Thursday, July 28, 2011

Should your late-talker get speech therapy? Depends on who you talk to.

There's a debate a brewin' in the world of early intervention.  Seeing as how we work with young children, we're generally pretty easy-going folks. But that doesn't mean we don't have our professional disagreements. And this is one of them.

It all started with this study, which was published in the journal of Pediatrics and released into the press in July. The Australian study followed 142 late-talkers as they aged; the researchers measured problem behavior at the ages of 2,5,8,10,14, and 17. They found that, despite having poorer behavior at age 2, the late-talkers exhibited no significant behavioral concerns at any of the follow up ages.  Articles about the study were written up in the press and ran with headlines such as "Late Talkers Do Fine As They Grow Up." Many of the articles also suggested that the "wait and see" approach for late-talkers might be the best option after all. 

That wasn't the end of it though. The Hanen Centre, a non-profit organization that focuses on helping parents learn to teach their children to communicate, responded.  They put out this press release, cautioning parents to be wary of these overly simplistic headlines. As it turns out, the study had looked at the emotional and behavioral outcomes of the late-talkers only.  The Hanen press release noted that, while it was reassuring that late-talkers appeared to have no long lasting emotional or behavioral difficulties, the study simply did not measure whether or not the late-talkers had persistent language delays or other academic difficulties. The Hanen Centre press release urged parents to seek help for their late-talkers early.

So what do I think of all this? I can see both perspectives.  I do think that, in some cases, we over-serve children with expressive language delays.  Many late-talkers really will be just fine, even without formal speech-language therapy.  Have you seen the film Babies?






A colleague of mine wisely pointed out that, despite their varied backgrounds, all of these babies--those who were quizzed with flashcards in their kitchens, and those who spent their babyhood dancing in fields next to goats-- probably still somehow grew up, developed the necessary skills they needed to function in their world, and flourished. Sometimes--sometimes--I think that we in the Western world do families more harm than good by focusing so much on what the child is not doing  instead of letting the family just love the child for who she is. I know we do much good in our field, but I worry that sometimes, against our very best intentions, we steal moments from families that could be spent dancing through life with their children.

BUT (and this is a big but), there is sound rational behind our tendency to push back against the "wait and see" philosophy.  First, talking late is a risk factor for other, more significant diagnoses, such as autism and apraxia of speech.  There are ways to tell if a late-talker is at risk for a larger delay, but it is often hard for parents, and even physicians, to differentiate between those children who have an expressive language delay only (and are therefore, just "late-talkers"), and those who may have a bigger diagnosis that warrants early intervention.  The "wait and see" approach, when applied too broadly and blindly, can lead to children being missed, to parents who are blind-sided by a diagnosis later in their child's life and are frustrated that they didn't get a chance to act on behalf of their child at a younger age, and to problems that could have potentially been mitigated through early intervention.

Further, as the Hanen press release points out, most late-talkers will catch up.  70-80% of those who are truly just late-talkers will outgrow their language delay. But not all will.  And therein lies the rub:   we just don't know yet how to tell which late-talkers will catch up on their own. We do know, however, that the children who don't catch up on their own are at significant risk for later language-based academic difficulty. And we know that the strategies we have to help late-talkers can work, especially when they are used at young ages.

So what would I do if I were the parent of a late-talker?
  • First, I'd make sure that the child was "just" a late-talker.  This can be more complicated than in sounds (Take a peek at this post, which describes the things that I would look at as a pediatric speech-therapist to help me determine of a toddler was a late talker). If I were not well versed in the world of young children, I'd probably ask my pediatrician for an evaluation through my local early intervention program, if for nothing else than to confirm that my child was, indeed, just a "late-talker."
  • If I did get an evaluation from my early intervention program, I would ask them to teach me the strategies for working with my child and help me learn to integrate them into my day.
  • I would read about and try out the different strategies for working with late talkers here, on Child Talk! (You had to know I'd plug this blog, right?). 
  • I would check out books such these, two of my very favorite books on working with children who have communication delays:


     
  • Finally, I'd make sure to balance any and all of the above with lots of love, laughter, and dancing.

