supports, timers, movement breaks, supported seating, and any other cues the child may need for success.  Speech sound movements are worked on during play to help the child attach meaning and strengthen memory.
  4. Review home practice plan (5-10 minutes)

Here are some examples of activities that I have used for children with varying cognitive abilities during my PROMPT sessions:

  • early childhood: Toy Vet Play Set with word targets to address needs in tongue control and jaw movements (go, goes, take, push, home, help)
  • preschool: Play-Doh Kitchen Oven with words to help work on lips-face control with movements that require rounding lips (no, two, dough, do, “mo” for more)
  • elementary school-aged: Pop the Pirate Game practicing words that support improving jaw control, lip contact (pop, Bob, up, “hep” for help)
  • middle school-aged: Knock, knock jokes to address improving prosody (intonation) and tongue control (Who’s there? cat, kitten, bike, show)

PROMPT Supports:

Nanette Cote Providing Tactile PROMPT to Toddler

There are four levels of PROMPT (Parameter, Surface, Complex, Syllable) with clinicians using at least 2-3 of these in one session.  Here is a breakdown on each level and the type of support it provides a child:

Parameter: provides the most support you can offer through stabilizing/ moving the jaw and lips.  There are 13 sounds supported at this level some of which include: h, p, b, m, sh, and vowels in words like “cat”, “father”, and “eat”.

Syllable: only used for consonant-vowel (CV) productions such as “go”.

Complex: helps the child contract and/or tighten his tongue to produce consonants such as (r), blends (sh), and vowels.

Surface: these supports specifically help a child with placing articulators accurately, timing movements using rhythm and prosody, and transitioning from one sound movement to another to create words.

Demonstration of Surface and Complex tactile for /s/

PROMPT and Teletherapy:

In 2020, PROMPT training for speech pathologists shifted from in person to virtual because of global shelter-in-place restrictions.  The PROMPT Institute also developed specific training for clinicians using PROMPT via teletherapy. Parameter PROMPT offers the most support for a child and can be easily administered by a caregiver following a trained speech pathologist demonstration.  Some surface PROMPTs can also be used in teletherapy with the clinician showing this support on herself, a doll, or willing assistant.

My hope in writing this post was to provide a thorough explanation of the dynamic intervention of PROMPT.  This program is unlike any other that I have been trained in over the last two decades in the field of speech pathology, as I have witnessed tremendous success when applying this methodology with clients who have motor speech disorders.  Both caregiver carryover and early intervention are crucial to these achievements, so please continue advocating for your child and seeking resources like the PROMPT website to further your knowledge and education.

If you want to find a speech pathologist in your area trained in PROMPT, then you can visit this link and conduct a search.  

What are Phonological Disorders and Processes?

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Mastering Teletherapy for Early Intervention: Portrait of cute girl participating in auditory bombardment with headphones on
school teacher showing a book to the children

In this comprehensive guide, we’ll explore phonological processes, discuss age-related expectations, and outline your role in supporting phonological goals at home. Whether early intervention or the school system has identified your child for services, this post provides valuable insights.

Evaluation, treatment planning, and homework for phonological disorders differ significantly from articulation and childhood apraxia of speech due to their distinct nature. Please note that this post does not take the place of a comprehensive and diagnostic evaluation for your child.  There are many factors that we assess when developing an appropriate treatment plan.  Talk with your pediatrician, child’s teacher, and/ or speech pathologist if you have questions and concerns specific to your child.

PHONOLOGICAL PROCESSES

There are eight, phonological processes that we typically encounter in speech therapy: syllable reduction, syllable structure, cluster reduction, final consonant deletion, stopping, fronting, backing, and gliding.  Below are definitions, examples, and age expectations for suppression of each of these processes.

