Wednesday, November 7, 2012

Fabulous First Words

As a pediatric speech-language therapist, I find myself teaching toddlers the same first words over and over.  Why?  Because, based on the principles of speech sound development, I know which types of words will be the easiest for a child to imitate.  And, I know what kids like!  Combining those two factors together has led to a first words list that I keep tucked in the back of my head and rapidly sort through during therapy sessions as I find ways to sneak the words into toddler activities.

Parents are often amazed as their toddlers start talking quickly using these words. But what looks like magic is really just simple science.  To arrive at this "magic" word list, I simply combine what we know about speech sound development with what what we know about the easiest syllable shapes.  And, presto, words emerge. 

Once a child has mastered words in one word list, I know he is ready for the next level.  And up the word lists we go.  This is especially effective for children who are diagnosed with apraxia of speech, but it works well for all children, typically developing or not. 

So, what are these fabulous first words?  

For very beginning speakers
Bye, Boo, Bee, Baba, Baby, Baaa (for a sheep), 
Bee, Bye, Ball (ba is okay), Bubble (buhboh)
Me, My, Mo (for more), Moo (for a cow),  Mama, 
Papa, Pooh, Pea, Pow, Puppy, Dada, 
Ni-ni, Nana (banana/grandma), Up, On, In, Out,  
Two,Toy, Toe, Tree (tee) Eat, No, Neigh
Hoo Hoo (owl sound), Hi, Go, Wee, Woah! Wow, Yay!

The next step up
Ta-da!, Oh-no, Uh-oh, Oh-boy! 
Mommy, Daddy, Num-num,
Apple (apo), Open (opuh), cracker (kaka)
Pop, Mom, Dad, Boom, Beep, Bam, Peep,
 Nite, Hot, Hat, Hop Down, Done, 
One, Dot, Toot, Elmo ("Emo")

One more step up
 Pony, Cookie, Nummy, Nite, Muddy, Table (tabo)
Happy, Tummy, Duckie, Doggie, Kitty, Water (watuh)
Book, Bonk, Please (pees), See, Bed, Bike, Choo choo ("too too")
Truck (tuck), Spoon  (poon),  Duck, Milk
Cow, Cheese (tees), Candy, Bunny, Piggie, 
Eyes, Nose, Toes, Bus, Car ("Ka"), Cup, Bed, Yes or Yeah, 
Block (bak), Big, Juice (doos), Off, Wet, Dirty (dihtee)

So now that you know the magic words, how do you get children to say them?
Surround him with these words in All Kinds of Talk,

Happy Talking! :)

Sunday, October 21, 2012

Theory of Mind, Language, and Conversation

When I am teaching others about speech and language, I sometimes reference theory of mind. Although this is not a term that many people throw around in everyday conversation (with the exception of us crazy SLPs, of course), all effective communicators draw upon their theory of mind skills frequently and without even knowing they are doing so. Without well developed theory of mind skills, our conversations would be disjointed or repetitive- we would risk insulting our audience or boring them to death with way too many details.

Simply put, Theory of Mind is the ability to understand the mental state of others. In other words, it is the ability to put yourself in the mind of another person- to have a theory about their state of mind.

Check out the video below. In addition to revealing how cute this little girl is and how cool her mom must be (okay, full disclosure: it's my daughter), it also helps us demonstrate the idea of theory of mind.

So. Given the question, "Where will Sally look for her money?" what would you answer? If you have well developed theory of mind, you should answer "Sally will look under the yellow cup" because you understand that Sally hasn't seen that sneaky sneaky Ann move her money.  Even though you know that the money is under the pink cup, you also know that Sally doesn't know this because she didn't see the money being moved.  You understand Sally's mental state which, in this case, includes a false belief. 

This classic "Sally Ann" test of false belief is generally failed by children under the age of four.  I had secretly hoped my 3-year-old daughter would amaze me and pass the test, but she was highly predictable and failed--just like she should.  The ability to pass a test of false belief generally develops between the ages of four and five; at this point, understanding of false belief seems to correlate strongly with and even predict an individual's ability to communicate effectively with others (Resches and Perez Pereira, 2007). 

Theory of mind is needed for effective communication because we all need to carefully select what we say for our listeners.  The concept of presupposition, or the ability of a speaker to make assumptions about a listener's background knowledge and modify his language accordingly, is closely linked to the idea of theory of mind.   