    Learn more about....

    Early Intervention


    Whitehouse, A., Robinson, M., & Zubrick, S. (2011)." Late Talking and The Risk for Psychological Problems During Childhood and Adolescence." Pediatrics: 128 (2): e1-e10.

    http://www.reuters.com/article/2011/07/04/us-late-talkers-idUSTRE7630OZ20110704

    http://www.marketwire.com/press-release/closer-look-late-talker-study-why-parents-should-beware-wait-see-approach-the-hanen-1538680.htm



    Please note: If you purchase a product I have linked on my blog, this will sometimes result in monetary compensation for me, which I use as a means of supporting Child Talk.  However, I *never* write posts simply to sell products, and my opinions about the products I blog about are my own.

Tuesday, July 26, 2011

Books For Language Development: If You Give A....

Today, I'm happy to share a guest post written by Meghan Gallahan Graham M.S. CCC-SLP, one of the authors over at All4mychild.  I love all her ideas! Enjoy! 
 
“If You Give A…”


As a speech pathologist, reading books with children is a huge part of what I do (and LOVE to do). It is a way for me to connect with the children I work with as well as help them reach any number of speech and language goals. As Becca mentioned in her post on reading books with toddlers, reading with your children is a wonderful way to model, expand, and build your child’s language.

 The “If You Give a…”book series  (e.g., If You Give A Mouse A Cookie; If You Give a Pig A Pancake) is wonderful series of stories by Laura Numeroff that offers many opportunities for language modeling for your child. The stories demonstrate a simple, repetitive “cause-effect” language frame which offers the opportunity to let your child make guesses as to what will happen next (i.e. What do you think the mouse will do next?) as well as the ability to answer/model “why/because" sentence structures (i.e. Why did the mouse need a napkin... because he had a milk mustache!).

What this book series can also do is provide a great avenue for social language skills as well. The illustrations are very vivid and detailed, which offers many opportunities to discuss body language, our all-important communication without words. Help your child “read the body clues:” the characters' facial expressions and what their bodies are telling us. Ask children to describe how characters are feeling and what they are thinking and point out observations such as, “I can tell the mouse is really thirsty-- look at his hands holding his neck and his tongue is hanging out!” This series offers many ideas and activities for children if you are reading individually, or together with other kids. See some ideas below, and enjoy!

Ideas for how to use:
  • Help your child “make a guess” as to what would happen next? If they are having a hard time, help them relate it to themselves. I.e. “What do you want after you drink a glass of milk?
  • Discuss the body language in each story. Ask your child how the mouse/moose/pig etc. feels? Why do you think that?
  • Act out a character on a page; see if your child can “guess” who you are trying to be. Take turns; see if they can make their bodies look like the character. Help them by pointing out their facial expression, where their eyes are looking, how their bodies are positioned, etc. This would be great with a few children too. A “charades like” game for all!
  • Have a couple kids in a group or on a play date? Try the Mouse and Cookie “beep” story. The first child acts as the mouse and does the first “action” (i.e. eat the cookie) then says “beep” and the next kiddo does the next action and gives the mouse a glass of milk and says “beep”, then the next kiddo (or first depending on how many children you have) does the next  action, etc. You can have kids line up in a line to make the sequence easier and more obvious.  Use the book pictures to help children remember by turning the pages for each turn.
  • Have your child make their own “If you” book. Start with a character that could be themselves and an animal. Help them understand the cause/effect sequence of the story. Maybe try “If you give a hamster a cupcake…” or “If you give an elephant a peanut…” etc. Have them make their own illustrations with crayons, markers, construction paper, etc.
  • If you have a couple kiddos have them collaborate and make an “If you” book together. Encourage listening to each other’s ideas, sharing materials, etc.
  • Have a pretend playhouse set and animals? Act out the story with pretend characters. Change up the story and see if your child can “react.” Maybe the boy gives the mouse an apple?
Click here for a link to the many “If you give a ….” Book titles and other books by Laura Numeroff.

