Taylor D'Aries 9/27/24 Taylor D'Aries 9/27/24

What is Apraxia and How Can Pediatric Speech Therapy Help?

This speech diagnosis has a lot to do with coordination, but it can be tricky to identify. Let’s dive in.

What does the word apraxia mean?

Apraxia is something that can happen after a stroke or brain injury. But some children who are otherwise healthy are born with apraxia. It can range from mild, moderate or severe, and there is research which suggests that it is genetic to some extent, being more common in boys.

Apraxia can impact walking and fine motor movements. When someone is apraxic they have difficulty making their body do something that their brain intends. Apraxia of speech is when this difficulty specifically affects the mouth for articulation. Sometimes children with apraxia of speech experience apraxia in other parts of their body as well, but often the movement planning challenges are isolated to speech.

I have heard apraxia of speech likened to the experience of trying to pronounce words backwards (sdrawkcab….oof). To conceptualize movement, or motor planning, you can also think about how discoordinated you would feel should you be thrown into a dance class, trying to keep up without having learned any of the steps.

My child’s speech is unclear: Do they have apraxia?

Maybe, but there are a plethora of reasons for unclear speech in childhood. It is up to your speech therapist to don their detective hat to see if Childhood Apraxia of Speech (CAS), is the underlying cause. CAS shares symptoms with other speech-language diagnoses, and sometimes children have multiple speech diagnoses happening at once.

But if you would like a peek behind the diagnostic curtain, below is a list of some of the signs your SLP will be looking for to make a diagnosis of CAS. A note while reading: All of the symptoms listed below may not be present in every child with CAS, and you should rely on a professional’s evaluation to draw conclusions.

A Very Young Child

Does not coo or babble as an infant
Their first words are late, and they may be missing sounds
Produces only a few different consonant and vowel sounds
Struggles to combine sounds; may show long pauses between sounds
Simplifies words by replacing difficult sounds with easier ones, or by deleting difficult sounds (although all children do this, the child with Apraxia of speech does so more often)
May have problems eating

An Older Child

Makes inconsistent sound errors that are not age appropriate
Can understand language much better than he or she can talk
Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
Has more difficulty saying longer words or phrases clearly than shorter ones
Appears to have more difficulty when he or she is anxious
Is hard to understand, especially for an unfamiliar listener
Sounds choppy, monotonous, or stresses the wrong syllable or word

*The above lists come courtesy of Motor Speech Queen, Pam Marshalla’s workshop Improving Intelligibility in Apraxia and Dysarthria, 2011.The government program and its acronyms: EI, IFSP, CPSE.

What Will a Speech Therapist Do to Help?

After making a diagnosis, which may occur after a period of early regular therapy, your SLP will begin to help your child learn to coordinate their speech movements. A bit of jargon is often used to describe this process: Motor Learning. There are key principles of motor learning that must be integrated into therapy to ensure your child is successful in learning their new speech sound movements. These include:

Having variety in practice contexts
Reducing the number of errors during practice (we don’t want mistakes to stick in the brain)
Providing meaningful feedback in response to a sound attempt

DTTC

If you want to experience speech discoordination for yourself, try saying the long form of this acronym 10x fast: Dynamic Temporal and Tactile Cuing. Coined by another motor speech queen, Dr. Edythe Strand, DTTC is an intervention for CAS that is strongly backed by clinical evidence. Some therapists who have not been trained in DTTC, may be surprised to learn that it is quite intuitive. If you are one of those therapists, Dr. Strand offers free workshops on to learn about CAS and DTTC. Here is a link!

Back to you parents, who don’t have time to take workshops (would be nice right?). What you need to know is that a therapist using DTTC to help your child will by doing things like:

Saying target words at the same time as your child, then adding delays

Providing visual cues with their hands or body to help them remember what to do with their mouth
Providing touch cues (sort of like how a fitness instructor would)
Stretching out words to make them longer, and easier to repeat

How Do I Get Started Therapy for CAS?