As just one example, pretend you are going to tell a story about something that happened to you during the day. Your story involves the following: you went to the doctor, discussed something troublesome with him, and found out that you had no need to be concerned at all.  Prior to leaving for your appointment, you had shared all your concerns with your husband; he is now is waiting anxiously for the information you get from your doctor.  The moment you get out of the doctor's office, you call your husband and blurt out, "It's fine! There's no need to worry at all!"  You can do this, because you know what your husband already knows about the situation. You know he's waiting on the edge of his seat, and you presume (or presuppose, if you will) that he will know exactly what you are talking about when you call him- and he probably will.  Should you want to share this news with your coworker who has no knowledge of your day, however, you can't just walk into her office and blurt out, "It's fine! There's no reason to worry at all!"  (unless you'd like to risk seeming a bit, well, odd). You need to provide her with some introduction to the topic at hand before sharing your wonderful news.  

We all modify our language all the time, depending who we are talking to, what information they already have, what their ability to understand us might be (e.g., we use more simple language when talking with preschoolers than with adults), and even what their status is (we are typically much more formal in the way we speak to our bosses than we are with our close friends).  We empathize, we apologize, we try to understand the perspective of others.   Each of these pragmatic language and social-emotional skills requires us to draw on our theory of mind skills to make assumptions about a listener's state of mind and modify our behavior accordingly. And the more effective we are in doing so, the better we are at communicating with others. 

Children and adults with language disorders, and those with autism, can especially struggle with theory of mind.  Teaching them to understand the perspectives of others can be a huge part of teaching them to be successful communicators. In addition, addressing theory of mind skills can be an important part of helping any child succeed at interacting well with others. 

How to address theory of mind? First of all, remember that theory of  mind is thought to be a cognitive skill that develops over time. There are certain things that we simply can't expect young children to do. Here's some of what we know about how theory of mind develops
  • Children as young as 9-12 months begin showing objects and pointing to interesting objects simply for the sake of getting another person to look at the object. Although these attempts to obtain joint attention aren't the same as theory of mind, they are thought to be a significant building block toward it. That's why lack of  joint attention is such an red important flag for autism.
  • By 18-24 months old, children begin to understand and talk about their own emotions (Owens, 2012).
  •  At 2-3 years old, children accurately label basic emotions they see in pictures
    (Michalson, L. & Lewis, M., 1985).
  • Around 3-4 years old, children start demonstrating pretend play in which they take on the roles of others (Nicolopoulou & Richer, 2007).
  • At 4-years old, many children will pass a false-belief task like the Sally Ann task describe above; this indicates they are starting to understand that others can hold beliefs that are different from reality
  • 4 -year olds also start to talk about the mental states or internal reactions of characters in stories they tell (Nicolopoulou & Richner, 2007).
  • By 4 years old, children begin to use words that represent internal states, such as know, forget think, and remember (Owens, 2012).
  • By 5 years old, children can accurately identify many of the emotions people might have in specific situations (Michalson, L. & Lewis, M., 1985)
It's important to ensure we know what to expect at certain ages, so that we don't require our children to do something that is just not possible. Having said that, here are some things we can do to promote theory of mind in young children:
  • Engage children in pretend play where they take on the roles (and perspectives) of others
  • Use verbs like think and remember and hope and believe when we talk about our own thoughts
  • Play games and discuss situations where children get to predict the outcome of an event and then compare their predictions to what actually happens ("I thought it was going to be dad at the door, but it was grandma!")
  • Help children to recognize, describe, and manage their own emotions
  • Help children to understand the emotions of others and what things lead to those emotions
  • Engage children in "barrier" activities, where they have to describe a task to someone without being able to demonstrate it. My grandma's version of a barrier activity was the "funny monster game," which involved:a. Me drawing a monster without her seeing it, b. Me telling her how to draw the monster without showing it to her, and c. Us comparing our pictures, which were invariably different (in a funny, funny way!). As an SLP, I use these activities all the time to teach children to use precise language that takes their listener's perspective into account.
  • Discuss the internal reactions, thoughts, and emotions of characters as you read books with your little one.
  • Explicitly teach your little one that others have different thoughts from them. Practice predicting what another person might be thinking and why they might be thinking this.
  • As always, talk, talk talk with your little one- the more language he has, the more he will use it effectively in a wide variety of ways. 

Michalson, L. & Lewis, M. (1985). What do children know about emotions and when do they know it.  In M. Lewis & C. Saarni (Eds). The socialization of emotions. New York: Plenum.

Nicolopoulou & Richer (2007). From actors to agents to persons: The development of character representation in young children's narratives.  Child Development, 78, 412-429

Owens (2012). Language Development: An Introduction: 8th Edition. Pearson Education Inc. Upper Saddle River, New Jersey.  

Resches & Perez Pereira (2007).  Referential communication abilities and Theory of Mind development in preschool children.  Journal of Child Language, 23, 219-239.