For more information on other children’s books and how to use them please visit www.all4mychild.com under Books4all. Coming August 2011 an IOS app to support children’s social skills as well!

Meghan Gallahan Graham M.S. CCC-SLP
Speech Language Pathologist

Monday, July 25, 2011

Books for Language Development: LLama Llama Holiday Drama

Looking for books for language development? Have I got a treat for you! One of my favorite new discoveries in the speechy blog-o-sphere is the amazing resource over on All4MyChild's site entitled Books4all. It contains books that are excellent for language development, along with specific ideas and tips for using each book to help with speech and language. Cool beans.

Today, Books4all is featuring a review I wrote on one of my daughter's current favorite books: Llama Llama Holiday Drama (yes, I do know we are nowhere near the holiday season. Someone tell that to my daughter). Head on over to Books4All and find out why I think Llama Llama is great for working on /l/ sounds (well, that one's obvious, I guess), vocabulary, pre-literacy skills, inferences, and narrative skills.And while you are there, check out the awesome selection of other books that are perfect for speech and language as well. Happy reading (and talking!)

 Looking for more books for language learning?


Looking for Llama Llama books? Here are a few of my favorites....









Please note: If you click on an advertising link or purchase an advertised product I have placed on my blog, this will sometimes result in a monetary compensation for me, which I use as a means of supporting Child Talk.  (Trust me, it's much less than you imagine it to be!). However, I *never* write posts simply to sell products, and my opinions about the products I blog about are my own.   

Thursday, July 21, 2011

How Many Words Should My Child Be Saying? A Quick Guide To Vocabulary Development

Parents often wonder how many words their children should have at different ages. This seems like a simple question, but there's not always a simple answer. Vocabulary development can be relatively variable among children of the same ages.  However, there are some general guidelines:
  • Children typically speak their first word somewhere around 12 months. Some children, however, take up to 16 months to utter that long-awaited first word and this is still considered to be within the range of typical. 
  • At 18 months, children typically use around 50  (but we don't worry too much unless they have fewer than 10-20).
  • At 24 months, children usually have an expressive vocabulary of 200-300 words (but we don't worry too much unless they have fewer than 50).
  • At 3 years, children can have anywhere from 500-1,100 words in their vocabulary.
  • By 5-7 years, children have an expressive vocabulary of 3000-5000 words.
It's important to note that when talking about vocabulary, we have to be careful to state what type of vocabulary we are looking at: expressive vocabulary (the number of words children use when they talk) or receptive vocabulary (which is the number of words children understand, and is almost always significantly higher than expressive vocabulary).  The above numbers represent expressive vocabulary, or the number of words children typically use at these ages.

And it's even more important to note that at least one study (Hart and Risley, 2006) found that the significant variability in children's vocabulary at the age of three was strongly related to the amount of talking parents did with their children. Specifically, they found that parents who used 'conversational' speech with their children (talking about what they did, what they saw and what they thought about what they did and what they saw-- basically just making conversation with their children on a regular and on-going basis) had children with significantly higher vocabularies and IQs at age three than children whose parents used mainly directive speech (get this, do that, come over here). The differences in language and IQ remained at age nine as well.

