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.
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.
Just Say No to the Sippy: Are Straws or Sippy Cups Better?
Sippy Cups
Sippy cups, prolonged bottle drinking, and excessive pacifier use can hinder oral development. As a speech pathologist, I advise families to switch to straw and cup drinking. This post aims to discuss why opting for straw and cup drinking over sippy cups can significantly benefit your child’s oral development and overall health.
A sippy cup mimics bottle feeding, promoting an immature sucking pattern. By age one, children should transition to straw or open cup. A suckle pattern means that your child needs to stick his or her tongue out of the mouth to drink. There is little to no tongue retraction involved in this movement. Most of the time, the liquid will drip out of a sippy if you turn it upside down.
Extended use of a bottle or sippy cup may promote poor tongue posture. As a result, you will notice your child’s tongue rest outside of the mouth and you may observe articulation difficulty, especially with production of sounds made inside the mouth along the palate (t, d, k, g, n). As toddlers grow, we want to support transitioning them from a suckle pattern to a more mature movement. Toddlers, particularly those with speech delays, often protrude their tongues slightly while speaking or eating. This tongue position mirrors the placement for suckle drinking.
Sippy Cup vs. Nuby Cup: Which is Better for Your Child?
Now that you know the pitfalls of using a sippy cup, let me offer two other options that not only secure liquids in a cup but also promote good oral motor development: a Nuby cup and straws. First, the Nuby cup looks like a sippy, but has a flexible top that encourages sucking rather than suckling to drink. The flow of liquid cannot drip out as easy as the sippy cup; rather it requires some effort, or sucking on the child’s part. Similar to straw drinking, this sucking pattern pulls the tongue back into the mouth thereby supporting good oral motor development.
The Benefits of Straw Drinking in Speech Therapy
A built-in straw cup is another great option but can be a little challenging for beginners, so it may be easier to start with a regular straw. If your child is not sure how to use a straw, then trap some liquid in one end and slowly release that liquid into your child’s mouth once he puts his lips around the straw. In the event that your one-year old or child with special needs needs more supports in learning how to drink from a straw, then I would highly recommend the Bear Bottle Collection from Ark Therapeutics.
Bear Bottle, lip blocker, and one-way valve:
This adorable, bear-shaped bottle is a great way to transition your child from bottle to straw drinking with several supports for quick success. We attach a lip blocker to the straw to prevent excessive insertion into the mouth and encourage tongue retraction. This durable tool stays put after washing. There are three types of blockers sold by Ark Therapeutic which allow for graduation as your child improves his ability to position musculature for drinking without tactile feedback. The one-way valve traps fluid in the straw, preventing it from dropping back when suction is released. This makes learning to drink from the straw less effortful and sets the child on a quick path for success.
The Benefits of Straw Drinking in Speech Therapy
Straw drinking promotes tongue retraction into the mouth while drinking. To draw liquid from the cup, the tongue must retract into the mouth, a crucial movement for speech sounds like (t, d, k, g, n). You can also mix things up a little by varying the intensity of the straw. Shorter straws with thin liquids suit beginners, while longer or twisty straws with thicker liquids demand more effort. The latter version challenges older children to improve oral motor awareness. Drinking thick beverages with a straw improves lip and tongue awareness, aiding sound placements. Speech therapy alongside this change shows success.
I’ve long advocated for the straw’s benefits, even using seasonal ones as speech practice prizes. A small change can impact development significantly. While eliminating sippy cup usage is a great start, it will not be the only change that you need to make. Please continue working with your speech pathologist and practicing sound targets at home to develop muscle memory for improved articulation development.
Seated Drinking
Children don’t need a cup in hand all the time. Overconsumption of liquids from sippy cups can hinder eating. Many children fill up on these liquids, making it difficult for them to eat because their bellies have an excess. Plus, it is far more challenging for children to drink while walking around, than it is when they are seated. Toddlers focus on moving around, making drinking from a cup challenging. They might spill or choke as they navigate and drink. Seated postures for drinking are just more optional all around. Let’s make sure children are seated safely before offering drinks, though they can still have water throughout the day.
In conclusion, by eliminating sippy cups and opting for better drinking choices, you’re not just improving oral motor development but overall health.
Toddler speech is an amazing and complicated ability that explodes in the early years, prompting questions about word count. For some toddlers, this explosion happens early while others are “late talkers.” This range makes it tricky to predict the right time to seek out an evaluation.
Monitoring a child’s language development is a critical aspect of understanding their overall growth. As children grow, they reach various developmental milestones that signal their progress. Speech development is one important area where caregivers and professionals look for specific advancements. Two-word phrases, for example, are a significant hallmark that typically emerge when a child is between 18 to 24 months old. Recognizing the number of words a child should know or use at different stages can be a useful gauge of their language acquisition.
Before looking at specific milestones, it’s important to first discuss what constitutes a word, as identifying what counts as a word is vital in speech therapy for toddlers. Words can include spoken terms, sound effects, and even signs used consistently and independently.
Sign Language, Speech Approximations, and Sounds
Words are not limited to spoken language. Other forms of communication can also count as words, including:
Sound Effects: Using sounds, like saying “meow” for a cat, can be considered words if used consistently and appropriately to represent the correct object or situation.
Sign Language: If a child uses a sign consistently and with intent, such as the sign for “eat” when hungry, it is considered a word.
Speech Approximations: When a child uses a word that isn’t perfectly spoken but is understandable, like saying “goga” for “dog,” it still counts as a word.
