How We Talk

Do you ever wonder how much is truly involved in communicating our feelings, our thoughts, our needs and desires? Do you ever kick yourself for saying something in the heat of the moment you didn't mean? I do. I kick myself for writing messages in the heat of the moment. As we grow older, we learn to control what comes out of our mouths. When we're young, all is fair game. We're more focused on expressing a thought correctly than the influence it will have on those who hear it.

Speaking begins with a person's thoughts; the brain formulates the thought and breaks it down into words, then into sentences, and finally, meaning. The act of speaking occurs by air coming up from the lungs, through the vocal folds, and out the mouth. We shape these sounds using our tongue (the tip, blade, front and back), upper and lower lips, upper and lower teeth, and the roof of the mouth in order to produce specific sounds and words. Speech sounds can differ by voice, place (where sounds are made in the mouth) and manner (the type of sound) (Stuckey 1).

How Do We Produce Different Types of Speech Sounds

Several different parts of the body, in fact, are used in the production of speech; not just our mouths. Our stomach muscles, lungs, voice box, tongue, teeth, lips, and even our nose are all used in the production of speech sounds. So, the thought originates in the brain. But where does the sound originate. Believe it or not, it originates in the stomach, with the diaphragm (the upper part of the stomach which controls the lungs). The diaphragm pushes air from the lungs into the voice box, which contains inside it numerous vocal cords that vibrate to produce your particular and distinct voice. Then, the lips, tongue, and teeth form the sounds to make speech, such as phonemes and words. For example, the tip of the tongue touches the roof of the mouth to produce the "d" sound while air is pushed out. When the tongue moves, the sounds the comes out changes. Over development, our minds create patterns for bodily movements to create specific words, or even phrases, to the point where it becomes second nature. It's quite phenomenal. So, your nose, eh? Don't believe me? Oh it's involved. Are people surrounding you? No? Good. Make the "mmmmmm" sound. You'll feel your throat and mouth vibrating. Now, pinch your nose, and try to make that sound again. Not so easy now, is it? 

What If My Child Has Difficulty Saying Speech Sounds?

Many children experience difficulty when attempting to create intelligible, clear and understandable speech. This can make it difficult for listeners to understand what they are saying. Speech sound production occurs on a developmental basis according to a child's age. By age 2, a child should be able to produce sounds such as p, d m, w, h, and n. By age 3: t, b, k, and g. By age 4-5: f, v, y. By age 5-7: s, z, j, l, r, sh, ch, th, blends (Stuckey 1). If you notice that your child is having trouble producing these sort of speech sounds around these ages, and if you recognize that they are having trouble speaking, as well as their listeners listening, it may be time to consult a speech therapist for a screening/evaluation of your child's speech production. Difficulty with producing intelligible speech is best tackled early on, and only becomes more difficult to treat as the mind tends to stick with its vocal patterns through development. 

Stuckey, Kevin. M.Ed., CCC-SLP. Super Duper Publications © 2009: How Do We Talk?

Grammar and Syntax: Put the Fun in Fundamentals

Formation of language begins at birth, believe it or not. When a baby cries, they're communicating the need for help and attention. Later, babies begin to produce sounds when they want certain objects or even family members; they are naming them: ba ba (bottle), ma ma (mother), da da (father), etc. We don't recognize this as the beginning of the development of grammar and syntax, but it actually is. Children are "speaking" and we are responding, appropriately! When we respond appropriately, we are teaching them (slowly but surely) how to talk. As a child's language is developing, parents can help children learn grammar (classes of words, their forms and functions) and syntax (the arrangement of words and the sequence in which we put them together to create meaning). Children with speech and language difficulties often have problems understanding the even the simplest and smallest units of words (-ed, -ing, -s). So, sometimes their sentences may come off as immature dependent on their age.

Children realize early on that the more words they hear and repeat, the more the world around them is expanding, or rather, their understanding of it. As early as two years old, children are trying to use prepositions, nouns, pronouns and verbs altogether to make meaning; "Me up mama," want my ba," "you go dada." Even though children put together sentences that may lack sense to a parent, they should respond appropriately using correct grammar in order to teach the child appropriate use of language. Responding with baby talk is cute up until a certain age, but there comes a time when it only reinforces inappropriate use of language. You see, when we respond using baby talk, we are telling a child that this type of talk is appropriate (we may not directly see the innate thirst to learn language in our toddlers, but it's there). Use appropriate language and children will follow ("Suzy hitted me!" - "Did Suzy hit you?")

