Play and Say Therapy.

Frequently asked questions regarding Speech and Language Therapy in the Chicago area.

Speech and Language Therapy: Our fully qualified and licensed Speech Language Pathologists diagnose and treat children with a variety of Speech and Language impairments. Our Speech and Language Pathologists are skilled in treating all communication disorders including developmental, sensory and motor based communication disorders, and social language disorders.

Is there a difference between Speech and Language?

Speech and Language are two different things that go together to enable a person to communicate. According to the American Speech Language and Hearing Association: "Language is different from speech.

Language is made up of socially shared rules that include the following:

• What words mean (e.g., 'star' can refer to a bright object in the night sky or a celebrity)
• How to make new words (e.g., friend, friendly, unfriendly)
• How to put words together (e.g., 'Peg walked to the new store' rather than 'Peg walk store new')
• What word combinations are best in what situations ('Would you mind moving your foot?' could quickly change to 'Get off my foot, please!' if the first request did not produce results)

Speech is the verbal means of communicating. Speech consists of the following:

• Articulation. How speech sounds are made (e.g., children must learn how to produce the 'r' sound in order to say 'rabbit' instead of 'wabbit').
• Voice. Use of the vocal folds and breathing to produce sound (e.g., the voice can be abused from overuse or misuse and can lead to hoarseness or loss of voice).
• Fluency. The rhythm of speech (e.g., hesitations or stuttering can affect fluency).

When a person has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings completely (expressive language), then he or she has a language disorder.

When a person is unable to produce speech sounds correctly or fluently, or has problems with his or her voice, then he or she has a speech disorder."

Resource: www.asha.org

What is Apraxia of Speech?

According to the American Speech Language and Hearing Association, "Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words."

Resource: www.asha.org

What are Oral Motor Deficits?

Oral motor deficits involve weakness and/or instability in a person's articulators (lips, jaw, tongue, etc.). Some characteristics of oral motor deficits include drooling, open mouth posture, low facial tone, as well as difficulty blowing, drinking from a straw, or licking.

How do I know if my child needs Speech and Language Therapy?

Each child's Speech and Language Development is different. Some children start speaking earlier and some start speaking later than others. Therefore, parents need to be cautious when comparing their child’s Speech and Language Development to another child the same age.

According to the American Speech Language and Hearing Association:

Parents are smart. They listen to their child talk and know how he or she communicates. They also listen to his or her playmates who are about the same age and may even remember what older brothers and sisters did at the same age. Then the parents mentally compare their child's performance with the performance of these other children. What results is an impression of whether or not their child is developing speech and language at a normal rate.

If parents think that development is slow, they may check out their impression with other parents, relatives, or their pediatrician. They may get an answer such as "My son was slow too. Now he won't shut up" or "Don't worry, she'll outgrow it."

But suppose (s)he doesn't? I'd feel guilty waiting and then finding out that I should have acted earlier. Waiting is so hard, especially when I'm concerned and only want what's best for my child. What's a parent to do? How will I know for sure what to do?

You won't know for sure. Although the stages that children pass through in the development of speech and language are very consistent, the exact age when they hit these milestones varies a lot. Factors such as the child's inborn ability to learn language, other skills the child is learning, the amount and kind of language the child hears, and how people respond to communication attempts can slow down or accelerate the speed of speech and language development. This makes it difficult to say with certainty where any young child's speech and language development will be in 3 months, or 1 year.

There are, however, certain factors that may increase the risk that a late-talking child in the 18- to 30-month-old age range, and with normal intelligence, will have continuing language problems. These factors include:

• Receptive language: Understanding language generally precedes expression and use. Some studies that have followed-up late-talking children in this age range have found, after a year, that age-appropriate receptive language discriminated late bloomers from children who had true language delays. Other researchers doing follow-up studies included only children whose receptive language was within normal limits because they believed that delay in this area was likely to produce worse outcomes.
• Use of gestures: One study has found that the number of gestures used by late-talking children with comparably low expressive language can indicate later language abilities. Children with a greater number of gestures used for different communication purposes are more likely to catch up with peers. Such a result is supported by findings that some older children who are taught non-verbal communication systems show a spontaneous increase in oral communication.
• Age of diagnosis: More than one study has indicated that the older the child at time of diagnosis, the less positive the outcome. Obviously, older children in a study have had a longer time to bloom than younger children but have not done so, indicating that the language delay may be more serious. Also, if a child is only developing slowly during an age range when other children are rapidly progressing (e.g. 24-30 months) that child will be falling farther behind.
• Progress in language development: Although a child may be slow in language development, he or she should still be doing new things with language at least every month. New words may be added. The same words may be used for different purposes. For example, "bottle" may one day mean "That is my bottle," the next, "I want my bottle," and the next week, "Where is my bottle? I don't see it." Words may be combined into longer utterances ("want bottle" "no bottle"), or such longer utterances may occur more often.

