SLPs

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)

Why is Mean Length of Utterance (MLU) Important? (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.

Why is Mean Length of Utterance (MLU) Important? (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

Why is Mean Length of Utterance (MLU) Important? (mother and baby girl reading a book)
Photo by William Fortunato on Pexels.com

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.

The Best Speech Therapy Toys for Toddlers

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Baby holding a play phone next to its ear

Embark on a journey to uncover the essential features that make speech therapy toys for toddlers 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 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:

Speech Therapy Toys for Toddlers That Make HARDLY ANY Noise

The Best Speech Therapy Toys for Toddlers (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.

Speech Therapy Toys for Toddlers That Fit Right In With My Theme

The Best Speech Therapy Toys for Toddlers (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!

Speech Therapy Toys for Toddlers That Stand the Test of Time

The Best Speech Therapy Toys for Toddlers (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?!

Multi-Functional Speech Therapy Toys for Toddlers

The Best Speech Therapy Toys for Toddlers (toddler 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.

Takeaway Thoughts

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.

Effective Evaluation & Treatment For Articulation Disorders

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Woman holding the letter S with child imitating a touch cue in speech therapy
Effective Evaluation & Treatment For Articulation Disorders (Bowl of pastel colored alphabet letters)

Articulation Disorders

Making progress in speech development starts with understanding the evaluation and treatment process for articulation disorders, 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.

Effective Evaluation & Treatment For Articulation Disorders (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.

Effective Evaluation & Treatment For Articulation Disorders (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!

Treating Articulation Disorders:

Effective Evaluation & Treatment For Articulation Disorders (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.

Articulation Disorders: 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: Why it’s Treated Differently

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Boy whispering into a girls' ear

Childhood Apraxia of Speech CAS: Why it's Treated Differently (Parents with young child holding book)Childhood apraxia of speech 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 Childhood Apraxia of Speech?

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.

Early Signs of Childhood Apraxia of Speech

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

Apraxia vs 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.

Apraxia vs Phonological Disorders

Childhood Apraxia of Speech CAS: Why it's Treated Differently (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 haven’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 Childhood Apraxia of Speech?

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.

Apraxia of Speech 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 on Childhood Apraxia of Speech

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 Therapy- Useful for Childhood Apraxia of Speech

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Nanette Cote Providing Tactile PROMPT to Toddler

What is PROMPT Therapy?

PROMPT therapy 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.

PROMPT is an acronym for: Prompts for Restructuring Oral Muscular Phonetic Targets.

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.

PROMPT Therapy: Constructing a Strong Foundation

PROMPT Therapy- Useful for Childhood Apraxia of Speech (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 with PROMPT Therapy:

PROMPT Therapy- Useful for Childhood Apraxia of Speech (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 Therapy Supports:

PROMPT Therapy- Useful for Childhood Apraxia of Speech (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”.

https://www.youtube.com/watch?v=CiUVHjSvCvM
Demonstration of Syllable tactile for boo-boo

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 Complex and Surface tactile for /s/

PROMPT Therapy and Teletherapy:

PROMPT Therapy- Useful for Childhood Apraxia of Speech (child and parent looking at computer)

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.

Understanding Phonological Disorders: What They Are and How to Help

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Mastering Teletherapy for Early Intervention: Portrait of cute girl participating in auditory bombardment with headphones on
What are Phonological Disorders and Processes? (school teacher showing a book to the children)

In this comprehensive guide, we’ll explore phonological disorders, 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.

Understanding Phonological Processes in Phonological Disorders

There are nine phonological processes that we typically encounter in speech therapy: syllable reduction, syllable structure, cluster reduction, final consonant deletion, stopping, fronting, backing, gliding, and devoicing. 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. Errors will be consistent unlike apraxia.
  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.
  9. Devoicing: occurs when a voiced sound at the end of a word is pronounced as a voiceless sound. For example, a child might say “bak” instead of “bag.” This occurs as children simplify speech patterns, typically resolving by age four.

Evaluating Phonological Disorders

What are Phonological Disorders and Processes? (Bowl of pastel colored alphabet letters)

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.

Treating Phonological Disorders

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:

What are Phonological Disorders and Processes? (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

What are Phonological Disorders and Processes? (mother and son doing art work)
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
Tongue Tie: Impacts on Speech, Dentition, Feeding, and More (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.

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

Tongue Tie: Impacts on Speech, Dentition, Feeding, and More (Dr Robert Pick)

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

The Best Speech Therapy Early Intervention Activities

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Speech Therapy Early Intervention Activities: Pile of Crayons

Speech Therapy & Early Intervention

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 during speech therapy early intervention
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:

  1. Water Play
  2. Arts and Crafts
  3. Play dough
  4. Sensory Bins

For a unique activity that is especially fun at Easter, read my post about using plastic eggs to discover mini treasures.

WATER PLAY: SPEECH THERAPY EARLY INTERVENTION ACTIVITIES

Water play during speech therapy early intervention

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

Mother and child blowing bubbles during speech therapy early intervention

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 during speech therapy early intervention

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:

  1. Draw 2 horizontal lines while saying “ZOOM” leaving a few inches between them.
  2. Now make vertical lines while saying “ZAP”.
  3. 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

Sensory bin play during speech therapy early intervention

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!

Best Practice School Assessment of Receptive & Expressive Language

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Group of children sitting on the ground outside

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

Teaching reading a book surrounded by attentive children during group testing for receptive and expressive language

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:

  • Naming (ball)
  • Requesting objects (want bubbles), actions (go), assistance (help)
  • Responding to questions
  • Making comments (I like it)
  • Protesting (No more)
  • Attention seeking (Look!)
  • Greetings (hi/bye)

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)
  • Expressive One-Word Picture Vocabulary Test- fourth edition (EOWPVT-4)
  • Expressive One-Word Picture Vocabulary Test-Upper Extension (EOWPVT-UE)
  • Expressive Vocabulary Test- third edition (EVT-3)
  • Peabody Picture Vocabulary Test-fourth edition (PPVT-4)
  • Receptive One-Word Picture Vocabulary Test- fourth edition (ROWPVT-4)

Informal Observations of Receptive and Expressive Language

Group of children sitting on the ground outside while observer collects informal data on 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

Father holding toddler displaying the importance of parent report in receptive and expressive language testing

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.

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