Speech and Language Milestones |
May is National Apraxia Month as well as Better Hearing and Speech Month. That makes it the perfect time to update my speech and language post. For those of you who aren’t fluent in Latin, Apraxia is a speech sound disorder where children or adults have difficulty with the motor planning and programming of the movements and transitions needed to form speech. This is heard as difficulties consistently producing speech sounds or speech sound sequences. Speech issues and language concerns come in a lot of shapes and sizes. Apraxia is just one of many. Speech and language milestones in general can stress lots of parents out. Here is my recent post milestones/shmilestones that was mostly an attempt to get parents to relax. I know that it is SO hard not to compare your kids with others. Many of us fall into that trap. Your friend’s kids or your nieces are one thing, but it can be especially challenging when it is your own kids who are so different from one another. I wanted to take some time to share my story about my own kids when they were learning to speak. My older daughter Lauren was an early talker. It turned out that she was stringing together sentences quite a while before we could reliably 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 attempting to communicate 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 following what she was trying so hard to tell 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 (don’t fret, she is a mental health therapist in the SF Bay Area and is quite articulate) 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. PUGUGUGODH 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 almost unfathomable communication skills with each other at a very young age. Eventually Alana had plenty of words, but there were still a few letter sounds 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. I am grateful that I was able to connect with Oath’s speech therapist Jody Vaynshtok, MS, CCC-SLP at Sound Speech and Hearing Clinic to help answer questions and provide support. By 4 months your baby should be cooing and making sounds. If this is not happening, 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 the United States are given a hearing screen at birth, but it is still something to check out if you have any concerns.
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 as well. 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, “eat more peas!” By repeating and expanding , not only are you reinforcing correct production of their words, but you are supporting their language development. Try not to pressure your kids by always asking them to say the specific word (or asking them a bombardment of questions). Instead, let them hear you use the word and wait for a response. Waiting can do wonders! Many speech therapists are looking at around this age to see what communicative intent is occurring (pointing, giving, waving) as these are the building blocks to language. Pay attention to the gestures your child provides. One of Jody’s favorite resources for gestures is “16 gestures by 16 months” 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 and the assessment can actually be quite fun. I am a big fan of being proactive. Often the evaluation is covered by insurance. Some services are available free of charge to kids under three. There can be a wait list and there is no harm in getting in line. Here is a link to find your state's early intervention center. By the end of the 2nd year, children should be able to speak roughly 100 words (including a variety of words not just nouns), understand 300, and have some word combinations. They should be imitating 2-3 word phrases and playing around with animal and environmental sounds. My 29 month old grandson Elliot has quite a bit to say. I understand him 90% of the time. Fortunately, our Alexa device generally can’t quite make out what he is trying to get her to do. So far only once has she complied when he tilted his curly head, gotten right up to ‘her’ and said “Alexa, play the wheels on the bus.” We all cheered when the song started to play, followed by the quick realization that we will be in trouble when it becomes easier for the device to understand him clearly. Another wonderful aspect of Elliot's communication is that Lauren has been signing with him from the time he was born. I was completely caught off guard when he was 7 months old. I was babysitting. We were cuddling in the rocking chair. He pointed to my breasts and made the sign for milk. Obviously most people don’t start teaching signs so early. I strongly recommend adding at least the sign for ‘all done’ when you start solids. YouTube is a great source for learning Teaching kids to sign can help mitigate tantrums because you are offering them a communication tool that doesn’t rely on verbal development. It is never too late to start. The earliest sounds for kids are usually /p/ (up), /b/ (baba), /m/ (mama), /d/ (dada), /n/ (no), /h/ (hi), /t/ (toe), /k/ (ick), /g/ (go), /w/ (wawa). By the age of 3, kids should have most speech sounds in a variety of word shapes. For example with the sound /p/ we would want to hear it in a variety of positions and word shapes “pa” “pop” “up” “apple”. In addition to making sounds we also are looking for speech clarity. The general rule of thumb is:
At 4, some sounds may continue to be distorted sounding (like the cute “wabbit” for “rabbit”) but around this age is a good time to check in with a speech therapist if sounds aren’t quite sounding precise. Recently, speech sound developmental guidelines changed and Jody shares with us that the following ages are when we expect mastery of the sounds (in all positions of words)
Stuttering is another concern often expressed by parents of preschool aged children. In fact somewhere near 10% of children aged 3-4 years will stutter, with it being 4x more prevalent in boys than girls. It might be more common in kids who are bilingual. While many of these children will stop having disfluencies (close to 80%), some may need intervention, which at this age can be quite successful. Families are recommended to seek an evaluation
Finally, Jody shares a few tips with you on how to help enhance language, especially in the littlest learners. Your child learns from every interaction you have together. Let’s learn some ways to enhance those communication opportunities to help your child learn the power of social interactions. Let’s O.W.L: Observe: Body language – action, gestures, facial expressions – learn what is motivating and interesting to your child. Wait: Stop talking, lean forward, look at your child expectantly – your child will take the lead. By waiting you can respond to your child’s signals, play, imitate, interpret and comment. Listen: Pay close attention to all words and sounds – no interruptions, even if you know what they are trying to say. Turn Taking: From body language, cooing, and words, use these tips for turn taking - match the length of your child’s turn. Try to match how much your child says or does by keeping your turns short and simple too. If your child uses one word, use no more than two! Match your child’s pace; let your child set the pace for the conversation. Slow down and wait longer if necessary. This allows your child time to explore, understand, and respond. Match your child’s interest; focus on what your child is interested in. When following their lead, they’ll interact longer. Jody’s Question Challenge: This week you are encouraged to not ask ANY questions of your child (that they can’t answer). If your child is only saying 4 words (mama, dada, up, more), most of the questions you ask them during the day they do not yet have the words to say. This can become frustrating or confusing to them, so let’s see if we cut out the questions if we get more communication from them. Try turning all your questions into comments…so instead of saying “what is that” say, “I see a dog, hi dog”. If you ask a question, don’t fret, answer it back, showing your child what you could respond with. Good luck! If you have concerns regarding your child’s speech and language, bring it up with your pediatrician for a local referral or look into speech therapists in your area through the American Speech and Hearing Association. Enormous thanks to Jody Vaynshtok from Sound Speech and Hearing (she also is the speech expert at Oathcare!) for sharing her valuable wisdom. Sound Speech and Hearing 415-580-7604 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. Check out their blog for more information on all things speech and hearing and special “building blocks to communication” videos in celebration of Better Hearing and Speech Month. |
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