Consistency and Independence
For a toddler’s communication to count as a word, it must meet two important criteria:
Consistency: The child must use the word consistently to refer to the same object, person, or action. For example: Saying “ball” every time they see a ball shows they understand and know what it means.
Independence: The child should use the word independently without needing prompts. For instance: If they say “juice” whenever they want a drink, it demonstrates they are learning to express their needs on their own.
Toddler Speech Developmental Milestones
Understanding developmental milestones helps you monitor your child’s growth and developmental progress, particularly in speech and communication.
Toddler Speech Development Fundamentals
Speech development is a critical aspect of your child’s overall development. By 15 months, a typical toddler might have a vocabulary of 8 to 10 words, although it’s not unusual for the number to vary among individual children. By 16 months, your child should use at least 15 words, increasing to nearly 20 words consistently by 17 months.
By 24 months, a child should comprehend at least 300 words, with some capable of understanding and using more. Variability is normal, and these figures serve as a general guideline. Speech development relies on both genetics and environmental factors, like interaction with parents and caregivers.
Early Toddler Speech Milestones
Age
Expected Vocabulary
15 Months
8-10 words: mama, dada, familiar objects
16 Months
At least 15 words
17 Months
Minimum of 20 words
18 Months
Rapid word learning, >100 words likely
24 Months
50 recognizable words, phrases emerging
Your child’s early communication includes gestures, babbling, and responsiveness to auditory stimuli even before the first word is spoken. You should observe increased intentionality in communication at around 18 months, with notable improvements in the complexity and clarity of expressed ideas. Early interactions greatly influence these milestones; engaging with your child through reading, talking, and playing supports their learning process.
Toddler Speech Milestones By Age
Understanding speech milestones helps you monitor your child’s language development effectively. Here are some highlights from the American Speech-Hearing Association (ASHA), when it comes to speech expectations:
By one year old, a toddler should say 2-3 words (such as hi, dog, dada, mama, uh-oh) and make attempts to imitate sounds.
Between 13 to 18 months, a toddler should say names of common objects, some actions, and important people. You will likely also hear long strings of sounds, syllables, and real words that appear conversational.
By two years, most toddlers should say over 50 words, which in turn gives them a large enough selection to combine single words into phrases like: “more apple”, “no bed”, “mommy book.”
Somewhere between 2-3 years, a toddler should be able to say sounds: p, b, m, h, w, d, n and most vowels in words. At 3 years old, toddlers are typically combining three words into a phrase to talk about things.
More Toddler Speech Resources
As a speech pathologist, I often send families this Google Document with alphabet labeling and ask caregivers to fill in a word count. This information aids in documentation of the Rossetti Infant-Toddler Language Scale when it is time for an initial assessment. The Rossetti measures communication from birth through three years. While there are a number of factors in measuring communication development, for purposes of this post, these are the number of words a toddler should say by range:
15-18 months: says 15 meaningful words
18-21 months: uses single words regularly and imitates phrases
When you observe speech development in toddlers, constructing two-word phrases is a significant milestone. Around the age of 24 months, you will likely notice your child beginning to pair words together. This step is crucial as it represents the start of combinatorial speech, allowing your child to express more complex thoughts and needs.
Key Aspects:
Expression: Two-word phrases enable your child to convey relationships between concepts, like possession (e.g., “my toy”) or actions (e.g., “go home”).
Understanding: This stage reflects an increasing understanding of grammar and syntax, even in its most basic form.
Expected Progression:
Age
Milestone
18 months
Imitates two- and three-word phrases
20 months
Uses two-word phrases occasionally
24 months
Routinely constructs two-word phrases
Vocabulary Growth: Your child’s word bank typically includes 50-100 words by the time they are 2 years old. This richness in vocabulary supports the construction of meaningful two-word combinations.
You can encourage your child to form two-word phrases by reading to them, speaking in simple sentences, and naming objects during your daily routines. It is important to acknowledge and reinforce their attempts at speech. Each child develops at their own pace, but if you have concerns about your child’s speech development, consulting with a pediatrician or a speech-language pathologist might be beneficial.
Frequently Asked Questions About Toddler Speech
This section addresses common inquiries regarding the progression of early language development in children.
By what age do babies typically start using two-word phrases?
You can expect babies to typically begin forming two-word phrases between 18 and 24 months. This is a natural progression as their vocabulary expands.
How many words should an 18-month-old typically be able to say?
An 18-month-old child usually recognizes names of familiar people, objects, body parts, and actions. They also begin to follow simple instructions, imitate two- and three-word phrases, and spontaneously say a two-word phrase on occasion.
At 2 years old, about how many words should a child know?
By the age of 2, children often comprehend about 300 words, express 50 recognizable, and combine words into short phrases.
“Speech is movement made audible…, oral-motor therapy, as it is practiced today, can be defined as the process of facilitating improved oral (jaw, lip, tongue) movements.” Oral-Motor Techniques in Articulation & Phonological Therapy by Pam Marshalla, M.A., CCC-SLP
Sometimes, children need a little more than auditory and visual cues to make sequenced movements for speech. We know that making these movements brings them one step closer to pairing sounds with those motions. Adding tactile learning can be an essential piece in the puzzle for children who need to feel more information in and around their mouths before producing a sound.
Developing a new speech movement takes time, successful practice, supports, and extinction of inaccurate movements. This comprehensive oral motor wake up routine for home intends to support caregivers in using oral motor tools sold through Ark Therapeutic to prepare the mouth for feeding and/or speech.
Years ago, I connected with Ark and they graciously gifted me several products to try with clients on my caseload. I do not advocate purchasing or implementing oral motor products unless a speech pathologist has recommended these specifically. Comprehensive assessments support appropriate treatment planning and identify other medical, contributing factors like hearing loss or tongue tie that may need intervention prior to initiating speech-language therapy.
