Friday, January 20, 2017

Speech milesstones/Local speech therapy resources 2017

This Post was updated July 2018

My older daughter Lauren reached her verbal milestones at  a young age. It turned out that she was stringing together sentences quite a while before we could actually understand what she was saying. The fact that she was actually using real words to communicate became apparent to me one day when she and I were wandering around the zoo. She may have been as young as 15 months at the time. Lauren started to tug on my arm saying “shoofaloff”
It sounded like typical babble; I tried to figure out what she was trying to say as we walked. Was it an animal perhaps? Did she want a snack?
“SHOOFALOFF” She kept repeating. She was getting upset that I clearly wasn’t understanding what she was insistant  on telling me. “SHOOFALOFF”
I paused for a moment, happened to look behind us and saw that her shoe had fallen off and was about 10 feet behind us. Shoofaloff was “shoe fell off!” Duh! At that moment I realized that her fairly incessant cute little gibberish was actually speaking. As the weeks passed, Lauren became more and more articulate and I completely took it for granted that we lived with a little talking wonder.
When Alana came along, I expected nothing less. Alana (no need to fret about her, she graduated top of her class with her Master's degree in Social Work from the University of Michigan) didn’t care about reaching milestones (any of them!) She had no trouble at all with comprehension, but her speech was incredibly garbled. By the time she was two, we could still barely make out a dozen words.  Fortunately we had Lauren, who translated for her without any problem.
GUGUGUGGODH  might mean “I would like more popcorn please”. Lauren was puzzled as to why we couldn’t understand her sister. This just goes to show that often siblings have magic communication skills with each other at a very young age.
Eventually Alana had plenty of words, but there were still a few letters that were hard for her to pronounce until she was quite a bit older.
There is a huge range of normal, so when do we need to have our antenna up? There are a few basics to keep an eye on.
By 4 months your baby should be cooing and making sounds. If they are not, one of the first things we would want to make sure is that your child doesn’t have an issue with their hearing. Babies born in California are given a hearing screen at birth, but it is still something to check out if you have concerns. Does your baby react to  your voice? Do they look in the direction of a loud noise? As they get older, can they follow simple commands? If you are looking at a picture book, can they point to the appropriate picture with your prompt?
By 15 months they should be able to speak at least a few recognizable words.These don’t even need to be valid words. Alana couldn’t pronounce Lauren, but she could say Yaya and it was clear that Yaya meant Lauren. To this day, it still does!
Perhaps da means dog. As long as they are consistent and communicating, those sounds count as a word. If your child knows some signs, those are counted among their words. If you know for sure what they are saying, repeat after them and expand on their utterance. When they see the dog and say “da!” you should say “Yes. DOG!” (repeat) “look at the big dog” (expand.) If they are using a sign, say the word. For instance if they are signing “more” during a meal, say “more.” (repeat) and then expand, “would you like more peas?
By repeating and expanding , not only are you reinforcing correct production of their words, but you are supporting their language development
Michelle Geffen, a speech therapist at Jennifer Katz, Inc., advises not to pressure your kids by always asking them to say the specific word. Instead, let them hear you use the word and wait for a response. Waiting can do wonders!
If your child reaches 18 months and there isn’t  any understandable language, this is an appropriate time to get a baseline evaluation from a speech and language therapist. Sure, it is okay to wait a bit longer if you like, but early intervention is always a good thing. I like to be proactive. Often the evaluation is covered by insurance.
By the end of the 2nd year, children should be able to speak roughly 100 words, understand 300, and have some word combos. They should be understood by close family members 50% of the time.
The earliest sounds for kids are usually  Pa Ba Ma Na Wa Ka Ga. By the age of 3, kids should have most speech sounds. Ruth White, a local speech therapist, counsels that if the majority of folks can’t understand most of what your three year old is saying, an evaluation is advised. On the other hand, it is not uncommon for many otherwise articulate kids to  distort some of the more difficult sounds such as l, r, s, sh,ch, y, v, z, th. These sounds may actually not be fully mastered until age 7 or 8.
Even though  we know that some sounds aren’t perfected until later, 4 or 5 is a reasonable age to check in about articulation issues.
Bailey Levis, owner of San Francisco Speech and Fluency Center, receives many calls from parents who are concerned that their pre-school child might be stuttering.  Many children will have some amount of disfluencies, (e.g. “Um um um, I want...I want...I want some ice cream.”) in their speech, but only some of them will show signs of stuttering.   Some red flags for early signs of stuttering include tension or frustration if/when words get stuck, more than 2 repetitions (e.g. “cuh-cuh-cuh-cookie”), or if there are other family members who stutter.  Whether or not you observe any of these red flags in your child’s speech, if you have any concerns, Bailey recommends seeking out a speech therapist who is comfortable working with stuttering.  With early intervention, the likelihood of complete recovery is very high.
Frequent ear infections or fluid in the ear can impact your child’s early language skills so it is important to work closely with the doctor if this is an issue. We may send you along to an audiologist or ENT to be part of the team.
Of course, keep in mind that there is a huge difference between hearing and listening.
I can’t tell you how many young child failed to follow the directions with our in-office hearing test, but when I quietly whispered “ would you like a sticker?” they heard me just fine.
One of my favorite in-home hearing tests is an active listening game. Tell your child to whisper a word to you (perhaps the name of an animal.) Then you quietly whisper a word back to them. Make sure they can’t see your face so that there is no lip reading. If you have any concerns that the hearing isn’t as sharp as you think it should be, get them checked.
Jodi Vaynshtok from  Sound Speech and Hearing Clinic shared her explanation of the different aspects of communication skills that a speech language pathologist addresses:
Listening: In order to use the correct speech sounds, and understand/use language, a child must build upon their listening skills. This includes detection, identification and comprehension of spoken words. Listening therapy helps children learn to detect and interpret sounds, allowing their learning system to develop speech and language skills appropriately.  
Speech: This is often what people think all speech therapy sessions consist of – the production of sounds that make up our words and sentences. Speech involves the coordination of articulators (i.e. jaw, lips, tongue, vocal folds, vocal tract and respiration), divided into three areas: articulation, voice and fluency.
Language: A child’s language can be split into two domains. The information they understand (receptive language) and the language they use (expressive). Language therapy can concentrate on spoken, written or non-verbal communication. Goals can target vocabulary, grammar, formulation of sentences, following directions, and reading comprehension, just to name a few! A child’s ability to correctly understand and use language can affect their behavior, academic and social success.
I am grateful to the speech therapists who took the time to share their wisdom with me about this post!

