On March 3, 2015, I was honored to present a Talk on Tuesday (ToT) webinar entitled, It’s Almost Never Apraxia: Understanding Appropriate Diagnoses of Speech in Early Intervention, that addressed appropriate diagnoses of speech sound disorders in infants and toddlers. The participants had some great questions and we wanted to ensure that the conversation continues…so here I am! My March ToT was just Part 1 of 2. The second half will be presented on May 5th and will focus on outcomes and intervention in regard to speech sound development! But in the meantime, it seems as though a big misconception from my March Talk is that I am advocating for fewer services for infants and toddlers…this is not the message that I intended to convey and I am hoping to begin this blog series by clearing that up!
First, let’s begin with a quick review of the facts:
When Should We Become Concerned about the Development of Articulation?
Typically, a speech-language pathologist (SLP) will diagnose an articulation disorder if a child is demonstrating a delay of at least 6-12 months in regard to the production of certain sounds, based on the age at which mastery of the sounds is expected. To put this in perspective, because the /k/ and /g/ sounds are expected to be mastered by the age of 4 years, a child should not be differentially diagnosed with an articulation disorder characterized by errors of these sounds…until the child is at least 4 and a half years old.
What about Phonology?!
A child’s speech development is not just about his or her articulation skills. When SLPs are assessing a child’s speech, we are also looking at the sound patterns—the phonological processes–that a child is, or is not, producing. As you can imagine—and as most of you have experienced!—in addition to developmental articulation errors, these processes often wreak havoc on our ability to understand what children are saying. And yet…should we be concerned when working with children under the age of 3 years old? Well…not really. A phonological delay or disorder refers to when a child continues to simplify his or her speech by using these phonological processes well beyond the typical age expected.
Unless we consistently observe a toddler demonstrating the following red flags:
- initial sound deletions;
- distortion or consistent difficulty with vowels;
- deletion of LOTS of sounds—the child uses only one or two consonant sounds…
…we should not diagnose an articulation or phonological disorder prior to the age of 3 years. Again, since most of the processes that we monitor are expected to be present in a child’s verbalizations until the age of 3 or older, we really just want to monitor the patterns in a child’s words and phrases until they are 3 years old.
And What about the Role of Intelligibility?
Well, again, since we now know that children are going to be difficult to understand prior to the age of 4 years, an SLP will determine just HOW unintelligible a child is at a given point in time. If a child is less than 25% intelligible by 2 years of age or less than 50% intelligible by 3 years old, we should be concerned. It is then the role of the SLP to determine what the roadblock to the child’s intelligibility really is. Otherwise, it’s important to keep in mind that a 2 or 3 year old IS going to be difficult to understand…often!
Now that We’ve Reviewed the Expectations, Let’s Address the Misconception!
I am certainly not advocating for FEWER services for infants and toddlers…instead, I am advocating for FUNCTIONAL services for our children and their families!
Stronger services = functional services!
Functional services will be based on appropriate diagnoses of the young children with whom we work. These kids DO need services—but when we are diagnosing appropriately and accurately, our services for infants and toddlers will be based on the diagnosis of a language disorder versus a speech sound disorder. We should, therefore, be providing services that FOCUS on language development rather than on speech sound development…or better yet, we should be providing best practices by coaching families to facilitate speech sound development within (rather than separate from) outcomes and activities that target functional communication by and with the child!
If you did not have the opportunity to participate in the live March 2015 ToT webinar, I invite you watch it now! I would love to hear what you think about the information that I presented and where we should go from here!
What strategies do you use to facilitate speech sound development within everyday functional activities?
Share your ideas in the comments below!
If you missed either of Corey’s webinars, visit the Talks on Tuesdays 2015 recordings page on the VA Early Intervention Professional Development Center, or click below:
It’s Almost Never Apraxia: Understanding Appropriate Diagnoses of Speech in Early Intervention
Ditch the Animal Sounds: Writing Appropriate Outcomes that Lead to Effective Implementation
If you’d like to catch up on all of the posts in this series, visit:
Address the Language: The Speech Will Follow!
ICD-10 Codes and Insurance Reimbursement in EI: The Fun Stuff?!?
Ditch the Animal Sounds! – Who’s Ready for the Next Talks on Tuesday?!
What great points! When supporting families in promoting more intelligible speech, I often first ask families about what routines are most impacted by intelligibility/articulation difficulties. Then we look at those routines, what words the child is using and what words are being modeled for him/her, then discuss specific strategies to address these sounds. Often times we discuss the many factors impacting overall speech intelligibility (articulation, rate of speech, context, inflection, etc.) and we discuss ideas on how to improve all areas if possible. We can absolutely support children and their families who have articulation difficulties, it just looks different than other models! And we have the opportunity to make real, meaningful changes at home. The parents are happy because they understand their child, and the child is happy because they are understood!
Beautifully written, Jessica! I love how you write about your focus on how the child’s intelligibility impacts everyday life. That is exactly what Corey was talking about when she said FUNCTIONAL services!
Thank you for your response to my blog post! I love that you mentioned the routine–and how we are most effective in addressing intelligible speech when we target words that fit into a child’s and family’s everyday activities. I could not agree with your more!