Children with speech and language difficulties often:

• Use words in the wrong order (their sentences don't make sense or are misleading)
• Struggle to use pronouns correctly (identifies self as 'she,' 'her,' or 'me' when 'I' is correct)
• Cannot grasp how to use word endings (-ed, -ing, -s) correctly
• Do not understand how to connect sentences or thoughts using conjunctions (and, but, or, yet)
• Do not understand verb tense (past, present and future)
• Need practical experiences to understand some concepts
• Need to use concrete materials to understand plurals (one doll, two dolls) 

Here are some strategies to use with children at home to help improve their use of grammar and syntax.

• Play sentence games. For example, cut out pictures from a magazine and verbally reenact the scene. This can help a child understand nouns, verbs, adjectives and where they belong (syntax). (Picture of a dog playing catch with his owner - "What is/was the dog/owner doing?" "The dog is/was/will..., His owner is/was..., The ball is/was... " As you can see, this can also helps children understand tenses. And it will be fun!
• Play sentence games. Cut pictures of individual items out of a magazine and paste them on cards. Mix them up, have your child describe the object to you and guess what it is. ("It has icing you can eat and candles that tell how old you are!")
• Scramble! Write words on small notecards, punctuation marks: everything that makes a sentence. Scramble them up and have your child put them together in the right order. Correct them when they're wrong, but in a way that challenges them to correct it themselves. If they're wrong about where a comma goes, ask "should the comma go here, or there?". This will engage them and help them pay more attention. 
• Mad Libs! Word searches, and puzzles galore!
• Use everyday objects around the house to teach plurals. "Jerry, how many spoons am I holding in my hand?"

Resources

Spivey, Becky L., M.Ed. Super Duper Publications © 2009 Handy Handouts. "Teaching the Fundamentals of Grammar and Syntax at Home"

Sound-Object Associations: The Foundation For Language Perception and Fluency

What are Sound-Object Associations?

We make all sorts of associations in our head. They're the building blocks of memory. Our strongest sense of memory associates with our sense of smell. Like Mom's perfume that one year, until she found a new one. You went on family vacation with her at Jersey Shore, and she used half the bottle for every dinner gathering. Ten years later, if she puts on that perfume, you can't help but feel a strong sense of nostalgia for that vacation; it's so vivid it's as if it were yesterday. Tiny associations create memory. Speech and language development requires a strong memory. Sound-object associations are associations we make with sound. They're quite simple: we hear the noise an object makes more than once and this association becomes engrained in us, like animal sounds.

Children begin learning sound-object associations very young. And as they grow older and experience more of the world, they continue to create these. One of their first associations is the sound of their caregiver's voice (Kjesbo 1).

So Why Are Sound-Object Associations So Important

Sound-Object Associations Help a child learn the environment around him. They make sense of the world every day with them. "The ability to hear, recognize and attach meaning to environmental sounds is a first step toward phonological awareness (the ability to indentify, mix together, break apart, and change around the sounds in words) and literacy" (Kjebo 1). It also aids children in developing both their vocabulary skills and overall comprehension of language. 

As well, different types of sound-object associations help children in increasing their perceptual skills. In other words, the way they perceive the world around them. It can keep them safe, and we can impress these on them. For example, a child hear's a dog growl and is automatically careful around it. Hopefully he didn't find out the hard way, and his parents told him "be careful when a dog growls like that." They associate the sound of a dog growling with the behavior of carefulness. Perceptually-speaking, if they hear a dog on the TV growling, they know they're safe, and won't elicit this behavior. This is why sound-object associations are so important. They are the building blocks of language and properly perceiving the world around one's self. 

Resources

Kjesbo, Rynette R., M.S., CCC-SLP. Super Duper Handy Handouts © 2011: Sound-Object Associations - Knowing What We Hear!

Recess: The Reasoning, Psychologically Speaking

Recess, oh recess. I remember you fondly. 

There's more than meets the eye when it comes to recess. Recess can be a truly valuable part to a child's day, providing them with the energy release they need to keep attentive during class thereafter. 

For some, it's the only time during the day when they get physical activity in. This reduces the risk of obesity, diabetes and other chronic diseases, assists in improved academic performance, improves self-esteem, and reduces risk of depression and effects of stress. 