The first step is to consult with a speech-language pathologist. Tell them about what you are observing, and ask questions about their experience treating CAS. From there you will have an evaluation. If you’re working with BKST, we conduct diagnostic therapy at the start of our programs, so that we are not relying on a single moment in your child’s week to get to know them! Regular therapy for CAS should be frequent and regular.

If you’re interested in discussing the concerns you have about your child’s speech, or want to chat about CAS, you can book a complimentary 30 minute phone consultation with us here!

Taylor D'Aries 9/4/24 Taylor D'Aries 9/4/24

Help! My Baby Hasn’t Said Their First Words. Should We See a Speech Therapist?

The 12 month milestone pressure is real, but what goes on in the lead-up is actually more important.

Developmental Milestones: A Range

I love to show my clients this graph I have. It is a timeline starting from 0 months, and going toward 36 months. It has a horizontal bar for every developmental milestone across speech, language, play, self-help skills, physical development, and social-emotional development. What is nice about this chart is how it clearly shows the wide range of acquisition for any individual milestone.

For instance, your child using their own name? It can occur anywhere from 18-24 months; Your child drinking from a cup? It can occur anywhere between 10-15 months. Answering questions? A whole year! (24-36 months). Now this doesn’t mean you should necessarily wait until after these periods to seek support if your intuition is telling you something, but what it does mean is that pressured expectations for things to happen at highly specific times is just unrealistic.

All that said, what I really like about this chart is how it makes visible the otherwise invisible tasks that go into becoming a fully formed human. Because when assessing whether a child could benefit from speech therapy, it is actually more important to pay attention to everything going on before that 12 month “first word milestone”.

Baby’s First Words: The Product of Invisible Brain Work

Your baby’s first words are in the center of a venn diagram that consists of two overlapping circles. Circle one: Things that are most important to your baby. Circle two: Sounds that their speech system is ready to produce. “Mama” and “Dada” often fall in this space for obvious reasons of importance (❤️), but also because /m/, /d/, and “ah” are the least complicated sounds for our mouths to make.

Least complicated, yes but possible without extensive practice? No. From the moment your baby starts using their lungs and mouth they are preparing for speech. When they are putting everything under the sun in their mouth, they are also doing speech work. Your baby’s growing awareness of their environment is helping their brain to realize that there are things in this world that are worthy of attention, and that they have names (!).

Given what we now know about milestones popping-up in a broad age range, the degree to which your baby might need speech support depends on where they are in the “invisible” work of speech development. So let’s shine a light on these unsung milestone heroes of speech development.

The Milestones That Really Matter

I love my graph, and we all love a list. So if you’re at that 12-ish month mark and in a place of worry about your baby’s first words, take a look at this list of pre-communication “invisible” milestones. If your baby has done/is doing most of these things, they are likely on a standard path toward first word acquisition. If you haven’t seen some of these yet, or if they are sporadic, then there is probably something speech therapy can do to help them along. Either way, please know that your child is very young with a brain like a sponge and they will be okay!

Early Communication Milestones

Laughing

Differing cries (e.g., a “hungry” cry vs. a “tired” cry)
Responding to voices
Watching a speaker’s eyes and mouth
Showing active interest in a person or object for increasing periods of time
Looking for objects that fall out of sight
Throwing objects
Enjoying peek-a-boo like games
Pointing to objects
Passing objects to a grown up, or play partner
Enjoying “dump-and-fill” play
Imitating gestures like waving
Babbling chains of consonants “babababa”
Looking, or making sounds when their name is called
Showing understanding of “no”
Beginning to incorporate different sounds into their babble (e.g., k, g, n, w, t, d, f, v, th, s, z, l, r)

Deciding To See A Speech Therapist

If you think your baby is missing some of these pre-communication milestones, or if you’re simply not sure, a good place to start would be a chat with a speech therapist. Speech therapy for what is referred to as “late talking”, is often an incredibly enriching and empowering experience for parents. Supporting little ones with their early communication milestones is largely about helping you, their caregivers. There is much we can do with regard to how we set up a child’s environment, and communicate with them that can get them babbling, pointing, playing and talking.

