Early Childhood Intervention
This website is a place for families who are facing
challenges pertaining to their child's development and
growth.
It is a place to find answers and practical
suggestions. That's what Early Intervention Support is all
about.

Whether a family has a child with a challenging behavior,
a disability or developmental issue, childhood is short - it
should be savored and enjoyed.
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We understand developmental milestones and the challenges
of Special Needs children. We spend a great deal of time
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routines and interactions. Ask us about your child today!
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Speech and Language Concerns
Listed below are a few previous questions from our
Ask The Therapist
form relating to speech and language. You may also want to review:
My daughter is 31 months and doesn't say many words (about 15 at the most).
She babbles a lot and points or pulls you by the finger and takes you to what
she wants. She seems to have great comprehension; you can tell her to go get her
pink shoes, for example, and she will do this. Could something be wrong? She is
kept at home by her grandmothers and doesn't get to have a great deal of interaction
with other children. I have bought some Baby Babble tapes and this has helped a little.
By 31 months your daughter should have well over 50 words and be combining words
into at least 2 word sentences/phrases such as "me want" or "my toy" or "Mommy go".
By three she should have around 200+ words. She should be repeating new words and
repeating phrases as well and adding new words to her vocabulary on a weekly basis.
Perhaps if her grandmothers or other adults are anticipating all her wants and needs,
she realizes she doesn't "need" to talk to get what she wants. Since she has 15 words,
that is a good indication that she had the ability to add more words to her expressive
vocabulary. You can check our link for
24-16 months and what is typical for speech
development at this age, and there are a few speech activities listed at the bottom
of the page as well.
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I would definitely recommend that you contact your local early intervention provider
and ask for a speech evaluation for your daughter. Expressive speech delays are very
common in toddlers and many of these children are understanding language at an age
appropriate level, but without therapy they begin to get frustrated by not being able
to express themselves and be understood by adults. The earlier you seek speech therapy
the quicker she can make progress and be on the road to age appropriate expressive
language skills.
I would recommend to you and her grandmother's that you try to set up situations
within her daily routine where she has to use a word or make an attempt at using a word.
For example, instead of having her cup where she can always reach it, place it out of
reach and when she points to it ask "what do you want?", "Do you want your cup/juice/milk?"
"Tell me cup/juice/milk". Or when getting dressed "Do you want to wear the red or the pink
dress?" Praise her for any attempt and don't withhold items if she cannot say the word or
becomes overly upset or frustrated, but do give her ample to time to attempt a verbal
response. Give her choices whenever possible, such as "Do you want to read the book or
play with the baby?" If she points to the baby, re-phrase it for her and say "Oh, you
want to play with the baby!" "Use your words, tell me baby" and again praise for any
attempts even if she only makes a "b" or "ba" sound. Be a good speech role model and
put all her single words back into sentences for her. If she says "ball" you say "Yes,
you are playing with the red ball".
Keep a word list on your frig and share it with her grandmothers, so they can encourage
her to use the words she currently has and do not accept pointing if she can say "book"
she needs to use the word book before getting it. For words she already knows you can be
a bit more persistent in with-holding items until she uses the word. Sing songs and leave
words off, such as "Twinkle Twinkle" and sing "Twinkle, twinkle little ___" and see if
she will attempt to sing "star" to fill in the missing word. Use books and name pictures
for her and say "I see an AP-PLE" exaggerate words and sounds for her and allow her to
look at your lips/mouth as you form words or use a mirror and have her look at her own
lips/mouth as she attempts to make sounds. You can play silly word games such as only
repeating sounds "la" "ma" "ba" "ta" or break words apart and have her repeat each
syllable and then try to put the word together such as "Ca-at"= cat or "p- ig"=pig.
Encourage her to repeat fun sounds like animal and environmental sounds "woof woof"
"meow" or "beep beep" "whooo whoooo". To strengthen muscles needed for speech you can
encourage her to drink from a straw rather than a sipper cup or use an open cup. Blowing
bubbles or blowing a piece of paper across a table using a straw is also good oral motor play.
This is the link for contacting Early Intervention Services in your state.
My son is 3 years, 7 months old. He was evaluated at 16 months
for sensory development and speech and began occupational therapy for
about 5 sessions. Then we moved to Germany (from Michigan). He has
since been evaluated by both his preschool and a private
developmental specialist. He has a combination developmental delay
mainly in speech, cognitive and motor skills. He averages about 2
years, 10 months in his abilities. We are looking to place him in a
special education preschool here where he will receive speech therapy
and physical therapy daily. But here is one of my many concerns. We
are an English speaking, American family and we are only in Germany
for 1 to 2 more years. His speech therapy will be in German, but we
speak English at home to him. He speaks primarily English, but hears
German from 9:00 am until 2:00 pm everyday. His teachers tell me he
understands them when they speak to him and he speaks a little German
in return. Is any therapy better then no therapy or will speech
therapy in German cause additional problems? And what will happen
when we return home? There are no options that we have found for
speech therapy in English. My husband and I speak very poor German so
we will not be able to help him in German. We could really use some
guidance. I feel our problem is greater than just raising a bilingual
child.
Typically a young child learning two languages simultaneously does
not cause language delay or present a problem, and in fact, is
beneficial to children in the long run. Since you mention that you
moved to Germany when your son was 16 months of age, I am assuming he
has been hearing German during school hours and English at home since
that time. Children who learn 2 languages simultaneously often do
speak later than same age peers who only learn one language, so do
make sure that your son's speech delay is not solely related to dual
language learning. Since you mention he has delays in other areas of
development as well, I am wondering if your son's speech delay is
both expressive (speaking) and receptive (understanding) in nature?
Since he is going on age 4, he should be understanding both languages
fairly equally and be able to follow directions in both languages,
however, when speaking he may still mix both languages and have
difficulty pronouncing words correctly or be difficult to understand.
It is encouraging that the teachers say he is understanding them and
that he speaks a little German back to them at school.