Develop Oral Awareness With a Wake Up Oral Routine
Before a child can develop sequenced movements for speech, he needs to be able to feel and attend to the structures of his mouth. Without this knowledge, he may not be able to perform tasks like putting lips together, moving the tongue, or chewing. As a result, these children do not comprehend an auditory (verbal) direction to “Lift the tongue up and make the /d, t, n/ sound,” even when you show them how it is done.
Oral awareness through “wake-up” practice helps children feel the boundaries in and around their mouths. One tool that I have used over the last two decades in private practice is the Z-Vibe by Ark Therapeutic. You can purchase this instrument alone or as part of a grabber in the form of the Z-Grabber. For more information on the Z-Grabber, please see my post on jaw work.
Tools for a Wake Up Oral Motor Routine
Ark’s Z-Vibe Oral Stimulator
This single probe tip instrument provides intense vibration input to support stimulation, improving awareness, and exploration. In other words, it helps “wake-up” the mouth before feeding and/or speech practice. While you can only use one tip at a time, there are over 35 different ones that you can twist and secure on the Z-Vibe.
Ark’s 10-Tip Kit Set for the Z-Vibe
This kit includes the following tips for the Z-Vibe:
Preefer
Probe
Mini
Hard Fine
Bite-n-Chew
Textured Bite-n-Chew XL
Hard Spoon
Soft Spoon
Hard Brush
Soft Brush
I will be describing a “wake-up” routine using the first, four tips in the list above: Preefer, Probe, Mini, and Hard Fine. You can read more information on the Bite-n-Chew and Textured Bite-n-Chew XL in my post about the jaw. The hard and soft spoons are helpful in transitioning infants to textured foods. These spoons are especially useful if your child stuffs his mouth full as this is a sign that he needs more information and input before being able to chew and swallow.
The Z-Vibe vibration with spoon tips give oral musculature appropriate sensory input and ensures safety while eating. Finally, the brush tips support oral hygiene and dental care. These are both good options for getting ready to use a regular toothbrush. Consult your child’s speech pathologist about appropriate tips.
Wake-Up Oral Motor Routine
ALWAYS maintain control of the Z-Vibe and refrain from letting your child hold the tool itself to place on his face. We do not want the child to use this tool like a toy and/or place it on bones like the nose or ears as this is a useless, sensory stimulation experience. You may allow your child to hold the device with you, but never independently.
Step 1:
When you first introduce oral motor tools, you will need to begin by having your child feel the gentle vibration on his hands, gradually moving up his arms and towards his mouth. We want to make every step of this stimulation a positive experience and starting at someone’s face is too intrusive. Hold and count from 3-5 on your child’s hands, arms, then cheeks using the Z-Vibe with Preefer Tip.
Preefer Tip: This particular tip was designed to roll along inner cheeks and/or lips to increase oral awareness. The ridged surface of this tip was a brilliant idea because it provides the perfect amount of stimulation without being overbearing.
Step 2:
Continue proceeding with caution and positive acceptance by alerting the outside of your child’s face before moving inside the mouth. Stroke the outside of your child’s cheeks in a downward motion, starting near his ears and moving towards the lips in three rows on each cheek, counting from 3-5 each time.
Step 3:
For lip awareness, you can continue using the Preefer tip or switch to the Probe or Mini Tip.
Preefer Tip: Hold vertically at one lip corner and roll it moving towards the opposite corner. If age appropriate, you can sing a song while you move back and forth 3-5 times or simply stretch out your counting.
Probe/Mini Tip: These removable tips have three surfaces: bumpy, striated, and smooth. Start out introducing the smooth side and then take baby steps towards trying the textured ones. Stroke the lips using one surface at a time applying gentle pressure and counting for 3-5 seconds. Please note that the Mini Tip is great for smaller mouths and infants.
Step 4:
Start moving inside your child’s mouth using the Preefer, Probe, or Mini Tip to alert the inner cheeks. This area is a boundary cue for moving foods towards the molars for chewing.
Preefer Tip: Roll the tip inside each cheek with an up-and-down motion while and counting for 3-5 seconds.
Probe/Mini Tip: Position the Z-Vibe Probe or Mini Tip horizontally on the bottom of your child’s cheek inside his mouth and then walk it up using counting or a song.
Step 5:
The last step is to alert the tongue. You may use the Preefer, Probe, Mini, or Fine Tip for this final part of the routine. The only area overly sensitive to vibration is the palate, or top of your child’s mouth.
Preefer Tip: Roll this across the middle of the tongue from side to side while counting from 3-5 repetitions.
Probe/Mini Tip: Start with the bumpy side for the first round of 3-5 repetitions and then repeat this count using the striated end. Place the Tip of the Z-Vibe a few centimeters from your child’s tongue tip, holding and gently pressing as you move the tip vertically back and forth. The Z-Vibe should maintain contact with the tongue during each of the 3-5 repetitions.
Fine Tip: To build awareness at the sides of the tongue, use the Fine Tip to gently stroke with a back and forth motion for 3-5 repetitions on each side.
Take Away Points for Wake Up Oral Motor Routines
1. I use a variation of the “wake-up” routine at session starts to build muscle awareness for feeding and speech.
2. Tactile sensation is part of my comprehensive plan for children with feeding and speech delays.
3. A multi-sensory approach includes auditory, visual, and tactile cues, supporting overall progress with caregiver training.
