Tuesday, March 29, 2011

Baby Steps for Baby Signs 1: How to Select Signs For Your Toddler

Last week, I responded to a reader question about what sign system would be best to use with her toddler. After blathering on for a bit about why signs can be so beneficial to language development, I finally got around to answering her question. In doing so, I spilled the beans that no sign system is best for any one child.  In fact, making up your own signs works just as well using a formal sign language system! But sometimes it's nice to have a place to start, and for this, I referred readers over to the Baby Sign Language Dictionary.

This week, I'm back to give you a few more tips on using signs with your child. Today, I'm going to touch on how to select the words you'll be signing with your little one.  Later, I'll be sharing some tips about how to go about getting your child to actually use those signs, which is sometimes easier said than done.

So. Where to start with baby signs? There's no magical starting point, but a few simple tips can get you headed in the right direction.

  • When you are first starting out with baby signs, you'll want to think about the signs that will be most apt to get your child what he wants most quickly. You also want to pick signs that you can use in almost any activity-- that way you'll get lots of chances to use them with your little one. For these reasons, most people will start with two simple but powerful signs: more and all done. If you choose to teach your child to sign "more," know that he will probably begin to sign "more" to request almost everything. That's okay. He's learning to communicate with you, and that's good!
  • Once your child starts learning that his hands have magical power over his world, you can start teaching him to be more specific about what he wants.  To do this, make a quick list in your head of the things he likes the most. Does he crave his blanket? Love his books? Relish in pointing out the kitty cats that go tearing through your house? Look at the things that make him the most happy, and introduce the signs for those very things.
  • As you sort through signs, choose the ones that are the most simple and distinct from each other. Young children have a limited ability to make their hands do what they want them to, so try to pick signs that have big broad movements and look for signs that are different from each other. For example, it may be hard to teach your child the difference between "eat" and "drink" because both of those signs are made up by his mouth.  Instead, perhaps, you could teach him to sign for "eat," which is made by tapping closed fingertips of one hand to your lips, and then also teach him the sign for  "milk," which is made by opening and shutting your hands and has nothing to do with your mouth.
  • If there is a word that you really want to use, but the formal sign is tricky or complicated, change it! Make it what you want it to be.
That's it! With just those few simple tips, you're well on your way to successful signing with your toddler.  Have fun!

Looking for more information about Baby Signs? 

      Activities for Language Development: Snow, Sprinkles, and Speech

      After a long, long, long, winter, we recently had another heavy snow.  What's a mom to do? Cook up some snow and sprinkles!  The prep was simple enough: I filled a bin full of snow, and gave my children some cheap cookie sprinkles, a couple spoons, and a couple bowls. Then I let their imagination unfold. 

      Not only did it keep my cooped-indoors-and-bouncing-off-the-walls children entertained for a good thirty minutes, it also provided us with a great opportunity for language development.

      While engaging my little ones in play,
      • I used self talk and parallel talk to model simple 1-3 word phrases that described what daughter was doing
      • I paired actions and words together so that she would imitate both.  We said "shake shake" while shaking sprinkles into the snow, "stir stir" while stirring our snow in our cups, and "bye bye" while waving to animals that we buried in the snow.
      • I imitated her actions while using new, simple words to go along with the reactions that she was having to the experience. When she made a face after touching the snow, I imitated her and said, "cold!"  Later, when she ate her sprinkles and smiled, I did the same and said, "yum!" The best part was that she then said these new words later in the activity on her own.
      • I used expansion to respond to her simple words by increasing her sentence by one word. When she said "snow," I said, "cold snow!" When she said "eat" I said "eat snow!" 
      • I gave her little directions to follow as we played ("put some in my cup, please") and showed her what to do if she didn't seem to know. 
      • I modeled pretend play actions like drinking, stirring, and baking. 
      • I helped her take turns with her brother having a "snow picnic." Later on, I worked on narrative skills by retelling the snow picnic experience with my son later before bedtime. 
      Most importantly, we had lots and lots of fun! (And then I did lots and lots of laundry....who knew sprinkles could be so messy? :))

      Monday, March 28, 2011

      Guest Post: Our Family World

      I'm excited to be guest-posting over at Our Family World today! My post is about late-talkers-- when to worry and what to do.

      If you haven't found your way over to Our Family World yet, you'll want to head over and check it out. Right now, there's a fun post up on Easter activities to do with your kids. A lot of them are language based, and we all know how much I love language! I'm thinking I might pounce on the idea to make an Easter Bingo board to play with my kids--Baby Girl will love picking up the pictures and repeating the names of the items, while my 6 year old will have a blast trying to beat me at the game. :)

      Happy Monday!

