Presented by Julie Meyerowitz, CCC-SLP, of Hear My Words RDI, Coaching and for Parents & Children with Autism and Adults Who are Independent with Autism

​In late July, I had the pleasure of speaking with Julie Meyerowitz, MA, CCC-SLP, of Hear My Words RDI, Coaching and for Parents & Children with Autism and Adults Who are Independent with Autism. Julie’s practice is based in Baltimore, MD. We met in an online seminar and decided we needed to find out more about each other, as we both work with individuals who are on the autistic spectrum. We come from differing, yet strikingly similar philosophies in our work. Please listen!

Parents are a child’s first educator. How parents talk to their toddler is one factor in how much and how well he or she will communicate as a preschooler.

Communicating well with toddlers takes patience and time. Due to the increasing demand on parents’ time, the daily schedule often turns into a marathon race to accomplish all of the day's tasks. Despite the hustle, it is very important that parents take time to “stop and smell the roses” with their children, especially at critical time periods when children act as sponges absorbing the language they will speak later.

This does NOT mean putting one more thing into the day’s schedule. In fact, communicating with children is best accomplished when the activity being talked about is a daily routine! It means “living in the moment” – being there 100% with the child, talking about what is happening.

For example, bath time is a great time to learn vocabulary, grammar and appropriate social language skills. Words such as “splash,” “wash,” “wet,” “soap,” “dry,” “hot," “cold,” as well as body parts can be said repeatedly to the child while checking the water temperature, washing, splashing, and drying off. This is most beneficial when a game or song can be made of the words – “Now we wash your toes, toes, toes, and then we wash your nose, nose, nose…(etc.).” Simply saying the words with emphasis while performing the actions (“SPLASH”) develops vocabulary, especially if it becomes a game that the child anticipates with bath time. You may soon be hearing a word that sounds like “splash” at times other than bath time. Confirm the word with your child – “Splash? You want to splash in the tub?  Should we take a bath and splash?”

Letting your child know that you have understood encourages more and better communication. Many times, toddlers are attempting to communicate to the best of their ability, but we do not understand their meaning. Careful observation of what the child is doing, letting him/her begin the interaction, and then interpreting (not correcting) what the child is saying, regardless of clarity, are keys to furthering language ability. It also develops the necessary "turn taking" skills that create good interactive skills between speakers and listeners, which in turn create readiness for learning!

Toddlers communicate in many different ways, long before they “talk.” They cry, shake their heads, smile, reach, gesture, look at what they wish to have, and even act out what they want to say. These are prime opportunities to interpret what your child is saying in the way described above.

They also talk for many reasons. They will protest, ask for objects and actions, express their feelings and attempt to get attention. They may imitate, greet, as well as name or describe things as they get older. It is important to recognize these reasons for communicating by confirming that you understood. You may also repeat what they said to do this.  Requests for your child to repeat these words correctly may prove frustrating for him or her. Simply showing that you understand and wish to communicate is best. 

Toddlers also talk about many different things – food or drink, toys, clothes, pets, parents, brothers and sisters, etc. Knowing what your child likes to talk about and encouraging conversations about those likes, is also a good tool to further language skills. 

​The American Speech-Language-Hearing Association (ASHA) describes otitis media as “an inflammation in the middle ear (the area behind the ear drum) that is usually associated with a buildup of fluid. The fluid may or may not be infected.”  The difficulty with otitis media is that the symptoms, severity, frequency and length vary. Certain special-need populations are more prone to otitis media.

Symptoms of acute otitis media include earache, irrational behavior and fever. Otitis media with effusion (fluid) often represents no symptoms, but can cause temporary hearing loss. Chronic or recurring otitis media may display a variety of symptoms. It is not uncommon for 4 or 5 back-to-back occurrences to happen in a six-month period.

Speech and language pathologists have been concerned with otitis media for year. Hearing loss accompanying otitis media can range from negligible to as high as 50 dB. The effects of hearing loss on speech and language development are well known. Children learn speech and language from listening to others speak. Research as revealed that infants need more intensity than adults to discriminate sounds and be able to reproduce them. Very young children with otitis media are, therefore, at greater risk for delays in speech and language development because the hearing loss associated with otitis media may not be considered “mild” by using the above standards. 
Another reason for concern with otitis media is its fluctuating nature: inconsistent auditory input makes it especially tough for the child during the sensitive period of speech and language development. 