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I am also happy to hear that you do have the option of enrolling
him in a special education preschool and obtaining therapy for him,
which is great and what I would recommend. I would definitely say
that if you cannot find an English speaking speech therapist than do
continue with his speech therapy in German. At home you can continue
to speak English to him and benefit him by being a good English
speech role model, pronouncing words and sentences clearly for him,
expanding single words into sentences for him, etc. I would also
suggest that perhaps you and your husband look into finding some
German language tutoring for yourselves so that you can help your son
with learning German as well. You don't need to be fluent in a
language to help a young child, since you will simply be naming
simple pictures in book for him or objects around the house for him.
It might help you at home if he is mixing languages and for example
says the German word for "help" so that you know what he is trying to
tell you. Ask your child's teacher for a list of the German words or
phrases they use commonly at school, see if they can help you out
with some phonetic pronunciation and hang it on your refrigerator for
easy access. If your son is having difficulty with
articulation in English, you can check out this article for help
on our website. This is also a great article on
early bilingualism that may give you some tips. It will be
beneficial for your son in the long run to know two languages even if
it takes him longer to learn both.
My daughter is almost 2 1/2 and she isn't speaking very much.
When you ask her questions, she will answer with head nods or
pointing but she will rarely speak. She says words such as ma, da,
and she will make some animal noises but she won't mimmick or repeat
anything. If she asks for something, she points, or gets it herself.
I believe the next step is Early intervention for speech therapy but
I didn't know if there was something else I should do. I am extremely
concerned she is developing with a speech delay.
By age 2.5 we expect that most children will have 50+ consistent
words (not including mama, dada or animal/environmental sounds) and
be putting words together into at least 2 word phrases such as "more
juice", "me go", "Daddy work", etc. There are many children with
expressive language delays who are understanding language in an age
appropriate manner, for example using only pointing/gesturing to make
wants/needs known, but following simple commands such as "get your
shoes" or "put your cup on the table" with ease. Since you live in
Allegheny County I would recommend calling the
Alliance for Infants & Toddlers
at 412-885-6000 and requesting a speech evaluation for your
daughter. A service coordinator from the Alliance will contact you
and do a home visit to gain preliminary information about your
daughter and then an independent assessment team will come to your
home and complete a developmental evaluation using a standardized
test such as the Battelle Developmental Inventory 2 to determine if
your daughter is eligible for early intervention services. Once her
eligibility for services is determined you will asked to pick a
provider for services and be given a variety of options. Our
therapists work for
ACHIEVA which
will be one of the choices you are given.
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In the meantime you can continue to be a good speech role model
for your daughter, expanding on any single words she says by putting
them into a sentence for her. For example, if she says "ball", you
can say "Yes, you found your red ball". You can break words apart and
see if she will make attempts to repeat them, for example "ba-by",
see if she will attempt single syllables, then have fun putting the
word together. Make sure you gain her eye contact when speaking to
her, so she can watch your lips and mouth as you form words. You can
give her choices during playtime or meals instead of always asking
yes/no questions and hold the toys or food items by your face to
encourage her to watch your face/mouth as you speak, such as "Do you
want juice or milk in your cup?" or "Do you want to play with the
dolls or bike?". Do encourage her to imitate fun sounds such as
animal sounds and environmental sounds, such as the car goes "beep,
beep" and the cow says "moo". Sometimes kids will imitate fun
exclamatory sounds such as those more readily than nouns like cup or
ball. Also use music and familiar songs like Wheels on the Bus to
motivate her. Use mirror play so she can watch her own lips and
tongue move during speaking. You can play games making funny faces
and sounds in the mirror with her to encourage imitation. You will
find more ideas and suggestions at these links on our Early
Intervention Support web page:
Speech - 24/36 months and
Speech.
I have a 2.5 year old son who has a great vocabulary, appears to be
meeting all the appropriate milestones, but has muffled speech. I
understand 95% of what he says. I think a stranger may understand 75% of
what he says. He had chronic ear infections as an infant and had tubes
put in at 9 months. We just had his adenoids checked and discovered they
are blocked and quite large. My oldest son had muffled speech at the
same age, and also had large adenoids. My oldest son's adenoids were
removed and his speech improved dramatically. We hate to put him under
again, but wonder if the muffled speech is related to the enlarged
adenoids. Could he just need some articulation exercises to improve the
quality of his speech?
As therapist's we don't begin to look at the actual
articulation/intelligibility of speech until a child reaches the age of
three. Since you describe your son as currently being 95% intelligible
to you and 75% intelligible to strangers, this indicates that at age 2.5
he is within the norm for his articulation skills. Children with chronic
ear infections do sometimes have articulation errors because when they
had the fluid in their ears they had a temporary conductive hearing loss
and during that time they pronounced words as they heard them, perhaps
substituting a "th" sound for an "s" during that time. They may still
continue to pronounce words that way even when the fluid is alleviated
because that is the way they learned them and it became a pattern.
Having said that, since your son received his tubes at age 9 months,
well before he probably began using too many single words, this probably
has no bearing on his speech unless he continued to have problems with
his ears after he received the tubes.
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Also, many two year old and older children continue to have
articulation errors that are expected and considered "normal" since
production of speech sounds is developmental in nature and many children
continue to work on more difficult sounds and blends up until age 8.
Enlarged adenoids often cause nasal blockage and in turn children will
mouth breathe excessively, often snore at night and may have trouble
smelling or even breathing properly. Enlarged adenoids and tonsils can
even be related to sleep apnea in some cases. Because of the nasal
blockage, enlarged adenoids can cause children's speech to sound as if
they have a cold all the time, which could be why your son's speech is
sounding "muffled" since you went through this experience with your
other child. I would definitely discuss your options with your
physician, mention your concern about his speech and see what he/she
recommends. If you do not have his adenoids removed or even if you do
and you still have concerns about your son's articulation skills at age
3, then you might choose to contact your local preschool early
intervention provider or a local speech clinic to have your son's
articulation skills assessed. You can check our
speech and language page for what is typical for a child of 2.5.
This is also a link for a
0-3 Early Intervention
Program in your area if you choose to contact someone before your
son turns 3.