Tuesday, March 13, 2012

Babbles and Bubbles: How Bubbles Help Your Child Learn Language

Hands down, bubbles are my favorite speech therapy toy.  There's just something magical about their ability to entice a little one to communicate. They shimmer and shine, appear and disappear, float away and pop at random, tempting even the most grumpy child into smiles and laughter.  And since engaging children in activities they love is the first step to working on communication, bubbles can be a beautiful bridge to language. 

Before I explain how the bubble magic unfolds, though, I'll share my favorite bubble recipe.  It's one I found back when I was eleven years old and spent hours upon hours perfecting HUGE bubbles, made with a spectacular bubble wand.  To this day, I use the recipe I found back then,  because I still haven't found one that works better. Plus, it's easy!
  • One cup Dawn dish soap
  • Ten cups water
  • 2-3 tablespoons glycerin (found at a local pharmacy)
That's it.  Makes the perfect bubble every time.

So then, what's all this about bubble magic?
  • Bubbles are a great activity for getting some first words going, because you can use lots of "b" and "p" sounds, These speech sounds are easy for children to imitate because they can see exactly what your lips do when you make the sounds. Obviously, the word "bubble" is full of "b" sounds; "pop" is another great word to model as you play, so is "up" as the bubbles go up up up into the air, and "bye" as the bubbles float away in the wind.
  • Because bubbles are hard for young children to blow themselves, they are a perfect communication temptation.  To use bubbles as a communication temptation, blow them for a while, and have some fun. Then put the cap on the bubble jar and wait, looking expectantly at your child. Or, catch the bubble on the wand, hold it up high, and wait. Or look like you are about to blow a bubble and wait. It is during the wait that your little one is most likely to communicate, either through a sound, a gesture, or a word. When she does, build on her communication by modeling back something a bit more complex than what she did, and then give her what she wants. 
  • You can also use my favorite three magic words: Say "Ready, Set, Go!" right before blowing the bubbles. Do this repeatedly, without any expectation of a response. Then, one time, say "Ready, Set...." and wait; the word "go" will often fall right out of your little one's mouth.
  • You can be silly with bubbles! Children love silly, and you can pair your silly actions with words to increase the chances that your child will imitate. When I am blowing bubbles, they often pop right into my face (sometimes by accident, sometimes by design) and I have to wipe them off with an exaggerated "uck!"  I also squash bubbles with my hands and stomp on bubbles with great delight, saying "pop" as I go, wave "bye bye," as the bubbles float off into the distance, and diiiiiiiip the wand into the bubbles.
  • Playing with bubbles is a great time to model action and description words to increase your child's language. Action words are easily woven into the activity as you open the bubbles, blow the bubbles, and pop the bubbles; simple and early developing concepts are present too, as you blow big and little bubbles, as the bubbles go up and down, the wand goes in and out of the bubble jar, and as things get wet when the bubbles pop (or spill!), so you have to get a towel to dry them off again.  These verbs and concepts can be worked on at the single world level at first, and then integrated into two word phrases as your little one's language develops. 
  • Best of all, it's hard not to smile while watching your little one enjoy the beauty of bubbles. And smiling is good for everyone. :)

Friday, February 24, 2012

Better Therapy Sessions For Kids

Ellen over at Love That Max has a great post up, full of tips from pediatric therapists about how to get the maximum benefit from therapist sessions. The tips came from Pediastaff  bloggers, each of whom have their own blog, too: My Munchbug, Starfish Therapies, All 4 My Child, and, yes, Child Talk. :)  Check it out here.

Friday, February 3, 2012

The ABCs of ABA in the SLP world

We speech-language therapists have a lot of acronyms in our little speechy world. We are SLPs (speech-language pathologists) who have our CCCs (Certificates of Clinical Competence) from ASHA (the American Speech-Language and Hearing Association). When I graduated with my M.S. (okay, you all know that one) in speech-language pathology, I was pretty sure I'd mastered the alphabet soup of our profession.

Until I fell in love with kids with autism, that is. That's when I was introduced to the world of ABA. If you've loved a child with autism, you've no doubt run smack into this term, too, and probably very early along the journey you took. Despite the fact that this word swirls around the autism world with great furiosity, it is often misused and a bit misunderstood. Some people love it with a passion; others hate it with the same intensity. Me? I think it both extremely valuable and sometimes overused.

But I'm getting ahead of myself. My goal today is to begin to define the term for those who don't know it well. Later, when I've laid the groundwork just a bit, we'll delve into the true complexities that exist with what appears, at first glance, to be a very simple concept.

