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NYC Speech Development and
Parent Concerns
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What is Floortime?
Floortime or the D.I.R. (Developmental, Individual, Relationship-Based) Model created by Stanley Greenspan, M.D. and Serena Wieder, Ph.D. uses motivating experience-based learning to improve language, independence, specific concepts and social skills to children with language delay.
Traditional language therapy often focuses on teaching specific skills, which children may memorize. With some children, this results in rote, unnatural responses.
Floortime, along with other contemporary language approaches, respects and engages a child's individuality and interests while challenging him or her to become a more related and logical thinker.
Parents have the power and ability to help their child communicate and learn, especially when guided by a Floortime trained speech therapist. While following their child’s lead, parents help their child learn within the natural conversations of daily activities and play.
For more information, or to find a Floortime therapist in your area, please visit: http://www.icdl.com/ |
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What is the difference between speech and language?
When a mom or dad calls me to set up an appointment for their child, we often discuss their concerns at length. Parents are often confused about the difference between speech and language.
Speech is the production of sounds that make up words and sentences. It involves the coordination of the jaw, lips, tongue, vocal folds (vocal cords), vocal tract and respiration. There are three divisions of speech:
1. Articulation - This is one of the most common reasons parents contact me, I typically hear things like “I am the only person that can understand my daughter.” or “My son is having trouble pronouncing R.” Treating articulation disorders is one of my specialties.
2. Voice – A consistent raspy or hoarse vocal quality or history of vocal nodules is a reason to seek out a speech therapist.
3. Fluency –The ease and flow with which words are connected in conversation. A disorder of fluency is stuttering. It is considered normal for young children to have some dysfluent speech. If the stuttering becomes more prevalent, it would then be appropriate to consult a speech pathologist that specializes in working with children who stutter.
Please contact me for recommendations of therapists that specialize in voice and fluency in New York City. For helpful information on stuttering, check out these resourceful websites:
www.stutteringhelp.org
and
www.nsastutter.org
Language refers to the use of words and sentences to convey ideas and express our wants and needs. Speaking, gesture use, writing, understanding verbal conversation and understanding what one reads are all language related.
Parents with children with language delay / disorders often report to me “My daughter is 18 months old and she only babbles, she doesn’t have any words.” or “My son is 2 and he has trouble putting words together to make sentences.”
I am a pediatric speech and language pathologist (AKA speech therapist) specializing in improving articulation (speech) and language skills. Many of the parents I work with are often craving ideas about how to help their child's speech and language skills thrive. I enjoy sharing ideas with them that are appropriate for their particular child.
I evaluate and treat children in their Manhattan homes and encourage parents to learn how to ask good questions, model language in an optimal way and follow their child’s lead to create an effective playtime. Exercises to improve the muscles of the jaw, lips and tongue are often incorporated into these sessions.
Maximizing your child’s speech and language skills will help build relationships with siblings, family, peers, teachers and most importantly, you.
If you live in Manhattan, and have speech and / or language concerns for your child, please contact me for an appointment:
Stephanie Sigal M.A. CCC-SLP
646.295.4473
email: sayandplay@yahoo.com
website: www.sayandplayfamily.com
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What is the most appropriate theatre you’ve experienced lately for children?
Check out Fairytales for Children at Galli’s Fairytale Theatre (38 West 38th Street on the 3rd floor between 5th and 6th Avenues: http://www.galli-group.com/ ). We recently saw Galli’s Rumpelstiltskin. It was beautifully told and orchestrated. The theatre encouraged children in the audience to sit together in the very front on sleeping bag type blankets, practically on the floor-level stage. The story was told at a level a three year old could easily relate to, and the cast delightfully incorporated the children into the show. For example, when the queen’s servant was sent to find unusual names, the servant calmly approached children in the audience and asked them their names. Unusual is an understatement when it comes to the names of NYC kids! The cast also asked open ended questions to each other, but the children felt they were a part of the play as well, and easily shared their responses aloud. The play was funny and creative, even for adults.