Looking for ways to keep your child's vocabulary growing? Here are a few. 
  1. At the toddler age, use simple language to talk about what you and your child are seeing and doing. Narrate your day and engage your child in simple back and forth conversations about what is happening. 
  2. Think about taking pictures and using them to extend and repeat the conversation about events that have happened, even with children as young as 24 months. Talking about things that have already happened helps your child learn to talk about decontextualized events (things that are not right in front of him)-- a task that requires a more precise and higher-level vocabulary.
  3. As your child develops language in the preschool and elementary years, continue to engage him in conversations about things that have happened in your lives. When you do so:
    •  Use active listening to show your child you are listening; create opportunities for your child to comment and add to your thoughts. Create pockets of time in which you really talk with your child.
    • Restate what your child says, using slightly more advanced, new vocabulary. For example, if he says, "Did you see that house by the water? It was big!" respond by saying, "I did- the cabin next to the creek was gigantic!"
    • As your child talks, ask "how" and "why" questions to help him extend and analyze his thoughts. Wonder out loud, for example, how the cabin was build or why the family chose to build it on the creek. Doing so allows your child to use new vocabulary to talk about abstract thoughts, rather than simply talking about the concrete objects that are right in front of him (Ruston &  Schwanenflugel, 2010). 


    Paul, Rhea. (2007). Language Disorders from Infancy Through Adolescence. Mosby, Inc: Canada.
    Risley, T. R & Hart, B. (2006). Promoting early language development. In N. F. Watt, C. Ayoub, R. H. Bradley, J. E. Puma & W. A. LeBoeuf (Eds.), The crisis in youth mental health: Critical issues and effective programs, Volume 4, Early intervention programs and policies (pp. 83-88). Westport, CT: Praeger.
    Ruston, H.,&  Schwanenflugel, P. (2010). Effects of a Conversation Intervention on the Expressive Vocabulary Development of Prekindergarten Children. Language, Speech, and Hearing Services in Schools (41): 303-313.


    Tuesday, July 19, 2011

    Activities to Increase Language: Homemade Sidewalk Paint

    I'm always on the look-out for great activities to use for language development and after reading this post from Hands On: As We Grow and this post from Quirky Mama, I was inspired to try making my own sidewalk paint--a wonderful activity for enhancing language.  The recipe for sidewalk paint is easy enough:
    • 1/4 cup cornstarch
    • 1/2 box baking soda
    • A squeeze of washable paint
    • A couple tablespoons of water (although I had to add quite a bit more than "a couple tablespoons" to make it into a good consistency paint! It thickens as you go, so don't be afraid to add more water. The author of Hands: On We Grow recommends making it soupier than you think you need it, and I agree). 
    Mix it all up in a bucket, head outside, and have fun painting the sidewalks! And, if you really want to jazz things up, you can let your kids spray the painted ground with bottles of vinegar and watch their paint fizz.

    I love this activity for language development for a whole bunch of reasons:
    • It's flexible enough to use with a variety of ages. My toddler, for example, loved the painting part, and I used parallel talk, and description to model simple, new action words (paint, dip, wash) and expansion to extend her one word phrases into two-word phrases. This is a great way to increase vocabulary and sentence length in little ones.
    • Older children will enjoy helping make the paint, as my son did. While making the paint, I gave him different directions to follow. This is a fantastic way to work on receptive language by having children follow new one and two-step directions; it also allows for the introduction of new vocabulary such as "slowly" and "carefully" to describe how to execute directions. 
    • As a speech therapist, I am always on the search for very simple recipes that lead to something fun. I use them to help children learn to sequence simple events and tell simple stories about what they did.  I often take pictures of each step along the way, print the pictures out, and have children actually put the pictures in order before retelling the experience. This recipe is short and sweet, making it perfect for this type of language experience.
    • This is also an activity that easily lends itself to teaching descriptive concepts to older toddlers and preschoolers. It's easy to integrate simple conversation about colors, shapes, and sizes into the activity.  You can paint big circles and small ones, purple houses and red ones, short snakes and long ones. 
    • Using this activity with older children allows you to ask them to predict what is going to happen when you spray the paint with vinegar and then compare that to what really happened after it is all done. Doing this type of higher level thinking gives children a boost in the language they will need at school, where they will be called upon to compare and contrast, predict, analyze, and infer.
    Paint, talk, and enjoy!