      Friday, March 25, 2011

      Reader Question: Baby Signs

      My son is 11 months and has a trach. We are going to start sign language; do you have any suggestion as to what kind of program to start him with?
      I've got lots of suggestions about using sign language with babies and toddlers! :) First things first, though, let's take a step back and look at why so many speech-language therapists recommend using signs with children, and why so many parents are doing so these days. Is it just a fashionable trend? Probably, in part. But there is a method behind the madness. 
      We speech therapists have been using sign language with infants and toddlers for years.  We are especially likely to do this if a child's speech lags behind his desire to communicate.  When this happens, children are prone to frustration because they have much more to express than they are able to say.  Sign language gives them a way to communicate even if they don't yet have verbal words, and it helps the language part of their brain keep developing while we work to get the speech part to catch up.  Because sign language carries these advantages, we often recommend the use of sign language with children who are late talkers, those who are having significant difficulty with speech--such as those with apraxia of speech--or those who have a diagnosis such as Down Syndrome, where speech is often later developing. Most recently, parents of all kinds of young children are learning the power of using sign language with their toddlers, whether or not their child's speech is delayed.
      Many parents, though, have concerns about sign language. They worry that if their child is taught sign language, she will then become reliant on sign language to communicate and won't develop verbal speech.  This is, in fact, the number one reservation that I hear parents voice about using signs with their toddler.  The good news is this: In my 10 years of working as a pediatric speech therapist, I have never seen this happen. What's more, a small NIH funded study  found that using sign language with toddlers led to more advanced language in toddlers and preschoolers.  Use of sign language as a toddler was also found to be related to a higher IQ at the end of second grade (despite the fact, of course, that the parents had long since stopped signing with their children).  Additional, smaller studies have also shown that using sign language along with verbal speech helps young children learn more words, more quickly, than using verbal speech alone. 
      Why does this happen? Probably for a few different reasons. First, toddlers are driven to imitate, and it is often easiest to tap into their desire to imitate when we pair our actions with our words. Actions last longer than words do.  Think about how quickly a spoken word comes and goes. Believe it or not, it lasts for less than a second. An action, though, can last longer. You can slow it down, giving your toddler a chance to really see what's going on.  What's more, the visual part of our brain is thought to develop more quickly than the auditory part of our brain, so your toddler is likely to respond more strongly and more consistently to what he  sees as compared to what he hears.  All in all, pairing actions and sounds together gives your toddler more clues about what he's supposed to do.  
      The other advantage to using sign language is that, if your child will let you, you can help him do the signs by gently taking his hands and guiding him through the motions. Obviously, you can't take his mouth and get it to produce words; signing gives you an alternate way to physically help your child learn to communicate.  When he then starts to use that sign on his own, he's learned a very powerful message: he has control over his world and he can get what he wants through communication.  Once kids get the idea that communication pays off for them, they start to communicate more and more with those around them.  At first, they may continue to use sign language, but eventually they will start to use the words along with the signs. Then, as verbal speech becomes more efficient (and it will-- moving your mouth takes much less energy than moving your arms), they will gradually drop out the signs and move over into the world of verbal speech completely.  
      Having said all that, I'll return to the question at hand: what sign language system is best for working with young children?  My answer is simple: None. None is best.  If you are using sign language as a bridge to verbal communication, it simply doesn't matter what sign system you choose to use.  You could even make up your own signs! In fact, that's what those parents in the NIH study did-- they were taught to communicate with their child through specific gestures that had meaning to them and their child.  The important part of using signs with your child is not what specific sign system you use, but rather the consistency with which the adults in your child's environment use those signs. 
      If you want to explore some formal signs to use with your little one, a great (free!) place to find some is over at the sign language dictionary at Baby Sign Language.com.  The dictionary has videos of a wide variety of signs that you might want to use with your toddler.  Just don't get too hung up on the formality of how you do the sign. This is one place in life where perfection is most definitely not required.
      Want to learn more about baby signs?
      Find out How To Select Signs To Use With Your Child
      Find out How To Teach Your Child Signs

      Tuesday, March 22, 2011

      Strategies For Language Development: Using Imitation To Get Language

      There's no question about it: toddlers love to imitate. One of the more powerful tools you have to encourage your toddler's language involves tapping into this strong desire to imitate by tying your words to your actions.

      This strategy works best between the ages of ten months and two years of age, when your child is learning rapidly through direct and delayed imitation. As with almost every other idea for working on language with young children, the idea is both simple and powerful at the exact same time.  To use it, simply attach a word to an action that you do repeatedly. You might say "up" while reaching up, right before you pick her up, or "yay!" while clapping, or "pat pat" while patting down play-doh,"down" while knocking blocks down or "boom" when you fall on the floor after a round of  "Ring Around The Rosie".

      Tying your word to an action gives your toddler more cues to get her to imitate you and more information to help her remember what to say. It's a strategy that is easy to work into almost any activity that you do, making it a perfect tool to use with an active toddler who has a short attention span (which, of course, describes all toddlers!).  Baby Girl and I were coloring with markers the other day (something that got a bit messier than I anticipated, as you can see by the state of her clothes in the video clip) and I started modeling some simple words along with simple actions. The thing to notice is that I didn't ask her to do anything. I just paired a simple action with a simple word and then waited for her to take her turn doing the same.  And she did. (But no, she doesn't always!).

      One of the things I love best about working with toddlers is that learning takes place right inside of play--so much so, in fact, that you can't even separate the learning from the playing.  Helping your toddler learn language is less about changing what your toddler is doing and more about making little tweaks to what you are doing inside of those activities.  And most of all, it's about enjoying the process along the way.

      Looking for more ideas for helping your infant or toddler develop language? 

      Monday, March 21, 2011

      First Words: Child Language Development at 12-18 Months

      Happy First Birthday to your little one! You've both survived the first year (whew!) and now that you look back, you can't imagine how time went so quickly.  There's much to look forward to over the next year, not the least of which is the amazing journey that your child will take as she grows from a babbling baby into a talking toddler.

      At the end of the previous stage of language development (6-12 months), your baby was just starting to use her first real words.  If you arrive at 12 months only to find that your baby isn't yet talking, though, fear not. Many children will take up to 15 months of age to utter their first real word. It's well worth the wait!

      Even if your child isn't yet talking, you'll notice that she continues to become more and more social.  Between the ages of 12 and 18 months, you'll see her really start to point at things that interest her, show you things to get your attention, and give you objects to interact with you. These skills are really important to watch for, as they show us that she wants you to join in her little world. You'll also notice that she's started to really enjoy being the center of attention and that she'll do things just to get you to laugh. Babies at this age revel in the attention they get from dancing to music, clapping, or making silly sounds. Watch out though-- laugh at the wrong thing and she'll repeat it endlessly to get you to laugh again!

      When your little one does start talking, you can expect words to come slowly at first.  Typically, children have around 4-6 words at 15 months and then between 20 and 50 words at 18 months.  When your child hits the magic 50 word mark, he will enter a language explosion during which he will astound you with his ability to quickly learn words that you didn't even know he'd heard! Until then, though, he will pick up a word here and there, with no real speed or urgency. This is totally normal, so just enjoy the words he does have and trust that more are on the way.

      During this" first-word" phase of language development, your baby's words will probably be limited to certain sounds. At this stage of learning language, most children are using p, b, m, n, w, h, t, d, and vowel sounds. Your toddler will probably say the first consonant in the word but not the last, and his two syllable words will likely be repetitions of the same syllable (mama, dada, baba). At this stage of language development, children will also often use one word to mean lots of things; in speech therapy world, we call this overextension. Baby Girl, for example, used the word "wawa" to refer to any liquid, even if wasn't actually water. As a result of your child's immature speech and his use of overextensions, you'll probably find yourself translating his language to those who don't know him well.