Leave yourself plenty of time to arrive on Galli’s third floor theatre – the single elevator that comes with instructions only fits four at a time. After the play, you can talk about it with your child while picnicking in Bryant Park or riding the carousel. You can also plan out what Galli Fairytale you plan to see next time.
You’ll find that reading Rumpelstiltskin, retold and illustrated by Paul O. Zelinsky will help give your child a better appreciation for the play.
You can find the book here:
http://www.amazon.com/Rumpelstiltskin-Brothers-Grimm/dp/0525442650/ref=pd_bbs_1?ie=UTF8&s=books&qid=1210129095&sr=8-1
For techniques about reading to your young child, check out the Kids’ Books page of my website:
http://www.sayandplayfamily.com/books.html
My two and four year old have enjoyed a number of family productions this past year at The New Victory Theatre, check out their website for their ever changing shows:
http://newvictory.org/ |
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My child's teacher told me that I should discourage my daughter from sitting in a "W" position. Why?
From a speech / articulation perspective, a W sitting position does not allow for good respiration, phonation and articulation. A child needs a strong and stable trunk to support the muscles of the jaw, lips and tongue.
From a physical and occupational therapists point of view, excessive W sitting during the growing years can lead to future orthopedic problems (e.g., hip dislocation and muscle tightness at the: hamstrings, internal rotators, and heel cords). A child is planted in place or "fixed" through the trunk in this position. The trunk can not rotate and the child can not use lateral weight shift which reflects on overall balance.
W sitting discourages crossing over midline because a child is fixed playing with toys right in front of him or her. A child who sits in this fashion may have difficulty determining hand preference because he or she may do everything unilaterally in this fixed position.
Please encourage a "criss-cross applesauce" (AKA Tailor Sit, cross legged, or the non PC "Indian Style") position all the time while seated on the floor.
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Hi Stephanie, I’ve heard you speak to my Mommy and Me group about creating a language enriching environment. Any new suggestions?
Spring is a perfect time of the year to bring Eric Carle’s book The Very Hungry Caterpillar to life!! Each year at this time, we re-use the Butterfly Garden we received as a gift. We simply order a live butterfly culture refill from the website listed below. Usually when we receive the culture, we have 5 very tiny caterpillars. The food for the caterpillars is included in the jar that has ventilation. All we do is observe the caterpillars crawling around and eating. They quickly grow and suddenly climb to the top of the jar and change into chrysalides. While they are in this stage, I carefully remove the lid and pin it inside the Garden so they still remain hanging. When they emerge, it is incredibly exciting. Beware! The butterflies have a red liquidy poop when they first emerge (I fondly refer to this as meconium J) so keep the pavilion away from anything you don’t want stained. We cut a small orange in half and place it at the bottom of the Garden for the butterflies to drink. After a few very thrilling days of observation, we take the butterflies to our favorite park and release them, to “do their jobs” as my son says.
You can just imagine the discussions you will have with your child through all the stages (great for learning to sequence!), the vocabulary he will acquire and the fantastic science behind it all!! Ask good "WH" questions (e.g., What are the butterflies doing? Where did they fly off to? Why do we give the butterflies an orange?). Don't forget to take pictures so you can practice discussing remote events. Your child will be so grateful for the experience and you will have provided a solid learning and bonding opportunity while exposing him to new language skills. You may also be reinforcing what is being discussed in his classroom!
This particular link includes the Butterfly Garden with the live insects. If you are giving it as a gift, or you’re not ready to raise the butterflies this week, purchase the garden with a mail-in certificate instead:
http://insectlore.stores.yahoo.net/butgarwitliv1.html |
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Should I have my child's hearing tested?
If you are concerned about your child's speech and language skills, you should have his or her hearing tested in a sound proof booth with a licensed audiologist before pursuing speech therapy.
In my phone interview, I always ask parents: "Have you had your child's hearing tested in a sound proof booth?" I always get one of three responses:
1. "He had his hearing tested at birth and he passed." This is a misconception because that was a hearing screening (not a test) and it only screened your child's hearing at THAT time.