ABA stands for Applied Behavioral Analysis.  It's based on the work of B.F. Skinner, a psychologist who focused on operant conditioning, or the study of observable behaviors and the events that cause and reinforce those behaviors. The applied part of ABA means that we take this system of looking at the way behaviors are shaped and apply it to everyday life; we use it to shape behaviors that are important to the lives we lead. When we peer at the world through the eyes of ABA, we find ourselves looking at three main things.

The Antecedent: What happened in the environment before the behavior occurred?

The Behavior: This part involves describing the overt behavior that you see or want to see. Not the motives, not the intent, not the feelings behind the behavior. Simply the behavior as you can observe it in front of you. Those who study and use the principles of ABA believe in describing the behavior as clearly and objectively as possible. For example, instead of saying "Sally got mad," a behavior analyst would say "Sally screamed and hit the door with her fist."

Consequence: What happens after the behavior? Does this thing that occurs after the behavior (the consequence) increase the chances the behavior will occur again, making it a reinforcement? Or does it decrease the chances the behavior will occur again, making it a punishment?

To help explain, let me share a couple examples.

Say you are teaching a child to say "cookie." The steps behind teaching the word might go a little something like this:

Antecedent:  You hold up a cookie and say, "cookie"
Behavior: The child imitates "cookie"
Consequence: You give the child the cookie. (This would be positive reinforcement, assuming that giving the child the cookie increases the chances he will say the word again in the presence of the the cookie. Or, in plain English, assuming the child actually wants the cookie--although behavior analysts would probably shy away from describing it this way, as it reflects the child's internal state, rather than his behavior).

Or, perhaps you are teaching your child to walk. 

Antecedent: You hold out your hands and say "come here!"
Behavior: Your child takes his first step toward you.
Consequence: You cheer and throw your child in the air as he giggles. (Again, this is only reinforcement if it actually increases the chances your child will take a step toward you the next time you hold out your hands and say, "come here!" It wouldn't be a reinforcement if he hated being thrown in the air- in this case, it might decrease the chances that he'd come to you and would, then, become a  punishment*. Consequences are different for different people- the exact same action that is a reinforcement for one person can be a punishment for another).

These three things- the antecedent, behavior and consequence (Or ABCs of ABA, if you will...yes, another acronym), make up the core of ABA. Those who live in the world of ABA focus very carefully on the ABCs behind any and all behaviors. They graph and chart and study these elements of life and plan interactions around them.  

ABA is much more complex than this, of course; I took four full graduate level classes about ABA when I completed my graduate certificate in Behavioral Intervention in Autism.  There are those that study ABA all their life and still don't have all the answers, and there are entire, complex, and well-graphed treatments for autism that are based the concepts behind ABA.  It is not nearly as simple as I am making it at the moment. And yet, if you understand the ABCs behind ABA, you can begin to understand the world through the eyes of an applied behavior analyst.

How, then, does ABA fit into the world of SLP? As an experienced applied behavior analyst once told me, we all (parents, teachers, speech-therapists, all of us) use ABA in one form or another.  SLPs are no exception. We use the principles of ABA to teach children first words (Antecedent: "Say, Ball!" Child's Behavior: "Ball!"  Consequence: Child is rolled the ball). We use ABA methods to teach children how to behave and understand language (Antecedent: "Sit down please." Child's behavior: sits down. Consequence: "Here's your snack.").  We call on ABA to help us figure why children behave in certain ways, so that we might help them find a better response and eliminate challenging behavior. For example, we might look at what comes just before a child hits another child (the antecedent), discover that it happens whenever another child obstructs the way, and then give the  child a new behavior (saying, "move please") by teaching and reinforcing this new behavior.

So yes, we all use the concepts behind ABA, intuitively and frequently, to teach, motivate, and shape our children's behaviors. And yet, controversy behind these methods exists. Why so? Because there are significant differences in how and when we apply these methods, in how stringently we define the behaviors we expect, in how we select and apply consequences, and in how strongly we believe that the ABA lens is the only one through which we can view the world.

That's a post for a different day though.  For now, we'll just be happy that we've learned our ABCs.

Sunday, January 15, 2012

Every Day Language Learning: Dishwashers and Socks

As a working mom, life is a perpetual balance of domestic duties, professional tasks, and child-related entertainment. When my son was young, I often attempted to maintain this balance by entertaining him with toys, books, and activities while he was awake and then feverishly trying to get all of the household chores done while he napped or after he went to bed each night. This worked well...except for the fact that the chores were rarely completed, I got way too little sleep, and I tended to be a bit, um, cranky due to both of these things.