It is important that children receive medical treatment as soon as possible for otitis media. Consult your pediatrician for your initial concerns. She/He may refer you to an Ear-Nose-Throat (ENT) Specialist. Antibiotics and pressure equalization tubes have been options for treatment, especially with special-need populations. If hearing loss is present, it is recommended that a complete hearing evaluation, including tympanometry (a measure of pressure in the middle ear cavity) be obtained and tracked. This is especially important for chronic otitis media, which can cause fluctuating hearing loss. For this reason, school hearing screenings do not always detect the child with otitis media. Depending on the day, the child may pass the screening at the typical 25 dB hearing level. Children with special needs would benefit from complete audiological evaluations every six months.

The preschool years are critical for laying a firm foundation of speech and language skills. If the child is not communicating at age-appropriate levels, later development may be affected, including the necessary skills for academics. It is best to identify and treat delays as soon as one suspects difficulty. Doctors and speech-language pathologists are trained to diagnose and treat these problems, as well as assist parents in being good models for speech and language development. Concerned about whether your child uses age-appropriate speech? Contact me at AAC on the Lakeshore for consultation and evaluation.

What are the areas of language with which these children have difficulty? ​Many children with ADD/ADHD do not show language problems on the traditional measures of vocabulary and grammar. Word finding difficulties are usually present. These are most often reported by the parent, teacher, or child rather than identified through language analyses.

Social language skills appear to be the area most affected in these children. They have difficulty taking turns, talking excessively, interrupting others, not listening to what is being said, and blurting out answers to questions before the questions are completed. It appears that these difficulties stem from problems with higher order language tasks that involve extended discourse (conversation) and use language for planning, problem solving and monitoring behavior. 

Learning problems in literacy are also related to language deficits identified in children with ADD/ADHD. Phonemic awareness ability (such as sound/symbol knowledge, sound blending, word segmentation, and sound manipulation) has been shown as necessary to success in reading. These skills are one aspect of “metacognition” or the ability to select, control, and monitor the use of thinking (cognitive) strategies. This again is a ‘higher order’ language skill with which many children with ADD/ADHD have difficulty.

​Another related problem is the ability to write on a topic (i.e., have each sentence relate to the same topic) and to link each sentence in a logical sequence. Often these children do not know how to plan for this type of task. 

If you are concerned with your child’s inability to focus attention and are considering a referral for Attention Deficit Disorder, it would be beneficial to include a full language assessment as part of a total evaluation. This will include an analysis of your child’s metacognition, fluency of speech, as well as abilities in phonology, grammar, vocabulary, comprehension, and social skills. For more information, contact me at ACC on the Lakeshore.

Otitis media is the inflammation in the middle ear that is usually associated with a buildup of fluid. The fluid may or may not be infected. The fluid dampens the vibration from the ear drum to the inner ear so that sound energy is lost. The result may be a mild or even moderate hearing loss. Some speech sounds, therefore, may be muffled or not heard at all. Compounding the problem is the fluctuating nature of the fluid. This fluctuation does not give the child a consistent signal for hearing speech sounds, hence interfering with the development of articulation.

Speech sounds also develop as the child progresses through the various feeding stages – sucking liquids, beginning soft foods, cup drinking, and chewing. The same muscles involved in eating are used for speech production. If a child has difficulty with this eating progression, there may be a delay in articulation. The skill required for more difficult eating assists the development of more complex speech sounds. For example, the lips are active in suckling and sucking from birth. The “lip” sounds - /m/, /p/, /b/ - are among the first sounds that children use when beginning to babble. AS the child handles soft foods, the tongue is more active and begins to move without the jaw. This sets the stage for the development of “tongue tip” sounds - /n/, /t/, /d/.

Sounds are not learned at once. Many studies have been done to determine the age that most children use speech sounds appropriately in conversation. There have been conflicting results! The American Speech-Language-Hearing Association (ASHA) states that “children should make all the sounds of English by 8 years of age.  Many children learn these sounds much earlier”.  The later developing sounds are typically thought to be /s/, /r/ and /th/ due to their motor complexity.

How do you know when to seek help for your child?  Parents should understand what their child is saying most of the time. Even at age two, parents should understand their child 80% of the time. For speakers over age four, listeners other than parents should be able to understand what is being said (especially when the topic is known) or should be able to pay more attention to what the words mean than to how they sound. Most important, the child should be confident about speaking. If the child is becoming self-conscious about his or her speech, self-concept is beginning to be affected. These are all signs that a speech evaluation is warranted. You can initiate a complete speech evaluation by contacting me at AAC on the Lakeshore.