At Brooklyn Speech Therapy, we offer a complimentary, commitment free 30 minute phone consultation where we can answer your questions, give a little insight, and share more about how speech therapy works. If you’re interested, you can book time with us here.

Taylor D'Aries 9/4/24 Taylor D'Aries 9/4/24

5 Tips for Teachers: How to Talk With Parents About Speech and Language Concerns

Having to tell a parent that their child might need speech therapy can be anxiety provoking, but it’s an important conversation to have.

Hi Teachers!

You are invaluable partners to us speech therapists, and working with you and your school leaders over the years has opened our eyes to how speech and language delays are noticed, discussed and supported in the classroom. You all are on the front lines of child development, and in my humble opinion, the best equipped professionals to spot the early signs of delays.

No knock to pediatricians, but what makes you teachers good developmental detectives is that you see children’s communication skills in action and in direct comparison with a variety of their peers. When parents take their children to the doctor, the doctor is observing them for a blip in time and relying mostly on the parent’s report of their child’s development. And there are many factors complicating a parent’s ability to pick-up on delays early.

Teachers, it is you! Us developmental therapists need you to give parents a heads up and recommend speech therapy. But it is hard to relay news like this, so we want to support you.

Below are our Top Five Tips for talking with parents about speech delays

Tip #1: Establish Trust

Trust is important in this dynamic. Parents will better react to, and process the news of their child’s struggle if they feel safe and trust your judgment. Your judgment is without a doubt reliable, but how long they’ve known you, or their own psychological experiences factor into their perception of this. Our suggestion is to coordinate to find a staff member who has a trusting relationship with this family and incorporate them in the chat. That person might be you, but if it is early in the year it might be the head of school, or a member of the administrative staff that they chat with every day.

Tip #2: Use language of difference rather than disability or disorder

Discuss your observations through the lens of developmental and learning differences vs. concerns or problems as much as possible. As I am sure you are aware, the field of child development has come to understand delays as learning differences, or spectrums (e.g., neurotypical vs. neurodivergent). However, parents aren’t as plugged into this as we are, and they may bring stigmas and biases from their own lives to the table. Reassuring them that children develop in their own way, and at their own pace can be helpful.

Tip #3: Tell them about neuroplasticity and the value of early intervention

Reassure parents that their children are young. You can say things like: “development can be a stormy time; needing some support is okay; it can only help.” You will be speaking the truth!

Tip #4: Try to get specific if you can

Think about the root cause of what you’re seeing: Is it speech (clarity), language (vocabulary, sentence building, comprehension), or based in the realm of cognitive/play (attention, regulation, social skills). A mix of one, or more is very common. Giving parents a sense that you understand these topics can ease their mind and reassure them that you have their back.

If you think the teacher community in your school could benefit from workshops to better understand the nuances of speech and language development, we do that too. Read more here.

Tip #5: Provide them with options for support

Wouldn’t it be terrible to hear: “Your child is struggling and needs help” without a path toward a solution or more information? Make sure when you’re relaying information to parents about delays that you have a list of resources available to share with them. These can include trusted websites for more information, but most certainly should include a list of local providers who can take the reigns.

If you would like to refer families to BKST for a complimentary 30 minute phone consultation, you can do so here. We aim to not only be a support to them, but to you as part of our therapy programming 🙂

Bonus Tip: Trust yourself and your training

From experience I know these conversations can be daunting, but you can never go wrong with positivity, encouragement and kindness. As teachers, you all are the last people I would have to tell that to. You were trained for this!

If this was helpful, you can follow along with our blog, or on Instagram or LinkedIn for more tips. You can also check out our Services for Educators page for information on our school workshop services.