In the meantime you and your family can continue to be good speech
models for your son by pronouncing words correctly for him. Don't draw
attention when he mispronounces a word, but simply pronounce it
correctly for him in a sentence back to him so he hears it correctly
i.e., "Yes, you are eating SPAghetti". You can exaggerate initial sounds
for him or make silly games of making sounds back and forth such as "PA,
PA PA", "TI, TI, TI", or the snakes goes "ssssssss" etc. You can use his
books or cut out pictures from magazines to make matching games of
pictures with similar sounds. Blowing bubbles is a great oral motor
strengthening activity and if you are using sipper cups, switch to a
straw cup whenever possible, since sucking through a straw is a much
more mature oral motor movement than suckling through a sipper spout
(which is more like a bottle).
My son just turned 21 months. He is very active and "speaks" a lot
with a wide variety of sounds but is not clearly pronouncing words other
than "no" and "uh-oh". He can communicate what he wants through pointing
and grunting but again his lack of vocabulary has me worried. My niece
is 3 months older than him and is speaking in 3-4 word sentences and I
am concerned about his lack of ability to verbally communicate more
clearly. I have an appointment with his pediatrician next Thursday at
which time I will be discussing this with her, but I am curious as to a
professional's opinion as to whether or not you would think further
testing should be done.
It sounds like you are being pro-active by discussing this with your
son's pediatrician. Generally at age 24 months we are looking for
children to have a single word vocabulary of at least 15 concrete words
that they use consistently (not counting mama, dada or exclamations like
uh-oh) and typically most children will have as many as 50 single words
by this time. At age two we also look for children to begin to combine 2
words into simple phrases such as "Mommy go", "Daddy work", "Me
bye-bye".
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Before age 3 we do not look at articulation or how clearly words are
pronounced. So for example, if your son is saying "gog" for dog or
"paghetti" for spaghetti and using the same word approximations for the
same objects this is still within the norm, as many toddlers are still
having trouble blending sounds together and may leave consonants off the
beginning or ends of some words. If your son is using only "no" and
"uh-oh" consistently and not imitating new words or combining 2 words
together within the next month or so you may want to schedule a speech
evaluation from early intervention just to rule out any problems. Your
doctor should be able to give you information on how to access your
local early intervention provider. You can also check the
Speech 12-24 months link on our website for more speech tips/red
flags.
My 3 year and 6 months daughter has a good vocabulary but battles
with pronunciation. She pronounces a t for s and can't same c. She has
never had a problem with saying 'ssss' as in the sound of a snake, but
if she says her brothers name Sam she pronounces it Tam. With practice
she is quite able to say the s in Sam. We do have the occasions when she
tries to say something and I can't understand a word, she gets very
upset by this. Her pre-school teachers says although she is in the
normal range of speech she is way below the rest of her abilities which
she excels in. My question is do I see a GP and get her ears tested, or
do I let her be for a while longer?
The acquisition of new sounds is a developmental sequence for young
children, with the easier sounds being learned before the more difficult
ones. Many children are still working on proper articulation of certain
sounds and blends of sounds until the age of 7 or 8. The following chart
shows average age estimates of when consonant production typically
occurs:
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| p |
1.5-3 years |
y |
2.5-4 years |
| m |
1.5-3 years |
r |
3.0-6 years |
| h |
1.5-3 years |
L |
3.0-6 years |
| n |
1.5-3 years |
s |
3.0-8 years |
| w |
1.5-3 years |
ch |
3.5-7 years |
| b |
1.5-4 years |
sh |
3.5-7 years |
| k |
2.0-4 years |
z |
3.5-8 years |
| g |
2.0-4 years |
j |
4.0-7 years |
| d |
2.0-4 years |
v |
4.0-8 years |
| t |
2.0-6 years |
th (thumb) |
4.5-7 years |
| ng |
2.0-6 years |
th (that) |
5.0-8 years |
| f |
2.5-4 years |
zh (measure) |
6.0-8.5 years |
Also be aware that the "r" and "s" sounds are not addressed until
around age 8 and should not be a reason for speech therapy at the
preschool age. If you daughter has not had her hearing tested it is
always a good idea to see your pediatrician to rule out that her hearing
has any impact on her articulation skills.
You can also help her with pronunciation by playing games that
involve breaking words apart and slowing them down for her, if she has
trouble saying "Sam", but can say "ssss" and "am" separately, let her
practice that way. You can use similar words such as "Sad" or "Sat" and
break them down for her, asking her to repeat "ssss" then "ad" and
finally the full word. When your daughter says a sound incorrectly you
should repeat the word using the correct pronunciation, but do not force
her to say a sound or word she is not ready to produce. You can also
blow bubbles with her using a bubble pipe and encourage drinking from a
straw (not a cup with a spout type lid) to strengthen muscles needed for
speech. You can cut pictures from magazines to make games using pictures
with similar sounds as well.
If you are still concerned in the next few months or if your child's
preschool is concerned and your daughter is becoming increasingly
frustrated by not being understood, you may wish to contact a licensed
speech therapist for an evaluation of her articulation skills to see if
she is eligible for therapy.
My child is 4-1/2 and has autism and his language is starting to
come with single words. How can I encourage language? We don't have a
speech therapist in Bahrain that could help me. I am just trying my best
through the internet. Can you help me in looking for a website and
programs that I can help my son in his language?
Regarding your similar question from today, many children with autism
find success in learning language and functional communication skills by
using either Sign Language or a Picture Exchange Communication System
(PECS). These are two methods that you can begin using at home with your
son. Below are some websites where you can access information on using
Sign Language and PECS:
Polyxo and
visual support;
Sign
language;
Autism news;
Autism disorders.
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Hopefully these resources will get you started in the right direction
for helping your son acquire a means of communication.
My two year old follows directions and he converses pretty good
with me but when I ask him questions like, what is your name, he
repeats my question instead of telling me his name. He knows the
answers to the questions I ask him but he only repeats the questions
to me. What can I do to help him?
Rather than repeat what has already been written by someone else
on this topic called "Echolalia", I am referring you to this link
where you can find an excellent article that should help answer your
question:
http://littlechildren.wordpress.com/2007/10/08/echolalia/
My 8 year old step daughter does not speak in a conversational
tone or volume. She screams in a forced voice. What can be done?
If you suspect that your step daughter's "screaming in a forced
voice" is due to a problem she is having with controlling the pitch,
tone and volume of her speech (voice modulation) and not a behavioral
issue, then you may wish to seek an evaluation from a licensed speech
pathologist. Since she is above the age level for early intervention,
you should first consult with her teacher at school to see if her
school can provide an evaluation since this sounds like it could be
an issue in the classroom as well.
