Trish Friedlander 10/10/24 Trish Friedlander 10/10/24

Kids, Screen Time and Recommendations

The Real Scoop on Screen Time for Young Children: How Much is Too Much?

Let’s talk about something that’s become a big part of our daily lives: screen time. Whether it’s a quick YouTube video during breakfast, a tablet app to keep kids entertained on a car ride, or a cozy movie night, screens are everywhere. But how much is too much? Does too much viewing lead to language delays? And how can we make sure screen time is a positive experience for our children’s development?

Quantity Matters: Setting Limits on Screen Time

The American Academy of Child and Adolescent Psychiatry suggests that children under 18 months should only have screen time for video chatting with an adult. For kids aged 2 to 5 years, the recommendation is to limit non-educational screen time to about one hour per weekday and up to three hours on weekend days. These guidelines help ensure that children have enough time for other important activities, like playing, reading, and interacting with others, which are essential for their development.

The American Speech Language and Hearing Association (ASHA) collaborated with the Children's Screen Time Action Network at Fairplay to develop the Be TechWise series. These printable handouts—available in English and Spanish—focus on screen guidance for families with babies, toddlers, and preschoolers.

The main concern isn't that watching TV directly leads to language delays. It's that kids benefit the most when they're actively engaging in conversations with others. Problems can arise if screen time replaces those important real-life interactions and activities that support their development. Our best strategy? Let's give our kids plenty of opportunities to talk, explore, ask questions, and have meaningful interactions.

Quality Over Quantity: What Kind of Content is Best?

It’s not just about how much screen time children have—it’s also about what they’re watching. Research shows that fast-paced, highly stimulating shows like CoComelon and Little Baby Bum can negatively impact a child’s development. These types of shows often have rapid scene changes, flashy visuals, and non-stop action, which can overwhelm young brains. This overstimulation might lead to shorter attention spans, difficulty concentrating, and potential issues with speech and language development.

On the flip side, slower-paced, educational shows can have a positive impact. Shows like Bluey (Disney+), Sesame Street (PBS), Daniel Tiger's Neighborhood (PBS), and Mister Clay (YouTube) are excellent options. These programs are designed with young children's developmental needs in mind. They promote learning through storytelling, problem-solving, and emotional intelligence, all while engaging kids in a fun and age-appropriate way.

Co-viewing screens turns passive screen time into an active activity

The Importance of Co-Viewing: Watch Together and Talk About It

One of the best ways to make screen time beneficial is to watch together and engage in conversations about what’s on the screen. This co-viewing experience turns passive screen time into an interactive activity. For example, you can pause a show to ask questions like, “What do you think will happen next?” or “Why is the character feeling sad?” This not only boosts comprehension and critical thinking but also enhances language development. Talking about and/or acting out a show after viewing is a great way to facilitate pretend play and language skills.

But when it comes to learning to talk, the most important takeaway concerns the effects of live conversations between children and adults.

Balancing Screen Time with Real-World Interactions

While screens can be educational and entertaining, they should not replace real-world interactions. Research has shown that children learn language best through direct interaction with adults and peers. Conversations, reading together, playing, and exploring the world around them are crucial for building strong communication skills. If screen time begins to replace these real-world activities, it may hinder a child’s ability to develop essential social and language skills.

Gestalt Language Learners can really benefit from using phrasing from songs or TV shows as their initial communication. When parents watch with their GLP (gestalt language processors), they are more easily able to identify the context of the phrase. One of the cons of lots of screen time for GLPS is that, “If a child only views media as their source of language, they might be inclined to continue amassing hundreds of gestalts from media, and potentially struggle to connect with natural language in their environment.” (Meaningful Speech, May 2024). To learn more about Gestalt Language processors click here)

recommendations for high quality shows for young children

High-Quality Shows to Consider for young children:

Here are some great shows that balance entertainment with educational value:

Bluey (Disney+): This show features a lovable Australian Blue Heeler puppy named Bluey and her adventures with family and friends. It promotes creativity, problem-solving, and social-emotional learning.
Ms. Rachel (YouTube): Focused on early language development, Ms. Rachel engages children with songs, stories, and interactive activities that encourage speech and communication skills.
Super Simple Songs: (You Tube) These songs have a variety of themes and the animations are, well…. simple. I often slow them down so children can sign along.
Mickey Mouse Clubhouse (Disney+): A classic choice for young kids, this show combines problem-solving with fun adventures led by Mickey and his friends.
Sesame Street (PBS): A long-time favorite that mixes fun with valuable lessons on literacy, numeracy, and social skills. It’s perfect for co-viewing and discussing topics like kindness, sharing, and understanding emotions.
Mister Clay (You Tube): Mister Clay is a fellow SLP who incorporates picture symbols into his songs. His songs are repetitive, catchy and teach real life concepts in a really fun and humorous way.
Daniel Tiger's Neighborhood (PBS): Based on Mister Rogers’ Neighborhood, this show helps young children learn about emotions, routines, and life skills in a gentle, relatable way.
Boom Learning: These are digital, educational activities developed by educators that parents and children can use together as a shared activity. I use Boom Cards in speech therapy to target speech and language skills. Take a look at my Boom store for interactive activities such as “Who is Knocking on my Door?” and “Vet Clinc for Preschool Children” which are a HUGE hit with young children!

Making Screen Time Work for You

Remember, screen time isn’t inherently bad—it’s all about how we use it. By being mindful of the quantity and quality of the content, and by actively engaging with our children during screen time, we can turn it into a valuable tool for learning and growth.

Think of screen time as one of many tools in your parenting toolkit. When used thoughtfully and balanced with other activities, it can be a positive part of your child’s development. So, let’s make the most of it! Watch together, talk about what you see, and don’t forget to turn off the screens and enjoy some unplugged playtime, too. Your child’s brain—and future self—will thank you!

Trish Friedlander 8/28/24 Trish Friedlander 8/28/24

Understanding Communication Milestones: A Guide to Speech and Language Development for Young Children

When it comes to young children's communication milestones, understanding typical speech and language development is key. As parents, caregivers, or educators, it's essential to know what to expect as children grow and develop. Monitoring these milestones can help you recognize if your child is on track or might benefit from the support of a speech-language pathologist or audiologist.

**“NOT ALL CHILDREN MASTER SKILLS AT THE SAME AGE”**

The American Speech-Language-Hearing Association (ASHA) provides valuable developmental milestones handouts that outline what most children achieve at specific ages. These handouts cover both communication and feeding/swallowing skills, giving a comprehensive view of a child's development. However, it's important to remember that these milestones are general guidelines. Not all children will master these skills at the exact same age, and that’s perfectly normal! The goal is to observe continuous progress in speech and language skills over time.

Key Points to Remember:

General Guidelines, Not Strict Rules: Milestones are not a diagnostic tool. They're a helpful reference to guide you in understanding typical development. Each child is unique, and variations are common.
Look for Continuous Development: Rather than focusing solely on specific ages, consider the broader range of development that may happen before and after the expected age. This holistic approach allows you to see a clearer picture of your child's progress.
Know When to Seek Guidance: If you're ever concerned about your child's communication or feeding skills, don't hesitate to reach out to a professional. Early intervention can make a significant difference in helping children reach their full potential.

**“GET TEXTS ABOUT MILESTONES, SUGGESTED ACTIVITIES AND WARNING SIGNS OF A SPEECH OR LANGUAGE DELAY”**

Resources for Parents and Caregivers:

ASHA has partnered with Bright by Text to provide free, expert-backed resources and tips directly to parents and caregivers of children ages 2-6. By subscribing, you'll receive text messages with practical activities and advice tailored to your child’s age. Content is sourced from trusted organizations like PBS and Sesame Street, covering topics from language and early literacy to health, safety, and behavioral tips. You can get texts about speech and language milestones, suggested activities and warning signs of a speech or language disorder or delay. Text TALK to 274-448

For more detailed information on communication milestones and to access ASHA's developmental handouts, visit ASHA's developmental milestones page. These resources are designed to empower you with the knowledge you need to support your child’s speech and language development effectively.

How much of my child’s speech should I be able to understand? Click here for guidelines.

Remember, every child’s journey is different. Celebrate the progress your child makes, and don't hesitate to seek support if you have concerns. Together, we can ensure our children grow into strong communicators, ready to engage with the world around them.

Trish Friedlander 7/23/24 Trish Friedlander 7/23/24

Engaging Preschoolers with Interactive Storytime: Using Books, Props, and Play

As a speech-language pathologist, I often use books in my therapy sessions to create engaging and interactive themes that help target communication goals. Using books with young children encourages receptive and expressive language skills, facilitates “reading” and listening comprehension, expands vocabulary and syntactic skills, and promotes a love of reading.