  1. Syllable reduction: eliminating a syllable in a word should cease by 4 years old. For example, “puter” for “computer”.
  2. Syllable structure: inability to produce part of a syllable.  There are four of these such shapes (CV, VC, CVC, CVCV) with “C” representing “consonants” and “V” meaning “vowels.”  Some examples of these shapes are: (CV) “bee”; (VC) “up”; (CVC) “cat”; and (CVCV) “baby.”  A child with a phonological disorder may have difficulty producing several of these combinations for an undetermined length of time.
  3. Cluster reduction: occurs when a child omits part of a blend, most often /s/ blends /sk, sm, sn, sp, st/.  You may hear him say “kin” or “sin” for the word “skin.”  Children should be able to produce blends together between 4-5 years old.
  4. Final consonant deletion: omitting the last sound in a CVC word (“ca” for “cat”) should suppress by 3 years old.
  5. Stopping: producing a sound that should be stretched like /s/ with a /b, d, p/ (“bun”, “dun”, or “pun” instead of “sun”) should end between 3-5 years old.
  6. Fronting: making sounds that are produced further back in the mouth more towards the front.  For back sounds /k, g, ng/, the tongue lifts in the back while the tongue tip stays down in the front of the mouth.  A child who fronts sounds lifts the tongue tip to touch his palate and substitutes /t, d/ for back sounds.  You may hear “tan” for “can” or “tookie” for “cookie” if your child is fronting.  This process ends at 3.5 years old.
  7. Backing: the reverse of fronting.  Here, your child continues producing sounds made with the tongue towards the front of the mouth, lifting the back of his tongue.  So, you may hear “do” for “goo” or “gog” for “dog.”  This process is often seen in children with severe phonological delays.
  8. Gliding: substituting an /r/ with /w/ (“wun” for “run”) or /l/ sound with /w, y/ (“yeyo” for “yellow”.)  This process may continue through 6 years old.

PHONOLOGICAL

Bowl of pastel colored alphabet letters

Evaluation:

Speech pathologists observe and screen before evaluations, guiding test choices. Analysis and probes help develop treatment plans for phonological delays.

A phonological delay is when your child omits, substitutes, and/or distorts a process. This is something that all children demonstrate at various ages, but eventually suppress as they enter the preschool years. These errors occur at a young age because a child’s speech mechanism (lips, tongue, jaw) is not yet fully, physically developed to move swiftly and precisely. As children grow physically, their speech becomes more intelligible. Those with phonological disorders may need auditory training to improve accuracy.

A phonological delay means multiple sound errors. For instance, using /d/ for /th/ in “thumb” doesn’t signify a delay. This example would likely be an articulation delay. However, if he uses /d/ in addition to one of more of these sounds: /j, sh, ch, th/ (i.e., “padama” for “pajama”, “dells” for “shells”, “lund” for “lunch”, and/or “dum” for “thumb”), then he has not suppressed a phonological process of stopping and needs intervention, especially if he is five years old or older.

One of my most popular, phonological goals is: Reduce cluster reduction for /s/ blends (sk, sm, sn, sp, st) in initial positions of words with 80% accuracy given supports as needed.

Therapy:

In phonological therapy, we work towards helping the child learn to suppress the process. The speech pathologist prioritizes processes occurring over 40% in a speech sample. Unlike articulation issues, phonological delays vary contextually. Two options for treating phonological processes are the cycles and complexity approaches.

Auditory Bombardment:

Portrait of cute girl participating in auditory bombardment with headphones on

Auditory bombardment involves repeatedly exposing your child to correct target sounds in different contexts. By hearing these sounds frequently, your child’s ears get used to them, helping them understand and recognize the correct sounds better. Hearing the correct sounds over and over helps your child learn and imitate these sounds, making it easier for them to produce the target sounds correctly.

This technique strengthens your child’s ability to hear and produce correct speech sounds, enhancing their overall speech clarity and phonological awareness. Auditory bombardment provides essential auditory input, supporting your child’s speech sound development and helping them improve more effectively in therapy.

Homework:

mother and son
Photo by cottonbro studio on Pexels.com

It is nearly impossible to skip homework practice and make progress in phonological therapy. Again, your child’s speech pathologist will want a certain level of mastery in the therapy room before assigning homework practice. Once targets are identified, clients with phonological delays can benefit from engaging in listening training at home. Ask for appropriate book suggestions. The sooner you start, the better.

Conclusion

In conclusion, grasping the nuances of phonological processes is vital for effective intervention strategies. With thorough evaluation and targeted treatment plans, accompanied by diligent home programming, children can overcome phonological challenges more effectively. Encouraging parental involvement in home practice reinforces therapy gains and fosters lasting progress in speech development.

