Speech is the production of sounds that make up words and sentences. It involves the coordination of the jaw, lips, tongue, vocal cords, vocal tract and respiration. There are three divisions to speech: articulation, voice and fluency.
- Articulation – This is one of the most common reasons parents contact Stephanie, she typically hears “I am the only person that can understand my daughter.” or “My son is having trouble pronouncing R.” Treating articulation disorders is one of Stephanie’s 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 New York City 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.
Language refers to how we use words and sentences to communicate ideas. Speaking, gesture use, writing, understanding verbal conversation and understanding written words are all language related.
Parents with children with language delay often report to Stephanie “My daughter is 18 months old and she only babbles, she doesn’t have any words.” or “My son is 2 and he has trouble putting words together to make sentences.”
Stephanie is a pediatric speech and language pathologist (AKA speech therapist) specializing in improving articulation (speech) and language skills.
Stephanie evaluates and treats children in their Manhattan homes. She encourages 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.
I’m worried about my child’s language development, but my pediatrician says not to be. What should I do?
Children develop language skills at their own pace, and there is a wide range of normal development. For example, it is considered normal to have two 18 month old children, one of whom says 9 words and another who says 50. This is similar to how children develop skills to crawl, walk and read. Also, at 18 months, you should notice that your child is talking more than using gestures.
Two-word utterances should start to emerge just before age 2, and should become consistent at the 2 year mark. By this time, children should have at least a 50-word vocabulary and always be using new words.
Between 2 and 3 years old, sentence length should increase and you should notice more of a variety of words (verbs, pronouns, adjectives, prepositions, etc.).
If you notice your child has difficulty answering questions, “finding” words, following directions, or repeats what others say, it is appropriate to seek out a speech therapist for a language evaluation.
Sometimes pediatricians don’t know your child as you do, and to calm your fears and possibly help your child’s progress, it is advisable to seek out an evaluation with a licensed, ASHA certified speech-language pathologist.
Your child should use speech sounds accurately in conversation by the ages listed below. Prior to these age requirements, you should hear approximations of these sounds.
The ages below (years.months) have been averaged by Stephanie based on her own experiences, from articulation textbooks and from the Goldman-Fristoe 2 Test of Articulation.
Overall, your child’s conversational speech should be understood by age 3.
|N, W, -ING, P||2.9|
|Y (as in yellow), G||3.4|
|TH (as in thumb)||5.4|
|TH (as in “this”)||5.5|
If you feel your child’s articulation is delayed, an articulation assessment, and possibly an Oral Motor assessment should be conducted. Treating articulation delay is one of Stephanie’s specialties.
When a child consistently has ear infections or fluid in the ears, it makes it difficult to hear sounds and words accurately. If you plug your ears with your fingers, you can appreciate the muffled quality of speech your child is experiencing. Recurrent ear infections often occur before age 3, when a child is learning to speak. It is crucial to keep follow-up appointments with your pediatrician or pediatric otolayngologist (ENT (Ear, Nose & Throat) physician) to make sure the ears have been cleared of fluid after a course of antibiotics. In addition, periodically have your child’s hearing formally tested in a sound proof booth with an audiologist. More information and tips regarding communicating with your child when he/she has an ear infection can be found on the blog Ear Infections and Language Development.
Signs / gestures can facilitate language development, and indicate a child is understanding and using language. Gestures can also help develop listening and visual attention skills because children observe parents’ gestures while hearing corresponding words. Gestures may allow you to know what your child is feeling (e.g., hot, tired, hungry) and help avoid frustration when your child can not verbally communicate to you that he may want a drink of water. You can read about the progression of Sophie’s use of gestures here.
My child is being raised bilingual. Are his language skills delayed because he has a difficult time learning both languages simultaneously?
In NYC many families are bilingual or even trilingual. When a child is exposed to two (or more) languages, he/she should meet language milestones. Developmental rough patches may include mixing vocabulary and grammar from the multiple languages. There have been only a few children with whom I have worked where I discouraged two (or three) languages based on the type and severity of the language delay.
Stephanie uses books in speech therapy and teaches parents how to choose appropriate, fun children’s books that may improve vocabulary, grammar and cognitive skills (e.g. attention, thinking, memory). Stephanie teaches parents how to ask their child appropriate questions and how to encourage verbal participation in familiar books.
Did you know that a great way to encourage speech and language skills while reading with your child is to do so face to face? When you face your child while holding the book next to your face, (not in front of your mouth) your child can observe your facial expressions and also watch how you move your mouth when you speak. Stephanie provides book recommendations on her website and on her blog.
Oral motor therapy and oral placement therapy use a variety of child friendly exercises to develop awareness, strength, coordination and mobility of the mouth muscles (jaw, lips and tongue).
Stephanie uses oral motor therapy to address problems such as drooling and open mouth posture. She uses Oral Placement Therapy when traditional articulation activities are not enough to help a child learn how to say specific speech sounds. In a simplistic example, if a child has difficulty with the sounds /p/ and /t/ and can easily bring his/her lips together for /p/ but cannot elevate the tip of the tongue for /t/, we would work on the sound /p/ in words (articulation therapy) while we strengthened the tongue using Oral Placement Therapy for /t/.