Recess is also an opportunity for children to be introduced a myriad of other skills that will help them out later in life. It improves both emotional and social skills. When free play is involved, children learn to put themselves in others' shoes, introducing them to empathy. Recess can teach children: cooperation, helping and sharing skills; respect for rules; conflict resolution skills, language skills for communicating with peers; turn taking skills; and problem-solving skills.

Finally, many children who attend recess tend to be less fidgety in class, more behaved and attentive. This is because sitting down most of the day isn't releasing a physical energy the children have, and the release of this physical energy is healthy. Recess is healthy! Reeses, unfortunately, are not.

Some children find it difficult to engage themselves during recess. They've spent most of the day learning, absorbing knowledge, and they just don't know how begin physically moving about. That's why it's important for faculty to have objects they'll have fun with, like frisbees and those harmless footballs. It gives children something to do, and it gives them something to revolve themselves around, together, in free play. 

Resources

Hodgson, Amber M.A. CCC-SLP, Super Duper Handy Handouts © 2011: Benefits of Recess

Test Taking Skills - Learn the Best Right Here, and Pass It Along

Test-taking skills…why isn’t there a class solely devoted to this? In my opinion, there should be. These standardized tests being handed out, even for children in middle school, are much more difficult than you would think. Now I’m not sure if teachers still follow this protocol (it’s been 9 years since middle school for me), but next time your child comes home with a test for you to sign, try taking it. They aren’t as simple as we’d like to think, and even for children who study for days before a big test, a lack of test taking skills could land them a below average grade. Test-taking skills are especially helpful for students with disabilities and reading difficulties. But trust me when I say that the tips I’m about to review will be helpful for any student, even up into their college years.

There have been times in my life where I was a great test taker. Other times, when anxiety hit, I’d make foolish moves on tests (like not reading directions carefully enough) that I wish I could take back. As an English student in college, I recall a drastic improvement in my test taking abilities. I’d would read a question, and keywords would immediately pop out at me; key words that triggered memory recall from my studies. And the answer would become immediately apparent. I remember I took an introductory class for poetry, a class in which we read over 200 poems by over 30 different posthumous poets. For our final, we had roughly 50 different one-liners given to us, and we were expected to know the name of each poem these lines were excerpted from, the poet who wrote them, and the year they were written. The class and especially the midterm were difficult, and so our professor promised all students an A for the entire semester given we scored a perfect grade (seemingly impossible) on this last test. I had a friend named Grace in that class, who sat right next to me during the test. The directions were simple, but the poems we read (and we were made to study ALL 200) were sometimes 50 lines long, and we were expected to recall just 1 line from each. As I read each “question”, each choppy line of poetry, keywords immediately popped out at me and I breezed through this exam within 20 minutes (out of the given 2 hours). I handed my professor my exam, who looked at me with this “you give up?” expression, and I walked out at least an hour before the next student finished up. Grace told me he immediately graded my paper and proclaimed, in front of the whole class as they banged their heads on their desks, “Tim is the first to ever ace this exam—in 20 minutes no less—and will be given an A for the entire semester." I’d have landed a B- were it not for this test (his midterm was a killer).

I digress. Your child has these capabilities just waiting to be mastered. Test taking these days is much more about memory recall than it is conceptualization, especially in middle school and high school. Don’t get me wrong, if you can help your child conceptualize their school work, it may be his/her best bet to acing their exams. But memory and word recall is also so crucial. Aside from language skills being paramount in developing strong test taking skills, there are many other ways to help your student out. Teach them to utilize these tips and they're sure to improve (unless they're already straight-A students).

Review the entire test before beginning. Skim it, at the very least. Make sure you understand what is expected from each section. Know the time allotted for the test. After reviewing each section, estimating how long each will take. Tackle the sections you know you’ll do best in first; leave the more challenging ones for last. Don’t be surprised if the sections you firstly tackle clue you in on other answers. Know the point value of each question. That is, if they are given, at least. This helps you prioritize the time you spend on each question. Follow directions to the T. This is self-spoken, but often not recognized as extremely important. Notice key words in instructions, questions, and answers. It’s also a good idea to associate key words in your studies. This might be hard to explain, but it’s simpler than you think. I’ll make an example: e=mc².  E=energy, M=mass, and C=the speed of light. Let’s say your physics teacher takes this equation, and puts it in words (most likely won’t happen), asking you what energy multiplied by mass equals. Well, it equals the speed of light times the speed of light, of course. Reread directions and questions for clarity. If you don’t understand it, reread it. And if rereading it doesn't clarify it, call your teacher for a rephrase. My Earth Science teacher liked me so much, she would point to the answer for me (shhh, I would have failed and she thought me too hilarious to flunk). Check off questions you don’t know and return to them later. Who knows, another question might clue you in on the answers to the questions left behind. Give it a chance. And finally, review the test before you hand it in! Big tests can give students high anxiety, and so when they finish, they just want out. Impress on your child how important it is to review before handing in. They may find a mistake or two, or they may stumble upon a question they initially made their best guess on only to realize (after answering a similar question later on) that it’s not the best answer.