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You may also wish to consult your pediatrician and have her
hearing re-checked to rule out any impact on her speaking so loudly.
You can search for a private speech therapist in your area by
entering your information at this link:
http://www.asha.org/findpro/
They will provide you with a list of licensed therapists in your
area. Since our therapists work primarily with the birth to three
population, I can't give you specifics on what the therapy would
entail, but I hope the above information is helpful.
My Son is 23 months old. He tries to speak but he can only say
20-30 words and, not joining the words, he speaks a lot in his own
language. What should I do? Is it a matter of concern? Otherwise, he
is too good at everything. He understands whatever we say fine with
gross motor skills.
It sounds like your son has a good start on a single word
vocabulary if he has 20-30 consistent words that he is currently
using. After age two, we do look for children to start combining
words into two word phrases such as "Mommy go", "me eat", "hi Daddy",
etc.
My son is 26 months old. He is an only child but has attended
daycare since he was 6 weeks old. My son doesn't say the beginning of
most words such as BANANA; its just NANA. He can follow simple
directions and has OK social skills. Like most kids, he has his days.
He can say things like "come one mama", or "lets go" and "mama what
you doing" or "where she go?". He knows his colors and can count to
10. I just wonder if he is having problems with speech because he
isn't saying the beginning of some words. Should I have him looked
at?
It sounds like your son has a good start on an emerging expressive
language vocabulary and several simple 2-3 word phrases, which would
be appropriate for 26 months of age. At age two we typically look for
a child to have an expressive single word vocabulary of around 50
words or more and the ability to put 2-3 words together such as your
son is doing with "let's go" or "come on Mom". If he is also
following one to two step commands for you such as "Get your shoes"
or "Pick up your book and put it on the table" then he sounds as if
his language skills both expressively and receptively are age
appropriate. Do not be concerned that he is leaving off some initial
sounds of words or pronouncing some words unclearly. As therapists we
do not begin to look at articulation or clarity of speech until after
age three.
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Many toddlers still have difficulty with initial or ending sounds
or even pronouncing words that have more than one syllable such as
banana as you mentioned. You will often hear toddlers say "nana" for
banana or "paghetti" or just "ghetti" for spaghetti, but by being a
good language role model you are always pronouncing the word
correctly for them, so they can see and hear you say it. When your
son says "nana" you reply "Yes, you want a BAnana" stressing the
initial sound for him, but there is not need to correct him or point
out that he is saying it incorrectly as this may only frustrate him.
You can even break the words down and practice beginning, middle and
ending sounds with your son for words with more than two syllables,by
having him repeat after you as a game "ba", "na", "na". You may
also hear toddlers say "boo" for blue or "cacker" for cracker or
"scare" for square and this is also typical since many toddlers will
particularly have difficulty with words which involve blends such as
"bl, pl, cr, sp, fr, pr, sq, and st". It is helpful again for you to
slow down and let your son watch your lips and hear you say these
sounds as he attempts to imitate you. You can also use a mirror
during speech play so he can see his own lips, tongue and mouth form
the sounds and words. As your son approaches age three, if you are
not seeing improvement in his ability to pronounce beginning sounds
of words or you or the day care staff are still concerned with the
clarity of his speech, then you may want to seek an evaluation from a
licensed speech pathologist to look at his articulation.
I have a 15 month old son who is not quite walking yet, but has
no problem cruising at this point. A recent visit to our pediatrician
suggested to us that he may be also behind on language development as
well. He is extremely aware and seems bright; however, he has only
said "dada" and "hi" up to this point (that we can understand). He is
generally a happy baby who seems to interact with other toddlers and
us, but we are concerned about his communication skills at this point
more than anything. He reaches for things he wants, he goes to things
he wants to get them, but he doesn't do things like crawl to the
refrigerator and point at it when he wants a bottle. We read to him
and interact verbally with him on a daily basis. He enjoys language
and having books read to him. We have done flash cards with him as
well, and he can recognize and say back the word "hi" when prompted.
I am confident he will be walking soon; he stands up and moves around
no problem, even jumping up and down when excited. Should we be doing
anything at this point to intervene?
Since you mention that your son is cruising and working on
independent walking, it is not uncommon for children to put speech
"on hold" while learning to walk. Speech is also a motor skill, and
many babies who are learning to walk are focusing all that energy on
walking, so they may be quieter and speech production may slow down
during this period. At age 15-16 months most children are saying Mama
and Dada specifically to refer to their parents, as well as saying a
few other single words or word approximations such as "ba" for ball
or "ju" for juice.
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They should be using gestures to communicate as well, such a
pointing or gesturing to get wants/needs met. For example, if your
son's cup is on the table and he can't reach it, he should be
gesturing or pointing to it and vocalizing (even if not using true
words) to get your attention that he wants his cup. He should also be
following a few simple commands such as "Get your ball" or "give me
the book". I am glad your son enjoys books and this is a wonderful
way to encourage language with him simply by letting him turn pages
and having you identify pictures for him. Encourage him to point to
or pat pictures as you name them and be a good language role model
for him by expanding on any sounds or words he may say. For example,
if he says "ba" when he sees a ball, you can say "You found the red
ball!". You can also use music and finger plays to encourage speech,
such as singing "Itsy Bitsy Spider" or "Wheels on the Bus" using hand
gestures.
I would also recommend to start moving away from the bottle and
teaching him to drink from a non-spill straw cup to help with speech
production (it's also better for his teeth). If your child has
mastered using a regular sippy cup with a spout lid, then speech
therapists recommend using a straw cup and eventually moving to an
open cup rather than always relying on sipper/spout cups. Drinking
from a straw or open cup is a much more mature oral motor movement
and is more beneficial for speech production than sucking from a
bottle or spouted cup. When a child constantly uses a regular sippy
cup their tongue tends to rest under the spout, which promotes tongue
thrust, which can sometimes have adverse effects on speech or
articulation skills. A straw cup promotes lip closure, oral moto
control and strength. If you would like more suggestions on how to
promote independent walking skills you can refer to this link, where
we have answered several recent questions on the topic:
http://www.earlyinterventionsupport.com/commonquestions/asktherapist-development.aspx.
