Speech Therapy Blog
Moving Articulation into Conversation
Your child has worked so hard in speech therapy and can now pronounce the sound(s) he has been working on! The only problem is he can’t say the sound in conversation. How can you help him?
Start with a five minute warm-up of words containing the target sound. Practice these words in sentences as well.
Next, depending on how much time you have and if you have daily chores to attend to, encourage your child to use the target sound while engaging in the types of activities listed below, while conversing with you.
There are a variety of ideas that span age-ranges. The structure of the activity will help maintain the goal: To say the target sound consistently in conversation.
Keep the goal in mind at all times during the activity, and remind your child as necessary.
Make sure you are always monitoring for the correct target sound. If you hear errors, simply try modeling instead of correcting. This method will have a more positive effect and won’t interrupt the flow of your game or conversation, etc. For example:
Georgia: I’m going to watch the THookeeper feed the THealTH. (Translation: I’m going to watch the zookeeper feed the seals.)
Mom (while bending down so Georgia can see her mouth): We ARE going to watch the zookeeper feed the seals. Hurry, we don’t want to be late! (Mom emphasizes the target sounds.)
You may need to manipulate the vocabulary to have a more optimal choice of target sounds in words (e.g., try “rabbit” instead of “bunny” if you are working on the R sound).
Household Ideas
Sort the clean laundry (e.g., Daddy’s sock, Joey’s shirt).
Bake cookies.
Food shop, run errands.
Clean the apartment (your child can use the Swiffer, recycle, clean up toys, etc.).
Games / Crafts
Hedbanz
Pretend play (tea party, school, doctor, Legos, Star Wars, etc.).
Playdoh
Make a collage.
Play games without too much strategy involved: Pop-up Pirate, Thin Ice, Twister, Perfection (At first don’t set the timer right away. Later, with the timer set, the excitement will make it more challenging to practice target sounds).
Fingerpaint inside or sidewalk chalk outside.
Sing songs.
Other favorites
Narrate a picture book. You can use wordless or worded picture books.
Talk about your favorite movies.
Look through family pictures.
Have your child tell you about his day (if you weren’t together).
If your child watches a television show, have him give you summary.
Go to a museum.
Browse through toy catalogues.
Playground time – maintaining target sound(s) while being physically active is challenging.
Go out for ice cream to celebrate how well your child is doing with his articulation!
Keeping the goal in mind during these structured tasks will help you learn to monitor your child more effectively throughout each day.
Making an effort to set aside the time to practice carryover of your child’s target articulation sounds will help reduce time in speech therapy.
These are tips I often share with parents to use as homework activities in my own practice. You can learn more about me, Stephanie Sigal, on my website. Thanks for reading!
Wordless Picture Books and Language Development
Wordless picture books encourage language development. Below, I’ve complied previously blogs and added more suggestions. Wordless picture books and funny pictures are excellent tools to address vocabulary, word finding, grammar, articulation, attention and pre-reading skills. Goals to improve each of these naturally fall into place when “reading” wordless picture books and describing funny pictures. Even better, the variety of wordless picture books and funny pictures available allows for activities to remain fun and fresh. You can use wordless picture books and funny pictures for…
Articulation
Sometimes a child can say a sound (e.g., /s/) in sentences, but needs extra practice in conversation. Wordless books and funny pictures can bridge the gap between sentence level and conversation.
Language
Take turns with your child describing the pictures in the wordless books. If your child leaves out important information when describing scenes in books or pictures, you can ask an open ended question (e.g., “Hmmm – What’s happening over here?”). If he can’t describe what’s happening, describe it for him. Perhaps your description will improve his awareness to be more specific next time.
Pre-Reading With Wordless Picture Books
When appropriate, before turning the page, excitedly ask “What’s going to happen next?” When given the opportunity to make a prediction (a pre-reading skill), children combine verbal and critical thinking skills.
With Funny Pictures
Describing funny pictures is entertaining! An instant smile appears when a child is shown a picture of the Statue of Liberty holding an ice cream sundae. This task allows your child to link visual and cognitive skills, which is crucial for pre-reading. Funny pictures need to be carefully examined, just as words need to be looked at closely to notice blends. What’s more, when a child focuses and attends to a funny picture and can explain why it is crazy a polar bear is on the beach, he is using attention and reasoning skills and making inferences.
Social-Emotional Awareness
A child may better appreciate the feelings of others if he can interpret and describe feelings. When the opportunity presents itself, ask your child how a main character feels. You may need to be more specific: “How does Jack the dog feel after his family left him without breakfast?” Provide explanations as necessary.
Looking for some wordless picture books and funny pictures?