I did not hear the talk because I was out and about seeing children, but it whether or not children ages 0-3 can have speech sound disorders/delays seems like a non-issue from my point of view. I work in 0-3 and find that parents do not come in that often saying that they want services because their child’s speech is not clear enough. It happens once in a great while, but mostly (90% or more) of the time they just come in and say that “little Sam is not talking as much as the other 2 year old down the street,” or something along those lines. Or they might say, “she has her own language,” which almost always means that the child is jargoning beyond the time period when jargon is typical. We might, after seeing how well the child understands language (if they do), suspect some type of speech sound/articulation disorder or delay, but labeling a child is generally irrelevant and unnecessary. The focus is always on functional language. I don’t personally know any SLPs working with this age group that focus on specific speech sounds with kids rather than functional language. I am interested to hear/read why we are supposed to stop making animal sounds with kids. They love this! Farm animals are very relevant to toddlers and high interest! I sing Old MacDonald with kids all the time, and it is a great way to get them started imitating, along with all sorts of other songs.
Thank you for your post! You make some great points. I am happy to hear that you are experiencing a greater focus on functional language (versus specific speech sound production) within your practice—that is exactly what we should be seeing! Unfortunately, there ARE still a lot of service providers who are focusing on outcomes that target the specific production of sounds, rather than embedding those sounds into language and communication outcomes. I also agree with you–animal sound play is fun and engaging! –and I am certainly not suggesting that we should remove that type of play from our repertoire of activities. I AM suggesting that targeting “animal sounds” as an outcome is not functional…I have never had a family tell me that their goal for their child is to “make animal sounds!” Instead, they want their children to “use words” to get their needs and wants met. So let’s work with families to help their children use words…if modeling and singing and playing with animal sounds are a strategy that we use to work TOWARD that outcome, as a means to an end, excellent! But those animal sounds should not be the “end” in and of itself. Based on your response, I think we are already on the same page about this one!
Hello — During my scheduled session I was sitting with several moms of 2-year olds during their play date. I observed and listened for a few minutes. This is what I heard from the other children: argggggh, whooosh, wock wock wock, get him, ee o ee o ee o ee o, dis mine, ahhhhhhh, no, shimmerytimbers, beep beep beep beep, argggggggh, whoosh whoosh, got ya, tick tock tick tock, ughhhhhhh boom, etc. The child I was seeing jargoned constantly with his mouth slightly open and GREAT intonation, but not a single consonant and odd vowel combinations. His mom DID want him to make some pirate sounds like his peers.
If the “scene” was a farm, I bet the mom would have loved to hear animal sounds. So, I think “play sounds” or whatever you want to call them ARE functional for children @12-30 months. I also agree that it does not matter what we call it, but working on sounds IS necessary and helping the parents “challenge” their child’s oral musculature is of benefit (humming, using a straw instead of a nipple, chewing in the back/side of mouth, etc.). I am not talking about working on /b/ cards for an hour, but I am talking about eliciting sounds that are appropriate in a child’s life , not just increasing the child’s vocabulary. Of course it is not the end goal, but still a goal that many parents understand and can work on easily and get quicker results.
Thanks for your perspective, Beth. I think sound play can be a great strategy but like you said, learning to “moo” shouldn’t be an end goal. I love it that one of the things you heard was “shimmerytimbers” – I can just hear that coming from a toddler! 🙂
Thanks for your response. I appreciate your feedback and believe that we agree on several counts! I agree that eliciting sounds that are appropriate and embedded within a child’s life is an important strategy to address overall communication skills. I would actually take this idea one step further to say that for most young children, including those with whom we work, speech sound production can and should be embedded into our practice and in our everyday interactions to ensure that their development of articulation and phonology is stimulated, monitored, and on target as expected. In regard to outcomes, we should be sure that we are addressing the child’s overall functional language and communication needs (versus specific speech sounds) and that these outcomes lead to language and communication-based intervention. This might certainly include the production and elicitation of fun sounds that correspond to the routines or play in which a child and his/her family are actively engaged, including farm animals, cars and trucks, or even pirates roaming the seas! I hope that you will join us for the May Talks on Tuesday, when we discuss this very topic in greater detail!
We have had 2 children recently that were referred at 30 months because they have many words and when communicating with 1-2 word phrase, they can generally be understood, especially if context is known. Issues, though, arise when the child, because he has many words, starts putting longer phrases together and because of the missing sounds, is very difficult to understand, to familiar and unfamiliar listeners. The difficulty in being understood comes more from the length of the utterance and omitted or substituted sounds than it does the rate of the child’s speech. The child knows what he is trying to say and knows when others understand him, so when this happens, a tantrum often ensues because he is not clear enough to be understood. Based on the ToT as well as the article here, he really is too young to be “diagnosed” with a phonological disorder. Strategies that have been used have had some success. In this situation where language is not the issue, what strategies would you suggest?
This is a great question. We certainly want to address the needs of this child…and the needs in this case do seem to be phonological in nature. One consideration is that, while his phonology may still be developing appropriately, his expressive language skills are taking off! When this happens, we often see that even typical intelligibility expectations can be particularly frustrating for these children. There are several strategies that I would incorporate into intervention that, while not directly addressing the phonology, would embed the phonological skills that are still emerging. Tell me more about the strategies that you have been using…perhaps my suggestions will overlap?!
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