Phonology

Phonological processes describe what children do in the typical development process of speech to simplify standard adult productions. When a child uses many different processes or uses processes that are not typically present during speech acquisition, intelligibility may be impaired. A few examples of phonological processes may include but are not limited to the following:

• Stopping is when a child uses his or her articulators to stop the airflow emitted during the production of a sound that requires a continuous stream of air during its production. For example, a child will replace the /s/ in /something/ with a /t/, or the /y/ in /yes/ becomes a /d/ as in /des/.
• Initial Consonant Deletion is when a child omits the first sound of a word or a syllable. For example, a child may produce /abbit/ rather than /rabbit/, omitting the /r/ in the initial position.
• Final Consonant Deletion is when a child omits the final consonant in a word or a syllable. For example, s/he may omit the final /t/ in /cat/ producine /ca/ instead
• Weak Syllable Reduction is when a child reduces a multisyllabic word to simplify it production. For example, /elephant/ may become /efant/.
• Consonant Cluster Reduction is when a child reduces a blended sound to approximate its production, such as; /pl/ becomes /p/, /plate/ becomes /pate/.

As children develop the correct production of speech they shed their phonological processes, making for more intelligible speech. All children demonstrate phonological processes of some sort during the development of speech. When their intelligibility is impaired and they continue to use the processes beyond the age when it is appropriate an SLP should be contacted. As with all developmental language and speech concerns, I recommend that a parent contact a certified speech pathologist if they feel uncomfortable with their child's development.

Developmental Stuttering

Many of my clients express concern when their children demonstrate disfluencies during their speech development. More often than not, the disfluency is due to a phenomenon known as "Limited Capacity". When a child has more to say than he or she is developmentally capable of, frequently a stutter will occur. "Limited Capacity" disfluiencies occur when a child is developing language, usually between the ages of 2 - 5.

When working with parents who are concerned about their child's fluency, I recommend the following strategies:

• Provide an environment without communicative stresses that allows many opportunities for the child to speak.
• Parents should not react negatively during stuttering events.
• Parents should praise and respond positively to fluent moments.
• Keep communicative demands low, and do not pressure the child to verbally perform.
• Implement relaxation exercises, including controlled breathing exercises.
• Do not complete your child's sentences, rather listen patiently to him/her as s/he speaks.

If your child's disfluency continues through an extended period of time, consult with a certified Speech Language Pathologist. A qualified SLP has the tools and the experience to assess the situation and teach strategies that will support fluent speech.

What is Childhood Apraxia of Speech

Childhood Apraxia of Speech (CAS) is a speech disorder that involves the motor planning of the speech production. Children with apraxia of speech experience difficulty planning and coordinating the many movements required for comprehensible speech. A series of well-coordinated movements of the articulators (tongue, lips, jaw, soft palate) coupled with controlled speech breathing, and adduction and abduction of the vocal folds must be precisely coordinated to form intelligible speech. Apraxia of speech is the inability to form and execute such a plan in all its complexity

Speech production is the most complex motor process we produce. Simply speaking, when the intention to communicate is formed the brain must send impulses to the respiratory system, the larynx and the muscles of the articulators in the exact order and timing of movement so that the message is properly conveyed. This means that each sound, word, and sentence must be produced accurately, within fractions of a second in order to send a clear message. Finally, the systems must function with enough strength and range of motion to produce understandable speech.

It is believed that children with Childhood Apraxia are not able to connect the motor plan with the actual movements required for precise speech production. CAS is often characterized by:

• Inconsistent production of sounds
• Frequent groping for words and sounds
• Hesitations in speech production
• Effortful speech with frequent and inconsistent phonological errors
• Unintelligible, jargon-like speech

As with all speech and language impairments, if you feel that your child is experiencing difficulties in their development of speech and language, contact your pediatrician or a qualified Speech Language Pathologist for an evaluation.

Early Childhood Language Development: Autumn Fun!!

Early Childhood Language Development: Autumn Fun!!: "Now that summer has ended and autumn is upon us, parents are looking for activities that will engage their children, build their self-esteem..."

