{"id":2459,"date":"2015-04-09T15:46:09","date_gmt":"2015-04-09T15:46:09","guid":{"rendered":"http:\/\/veipd.org\/earlyintervention\/?p=2459"},"modified":"2021-10-15T18:41:06","modified_gmt":"2021-10-15T18:41:06","slug":"address-the-language-the-speech-will-follow","status":"publish","type":"post","link":"https:\/\/www.veipd.org\/earlyintervention\/2015\/04\/09\/address-the-language-the-speech-will-follow\/","title":{"rendered":"Address the Language: The Speech will Follow!"},"content":{"rendered":"

Joey is 25 months old.\u00a0 He was referred to his local early intervention intake coordinator by his parents secondary to their concerns about his \"babyintelligibility and inability to effectively communicate his needs or wants.\u00a0 They reported that he uses approximately 15 words but \u201ctalks in such a garbled manner\u201d that both parents and Joey\u2019s older siblings become frustrated when they don\u2019t know what he is saying or requesting. When asked to describe Joey\u2019s speech, his father noted that it sounds like: \u201cbabble-babble-babble-mama-babble-babble-babble, as if he knows he should be talking in longer sentences but he doesn\u2019t have the vocabulary yet to form the actual sentence\u201d.\u00a0 His mother added that he sometimes sounds like he is humming around his words: \u201cmmmmmmm-ball-mmmmm\u201d.\u00a0 Joey loves playing with balls.\u00a0 His family often takes an extra ball with them to Joey\u2019s brother\u2019s soccer practice.\u00a0 While his brother practices, Joey and his Dad kick the ball. According to Joey\u2019s parents, they find his speech particularly frustrating before meal times; they noted that he loves to help them choose and prepare food for snacktime every day, but that they often don\u2019t understand which foods and\/or drinks he is requesting or suggesting.<\/p>\n

What to Do? What to Do?!<\/h2>\n

We see this quite often, don\u2019t we?! \u00a0Parents will often come to us with concerns about their child\u2019s intelligibility and \u201cspeech skills\u201d because they have difficulty understanding the messages that their children are trying their hardest to convey.\u00a0 As a speech-language pathologist (SLP), my first goal with this child would be to conduct a comprehensive<\/em> communication assessment by collecting a speech and language sample.<\/p>\n

Within this play-based sample, I would listen for those three speech-related red flags that I presented in the March Talks on Tuesdays webinar<\/a> and in my previous blog post<\/a>: 1) initial sound deletions; 2) distortion or consistent difficulty with vowels; and 3) deletion of LOTS of sounds\u2014the child uses only one or two consonant sounds. Ultimately, however, above and beyond my observations regarding Joey\u2019s speech productions, I would assess whether he is using the language<\/em> skills that are developmentally expected for his age.<\/p>\n

Typical Language Development vs. Expressive Language Delay or Disorder<\/h2>\n

Keep in mind that we expect children to have a vocabulary of at least 15-20 words by 18 months, although typically developing children often have more than 50 words and are beginning to string simple, repetitive 2 word phrases together (e.g. more drink, my juice) by this age.\u00a0 By 24 months, we expect a children who are typically developing to use<\/a> AT LEAST 50 words and to combine lots of different phrases. Between 18-24 months, children may still use some jargon to expand their sentence length and to attempt to provide \u201cmore information\u201d in their messages.\u00a0 If you have a child who is 20-24 months and using a lot of jargon and not a lot of words, however, you are probably looking at a child who has an expressive language disorder<\/a>.<\/p>\n

Is It a Language Disorder or a Speech-Related Disorder?<\/h2>\n

Toddlers who are extremely difficult to understand are often still using a lot of jargon when they speak because they lack vocabulary\u2026or have difficulty with grammatical markers\u2026 or struggle to put words together into phrases.\u00a0 All of these are skills that are expected by two years of age.\u00a0 We typically expect that jargon (which can be defined as \u201cbabbling with intent\u201d) will begin to fade at about 18 months and completely dissipate by 24 months.\u00a0 If a toddler has an expressive language delay or disorder, his intelligibility will be affected as he will often continue to use a lot of jargon in lieu of words.\u00a0 Instead of recognizing that the jargon is a substitute for real words or grammar that SHOULD have developed, we often misinterpret the jargon to be speech sound production errors.<\/p>\n

In this scenario, Joey\u2019s desire to communicate is there\u2026his speech is continuing to develop\u2026his language<\/em> skills are not.\u00a0Therefore, most toddlers, including Joey, who are difficult to understand will be diagnosed with a language <\/em>disorder\u2014not a speech-related disorder!\u00a0 It is the language (or lack thereof) that is most likely having the greatest impact on this child\u2019s intelligibility.\u00a0 Unless Joey presents with any of the speech-related red flags, his speech will most likely continue to develop as his language<\/em> skills are addressed in early intervention!<\/p>\n