And there you have it: 8 great tips for developing strong test taking skills. Teach these to your children or students, and even if you don’t see improvement right away, it will help them out big time, even during college. As I finish up this blog, I find myself wishing I could go back four years and retake every test. These tips would have surely helped out my GPA.

Resources

Prince, Audrey W., CCC-SLP. Super Duper® Publications (2008) Handy Handouts: Activities for Developing Test Taking Skills

Why We Drool, When Drooling Becomes Dangerous, and Tips on Reducing the Salivary Wrath

The salivary glands in the mouth produce about 2-3 pints of saliva a day. That's 2-3 of those tiny little water bottles. Gross, right? Natural, though. We're forced to regularly swallow it as to not let it fall out of our mouths while were sleeping, sometimes while we're talking, and if it goes down our airway, our natural reaction is to gag and cough. Controlling it becomes an involuntary action.

Drooling occurs with an overproduction of saliva. When a baby drools, it is because their teeth are growing in. As their teeth grow in, their salivary glands produce extra saliva to sooth the gums. This drooling behavior typically ends when a baby stops teething. But if it doesn't, it can have some negative consequences.

Adults might drool for reasons such as the removal of a tooth, particular medications, etc. An adult with excessive drooling should visit his/her physician.

Why do we need saliva?
Speech, for one. Saliva lubricates the teeth, tongue, and other areas of the mouth. When the lips, tongue or teeth become dry, it can be difficult to speak.

Eating, of course. When we eat dryer foods, our saliva steps in to moisten them up before we swallow. We need saliva to swallow and eat. Saliva also lubricates the pathways so food glides down the pipes. Digestion begins in the mouth. Saliva is the first enzyme to begin breaking down fats and sugars in our food.

So, is too much saliva bad? It can be. Parents whose children continue to drool after teething may want to consult a physician. School-aged children who haven't tackled their drooling problem might be teased, made fun of. Their clothes may become wet, and they might have bad breath because of it. Poor posture, neurological impairments and lack of sensitivity in the areas around the mouth may contribute to drooling as well.

Strategies to reduce drooling:
I wouldn't write a blog about excessive drooling without letting you in on some pretty solid tips on keeping the pillow dry. These tips include:

• Brushing the teeth or rinsing the mouth out after eating
• Eating foods and soups of different textures to improve sensory stimulation in the mouth
• Using a mirror to dry the face frequently; checking for food inside the mouth (sometimes, a child may have trouble feeling food stuck in the teeth, and needs a mirror to realize it's there)
• Massaging the mouth before meals to improve sensation within and outside the mouth

Treatment for drooling may include:

Exercises to improve the muscle tone, strength, sensitivity, movement, and stability of the structures in the mouth

Prescribed drugs that help decrease the production of saliva

Radiation therapy to help decrease the production of saliva (although I personally wouldn't advise this unless it were a dire situation with the utmost necessity for it, when all other options are exhausted)

Surgery on the glands around the mouth to help reduce production of saliva

 Parents should realize that not all children are the same, and some may take longer to stop drooling than others.
Then, there are those we hope will never stop drooling.

Resources

Hutton, Thaashida L. M.S., CCC-SLP, Super Duper Handy Handouts (2009):  All About Drooling

"Site Words" and their Importance in the Development of Reading Skills

"Site words" are written words that children associate strongest with their site. "Cat" is an example of a site word. A child may see a cat very often, and so it is easier for them to recall and say the word "cat" than it is to say the word "lion." They are simply words that a child sees over and over again, to the point where it becomes it's own entity. It becomes a whole word rather than letters pieced together, and the child spends less and less spelling out site words and instead, they just come out. These site words are a crucial beginning for the development of reading skills (Daymut 1). Not only are site words crucial in building a base for vocabulary skills, they also help children to read fluently. As a child develops fluency skills, his/her attention on figuring out what each word means turns into an attempt to comprehend a sentences meaning.