“Jack” Books
The “Jack” books by Pat Schories are a great introduction to wordless picture books. While the Jack books do not need to be read in any particular order, the following order works nicely:
Breakfast for Jack
Jack Wants a Snack
Jack and the Missing Piece
Jack and the Night Visitors
When Jack Goes Out
Children are interested in the characters in Jack’s life. Searching the detailed pictures for surprises is motivating, facilitates attention and assists in developing visual scanning skills.
Frog Series
The Frog Series by Mercer Mayer (and sometimes Marianna Mayer as well) is an appropriate series to try next. Again, the books don’t need to be read in any particular order, but given the language skills required within each book, this order may be preferable:
Frog, Where Are You?
A Boy, A Dog and A Frog
One Frog Too Many
A Boy, A Dog, A Frog and A Friend
Frog on His Own
Frog Goes To Dinner
I was first introduced to The Frog Series in my graduate school clinic. School-age children described scenes in a Frog book chosen for them during an evaluation so we could obtain a narrative sample.
More Favorite Wordless Picture Books
Changes, Changes by Pat Hutchins
Pancakes for Breakfast by Tomie DePaola
Carl Goes Shopping by Alexandra Day
Good Night, Gorilla by Peggy Rathmann
Hug by Jez Alborough
Rosie’s Walk by Pat Hutchins
Chalk by Bill Thomson
Window by Jeannie Baker (best for older children, purchase a used copy)
No, David! by David Shannon (My favorite, essentially wordless book, also a Caldecott*)
You can also use picture books with text, as long as the pictures are detailed. This is generally more difficult than using wordless picture books, but if you try, it will work best with *Caldecott Medal / Honor Books. One of the criteria for the Caldecott Award is that a child can interpret the story directly from the pictures. A child doesn’t need to know how to read the text, in fact, cover text if your child can read, so he can freely choose his own words.
Caldecott Favorites
Knuffle Bunny: A Cautionary Tale by Mo Willem
Knuffle Bunny Too: A Case of Mistaken Identity by Mo Willems
Flotsam (This is also a wordless picture book) by David Wiesner (Tuesday and Sector 7 are good for school age children)
The Hello, Goodbye Window by Norton Juster, Illustrated by Chris Raschka
When Sophie Gets Angry, Really, Really Angry by Molly Bang
The Paperboy by Dav Pilkey
Rumpelstiltskin by Paul Zelinsky
King Bidgood’s In the Bathtub by Don and Audrey Wood
A Chair for My Mother by Vera B. Williams
One Fine Day by Nonny Hogrogian
Where the Wild Things Are by Maurice Sendak
Umbrella by Taro Yashima A Tree Is Nice by Marc Simont
Madeline by Ludwig Bemelmans
The pictures in books by Leo Lionni and Ezra Jack Keats also allow for great descriptions.
Funny Pictures
I often provide What’s Wrong coloring books to children I work with so they can discuss one page a day with a parent as part of their homework. I often leave the wordless picture book that we read together in therapy for homework as well. What’s Wrong by Anna Pomaska is good to start with. Then try What’s Wrong with this Picture? also by Pomaska.
Try this incredible set of silly photographs. Wacky Wednesday by Dr. Seuss is fun to read together. Practicing describing a worksheet or two each day from Super Duper’s 150 “What’s Wrong With This Picture?” Scenes can also help carryover speech and language skills.
Eliminating Tongue Thrust
In conversation during therapy, six year old Nikki could accurately say S and Z words like “Stephanie”, “sorry” and “pretzels“. The second her mom joined us to wrap up our session and discuss homework, Nikki immediately lost correct tongue placement, exhibiting a tongue thrust.
Oral placement therapy had previously been addressed. Nikki’s jaw, lips and tongue were strong and stable to support all speech sounds.
Nikki’s mom found it frustrating to frequently remind Nikki to use our techniques, and Nikki didn’t enjoy the nagging. What to do? We added Sticky Tape (AKA Sticky Spot)!
Sticky Tape acted as a tactile reminder. Nikki’s tongue tip was naturally drawn to the tape. We also found when Nikki’s mouth was at rest, she did not exhibit her classic open mouth / tongue protrusion posture. Sticky tape helped to habituate appropriate tongue and lip position.
Sticky Tape is a smooth, thick, medical grade tape. We fixed a small square (about 2cm x 2cm - sometimes a slightly bigger size is more effective) just behind, but not touching, the two top central teeth (upper central incisors) at midline on the hard crescent shaped area (alveolar ridge).
This spot might also be called the special spot, secret spot or as Robyn Merkel Walsh calls it, The Smile Spot.
The tape may be purchased from activeforever or flavored Sticky Spot (cherry, bubble gum, mint) may be purchased from myomadeeasy (you have to call or email to order products from the later).
When I asked Rhonda Collier of myomadeeasy what the Sticky Tape is made of, she wrote:
My prior research into concerns about possible allergens revealed that the content of the product is free of common irritants or vegan objections. The main ingredients are pectin (if you’ve ever made jam you know how sticky this is!) and fruit cellulose which is technically the cell walls of plant fiber. We use similar flavorings as used in orthodontic offices to flavor impression molds.