2. "The pediatrician tested his hearing and he's fine." Again, this was a screening, not a complete test in a sound proof booth with a licensed audiologist.
3. "He can hear everything, I'm not concerned." I'm sure he can hear, but he may have difficulty, for example, hearing high frequency sounds such as S and F, which could make it difficult for him to produce these sounds accurately, or understand certain words in rapid conversational speech, especially in a classroom setting.
It is not possible for a parent to determine if their child can hear accurately without having a complete audiological exam.
Please feel free to contact me for a referral in Manhattan.
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It is difficult for people who don't know my child to understand what she says. What is your approach for improving articulation problems in children?
Along with traditional speech therapy techniques, I use a muscle-based (oral-motor) approach to improve the muscles of the jaw, lips and tongue, which support each other in this order. When completing a muscle-based assessment, I begin at the level of the jaw, administering child-appropriate exercises that a parent or caregiver may carryover for homework. Exercises for the lips or tongue may be incorporated as well, depending on your child's skill level. These exercises may include blowing horns and bubbles using specific, hierarchical, adult-directed methods that target the necessary movements for effective speech production.
Exercises to be completed at mealtime may also be incorporated. For example, when a child drinks from an open cup, we only want them to use their lips to take a sip, we do not want them using their teeth (jaw) on the cup. It is best to see dissociation - the jaw, lips and tongue working independently. The same is true for removing pureed food from a spoon. We want children to remove the food with their lips only. I teach children and instruct their parents / caregivers how to do this most effectively to improve muscle movements used for standard speech.
We also want to eliminate the use of pacifiers, bottles, sippy cups, etc. as the suckling action that occurs will work against all our efforts. Nutrition should never be compromised; the bottle or sippy cup should be removed when the child can drink effectively from an open cup or straw.
The recommended exercises are thoroughly discussed with parents during or at the end of each therapeutic session, and a written program plan along with detailed instructions is consistently provided. Parents are encouraged to call or email with questions about the homework in-between sessions to maximize skills.
The specific sounds your child is having difficulty producing are analyzed using a standardized test. It is then determined which, if any sounds would be appropriate to address, depending on the muscle-based results.
I have found that using a muscle based approach, along with traditional articulation therapy (targeting individual speech sounds) increases children's speech clarity in conversation, rather than simply at the word level. |
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My two year old son is currently receiving speech therapy for a language delay. I have heard about PROMPT – is this a type of treatment I should arrange for him?
PROMPT involves using dynamic tactile cues (paired with verbal and visual cues) to stimulate speech production in children who have difficulty articulating specific sounds. PROMPT may also be used with children who have a motor-based speech disorder, such as developmental apraxia of speech (difficulty forming sounds into words).
When I begin working with a two year old who is not speaking or has very few words, I often incorporate PROMPT techniques, along with traditional language development play therapy. We can not rule out that this child isn’t speaking because of a motor-based problem, so combining PROMPT along with oral–motor therapy can play an active role in facilitating language development. Oral-motor treatment should be used in a hierarchical approach to develop awareness, strength, coordination and mobility of the jaw, lips and tongue. Using these three techniques simultaneously will provide a complete treatment package for your son.
Ask your current speech pathologist if he / she is trained in PROMPT and if he / she has significant training and experience with oral-motor therapy.
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I’m ready to wean my child from a bottle. Should I use a Sippy Cup?
A Sippy cup is simply a bottle in disguise – there is nothing functionally different. Parents should pursue bottle weaning by age one, as suckling on the bottle promotes a variety of potential issues, including poor development of mouth muscles for speech. Dentition is also often affected by suckling.
The shape of the Sippy cup spout and the suction / resistance that the no-spill feature provides are just as harmful as the bottle. Skip the hassle of transitioning to the Sippy cup, teach your child to drink from an open cup (you can begin when your child starts solid foods) and properly from a straw to avoid another (painful) transition down the road.
I teach children on my caseload how to drink properly from a straw via the Talktools Straw Kit, created by Sara R. Johnson. |
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