It should be re-emphasized that negative aspects of these factors increase the risk of a true language problem but do not mandate its presence. For example, one research group found that one of their 25- or 26-month-old children with the worst receptive language had the best expressive language outcome 10 months later. On the other hand, children on the positive side of these factors may turn out to show less progress than predicted. The research group found that the child with the poorest outcome had the best receptive language and the largest vocabulary at the beginning of the study.

One study has found that the number of gestures used by late-talking children with comparably low expressive language can indicate later language abilities.

Individual children may not behave like children in a group. Group data can only be used to predict what most children who are very similar to the children in a study might do. Predictions, by their very nature, are not always correct.

So what's a parent to do?

Parents don't have to rely on the predictions of others or to guess that their child will be just like a friend's and eventually catch up in language development. If parents are concerned about their child's speech and language development, they should see a speech-language pathologist certified by the American Speech-Language-Hearing Association for a professional evaluation. The speech-language pathologist can administer tests of receptive and expressive language, analyze a child's utterances in various situations, determine factors that may be slowing down language development, and counsel parents on the next steps to take.

The speech-language pathologist may give suggestions on stimulating language development, and ask that the parent and child return if parental concern continues. Or, the speech-language pathologist may want to schedule a re-evaluation right then. In more severe cases, the speech-language pathologist may want the parent and child to become involved in an early intervention program. The programs typically consist of demonstrating language stimulation techniques for home use, and more frequent monitoring of the child's progress. In the most severe cases, a more formal treatment program may be recommended.

Waiting to find out if your child will catch up will still be hard, but you won't feel guilty that you did not do everything you could.

Resource: www.asha.org

To view the Speech and Language Milestone Chart click here.

What is autism?

Autism is a developmental disability that causes problems with social skills and communication. Autism can be mild or severe. It is different for every person. Autism is also known as autism spectrum disorders.

Resource: www.asha.org

What are some signs or symptoms of autism?

Children with autism may have problems with communication, social skills, and reacting to the world around them. Not all behaviors will exist in every child. A diagnosis should be made by the child's doctor or other professional with experience in working with children with autism. Possible signs and symptoms are outlined below.

Communication:

• Not speaking or very limited speech
• Loss of words the child was previously able to say
• Difficulty expressing basic wants and needs
• Poor vocabulary development
• Problems following directions or finding objects that are named
• Repeating what is said (echolalia)
• Problems answering questions
• Speech that sounds different (e.g., "robotic" speech or speech that is high-pitched)

Social skills:

• Poor eye contact with people or objects
• Poor play skills (pretend or social play)
• Being overly focused on a topic or objects that interest them
• Problems making friends
• Crying, becoming angry, giggling, or laughing for no known reason or at the wrong time
• Disliking being touched or held

Reacting to the world around them:

• Rocking, hand flapping or other movements (self-stimulating movements)
• Not paying attention to things the child sees or hears
• Problems dealing with changes in routine
• Using objects in unusual ways
• Unusual attachments to objects
• No fear of real dangers
• Being either very sensitive or not sensitive enough to touch, light, or sounds (e.g., disliking loud sounds or only responding when sounds are very loud; also called a sensory integration disorder)
• Feeding difficulties (accepting only select foods, refusing certain food textures)
• Sleep problems

Resource: www.asha.org

How is autism diagnosed?

It is important to have your child evaluated by professionals who know about autism. Speech-language pathologists (SLPs), typically as part of a team, may diagnose autism. The team might include pediatricians, neurologists, occupational therapists, physical therapists, and developmental specialists, among others. SLPs play a key role because problems with social skills and communication are often the first symptoms of autism. SLPs should be consulted early in the evaluation process.

There are a number of tests and observational checklists available to evaluate children with developmental problems. The most important information, however, comes from parents and caregivers who know the child best and can tell the SLP and others all about the child's behavior.

Resource: www.asha.org

What treatments are available for people with autism?

There is no known cure for autism. In some cases, medications and dietary restrictions may help control symptoms. Intervention should begin when the child is young. Early intervention and preschool programs are very important. An evaluation by an SLP should be completed to determine social skill and communication needs. An appropriate treatment plan that meets the needs of the child and family can then be established.

Treatment may include any combination of traditional speech and language approaches, augmentative and alternative communication, and behavioral interventions. It is also important to have the child's hearing evaluated to rule out hearing loss.

Resource: www.asha.org

What is Augmentative and Alternative Communication (AAC)?

Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write.