Over the last three decades, I have witnessed that some children benefit from feeling where to place their tongues to successfully produce target sounds, particularly those who have made little progress with traditional articulation therapy. A tactile approach, such as speech buddies, has proven effective in unlocking articulation breakthroughs for children who have struggled with conventional therapy methods.
What are Speech Buddies?
One tool that I have used with moderate success is Speech Buddies. These tools are the size and length of a tongue depressor that individually target: L, R, S, CH, and SH sounds by helping a child identify correct placement of the tongue to accurately produce that sound. Here is how you introduce and use this product:
I always begin with letting the child hold and feel the flexible tool before placing it in his mouth.
Next, we talk about where his teeth and tongue should be positioned on the tool using the images in the booklet that the company provides.
I always hold the Speech Buddy at first to help the child feel the right placement, but I quickly give them independence as this helps make them feel more comfortable.
We start with saying words that begin with the targeted speech sound with the Speech Buddy in the mouth, but I swiftly transition to saying the word with the Buddy and then without. Removing the Speech Buddy provides a reset that supports programming the muscles to store a memory of proper movement. To teach the mouth muscles to recall the correct placement, the child needs to say the word with support, then without.
Practicing with the Speech Buddy twice weekly for 20 minutes fosters muscle memory better than longer, once-a-week sessions.
Considerations Before Buying Speech Buddies
Consult your speech pathologist before trialing any tool; it ensures suitability and maximizes investment effectiveness for parents. These tools are not appropriate for everyone for several reasons:
They require a certain level of cognitive ability to follow directions.
Some children need to develop better jaw support before working on tongue movements.
Not every child can tolerate having a tool in his mouth due to oral sensitivity and/or hyperactive gag reflex.
Your child may not require this type of feedback to learn how to produce /l, r, s, ch, sh/ sounds. Verbal cues alone may suffice.
These products are not a ‘stand alone’ option or replacement for skilled speech evaluation and therapy.
Pros
I’ve found great success with Speech Buddies for improving /s, sh, ch, l/ sounds, in both school and private practice.
Parents can easily help children generalize practice at home. The tool helps ensure accurate articulator placement occurs every time.
Cons
In truth, my success with the R Buddy has been limited. There are two options for producing R: retroflex and bunched. The Speech Buddy only supports the retroflex option.
The retroflex R movement is not best for everyone. Some children, especially those with tongue ties have a hard time with retroflex R.
Mastering the retroflex movement with the R Speech Buddy poses a challenge as it requires unraveling the Buddy with the tongue tip.
Speech Buddies are costly and not covered by insurance
Costs
Individual Speech Buddy tools range from $99-$124 in price with a complete kit costing close to three hundred dollars. Unless your child needs help with all the above-mentioned targets, you do not need to purchase a kit. I would suspect that if he does require help with several sounds, then your speech pathologist may need to work on improving jaw stability first.
I aimed to educate on tactile feedback for articulation delays and suggest Speech Buddy tools. A formal evaluation before any home program is necessary. These evaluations are crucial in identifying other medical reasons like hearing issues or tongue ties that impede therapy progress. As frustrating as it is to wait for testing, it is well worth the time.
Speech therapy early intervention services are designed for children from birth until they turn three. This service delivery model is rooted in parent training and coaching to work on developmental goals from speech to physical motor skills during everyday play routines. My experience has taught me that the more practice a child has of any target, the quicker you will witness developmental gains and progress. What better way to work on developmental skills than to incorporate engaging activities for preschoolers?
Mother and daughter Engaging in Crafts
This post contains examples of the best speech therapy early intervention activities with complete details of materials, speech and language targets, and play sequence suggestions for each of the following themes:
WATER PLAY: SPEECH THERAPY EARLY INTERVENTION ACTIVITIES
Water play activities for preschoolers are always a splash in my coaching sessions. You will need a bucket or bin filled with a little water or you could set up your online therapy room near a kitchen or bathroom sink. No need to purchase fancy bath toys, but if you have some at home then you can use them. These everyday items will lend to some language enrichment just as well:
Small disposable or plastic cup
Funnel
Dish soap
Sponge
Empty bottles (hand soap, dish soap, shampoo)
Baby doll or dishware for pretend play
Child’s watering can
Wash cloth
Grow towels from the Dollar Store
Following Directions with Water
I ask parents to bag up a few things and keep it handy for the session. There is no need to fill the bucket, bin, or sink before the therapy session. Why take the fun of it at the start, right? Instead, your child can use bottles, cups, faucets to fill the container and squirt in a few pumps of soap. This is a great way to work on following directions such as:
Get bin.
Fill bottle with water.
Turn the water on/off.
Pour in cold/warm water.
Squirt 3 pumps of soap
You can even practice 2-step directions by combining the above or creating your own. When the water bin is filled, it is time to break out the objects for play. Your speech pathologist should give you a reminder about the goal you are targeting in this activity just before you open the bag/ container of objects. However, once the action gets going, you should not hear much instruction to allow for the natural flow of communication. Below are some examples of goals that you can target in this water play activity:
Imitating actions/ sounds/ words
Using objects/ pictures/ signs/ gestures/ words/ phrases to make requests
Following simple directions
Using two objects together in play
Expanding play sequences (i.e., put toy cars in the water, scrub them with a brush, dry them)
Bubble Bin
You could always transform this water play bin into a homemade bubble one! I stumbled upon this little gem years ago one overcast, summer day and my neighbor and I decided to try it out with our kids aged four through seven years old. They all LOVED it; big kids included! You can follow this bubble link to a site that tells you how to make the solution and use your finger wands. Plus, there are some activities included in the post that enhance speech and language.