Taylor D'Aries 9/4/24 Taylor D'Aries 9/4/24

What Should I Do if My Child is Stuttering?

Three Steps to Get You Started With Speech-Language Therapy for Stuttering

First, find the right therapist

The speech-language therapy profession is a big tent. Us therapists are trained to treat close to 20 different types of communication and swallowing disorders (from late talking, to feeding, to brain injury rehab and so on). Some therapists develop into a jack-of-all-trades, while others prefer to specialize in one area.

Fluency, or disfluency (aka stuttering), is an area that lends itself well to specialization. It is unique from other types of communication disorders, mostly because there is a large psychological component to the experience of a person who stutters, and to the intervention that is required. It’s special, and those who dedicate their practice to it are very good at what they do.

Next, consider your child’s age

IIntervention for stuttering is very different for toddlers and preschoolers, than it is for older children and adults. There is a period in a child’s early development, between ages 1-3 years, when it is common to have what we call “typical disfluency”. You may recognize this when you think about how young children speak. There is often a lot of repetition, or pausing. For instance: “I I I I….want…some!”; One might also hear “sound prolongations”. For instance: “shhhhhhe took it from me!”. Oftentimes children grow out of this bumpy speech phase, however if this is particularly pronounced, if it creates an emotional challenge for your child, or you have a family history of stuttering, it is best to chat with an expert about it. Stuttering intervention for children in this age range is about prevention of persistent stuttering, supporting their emotional experience, and training their caregivers in the best ways to communicate with them.

For children older than 4 or 5, and especially those in later elementary school or adolescence, a stutter is most likely what we call “a true disfluency”, in that it is not a temporary phase, but a feature of their communication patterns. Therapy for children in this age range is about mitigation- reducing the intensity or frequency of disfluencies, as well as fostering self-awareness, self-advocacy and providing emotional support.

Then, learn the basic principles of stuttering support

“When My Child Is Stuck, Should I Give Them The Word?”

As empathetic beings, the pull to help someone who is struggling to communicate, or the discomfort you feel as a listener in those moments is universal and normal. The best ways to support a person who is stuttering are less instinctive. This is why a large component to speech-therapy programs for disfluency is the education and training of a person’s key communication partners (e.g., parents, siblings, grandparents, teachers). A supportive communication partner can change the game for a child who is stuttering.

Here are some do’s and don’ts for parents of children who stutter:

Do not chime in with the word your child is stuck on, it creates a negative psychological experience for them
Do wait and listen patiently. Try not to show physical signs of discomfort
Don’t add unnecessary pressure to a situation by trying to rush them while they are stuttering, or making comments like “spit it out”
Do learn ways (with your speech therapist) to speak plainly about stuttering, and to normalize it within your household. This will look different depending on your child’s age.
Do not avoid talking about it with your child. We don’t want them to feel like it is the elephant in the room.
Do educate yourself and your extended family about stuttering. Your speech therapist will help.
Do seek emotional support. Parenting a child through a struggle is really hard. For some children, stuttering is pronounced and difficult to ease. It can trigger feelings of shame and pain for both the child who is stuttering, and for those that love them most. The way we respond to anyone who is stuttering comes from our place of emotional charge. It is best to explore your experience as a parent with your own psychological support system.

Therapy for Stuttering Foundations with BKST

At Brooklyn Speech Therapy we aim to provide gold standard intervention for all families. If we do not have a fluency specialist available when you call us, we offer two options. One is a referral: We can help you find one.

The other option we offer is Fluency Foundations. This introductory program for disfluency is designed for:

The mitigation of persistent stuttering in children under the age of four years

The basics of stuttering education and fluency shaping strategies for older children.

No matter your child’s age, our programming centers heavily around training parents and caregivers to be the best support they can be to their children.

If you would like to talk more about your child’s stuttering, book a complimentary 30 minute call with us, here.