So now that you understand the importance of site words, here are some ways you can help your little one learn more and more of 'em.

At home:

• Label common objects around the house with sticky notes. 
• Write site words on the house chalkboard (if you have one) or during sidewalk chalking, or encourage your child to write what you draw
• Put magnets with site words on the refrigerator
• Read story books that say words over and over again (Brown Bear, Brown Bear, What Do You See? or Goodnight Moon)
• Make grocery lists and read the common words with your child, especially those items he/she indulges in

At school:

• Create a wall with site words and add new ones to it every week
• Have children practice reading site words
• Have students read newspapers, magazines, journals, animal books, and highlight all the site words they can find (that are on your wall)

Resources
Daymut, Julie A. M.A., CCC-SLP, Super Duper Handy Handouts (2009):  Site Words

Pretend Play and its Real Benefits

You see it all the time. It makes you truly wonder; it also makes you remember. You can’t stop it, even when supper is ready. It wants your child. Playtime: it just seems so unproductive. Your kid wants to be out there engaging in “pretend play,” and although you’d rather have them preparing and focusing all their strength on school (this sounds like a ticket straight to college), pretend play has some pretty great benefits for achieving healthy development. Now, I know this might sound crazy when you’re watching your little guy run around with his equally imaginative friends exploding aliens with invisible grenades, but bare with me.

Pretend play is an important part of childhood. You may see it begin around the toddler stage. Children learn about their friends, their family, and the world around them when they pretend play. When their imaginations take over, they’re learning social skills, vocabulary skills, problem solving skills, and even disciplinary skills, all timed perfectly in their early development (Hodgson 1).

When children are playing together, they practice sharing, turn-taking, and negotiating. They’re building a foundation for social-emotional skills. They’re acting out certain experiences, pretending to endure them, and this can guide them in control of authentic emotion. And as they play around with consideration of how their peers act, think and feel, they’re scooping a place in their heart for empathy.

Children have a myriad of experiences to share with each other, all new and exciting. When they engage with each other, they’re learning language and vocabulary skills. When they communicate with each other, especially when they tell each other stories, they must develop a logical plot with a sequence of events. Fact is, they’re learning.

During pretend play, children often come up with their own problems to solve. It’s like their miniature model of the world. If a problem arises (or is created) during their journey, they must think as a team of ways to overcome said problem to successfully reach their final goal. It engages their imagination, and gives them a smaller feel for problem-solving skills. Early introduction to problem-solving skills, as you might easily believe, is crucial in its stronger development later on in life.

Children will often practice with rules when they play. And when someone breaks a rule, another is bound to put his/her foot down. This is discipline in their small, imaginative world, and it can prepare them to understand and learn from discipline later on in life.

So how can you encourage pretend play if your child isn’t displaying it? Well, for starters, make time for it. Try not to overload your child’s plate with extra-curricular activity; leave them time for unstructured play. Creativity takes time to develop, and children can have difficulty entertaining themselves if they aren’t given enough free time to use these imaginations (Hodgson 1).

• Show them that play is valuable by playing with them. They’ll realize it’s important if they see their parent or caregiver paying attention to them while they’re playing. I mean why not, I’m giving you an excuse to be a kid again. Take it! It’s one of the best parts of having kids. Don’t miss out on it.
• Appreciate the skills, no matter how minuscule, that they display during pretend play. If you see them solve a problem in some crafty, totally unrealistic way, praise them for it. This can really up your child’s interest in pretend play.
•  Give your child a place to play. Fill it with props, things to explore and play with.
• You should monitor your child’s playtime. Not only to keep them safe, but to offer them ideas when they seem stuck. If they’re getting bored, be their muse. Offer new props, new character roles, or new places to “explore”.
• Children get their ideas for pretend play from life itself. Usually, what interests them the most finds its way to the plot in your child’s epic unwritten novel. Find out what they’re interest is and go with it. Read them books on it. This will give them plenty of ideas for pretend play!

Why Consistent Attendance in Speech Therapy is So Important

In Speech-Language Therapy, the frequency and duration of visits is always dependent on the child and their particular needs. It’s the therapist’s duty to set these expectations, but it is up to the parent to impress their follow-through. Some parents don’t understand this about the practice, so I feel it my duty to expand on the reasons why consistency in this type of therapy is so important. 