People with severe speech or language problems rely on AAC to supplement existing speech or replace speech that is not functional. Special augmentative aids, such as picture and symbol communication boards and electronic devices, are available to help people express themselves. This may increase social interaction, school performance, and feelings of self-worth.

AAC users should not stop using speech if they are able to do so. The AAC aids and devices are used to enhance their communication.

Resource: www.asha.org

What are the types of AAC systems?

When children or adults cannot use speech to communicate effectively in all situations, there are options.

Unaided communication systems – rely on the user's body to convey messages. Examples include gestures, body language, and/or sign language.

Aided communication systems – require the use of tools or equipment in addition to the user's body. Aided communication methods can range from paper and pencil to communication books or boards to devices that produce voice output (speech generating devices or SGD's)and/or written output. Electronic communication aids allow the user to use picture symbols, letters, and/or words and phrases to create messages. Some devices can be programmed to produce different spoken languages.

Resource: www.asha.org

Speech & Language Skills in Infants, Toddlers & Young Children with Down Syndrome.

—by Libby Kumin, PhD, Professor of Speech-Language Pathology/Audiology, Loyola College in Maryland

Speech and language present many challenges for children with Down syndrome but there is information that can help infants and toddlers begin learning to communicate, anf help young children progress in speech and language. Although most children with Down syndrome learn to speak and will use speech as their primary means of communication, they will understand language and have the desire to communicate well before they are able to speak. Total communication, using sign language, pictures, and/or electronic synthesized speech can serve as a transitional communication system.

Are hearing problems common in children with Down syndrome?

Ear infections occur frequently in infancy and early childhood in all children. But, because of anatomic differences in the ears of children with Down syndrome (narrow and short canals), they are more susceptible to accumulations of fluid behind the eardrum. This is known as Otitis Media with Effusion (OME). These problems result from fluid retention and inflammation in the middle ear; sometimes with infection. The presence of fluid makes it more difficult for the child to hear, resulting in fluctuating conductive hearing loss. Children should be followed by their pediatrician and otolaryngologist (ENT) and visit an audiologist for auditory testing. This testing can be done soon after birth. Hearing testing should also be done every six months until three years of age and annually through age 12 years. Treatment usually involves either an antibiotic regimen or the insertion of tubes to drain the fluid. These recommendations follow the schedule found in the Down Syndrome Medical Interest Group Healthcare Guidelines, available through NDSS.

Resource: Cohen, W. et al (1999) Health Care Guidelines for Individuals with Down Syndrome (Down syndrome preventive medical check list). Down Syndrome Medical Interest Group. Down Syndrome Quarterly, 4, 1-26.

What effect does hearing loss have on speech and language development?

Speech and language are learned through hearing, vision and touch. Hearing is very important to speech, and studies have shown that speech and language development are negatively affected by chronic fluid accumulation. Children with Down syndrome often have fluctuating hearing loss due to the frequency of fluid accumulation. When fluid is present, hearing is affected; as fluid drains, hearing improves. When children do not consistently hear well, it is difficult to learn how sounds and events are related, e.g. the ring of the telephone or someone calling you. So, it is important to ensure that your child is hearing well. Pediatricians and otolaryngologists have great success in treating fluid accumulation, but treatment requires close monitoring.

For more information, see: Shott, S. R. (2000). Down syndrome: Common pediatric ear, nose, and throat problems. Down Syndrome Quarterly, 5, 1-6.

Shott, S.R., Joseph, A., and Heithaus, D. Hearing loss in children with Down syndrome. International Journal of Pediatric Otolaryngology 1:61 (3): 199-205, 2001.

How is feeding related to speech and language?

Speech is a secondary function that uses the same anatomic structures used for feeding and respiration. Low muscle tone (hypotonia) affects feeding and will also affect speech. In feeding, children gain practice with strengthening and coordinating the muscles that will be used for speech. If your child has difficulty feeding, it is important to seek guidance from a feeding specialist (a speech-language pathologist or occupational therapist who has advanced training). Feeding therapy can to help strengthen the oral muscles. This can also have a positive effect on speech.

What other skills are related to speech and language development?

Other important pre-speech and pre-language skills are the ability to imitate and echo sounds; turn-taking skills (learned through games such as peek-a-boo); visual skills (looking at the speaker and looking at objects); auditory skills (listening to music and speech for lengthening periods of time, listening to speech sounds); tactile skills (learning about touch, exploring objects in the mouth); oral motor skills (using the tongue, moving lips); and cognitive skills (understanding object permanence, cause and effect relationships). The family can stimulate these pre-speech and language skills at home. Contact Child Find in your area, and ask for speech-language pathology services for your child. The SLP can help you learn the skills that you need to help your child move along the journey to learning language and using speech.