Taylor D'Aries 9/4/24 Taylor D'Aries 9/4/24

What is a Speech Pathologist Really?

Valid question! Speech-language pathology is pretty niche, and in my opinion our professional title is a misnomer.

Valid question! Speech-language pathology is pretty niche, and in my opinion our professional title is a misnomer

Terminology Key

For the sake of my word count and our brains, I will use the abbreviation “SLP” to refer to speech-language pathology in this article, but here is a breakdown of the terminology jumble:

Speech therapist = speech pathologist = speech-language therapist = speech-language pathologist

Pathologist: is a professional who makes diagnoses

Therapist: is a professional who treats the features of a diagnosis

All SLPs are both pathologists and therapists. We identify, diagnose and treat communication disorders, and apparently don’t know how to summarize this duality in a title.

Speech and language are skills that need support

The best way to get a sense of what an SLP really is is to know that our closest professional collaborators are Physical Therapists (PT) and Occupational Therapists (OT). To oversimplify vast knowledge bases and years of schooling: PTs help people use their legs for mobility, OTs help people use their arms and hands for daily activities, and SLPs help people use their head, throat and mouth.

SLPs are sort of like the lesser known cousins of the therapy world. It is easy to recognize and connect with the physical experiences of being human, and the need for PT is a bit more ubiquitous than the need for speech therapy. Let’s just say that we are all very lucky that we don’t lose our ability to talk as easily as we pull a muscle. But just as walking and tying your shoes are skills that sometimes need help, speech and language can as well.

To add a little dash of complexity, because why not: SLPs are also feeding and swallowing specialists. These are mouth functions, okay?! To understand more about an SLPs role in feeding and swallowing, check out this blog.

What is the difference between speech and language?

This is a very important distinction.

Speech refers to the coordination of movements from your lungs, vocal cords, tongue, lips and jaw to make sounds and words. Speech is impacted when you are numb from the dentist.

Language refers to the brain’s storage and retrieval of vocabulary, and the use of grammar to communicate and understand messages. You are experiencing a difficulty with language when a word is “on the tip of your tongue”.

Speech is very physical, and language is more conceptual. Think of them in terms of an English speaker studying Spanish. Speech is perfecting the accent, whereas language is learning the words for things and constructing sentences.

When do people need to see a speech therapist?

SLPs work with people across the entire lifespan. There is a phrase that feels quite crass, but is (was?) used in the field when talking about our scope of practice: From womb to tomb. Don’t love it, but you get the idea.

SLPs work to support feeding and swallowing in NICUs with premature babies, and in nursing homes with the wiser among us. We work with people of any age who are recovering from strokes, brain injuries, or neurological illnesses that impact their ability to communicate. Most commonly we work with children who are having trouble talking, or who’s speech is hard to understand.

What are the conditions that speech pathologists diagnose and treat?

I have just the list:

Late Development of Communication Milestones in toddlerhood

Expressive and Receptive Language Disorders
Articulation & Phonological Speech Disorders
Apraxia of Speech
Myofunctional Deficits
Disfluency, or stuttering
Voice Disorders
Communication Challenges of Autism Spectrum Disorders
Difficulties With Reading and Writing
Executive Function Skills
Aphasia
Dysphagia (Swallowing)
Sensory Based Feeding Difficulties
Cognitive-Communication Disorders from Neurological Illness and Injury

Check out our blog page for more specifics about these.

A Hill I Will Die On: Speech Therapy is a Misnomer

As you can see from the presence on the above list of things like “executive function skills”, literacy, and swallowing difficulties, us SLPs don’t just treat talking. More broadly, we treat disorders of communication.

Communication is speaking, listening, reading, writing, gesture, and using voice output devices. Successful communication does not happen without the executive functions of attention, inhibition, planning and problem solving. And we treat those too.

I love the idea of referring to us SLPs as communication therapists, but this exposes the difficulty: What about feeding and swallowing?!