After 15-20 minutes you can give your child a movement break or have him help clean up objects while you listen to specific feedback from your speech pathologist, review homework for enhancing communication during functional routines, and discuss the next week’s coaching session.
ARTS AND CRAFTS: SPEECH THERAPY EARLY INTERVENTION ACTIVITIES
Arts and crafts activities for preschoolers require just a few materials: paper, crayons/markers, and/or a Magna Doddle. You can tell that I like to keep things simple! Here are some goals you can address in at home speech therapy arts and crafts activities:
Imitation:
Draw 2 horizontal lines while saying “ZOOM” leaving a few inches between them.
Now make vertical lines while saying “ZAP”.
Enjoy your train track for pretend play!
Early Speech Sound targets:
Trace hands while singing any tune that the child enjoys.
Model/ demonstrate me, mine, my, you, big, tiny, hi, and bye while coloring the hands together.
Following directions (varies according to ability):
1 Step: Identify objects in fields of 2-3 choices (Get paper, Give crayon)
2 Step: First get the paper, then give me the crayon/marker.
Novel: Put the paper on your head.
Descriptive: Give me the blue crayon/marker.
Pragmatic skills (Using gestures, pictures, sounds, words, or phrases):
Greeting and Departures: Practicing “hi” and “bye” during the activity.
Requesting objects: Giving choices or placing objects within reach for selection.
Responding to questions
Protesting
Turn taking with the same colored crayon/marker.
Commenting: Labeling hand sizes (big/tiny).
Language Skills:
What color is this crayon/marker?
What do we do with crayons/markers?
Where should we hang this picture?
Which hand is big/tiny?
Did you like this?
If you want to add a sensory experience to this early intervention activity for preschoolers, then you could use scented crayons/markers and talk about the things you smell. Another option would be to color the hand drawings with some glue and then sprinkle Jell-O powder or a fragrant spice. Most importantly, encourage FUN because that is what will bring out the most communicative interaction!
PLAY DOUGH: SPEECH THERAPY EARLY INTERVENTION ACTIVITIES
I have yet to meet a child who will not sit for a good period to create with playdough. While there are some fun playdough products on the market, you can use just about anything with dough such as:
Seasonal cookie cutters like spring flowers, shamrocks, or an umbrella
Sturdy plastic cups for making circles and/ or rolling dough
Plastic knife for cutting
Mixing bowl to store tools and supplies
In the event that you do not have some play dough on hand, then you can make your own ahead of your session with this recipe. I might suggest adding some green food coloring to transform the play dough into grass and decorate it with flowers using plastic gems, pipe cleaners, seashells, feathers, or outside objects like mini rocks or pine cones.
Now, what can we address with play dough? A better question might be: what CAN’T you target with play dough? Here are some of my personal favorites:
Create “fossil” imprints with outdoor items retrieved on a scavenger hunt. Use a cell phone to take pictures of the treasures in your yard and then go on a hunt for those objects. Target concepts such as same and different while matching objects to impressions.
Work on imitating actions to roll, press, smash play dough using familiar tunes to sing a song.
Address following directions at the simple or complex levels.
Use the play dough to cover puzzle pieces in a bin. Your child then searches for a piece to complete a puzzle. Pieces shaped like an object can be used to make impressions in the play dough for a conversation piece.
Make a pretty flower with your child. I suggest sorting whatever objects you have on hand into bins or an appetizer tray, so the decorative items are within sight but out of reach to prompt requesting.
Foster pretend play by making small “hats” for Lego figures/ mini objects/ baby dolls. This also lends for a nice opportunity to work on a simple lexicon: hat, on, off, hat on/off. Another option would be to make “food” like thin spaghetti, pizza, or hot dogs and then model feeding a baby doll these delicious creations.
SENSORY BINS: SPEECH THERAPY EARLY INTERVENTION ACTIVITIES
Last, but certainly not least, my favorite early intervention activity for preschoolers is a sensory bin. For this activity, you will need a bin, preferably one with a cover to foster having your child make requests/ ask as opposed to reaching into an open bin and taking desired items. Also, you need something to use as a fill. Here is where you can get creative and use some nearly expired dry goods that you were about to toss. Some of my favorite, sensory bin fills are:
Assorted, dry pasta
Decorative straw typically used in gift bags
Dried beans
Cotton balls
Sand
Play dough
Note that I did not include rice as a preferred fill. It makes too much of a hot mess for my liking and is a pain to clean up later. If the intent is to pull together a fun activity with easy clean-up, then I would advise reserving rice for meals only.
Enhance Play with Toy Integration
Sensory bins are a F A N T A S T I C way to liven just about any play task, such as puzzles, mini objects, Mr. Potato Heads, blocks, pretend play, and flashcards. Below is a breakdown on the speech and language targets you can address using sensory bins:
Matching object to picture with puzzles: There’s just something exciting about searching for puzzle pieces hidden in a sensory bin rather than just dumping the parts onto a table.
Answering basic questions with mini objects: Mini objects are everywhere at home! You could use doll house figures; Fisher Price play set items; wind-up toys; or a variety of matchbox/ pull back vehicles. In this sensory bin, I would suggest partially hiding items to allow for visible answer choices and coaching parents to ask: “Where is the car?” or “What can we drive?”
Mr. Potato Head: Target identifying or expressing body parts with this classic toy. Again, partially hide objects for visible, answer choices.
Blocks: Duplo, Legos, or wooden blocks will work fine in a sensory bin. Address color recognition/ naming; early prepositions like “up”, “on”, “off”, or following directions.