Routine therapy is best for both the child and the therapist. If a child misses out frequently, they may be regressing much rather than progressing. This regression has consequences. If a child takes a backward step in therapy, the SLP must then spend valuable time re-teaching certain language skills. 

A lot of children who see speech-language pathologists are still in their developmental period. Their brains are continuously being filled with unfamiliar stimuli. Place yourself in their shoes. Do you really think you’d be able to learn anything inconsistently, while a myriad of new and exciting experiences pass you by. Some children with speech difficulties don’t understand the importance of speech language pathology. Consistency can help with this too: it’s a reminder and a goal-oriented experience. It’s important not to let a child lose their ground in speech-language therapy.

There will come a point when a child has improved to a certain level. At this point, the SLP may reduce the amounts of visits, say, from twice a week to once a week. This is all dependent on the amount of mental work the child puts into therapy and the consistency as well. At home practice, as you may know, is crucial in reaching this level, until the only place it is practiced is at home.

And this is probably the most important part: after therapy. For speech-language therapy to be most successful, parent involvement is an important factor even after therapy. Speech therapy takes setting goals and practicing toward perfecting them; much like any other activity of this caliber, it can diminish. All the wonderful skills a child has learned during therapy can cease to exist, be forgotten if parents don’t continue to impress these skills. So, if your child is in speech therapy, and you want to get the most of their potential, continue to practice at home. Bring the success your child learns at speech therapy and guide them in continuing it at home.

Resources

Stuckey, Kevin M.E.d., CCC-SLP, Super Duper Handy Handouts (2001):  "Consistent Attendance in Speech/Language Sessions - It's Important for Children and Their Communication!

Childhood Apraxia: Understanding It and Treating It

Childhood Apraxia of Speech (CAS) is a specific speech disorder which involves a difficulty in planning and consistently producing sequences of speech using the tongue, lips, jaw and palates. This difficulty can prevent a child from producing intelligible speech. It is not a weakness of these structures that produces this difficult; rather, the difficulty originates in the brain. A child with CAS has trouble putting these structures to use properly in order to form comprehensive statements or sounds.

When we communicate, an idea first forms in our brain as to what we want to say. Our brain thinks about the words it needs to recall and produce as well as the order in which these words should be produced to correctly verbalize our ideas. This information than translates into highly coordinated movements of the tongue, lips, jaw and soft palate, AKA the "articulators". The brain tells the muscles that control articulators the exact order and timing of movements to produce intelligible speech. Children with CAS may not be able to accurately and consistently produce these plans, due to neurological impairments or developmental disabilities.

When a child receives a diagnosis of CAS, he/she needs to begin speech therapy. This type of therapy varies for children according to the severity of their diagnosis. Experienced therapists may attempt different therapies, since there is no "one-size-fits-all" approach to treatment and all children are motivated differently. They may need frequent one-on-one therapy, lots of repetitive practice with sounds, sequences, and movement patterns in order to be able to automatically incorporate them into their speech normally and intelligibly. Overcoming apraxia of speech can be tedious, but it is well worth it. Practicing at home is crucial in just about any speech and language program; this one especially.

Many therapist recommend the use of sign language, picture communication systems, and other augmentative or alternative communications. Combined therapies (sign and vocal word attempt) may enhance the chance that the listener will be able to understand the child. This will help with their self-esteem, which will help with their motivation in speech therapy and overcoming apraxia.

Young children recognize their speech difficulties, and any successful communication experience will encourage them to work harder. This is why various therapies and a continuous aim is highly encouraged by therapists. For some children, visual cues (ie. pointing to lips to insinuate a "b" sound) can aid in learning to use their articulators to produce a desired word. When a word and sign are consistent, children begin to associate the visual image of the sign with the placement of the articulators.  It's a very complex form of treatment for a very complicated disorder, but it works if a child works it.

If you notice speech delays or difficulties with your child's production or problems with his/her communication skills, please contact your physician or consult a speech-language pathologist in your area.

Resources

Spivey, Becky, M.ED. Super Duper Handy Handouts (2001):  Tongue Thrust, Dental Problems and Lisps

Oral Motor Development: The Baby Steps

What is oral motor development? 
Oral motor development simply involves the use of lips, the tongue, the jaw, the teeth and the hard and soft palates. Proper movement and coordination of these structures are crucial in speech production, safe swallowing, and consuming different food textures. Consistent oral motor activity begins prior to birth and continues beyond age three. By age four, most children can safely consume solid and liquid food without choking.