The unflavored tape from activeforever and the tape from myomadeeasy are both Stomahesive Skin Barrier made by ConvaTec. Myomadeeasy just adds flavoring.
Children enjoy the option of the flavors, but the flavor wears off quickly.
I found Sticky Tape to work most effectively when it was applied after meals. The tape may dissolve, fall out on its own, or it can be carefully removed. Some children don’t mind eating with the tape in place. Generally, three small squares are used each day.
The Sticky Tape sticks best when a child swallows saliva first. Next, dry off the alveolar ridge with a small piece of paper towel. Take the small square of Sticky Tape you have previously cut and hold the tape in the correct place while you sing a song or tell your child about your day. After about a minute, the tape should adhere.
In addition to using the Sticky Tape, Nikki and her mom followed the plan below for homework:
Tongue Tip Placement Reminders:
1. Nikki should follow the rules below for swallowing all food and liquid. These rules are adapted from Sara Rosenfeld Johnson’s Therapeutic Straw Drinking / Single Sip Swallow technique:
A. Place the top ¼ inch of the straw between your puckered lips at midline (or if you drink from an open cup, lips only on the rim (no teeth)
B. Sip in the liquid until you feel it in your mouth
C. Remove the straw but do not swallow the liquid
D. Close your lips as you put your tongue tip up to the secret spot
E. Freeze
F. Swallow the liquid without moving your tongue tip
G. Open your mouth, your tongue tip should still be on the secret spot
2. Tongue Tip Elevation Tool - Please read about how to use this tool.
3. Tongue Tip Elevation with Cheerio - Place a Cheerio on the secret spot. Nikki should place her tongue tip into the center of the Cheerio. Her jaw should be relaxed and open about one inch. She should hold the Cheerio with the tip of her tongue for 50 seconds, 3 times per day.
Traditional Carryover Tasks:
1. Nikki should read wordless picture books aloud. These books will create structure when trying to produce accurate S’s and Z’s. Describing funny pictures will do the same.
When Nikki is turning a page, encourage her to self-monitor. Encourage Nikki to point to a drawn out “happy” or “sad” face to let you know how she thinks she did.
2. Talk about using accurate S’s and Z’s before school, when she gets home, and before you practice.
3. Have a focused period of time (about 15 minutes) each day where Nikki is concentrating on using S and Z properly in conversation. Set a timer, as necessary.
4. Choose high frequency target words that she must always say correctly (e.g., please, strawberry, school).
5. Use a mirror for visual feedback or a video camera to record a sentence or two Nikki says. Have her critique her own speech.
6. Encourage Nikki to speak slowly all the time.
Additional Notes / Tips:
Nikki has a bad habit of clenching her jaw when she tries too hard to say s/z or when she fatigues. Encourage her to relax her jaw if this occurs.
Watch out for words that trip her up: S at the beginning and at the end of the same word (e.g., socks) – and TH blends close to S and Z (e.g., the zebra).
We also found it helpful to recruit Nikki’s teacher to help with carryover. Nikki and her teacher made up a private hand signal. If Nikki mispronounced S or Z, her teacher made eye contact with her and touched her own nose. Nikki knew to slow down and say s/z correctly. Her teacher also gently reminded Nikki to use her special swallow at snack and lunch time.
Additionally, a few therapy sessions in the outside world (e.g., grocery store, library, toy store) using our techniques with store employees helped to solidify our work.
This summer, Nikki is happily using correct productions of S and Z in conversational speech without Sticky Tape or reminders!
Stephanie Sigal is a New York City speech therapist working on Manhattan’s Upper East Side. She works with children with articulation and language delay. You can read more about her work at sayandplayfamily.
Funny Pictures Help Develop Language Skills
Children find describing What’s Wrong pictures to be a fun carryover activity for articulation, grammar and vocabulary. An instant smile appears when a child is shown a picture of the Statue of Liberty holding an ice cream sundae!
This speech and language task also allows a child to demonstrate the ability to link visual and cognitive skills, which is crucial for pre-reading. A child has to carefully examine a What’s Wrong picture, just as he needs to look closely at printed words to notice blends.
When a child focuses and attends to a silly picture and can explain why it is crazy a polar bear is on the beach, he is using reasoning skills and making inferences.
Picture completion (pictures that have something missing) subtests appear on intelligence tests, such as the WPPSI (Wechsler Preschool and Primary Scale of Intelligence), the WISC-IV (Wechsler Intelligence Scale For Children) and the Stanford Binet (Picture Absurdities). A child’s visual acuity and reasoning skills are measured when asked to identify a missing part of a familiar pictured object.