“Language and literacy develop concurrently and influence one another. What children learn from listening and talking contributes to their ability to read and write and vice versa. For example, young children's phonological awareness (ability to identify and make oral rhymes, identify and work with syllables in spoken words, and the ability to hear, identify, and manipulate the individual sounds—phonemes—in spoken words) is an important indicator of their potential success in learning to decode print,” according to a Preschool Policy Brief by the National Institute for Early Education Research (NIEER) at Rutgers University, April 2006.

Research tells us that children who fall behind in oral language and literacy development before formal schooling are less likely to become successful readers, and their achievement lag is likely to persist throughout primary grades and beyond. Therefore, it is crucial for SLPs, teachers, and parents to make reading and literacy fun and engaging. It’s not about sitting down to read or listen to an entire book; it’s about engaging children in the story, the pictures, and the words. We can do this by giving kids a “part” in the story with their words, sounds, movements, or props.

using props with books over aqua background

Engaging Children with Props:

Using props during storytime can make stories more meaningful and memorable for children. Props can include pictures, stuffed animals, and toys that children can hold and move as the story progresses. For example, books like "5 Little Ducks," "The Gingerbread Baby," and "Tip Tip Dig Dig" are perfect for incorporating props to engage children. I have a variety of book companions ready-made in my store that include props and activities to use in speech therapy, the classroom, and at home.

Types of Books That Engage Children

Books with Repetitive Text: Repetitive text helps children comprehend and remember the story due to repeat phrasing. "The Pout Pout Fish," "5 Little Ducks," and "It’s Mine" are excellent examples of books with repetitive text included in my water-themed companions.

Books That Encourage Movement: Movement helps children attend to longer stories and builds imitation skills and memory. Books like "Tip Tip Dig Dig," "The Napping House," and "Dinosaurumpus" are great for incorporating actions such as stirring, pouring, and whisking, using real-life objects. Click here for Movement themed book companions

To grab the bundle of book companions for year-round props and activities, including books with incorporated movement, repetitive text, lift-the-flap books, and interactive books, click below.

BOOK COMPANION BUNDLE

Want to know more about the types of books that best engage preschoolers?

Click to see this blog post, Top Children’s Books for Speech and Language Development. I’ve highlighted the top children’s books, linked all of the books and categorized them by type.

By using books, props, and play, we can create interactive and engaging storytimes that not only make reading fun but also support the speech and language development of young children.

Happy reading!

Trish Friedlander 6/21/24 Trish Friedlander 6/21/24

Creative Speech Therapy Ideas: Using Stickers for Articulation, Apraxia and Language Goals

Discover creative speech and language therapy ideas using stickers! This blog post explores how to use stickers to target apraxia, enhance articulation trials, and create engaging sticker scenes. Perfect for achieving various goals in speech sessions, this low-prep, high-impact tool is a favorite among kids and therapists alike.

I want to shine a spotlight on an often underrated but inexpensive versatile resource for targeting goals in our speech therapy sessions. They are lightweight, require minimal prep, and the kids absolutely LOVE them! Yes, I’m talking about……

What is it about sticky pieces of paper that is so intriguing?

Recently, I’ve been using a Paw Patrol Puffy Sticker Book that I found at Marshalls (they also had a construction vehicle one!). It’s become a favorite among my kids, and I just had to share all the ways we can use stickers to target both speech and language goals.

Use stickers for……

Speech Sound Practice

Working with kids with Childhood Apraxia of Speech. When adding stickers to a page or background scenes model “power phrases” like “put on”, “take off” and “my turn” and use self advocacy phrases like “help me” and “it’s stuck”.
Sticker Charts: Create a chart with different articulation targets. Each time a child successfully practices a target sound, they get to place a sticker on the chart. This visual reinforcement can be very motivating (ok, so this one is overused and underwhelming, but I had to add it!)
Sticker Stories: Have the children create a story using stickers. Each sticker represents a word or sound they are working on. They can narrate their story, practicing their target sounds as they go.

Language Development

Sticker Sequences: Use stickers to create sequences or patterns. Have the child describe the sequence, focusing on using words like "first," "next," and "last."
Sticker Descriptions: Give each child a set of stickers and have them describe what they see. This can help with vocabulary building and descriptive language.
Sticker Scenes: Provide background scenes and let children create their own stories using stickers. Have them narrate their story, focusing on sentence structure and vocabulary.

**STICKER SCENES**

Add sticky magnets from a magnet tape roll to stickers to create magnetic stickers!