Pretend play: I have used beans and mini work trucks to create a construction truck bin or garden for planting fake flowers into mini pots. You and your speech pathologist could brainstorm something based on your child’s likes and interests.
Flashcards: I prefer using flashcards from sensory bins over traditional drill practices for expressive vocabulary and speech sound targets. Flashcards can be homemade or bought online.
At the end of the day, fostering an emotionally charged, fun play experience will support retention of communicative skills. All this planning ahead of sessions takes time, but the rewards are certainly worth the efforts!
Unlocking a child’s linguistic potential is crucial in school assessments, especially for evaluating receptive and expressive language skills. In this post, we explore the best practices and methods used by school speech pathologists to assess these essential components of communication. From standardized tests to observational techniques, educators and speech-language professionals use various strategies to thoroughly understand a student’s language abilities.
A language delay refers to a temporary lag or slower-than-typical development in a child’s ability to understand and/or use spoken language. My intent in writing this post on language delays was to provide some parent education on diagnostics. If your child has been found eligible for speech and language services because he or she has a language delay, then this finding was likely based on several factors.
Standardized Evaluations: Assessing Receptive and Expressive Language Skills in Children
One essential tool in determining eligibility for language services is a standardized evaluation, which would yield standard scores to assist in comparing your child’s results to his or her peer population. When a child is initially referred for language assessment, speech pathologists should conduct a comprehensive evaluation that includes all aspects of communication (medical history intake, hearing, vocabulary usage and comprehension, speech articulation, fluency, voicing, and expressive and receptive language.)
Receptive Language
Testing receptive language in school-aged children helps us understand how well they comprehend spoken language. Receptive language is about how children understand words, sentences, and instructions. During testing, a speech-language pathologist might ask the child to follow directions, answer questions about a story, or point to pictures that represent specific words or actions. These activities help assess how well the child understands vocabulary, grammar, and overall meaning. Identifying difficulties in receptive language is crucial because it can affect a child’s ability to follow classroom instructions, understand lessons, and engage in conversations. Early identification and intervention can support the child’s language development, enhancing their ability to learn and interact effectively with others.
Expressive Language
Testing expressive language in school-aged children is an important part of understanding their communication abilities. Expressive language refers to how children use words and sentences to express their thoughts, needs, and feelings. During testing, a speech-language pathologist will evaluate various aspects of the child’s speech, such as vocabulary, grammar, sentence structure, and the ability to convey ideas clearly. This might involve asking the child to name objects, describe pictures, tell stories, or answer questions.
The goal is to identify any difficulties the child may have in forming sentences or finding the right words, which can impact their academic performance and social interactions. Early identification of expressive language issues allows for timely intervention, helping children improve their communication skills and succeed in school and daily life.
Enhancing Expressive Language in Children: Understanding Content, Form, and Use
Understanding the different aspects of language development in children is crucial for identifying and addressing any challenges they may face. In speech therapy, we focus on three main areas: content, form, and use. Content involves the meanings of words and how we use semantics to create phrases and sentences that make sense. Form refers to the structure of sentences, including word order and length, ensuring that children can construct grammatically correct sentences.
Use encompasses the various communicative intents, such as naming objects, making requests, and greeting others. Each of these components plays a vital role in effective communication, and our clinical sessions aim to enhance these skills through targeted strategies and tools. Let’s delve into each of these areas to better understand how they contribute to a child’s language development.
CONTENT:
Content refers to word meaning, otherwise known as semantics. We use semantics to construct phrases and sentences that make sense to others. This requires an ability to comprehend vocabulary terms and concepts such as multiple meanings, synonyms, and antonyms. Some children have difficulty learning vocabulary and using terms appropriately; therefore, clinical sessions would focus on teaching strategies such as categorization, associations, and graphic organizing (visual diagram that maps definitions, associative words, pictures and more) to improve both comprehension and word retrieval.
FORM:
Form is the process of attaching a symbol, such as a word, picture, or sign to the content/meaning. It also refers to word ordering (syntax) in sentences and length (number of words) in sentences. Some children are challenged by constructing syntactically correct sentences that use an appropriate pattern such as, noun-verb-noun, or noun-verb-adjective-noun. These sessions would focus on practicing a variety of patterns appropriate for the child’s age and ability levels given visual supports (pictures) and/or verbal prompting. We may do this through worksheets, games, and computer programs.
There are a variety of applications for phones and tablets that we can recommend for home practice too. For example, Rainbow Sentences by Mobile Education Store is an app that works in levels and visual supports to teach putting words in order to construct sound sentences. During clinical sessions, we may also work on increasing the number of words in a production to include terms like adjectives or adverbs.
USE:
Finally, use refers to the many communicative intents:
Common Standardized Evaluations for Assessing Expressive and Receptive Language
Preschool:
Clinical Evaluation of Language Fundamentals-Preschool- third edition (CELF Preschool-3)
Receptive-Expressive Emergent Language Test-third edition (REEL-3)
Rossetti Infant-Toddler Language Scale
Preschool Language Assessment Instrument- second edition (PLAI-2)
Preschool Language Scale- fifth edition (PLS-5)
Structured Photographic Expressive Language Test-Preschool- second edition (SPELT-P 2)
Test of Early Language Development- fourth edition (TELD-4)
School-aged:
Clinical Evaluation of Language Fundamentals- fifth edition (CELF-5)
Comprehensive Assessment of Spoken Language- second edition (CASL-2)
Fullerton Language Test for Adolescents- second edition
Functional Communication Profile (FCP-R)
Oral-Written Language Scale-2 (OWLS-2)
Test of Adolescent and Adult Language- fourth edition (TOAL-4)
Test of Language Development-Primary: fifth edition (TOLD-P:5)
Test of Language Development-Intermediate: fourth edition (TOLD-I:4)
When speech pathologists assess language skills, we also test expressive (use) and receptive (understanding) of vocabulary. Vocabulary delays can significantly impact language structure and use. Therefore, we need to evaluate vocabulary in determining if formal treatment goals are indicated. Here are some examples specific to vocabulary assessment:
Assessing Semantic Skills through Everyday Themes (ASSET)
Comprehensive Receptive and Expressive Vocabulary Test-third edition (CREVT-3)
Informal Observations of Receptive and Expressive Language
Other factors that help determine eligibility are informal observations. Speech pathologists may note how a child converses during less structured situations and transitions from one setting to another. An informal observation often includes a language sample analysis. Since language sampling is not a standardized test, it can be completed several times over the course of therapy to document progress.