Try What’s Wrong coloring books. What’s Wrong? by Anna Pomaska is good to start with. Then try What’s Wrong with this Picture? also by Pomaska. I often provide these coloring books to children I work with so they can discuss one page a day with a parent as part of their homework.
An incredible set of silly photographs is a great informal activity / ice breaker at an evaluation. You can read Wacky Wednesday by Dr. Seuss as a therapy activity or provide a few worksheets for homework from Super Duper’s 150 “What’s Wrong With This Picture?” Scenes.
Stephanie is a pediatric speech therapist in Manhattan.
Language Skills through Books with a Group of Children
Parents often read to their two year old and four year old simultaneously. Early childhood teachers read to their students every school day. When reading to a group of children, it is vital that you are familiar with the text. You may wish to take a moment to think about open-ended questions you can ask children before you begin a story. For example, if you were to be reading Bear Snores On by Karma Wilson, you could ask “Does anyone know what bears do all winter long?” If you get a response such as “sleep” or “hibernate,” great! If you do not get a response, inform the children. Giving them a glimpse into the story will enhance their understanding and appreciation.
Ask questions during the story. Perhaps there is a vocabulary word the children might not be familiar with. In the book Don’t Let the Pigeon Stay up Late by Mo Willems, the pigeon insists the children listening to the book let him stay up so he can watch an educational program on television. You can ask, “What does educational mean?” You can also explain to the children how the pigeon is trying to “trick” (manipulate) them into letting him stay up late. Then, ask the children “How have you tried to trick your parents?”
At the conclusion of a story, ask children to carry over a main theme from a book into their daily lives. For example, after reading My Friend Rabbit by Eric Rohmann, ask the children “What does it mean to be a good friend?”
Adding props and puppets to group story time can engage kids with various levels of attention. In Caps For Sale by Esphyr Slobodkina, the peddler walks around carrying many caps on his head. The children can do the same with caps that you have previously collected for story time, or they can use their winter hats, or caps that they make as an art project to accompany the theme of the book.
Using different voices and revealing the characters’ emotions while acting out the story can also help children attend and relate more effectively. The mother dog in Bark, George by Jules Feiffer gets frustrated with her son, while he makes great animal sounds. The children will laugh when you over-act the role of George, his mother and especially the veterinarian reaching deep down into George’s mouth to pull out all the animals he has consumed.
Children are inspired to verbally participate when their peers say the repetitive line in a story together. In Tikki Tikki Tembo retold by Arlene Mosel, the older brother’s name is Tikki tikki tembo-no sa rembo-chari bari ruchi-pip peri pembo. Opportunities to say this long name come up numerous times, sometimes fast, sometimes slow, and children listening will want to try to say the name along with you.
Always read the title, author and illustrator’s names. Ask the children “What is an author?” “What is an illustrator?” Provide the information accordingly. If the author has written other books the children may be familiar with, ask them “What other books has this author written?” If necessary, name one or two of the books and you may notice how excited the children become when they realize they have shared a previous experience with you.
If you need help choosing the right books based on your child’s needs, you can ask your speech therapist, child’s teacher or librarian.
This article was written by Stephanie Sigal M.A. CCC-SLP. It appeared today on the American Speech-Language-Hearing Association (ASHA) blog, ASHAspere.
Stephanie Sigal, M.A. CCC-SLP, is a speech language therapist practicing on the Upper East Side of Manhattan, NYC. She works with babies, toddlers and school age children with expressive language delay and articulation disorders. Stephanie provides home based speech therapy and encourages parents to facilitate their children’s speech and language skills. To learn more about Stephanie, please visit sayandplayfamily.
Reading Books with Children with Language Delay
Reading books with your child can provide experiences and vocabulary that he or she may not be exposed to on a daily basis. Experience allows children to gain understanding. When a child understands vocabulary and situations, he or she has the foundation to use these words in verbal language.
Always read with your child face to face with the book next to your face, not in front of your mouth. This will allow your child to see how you move your mouth when you say words, see your facial expressions and engage in eye contact. With a baby, you can create this opportunity while he or she is on the change table, floor, car seat, bouncy chair or on your thighs facing you.
Reading with your child everyday should start from birth. At this time, you can read anything to your son or daughter, even The New York Times. What matters is HOW you read it. Read with feeling, show emotion and pause to allow your baby to vocalize back to you.
Initially, choose books with a story and meaning. Vocabulary board books (e.g., books by Roger Priddy or select DK Publishing books) will be boring for you and not provide much benefit for your baby. Reading longer stories during the first months will help to build your child’s attention. Books like The Three Bears by Byron Barton, Summer by Alice Low and Chewy Louie by Howie Schneider will be fun for you and your baby.