      At the same time as your baby is learning new words, he's also learning lots more about the world around him.  He is actively exploring his environment (lock your cabinets or prepare to have them emptied on a daily basis!) and he's watching you all the time now.  His imitation skills have improved by leaps and bounds and you'll probably notice that he takes great pleasure in imitating the things you do around the house on a daily basis.  Last Christmas, for example, Baby Girl ignored all her new toys in lieu of playing with our Swiffer. These rapidly developing imitation skills will serve your child well as his increased motivation to imitate you helps him to learn all kinds of new skills (swiffering included!).

      At 12-18 months, your baby will begin to understand a lot more, too. He'll be able to find a variety of named people, toys, animals, clothes and body parts. By 18 months of age, he'll understand at least 50 words, if not many more. All of a sudden, you'll have to careful what you say around him--utter the word for his favorite snack without being prepared to give it to him and you risk a tantrum! This is when spelling starts to come in very handy as you work to convey messages to your spouse without your toddler understanding. You'll also notice your toddler really demonstrating his understanding of what you say by following an increasing number of directions--especially familiar directions that you give him inside of your daily routines.  By 18 months, he'll even be able to go to another room to find something that you ask him to get and bring it back to you.

      Finally, his play will continue to evolve.  Play is related to language development, so it's important keep an eye on play skills as well.  At this age, you'll notice your baby start to use some fleeting pretend play actions. He might pretend to drink out of a cup, or put a spoon to a baby's mouth, or hug his stuffed animals. He'll also start to play more by himself, letting you get a a bit more done around the house in the meantime (yahoo!). And finally, he'll really start to enjoy looking at books, providing you with yet another great opportunity to enhance his language development.

      Enjoy your little one as you watch him discover his ability to communicate with you during his second year of life. In the blink of an eye, you'll be at his second birthday, gazing back at his first and wondering how your little baby could have possibly turned into a toddler already.

      Looking for more information about your child's speech and language development?
      What To Expect at 0-6 Months
      Dance Puppet Dance: Communication at 6-12 months
      Your Talking Toddler: What To Expect at 18-24 months 
      Speech Sounds 
      Red Flags for Autism

      Looking for ways to help your your toddler learn more language?
      Sing, Dance, and Be Merry
      Books, Toddlers, and Language
      Three Magic Words 
      Baby Signs 
      Moo Baa La 

      Friday, March 18, 2011

      Early Intervention: What To Expect

      A reader sent me the following question:

      I'm worried about my little boy. He's almost 18 months old and he's not saying any words yet. We've tried to teach him some sign language but he's not really using it. He didn't really babble all that much when he was a baby either.  I'm going to talk to my pediatrician at his check up next week, but I was wondering if you could tell me what to expect after that. What will happen if my pediatrician is concerned, too? Will he recommend speech therapy? If so, how can you do speech therapy with an 18 month old??

      Great question! First of all, I think you are on the right track. Your pediatrician is an excellent source of information for you and your child. Hopefully she will listen to your concerns, set your mind at ease about what is to come, and get you going in the right direction.  Having said that, I'm happy to give you my thoughts on how things might flow if your pediatrician does recommend that you look into speech and language therapy services for your son.

      Here's the scoop. Each state is required by the federal government to have an early intervention program for children under the age of three years. Although each state's program is different, each must serve young children who either have delays in a specific area of development (a speech and language delay, for example) or who have a diagnosis that puts them at risk to have a delay (a cleft palate, for example). The state is given federal grants to provide early intervention services to young children and their families at minimal to no cost to the family.  An early intervention program is made up of a group of professionals who work with young children with delays and their families to help them grow into their highest potential.  Typically this group is made up of a wide variety of professionals such as (but not limited to): speech-language therapists, physical therapists, occupational therapists, early education teachers, social workers, nurses, and/or psychologists.

      If your pediatrician suspects your child has a delay or is at risk to have a delay, he'll probably refer you to your state's early intervention program, which is usually run at the county level. Once you've been referred to early intervention, someone from your local program will probably* call you to gather some basic information and explain the program to you. That person will generally schedule a meeting with you to gather even more information about your family, your child, and your concerns. Early intervention services are mandated to be provided in a child's natural environment, so it's likely that this meeting will take place in your home (and no, we do not care if your house is clean!).  During that initial meeting, you will help decide what areas of your child's development should be evaluated.

      (*If you're noticing that I'm saying probably and generally a lot in this post, it's because every county's program is a little different. Although there are broad guidelines for early intervention programs, there's no universal process by which early intervention is delivered.)

      Next, usually on a different day, your child will be evaluated by a couple of different professionals from the early intervention program. The word "evaluation" sounds so much more formal than it really is, though. An evaluation for a child in an early intervention program generally looks a lot like a bunch of adults sitting around and playing and talking. We sit on the floor with you and your child, play, observe, and ask you lots of questions. We completely understand that, with us there, your infant or toddler might not do all the things he'd normally do around just you, so you please don't worry about your child being shy or nervous or not himself.  When I do an evaluation, I usually talk to the family as much as, or more than, I interact with the child.  The overall goal of the evaluation is to get a good picture of what the child is doing so that we can determine if he has a delay that would qualify him to receive treatment services through the early intervention program. Again, the word "delay" sounds much more worrisome than it often is. Finding out your child has a speech and language delay does not mean that he'll be delayed for the rest of his life or that he'll carry that label forever.  It just means that, right now, he struggles a bit to communicate with others and that, because he does, he and your family are eligible to receive support from an early intervention professional.

      After the evaluations are completed, you and your early intervention team will have a meeting to decide what you'd like to do.  If your child does qualify for services, you'll come up with a plan. The plan, formally called an IFSP or an Individualized Family Service Plan, will lay out what goals you have for your child and family and what professionals are going help you to meet those goals. This is where things get really different depending on the state in which you live. Some states typically have only one professional work directly with your family and child, while other states might have multiple professionals working in the home of just one family.  You can find out more about the early intervention program in your state by finding their website here.