I guess this is why the field has gone with something…vague. If you want to take it to the source, or learn more about the world of speech therapy, here is a link to the American Speech-Language Hearing Association (ASHA). They make the rules.

If you want to chat about speech therapy for someone in your life, you can book a complimentary 30 minute phone consultation with us here.

Taylor D'Aries 9/4/24 Taylor D'Aries 9/4/24

What is Early Intervention in Speech Therapy?

Both a concept, and a government funded program in the United States. Let’s get into it.

The Concept: Why does everyone say Early Intervention is so important?

Early Intervention (EI) is best described by the phrase “the earlier the better”. It refers to the idea that if challenges are recognized early in a child’s life, and intervention is provided accordingly, long-term developmental outcomes are optimized. The concept of EI applies to all areas of development, not just communication. Some other examples are: feeding & swallowing, sensory regulation, fine and gross motor skills, and cognitive abilities. For communication and feeding, speech-language therapists provide diagnosis and treatment. Otherwise, Occupational Therapists (OTs), Physical Therapists (PTs), and special educators are working with children. We often work as part of a team.

When exactly, is “early”?

This is relative to the type of challenge that is being treated. Here are some examples in the realm of communication:

For a child with a lisp, 3-4 years of age is considered early

For a baby with difficulty coordinating sucking with swallowing and breathing, the first weeks of life are considered early
For a child with a language or speech delay, 9-12 months is early

The natural next feeling after reading this is anxiety: Are we too late? How do I identify a need for help early enough?

It’s okay. Recognizing the signs of a delay at the exact time they pop up is only possible if you’re specially trained to spot them, and even then: sometimes difficult! Generally speaking, if you are seeking support for your child in infancy for feeding or swallowing issues, toddlerhood/early preschool for language, or under the age of six for speech sound errors you are good 🙂

An important concept to keep in mind: Children’s brains are incredibly malleable. They are fast learners, and as parents of teenagers can attest, they are still working on that brain development until they’re 20. God bless.

At Brooklyn Speech Therapy, we aim to provide all of our intervention as early as possible. A large part of our work is connecting with family facing community programs like pediatrician’s offices, preschools and daycare centers to advocate for the importance of delay identification and therapy referrals.

The government program and its acronyms: EI, IFSP, CPSE.

Who doesn’t love a government program??

Jokes aside, as someone who has provided speech therapy in a developing nation (India, a beautiful one!) I can say that we are incredibly lucky in the U.S. to have access to free developmental support.

Are the standards of who qualifies reflective of actual needs? No!

Is the quality of service provision, consistency of delivery, and timeliness of onset adequate? Also, no!

Are we lucky like people in Sweden or Switzerland? Ugh.

However, it exists, and it helps a lot of families of children with significant developmental challenges.

That being said, the bar for a child to qualify for this free therapy is high. Children need to score at least three standard deviations below average in many cases to receive services, or have delays in more than one area of development (e.g., speech and gross motor; or speech and cognitive development). This qualification structure means that a child’s speech and/or language delay might not register on testing to be significant when they are 18 months, but will when they are 2.5 years. If relying solely on government funded therapy, that results in a period of a year without important support. A year that could have potentially helped that child close their developmental gap.

It’s imperfect, but it is still worth exploring for the chance of free services.

Still curious about those acronyms?

EI- Early Intervention, as in the program that provides services for children ages birth-three years. It is federally mandated, but operated at the state and city level.

IFSP- Individualized Family Service Plan. This is a document developed after an evaluation that lays out your child’s needs and goals. It is a legally binding document, recording that your child needs x,y,z and therefore the government is obligated to provide support for x,y,z. You are technically able to sue if the mandates are not fulfilled, and you better believe that many resourceful New Yorkers do just that.

CPSE- Committee on Preschool Special Education. This is the entity that provides therapy services once children turn four, but before they enter Kindergarten. Then it becomes CSE, a new world of acronyms.