The milestones I'm about to list are typical, they are not strict by any means and all infants develop at their own rates. Use these milestones as a guide in monitoring your child's progress toward oral motor and swallowing development. It is suggested you consult your pediatrician before introducing new foods to your baby.

Before birth, the baby begins to develop sucking reflexes (around 36 weeks).

From birth to 3 months old, a baby will:

• Demonstrate many reflexes to protect his/her airway
• Respond to stimulation in and around the mouth
• Turn his/her head toward the nipple when a caregiver strokes his/her cheek (this is a sign for "I'm hungry")
• Consume breast milk or formula using a nipple
• Coordinate his/her breathing with two to three sucks of liquid before swallowing and breathing

From 3 to 6 months, the baby will:

• Bring both hands up to clasp the bottle, but may need assistance holding it
• Consumes rice cereal or pureed fruit and pureed vegetable baby foods
• Eats from a small infant/toddler spoon during feeding

From 6 to 9 months, the baby will:

• Hold the bottle independently
• Clean the spoon with their upper lip (get the whole airplane up in there)
• Eat pureed meats and a variety of pureed baby foods (pureed is a strangely spelled word)

From 9 to 12 months, the baby will:

• Show lip closure when swallowing liquids and soft solids
• Begin to self-feed by using his/her fingers to grab small food. The baby may attempt this with small, soft and easily dissolvable foods. Now I want Cheerios -_-
• Begin experimenting with a sippy cup
• Begin to consume mashed table foods
• Drink from the sippy cup and attempts to hold the handle by his/herself
• Drink through a straw

At 12 to 18 months, the baby will:

• Coordinate his/her sucking, swallowing, and breathing patterns for longer sequences
• Eat finely chopped table foods
• Bite through crunchy foods, like cookies or crackers
• Move the food in her/her mouth from side to side as they chew

At 18 to 24 months, the little one will feed him/herself using a spoon, but still may need assistance with this.

At 24 to 36 months, the medium one will:

• Eat and drink a variety of solids and liquids through a straw and open mouth cups
• Use a spoon to scoop soft foods while feeding him/herself 
• Independently move toward find tuning all feeding skills

At 36 to 5 years, the large one will:

• Progress toward chewing and swallowing more advanced textures such as meats, fried foods, whole fruits, etc. with close supervision by a caregiver
• Begin to use a fork to stab food (also, with supervision)
• Drink from an open mouth cup with no assistance

If this sounds like a lot to coordinate, look forward to the little things. Like catching this candid face on camera:

Resources

Richmond, Megan-Lynette. Super Duper Handy Handouts (2016): "Oral Motor Development Milestones"

The Lisp, The Tongue Thrust and their Subsequent Dental Problems

The lisp is a speech disorder known amongst, well, just about everybody. Everyone has heard someone with a lisp, and plenty have had a lisp of their own which diminished with age. What some people don't know is that their are two different types of lisps: "interdental" and "bilateral".

Interdental lisps are most commonly occurring. Sylvester suffers from an interdental lisp. While making an "S" sound, Sylvester pushes his tongue through his front teeth, create a "th" sound where a "s" sound should be.

Then, there's the bilateral lisp; a little less common. This occurs when air is pushed through the sides of the mouth because the tongue lies flat when it should be curling during pronunciation of the "s". Think about Sid the Sloth from Ice Age when you're picturing a bilateral lisp. Cartoon characters never catch a break. These two can't even get their names right. 

Oh Sid. You're the reason everyone suddenly loves sloths. But there you have it. There are actually two different types of lisps, in case you didn't already know. Both treatable at the Suffolk Center for Speech. 

The Tongue Thrust, also known as a "reverse swallow," is very common in young, school aged children. Babies use this "reverse swallow" at birth in order to protect their airway. But, as a child grows, they develop a better pattern, and the tongue thrust action should cease. For those whose tongue thrust does not cease, there can be a few well-regarded contributing factors. Developmental delays, hereditary factors, premature loss of teeth, thumb sucking, respiratory difficulties, and even prolonged bottle feeding are all possible causes of the tongue thrust problem. 

To help you visualize the tongue thrust, you can compare the normal swallow to the deviant swallow of a "tongue thruster". 