    Looking for more activities for language development?


      Read the original posts that inspired this post at: 
      http://www.handsonaswegrow.com/2011/06/outdoor-play-homemade-sidewalk-paint.html
      http://quirkymomma.com/2011/fizzing-sidewalk-paint/

      Thursday, July 14, 2011

      A Post of a Different Flavor: Reflections on Change in The Early Intervention World

      Back in April, I posted about some of the changes that were occurring in the world of early intervention and linked to my post on ASHA that described the things I had learned this past year as I worked my way through those changes.  In each of those posts, I alluded to some of the emotions I had experienced as I learned new ways of working with families.  More recently, as part of wrapping up a position as "preparing mentor" for the State of Wisconsin's Birth-to-Three program, I was asked to summarize my year again. This time, I expanded on the various challenges I faced as I worked to shift my practice. After writing my thoughts down, I thought I'd share them here too.  Here's what I had to say.

      Shifting our practices is a journey. 

      It’s a journey that requires us, as therapists, to look at our current practices and have the courage to step back and understand that there may be areas where we need to grow. This is difficult because it requires us-- first and foremost-- to acknowledge that we may not have been serving families in the best way possible... that we may have let families down.  It takes courage. 

      It's a journey that requires us to be open to exploring new ways…to tolerate the internal struggle that results from studying something new and examining the evidence behind it, all while continuing to serve the children and families who are already on our caseloads.   It's a journey that requires us to challenge our traditional views; to re-examine the things we were taught and the ways we learned to be therapists; to go to the very core of what we do and challenge ourselves to do even better.  It takes faith. 

      It's a journey that requires us to deeply understand the concepts of attachment and family systems—things that very few of us studied in school--and to find ways to integrate those systems of knowledge into ours. It's a journey that requires us to know our scope of practice and to challenge how we think about it while still operating within it. It's a journey that asks us to redefine our own systems, to find ways to bridge the gap between the requirements for billing and documentation and the expectations of evidence-based practice, to both know our limits and push them.   It takes creativity. 

      And it's a journey that challenges us to give our colleagues space to forge their own path while still walking toward the same destination; to find ways to respectfully disagree; to develop trust with each other; and to take comfort in the belief that, in the end, we all want to do the best for the families and children that we are called to serve.  And doing this, we find hope. 


      Looking for more posts on early intervention?


      Tuesday, July 12, 2011

      Communication Temptations: How Use Your Environment to Get Your Child Talking

      Wondering how to get your child talking? We speech-language therapists have lots of tricks in our pockets to do just that. One of our very favorites involves enticing children to talk by creating what we call communication temptations (Wetherby and Prizant, 1989).This little strategy can be used to help a late-talker start talking, to help a toddler begin using two-word phrases, or to increase the chances that a young child with autism will begin communicating.

      Communication temptations are pretty much just what they sound like: we set up the environment to tempt children to communicate with us. The rationale for using them is also a pretty simple one: a child is much more likely to communicate if he has a reason for doing so! 

      Setting up communication temptations is easy and there are lots of ways to do so. Wetherby and Prizant (1989), who formalized the term, were pretty creative in their list of examples. They suggested things such as:
      • Offering your child something to eat you know he dislikes,
      • Putting a toy in an opaque bag and shaking it to get the child's interest,
      • Putting your child's hand in something sticky or gooey such as pudding, and
      • Waving bye-bye and saying "bye" as you put toys in a box three times, then pausing right before you put away the next toy.
      Each of these ideas has one thing in common- the environment is set up so that a child is tempted to communicate about something ("no, I don't want that!" "what is that?" "yuck" or "bye!"). Another form of communication temptation involves enticing a child to request. This is a great place to start for any child, but it's especially good for kids with autism, because requesting is often the easiest form of communication for these children at first.