If your son is soon walking independently and by 17-18 months you
have not seen any increase in his single word vocabulary, you may
wish to have a speech therapy evaluation through your local early
intervention provider. Here is a link to services in your area:
http://www.therapycenterforchildren.com/parents-rights.html
My son is 26 months. He is the only child but has attended
daycare since he was 6 weeks old. My son doesn't say the beginning of
most words such as BANANA its just NANA. He can follow simple
directions and has OK social skills. Like most kids he has his days.
He can say things like "come one mama", or "lets go" and mama what
you doing or where she go. He knows his colors and can count to 10. I
just wonder if he is having problems with speech because he isn't
saying the beginning of some words. Should I have him looked at?
It sounds like your son has a good start on an emerging expressive
language vocabulary and several simple 2-3 word phrases, which would
be appropriate for 26 months of age. At age two we typically look for
a child to have an expressive single word vocabulary of around 50
words or more and the ability to put 2-3 words together such as your
son is doing with "let's go" or "come on Mom". If he is also
following one to two step commands for you such as "Get your shoes"
or "Pick up your book and put it on the table" then he sounds as if
his language skills both expressively and receptively are age
appropriate. Do not be concerned that he is leaving off some initial
sounds of words or pronouncing some words unclearly. As therapists we
do not begin to look at articulation or clarity of speech until after
age three.
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Many toddlers still have difficulty with initial or ending sounds
or even pronouncing words that have more than one syllable such as
banana as you mentioned. You will often hear toddlers say "nana" for
banana or "paghetti" or just "ghetti" for spaghetti, but by being a
good language role model you are always pronouncing the word
correctly for them, so they can see and hear you say it. When your
son says "nana" you reply "Yes, you want a BAnana" stressing the
initial sound for him, but there is not need to correct him or point
out that he is saying it incorrectly as this may only frustrate him.
You can even break the words down and practice beginning, middle and
ending sounds with your son for words with more than two syllables,
by having having him repeat after you as a game "ba", "na", "na". You
may also hear toddlers say "boo" for blue or "cacker" for cracker or
"scare" for square and this is also typical since many toddlers will
particularly have difficulty with words which involve blends such as
"bl, pl, cr, sp, fr, pr, sq, and st". It is helpful again for you to
slow down and let your son watch your lips and hear you say these
sounds as he attempts to imitate you. You can also use a mirror
during speech play so he can see his own lips, tongue and mouth form
the sounds and words. As your son approaches age three, if you are
not seeing improvement in his ability to pronounce beginning sounds
of words or you or the day care staff are still concerned with the
clarity of his speech, then you may want to seek an evaluation from a
licensed speech pathologist to look at his articulation. Hopefully
this information was helpful to you.
My son is 5 years old. He has been in speech therapy off and on
since he was three. He cannot put a sentence together. If you ask him
to say I like puppies, you might get him to say like puppy. He rarely
can put three words together. He does not have a direction. What I've
read about his case, I think that he fits. His school speech
therapist says she's heard of apraxia, but doesn't know much about
it. My son does most of his communicating by pointing and attempting
to say words in bits and pieces. I had him evaluated at child
development centers 2 years ago and didn't get any direction there
either. He needs help by someone who knows about childhood apraxia.
Childhood apraxia of speech often is defined as a motor speech
disorder where the child has difficulty saying sounds, syllables and
words. Children often have a small number of sounds they can produce,
their vowels are distorted, difficulty combining sounds (can say /m/
but may have difficulty adding one sound /ma/ or more sounds /mam/.)
Children with CAS may try to say a sentence but correct syllables and
words may sound like a melody instead of clear words. Frequently used
phrases may be easier for the child to use and words may be clear
sometimes but not other times.
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The child may also have non-speech characteristics such as feeding
difficulties, drooling, and oral motor (mouth/tongue movement) is not
coordinated. CAS occurs when the brain tries to tell the mouth parts
needed for speech to move certain ways but the brain signal is
interrupted and the accurate movement does not occur.
Often CAS is not diagnosed when the child is very young (usually 3
years or younger) because of the developmental level needed for
evaluation. The speech language pathologist should conduct an oral
motor assessment where the child imitates or follows a request for
mouth movements and how the mouth moves with specific sounds asked.
The therapist also examines the child's melody of speech and how the
child produces single sounds, sound combinations, words, phrases and
sentences. There are formal tests that the therapist may also use.
I would take your child to a certified (CCC-SLP) speech language
pathologist who specializes in apraxia and childhood speech/language
disorders for a re-evaluation. He is at an age that he should be able
to participate in the evaluation.
I found a website that lists therapists in your area and several
note apraxia and childhood speech/language. Go to
www.asha.org. Scroll down to Quick links, Click on "Find a
Professional Near You" Type in your city and state and you will see
therapists pop up. Click on the therapist's name or company's name
and it will list the areas they specialize in. When you find a
location you like request a therapist that has experience with
apraxia if you feel your child fits this description.
I would continue to encourage your child to point to items to get
his needs met. I would try to use any form of communication to keep
him from being frustrated and to be able to get his point across. You
can also use sign language, pictures and augmentative communication
systems are sometimes used to assist with speech/language while the
child is working on oral language.
My seven year old son has recently started mispronouncing words he
used to pronounce correctly. He is very bright (is being tested for the
gifted program at school) and was a very early reader. Some of the
mispronunciation seems to be related to how he is now "seeing" words he
is reading, but it still seems strange. By way of history, he is a
fraternal twin and was born 5 weeks premature. Although very healthy, he
does show some quirky behaviors like rocking himself to sleep at night
(since he was a baby) and humming to himself at school during quiet and
test times (very recently and not consistently). Is all or any of this
related? Should I be concerned if he is doing well in school
academically and socially?
It is always wise to question any changes in your child's skills or
behaviors. In regard to word mispronunciation, I would seek consultation
and evaluation from your school reading specialist.
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Since your son was an early reader, he may have begun his reading
skills by recognizing site words. Preschool level books are more
concrete and word use is common. While reading to your son, you may have
pointed to words as you spoke which could have helped him begin to
recognize those words. It maybe he is seeing a site word within word he
is reading and saying site word instead of actual word. Example of this
would be recognizing "cat" within word "catch". Seek advise and counsel
from your son's teacher and school reading specialist to determine if he
is reading phonetically. Good foundation of reading skills are crucial
at this time in his education.