If your toddler has trouble paying attention to a book, try reading when he or she is “trapped” (e.g., in the highchair eating, in the car seat while traveling, just waking up from a nap in the stroller). I once worked with a two year old boy who would only happily pay attention to an unfamiliar book while standing in his crib facing me. Once he became familiar with a book, we could read the book elsewhere.
Choosing the right books can help target speech and language skills you want to develop.
If your child is not talking, choose books that contain words that begin with bilabial sounds. These are sounds where your upper and lower lips come together (/m/, /b/ and /p/). Bilabial sounds are generally early sounds produced by children because they can see how an adult is moving their lips, which is helpful for imitation. Favorite books that include bilabial sounds are It’s Not Easy Being a Bunny (Marilyn Sadlow), The Berenstains’ B Book (Stanley and Jan Berenstain) and any book that contains animal sounds (moo, baa, maa). Overemphasize /m/, /b/ and /p/ and make eye contact with your child when saying bilabial sounds in any book.
Selecting books with repetitive phrases may allow your child to participate during story time. Great examples include: Dear Zoo (Rod Campbell), The Very Busy Spider (Eric Carle) and The Gingerbread Boy (Richard Egielski). Give your child the opportunity to complete the repetitive line, or if he or she is ready, the whole line. Hopefully, these words will carry over into daily vocabulary.
Rhyming books help children with word prediction, which is crucial for reading development. Once familiar with a rhyming book, have your child try to fill-in the rhyming word. Dr. Seuss’ The Foot Book begins: Left foot, Left foot, Right foot, Right – Feet in the morning, Feet at _____ (child should say “night”).
If your child’s speech therapist has determined that understanding and using prepositions is an important goal for your child, use books to reinforce what occurs in therapy. Trashy Town by Andrea Zimmerman and David Clemesha, Up Above and Down Below by Sue Redding and Around the House the Fox Chased the Mouse by Rick Walton are all loaded with prepositions.
A child with more developed language who has difficulty providing details and descriptions may benefit from “reading” wordless picture books to you. Pictures in the story should be described so that the story makes sense. You can use picture books with text, as long as the pictures are detailed themselves. (You may cover the text with your hand if your child can read.) This works best with Caldecott Medal / Honor Books. Excellent examples include Knuffle Bunny books (Mo Willems), No, David! (David Shannon) and Where The Wild Things Are (Maurice Sendak).
Other favorite wordless picture books include A Boy, a Dog and a Frog Series by Mercer Mayer, Pancakes for Breakfast by Tomie DePaola and The Jack Series by Pat Schories. If you feel your child leaves out important information, ask an open-ended question (e.g., “Ooo – What’s happening over here?”). Provide a description if you feel this is too challenging. Perhaps this will increase your child’s awareness to be more specific and when you sit down to read the book again, the new information will be included.
Sometimes it is helpful if you “read” a wordless picture book to your child first. Describe what you see or make-up the story-line. For example, when David, the main character in the book No, David! is about to fall off the chair while reaching for a cookie, you can say: “Be careful David, you’re going to get hurt!” or “No cookies before dinner!!”
Look for Part Two Coming Soon: Encouraging Speech and Language Skills while Sharing Books with a Group of Children
This article was written by Stephanie Sigal M.A. CCC-SLP. It appeared today on the American Speech-Language-Hearing Association (ASHA) blog, ASHAsphere.
Eliminating Drooling
A speech therapist recently wrote to me about a child she is working with. Some of the information has been edited for privacy purposes.
Question: Stephanie, I am working with a 6 year old boy who is drooling. He had his adenoids recently removed. His parents have noticed a decrease in his drooling, but the problem still persists.
He does not have open lip posture, his top teeth slightly protrude and he swallows nicely on command. His awareness of his excessive saliva is poor. This saliva impacts his articulation. When he swallows, his speech (articulation and vocal quality) are more intelligible.
What can I do to help this student? Any specific oral motor exercises you recommend?
Answer: Take a look at his tonsils. I’m wondering if he has a tongue thrust since you noticed his top teeth are protruding. The tongue thrust may be occurring for a variety of reasons, including large tonsils (the tongue will be misplaced anteriorly if the tonsils take up too much room posteriorly). If you feel his tonsils are enlarged, it may be appropriate to revisit the pediatric otolayngologist (ENT).
If you are in NYC, you can find a list of pediatric ENT’s here.
As with any oral motor work, you have to start from the bottom-up. Make sure his body posture and jaw are strong and stable, then the tongue, and finally the lips. Weakness at any of these levels needs to be addressed. Have you taken any good oral motor courses? Try renting Talktools / Sara Rosenfeld Johnson’s level one class to get started, if you feel this is an area you need experience. Once you know his jaw, lips and tongue are strong and stable, here are some Ideas To Eliminating Drooling:
1. Help him become aware of his mouth
2. Improve his swallowing frequency and efficiency (he needs to fully retract the saliva)
3. At rest, his lips should always be closed
Talk to him about wet vs. dry mouth, lips and chin to build his awareness. Have him wear terrycloth wristbands. Ask him to wipe his lips and chin when they are wet. Each time he wipes his lips and chin, he should be reminded (until he does this independently) to swallow. You may need to teach him the concept of swallow. Wristbands will also act as a visual reminder to dry his face and to swallow. Purchase a few pairs as they need to be washed daily.
