Articulation and ages of sound development

Do you know when to expect your child to produce certain sounds?

The easiest sounds for a child to begin with are vowels. Generally, the first consonants that a child produces include the /m/, /n/, /h/, /w/, /p/, /b/, /k/, and /d/. Other sounds, such as /t/, /g/, and /sh/ come later. The most difficult sounds for children to master include /th/ (as in thumb) and /zh/ (as in measure).

Here is some information about articulation of speech sounds:

- Consonant sounds are made by either stopping the flow of air in the oral cavity ("stops", such as the sounds /p/, /b/, /t/, /d/, /k/, and /g/) or by letting the air flow through restricted areas which are formed by changing the position of the lips, tongue, teeth and palate ("fricatives", such as the sounds /f/, /v/, /s/, /z/, and /th/. Some sounds, called affricates, are a combination of a stop and a fricative; examples include /j/ and /ch/.

- Nasal sounds (/n/, /m/, and the /ng/ at the end of the word "sing") are made by forcing air through the nasal cavity.

- Sounds that are produced by vibrating the vocal cords are called "voiced", while sounds that are produced without vibrating the vocal cords are called "unvoiced" or "voiceless". There are many pairs of consonants that are identical in every feature except for the voicing; examples of these pairs include /p/ and /b/, /t/ and /d/, /d/ and /g/, /f/, and /v/, /th/ and /th/, /sh/ and /j/, /s/ and /z/. Try pronouncing each of the pairs while touching your throat; you will be able to feel your vocal cords vibrating for one sound in each pair.

- The respiration used in speech and quiet breathing are different. Regular breathing is easier than breathing for speech. For speech, the diaphragm and muscles of the rib cage and between the ribs pull the ribs out and up to draw air into the lungs then the muscle of exhalation push the extra air that is needed for speech out of the lungs. Respiration for speech develops as the child learns to push up with their arm, sit, crawl, stand, and walk. 

To learn more, check out this blog post.

Childhood apraxia of speech - do you know the signs?

Do you know the signs of childhood apraxia of speech (CAS)? CAS, also known as verbal apraxia or dyspraxia, is a speech disorder in which a child has trouble saying what he or she wants to say correctly and consistently. It is a motor speech disorder, as the child's brain has difficulty coordinating the oral muscles used for speech; it is not due to weakness or paralysis of the speech muscles. Children with CAS have difficulty saying sounds, syllables, and words. The severity of apraxia of speech can range from mild to severe.

Although not all children have the same symptoms of CAS, here are some signs of CAS in young children:

- The child does not coo or babble as an infant

- Late onset of first words
- Missing sounds
- A small inventory of consonant and vowel sounds
- Problems combining sounds or long pauses between sounds
- Frequent deletion of difficult sounds or sound simplification
- Problems eating
- Expressive language problems like word order confusions and word recall

Here is an excerpt from an ASHA article on CAS:

"Research shows the children with CAS have more success when they receive frequent (3-5 times per week) and intensive treatment. Children seen alone for treatment tend to do better than children seen in groups. As the child improves, they may need treatment less often, and group therapy may be a better alternative.

The focus of intervention for CAS is on improving the planning, sequencing, and coordination of muscle movements for speech production. Isolated exercises designed to "strengthen" the oral muscles will not help with speech. CAS is a disorder of speech coordination, not strength.

To improve speech, the child must practice speech. However, getting feedback from a number of senses, such as tactile "touch" cues and visual cues (e.g., watching him/herself in the mirror) as well as auditory feedback, is often helpful. With this multi-sensory feedback, the child can more readily repeat syllables, words, sentences and longer utterances to improve muscle coordination and sequencing for speech ... Practice at home is very important. Families will often be given assignments to help the child progress and allow the child to use new strategies outside of the treatment room, and to assure optimal progress in therapy."

To learn more, read this ASHA article on CAS or talk to one of our speech-language pathologists.

Early identification: Late bloomer or language problem?

Wondering whether your 18 to 30-month-old child is a late bloomer or may have a language problem? There are some factors to look out for that can help a parent differentiate between the two. Do they understand language? Can they get their point across using gestures and other non-verbal communication? Are they rapidly progressing with language between 24-30 months of age? And lastly, if they seem to be delayed, are they still making some progress? If you've answered "no" to one or more of these questions, you may want to consider an evaluation with a speech-language pathologist.