How do I get my child evaluated by the EI program?

You can start by talking to your pediatrician, but there are resources available online. Here is a link to the NYC Early Intervention info page, with instructions for setting up an evaluation.

What is Early Intervention like at Brooklyn Speech Therapy?

In our practice there are no barriers to entry into therapy. If you are concerned about your child’s developmental level at any age, or your ability to support them then you “qualify” for early intervention support with us. That support may look like weekly therapy sessions for a period of time until your child has achieved their goals, or it could look like a few sessions of parent coaching to make sure your child stays on track to meet their communication milestones.

You can read more here, about how speech therapy programs at BKST work.

Because our intervention model does not adhere to the structure of state EI programs, we do not provide state funded services. Our services are private pay and we provide documentation for out-of-network insurance reimbursement.

Supplementing the EI system and collaborating with their therapists

Many of the families we support have children under the age of five. The majority of whom have either not qualified for the government program, or are having trouble accessing a therapist via that route. However, we always encourage our families to seek out government services even after we get started together. It is often more sustainable if there are long-term needs, and we love collaborating with other therapists. An extra dose of EI speech therapy can never hurt!

If you are interested in talking more about early intervention speech therapy for your child, click here to book a complimentary 30 minute consultation call.

Hannah Mac 8/19/24 Hannah Mac 8/19/24

“How Long Will Speech Therapy Take?” And Other Frequently Asked Questions

Let’s get into some FAQs!

Realizing your child may need a little support with their development brings about scary unknowns, of the 3am insomniatic variety. They might be questions like:

Will he ever sound like the other kids?
Why isn’t she talking yet? We’re doing all the right things!
Are they going to be okay and make friends in school?
What if this never gets better?

Worries about your child’s development are destabilizing and unsettling. But if you are here reading this, you are not far from a support system. At Brooklyn Speech Therapy, our home programs are designed to help children overcome the communication challenges at the heart of your concerns, but to also be an emotional support system for you in the process.

These bigger questions are easiest to address during our initial chats and play sessions (That you can book here). So for now let’s take another load off of your mind and explore some of the FAQ’s about speech therapy basics.

Is Speech Therapy Even Necessary, or Am I Overreacting?

I have never had a phone call with a parent who was overreacting, but many who feel that they are. Sometimes society and other family members send conflicting messages about what is concerning or what warrants intervention. Oftentimes a parent(s) call to say: Everyone is saying it is fine (“I didn’t talk until I was 5!”), but I just can’t shake the feeling that something isn’t right. In 90% of these scenarios, the parent is correctly identifying a need for support to help their child through a tricky developmental phase.

My advice is to trust your instincts. A free 30 minute chat with a professional doesn’t hurt!

Is My Child Too Young for Speech Therapy?

Technically, no, pediatric speech therapists work with children sometimes as early as a NICU stay. However, speech therapy in the initial weeks of infancy is typically only necessary if your child was born premature, or has medical and developmental complications identified at birth.

That being said, a trained eye can detect the signs of a speech, language or cognitive delay well before the milestones of first words (at roughly 12 months of age). If your baby isn’t smiling, enjoying physical comfort, visually attending to toys, or reacting to sounds before 6 months; or if your 9 month old isn’t beginning to imitate gestures and facial expressions, or babble with increasing complexity: Have a chat with a speech therapist.

For children 12 months and older, speech therapy is always a good idea if you are noticing them to be behind their peers or siblings.

Why Did My Pediatrician Tell Us to “Wait and See” Before Contacting a Speech Therapist?

Pediatricians have different ways of practicing, and different specialties. Not all of them consider development as centrally as others. Will they make sure your baby is meeting weight, height, and general health milestones? Absolutely. Will they guide you through vaccines and colic? Yes. However, they are medical professionals, and some are not very well versed in the nuances of holistic development. And some well intentioned doctors do not want to cause new parents alarm. Anecdotally I have been hearing of many more pediatricians advising parents to reach out to professionals like us for children as young as 14-18 months. We love to see it!