Below is a partial list of some excellent resources that we have in the SF area
Sound Speech and Hearing 415-364-8774
Sound is one of the wonderful resources here in SF. They are the one stop shop that can combine the hearing and speech assessment in one visit. They also have the option of having  Mavis, the animal therapy pup at the visits ( it doesn’t get better than that.)
Check out their blog.
Below is a recent article about children's headphones

Jennifer Katz Inc. 415-550-8255
This popular practice has several locations and has been taking care of my patients speech therapy needs for many years. They have expanded to several locations. They also work with many insurance plans, which is a bonus.
This practice also has some feeding therapists on staff.
SF Speech Therapy 415-404- 8343
SF Speech Therapy is a small, family centered private practice in Diamond Heights.It provides speech, language, and feeding therapy to people of all ages, with a particular emphasis on early intervention for the very youngest San Franciscans.
Therapists at SF Speech Therapy have specialized training in a number of areas, including infant and toddler language, articulation, stuttering, voice disorders, and the Sequential Oral Sensory (S.O.S.) approach to feeding. There are both English and Russian speaking therapists on staff, and home visits are offered. To get a feel for the practice, check out the blog and website below. Appointments can be made by calling Teresa Newmark at 415-404- 8343 or by

Bailey Levis 415-496-6757
Bailey does all sorts of general speech therapy for all ages but is top notch for stuttering issues. He offers a free 30 minute consultation.
Northern California Speech and Hearing 415 -921-7658

Ruth White 415-225-6152
Ruth has a private practice but is also an instructor at SFSU  and currently run graduate clinics there.

Shannon Kong and Sara Spencer 415-469-4988

 Shannon Kong, MS, CCC has been renamed  to Seven Bridges Therapy ( and they now have offices in SF, San Mateo, and Oakland.  They specialize in working with children 5 and under as well as Autism but see children of all ages!

Sara Spencer,  continues to service children ages 6 and up under her company name, Sara Spencer and Associates.  Same addresses in SF and San Mateo.  They continue to work hand in hand as they always have (since 2000).

Tulips Speech  415-567-8133
tuLIPS Speech Therapy has exciting news.  After 7 years on Union Street in Cow Hollow, they have opened a 2nd location on Castro Street in the heart of Noe Valley!  tuLIPS Speech Therapy offers speech and language therapy, social skills groups and their very popular Talking tuLIPS program.  They have an amazing neuropsychologist on staff who offers neuropsychological testing and they work closely with a wonderful occupational therapist. tuLIPS Speech Therapy is now accepting new patients.  Call them today and ask about their complimentary speech and language screening!   

Lauren Van Burkleo  415-633-6648

UCSF Audiology 415-353-2101
For our patients using any of the UCSF pediatric specialty clinics, including audiology, a referral is needed before they will make an appointment.
If you are interested in meeting with them, let your doctor or nurse know. We can send a referral over and they will contact you to get something scheduled.

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