During a normal swallow:

• teeth and lips are sealed, relaxed and firm
• the tongue tip presses up against the top teeth
• the anterior of the tongue slopes downward to push food into the throat
• a negative inter-oral pressure forces the tongue into a wave like motion

During a deviant swallow:

• sides of the tongue press against the inside of the front teeth
• the front of the tongue pushes upward and the tip of the tongue thrusts forward, sometimes through the teeth and lips
• the lips are pursed, the jaw is open
• food is pushed back with a "positive pressure"

The Dental Problems

The continual thrusting movement against the front teeth causes a Class II Malocclusion: an overbite. Orthodontists give children with these overbites a set of braces with an anterior cage. Significant spacing between the front teeth is another problem often ensued by the tongue thrust. 

Why Speech Therapy?

Research into the tongue thrust problem suggests that it results in a lisp with secondary orthodontic features. Braces cannot cure the problem without "myofunctional therapy". The lisp also requires "myofunctional therapy" for remediation. 

Children who present these problems often see speech therapists in school, or privately. Therapy consists of a combination of strengthening the tongue, repositioning it, and practice with producing the correct "s" sound. An orthodontist and speech therapist paired will confer on an appropriate time to fit braces and start therapy. Children who still bare intrusion of the tooth fairy every so often may not be ready for this. But, some children who are still losing teeth get the therapy anyways because of poor speech intelligibility in the classroom.  Lisps and the tongue thrust problem should not be ignored based on the importance of applying good dental health (braces, a retainer, etc.). Most often, these treatments alone will not fix the underlying tongue thrust problem, and so myofunctional therapy is crucial for young tongue thrusters. If you suspect your child is a tongue thruster or is exhibiting a lisp, and likewise if you are a teacher and suspect this of a child, bring the child to a speech therapist or fill out a speech referral form.

Resources

Merket-Piccini, Robyn, M.A. CCC-SLP. Super Duper Handy Handouts (2001):  Tongue Thrust, Dental Problems and Lisps: A perfect combin

Ten Surefire Ways to Teach Good Manners

I'm 23, and I'm still, well, mannered. See what I did there? But I am, when I have to be especially. Teaching good manners is extremely important, and whether or not your standards meet those of the world, it's still important to teach your child to mind their matters. It's expected from a lot of the world to maintain good manners, so best start early. Here are some sure-fire ways to teach your child good manners that will be a pleasure for both you and your child.

1. Model good behavior. Be their shining example. Use good manners when talking with them and use good manners when talking with others. In their youngest years, their behavior usually emulates a child's behavior. So take this one seriously if you want to see your child mind his matters.
2. Teach polite words. "I'm sorry" "please" and "thank you" are winners. "May I" is trending. Explain what these words mean to them, and how important they are to use. And of course, always make sure they use them .
3. Watch children's TV shows with them. A lot of children's shows teach good manners, and they're a great way to do so because children enjoy them. Try and find one that they truly enjoy and laugh at, or just express emotion over. More emotion probably means they're placing a significance on the show and it's messages or motifs. Address when they should model good behavior they see on the show. 
4. Role play good manners. I already said model it, but role play it too. What goes on at home is much different than what goes on outside, so make sure your child is prepared to be well mannered in the world by role playing scenarios like them. Don't over-complicate brainstorming for scenarios. Base your scenarios on times in which you believe your child should use the "polite words" I listed above.
5. Read books about good manners. I wish I had a list for you, but I don't remember much of the first books I ever read. The reasons this is successful mimic those of #3.
6. Praise good manner. And I mean always. Or at least when it's most plausible: at home. You don't have to praise it right away, so long as you tell them that their good manners at such-and-such event earned them a day of lazer-tag. Positive reinforcement will increase the chances of good manners sticking.
7. Give replacement behaviors. When you see your child display bad behaviors, explain to them why the behavior was bad. But, additionally give them a replacement behavior, something they should have done instead of what they did do, or what they did say. 
8. Play in good manner games. What are those I know. A good example is picking a "well-mannered word" of the day. Have them count how many times they heard said word and inform you at the end of the day. The game should take you approximately 2 minutes  (to hear out a scenario or two), and them all day. 
9. Make rules and set expectations. The younger the better. When children grow older it's difficult for them to understand reasoning behind new rules and often rebel against house rules, so make them early and stick to them!
10. Enroll your children in etiquette class. Check to see if your school has it, and if they do, why not. Enroll them. It's a life skill outside their career that's most important. Putting them in a learning setting can help them when it comes to applying it in real life. 

Teaching good manners can be a long road for some, but it's for the best. Trust me, they'll thank you later.