Speech pathologists use language sampling to analyze a child’s conversational, open-ended speech. We strive to write down fifty sentences or utterances that your child produces during free play and then we calculate the mean length of utterance (MLU) or average number of words and structures used per sentence. During this sample, we refrain from asking questions; rather, we set up items within your child’s reach or ask them to discuss a few topics with minimal prompting. We also use language sampling to assess a child’s language form, content, and use.
Parent Report
Finally, the last component in determining eligibility is parent report. This unit of information is key since caregivers know their children best while examiners are only getting a brief snapshot of a child in a new setting. Caregivers can provide information pertaining to social skills development, self-care skills, and communication ability in a variety of settings.
Using formal assessment, informal observations, and a caregiver report, speech pathologists strive to develop a plan of care to address language deficits. These goals should be measurable and achievable within a year’s time. After a year, your child may continue to need support services, therapy frequency may need to be increased or reduced, or a discharge plan may be indicated.
Closing Thoughts
To maintain test validity, we cannot repeat the same test battery with a child sooner than one year. While assessments are ongoing using logs and data charting at sessions, it is best practice to formally review goals with caregivers after one year of therapy. Schools require speech pathologists to rate progress on each goal on a quarterly or semester basis, while these reviews may happen more frequently with children receiving private services.
I hope that this post helped provide some information about how speech pathologists assess and design treatment plans for children with language delays. Caregivers are one of the most vital members of their child’s special education team; therefore, it is essential that you are just as knowledgeable about your child’s needs and treatment strategies as any other team member. Your comprehension and support fuels and sustains your child’s progress.
There are six effective vocabulary strategies to improve development. Explore our comprehensive guide to discover practical techniques and activities tailored to enhance vocabulary skills in speech therapy sessions. Caregivers can help improve their child’s vocabulary by practicing categorization, association, using themed-units, identifying attributes, and understanding context clues together.
The title: speech pathologist is rather misleading as it implies that we only work on speech. Whether we work in private practice, hospitals, or school settings, speech pathologists address language delays just as much as speech and articulation disorders. One aim of this post is to enhance expressive and receptive vocabulary skills, considering comprehension’s significance for meaningful language use. Some children excel expressively but require receptive skill development. Others need more focus on expression. Still, others can show a delay in both areas. After formal evaluation, a therapy plan is designed to best meet your child’s needs.
There are a few strategies that we can use to help improve vocabulary skills. The essence of this work is to teach children how to store vocabulary concepts like a filing system. Categorization activities may involve asking the child to name or identify members of a target group. For example, three items that belong in a zoo group include: lions, tigers, and bears (oh my!) On the flip side, we can also ask the child to provide or find the category name for a group of its members. We address categorization skills every day in our functional routines when we put away groceries, laundry, and toys.
I had the good fortune to work with some exceptional Speech-Language Pathologists early on in my career. During one of my observations, I watched students play a lively, category game using just brown paper lunch bags and small sheets of paper. This game can easily be adapted for children in 1st through 5th grade. If your child is younger and has a hard time reading, then you can always put pictures on the bags in place of words.
Before you begin, get at least 10 paper bags, and write the names of various category groups on each one. Then, make a list, using a small piece of paper or half of an index card, of 4-5 group members. For pictures on bags, create and attach them. Make groups like Colors challenging by listing specific members, not just primary colors.
This is how you play:
Have your child set up bags with category titles. Then, read category members aloud for your child to listen. Then, have your child take the paper and place it in the correct bag. At the end, I always go back and take a paper out of the bag and practice recalling category members. You can make it into a game by giving a point for every correct placement for the word list and a point for each member he or she can recall from the list.
Word associations are another example of teaching a “filing” system for word retrieval. These word pairs express a relationship that comes in many forms such as:
Themed based units typically follow seasonal events, activities, and familiar sights throughout the year. You can even build categorization and association strategies using themed units. This approach can be effective because you teach what the child is exposed to in his or her everyday life, which can make these terms become more functional as the child can apply therapeutic learning naturally in other settings.
Another strategy for improving vocabulary is teaching attributes for target words. Here, we incorporate games, worksheets, and homework lessons that focus on describing items according to their function or use, color, shape, and size. We can also use other senses like taste and touch to define words. In this way, we have taken one vocabulary word and taught up to six more while formulating definitions.
HOME ACTIVITY:
Here’s an association activity based on seasonal themes and incorporating attributes that you can do for each season of the year with your child.
SUMMER: First, make a yellow circle and write in the middle, “Things that make me think of summer.” Then, cut up to 10-15 strips of paper to make the rays for the sun. Finally, brainstorm associations together and write down answers on rays. Some associative words my son helped me come up with for this task included: pool, beach, lake, water, hot, heat, ice cream, sunscreen, vacation, and swim.