      No matter what your state's model for providing early intervention services, though, I can tell you this: All early intervention professionals want to help your family and your child, and we almost always try to find ways to help you and your child in the context of child-based activities.  This might mean that we work with you and your child while he is playing with toys in the living room or while he is eating lunch in the kitchen, or while he is running around outside. Our visits with you and your child often look much less like "speech therapy" or "physical therapy" and much more like playtime or lunchtime or bathtime.  We do this because we know that young children learn best from interacting with loving caregivers inside of routine, motivating activities that occur on a daily basis. It's our job to help figure out how what we know about child development fits with what you know about your own child. To do this, we join you and your child in play or another daily routine, try out some strategies, see how they work, and then teach you to do the same.  And together, we take joy in watching your child grow.

      Got Questions? I've got answers. E-mail me at childtalk01@yahoo.com 
      or find me on Facebook at facebook.com/ChildTalk 

      More information on Early Intervention 

      Tuesday, March 15, 2011

      How To Help Your Child Start Talking: Three Magic Words

      There are three magic words that I carry around with me in my speech-therapy pocket to help children start talking. I use them frequently and with great success. These three words so often entice a non-talker to make the jump into the world of words that it's almost magic. What are these three words, you ask?

      Ready, Set, Go.

      Hmmm. With all that build-up, perhaps the actual words seem less magical than you had hoped? That's because, as with all things speech-therapy related, it's less about the actual words and more about how you use them.

      The magic words are the most powerful when "go" is followed by something very exciting such as being tossed up in the air, chased around a room, pushed on swing, or sent down a slide. I also frequently use them while playing with a toy that's got some kind of build up-- I might say them before blowing bubbles, or when about to spin a top, or before pushing a car down a ramp, rolling a ball, or turning on a toy that's full of fun lights and sounds. Or, say, after my Baby Girl has crawled into a laundry basket and we've turned it into a boat that I push back and forth while singing "Row Row Row Your Boat."

      The key is to find something your toddler loves and then use the magic words over and over right before the fun begins. As with all things toddler-related, consistency is the key. You may have to repeat these words hundreds of times before your toddler starts to use the word "go" on his own. So, don't expect magic results right away. Give him time and keep it lots of fun. Then, every so often, try pausing right before you say, "go." Pause long enough, and your toddler might just fill in the word....or he might not. If he doesn't, continue on with the fun. It'll work eventually. But if he does say the word, say it back to him with lots of enthusiasm and then carry on with the activity. He's now on his way to being a new talker... and that's when you'll see the magic really start to unfold.

      Why does this work? Ready, Set, Go is a powerful tool for helping young children start to talk because the words fall into that all important category of an anticipatory set. This means that, when the words are used over and over in your child's day, he will start to anticipate what is coming. Use them often enough and the word "go" will just fall out of your toddler's mouth without him even knowing what he's doing. When that happens, he'll learn that language is a powerful key to unlocking the world around him, and he'll be that much more ready to start learning other new words as well.

      The other benefit of "Ready Set Go" is that it helps your toddler learn that something good is coming....if he just waits a tiny bit. Young children are notorious for having a low tolerance for waiting. They want what they want, when they want it, which is often NOW. If you use Ready Set Go frequently enough, the words will become a cue for him to wait for just a bit; he'll hear them and know that something good is about to happen-- in just a moment. This creates what I call a "communication space"-- a little pocket of time between the time when a toddler wants something and when he actually gets it. When we create a communication space, we can then teach new words or signs within it.

      Now that you've learned the three magic words, it's your turn to give them a try with your little one. Ready? Set? Go!

      Want to learn more? You can follow my posts on Facebook at Facebook.com/ChildTalk

      Have a question? I've got answers! Email me at childtalk01@yahoo.com

      Sunday, March 13, 2011

      Dance Puppet Dance: Baby Communication Development at 6-12 months

      Welcome to the second half of your baby's first year. These months mark the beginning of my favorite part of language development, when children begin to realize that they can actually communicate with their world. Is a spectacle to behold, so take a step back, revel with delight, and hold on for the ride as your baby learns to share her inner world with you.

      Upon first entering the 6-12 month age range, things won't actually look all that different than they did at 3-6 months. Your little one will continue to engage in turn-taking as the two of you have your important but rather nonsensical "conversations" that are really only exchanges of sounds. Around six months, you'll notice that her speech really starts to explode with different sounds. Your baby will start truly babbling, as she strings long strands of sounds together. It's most likely that your infant's babbling will be made up of b, p, m, w, d and n sounds; these are highly visible sounds that most babies make pretty early on. That's why so many early words--all across the world, in a wide variety of languages--are variations of mama, dada, baba, and papa. Not only are these words very important to babies, they are also generally the easiest to say.

      Then, around nine months, the magic really starts to happen. This is when your baby transforms from a passive recipient of language into what we call an intentional communicator. Although she's been "communicating" with you by crying since the day she was born, this has been mainly reflexive in nature-- your baby didn't really know what she was doing when she cried. Right around nine months, though, her internal world undergoes an important transformation as she begins to realize that she has control over the external one. She begins to understand that what she does changes what
      you do. My husband and I call this the "dance, puppet, dance" stage, because we adults are so tickled that our children are communicating that we're apt to do whatever they command of us.

      You'll see your baby start wielding her new power in a wide variety of ways. Although she won't yet be using words, she'll start to understand that using her voice is an effective way to communicate. She'll use it to protest, to get your attention, to ask for help, and to sing along to songs with you. At the same time, she'll start using gestures. When you ask her if she wants "up," she'll show you she does by reaching up. She'll start to wave good-bye, and she'll show you what she wants by reaching and pointing toward it. All of this leads to a rather astounding ability to intentionally communicate without any words at all. Here are just a couple examples of Baby Girl communicating very effectively, sans words:

      Although it can be annoying to have your little one commanding your every move with protests, grunts, and gestures like this, it’s actually a very good sign. We speech therapists really like to see that a child understands that she can communicate with others, even if she isn’t yet using words to do so. At this age, you’ll start seeing your baby do just that.