If you or his parents do catch him with lips apart, remind him to keep his lips together, especially at rest and when he is actively involved in a task. Can he keep his lips closed during a fine motor task?
To help him build awareness of his lips, have him put on flavored Chapstick, make “raspberries” and smack his lips. If it is safe to, and he can tolerate vibration, use a gentle, child-sized battery operated toothbrush to brush his teeth, inside of his cheeks and tongue. With firm (not too hard / not too light) pressure, run the toothbrush over his lips, to stimulate them / make him more aware.
Good luck – please let me know if you have more questions.
P.S. Should you actively work with this child for 4 weeks (and speech homework is consistently practiced) and improvement is not observed, a follow-up pediatric ENT visit is critical.
Stephanie Sigal, M.A. CCC-SLP is a New York State and ASHA certified Speech and Language Therapist. She works with children with articulation and language delay, as well as with children that drool and suck their thumbs on Manhattan’s Upper East Side. You can contact Stephanie at sayandplay@yahoo.com.
Wordless Picture Books and Language Development
Wordless picture books are an essential part of a speech therapists bag of tricks. Please read my previous blog entry about encouraging details in conversation for background information.
I recently began using the “Jack” books by Pat Schories with 3 and 4 year-old children. They are great for addressing vocabulary, grammar, word finding, sentence building, describing scenes and feelings and predicting what will happen next.
These books are also an excellent tool to bridge the gap in articulation therapy between sentence level and conversation. Sometimes a child can say a target sound (e.g., “S”) in sentences, but can not say the sound correctly in conversational speech. Wordless picture books are an in-between step because children will describe the scenes with consecutive sentences using the picture scenes for support.
While the Jack books do not need to be read in any particular order, the following order works nicely:
Breakfast for Jack
Jack Wants a Snack
Jack and the Missing Piece
Jack and the Night Visitors
When Jack Goes Out
Children learn and become excited about the characters in Jack’s life that appear in at least two books each in the series – the boy, his sister and the night visitors! It is fun to search the detailed pictures and the search helps with visual scanning too.
Stephanie Sigal, M.A. CCC-SLP is a speech language therapist practicing on the Upper East Side of Manhattan, NYC. She works with babies, toddlers and school age children with expressive language delay and articulation disorders. Stephanie provides home based speech therapy and encourages parents to facilitate their children’s speech and language skills. To learn more about Stephanie, please visit http://sayandplayfamily.com/.
Fine Motor Delay and Speech Delay Correlation
Tongue Thrust and Lisp
Additionally, should a speech therapist suspect enlarged tonsils or that there is an anomalous issue contributing to the tongue thrust, a referral may be made to a pediatric otolaryngologist (ENT).
Tongue Tie
After a tight frenulum is clipped or stretched, a child may require articulation therapy and / or oral motor therapy to help the child achieve accurate placement of the jaw, lips and tongue for speech sounds.
I am a private speech therapist specializing in articulation disorders in New York City, in children’s homes on the Upper East Side. You can contact me, Stephanie Sigal, at 646-295-4473 or sayandplay@yahoo.com.
Sippy Cups and Articulation
A bill that required a dental decay warning label on sippy cups and baby bottles was vetoed by Governor David Paterson yesterday. The label would have alerted parents that there is a risk of tooth decay from prolonged use of a “vessel with a duckbilled lid, bill-shaped extension or bill-shaped spout”.
In his veto message, Governor Patterson wrote: “Brief warning labels are simply not the best vehicle to convey detailed information about general parental practice and proper use of a product that is not inherently dangerous.”
Sippy cups and prolonged bottle use may cause more than dental issues, they may cause speech delay / articulation delay. Each time I speak with parents of a new client, I always ask what type of drinking cup their child uses. Children age 4 or younger often use a sippy cup because it is convenient for the parents (the cup won’t spill liquid) and toddlers and young children love it because the suckling motion used to remove the liquid is soothing and organizing.
When a child suckles from a sippy cup, bottle, breast or on a pacifier, thumb, etc., the jaw, lips and tongue all move simultaneously. This movement is repeated over and over when a child drinks from a bill-shaped spout or sucks on a pacifier throughout each day. This does not allow the jaw, lips and tongue to work separately, which is what is necessary for clear speech.
Children with tongue thrusts have often used a sippy cup or the like way past age one, when their usage should have been eliminated. This of course should not be the case if nutrition is compromised. When the tongue thrusts forward, it may push against and displace the front teeth resulting in orthodontic issues.