Social Skills

Sticker Conversations: Use stickers to prompt conversations. For example, place a sticker of a happy face and ask, "What makes you happy?" or use a sticker of a group of friends and discuss friendship and social scenarios.
Emotion Stickers: Use stickers depicting different emotions and discuss each one. This can help children identify and express their feelings.

Following Directions

Sticker Maps: Create a simple map or scene on paper and use stickers to give directions. For example, "Place the dog sticker next to the tree" or "Put the car sticker on the road."

Examples with Paw Patrol Puffy Sticker Book

To give you some concrete examples, here’s how I’ve been using the Paw Patrol Puffy Sticker Book in my sessions:

Prepositions: Receptive and expressive use. "Put Chase under the tree," "Where is Chickaletta?"
Expanding Utterance Length: Targeting 2+ word phrases. "Go Ryder," "Marshall wants a ride," "Bye ___." I model and repeat these phrases throughout the session.
Working with children with Apraxia: Power phrases like “put on”, “take off” and “my turn”. Self-advocacy phrases like “help me” and “it’s stuck”.
Gestalt Language Processors: Mixing and matching phrases. For example, if a child uses "Rubble on the double" and "I'm fired up," I model a combination like "Rubble is fired up."
Production of 2+ Syllable Words: We worked on "Mayor Humdinger" - a motivating 3-syllable word!
Verb Tense: Using background scenes with minis, we practiced past tense: "The car jumped over the sign," "He drove away."
Negatives: Using stickers on background scenes. "I don’t want it there," "Not in," "Not on my nose!"

**PAINT STICKS WITH PACKING TAPE**

Use paint sticks or tongue depressors and cover them with packing tape for repeated articulation trials.

Low Prep, Low Expense Ideas

Here are some additional low-prep, low-expense ideas to get plenty of repetitions with stickers:

Paint Sticks or Wooden Tongue Depressors: Add stickers for each target the child gets correct. I add packing tape to my paint sticks so kids can put on and take off stickers over and over for multiple trials!
Body Parts: Stick stickers on different body parts on you and the kids following each production, then have the kids take them off again while practicing their target sounds, words, or sentences.
Matching Games: Add matching stickers onto milk or juice lids, or cardboard circles or squares and play a matching game with them.

Stickers are a fantastic tool for making speech therapy sessions fun and engaging. I hope you find these ideas as helpful and enjoyable as I do. Happy sticking!

Trish Friedlander 12/3/23 Trish Friedlander 12/3/23

Best Christmas and Winter Books for Kids Ages 3-5

Winter and Christmas books are some of my favorite to use in speech therapy for facilitating language skills in preschoolers. Following is a list of books I use in my speech sessions each season with different target goals in the descriptions. I wanted to post this blog now if you are thinking about gift for this age children.

For more information on choosing books for children, go to Choosing Books for Preschoolers to Encourage Communication Skills

Each title has a link to the book on Amazon (these links are affiliate links, so I get a few cents if you purchase one- at NO extra cost to you). You can also find most of these books at your local library!

**Holiday Books**

Holiday and Winter Books can target an array of speech and language goals

The Snowy Day by Ezra Jack Keats

This is a classic book with simple colorful contrasting pictures of a journey of a little boy and his adventures through the snow. I use the concepts of “toes pointed in” and “toes pointed out” when walking to incorporate some motor movement into speech therapy. I use my book companion for this story each winter! We also work on opposites like “down the hill” and “up the hill”. You can have tons of supplemental craft extension activities with this sweet story.

The Snow Globe Family by Jane O’Conner.

This story is about a real family living in a house, then the snow globe family living in a snow globe in the real family’s house and only the baby sees the snow globe family. This is for 4-5 year olds and is also great for older children also. It lends itself to working on “pretend” versus “real”, “big” versus “little” and working on finding solutions for problems. This one has fun extension activities like making snow globes.

Merry Christmas Big Hungry Bear by Audrey Wood

This is really a perfect Christmas book for this age! A little mouse initially tries to hide his presents from the big hungry bear, then realizes that the bear needs some presents too!

This story has repetitive text and the reader is talking to the mouse keeping children interested in knowing how this will end up! I target asking the mouse questions for information and kids love to join in talking to the mouse. We also target “big and small” when talking about the bear versus the mouse, what they wear, the presents and where they live.