With my daughter, I'm doing things differently. We still play and read books for sure. But I've also realized how much more fun chores can be when she is a part of them. And how much learning occurs inside those household tasks if I just slow them down a bit.  Recently, we've been having a blast unloading the dishwasher and sorting the laundry.  (No, really. Stop laughing).

Luckily, learning is easily woven into both these activities. The biggest thing we do right now is sort things.  Sorting is a cognitive skill that really begins to emerge in the toddler years. As we unload the dishwasher, I let her sort the utensils into the right baskets; when we do the laundry, she sorts the clean clothes into piles of shirts, pants, socks and undies.  (Yes, it helps that she's an agreeable little girl who wants to do these things with me. I think her propensity for sorting suggests that she may have inherited her organizational gene from me. Poor thing).

I didn't expect her to sort all on her own right away, of course. Laundry, for example, started out with just finding the socks and putting them in a sock pile. Then we moved to separating the socks from the shirts. Now-a-days, she sorts all the clothes out of the whole basket, but I still have to start the piles for her.  Lest you think that I am just using some form of child labor, let me assure you that I sit right on the floor next to her (almost) the whole time.  We go slowly, and there is lots of praise and excitement when she puts things in the right piles. Sometimes we even sing to a simple tune like Where is Thumpkin.

Where's the shirts? 
Where's the shirts? 
There they are! 
There they are! 
You found the shirts, 
You found the shirts, 
Yes you did. 
Yes you did!  

(I'm not a cool mom, but she seems to love me anyway).

Why is sorting important? It helps children begin to understand the concept of groups of things. A shirt is still a shirt- whether it's red or blue or tattered or new.  Forks are forks whether they are small or big.  Sorting helps children see the similarities in objects, even when the objects are a bit different at the same time.  As they learn this, they gain the ability classify things in their mind--to create groups of similar things; this skill is important for language and eventually math as well.

Beyond sorting, laundry and dishwashing provide lots of opportunities for language, too. My daughter and I discuss the utensils and clothing items as we go along. At first I used parallel talk and self talk to model the words for her; as she got older and started talking more, I started using choices and expansion to grow her phrases longer.  We often weave in concepts, too: size concepts (big, small, long, short),  color concepts (red shirt, blue shirt), possession (daddy's shirt, mommy's sock), descriptive concepts (soft socks, dirty pants), number concepts (one sock, two socks) and position concepts (fork in, fork out) are all emerging in the toddler years. 

Who knew dishwashers and socks could be so useful for learning?

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Saturday, January 7, 2012

Top Ten Tips For Late Talkers

Worried about your late-talker?  Here are my top ten tips for helping your little one grow.
  1. Get his hearing checked. Some parents assume that if their child passes the newborn hearing test in the hospital, they no longer have to worry about hearing. This isn't true-- your child can pass the newborn hearing test and still have a hearing loss.  If your child is a late-talker, talk to your pediatrician about having a formal audiological evaluation.
  2. Take a peek at his use of gestures, his play, his eye contact, and his understanding of language. Find out more about what he should be doing in each of these areas here and here. If you notice that he is lagging behind his peers in any of these areas, talk to your pediatrician about a referral to your early intervention program. Late-talkers are more likely to need intervention if they have delays in gestures, play, eye contact, and/or receptive language.
  3. Read repetitive books and sing repetitive songs with him.  Hearing the same pattern over and over will help him anticipate what is coming next. Soon, you'll find that he starts filling words into those books and songs when you pause just a bit before the important words.
  4. Help him learn the power of words by saying, "Ready, Set, Go!" before doing something fun. Do this over and over and watch as he starts to fill the word "go" into the phrase.
  5. Talk, talk, talk to him. Use parallel talk, description, and self talk to describe what he is doing and seeing in short phrases.
  6. Pair your words with actions. Children are more likely to imitate a word when the word goes along with a familiar, repeated action.
  7. Think about using Baby Signs as a bridge to verbal communication. Parents sometimes worry that children will become dependent on signs, but research suggests the opposite: using signs and gestures with children can increase their language skills.
  8. Use communication temptations--change your late-talker's environment to give him more opportunities to communicate. For example, put his favorite toys in a see-through box. Or put his snacks up in a cupboard so he has to ask for them.  When he wants something, wait a bit to see what he does. He might say the word! If he doesn't, say the word for him and wait just a bit. If he doesn't imitate you, give him what he wants and repeat the whole process the next time.  Over time, he'll start using the word before you do.
  9. If he's not making progress, or if you just want some additional help, don't hesitate to talk to your pediatrician about a referral to an early intervention program. We don't bite. I promise. :)
  10. Love him. More than anything else, children need to be in loving, responsive relationships with their parents.  All of the above tips are important, but this is the most important one of all. 

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