      The steps to this type of communication temptation are as follows:
      1. Find an activity or an object that your child really enjoys.  Look for an activity that is easily stopped and started (e.g., bubbles or a swing) or an object that has multiple parts that you can hand to your child (e.g., crackers that he loves to eat, cars for a car track).
      2. Arrange the environment so that you create an obstacle to getting that object, but so that your child can see the object. For example, put your child's favorite crackers up on a high shelf. Or, put the cars in see-through container he can't open.
      3. Start the activity, have a bit of fun and then stop (put the lid on the bubbles or pull him up in the swing but don't let him go) or give him one item (e.g., give him one cracker or one car). 
      4. Wait! Many parents forget this part, but it's an important one. Give your child a chance to communicate first.  Ideally, we want him to communicate without us helping him (we want him to initiate the communication), so always wait first. See what he does. Look expectantly at him, like you are waiting for him to do something (which, of course, you are!)
      5. When he communicates with you (either verbally or nonverbally):
      • Give him what he wants and cheer him on--especially if it's the first time he's used that particular word or two-word phrase, or
      • Build on his communication just a bit to help him move into the next stage of speech and language development.
      What you actually do for step number five depends completely on your child and his current level of communication. 
      • If your child isn't yet using words, wait until he does something--anything-- to indicate that he wants more (e.g., moves his body in anticipation, points, reaches); when he does (and he will!), say the word for what he wants, wait just a few moments more, and give it to him
      • If your child vocalizes to indicate he wants more but doesn't actually say the word, say the word for him, wait just a few more seconds, and give him what he wants
      • If your child imitates the word, or even part of the word,  give him what he wants and cheer him on!
      • If your child always imitates your words, but doesn't say them on his own, try waiting progressively longer before you say the word for what he wants; wait for one second and then say the word, then (the next time), wait for two seconds before saying the word, then (the next time, wait for three seconds before saying the word....and so on. If he gets frustrated, go back to waiting a shorter amount of time and build up again.
      • If your child uses one word to request more of the item, use expansion to put his word into a two-word phrase for him (your child: swing! you: "more swing!"), wait for just a few more moments, and then give him what he requested
      • If your child uses one word, you might also want to use a choice that involves two different two-word phrases (your child: cracker!; you: "big cracker or little cracker?") and encourage him to use the two-word phrase to make a choice
      • If your child uses a longer phrase, but makes an error, you can correct his error by conversationally repeating what he said (your child: "wing!" you: "sssssswing!") and encourage him to imitate you accurately.
      • You might also think about using communication temptations to teach your child to use baby signs or pictures to communicate. 
      No matter what your child's level, communication temptations are often a very successful way to create opportunities for your child to advance her communication skills. Tempt away!


      Wetherby, A., & Prizant, B. (1989). The expression of communicative intent: Assessment issues. Seminars in Speech and Language,10, 77-91

      Looking for more strategies to increase speech and language?


      Wednesday, July 6, 2011

      The Blogosphere, ASHA Style

      My post on using photo books to enhance language is being reposted over on ASHA today!  ASHA is the acronym for the American Speech-Language-Hearing-Association-- the national organization that represents and coordinates nearly 128,000 of us speech-language therapists, audiologists, and speech-language-hearing scientists.  I've guest-posted over there before, but it's fun to see a post of mine over there again. Since I'm sure you are going to want to rush right over and re-read my post (ha ha), you can find it here.

      While you're there, check out some of the other posts they have. The ASHAsphere is a really great way to stay on top of the happenings of the SLP world. You'll find information on topics like...

      Enjoy!

      Tuesday, July 5, 2011

      A Picture Is Worth 1000 Words: Using Photo Books to Increase Vocabulary, Grammar, and Narrative Skills


      Making photo books with your kids is a fabulous way to help increase their language skills. It matters not if you are a mom simply looking for  creative ways to provide your toddler with a language-rich environment or a dad looking for ways to help your kindergartener learn to tell stories-- photo books are a flexible tool than can be used in a huge variety of ways.