Choosing a Qualified Speech Language Pathologist

A Speech Language Pathologist is a well trained professional who is skilled in the assessment and treatment of adults and children with communication disorders. While licensing of an Speech Language Pathologist is the responsibility of each state, the association charged with the certification process is called American Speech and Hearing Association (ASHA). While all Speech Language Pathologists must be licensed, they do not have to be certified. A more stringent set of professional criteria must be met to achieve an ASHA certification. ASHA maintains an online registry of SLPs with ASHA certifications. A Pathologist with credentials of CCC-SLP indicate that they achieved their Certified Clinical Competency from ASHA.

Your doctor or your child's pediatrician should be able to provide a recommendation for a competent pathologist. In fact I recommend that a physician be consulted if you are concerned about any aspect of your child's development or your own functional communication. Your child's school can also guide you through the process of seeking services through the educational system.

During your first meeting, you should expect a thorough evaluation, both a formal assessment (standardized tests) and an informal assessment (observation in several communicative context), before a conclusion can be formed. A thorough evaluation may take a bit of time to cover all functional aspects of speech and language -- and a good one will.
During the following meetings with your therapist you can expect to learn and implement strategies that will support functional communication in and outside of therapy.

Your speech therapy should be covered by insurance if medically necessary and recommended by your physician or pediatrician. Because each insurance plan is different, you should contact your carrier. Your child may also receive services through governmental programs if he or she have met certain criteria after being evaluated. Each state administers their own programs and criteria and therapeutic services differ from state to state.

Also please consider language and cultural factors when seeking a professional. There are clinicians who are certified in bilingual professional practice. If you are bilingual you cannot overlook this factor in treatment. A second language will always have an impact in language development in children and in rehabilitation for adults.

Articles of Interest

For those of you who are interested in articles about Autism Spectrum, here is a link to an Article in The NYTimes

For parents and SLP's interested in childhood language development, here is another article from the Times that may be of interest.

What Do Toddlers Talk About?

The development of speech and language can vary between children -- and often does. However, there is a natural progression that typical development follows. Simply speaking, easier skills must be mastered before more difficult ones. Nonverbal benchmarks before verbal. Vocalizations typically emerge before babbling. Shorter utterances come before more lengthy ones. Sounds that require an open vocal tract such as ah come before sounds that require complex coordination of the articulators such as b or p. B and p come before s and z and so on. Additionally, children will typically tell you that there is an apple before they tell you that they eat apple and they will tell you they eat apple before they tell you that they eat apple on table.
While many of us may know when single words start to emerge in a child’s communication, other benchmarks are not so straight forward. When determining language development in your infant and toddler, the following points of reference can help frame typical development from birth to three years of age.
· At 6 months a child should be responsive to his/her name. S/he should vocalize and babble with intonation, respond to different emotional vocal tones and facial expressions, and turn his or her head towards sounds.
· At 12 months a child may be using one or more words with meaning such as mama, or baba. This is when a child begins to express intention. S/he should also understand simple directives when accompanied by visual cues and gestures.
· At 18 months a child’s vocabulary should be approaching 25 word; mostly nouns. S/he should use jargon with intonation, repeat a lot of what s/he hears, and follow simple directives without supporting gestures or visual cues.
· At 2 years of age a child should be able to verbally identify common objects with approximately 65% intelligibility. S/he should produce 1 and 2 word utterances combining nouns with verbs such as “eat cookie”. Verbs and adjectives are emerging in their lexicon and their vocabulary is growing larger approaching two to three-hundred words. Prepositions will also emerge such as on and in. S/he will begin to refer to him/herself as I or me. Their voice quality (pitch and amplitude) will not be well regulated at this time. Receptively, your child typically will follow directives such as “show me” “give me” and the most important “clean- up”
· At 3 years of age, your toddler should communicate with close to 90% intelligibility. S/he should use pronouns correctly. You may notice temporal markers such as the past tense “ed” are emerging in their language. Their vocabulary could be between 500 and 1000 words and s/he produces 3 word utterances. S/he will identify body parts and will be able to answer some “wh” questions such as, what do you do when you are tired? Additionally, a 3 year old child will relate better to their environment and they will begin to comment on their surroundings.
Do not fret, it does not necessarily mean there is a delay or impairment if your child has not met all of these milestones. Language development is influenced and dependent upon so many other factors. If you are concerned, contact your child’s pediatrician or a licensed Speech-Language Pathologist with your questions. They will help you to determine if a full language evaluation is necessary.