      This is also the time when she might start showing you objects without actually giving them to you and pointing out things that are interesting to her. In doing so, she's establishing what we call joint attention, which occurs when you and your baby are paying attention to the same thing at the same time. Your baby is learning that she can get you to look at an object of interest by showing it to you or pointing at it. This is a skill that develops between 9 and 15 months of age, and it's an important one, because it demonstrates that your emerging toddler is a social little being who really wants to share her interests with others.

      Your baby will start to understand a lot more, too. She'll turn toward you when you say her name. She'll understand when you say "no" (although, as any experienced parent will tell you, that will probably mean she'll crawl faster toward the forbidden object). She'll start to find some body parts when you name them, and she'll understand simple routine questions like, "do you want to eat?" It's amazing to see how quickly babies begin to understand what is said to them--their understanding exceeds what they are able to communicate back to you for a very long time.

      Your baby will also start showing off her smarts. If an object disappears out of sight, she'll start to look for it rather than assuming it's gone for good. We call this object permanence, and it's an important foundation for helping her develop real words. If you've been singing and playing games with your baby, this is when she'll show you she really has been listening all this time, as she starts doing some of the actions to the games and songs right along with you. She'll also start using objects a bit more appropriately, rather than just mouthing them. For example, she might use a spoon to stir a cup or push a toy car; this shows us she is beginning to remember that specific objects are used in specific ways.

      And, importantly, your baby will begin imitating you in earnest. Around seven months, she'll imitate your action if it's one she's already got mastered. Clapping is a good example of this. Many babies discover "clapping" all on their own, before they even see an adult do it. Once they've done this action on their own, they're more likely to imitate an adult clapping and, eventually, they'll begin clapping when they know they've done something exciting. Around one year, though, imitation skills really take off. Babies start to imitate adult actions they've never done before on their own. You'll see your baby imitate sounds, facial expressions, coughs, and lots of new motor actions. Imitation is one of the biggest tools babies have for learning language, so it's terribly exciting to see it emerge.

      Finally, words will start to take shape. Older infants will start to use sounds like "ooooh!" and "uh-oh" to mean "I like that!" or "Something bad happened!" Many kids will develop what we call
      protowords, which are words that they say over and over again to mean the same thing, but that aren't actually related to an adult word. For the longest time, Baby Girl said, "dawas," which always meant, "I want that thing over there, please." Why "dawas"? I have no idea...and that's what makes it a protoword. Around 10-13 months, the long-anticipated and much-recorded event will occur: your baby will use her first real word. Moms, of course, vie to get their name said first and dads will do the same. Indeed, your baby's first word is most likely to be a noun that represents something that is both very familiar and much enjoyed by her. But if it's not you that she names first, you'll still be jumping for joy that your baby has taken a huge jump into the wide world of language.

      Learn More...
      On What To Expect:

      Thursday, March 10, 2011

      Books, Toddlers, and Language: How to Use Books To Enhance Language

      Some of my fondest memories from childhood involve reading books with my mom. I can still her voice dance as she made her way through Goodnight Moon, a book that I had long since memorized. Good books, parent snuggles, and love- it's the stuff that childhood is made of.

      What a joy, then, to be able to share with you the powerful role that books can play in growing your child's language. Not only does reading books with your young child create rich opportunities for vocabulary development, it also sets the stage for pre-literacy skills. Reading books with your toddler or preschooler is a great place to start her on the journey to all things language related. And whether or not your little one has a language delay, there are some specific ways that you can read with your child to enhance language development.

      Many parents will choose to actually read the words of a book when sitting down to read with their children, and this can work well--sometimes, for some children. It works especially well with short, repetitive books such as the aforementioned Gooodnight Moon by Margaret Wise Brown , or Blue Hat Green Hat Sandra Boynton, or Brown Bear Brown Bear What Do You See? by Eric Carle. These books have a rhythm, a cadence, that draws young children in, much like singing does. As I explained in Sing, Dance and Be Merry, recurring and predictable language experiences like songs and repetitive board books are very powerful. Such experiences give young children the chance to develop anticipatory sets. Because the words are repeated over and over in the same enjoyable way, infants and toddlers learn to expect what comes next....and they often start filling those words in on their own. It's a trick that we speech therapists use frequently to entice young children to talk. And it works all the time. The key is to find a book the toddler likes, read it over and over and over, and then the 100th time you read the book (or so it seems), pause. Pause for moment and see what your toddler does. She may do nothing, and that's okay. Carry on. But she might just fill in the word and start reading that book right along with you.

      Toot toot!

      Repetitive board books, then, can be wonderful. They don't always work, though-- young children have a notoriously short attention span and it can be hard to capture their attention long enough to get through a book. Some toddlers simply don't want to sit still for the time it takes their parents to actually read the words to a book, especially if if that particular book isn't short and snappy. Fear not! There's another highly effective way to use books to enhance language. It's almost deceivingly simple, but it's powerful nonetheless. Instead of reading the words to a book, just look through the book with your child and label the pictures you see. Let your child take the lead at times and point out things of interest-- and then say the names of whatever she points at. Then, if your child does use a word, put that same word into a short sentence for her as you respond to what she said. In speech therapy land, we call this interactive focused stimulation. You can just call it fun.

      Despite my reluctance to appear on camera (seriously, what is with the eye blinking?), I captured Baby Girl and I reading a book using this method. We'd tried to read this book before, but she got bored quickly and wandered off. So I switched it up a bit. As you watch the video, notice a few things: 1. I'm following her lead. She points things out, and I label them. Simple, easy. 2. At first she just points. Then she starts using words and I respond by taking her words and putting them into short phrases for her, and 3. Toward the end, she takes one of the things I've been modeling for her ("quack quack") and uses it on her own, even though I didn't ask her to say anything at all. It's a great example of how indirect methods of working on speech and language can be very effective. (I pause here to note that it doesn't always work this well in the moment. Baby Girl is imitating a ton now. But that wasn't always the case! So don't be disappointed if your child doesn't immediately respond to your language models. You are laying the groundwork for future language. I promise).