FALL: Create a tree with different colored leaves for association words: colors, windy, apples, pumpkins, football, leaves, Halloween, Thanksgiving, hayrides, and scarecrow.
WINTER: Use snowflakes for association words and form these into a giant snowball. Some suggested terms: cold, ice, snow, coats, hot chocolate, holidays, snowman, sledding, ice skating, and boots.
SPRING: Create a giant center to a flower and write these words on petals and stems: warm, crisp, rainy, bloom, flowers, green, jackets, growth, new, and muddy.
Vocabulary Strategies: Context Clues/ Word Parts (Prefixes, Suffixes)
Utilizing curriculum vocabulary with older children poses challenges in language goals due to progress assessment difficulties in my experience. However, we can measure improvement in a child’s ability to interpret vocabulary meaning in context or demonstrate knowledge of word parts. One of my most treasured purchase from Teachers Pay Teachers (TpT) is product called: Context Clues Packet using Tier Vocabulary by Nicole Allison. It is engaging and comprehensive for both elementary and middle school students. I especially like having answer choices for determining vocabulary meaning in context because it teaches another strategy of eliminating less obvious selections.
As support staff, we are challenged with helping foster independence with our students. We will not be there during their classroom instruction or testing to provide cues and probes to increase comprehension, so we need to teach strategies for unaided success. Incorporating the above mentioned techniques into daily activities at home can significantly boost your child’s vocabulary development. Remember, even just reading together is a great way to expand language skills!
For children with speech and language delays, using visual supports like sign language, natural gestures, photographs, and digital pictures is incredibly empowering and educational in teaching comprehension and verbal expression. Imagine the frustration of a hungry toddler, unable to speak his needs, without any way to express his snack preferences. Having a visual support handy does not take the place of teaching your child speech skills. Rather, visuals enhance a child’s comprehension; help you identify the intended word to support your child in practicing saying it accurately; and reduce frustrations and negative behaviors. There are several ways that you can provide visual supports.
Using Sign Language For Visual Supports
Nowadays, it is very much in fashion to use sign language with young toddlers. Bookstores, libraries, apps, and mommy groups offer sign language resources for learning with ease and convenience. My favorite resources are produced by Signing Time. This company offers DVDs teaching sign language for babies and toddlers, featuring infant and toddler models. They’re highly recommended by many. The greatest thing about using sign language for communication is that unlike pictures, you always have your hands with you. Below are the top three reasons why caregivers and speech pathologists alike are using sign language.
It significantly reduces frustrations for both toddlers and caregivers. Toddlers often understand more words than they can express, demonstrating a larger receptive vocabulary compared to their expressive vocabulary. Your child knows what he wants to say, but he cannot get those words out just yet. Signing a word requires less effort and fewer steps than verbally producing the same word, making communication more efficient.
Teaching sign language supports speech development. Now that you have reduced those frustrating moments, there are naturally many more teachable opportunities in your day. For example, your child signs “milk” and you repeat the word “milk” a few times as you prepare the Nuby cup.
It supports receptive (comprehension) development. Children need to understand the meanings for words to bank those words into their spoken word repertoire. They may not say “milk,” but using the sign for it, they request it, reinforcing its meaning as they enjoy it.
Natural Gestures
In addition to sign language, you can use natural gestures with your child to help elaborate on communication. You are probably already doing many of these naturally (hence the term natural gestures.) Common examples seen with children between 9-21 months old are:
Waving hello and goodbye
Holding out your arm to show someone an object in your hand
Pointing to objects to express wants
Shaking your head to say “no” and nodding to say “yes”
Taking your hand and bringing you to a desired object
Making a movement to request an action (i.e., jumping to request trampoline play)
Giving a “hi-five”
Photographs: Dynamic Visual Supports
For some children, planning out a motor sequence to maneuver their hands to show a sign is incredibly difficult. I use sign language to enhance comprehension but rely on photos and digital images for effective communication of wants and needs. Photos of favorite items in a mini book or magnetic cases are handy. There are several goals in using these pictures:
Photographs narrow down the options and help you quickly understand your child’s wants. For example, if your child can make the first sound in a word, he may say, “guh” for granola, grapes, and gummies. If you have a photograph for each, he can continue to say “guh” and point to or look at the picture of the object he desires.
The natural progression in language development begins with comprehending names for objects. Children first learn that a three-dimensional object is called a “ball”. Using photos helps children understand objects. Show a picture of a ball to teach its representation. It enhances communication and comprehension.
Storing food and toy pictures in specific areas teaches categorization skills, aiding your child’s vocabulary development. We use this strategy to store new information and broaden both use and understanding for vocabulary words. Compiling food pictures in the kitchen and toy images in the family room teaches your child organization based on category.
Digitally Created Visual Supports
As your child becomes familiar with actual photographs of objects, you can transition to digitally produced pictures. These images are the creation of a digitally encoded representation of the visual characteristics of an object, such as an image of a ball that is not a photograph. Consult with your child’s speech pathologist to create a picture vocabulary, especially if your child has limited verbal skills or needs long-term support. If digital visuals are needed, then consider purchasing an iPad app. Custom Boards by Smarty Ears apps is well worth every penny!
In conclusion, integrating visual supports into your child’s learning journey can be transformative, offering a bridge between comprehension and expression. By utilizing sign language, gestures, and visual aids, you’re not only helping your child navigate communication challenges but also fostering a supportive environment where their needs are understood and met. Embrace the power of visuals as a tool to unlock your child’s potential and enhance their speech and language development journey.