With modulation problems, children may be under- or over-stimulated, leaving the child unable to use the language input received and having difficulty with organized speech output. With perception problems, children may have difficulty in auditory discrimination (necessary to spelling) and articulation (use of appropriate speech sounds).

Children with sensory integration difficulty may be:

• physically clumsy or have coordination problems
• over- or under-reactive to movement, touch, sight or sound
• impulsive or have poor self-control – including very high or very low activity level
• delayed in language and/or motor skills
• distractible or show attention disorder

Therapy for these children includes a combination of sensory integrative treatment with speech and language remediation. Physical or occupational therapists are usually the professionals trained in sensory integrative therapy. Therapy ideally is given between age one to school age.  The combination of approaches helps children to achieve optimal attending levels, increase efficiency in discrimination, and improve ability in motor planning for speech and language skills. 

Work in modulation is very similar to those common things we do for babies:  slow rocking; rubbing the back; singly softly and rhythmically to calm; as well as tickling, bouncing or placing cold hands on the child to gently arouse. It is very important however that you know what type of stimulation is needed before attempting any of these. 

Work in perception/discrimination may include activities for improved organized movement (body and speech) that will show up as an increase in motor coordination. The improvement is due to the child being able to process the complex sensory information with more efficiency.

More normalized responses to sensory stimulation may also lead to better emotional adjustment, improved social skills and self-concept. Parents of those children who have had a sensory integrative approach to therapy report that their child seems to be “better put together,” more assured, better organized and easier with which to live. Others improve significantly in school achievement as their nervous systems begin to function more efficiently. To find out even more about sensory integration difficulties, contact AAC on the Lakeshore.

As they are learning, it is not uncommon to hear them repeat parts of words. There is no awareness on the child’s part o​f any difficulty communicating. The dysfluency may occur for a week, a month, or longer and then stop. Or a child may be dysfluent for a time, stop, and then start again.

Parents’ reaction to this time is vitally important!  If they become upset and correct and/or over protect the child, a true stuttering problem may develop. It is important to listen to what the child is saying instead of how he or she is saying it. Parents who adapt their speech skills by reducing their rate somewhat and taking a few seconds before responding to questions, are modeling speech behaviors that will assist the child through this period.  
 
Approximately 1% of this “normally dysfluent“ group develop true stuttering. Of this group there are four times as many boys as girls. Contrary to popular belief, dysfluency is not related to an emotional problem. However, it can cause difficulty with self-esteem if it continues. 

Stuttering or “secondary dysfluency” is characterized by frustration with communicating, unwillingness to speak, and physical characteristics such as blinking, grimacing, and odd body postures. When these occur, there is cause for concern and a speech professional should be contacted as soon as possible. To find out more about stuttering, please contact me.

Or the child may distort the sound slightly. Some children appear to have the ability to say sounds some of the time, but not all of the time. This makes them very difficult to understand, as the inconsistency does not let the listen cue into their pattern of errors. A few children use only a small number of sounds, making their speech patterns sound the same for all sentences. Other children may say a word once and never say it again.

Anytime a child omits sounds consistently, an articulation problem is occurring. Hearing should be evaluated as soon as possible.  Substitutions and distortions do not necessarily mean a speech problem exists. The sound(s) in question and the age of the child determine the presence of an articulation disorder. Children who have a lot of variability in their speech sound production and are not understood usually are experiencing a more involved problem, such as “phonological processing disorder” or “apraxia”.

The diagnosis of articulation problems is handled differently depending on the setting in which a speech-language pathologist works. Most problems can be helped regardless of age, but the longer the problem persists, the harder it is to change. 

Many parents are concerned with prolonged thumb or finger sucking. These habits deform the dental arches, often causing “open bites” and hindering normal jaw growth. Possible results include difficulty chewing properly and incorrect sound production during running speech. Frequently the upper front teeth have been pushed forward enough with the tongue protruding through the open teeth to hinder proper nasal breathing, leading to frequent upper respiratory problems. Eliminating sucking habits, preferably during early childhood, helps prevent improper jaw positioning and assist in allowing the permanent teeth to erupt in normal alignment. Eliminating these habits is not an easy task. Punishment, bribing, and coercion are rarely successful. A positive approach is necessary. An evaluation by a speech-language pathologist trained in oral motor therapy would be beneficial.  AAC on the Lakeshore can help. Contact me here.