In regard to rocking self to sleep at night and humming during test
taking, these are common behaviors used to self-regulate, calm, and/or
organize. We use self-regulation in order to attend and /or adapt to
demands of our day whether that maybe to find strategies to relax a busy
mind for sleep or to rev up to the challenges of testing. If these
behaviors do not interfere with daily activities, routines, or cause
disruptions in group activities, I would not be concerned. However, if
you feel it is causing disruption speak with an Occupational Therapist.
Pediatric therapy clinics will be a good resource within your community.
During a routine hearing evaluation my 4 yrs, 5 month old daughter
was found to have some hearing loss to both ears. A follow up evaluation
at 4 yrs, 11 months stilled showed a "borderline normal" hearing loss to
the right ear and a "mild hearing loss at low frequency" to the left
ear. She has normal middle ear function (tested at 5 months and again at
11 months with the same results). With language development she was
found to have difficulty with k, ch, and g like sounds. What might be
the cause of her low frequency hearing loss? Should I seek additional
care from a pediatric specialist?
It sounds like your daughter has had a hearing/language screening. If
she has not been seen by a pediatric audiologist we recommend she be
seen by one. They will do a complete evaluation and be able to further
explain her hearing loss.
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Some possible reasons for a mild low frequency hearing loss could be
hereditary/genetic or viral infections. You noted she is having
difficulty with k, g and ch sounds. These sounds are not considered low
frequency sounds, vowel sounds are in the lower frequency. A common
difficulty for children with mild to moderate hearing loss is leaving
end sounds off words (final consonant deletion) and omission/distortion
of blends, fricatives (f,th,s,v,sh,z) and affricates (ch,j). If your
daughter has not had an evaluation by a certified speech language
pathologist I would recommend that also. The speech pathologist and
audiologist would work well together to determine a plan that is most
appropriate for your daughter.
My son is eighteen months old and barely talks. He has had numerous
ear infections and now has tubes. At one point, I thought his hearing
was affected, but his hearing was tested in December and it was fine. He
also sucks a pacifier. He has an older brother who does a lot of the
talking for him. He is able to communicate with pointing and grunting,
and we give in to it. Should my son be seen by a specialist?
You were correct in first having his hearing checked. Numerous ear
infections can impact speech development and it is good he has had tubes
placed. The tubes help to clear the fluid from the ear and help to make
sounds and words more clear, which allows the child to hear and learn
the sounds more accurately.
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When children have an older sibling, it is common for speech to be
delayed, especially if the older child talks a lot. The older child will
often talk for the younger child when the child wants or needs
something. This can delay the younger child's speech. Several
suggestions for this situation: 1) Try to set aside specific time every
day (15-30 minutes 1 or 2 times a day - or more if possible) when you
can have focused time with your younger child; 2) Interact with your
child in an activity he enjoys, such as playing with a ball or trucks.
Model one word for your child and encourage him to imitate the simple
word. If he is unable to imitate the word, encourage him to produce a
sound related to the activity. Praise him for any sound or attempt he
makes; 3) Encourage your older child to help in "teaching" the younger
child. If the older child is old enough, have him try to help the
younger one make sounds, say simple words or perform oral motor
activities such as sticking out his tongue, blowing raspberries, etc.
You can also explain to the older child that the younger child has his
special times to "talk."
With regard to the pacifier, I would suggest
stopping/reducing the time your child is using it. If your child
is using the pacifier throughout the day, I would suggest
reducing the use to only sleep times, and eventually weaning off
the pacifier altogether. If the child has the pacifier during
wake times, it does hinder speech production and oral motor
movements.
It is very positive that he is pointing to objects/things he
wants. This is a form of communication because he is exchanging
with you. When he points to the object, you should name it and
encourage him to imitate the word/sound. It is very easy to give
the child what he wants without encouraging this, but really
focus on having him make an attempt to "tell" you with a sound,
a head nod (yes/no), a word, or simple sign language.
These are some suggestions for you to try. If you continue to
have concerns, you should address them with your child's
pediatrician and schedule a speech and language evaluation with
a speech-language pathologist, who can determine if there's a
need for therapy.
My two-year-old was born with Lyme disease (he got it in utero). It
took us 13 months to figure out was wrong with him. Anyway, he seemed
fine once he was treated. Prior to receiving antibiotics, he had FTT
until he was about 2 months old and barely reached his milestones. For
example, he sat on his own at 11 months. A neurologist saw him at 13
months and 16 months and seemed to think that he was bright and didn't
seem to think that the Lyme disease had affected him cognitively. The
Lyme doctor seemed to think the same. At 24 months, we had him
evaluated. His speech was ten months delayed, but more distressing was
that his cognitive testing came up 5 months delayed! I was
told I shouldn't worry at this point - that he seemed very alert, that
he would most likely catch up or that it could be a receptive language
problem getting in the way. My question is whether or not this is true -
that he can catch up. What I've read online doesn't seem very positive.
It doesn't surprise me that he is showing language delays given that
he was also very delayed in other areas (FTT, sitting, etc.). If you are
receiving speech and language therapy and are following through with
their recommendations at home, your son should be able to make great
receptive/expressive language gains.
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Just as his sitting eventually developed, often we see the same with
language. It may take a little longer, but he will continue to make
gains. I know you are concerned about his lower receptive language score
(5 months delayed) but one positive is that he is still above his
expressive language score (10 months delayed). We (SLPs) do show concern
when the expressive language score is above the receptive language score
because all through life we know more than what is expressed so the
receptive score should remain above the expressive score.
If he is not receiving speech and language therapy, I do recommend
it. Also, if you begin to see any regression, please speak with your
doctor and neurologist.
My seven year old son has recently started mispronouncing words he
used to pronounce correctly. He is very bright (is being tested for the
gifted program at school) and was a very early reader. Some of the
mispronunciation seems to be related to how he is now "seeing" words he
is reading, but it still seems strange.
By way of history, he
is a fraternal twin and was born 5 weeks premature. Although very
healthy, he does show some quirky behaviors like rocking himself to
sleep at night (since he was a baby) and humming to himself at school
during quiet and test times (very recently and not consistently). Is all
or any of this related? Should I be concerned if he is doing well in
school academically and socially?