Drooling can often be eliminated through improving awareness and oral motor exercises.
Click to learn more:
- Thumb, finger, shirt and object suckling
- Pacifier use after 12 months of age
- Bottle and Sippy Cup usage after 12 months of age
These habits may directly interfere with speech (articulation) and feeding skills.
PROMPT = Prompts for Restructuring Oral Muscular Phonetic Targets.
PROMPT therapy uses tactile, verbal and visual cues to stimulate articulation skills. When therapists are “PROMPT trained,” they have taken beginner PROMPT courses.
A “PROMPT certified” therapist has taken the introductory course, the bridging course, a technique practicum and has completed a self-study project. PROMPT certified therapists are most qualified to help children who have been diagnosed with motor-speech disorders such as developmental / Childhood Apraxia of Speech.
When I begin working with a toddler who is not speaking or who has very few words, I often incorporate PROMPT techniques along with traditional language development play therapy and Oral Placement Therapy. Childhood Apraxia of Speech or Suspected Motor Speech difficulties can not be ruled out in this scenario. Combining PROMPT, Oral Placement Therapy and a strong language program can facilitate language development.
In Childhood Apraxia of Speech (CAS), the brain has difficulty communicating to the mouth how to effectively move the jaw, lips and tongue to say speech sounds. Apraxia is a movement disorder. PROMPT therapy is one effective way to address apraxia, but with a toddler, the key is to target communication development.
Common characteristics of Childhood Apraxia of Speech or Suspected Motor Speech (SMS) difficulties may include:
- Use of only a few sounds
- Unintelligible and / or inconsistent speech (e.g., difficulty placing sounds in the correct order, deleting sounds)
- Difficulty with imitation of sounds and words
- Family history
- Difficulty planning movement sequences / Limited variety of speech motor movements
- Limited vocabulary (mostly nouns)
- Slow rate of progress
- Use of non speech sounds to communicate
Childhood Apraxia of Speech / Suspected Motor Speech difficulties can be difficult to diagnose in toddlers because children who are late talkers may exhibit the same symptoms. Also, it is difficult to determine if the child has a severe phonological delay (articulation disorder) or apraxia. However, an experienced speech therapist will use a comprehensive treatment approach, addressing the child for language delay and potential Childhood Apraxia of Speech / Suspected Motor Speech difficulty simultaneously.
Childhood Apraxia of Speech can not truly be diagnosed until age 3 or 4, and it is typically a developmental pediatrician or a neurologist who provides the diagnosis.
Feeding issues may include, but are not limited to: “picky” eating, refusing to eat, choking, gagging, food pocketing, drooling, difficulty transitioning to more demanding textures, and difficulty with cup drinking. Feeding issues often require Oral Motor Therapy. A feeding technique often used with babies is a spoon-feeding method that helps achieve lip closure and diminishes tongue thrusting. Later, when a child is ready to talk and can now close his/her lips, it should make it easier to articulate sounds like m, b and p.
A tongue thrust occurs when the tongue moves in a horizontal plane (instead of vertical) and pushes against the teeth during a swallow.
A tongue thrust may cause dental issues such as an overbite or an open-bite and may be associated with thumbsucking, mouth breathing, and ear infections. Children with upper respiratory issues and chronic ear infections may exhibit an open-mouth posture. An open-mouth posture may lead to a forward tongue position.
Tongue thrust may affect the production of sounds such as /s/ and /z/. A speech therapist may combine traditional articulation therapy along with oral motor therapy and Oral Placement Therapy to improve the production of these sounds, and eliminate tongue thrust.
Floortime or the D.I.R. (Developmental, Individual, Relationship-Based) Model is a technique that helps children learn language and social skills in a more related and logical way than traditional language therapy. Traditional language therapy typically promotes specific skills (vocabulary, grammar, etc.) that may leave a child with rote responses.
For more information, or to find a Floortime therapist in your area, please visit The Interdisciplinary Council on Developmental and Learning Disorders.
How can Stephanie help my preschooler’s language skills thrive at kindergarten admission interviews?
Stephanie helps children develop confidence, build attention and learn language skills to succeed at NYC kindergarten admission interviews.
Through fun games and activities, your child will strengthen skills such as following directions, story comprehension, grammar, vocabulary, articulation and critical thinking skills.
Addressing these speech and language skills in weekly sessions with Stephanie can help your child throughout the kindergarten admission interview process and far beyond.
Stephanie is not directly involved in the NYC school admissions process (public or private) and preparation does not guarantee your child will perform well at interviews.
Stephanie Sigal, M.A. CCC-SLP, provides speech and language evaluations, treatment and consultations in the comfort of your Upper East Side Manhattan home. Stephanie does not have an office. She provides services between 65th and 95th Street from Third Avenue to Fifth Avenue.
The best way to schedule an appointment with Stephanie is via email. Please email your name, your child’s name and age, your cross streets and phone number. A brief description of the concerns you have for your child would be most appreciated.
All communication is kept confidential. Stephanie looks forward to hearing from you!