What type of cup should your child use instead?
Teach your child to drink from an open cup, which they should use while seated at the table. Encourage your child to take sips with only his or her lips on the cup, not the teeth / jaw.
When you are outside, you can try having your child drink from a straw cup (preferably one without a one-way, spill preventing valve). Although it is very likely he will suckle on the straw (he may place an inch or so of straw between his teeth and pump the liquid into his mouth with help from the jaw) you can encourage him to only place the tip of the straw between his puckered lips and not to use his teeth.
If you feel that your child already has articulation issues, and you have eliminated the use of sippy cups, etc., it may be best to meet with a speech therapist who can guide you on good speech habits, including therapeutic straw drinking.
I provide private speech therapy in children’s homes in Manhattan / NYC’s Upper East Side. You can contact me, Stephanie Sigal, M.A. CCC-SLP, at sayandplay@yahoo.com or 646-295-4473.
Read the article from Crain’s.
Stuttering Update
- Repeats parts of words, prolongs a sound, or breaks up words
- Often repeats part of the word about 3 times
- During repetitions, the child substitutes an uh vowel (tuh-tuh-tuh-table)
- May use a broken rhythm during repetitions (b.b…..b..boy)
- Has 10 or more disfluencies every 100 words
- Opens mouth to speak but no sound comes out
- Has other family members who stutter
- Often repeats whole words or phrases
- Typically repeats part of the word no more than 1 or 2 times
- During repetitions, the vowel sound remains the same (ta,ta,table)
- Rhythmic repetitions
- 9 or fewer disfluencies every 100 words
- Starts speech easily; keeps speech going
Find helpful tips for parents of preschoolers that stutter from the Stuttering Foundation of America.
Attend a Stuttering Group For Kids that Meets At Brooklyn College
Fine Motor Activities
Children with articulation delay often have fine motor delay. At times, a consultation with an occupational therapist (OT) is necessary. Other times children may simply need to be exposed to the types of activities listed below to encourage development of the hand muscles.
Encourage the writing fingers (see picture above) to do the work during precise fine motor activities. While holding a marker or crayon, encourage a proper grip (see picture at right).
During writing and many other fine motor tasks, the writing fingers (thumb, pointer and middle fingers) are active, while the pinky and ring fingers stay tucked in, secure against the palm.
Proper use of the fingers lays the foundation for higher level fine motor skills like writing letters and tying shoes.
- Mr. Potato Head
- Crayons – try coloring with small, broken crayons to encourage a better grip.
- Pip-Squeaks Markers
- Stickers – peel off stickers with pincer grasp and place them on a vertical surface (piece of paper taped to the wall).
- Magnetic Sets
- Wikki Stix
- String large beads or dried pasta – make a noodle necklace!
- Place coins in a bank – you can make a slit in a coffee cup top.
- Playdoh, Silly Putty - break off small pieces and roll them into balls between the pads of the thumb and pointer finger. Then, squish the small balls between the thumb and pointer finger. You can also roll and squish between the thumb and middle finger, thumb and ring finger and thumb and pinky. Place toothpicks or thin birthday candles into Playdoh and make a birthday cake!
- Glue dry macaroni – make a collage
- Scissor work – make sure the thumb stays facing upwards. Begin with My First Fiskars and promptly transition to a kids blunt tip.
- Magnadoodle
- Standard hole punchers or try challenging shape punchers
- Lacing cards (or make your own with a hole puncher)
- Clothes pins – pinch them onto the edge of a container or a dishcloth. Alternate fingers (first squeeze with thumb and pointer, then thumb and middle finger, then thumb and ring finger and finally thumb and pinky).
- Paper clips – connect colorful clips
- Practice fasteners (buttons, snaps, buckles, zippers)
- Eat with Farm or Fish sticks
- Blunt tweezers – pick up small cotton balls and transfer them from one cup to another.
- Unifix cubes
- Zoobs
- Legos
- Lite Brite – you may like the travel size
- Small Pop Beads
- Pick Up Sticks
- Keychains like these are fun to connect. I recommend purchasing them from a hardware store where they will have more resistance than from a therapy toy catalogue.
- Theraputty – Choose a texture that will slightly challenge your child and then increase the resistance with a firmer texture. Hide pennies inside and encourage your child to find them.
Ear Infections and Language Development
- Speech (articulation) is the production of sounds that make up words and sentences.
- Language refers to the use of words and sentences to convey ideas and express our wants and needs.
- Talk and read to your child face to face
- Eliminate background noise
- Get your child’s attention before you speak
- Use a normal loudness level
- Confirm that your child is understanding what you are saying
Articulation Development
Many children make predictable developmental sound substitutions as they are learning to talk. Articulation errors may involve substituting one sound for another (“tar” for car), omitting a sound in a word (“boo” for blue), or distorting a sound.