It sounds like you are very frustrated by your son's behavioral
issues at school. It is difficult for me to make specific
recommendations without knowing all the details of your son's situation.
Does your son already have a behavioral diagnosis (ADD, ADHD, etc.) that
may contribute to his behavior? I'd also like to know if you see these
same behavioral patterns at home that are reported at school, and did
these issues just begin this year?
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It sounds like you have been trying to work with your son's teacher,
which is the key first step. Positive collaboration with his teacher and
other school personnel is crucial in shaping your son's behavior. Has
your son's teacher shared with you what interventions they are trying at
school with your son? Is a record kept of when and how often these
behaviors occur throughout the day and what happens directly before and
after each behavior that may be a trigger or a clue as to why he is
behaving in this manner? Have you had contact with other professionals
or counselor's at his school for advice? I would suggest talking to your
son's guidance counselor or the principal if you feel you are not
getting your son's challenges appropriately addressed by his classroom
teacher and see if together you can create a plan to modify your son's
behavior so that his classroom experience is more productive and
positive. Switching schools would indeed be a last resort, but if the
personnel at the current school are not willing to work with your son
for a positive outcome, you may want to seek out one that will.
Secondly, I would suggest conferring with your son's pediatrician for
a referral for a behavioral/psychological evaluation for your son to
rule out any underlying issues that may contribute to your son's
behavior at school, especially if you are seeing the same behaviors
occurring in your home as well.
Be aware that many, many things can affect a child's behavior such as
a specific learning disability or diagnosis, as well as changes in the
home environment (moving, divorce, death in the family, marital
tension), lack of sleep, diet, bullying by classmates, even temperament
(shyness, fear). Sometimes behaviors such as the ones you report (lying,
using bad language, acting out) are a way to get attention because the
child does not have the social skills necessary to gain attention in an
appropriate way and has learned through repetition that these behaviors
get adult and peer attention quickly, even if it is negative attention.
Sometimes children need social skills training so they can learn what is
and is not appropriate for their age and grade level.
In any case, a system of consistent rules with rewards and
consequences both at home and at school may be helpful for your son. Let
him earn rewards for doing positive tasks, so that he can build some
self-esteem and feel good about himself. But, when a rule is broken
(such as he is caught in a lie or says a bad word) stick to your guns
and a reward or privilege should be taken away. Make things fun, use
charts for chores or homework or to target a specific behavior and at
the end of the week if all requirements are met reward him with
something special (going for ice cream, playing a video game for an
extra 1/2 hr, etc). Try to praise him anytime he is being "good" or
speaking positively so that he learns to associate attention for
positive behaviors, not negative behaviors. Role play can be affective
with elementary age kids, meaning you pretend to be your son and he can
pretend to be you or his teacher...you tell a lie or act out as he does
and then have him tell you how that makes him feel. Many young kids are
not aware how their behavior affects others and role playing can make
them more aware of other people's feelings, as well as their own. Also,
if your son is able, have him keep a journal each day, encourage him to
write about things he did and how he felt when things happened to
him...it can be a way for him to reflect on his actions and a way for
you to gain insight into why he acts the way he does.
Here is a link you can use to print a
free behavior/reward chart (on the left side of the page there are
links to many other charts that may be helpful to you).
I am writing on behalf of family members who have 2-1/2-year-old
twin boys. The boys were preemies. They live in a bilingual household in
New Jersey. The family is interested in private speech therapy for the
boys in their home; they are not interested in institutional or state
intervention that may stigmatize the boys at a later age. They are also
interested in DVDs or any books that would be helpful for the family and
the boys. I would appreciate any recommendations. Also, I found a web
site for "Baby Bumble Bee." How are these DVDs?
Assuming that the pediatrician has been addressed, there are no other
medical complications, and a speech and language evaluation has been
recommended, you can choose which provider you want and what fits your
income/insurance/needs. You need to be sure that the therapist is
licensed (CCC-SLP) or is a clinical fellow with a supervisor (CFY-SLP).
There are also therapists who specialize in bilingual therapy (English
and Spanish especially).
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Assuming that the pediatrician has been addressed, there are no other
medical complications, and a speech and language evaluation has been
recommended, you can choose which provider you want and what fits your
income/insurance/needs. You need to be sure that the therapist is
licensed (CCC-SLP) or is a clinical fellow with a supervisor (CFY-SLP).
There are also therapists who specialize in bilingual therapy (English
and Spanish especially).
These children do have several factors that could put them at risk for
being slightly delayed: twins, boys, and prematurity. Not all twins,
boys, and premature children are delayed, but they can be at risk.
Also, with two or more languages spoken in the home, the children's
brains are working harder to distinguish and learn the languages (both in
comprehension of words and how to use the words). With children who are
learning two languages, it is fine for the parents to use both of the
languages. When children seem to be having a difficult time learning either
of the languages, usually therapists recommend that one parent speaks one
language while the other parent uses the other language with the child. This
allows the child to focus on one language at a time. Once the languages
begin to be easier for the child, the parents can begin to use both of the
languages again.
I am familiar with the Baby Bumble Bee series and think they are a good
series. I have worked with several families who have really enjoyed them.
Some ideas for activities for the parents/caregivers are:
- Each parent plays the same activity with the children
but at different times. (Example: In the morning, Mom plays
ball or trucks with the boys using language 1. In the
evening, Dad does the same activity using language 2. The
kids will hear the same words but in different languages
(Ball: bounce, throw, hit, big, little, etc. Trucks: big,
go, fast, slow, colors, etc.)
- Each caregiver reads the same book in their language at
different times ' you do not always have to only read the
words in the books. Look at pictures and name the objects,
actions, and emotions in each language. c. One caregiver
helps kids get ready for breakfast using their language to
name/describe the items (cup, drink, plate, fork, spoon,
food types, etc). The other caregiver uses their language
during supper.
- One caregiver helps kids get ready for breakfast using
their language to name/describe the items (cup, drink,
plate, fork, spoon, food types, etc). The other caregiver
uses their language during supper.
These are just several suggestions. Your speech pathologist
will be able to provide more.