Are You Grumpy Santa by Gregg Spiridellis

Santa is grumpy in the beginning of this wonderful rhyming story then comes around. This is fun to read and kids think this grumpy Santa is hysterical because of all the reasons he is grumpy (itchy suit, he’s on a diet..). This one is for 4-5 year olds and is perfect for working on emotions like “grumpy, happy, sad, frustrated, annoyed”.

Merry Christmas, Stinky Face by Lisa McCourt

Stinky Face loves Christmastime...but he still has plenty of questions. What if a big, wintry wind blows his Christmas tree away? What if one of the reindeer gets his antlers stuck in the branches that hang over the roof? His Mama knows how to answer these questions. This one is fantastic for working on “wh” questions!

Snowmen at Christmas by Caralyn Buehner

This is one book in a series of 5 about Snowmen at different time (Winter, Night, Play). There are hidden items throughout the story that children can try to find (although it’s not easy even for me!). Working on concepts like “behind’, “under” and “on top” when describing where the snowmen are as well as using descriptive language when describing the different snow people works well in this book. There is quite a bit of text, but remember, you do not have to read it all if you have a younger child.

Llama Llama Jingle Bells by Anna Dewdney

This is a book for younger children or children with difficulty attending to longer stories. It has rhyming phrases where children can attempt to fill in the words. The pictures are engaging and good to work on pointing to pictures named.

The Snowman by Raymond Briggs

This is a story about a little boy who makes friends with a snowman. I like the “lift the flap” version of this book with my younger children. There is very little text (or no text in the original version), so children can use their own words to tell the story.

Dream Snow by Eric Carle

This is one of my favorite winter books! A farmer dreams that snow has covered him and his farm animals. There is a snow cover plastic page covering each animal in the story, so children can guess what is under each page. This works well for answering and answering “who” questions and labeling animals and using animal sounds for minimally verbal children.

Max’s Christmas by Rosemary Wells

Max has plans to stay up late to see Santa Claus, but his big sister, Ruby, won’t let him. Max asks questions throughout the book making it perfect for working on “wh” questions with children. It has limited text which is perfect for younger wiggly listeners!

Gingerbread Baby by Jan Brett

The repeated phrasing in this story makes it easy for children to “help” tell the story. The people and animals that the Gingerbread Baby meet continue to grow lending this story to working on sequencing of events with children. There is a “hint” with the side pictures of what is coming next, that children love to guess! You can find a ready made book companion here!

The Night before Christmas by Clement Moore

Need I say more? Just had to include this for those of us who had to read this every Christmas Eve!

Check out my Winter Book Companion Kit in my TPT store for activities to use with some wonderful winter and holiday books!

Trish Friedlander 9/8/23 Trish Friedlander 9/8/23

Treatment of Childhood Apraxia of Speech

Childhood Apraxia of Speech (CAS) is a speech disorder that affects a child's ability to plan and execute the precise movements required for clear speech. Treatment differs from other speech sound disorders in that the focus must be on the motor speech movement and not on individual sounds. Treatment should be multi-sensory and targets should be selected based on the child’s interests and needs.

About 15 years ago, I got my first case of Childhood Apraxia of Speech (CAS) that was diagnosed by a developmental pediatrician as “verbal dyspraxia”. From that moment, I did some big digging into what CAS really is. Since then, I have had many children that I have worked with with CAS (most whom I diagnosed) and although complex, I really love working with kids with CAS because of the difference I can make! Kids with CAS are close to my heart and I want you to feel as comfortable as I do know with techniques for treatment. Understanding it better can help us make a significant impact on the lives of our young clients.

I recently took a refresher course by Alonna Bondar that I would highly recommend if you need more information on CAS, choosing targets and applying treatment techniques. There are also some videos on YouTube by Edyth Strand that provide some really practical therapy and treatment information!

1) What is Childhood Apraxia of Speech?

CAS is a speech disorder that affects a child's ability to plan and execute the precise movements required for clear speech. It's like the brain and mouth are not on the same page when it comes to talking. Unlike other speech sound disorders, CAS isn't caused by muscle weakness or muscle coordination problems but rather by neurological issues that disrupt the planning process.

2) How CAS Differs from Other Speech Sound Disorders

Unlike phonological disorders or articulation disorders, CAS is not about substituting one sound for another. It's about the brain struggling to coordinate all the movements required to produce the planning of speech sounds and combinations of sounds. CAS can sometimes be mistaken for other speech sound disorders like phonological disorders or articulation disorders. The key difference lies in the motor planning aspect. In CAS, the child knows what they want to say, but their brain has trouble coordinating the precise movements necessary for speech. This makes CAS unique and requires a different approach in therapy (see the earlier Blog Post: Principles of Motor Learning in CAS).