Here is an excerpt from an ASHA article on the topic:

"Although the stages that children pass through in the development of speech and language are very consistent, the exact age when they hit these milestones varies a lot. Factors such as the child's inborn ability to learn language, other skills the child is learning, the amount and kind of language the child hears, and how people respond to communication attempts can slow down or accelerate the speed of speech and language development. This makes it difficult to say with certainty where any young child's speech and language development will be in 3 months, or 1 year.

There are, however, certain factors that may increase the risk that a late-talking child in the 18- to 30-month-old age range, and with normal intelligence, will have continuing language problems. These factors include:  
* Receptive language: Understanding language generally precedes expression and use. Some studies that have followed-up late-talking children in this age range have found, after a year, that age-appropriate receptive language discriminated late bloomers from children who had true language delays. Other researchers doing follow-up studies included only children whose receptive language was within normal limits because they believed that delay in this area was likely to produce worse outcomes.   

* Use of gestures: One study has found that the number of gestures used by late-talking children with comparably low expressive language can indicate later language abilities. Children with a greater number of gestures used for different communication purposes are more likely to catch up with peers. Such a result is supported by findings that some older children who are taught non-verbal communication systems show a spontaneous increase in oral communication.
  
* Age of diagnosis: More than one study has indicated that the older the child at time of diagnosis, the less positive the outcome. Obviously, older children in a study have had a longer time to bloom than younger children but have not done so, indicating that the language delay may be more serious. Also, if a child is only developing slowly during an age range when other children are rapidly progressing (e.g. 24-30 months) that child will be falling farther behind.
  
* Progress in language development: Although a child may be slow in language development, he or she should still be doing new things with language at least every month. New words may be added. The same words may be used for different purposes. For example, "bottle" may one day mean "That is my bottle," the next, "I want my bottle," and the next week, "Where is my bottle? I don't see it." Words may be combined into longer utterances ("want bottle" "no bottle"), or such longer utterances may occur more often.
  
It should be re-emphasized that negative aspects of these factors increase the risk of a true language problem but do not mandate its presence. For example, one research group found that one of their 25- or 26-month-old children with the worst receptive language had the best expressive language outcome 10 months later. On the other hand, children on the positive side of these factors may turn out to show less progress than predicted. The research group found that the child with the poorest outcome had the best receptive language and the largest vocabulary at the beginning of the study.
  
One study has found that the number of gestures used by late-talking children with comparably low expressive language can indicate later language abilities."

So what should you do if you are concerned about your child's speech and language development?

Come see one of our speech-language pathologists, and we will answer any questions you have about your child's language development. Research has shown that the time between birth and 36 months is an extremely critical period of development, so our work in early intervention allows us to both identify and treat very young children in an effort to minimize any potential speech and language developmental issues.

Helpful Links:
ASHA article
Developmental Speech & Language Milestones, Birth - 5 Years of Age  
Warning signs for communication disorder in young children

Treating Children With Feeding Disorders

Is mealtime a struggle with your child? Do they reject new foods, textures and tastes with gagging and fits? If so, they may benefit with help from a speech-language pathologist. SLPs work with a wide variety of feeding disorders in infants and children, usually as part of a team approach including the physician, occupational therapist, physical therapist and behavioral analyst.

From a 2003 article in the ASHA Leader:

"Justine Joan Sheppard, an SLP from Nutritional Management Associates and Columbia University, notes that behavioral problems associated with feeding may be called conditioned dysphagia. Conditioned dysphagia is a learned disorder or maladaptive habit that maintains a behavior beyond the physiological need. Feeding aversion, failure to advance to age-appropriate foods, food selectivity, negative mealtime behaviors, and gagging are examples of conditioned dysphagia and may lead to problems such as failure to thrive. ... When instituting a behavioral feeding program, it is essential that the clinician remember that nutrition is the primary issue."

Our goal as SLPs is to prevent problems such as failure to thrive and malnutrition.

Links:
ASHA article
Overview of our feeding therapy
Our feeding therapy FAQ
Feeding developmental milestones

Do you have a picky eater? Let Munchie Monkey help!

Munchie will happily eat anything, which will help encourage your picky eater to try new things. Munchie takes a bite, your picky eater takes a bite.