Tongue Tie: Impacts on Speech, Dentition, Feeding, and More

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Young Child Sticking Tongue out with Noticeable Tongue Tie
multiethnic family spending time together at home

Unlock the mysteries of tongue tie with our comprehensive, helpful guide tailored specifically for caregivers of children facing this challenge. We will define this condition, review identification, discuss the impacts, outline laser surgeries, and provide more reading material about tongue tie.

Tongue Tie Defined

Tongue tie, formally known as, ankyloglossia, restricts the tongue’s range of movement, making it challenging to reach the top palate or sides of the mouth. This movement is not only important for producing speech sounds, but also for manipulating foods to the sides of the mouth for chewing and clearing mouth pockets of leftover foods.  The tongue is connected to the bottom of the mouth by a band of tissues called lingual frenulum.  Tongue tie occurs when this collection of tissues is unusually short, thick, or tight. Children are born with tongue ties with some needing laser surgery to release the restriction.

How is Tongue Tie Identified?

Most often, a tongue tie is first identified by lactation consultants when nursing mothers have difficulty feeding their infants.  Otherwise, your child’s speech pathologist may refer you to specialists for suspected tongue tie.  Some behaviors observed in a child with tongue tie include:

  • Inability to point tongue straight out of the mouth
  • Difficulty lifting the tongue up inside the mouth and reaching the palate
  • Reduced ability to move the tongue from side to side
  • Small indentation at the tongue tip that makes the tongue look like a heart when the person sticks his tongue out
  • Unable to stick the tongue out past the lower teeth
  • Trouble with moving the tongue up when licking ice cream or lollipops

Speaking from personal experience, I have referred five clients over the last eight years to a local periodontist for suspected tongue tie.  Two of those clients needed a tongue tie release surgery and soon after demonstrated immediate, notable improvements in both speech sound productions and feeding.

Young Child Sticking Tongue out with Noticeable Tongue Tie

What Else can a Tongue Tie Impact?

In addition to a tongue tie, some clients also have lip ties.  Beyond having implications on speech production, tongue and lip ties can also impact the following:

  • tooth decay
  • pain while brushing teeth
  • dental issues such as teeth crowding
  • food and texture aversions
  • chewing and swallowing difficulties
  • TMJ
  • facial tension
  • chronic sinus/ congestion issues
  • ear infections
  • migraines

Why are Laser Surgeries a Better Option than Clipping Tongue Ties?

Laser procedures completely disintegrate the restricted lingual frenulum with no reattachment of the muscles observed with children undergoing this procedure.  According to a local periodontist, Dr. Robert Pick, who pioneered the using a carbon dioxide Laser Frenectomy technique with his team at Northwestern in 1983,

“The laser is fabulous for tongue tie release because there is no bleeding during and/or after the procedure, no suturing needed, minimal to absent swelling and scarring, almost no chance for recurrence and a decreased to complete absence of pain post-surgically! In addition to use of the laser surgical time is dramatically reduced.”

Observations during Tongue Tie Release

Dr Pick has been using his innovative laser procedure with pediatrics for over 30 years at his office.  I called the office as soon as I finished exploring his website. A month later, I found myself observing a tongue tie release in Dr. Pick’s office.

The frenectomy, lasting 30 minutes, ensured numbing, keeping the patient informed and calm. Dr. Pick’s jovial manner and skilled surgery left a lasting impact. Within seconds of the laser surgery, the patient exclaimed, “I can finally stick my tongue out of my mouth!”  The muscle vanished before my eyes and the tongue found freedom. Five minutes later, the procedure was complete, and the patient was heading out the door to a lunch date with mom.

Recommendations and Resources

For tongue tie surgery, seek a specialized surgeon. Dr. Pick’s expertise ensures successful releases. According to Dr Pick, he has not had to perform a second release on any patient that he has seen over the last few decades; however, he does refer post-operative patients to their speech pathologists and/or myofunctional therapists to teach the tongue new placements at rest and during speech productions.  Below are some links and resources that you may find helpful in identifying red flags and performing post-operative exercises.

List of Published Articles Concerning Tongue and Lip Tie

Tongue Tie Babies

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