      Parents are sometimes reluctant to use "baby talk" or simplify their language when talking with their kids. It's important, however, to match what you say to your child's language level. If your child is pointing at something, label the item for him. If he uses one word to label or request something, come back at him with two. If he uses two, you pull out three. Research consistently indicates that this type of indirect language modeling and expansion can be a powerful way to increase your child's language. You don't need to talk in simplified language all the time, of course-- your child needs to hear you give him directions and speak in full sentences and conversation as well. Yet, it is very important to build some time into your day where you follow your child's interest and match your language to his. Books are a great time to do just that....and you'll be creating some beautiful memories along the way.

      Looking for repetitive books to read with your toddler? Try...

      Tuesday, March 8, 2011

      Should I be worried about my late-talker?

      I recently received the following question from one of my readers: 

      I have a question about my just about 22 month old. He is very active and smart. He can figure out how to take anything apart and put it back together. He loves to be busy. A few people have commented he should be "saying more." I don't agree, but then again I'm no expert. He can talk and has always been vocal. He will bring things to me (or bring me to things!) point and say help and nod. He will ask for his needs. He asks me for his water, snack, relax (when he's sleepy.) He can communicate what he wants very well. He doesn't have melt downs, because he knows how to tell me what he wants. With all that said, he says only a handful of words. Snack, water, help, dog, go play, home, yes, no. He has started to make noises when he's playing...quacking like his ducks and making a car sound with his trucks. I have heard he's not saying enough often enough, to become a bit concerned. I was never concerned before, because he really communicates awesomely and comprehends what we ask him and does it right away. My question, is should I be worried? He has his 2 year check up in a couple months.

      It can be disconcerting and a bit confusing when well-meaning family members and friends bring up concerns about your child that you don't share. What's more, young children are highly varied in all areas of development and so it can be hard to know exactly what your child should be really be doing and when you should be worried enough to talk to your pediatrician. Although I obviously can't evaluate a child without seeing him in person, I can certainly provide some guidance about when I would typically suggest a referral for an evaluation and how I would help parents of toddlers determine if speech and language intervention was needed.

      First, the easy answer: if a child reaches 24 months and isn't yet using 50 words and/or isn't yet putting two words together into short phrases (e.g., more juice, bye mama), we do typically recommend that they talk to their pediatrician about an evaluation by a speech-language pathologist.

      That, however, isn't the full answer (life is never that easy, right?). When I evaluate young toddlers who aren't yet speaking as much as we'd expect, I don't just look at how many words they are saying. While that is an important piece of the puzzle, there are many more pieces to the full picture. I also look at what that child understands, how he is communicating with gestures and facial expressions, how he is using the words he does have, what kinds of sounds he is using, and how he is playing. Looking at each of these areas helps me to determine if a child is "just" a late talker or if there are bigger concerns that need to be addressed.

      What would I look for in each of those areas? While I can't detail every skill that I would look at in an actual evaluation, I can certainly paint a broad picture of what we would hope to see in a young toddler.

      At 24 months, I'd want to ensure that the child could follow a wide variety of directions, find objects when mom and dad ask him to do so, point to pictures in a book, show off some body parts when they were named, and follow silly directions like "put a cup on your head."

      I'd also look to make sure that the child was using gestures; by 24 months I'd expect to see him nodding and shaking his head no, pointing at things that he wants, waving "hi" and "goodbye", and clapping with delight. Very importantly, I'd also want to make sure that he is pointing at things that are interesting to him, just to get his mom and dad to look at those things (not just to ask for those things). This is a skill that emerges around 12-18 months, and it's important to ensure that a child is using it. I also like to see that children are showing objects of interest to their parents on a regular basis. And I'd ask the child's parents if he enjoyed playing simple games like "Pat-a-cake" or "Peek-a-boo" with them.

      Then I'd take a peek at what the child was doing in play. At 24 months, we like to see children starting to use pretend play in some very simple ways. They might, for example, give a bottle to a baby. Or they might feed a stuffed bear with a spoon. Kids this age also play simple rolling or fetching games with balls with their mom and dad and should be starting to imitate housework (my 19 month old daughter, for example, is currently enthralled with wiping up the floor with paper towel. Who needs toys when you've got paper towel?). I'd also want to see that the child was imitating actions: Will he clap when an adult does? Does he imitate stacking blocks? Will he imitate his parents if they do something silly and unexpected, like place a block on top of their head?

      Then I'd listen to the sounds the child was making. At 24 months, I like to see children using a variety of sounds such as p,b,m,n,t,d,h, and w, and I hope to see that child using those sounds in a variety of words. I'd also want to know that the child uses his voice to get attention, that he vocalizes often throughout the day, that he babbled often as a baby, and that he uses his voice in a way that sounds like he's having a conversation, even if there are no real words involved in that conversation.

      Finally, I'd talk to the parents about hearing. I'd ask if they had any concerns with hearing and might also encourage them to talk to their pediatrician about doing a hearing test to rule out a hearing loss. Some kids can hear some sounds but not others. If a child has a language delay, we usually recommend a hearing evaluation just to make sure the child is really hearing everything.

      What if the child was doing all those things I just described but still wasn't talking as much as we'd expect? Then he'd be what we call a "late talker" (such a professional term, eh?). The benefit of getting an evaluation for a "late talker" is that parents get to have a professional speech-language therapist look specifically at all those areas and help them to figure out what's really going on. If nothing else, this can ease a parent's mind. The speech-language therapist can also give parents some simple suggestions that can be woven into their day to increase the odds that their child will start using more words. A really good speech-language therapist will shed light on what comes next in child development and help parents figure out how they can get their child to that next level.

      Having said all this, though, opinions are mixed about whether or not speech therapy is truly needed for children who are just late talkers. Some studies seem to indicate that as long as late talkers are in supportive, nurturing, and responsive families, they will catch up on their own. Other studies suggest that late talkers can potentially have lingering difficulty with reading and spelling when they enter elementary school.

      My advice for parents of late talkers? Have a good conversation with your pediatrician about your concerns and ask your pediatrician to help you weigh your options. Then, listen to your own inner parenting voice to make the final call about what to do. You know your child best. Trust yourself.