3) Early Signs of Apraxia of Speech

Limited babbling before 12 months
5 or less consonants between 17-24 months
Limited vocalizations
Simple syllable shapes (vowel or consonant-vowel only)
Late or difficult development of first words
Words that appear then disappear

(Bondar 2023, Bjorem Speech Informal Motor Speech Assessment 2020, Davis and Velleman 2000)

4)What characteristics distinguish Childhood apraxia of speech from other speech sound disorders?

Awkward transition from one sound and/or one syllable to another
Groping behavior while attempting word or sound production
Vowel Distortions
Errors with prosody (stress, loudness, intonation, pitch and rhythm
Inconsistent voicing errors
Inconsistency of word or phrase production over repeated trials
Struggling with longer and more complex words
Inconsistent errors when trying to repeat words

(ASHA 2007, Strand 2020, Bondar 2023)

5) How do we know a child is ready for CAS Treatment?

Does the child have an internet to communicate? Are they using some type of communication to make wants and needs known (i.e. pointing, grunting, pulling the hand of a caregiver)
Is the child able to focus on an activity (i.e focus on a favorite toy).
Can the child imitate motor movements (i.e opening their mouth, pursing their lips)
Is the child able to request items with gestures like pointing or reaching?
Will the child look at an object near your face?

6) Techniques for Children with CAS

Let’s get to the fun part! Treatment! When working with kids who have CAS, we've got to be creative and choose the approach and feedback that best fits the individual child. Whatever treatment approach is used the key is working on MOTOR MOVEMENT. Multisensory approaches work well for children with CAS. Here are a few techniques that have worked for me (and many others based on the research!) this is not ALL of the treatment procedures, I am highlighting some that proven to be successful for my students:

DTTC (Dynamic Temporal and Tactile Cueing):

This is a dynamic approach that combines touch and sound cues. It helps kids improve speech motor planning by guiding them through the correct movements.

With DTTC, there is a specific hierarchy and cueing methodology to facilitate the acquisition and generalization of movement accuracy for speech. It is structured to slowly lengthen the amount of time between the clinician’s production of a motor movement and the child’s production of the word or motor movement. Initially the child says the word at the same time with the clinician, then the child voices the word while the clinician only produces the mouth shapes of the word and later is cued to say the word with no cues.

DTTC is designed for children with more severe CAS and is not intended for long-term use.

For more detailed information regarding the DTTC hierarchy please see the references below
(https://www.bjoremspeech.com/collections/free-resources/products/dttc-hierarchy-flow-chart-for-apraxia-therapy, American Journal of Speech-Language Pathology, Strand, Edyth, Vol. 29, 30–48 • February 2020, Apraxia Course, Bondar, Alonna 2023)

Speech Sound Cue Cards:

Visual aids can be a game-changer! Using cue cards with pictures and written prompts can help children understand and produce specific sounds. You can find the speech sound cue cards that I developed for my students with CAS that provide visual (pictorial and hand cues), and auditory cues to aid in motor movement.

Using cue cards with pictures and written prompts can help children understand and produce specific sounds. Using a finger or pointer or marker on a wipe board to move from one sound cue card to another showing the child movement while elongating the sound (if possible) works well for a visual representation.

Promote Functional Communication:

Encourage children to communicate using signs, gestures, or alternative communication methods while working on speech goals. This helps reduce frustration and builds their communication skills.

7) Appropriate Target Selection

Choosing the right targets is key for the child to feel successful in the therapy program. Initially, if a child has very little verbal productions, begin with sounds and sound effects such as animal sounds (“baa, moo, neigh"), sounds like a car sound or “beep” and “uhoh” or” eeekk”. These sounds are fun to produce and promote the child’s engagement. It is important to reinforce the child’s attempts at vocalizations and imitate their vocalizations and assign some meaning to them.

Start with functional verbal words that are relevant to the child's daily life and communication needs if the child is at this level. As progress is made, gradually work your way towards more complex sounds and words. Words like “on, up, pop, bye, ma, poo” are great powerful words for kids to start with, but what is meaningful to the child is the best way to choose the targets. Use words that are meaningful to that child such as favorite toys, family names, friends names and favorite foods.

