Thursday, January 3, 2013

Understanding Your Child’s Standardized Test Scores

Understanding speech and language testing scores can bring you back to the basics of statistics and the bell curve.  Typically, speech-language testing scores are based on normative sampling in which test makers administer the test to a large group of children.  Your child’s scores are compared to the sample to see how their skills compare to peers.  With most speech-language tests, you can expect to derive the following scores:
Raw Score:  The raw score is typically either the total number correct or the total number of errors. 

Standard Score:  The standard score is determined by the raw score and is a conversion that allows for comparison to the normative sample.  The median standard score is 100.  The standard score and percentile rank essentially provide the same information, but most people find the percentile rank to provide a clearer benchmark for their child. 

Percentile Rank:  The percentile rank is also determined by the raw score.  It tells you the percentage of peers your child scored above.  For example, a percentile rank of 40% means that your child performed higher than 40% of peers.  The median percentile rank is 50%.  The following guideline can be used for understanding the significance of percentile ranks:

Below Average
Your child may have a severe delay.
Low Average
Your child may have a mild or moderate delay.
High/Above Average
Your child does not have a delay.

Test Age-Equivalent:  A test age equivalent is also derived from the raw score.  It indicates the age to which your child’s skills can best be most compared.  This score should be interpreted with some caution since sometimes a delay in skills also involves a difference in skills.  For instance, a child who is 4 years old and receives an age-equivalency of 3 years old may present differently than a typical 3-year-old child.  Age equivalencies are best used as severity measures for this reason. 

Friday, November 2, 2012

Defining Apraxia & PROMPT© therapy

Childhood Apraxia of Speech (CAS) “is a neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements for speech are impaired." CAS may occur as a result of known neurological impairment, in association with complex neurobehavioral disorders of known or unknown origin, or as an idiopathic neurogenic speech sound disorder.

Childhood Apraxia of Speech (CAS) is a complex and variable motor based speech disorder which emerges in early childhood, marked by inconsistent and imprecise motor executions.

Although there are not any formal guidelines for diagnosing CAS, as it is a variable disorder and features change over time, there are three key features that SLP’s look for to identify such a disruption in a child’s motor planning:

Inconsistent Speech Sound errors in repeated productions of syllables and words
Disrupted and/or lengthened co-articulatory transitions between sounds and syllables, as well as impaired prosody (or rhythm of speech)
Inconsistent errors in repetition of the same target. (This is the strongest indicator of CAS)

Children with CAS tend to also have impairments in non-speech motor movements. They also tend to present with vowel and sound ordering errors, while experiencing groping.

A diagnosis of CAS is reached via an assessment in observation of the child’s speech production skills, prosody, and expressive language and non-speech skills. Such an assessment may include:

A sound discrimination task (have children listen to, and discriminate phonemes)
Syllable repetition and alternating production task (such as asking the child to repeat: “pu-tuh-kuh” several times)
Sound imitation task: Children with CAS have significant difficulty imitate sounds.Obtain a speech sample of utterances of greater length and complexity.
Administer a standardized Articulation Test, such as the GFTA (Goldman Fristoe Test of Articulation) to evaluate all sounds in varying word positions. 

Chatterboxes’ SLP’s are trained in a specialized form of ‘hands on’ speech therapy, known as PROMPT© therapy. The PROMPT© System stands for ‘Prompts for Restructuring Oral Muscular Phonetic Targets’.

WHAT:          PROMPT© is a dynamic tactile method of treatment for motor speech disorders which is based on touch pressure, kinesthetic and proprioceptive cues.

WHY:            PROMPT© helps to reshape individual and connected articulatory phonemes and sequences (coarticulation).

WHO:            During this approach, the clinician helps to manually guide articulators to produce specific sounds or words that seem to be problematic.