      The other piece of good news is that there are lots and lots of strategies that all parents can use in the context of their typical day to help their children develop language, whether or not their child is a late talker. Check out these to get you started:

      And find an updated list of all strategies here

      You might also want to check out this post:
      Should Your Late Talker Get Speech Therapy?

      Friday, March 4, 2011

      Sing, Dance, and Be Merry

      It turns out that Mother Goose had it right. All those songs she was always singing? They're a powerful tool for enhancing your baby's communication at a very early age.

      What's that, you ask? Is it really as simple as singing some songs with my baby? Yes, yes it is.

      It goes without saying that babies learn best when they are consistently wooed into loving, responsive interactions with the adults around them. In fact, there's growing research that shows that one of the best indicators of a baby's development is how responsive his parents are to him. Before I go on, it's incredibly important to pause for a moment and note that this does not mean that children who are slow to develop speech and language are parented by non-responsive moms and dads; to the contrary, it is very possible for a child with incredibly interactive parents to struggle to communicate. It is likely that all children are born with certain inborn tendencies that will help determine the range within which their communication skills will fall. However, we do know that the more interactive, loving, and responsive parents are, the more apt a child is to develop to the highest of his abilities.

      So. Back to Mother Goose.

      In addition to knowing that babies thrive when their parents consistently engage them in loving interactions, we also know babies also learn best when they are involved in repetitive and predictable routines that help them make sense of the world around them. These routines help infants and toddlers develop what we call anticipatory sets, which is just a fancy way of saying that young children will begin to develop expectations for actions that have been repeated so frequently that the baby learns to anticipate what comes next. These expectations help them organize their world and begin building the framework they will need to develop language.

      Singing simple songs and doing other silly, predictable games like "Peek-a-boo," "I'm gunna getcha," and "5 little piggies" with your baby is one of the easiest ways to help him learn to develop these anticipatory sets. The more you do them, the more quickly your baby will learn to expect what comes next. He'll show you that he knows what's coming by quieting his body in expectation or moving his body in excitement when you pause in the middle of the action. Eventually, he'll start spurring you into further action by grabbing your hands or vocalizing to tell you he wants more. He'll take turns covering his own face in peek-a-boo. And, finally, around 6-12 months, he'll start filling actions and words into those songs that you've been singing all along.

      Sing away. Be silly. Play games. Enjoy your baby. And while you do all those things, take pride in the fact that you're giving him a solid start on the road to communication.

      Preschool Stuttering

      It happens all the time. Parents watch in awe as their three year-old develops language, marveling as her communication skills fold out in front of them. They find delight in the way her language seems to evolve overnight, rapidly and almost effortlessly. Then, out of nowhere, they begin to notice their young preschooler starting to struggle just a bit when speaking. They notice her repeating sounds and sometimes syllables, often at the beginning of sentences. Sometimes her words come out smoothly, but other times she seems to get tangled up and stuck. All of a sudden, they begin to worry: Is this stuttering? Will it go away? And what should they do?

      Although it may seem scary, this is actually a very common scenario, especially among toddlers and preschoolers who are bursting with language development. Many, many toddlers and preschoolers have what are considered to be very normal bumps in their speech between the ages of 18 months and 7 years of age. Children will repeat phrases, words, and even the beginning syllable of a word. These normal bumps occur most frequently at the beginning of sentences, are most apt to show up when a child is tired or excited, and typically only happen about one out of every ten sentences. This type of bumpy speech happens so frequently that it isn't even considered real "stuttering."

      Many children, though, will have more stutters in their speech. They may get stuck for longer, or more frequently. They might repeat a word or syllable a whole bunch of times before getting "unstuck." Still, though, this is not often cause for significant alarm at all. In fact, for the vast majority of young children, it will take care of itself: research indicates that nearly 80% of all young children who have difficulty with fluency (or who "stutter") will recover on their own within 12-24 months without the need for speech therapy.

      If your child is starting to show signs of stuttering, a few questions can help you decide if you need to talk to your pediatrician about it. Ask yourself these questions: Does your family have a history of stuttering? Has your child been stuttering for more than 6-12 months, on a pretty consistent basis? Did the stuttering start after 3 and 1/2 years of age? Does she ever get completely stuck with no sound at all coming out of her mouth? Does she show physical signs of tension? For example, does she shut her eyes, or look away, or does her face look tight when she stutters? Is your child having difficulty with any other aspect of speech and language?

      If you answered "yes" to any of these questions, you may want to talk to your pediatrician about a speech and language evaluation. Please be assured that this does not mean that your child won't recover on her own. It does mean, however, that a complete evaluation from a speech-language therapist can help you to better determine if the stuttering is likely to persist.

      And what if you answered "no" to each question? Good news-- it's more likely than not that the stuttering will pass on its own. Still, though, there are some things you can do to help.

      First, and foremost, resist the temptation to tell your child to stop and slow down or to think about what she is going to say. Many of us feel tempted to dole out this advice because this is what works for us when we start to get tangled in our thoughts while speaking. Stuttering, however, stems from a different type of difficulty than does our grown-up ability to organize our thoughts. Telling a child to stop and slow down often serves to increase stuttering rather than decrease it.

      Instead of interrupting your child or calling attention to the stutter, do the opposite: Give your child eye contact, give her plenty of time to finish her thought, and then simply respond to the content of what she said. I know it's hard to avoid the temptation to interrupt your child. No parent wants to watch their child struggle, and it's only human nature to want to help. But rest assured that by doing nothing--by letting your child finish in her own time--you are actually very much doing something.

      Then, when you go to respond to what your child is saying, pause a moment before you respond. Allow the pace of the conversation to slow a bit. When you respond, talk slowly and calmly, but naturally at the same time (a tricky feat, for sure. It took me many times in grad school to get it right!). Although many children do not respond to being directly told to "stop" and "slow down," they do respond when this type of speaking is subtly demonstrated for them by an adult. No need to tell them what you are doing-- just slow down the pace of the conversation on your own and watch as your child follows your lead.