Getting Munchie to eat is simple:

1. Take a picture of some food.
2. Draw a path on the food that you'd like Munchie to follow.
3. Shake the phone for Munchie to take a bite.

Your little one will be rewarded as Munchie eats the food to reveal a fun Munchie plate.

Does your picky eater take too long to eat? Munchie has a timer mode that can be used to time goals from 1 to 45 minutes. Simply set the timer and Munchie will finish eating within the allotted time. Your little one can see exactly how much time is left by how much Munchie has eaten.

So, stop struggling to get your picky eater to eat. Let Munchie help now!

Miles for Miracles: Let's Support Brittany!

Help us Support Brittany in the upcoming Boston Marathon on April 16th!

"I'm fundraising for this event because I believe so strongly in all the good things Children's Hospital Boston does for kids. Its patient care programs are unusually sensitive to what sick and injured children and their families really need. Its researchers regularly make amazing discoveries that change children's lives. It welcomes kids whose families can't afford health care-more than any other hospital in Massachusetts. It makes a point of reaching out to local communities to help low-income and at-risk kids. And it really gets the importance of training the next generation of top pediatricians and nurses."

"Helping children and their families is a significant part of my everyday life. I work to help children achieve their utmost potential, as a Speech-Language Pathologist, at Chatterboxes Pediatric Speech Language Pathology, in Newton Center, MA."

"Thank you in advance for visiting my fundraising page below! I greatly appreciate your support in helping me achieve my fundraising goal."
-Brittany Boyle, M.S., CCC-SLP

To learn more about this event, or to make a donation, please visit Brittany's page by clicking on the below link:

http://howtohelp.childrenshospital.org/bostonmarathon/page/Brittany-Boyle.htm

10-Step Plan for Improving Nutrition & Feeding for Children with Autism

1)Transition to a healthy diet:
Avoid food additives, pesticides, refined sugars, processed foods, and trans fats

2)Get enough basic nutrients
Water
Macronutrients: protein, carbohydrates, fat
Micronutrients: fat soluble vitamins, water soluble vitamins

3)Take a multivitamin and mineral supplement
Contains 100-300% RDA of fat soluble vitamins (A, D, E, K), vitamin B complex (B1, B2, B3,B5, B6, B12, folic acid, biotin), vitamin C, minerals (calcium, magnesium, zinc, selenium, manganese, chromium, molybdenum)

Avoid multivitamins that have artificial colors and flavors, potential allergens (wheat, milk, soy, egg, corn), and herbs

4)Increase Omega-3 fatty acid
By eating fish and other foods that contain Omega-3 and/or with a supplement
Recommended intake of EPA and DHA Omega-3 fatty acids:
1-3 years old: 390mg/day
4-6 years old: 540mg/day
7 years and older: 650mg/day

5)Improve feeding problems
Enroll in the feeding therapy program if:
Restricted repertoire of foods (less than 20 foods)
Foods lost from diet due to burnout, and foods not regained into the diet
Persistent refusal of novel foods
Refusal of entire food texture groups
Adds new foods only after greater than 25 exposures

6)Heal the gut
Signs of gastrointestinal (GI) disorder include abdominal pain, bloating, gaseousness, diarrhea, constipation, reflux, vomiting, food refusal, limited variety of foods, mealtime tantrums, irritability, self abuse, sleep disturbances
Treat by modifying the diet, eliminating problematic foods, and/or taking supplements, including probiotics, antifungals, digestive enzymes, therapeutic levels of Omega-3 fatty acids, and glutamine

7)Identify food allergies and implement treatment
Foods responsible for 90% of allergic reactions include milk, wheat, soy, egg, peanuts, tree nuts, fish, and shellfish

8)Try an elimination diet
Most popular is the Gluten Casein Free Diet (GFCF)

9)Try high dose vitamin B6 with magnesium
Recommended dosage:
8mg of B6 per pound of child's body weight
3-4mg of magnesium per pound of child's body weight

10)Consider additional supplements
To enhance immune system: dimethylglycine (DMG), iron, magnesium, selenium, zinc, vitamins A, C, D, and E
To enhance cognitive function: carnitine, choline, coenzyme Q10, iron, zinc, ginkgo biloba
To enhance detoxification system: alpha-lipoic acid, glutathione, N-acetylcysteine, selenium, trimethylglycine (TMG), vitamin C, milk thistle

-Elizabeth Strickland