      -->
      How to use picture books? The general idea goes a little something like this:
      • Take pictures during a fun event such as a trip to the zoo or the beach,
      • Capture key moments in the pictures,
      • Print the pictures that highlight the key moments from the event,
      • Spend a few afternoons gluing the pictures onto construction paper, letting your children help cut, glue and color around the pictures; if your child is old enough, help him to write captions for the pictures, and
      • Laminate the pages and have them bound into a book that can be read over and over.
      One you've done this, you're all set up to use the books to help increase language.  Kids love these books because they are based in experiences that they had; this makes the books both meaningful and fun. And children usually want to read the books over and over again-- as annoying as this can be, it makes picture books the perfect vehicle for developing language.

      With toddlers, you can use the pictures to build on language.  Most toddlers love to start looking at pictures of themselves around 12-24 months, right when they are starting to rapidly increase their vocabulary and move from one-word phrases to two-word phrases. Photo books create excellent opportunities for using parallel talk, description, and expansion to help toddlers develop new vocabulary and help them make the jump from one to two words. They can be especially helpful for late-talkers.

      Check out the video below.  I use expansion with my daughter, who is looking at a picture of herself riding a toy motorcycle with her brother, James.  First, I wait for her to say something ("ride!"). Then I build on her words by putting them into short phrases, two different times. As a result, she comes back with a two-word phrase of her own ("James riding")! Using simple techniques like this, repeatedly and consistently with late-talkers has been shown to increase their language. (Although I should also mention it doesn't always work this quickly....I've been using parallel talk, description and expansion with my daughter for the past year and it's only really starting to pay off now!)



      Toddlers aren't the only ones who benefit from photo books, though. Using these books with preschoolers and early elementary age children can be great way to work on a whole variety of language-related skills. You can:
      • Work on sequencing by having your child lay out the pictures in the right order as you make the book,
      • Work on pre-writing and writing skills by having your child trace words you write or write his own words and sentences as you make the book,
      • Work on vocabulary by defining new words and integrating those words into the story and by using time words such as first, next, then and finally,
      • Work on language by using indirect correction, in which you correct errors in your child's grammar by restating what he said, correctly and conversationally (e.g. Your child: "I runned really fast!" You: "You did. You ran so fast!"), and
      • Work on memory by having your child practice telling the story with and without the picture book in front of him.
      Finally, photo books are a fantastic way to work on narrative (story) development. Developing an understanding of narrative structure (the typical flow of stories) is essential to being able to engage in conversations, tell others about things that have happened, and understand academic texts later in the elementary years. Enhancing narrative development is an asset for any child; I work on it with my son, often. It's also a skill that can be very hard for children with language delays and specific diagnoses such as autism, so working on it with these children is essential.  Using photo books to visually show stories in which children actually participated helps make narrative structure more concrete and easier to understand.   At first, you can use photo books to help your child understand that the story has a beginning, a middle, and an end. Later, during the early elementary age years, you can help your child form a story that has the following elements:
      • Setting ("We were at the zoo")
      • Goal ("We wanted to see the animals,")
      • Problem ("But Sally was scared of the lion.")
      • Feelings ("I was so mad, because I wanted to see the lion.")
      • Attempt to solve the problem ("So we went to see the owls instead. Then Sally was ready to see the lion. Mom just covered her eyes.")
      • Conclusion ("After that, we had a really fun day.")
      It doesn't have to be perfect, of course. Stories are messy, just like life. They won't fit perfectly into those elements, nor should they. But telling stories in a way that wraps loosely around those story elements, over and over and over again, will help your child begin to internalize the flow of stories.

      There is so much to do with picture books that the possibilities seem endless.  What's more, at the end of the day, you also have a book full of memories that your children will cherish for years to come.  And that's just priceless.