For more information, see: Kumin, L. (2003). Early communication skills for children with Down syndrome: Guide for parents and teachers. Bethesda, MD: Woodbine House.

When will my child say his first word?

Children with Down syndrome frequently begin to use single words between the ages of two and three, but the age of the first word varies, and the first true word may not be a spoken word, but it may be a signed word. Most children with Down syndrome communicate from birth through crying, looking and gesturing. They have the desire to communicate and learn that crying or making sounds can affect their environment and bring them help and play and attention. Many children with Down syndrome, by 10-12 months of age, understand the relationship between a word and a concept. However, at that age, the child generally does not have sufficient neurological and motor skills developed to be able to speak. That’s why it is important to provide another system so that the child can communicate and learn language before they are able to speak.

What is total communication?

Total communication (TC) is the combined use of signs and gestures with speech to teach language. Total communication provides the child with an output system to communicate when he or she has not yet developed the skills needed for speech. In total communication, the adult uses sign and speech when talking with the child. The child learns signs in conjunction with speech and uses the signs to communicate. Sign language is a transitional system for children with Down syndrome. Other choices for transitional communication systems are pictures used on a communication board or in a communication exchange system, and/or electronic communication systems which use synthesized speech. Most children with Down syndrome are ready to use a language system many months or even several years before they are able to use speech effectively to communicate. Therefore, a transitional communication system such as sign language, pictures or synthesized voice is frequently needed. A speech-language pathologist and/or augmentative communication specialist (AAC) can help design a transitional communication system for your child. Most children with Down syndrome will use speech as their primary system for communication.

What can parents do to help infants and young children learn speech and language?

Parents are the primary communicators interacting with their babies and young children; thus, parents can do a great deal to help their children learn to communicate. Many of the pre-speech and pre-language skills are best learned in the home environment.

• Remember that language is more than spoken words. When you are teaching a word or a concept, focus on conveying meaning to the child through play or through multisensory experiences (hearing, touch, seeing).
• Provide many models. Most children with Down syndrome need many repetitions and experiences to learn a word. Repeat what your child says, and give him a model to help him learn words.
• Use real objects and real situations. When you are teaching a concept, use daily activities and real situations as much as possible. Teach the names of foods as your toddler is eating, names of body parts while you are bathing your child, and concepts such as under, in and on while your child is playing. Communication is part of daily life.
• Read to your child. Help your child learn concepts through reading about them, field trips in the neighborhood and daily experiences.
• Follow your child's lead. If your child shows interest in an object, person or event, provide him or her with the word for that concept. There are many milestones as the child progresses toward using speech. The child responds to a familiar voice, recognizes familiar faces, experiments with many different sounds, produces strings of sounds over and over and makes a sound to mean you (dada, mama). Many children enjoy looking in a mirror, and increase their sound play and babbling when vocalizing in mirrors. Effective ways to work on these skills at home can be learned through early intervention sessions, through books, workshops and speech and language professionals.

For more information, see: Kumin, L. (2003). Early communication skills for children with Down syndrome: Guide for parents and teachers. Bethesda, MD: Woodbine House.

When should speech-language pathology services begin? What is early language intervention?

Speech-language pathology services can begin in infancy. Treatment may involve sound stimulation, language stimulation accompanying play, feeding, oral motor exercises and/or other techniques. It should always include the family as a partner in treatment because the family is the primary teacher of speech and language. Early language intervention (ELI) is the designation given for services provided to infants and toddlers from birth through the end of age two. Speech-pathology services should be part of a comprehensive overall treatment plan for infants and toddlers. It may involve sessions at home or in a center, and may be part of a team approach involving physical, occupational and other therapists working together with the family.

A government-sponsored early intervention program is available in all communities in the U.S. Speech-language and other therapy services are often provided at these programs for eligible children under age three, based on disability and an evaluation. Most children with Down syndrome qualify for speech-language services. After age three, there may be continuing services sponsored through the school system with an IEP or through community agencies, private practitioners, university clinics, medical centers and other sources.

How do you find a qualified speech-language pathologist?

Qualified SLPs are certified by the American Speech-Language-Hearing Association and licensed by the state. When a professional is certified, they can use CCC-SLP (Certificate of Clinical Competence in Speech-Language Pathology) following their name. This means they have completed a master's degree in an accredited program, have completed required hours of clinical practice internship and passed a national certification examination. If you are receiving services through Child Find (a federal program that identifies the needs of children with disabilities), the health department or school system in your local area, they will have professionals working with them or they can refer you to local professionals. Members of local Down syndrome support groups can often refer you to speech-language pathologists in your area who have experience working with children with Down syndrome.

Resource: ndss.org