Why Not Provide Traditional Articulation Therapy Anyway?<\/h2>\n

Early speech and language skills are acquired and used primarily for communicating during every day, natural social interactions. Traditional articulation therapy focuses on the repetition and drilling of target sounds\u2026there is nothing natural about this process. Early intervention is intended to be embedded into families\u2019 every day, natural activities and routines<\/a> to ensure that children are processing the information that they are learning in order to utilize these new skills within their own environment\u2014this is known as authentic learning<\/em>.\u00a0 Targeting articulation directly and drilling toddlers to produce speech sounds is the furthest thing from \u201cnatural\u201d that there is!<\/p>\n

Optimal early communication intervention services are provided in natural environments, which offer realistic and authentic learning experiences for the child and promote successful communication with the caregivers. Authentic learning can maximize children’s acquisition of functional<\/a> communication skills and promote generalization of newly mastered behaviors to natural, everyday contexts<\/a>. In order for a child to process information, it needs to be presented within a normal, naturally occurring event or opportunity in his or her own environment.\u00a0 Using flashcards to teach sounds or words, or creating superficial teaching opportunities like pushing the child to imitate specific sounds in isolation (e.g. \u201csay \/ba\/\u201d), is not going to work.\u00a0 Infants and toddlers truly do not learn speech or language through artificial methods.\u00a0 For most children, when functional language and communication needs are addressed within the natural environment, speech will develop as well (ASHA, 2008)!<\/p>\n

What Would This Look Like for Joey and his Family?<\/h2>\n

My first suggestion for Joey\u2019s parents is to support and encourage him to continue to produce the sounds and words that he IS producing within the routines that he most enjoys.\u00a0 If he makes ANY sounds, imitate those. If he uses any word approximations or words, repeat them back to him! Continue to imitate his sounds and words\u2026and then expand on them a bit.\u00a0 If Joey says \u201cbabble-babble -nana-babble-babble-juice\u201d while choosing foods for his snack, repeat his word approximations and words back to him:\u00a0 \u201cBanana!\u00a0 Juice!\u201d\u00a0 Then, I would coach his parents to expand on his verbalizations: \u201cYou want bananas and juice for snack today! Let\u2019s have bananas and juice!\u201d \u00a0Let him know that what he is attempting to say has been heard and IS important.\u00a0 I would encourage his parents to provide him with articulate models of his words and to provide a model of a complete sentence in order to facilitate Joey\u2019s expansion of his message.<\/p>\n

What other authentic learning opportunities might you use to facilitate Joey\u2019s expressive language development during snack time and ball play during his brother’s soccer practice? <\/strong><\/p>\n

What are some other ways in which you can help Joey\u2019s family incorporate naturally occurring opportunities to embed speech sound development into these experiences along the way?<\/strong><\/p>\n

\n

Reference<\/p>\n

American Speech-Language-Hearing Association. (2008).\u00a0Roles and responsibilities of speech-language pathologists in early intervention: guidelines<\/em>\u00a0[Guidelines]. Available from www.asha.org\/policy.<\/p>\n

\n

If you missed either of Corey’s webinars, visit the Talks on Tuesdays 2015 recordings<\/a> page on the VA Early Intervention Professional Development Center<\/a>, or click below:<\/p>\n

It’s Almost Never Apraxia: Understanding Appropriate Diagnoses of Speech in Early Intervention<\/a><\/p>\n

Ditch the Animal Sounds: Writing Appropriate Outcomes that Lead to Effective Implementation<\/a><\/p>\n

If you’d like to catch up on all of the posts in this series, visit:<\/p>\n

What’s the Bottom Line Regarding Articulation in EI?!<\/a><\/p>\n

ICD-10 Codes and Insurance Reimbursement: The Fun Stuff?!?<\/a><\/p>\n

Ditch the Animal Sounds! – Who’s Ready for the Next Talks on Tuesday?!<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Joey is 25 months old.\u00a0 He was referred to his local early intervention intake coordinator by his parents secondary to their concerns about his intelligibility and inability to effectively communicate his needs or wants.\u00a0 They reported that he uses approximately 15 words but \u201ctalks in such a garbled manner\u201d that both parents and Joey\u2019s older […]<\/p>\n","protected":false},"author":137,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_s2mail":"yes","footnotes":""},"categories":[139,10,12,14],"tags":[38,43,46,48,50,54,58,59,62,67,68,79,80,86,87,93,96,100,112,125],"class_list":["post-2459","post","type-post","status-publish","format-standard","hentry","category-all","category-engaging-collaborating-with-families","category-intervention-visits","category-practical-strategies-for-intervention","tag-communication-development","tag-daily-routines","tag-development","tag-early-childhood","tag-early-intervention","tag-embedding","tag-families","tag-family-centered-practices","tag-home-visits","tag-implementation","tag-infants","tag-natural-environment","tag-natural-learning-opportunities","tag-parent-professional-partnership","tag-parents","tag-red-flags","tag-research-to-practice","tag-routines-based","tag-strategies","tag-toddlers","clearfix"],"yoast_head":"\nAddress 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