HOW:            This is a hands-on approach. The SLP uses her hands to cue and stimulate articulatory movement, at the same time helping the child to limit unnecessary movements

The below series of photographs demonstrate the touch cues that may be applied during a typical PROMPT© therapy session by the Speech-Language Pathologist. Please note: such kinesthetic cues may be provided by the SLP to aid the child in eliciting a single sound, such as “ah.” In addition, combinations of tactile cues may be used to aid in elicitation of sound combination, single words, short phrases, and even sentences.  More information about PROMPT can be obtained via  

The PROMPT photograph demonstration is as follows:

Friday, October 26, 2012

Puree recipes

Many table foods can be pureed.  To puree, chop the food into small pieces and place in a blender or food processor.  Depending on the food, you may need to add some liquid.  Blend to a mashed potato/pudding like consistency with no lumps.  Food that is already cooked to a soft consistency blends more easily.  Avoid foods that have shells (peas, blueberries, corn, etc.) as these are difficult to properly blend.  


Below are six puree recipes.  Please note that these are only suggested proportions of ingredients.  Experiment with these recipes to determine the best proportions of ingredients. For instance, when pureeing rice, add the gravy a few tablespoons at a time, then puree and determine if more liquid is needed.  

Pureed Rice
1 cup cooked white rice
1/2 cup gravy
1 tablespoon butter

Pureed Macaroni and Cheese (from box macaroni and cheese)
1 cup cooked macaroni and cheese from box recipe (includes butter and cheese)
½ cup milk

Pureed Pasta and Tomato Sauce

1 cup cooked macaroni noodles
½ cup tomato sauce
1 tablespoon butter

Pureed Carrots

½ cup cooked carrots
¼ cup chicken broth
1 teaspoon butter

Pureed Broccoli and Cheese Sauce (from frozen package)

½ cup cooked broccoli and cheese sauce
¼  cup whole milk

Strawberry-Banana Smoothie

1/2 banana
4 strawberries
¼ cup whole milk
2 tablespoons vanilla yogurt

Monday, October 22, 2012

Ideas for Practicing Pronouns “He/She” in Daily Routines and Play

For some children, the personal pronouns "he" and "she" can be difficult to master. Here are some strategies and activities to try at home to help your child practice the pronouns.

  • Model the language that you want your child to use.
  • Teach your child, “When it’s a boy, we say HE. When it’s a girl we say SHE.”
  • Place emphasis on the words “he” and “she” to draw your child’s attention to them.
  • When practicing “he/she” with boy and girl dolls, animals, etc. first make sure that your child identifies which one is a boy and which one is a girl.
Activities to try at home:

1.)    Pretend to have a picnic with girl and boy dolls. Take turns passing out pretend food.  As you pass out each food, model appropriate use of pronouns “he/she” and have your child repeat. For example, say “He eats apple” or “She eats banana.”
2.)    While reading books, comment about the pictures of boys and girls. Model accurate use of pronouns, for instance, point to a picture of a girl and say, “She is smiling.” Have your child repeat your comments.  Also, ask your child about the pictures. For instance, ask, “What is he wearing?”  Have your child respond using the pronouns.
3.)    Set up boy and girl dolls and blow bubbles to them.  Have your child choose who to blow bubbles to.  Ask your child, “Who wants bubbles?” Your child responds either “He does” or “She does.” You can offer your child a choice between the two options.  For instance, ask your child, “She wants bubbles or he wants bubbles?”
4.)    Color pictures of boys and girls.  As you color each, make comments about what you are coloring using pronouns “he” and “she.” For instance, say “He has blue pants,” or “She has a red hat.”