- Respiration (abdominal air)
- Phonation (larynx / vocal cords)
- Resonation (mouth / nose)
- Jaw, lip, tongue and abdomen strength and stability
Pacifiers and Articulation
Stephanie is a speech therapist and can be contacted at sayandplay@yahoo.com. She provides speech therapy in their New York City Upper East Side homes.
Thumbsucking and Articulation
We finally managed to get rid of our daughter’s pacifier! However, We’ve noticed that she is sucking on her thumb and fingers now. How can we help her?
This is a common predicament. The most important thing is to anticipate when your daughter will suck her fingers and why she will do so. Is she hungry? Bored? Tired? All three?
If she is hungry, try giving her hard, crunchy or chewy foods (e.g., vegetables cut into strips, raisins, pretzels). Encourage her to chew the food “on the side” (on the molars) to give input to her temporomandibular joint (TMJ). The TMJ was soothed by the pacifier, now we need to provide a substitution. Gum chewing, when the jaw stays in alignment, can effectively provide this input as well.
If your daughter is tired, but it’s not an appropriate time to nap, turn on the music and encourage jumping jacks, toe touches, rolling on the floor, playing catch / rollie pollie, stretching, yoga, dancing, etc. The worst thing to do is to plop her in front of the television, which would probably encourage the thumbsucking.
If she’s bored, try to have art activities like these on hand – they will keep little fingers busy (please note that these suggestions contain small parts and should be used with caution / supervision only):
- Lite Brite
- Stickers
- Small Pop beads
- Magnetic Sets
- Wikki Stix
- Stringing beads or dried pasta – make a noodle necklace!
- Legos, Duplos, Quatros
- Practicing fasteners (buttons, snaps, buckles, zippers)
- Playing with playdoh, silly putty
- Gluing dry rice or macaroni – make a collage
- Cutting – make sure her thumb stays facing upwards
- Hole punchers
- Lacing cards
- Finger painting
- Stamping
There are also specific oral-sensory-motor exercises that a speech therapist like myself can recommend based on your child’s needs. These activities may include massage, vibration and resistance exercises.
I work with children in their NYC (Upper East Side) homes and can be contacted at 646-295-4473 or sayandplay@yahoo.com.
Speech vs Language
What is the difference between speech and language?
Speech is the production of sounds that make up words and sentences. It involves the coordination of the jaw, lips, tongue, vocal folds (vocal cords), vocal tract and respiration. There are three divisions of speech:
- Articulation - This is one of the most common reasons parents contact me, I typically hear things like “I am the only person that can understand my daughter.” or “My son is having trouble pronouncing R.” Treating articulation disorders is one of my specialties.
- Voice - A consistent raspy or hoarse vocal quality or history of vocal nodules is a reason to seek out a speech therapist. Therapists in New York City who specialize in voice can be found here.
- Fluency - A disorder of fluency is stuttering. It is considered normal for young children to have some dysfluent speech. If the stuttering becomes more prevalent, it would then be appropriate to consult a speech pathologist who specializes in working with children who stutter, which you can find here.
For helpful information on stuttering, check out: The Stuttering Foundation and National Stuttering Association.
Language refers to how we use words and sentences to communicate. Speaking, gesture use, writing, understanding verbal conversation and understanding what one reads are all language related.
I am a pediatric speech and language pathologist (AKA speech therapist) specializing in improving articulation (speech) and language skills.
I evaluate and treat children in their Manhattan homes and encourage parents to learn how to ask stimulating questions, model language in an optimal way and follow their child’s lead to create an effective playtime.
If you live on the Upper East Side of Manhattan, and have speech and / or language concerns for your child, please contact me for an appointment:
Stephanie Sigal M.A. CCC-SLP
phone: 646-295-4473
email: sayandplay@yahoo.com
website: sayandplayfamily
W Sitting and Articulation
My child’s teacher told me that I should discourage my daughter from sitting in a “W” position. Why?
From a speech perspective, a W sitting position does not allow for good respiration, phonation and articulation. A child needs a strong and stable trunk to support the muscles of the jaw, lips and tongue.
From a physical and occupational therapists point of view, excessive W sitting during the growing years can lead to future orthopedic problems (e.g., hip dislocation and muscle tightness at the: hamstrings, internal rotators, and heel cords). A child is planted in place or “fixed” through the trunk in this position. The trunk can not rotate and the child can not use lateral weight shift which reflects on overall balance.
W sitting discourages crossing over midline because a child is fixed playing with toys right in front of him or her. A child who sits in this fashion may have difficulty determining hand preference because he or she may do everything unilaterally in this fixed position.
Please encourage your child to sit in a “criss-cross applesauce” position (also known as a Tailor Sit, as seen below) while seated on the floor.
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