      You can also try to reduce the number of questions you are asking your child, and just comment on what they are saying. Keep up the pausing and slower talking as long as you can, especially when your child is having a really "bumpy" day.

      If you have a particularly busy household (um, who doesn't?) you might also try to set up some rules for taking turns talking, say, at dinner time. Try to create situations where each person gets to talk without the pressure of being interrupted; children who stutter are more apt to do so when they are under pressure, in a hurry, or excited. It's unrealistic, of course, to try to avoid these situations all together. The key is to simply try to reduce them and create pockets of time for less hurried conversation that are scattered throughout your child's day.

      If you try all these things and find that the stuttering still persists for 6-12 months without getting better, or if your child starts to show signs of physical distress, go ahead and talk to your pediatrician about a speech and language evaluation. If nothing else, you'll feel better knowing that someone else has helped you decide what to do.

      Stuttering can seem much scarier than it is. The key is knowing when to really worry, and what to do should your child struggle. Once you have that information, you're well on your way to helping your child through any bumps that come her way.

      Thursday, March 3, 2011

      Speech and Language 101

      Most people haven't given all that much thought to the words speech, language, or communication. In fact, many people use those words interchangeably. Speech-language therapists, though? Not so so much. To us speechies, each of these words holds very specific meaning. And, as we all know, we take our words pretty seriously. Since the whole point of this blog is to delve into all things communication related, I figured I'd better define the words before going too much further. Then, if when I use the words in a later post, I'll just direct you over to this one for further clarification as needed. Capiche? Capiche.

      Communication is, well, communication. It's the transmission of a message from one person to another. It is the most broad of the three terms, and it encompasses a wide variety of methods for communicating ideas to each other: nonverbal communication, spoken language, written language, sign language. We communicate all the time without saying anything at all, through touch and looks and facial expressions and gestures. Allow me, for a moment, to share the following video of my daughter with you. One, because it makes me smile. And two, because it is a beautiful demonstration of communication. As you watch, look at the ways Baby Girl communicates effectively without using any actual speech or language.

      My baby girl manages to communicate joy, surprise, confusion, and love, all without saying a word. And yours will too-- babies communicate long before they are able to use speech and language. It's one of the things we speech therapists look for when we evaluate a child-- if the child isn't using speech or language, how is he communicating? This gives us clues to what's going on. But I digress. Back to the basics.

      Language is the symbolic form of communication. It is comprised of words that represent objects. The actual words, of course, depend on the form of language you are using. Language is further divided down into receptive language, which is how well a person understands the words that he hears, and expressive language, which is how well a person is able to use words to communicate. Then, when talking about both receptive and expressive language, we go even further and break it down into things like semantics/vocabulary (the number of words person uses and understands), and syntax/grammar (the way a person puts words together to form sentences that make sense). As children learn to talk, they first develop their vocabulary. Then, they begin adding elements of grammar, and, as they do, they make predictable mistakes that we've studied well. As speech therapists, we know (for example) what mistakes in grammar a three year old is likely to make; this helps us know when to worry and when to assure parents that things are going just fine. Language, though, doesn't have to be spoken. It can be sign language or written language. When it is spoken, speech enters into the equation.

      Speech, then, is the act of actually producing speech sounds when speaking a formal language. A child may have really great language, but not be able to produce it in a way that others understand because he has difficulty with speech (or, articulation/phonology as speech-language therapist would call it). Again, we speech therapists have information about what sounds young children usually produce incorrectly, what kind of errors they are most likely to make, and when we should expect them to start using those sounds correctly.

      So there you have it. Speech, language, and communication. Words about words that to allow us to communicate about the way we communicate with each other.

      Tuesday, March 1, 2011

      Baby Communication Development: 0-6 Months Old

      So you've got a new baby, and you want to know what to expect, eh?

      The good news is that it's my job to tell you just that. The bad news, however, is that you're really not going to be able to expect much at all for the first four weeks or so. During those first long weeks of parenting, you'll give yourself over to that brand new bundle of joy, only to find that you really won't get much back. At all. As the weeks go on, you may even begin to wonder why you ever decided to sign up for this whole parenthood thing.

      And then. Just as you're about to throw in the towel, it'll happen. At about four weeks of age, your baby will bestow upon you her first real social smile. And that beautiful milestone will mark the beginning of a two-way dance of communication that will unfold across the days, months, and years to come.

      Although this smile may seem to appear quite suddenly, you've actually been laying the groundwork for it since the day you first held your baby in your arms. Newborn babies are primed for social interaction; studies have shown that they prefer the human voice and the human face almost immediately after birth. Your baby has been studying you since the day she was born. What's more, you and your baby have already established an important rule that is crucial to your child's development: when your baby cries, you respond. Each time this happens, a newborn learns that she has control over her environment and that when she "talks," her parents listen. As a result, in just four short weeks, your baby will learn that you are the source of all things good. And she'll smile.

      Right about the time your baby starts smiling, you'll also notice that she starts to get excited when she sees you. Even though babies can't yet verbally tell us that they are excited about things, they can still show us: when they see favorite objects or people, their whole body will tell the tale. Then, around three months, you'll notice your baby beginning to "coo" softly with her little voice. She'll make quiet vowel like sounds and, if you respond by talking back to her, she's likely to start up a little "conversation" with you that will win you over with sweetness. Many babies are especially prone to doing this after bath and bottle, when they are at their most relaxed.

      Then, between four and six months, things really start to get fun. If you've been playing little games like "peek-a-boo" and "5 little piggies," your baby will start to show you that she knows what's coming. When you pause in the middle of these games, her body may get really still as she shows you that she knows something fun is about to happen...or she might be unable to contain her excitement as her whole body moves in anticipation of what's to come. Smiles turn into full-fledged laughs that will make the stresses of the day seem wholly insignificant compared to the beautiful sight that is your baby's joy.

      Toward the tail end of this period of language development, your baby will start to make all kinds of good noises. She'll squeal with delight and grunt with displeasure. She'll start to blow raspberries, smack her lips, and use some little consonant sounds every now and then. And each and every one of her sounds will be a building block toward that long awaited first word.

      Find out what's next: 6-12 months