I once saw a single mother who did not want to speak English in the home
but wanted the kids to learn from other examples. In this situation, be sure
to have the child involved in play groups, a preschool group, a library
story time, etc. If it is a single-parent home, try to find a friend or
another family member who can help.
These are some recommendations for your family. Please be sure to talk
with your doctor and speech/language pathologist regarding your concerns.
Thanks again for your question.
Can you please refer me to information regarding bilingualism in
premature twins?
There are several factors that were not included in your question
that can influence the answer to this question. How premature were the
babies? How old are they now? Are there any delays or disorders that
have been identified? Do they currently have any language they are
using? These questions would help my answer be more specific to your
children.
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There are several books I can recommend for bilingual language:
If you do have concerns regarding the language development of your
children please speak to your child's doctor and have an evaluation by a
speech pathologist.
What types of therapy could the speech therapist do with my child
who has PVL (Periventricular leukomalacia)? He is 14 months old and
doesn't have an interest in toys.
Periventricular leukomalacia is often seen in premature infants when
there is decreased blood flow to the brain before, during or after
birth. Due to the decrease in blood flow to the periventricular area of
the brain, nerve fibers are damaged and can effect muscle control
throughout the body. PVL can cause cerebral palsy and other brain
functions can be affected such as behavioral problems and developmental
delays.
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The speech language pathologist will be able to evaluate your child
to determine if there are expressive language delays, receptive language
delays, oral motor delays and/or feeding delays. They can also observe
play skills and social skills to determine if they are within normal
limits. If your child is showing delays in an area a plan will be
developed to determine what goals should be addressed to advance his/her
skills.
To examine expressive language the therapist will observe how the
child communicates his wants/needs (pointing, sounds, words etc.) If a
delay is found the therapist could focus on improving oral
communication, gestures/sign language, simple communication devices or
other methods of communication depending on the child's needs.
Receptive language is what the child understands is being
communicated to him/her. Examples of this are (following simple
directions, identifying specific people/objects, identifying simple body
parts etc.) The speech therapist should identify if the child is delayed
and work on improving comprehension through play and various activities.
Oral motor skills are needed for sound production and feeding skills.
There are many techniques to improve these skills such as increasing
tongue mobility, lip closure, chewing, moving through textures etc.
depending on the problem areas.
You noted your child is not playing with toys. I would focus on
increasing his/her interactions with you. Have him make sounds with you,
play patty cake, peek-a-boo etc. If he participates in these games
incorporate a ball or car into the play. You lead play with the toy and
see if he will imitate. If his motor skills are effected you can help
move his/her hands/feet so your child is able to experience the action
for play.
We recommend talking with your child's doctor and a pediatric speech
language pathologist (SLP) regarding your concerns and having a speech
language evaluation. If speech therapy is recommended the SLP should be
able to provide suggestions regarding what toys/activities would be
appropriate for your child to improve development in areas of delay.
My son is 33 months and I have noticed he isn't speaking as much as
children his age and younger. He still babbles a lot. He says around 60
words and 7 2-3 word phrases. Most words he will only say once, maybe
twice and then doesn't say them again and you can't get him to repeat
words that you are saying. He will only answer questions if his answer
is no. If you ask him to identify something such as a body part he
doesn't want to do it. He is very active and doesn't want to stop long
enough for you to explain anything to him, like "I want you to ...".
In the past week he has began to sit down and let you read to him but
mostly he just wants to play with the book. When he wants something he
will just stand there and babble talk until you get up to see what he
wants. I'm taking him to the pediatrician tomorrow but would also like
to know your thoughts and let me know things I should talk to the
pediatrician about.
Thanks for your question. From what you have told
me I would recommend that you ask your pediatrician
for referral information to the early intervention
provider in your area so that your son can receive a
speech therapy evaluation by a licensed speech
pathologist. It sounds like your son has a lot of
single words in his vocabulary which is a good
start, but you aren't hearing them consistently and
he is not attempting to repeat new words for you. I
am glad he has a few 2-3 word phrases already, but
by 33 months he should be using primarily two and
three word phrases (for example "me want milk",
"daddy go work", etc) more so than single words and
his babbling/jargon should be minimal.
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By age 2 1/2 we generally like to see a vocabulary of at least 50
words, and that list should increase weekly, so that by age three a
child has 100 or more words. Saying "no" to most questions is fairly
typical for children at your son's age, even if he really means yes. He
should also have begun to ask you some "wh" questions such as "where
go?", "what that?" etc. It sounds like your son is extremely active and
since speech is also a motor task involving complex movements of the
tongue, lips and jaw, sometimes children who are putting all their
energy into gross motor activities (running, jumping, climbing) are
quieter during play or talk less or later because all their motor energy
is going to one place-physical activity.
You can start offering him choices during meals and playtime to
encourage him to use words instead of just babbling or pointing to get
wants and needs met. For example, at dinner ask "Do you want juice or
milk to drink?" If he is not yet saying either juice or milk, you can
accept him pointing to one or the other and then put it back into a
sentence for him "You want milk to drink for dinner tonight". Whenever
your son says a single word, always expand on that word for him so he
can hear it in a simple sentence. For example if he says "ball", you say
"You threw your red ball". Being a good speech role model is always
helpful.
If there are words your son cannot yet say,
and you see him pointing or gesturing for
things, you may want to think about building in
a few simple sign language signs into his
vocabulary, especially if he gets frustrated by
not being able to tell you what he wants. Using
signs paired with a word helps young children
learn new vocabulary words before they can
physically say them. Once children have mastered
the spoken word the sign typically fades away. A
speech therapist can teach you a few simple
signs if this would be helpful to your son. If
he is not yet pointing to body parts or
following through with simple directions such as
"Bring me your shoes" or "get the book and put
it on the table" then your son may also be
having some difficulty with receptive
language-either understanding it or processing
what is said to him. We do not start to look at
articulation (clarity of speech) until a child
turns 3, but by age 3 we like to see children be
understandable by adults and other children at
least 80% of the time.
Since your son is already nearing preschool
age, I would definitely try to get an early
intervention speech evaluation or a private
speech evaluation set up for your son as soon as
possible to assess his expressive and receptive
language skills and determine if he is eligible
for therapy.
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