Wednesday, October 17, 2012

Liquids, Purees, and Dissolvable Solids

Looking for ideas for which liquids, purees, and dissolvable solids to try with your child? Here are our recommendations:


Chocolate milk
Strawberry milk
Soy milk
Pediasure - vanilla, strawberry, chocolate
V8 tomato juice
Odwalla or Naked juice
Hot chocolate 

Dissolvable Solids
Cheese puffs
Pirate’s Booty
Graham crackers
Veggie Sticks
Ritz crackers
Ice Cream
Frozen yogurt

Mashed potatoes and gravy
Mashed sweet potatoes
Pureed macaroni and cheese
Pureed pasta and sauce
Cream of Wheat
Pudding - vanilla, chocolate
Pureed carrots
Pureed butternut squash
Pureed broccoli in cheese sauce
Pureed green beans
Pureed asparagus
Mashed avocado
Sour cream
Tomato soup
Butternut squash soup
Split pea soup
Strained cream of mushroom soup
Strained cream of broccoli soup
Mashed bananas
Strawberry-banana smoothie
Pureed peaches
Pureed cantaloupe 
Refried beans
Pumpkin pie filling
Whipped cream
Any pureed baby food

Many table foods can be pureed. To puree, chop the food into small pieces and place in a blender or food processor.  Depending on the food, you may need to add some liquid (e.g., milk, juice, water, etc.). Blend to a mashed potato/pudding like consistency with no lumps.  Food that is already cooked to a soft consistency blends more easily. Avoid foods that have shells (peas, blueberries, corn, etc.) as these are difficult to properly blend.

Sunday, October 14, 2012

Infant Sibling Project

What if we could diagnose autism or language delays before a child’s first birthday?

Although there is some knowledge available about the cause and treatment of these disorders, we still have much to learn. The Infant Sibling Project—a joint collaboration between Boston Children’s Hospital and Boston University—aims to identify very early risk markers for language impairment or autism spectrum disorders. Currently, children are not usually diagnosed until they are 18 months of age or older. Identifying high risk infants at this early stage would allow for early intervention to begin much sooner than is currently possible, greatly increasing the potential for such treatments to have a lasting, positive impact.  

To achieve these goals, the project depends on area families who are willing to volunteer. They are looking for infants (age 12 months or younger) who have an older sibling with either a language impairment or an ASD. Parents who are expecting a new baby are also welcome to enroll. Babies in this project will be monitored closely for signs of autism or language impairment; they will be seen a few times during their first two years and for a follow-up at age three. Scheduling is flexible and based on each family’s needs. Travel and parking expenses are fully covered, and there is free childcare for any siblings who may come along with you to study visits. Participating parents are compensated for their time, and children receive small thank you gifts at each visit.

For more information, please contact Vanessa Loukas at or 617-455-7238.

Thursday, October 11, 2012

5 to 6 Years Communication Milestones

By the age of 5-6, children should be able to do the following:

Follow 1-2, and 3 step simple directions in a sequence
Listen to and understand age-appropriate stories read aloud
 Follow a simple conversation

Answer open-ended questions (e.g., "What did you have for lunch today?")
 Retell a story or talk about an event
Show interest in and start conversations
 Be easily understood
Answer more complex "yes/no" questions
 Tell and retell stories and events in a logical order
Express ideas with a variety of complete sentences
Use most parts of speech (grammar) correctly
Ask and respond to "wh" questions (who, what, where, when, why)
Stay on topic and take turns in conversation
  Give directions
  Start conversations 

READING: (by age 5)
 Know how a book works (e.g., read from left to right and top to bottom in English)
Understand that spoken words are made up of sounds
Identify words that rhyme (e.g., cat and hat)
 Compare and match words based on their sounds
Understand that letters represent speech sounds and match sounds to letters
Identify upper- and lowercase letters
Recognize some words by sight
"Read" a few picture books from memory
Imitate reading by talking about pictures in a book

READING:  (by age 6)

Create rhyming words
 Identify all sounds in short words
Blend separate sounds to form words
Match spoken words with print
Identify letters, words, and sentences
Sound out words when reading
  Have a sight vocabulary of 100 common words
  Read grade-level material fluently
  Understand what is read

WRITING:  (by age 6)

 Express ideas through writing
Print clearly
Spell frequently used words correctly
 Begin each sentence with capital letters and use ending punctuation
Write a variety of stories, journal entries, or letters/notes