Using games that have lots of pieces to them can provide many trials and motivation for CV, VC and CVC words like “out, in, up, pop, push, my, me and see”.(Games like Pop-up Pirate, Banana Blast and Jumpin’Jack are great for this!).

Remember, progress may be slow, and that's okay. Every small victory is a step in the right direction. Celebrate those wins, no matter how tiny they may seem! CAS is a unique and challenging speech disorder that requires a specialized approach. By understanding the nature of CAS, spotting it early, and using appropriate techniques, we can make a world of difference in the lives of our young clients.

For more information: (https://www.bjoremspeech.com/collections/free-resources/products/dttc-hierarchy-flow-chart-for-apraxia-therapy, American Journal of Speech-Language Pathology, Strand, Edyth, Vol. 29, 30–48 • February 2020, Apraxia Course, Bondar, Alonna 2023)

Trish Friedlander 9/5/23 Trish Friedlander 9/5/23

Principles of Motor Learning for Treatment of Childhood Apraxia of Speech (CAS)

When learning about treatment for Childhood Apraxia of Speech (CAS), we hear that we need to use the principles of motor learning (PML), so what does that mean? These principles or processes are how we all learn new motor skills or plans. Speech is a motor skill that can improve using these principles. Treatment may be designed differently depending on the child (with differences in severity, attention and motivation ), but applying the PML will provide a roadmap to support and treat children with CAS.

Speech is a motor skill that can improve using these principles.

Treatment may be designed differently depending on the child (with differences in severity, attention and motivation ), but applying the PML will provide a roadmap to support and treat children with CAS.

Following is a guide for using principles of motor learning that I use when I treat children with CAS (based on research):

1) PRACTICE, PRACTICE, PRACTICE:

Imagine learning to swim. You didn't jump in the water and swim right away, you had to practice moving your body in different ways to float and stay afloat, then to move forward, all the while breathing at the same time. The same goes for children with CAS. Regular practice is the most important aspect for generalization of speech production.

It's all about getting enough practice trials per session to make the motor speech movements second nature and automatic. But remember, quality matters as much as quantity. Be attentive to the child's response, and adjust cues accordingly. As they progress, you can gradually fade those cues.

2) MASSED PRACTICE VS. DISTRIBUTED PRACTICE:

Think of this as the difference between cramming for an exam and studying consistently over time. For CAS, research suggests that frequent, shorter sessions spread out over time are more effective for progress and generalization.

Starting with massed practice (practicing all at once- think one session weekly for a longer time period) to build a strong foundation, then transitioning to distributed practice (therapy spread out across sessions- think 4, half hour sessions weekly). I know sometimes we don't have the luxury of changing a schedule like that in schools- but see principle number 3 for ways to change up practice within time constraints.

3) BLOCKED VS. RANDOM PRACTICE:

Blocked practice is practicing one target extensively before moving on, then later randomizing practice by mixing several targets together. An example is initially you might choose 5 words including bilabials plus vowels (like poo, ba, me, ma, and pee) and focus on those only. As the child improves, you can randomize the targets for example adding a vowel consonant productions in (i.e. “up, oop, um”)

The severity of CAS can be your guide here. For severe cases, more blocked practice might be necessary, but you can modify it by mixing targets within blocks. This variation allows you to get more repetitions of target movements within each blocked practice.

4) VARY CONTEXTS AND PROSODY

Facilitate practice in different contexts. Vary the types of consonants or vowels and the positions that they are in . For example, change the initial set, going from CV (consonant-vowel) to CVC (consonant-vowel-consonant). Increase complexity of movements as the child gains the accurate motor movement sequences.

Experiment with prosody, loudness, and emotional intonation. This variability engages different muscles, enhancing motor planning processing and efficiency – our ultimate goal.

5) FEEDBACK MUST BE EVER-CHANGING

Feedback is dynamic throughout a child’s therapy program. Feedback can be intrinsic (what the child perceives) or extrinsic (what we provide for the child). Extrinsic feedback can be knowledge of results (was that right or wrong) or knowledge of performance (specific guidance on what specifically needs improvement).

Initially, provide more feedback to guide the child, but gradually fade it as they become more accurate and independent in their speech movements. We don’t want too much support for too long otherwise the child could become dependent on the supports. We want to fade supports so children know how to produce the movements independently.

Often the type of feedback can change depending on the target and the accuracy of that target.

Using the Principles of Motor Learning:

Using the Principles of Motor Learning is like having roadmap in the world of CAS therapy. These principles guide speech therapy leading our children toward improved communication skills. So, practice often and adapt to the child's needs whether it be with feedback, type of practice or contexts.

Trish Friedlander 1/19/23 Trish Friedlander 1/19/23

Speech Therapy Tips for Minimally Verbal Preschoolers

How do I get my child to talk? What can I do at home to help my child communicate what they want and need? If my child isn’t talking, is there anything I can do?

How do I get my child to talk? What can I do at home to help my child communicate what they want and need? If my child isn’t talking, is there anything I can do?

These are some initial questions that I hear when I first see a minimally verbal child for a speech and language evaluation. Although it is important for intervention (speech therapy) to be tailored to the individual child, there are some intervention techniques that are helpful for all children. Some experts (Fish, 2016; Velleman, 2003) suggest intervention for young children include the following (modified from article by Megan Overby, PhD, CCC-SLP original article Sharon Gretz, M. Ed.):

Learning to imitate gross motor skills

Large motor movements (such as clapping, hands up to be picked up)
Actions with objects (banging two blocks together)

Imitating vocal play (i.e. raspberries, tongue clicks)
Imitating oral-facial movements (i.e.,puffing cheeks out, blowing kisses)
Vocalizing visible early sounds such as /m/, /b/, or /d/ (e.g., /mmmm/, “muh” or “buh”)
Vocalizing to get attention (e.g., “uh” and pointing to a cookie)
Sound effects: animal noises (e.g., “grr” for a tiger, vehicle sounds)

As children start using more of the above and begin to use more sounds imitatively and spontaneously, focus can include more functional vocalizations:

Words with distinctive pitch patterns (e.g., “uh-oh,” “wow,” “whee,” “yay”)
Words with strong emotional meaning (“no”, “up”)
Vocalizations that can be paired with actions (e.g., “whee” as a car goes down a track, “hi,” with a wave and “oops” when an object falls)

Sound effect words (e.g., “woof’, “beep,” etc.). There are great books that use sound effects (see Blog post, 13 Tips for Choosing Books for Preschoolers)
Verbal routines and singing (e.g., songs like “5 Little Monkeys Jumping on the Bed,” favorite predictable books like “Brown Bear Brown Bear What Do you See”) : (see Blog post, 13 Tips for Choosing Books for Preschoolers)
Words with very early consonants and simple syllable shapes (e.g., “hi,” “me”, “mama”, “oh no”)

Some helpful speech therapy tips:

Use sounds already in the child’s repertoire to build simple productions (e.g., if a child has /p/, can they learn to say “pop” “up,” or an approximation of those words)
Hold toys or objects of interest near the speaker’s mouth to direct the child’s attention to mouth movements during imitation tasks.
Use movement during practice (push a car down a track to work on “wheee” or build a tower and place block on top and practice “up” then “uhoh” when they fall down.
Make it fun and incorporate play with stuffies or whatever the child is interested in to elicit speech and language (i.e. let your child see you “hiding” toys in the room and have them find them)
Books and music are extremely helpful to facilitate skills.
Keep in mind, once a child begins to use sounds, it is more important to expand their sound and syllable repertoire than to have them accurately produce the sounds ( that will come later!)
The more repetitions you can get the better! Using target vocalizations in play is not only fun for the child, but also encourages the most engagement and in turn increased repetitions.

The primary goals for children who are exhibiting minimal communication skills are (modified from Davis and Velleman, 2000):

Help the child establish a consistent form of communication. This could include sign language, pointing to pictures, using approximations of words, pointing to what a child wants, gestures and facial expressions (or a combination of these!). It is important that the child and the people in their environment agree what a gesture, sound, picture, or word approximation represents or means.
Using alternative communication such as sign language, gestures, or pictures can help move a child toward verbal communication by relieving frustration and establishing a consistent, reliable means of communication (Fish, 2016).

Once my child/student starts vocalizing, where do I go from there?

A hierarchy is suggested for working on production of syllable shapes for children with Childhood Apraxia of Speech (modified from Fish, 2016 and Velleman, 2003) but can also be applied to minimally verbal children. I have include the initial steps in this hierarchy:

CV (Consonant plus a vowel) (“me”)
VC (vowel plus a consonant “up”)
Reduplicated CV.CV (“bye-bye” or “no-no”)
CV.CV with a vowel change (“mommy”, “nehnuh”)
Variegated CV.CV (“bunny”)
CVC (“pop”)
CVC with different consonants (“top”)