A general tip: If you are expressing repeated concerns to your doctor and feel that you are being dismissed, find a new doctor.

Other Family Members Can’t Understand My Toddler. Do We Need Speech Therapy?

If your child is 3 years and older, then chances are you might. By age 3, the majority of children should be at least 70% intelligible to an unfamiliar listener. This means their extended family members, daycare providers, other children, the dads at the park etc.

Could My Child Have Gotten Their Stutter/Language Delay/Lisp etc. From Me?

Possibly, yes. Just as they have inherited their laugh, personality or dance moves from you. There is work to be done regarding genetic mapping of communication development, but speech/language delays or idiosyncrasies tend to run in families. Our aim is not to dwell in the why but focus on helping the families working with us to overcome, and celebrate their individuality.

How Long Are Speech Therapy Sessions?

All sessions are 60 minutes. Direct play therapy with your child is 50 minutes, with 10 minutes set aside afterward to update you on progress and give you strategies to support your child outside of sessions.

How Often Do We Need to Do Sessions?

Weekly to begin. Frequency of speech therapy sessions is dependent upon our area of focus, or the degree of challenges present. However, generally speaking the more often therapy occurs the better. Here in the real world with our packed schedules, we most often work at a cadence of 1x/week.

My Child Has Difficult Time Focusing. Will They Be Able to Participate in Sessions?

Yes! It is our job to make sure that your child can sustain focus for speech therapy sessions. Sessions are designed with your child’s age, attention, and interests in mind so that they are engaged and having fun throughout. It is often the case that children working with us in speech therapy do not even realize they are “working” or “learning”, because all goals are targeted in play. If your child struggles with attention, or regulation we incorporate specialized techniques to meet their learning style.

Do I Need to Be Present for Sessions?

It is best that you connect in a meaningful way with your therapist for each session. Our approach involves a considerable degree of caregiver training and education. We want you to feel fully informed about the speech therapy process, and be able to support your child in the right ways, so if that means you are listening in nearby during sessions- great! But if it is only possible to connect via email, or on a call after the session then that works too.

What Kind of Space Do We Need for Speech Therapy Sessions at Home?

Whatever space you have that your child enjoys is where we will come! We do home speech therapy because it is where your child is doing most of their communicating. Depending on your child’s goals we may make suggestions about types of toys, or ways to set-up their play space that could maximize their progress.

My Other Kids Are Around the House: Will They Be a Distraction?

We love a sibling participant, and frankly siblings are often our biggest fans (A grown-up with their own toys to come over and play?!). Focused attention on your child who needs support is of primary importance though, so we will work with you to make sure to balance sibling fun with quiet one-on-one therapy time.

How Many Therapy Sessions Will We Need?

This is the trickiest question to answer before knowing, and working with a child. Factors such as the reason for a communication delay, responsiveness to intervention, a child’s attention levels, social-emotional world, behavioral patterns, and caregiver involvement for carry-over all influence the pace of progress in therapy.

We are a chatty and collaborative bunch, so we like to keep our families closely informed of our progress impressions each session. Things will feel more clear as we go.

Do You Do Sessions in Schools?

Sometimes, depending upon the location of your child’s school, their daily schedule and the school’s openness to welcoming outside private providers. If we are working at school, we collaborate closely with staff to support your child, and send you a detailed summary email after each session.

Do You Accept Insurance?

No, we are out of network. However, we help our families with the necessary paperwork to receive reimbursement from their insurance companies.

Do You Service RSAs, or Provide Early Intervention Services for the Department of Education?

We do not work directly with the department of education, so we cannot legally satisfy the mandates of your child’s IEP, or IFSP. If you are open to private therapy to support that which your child is receiving through the state (or their school), then we are happy to work in collaboration with that therapist.

For any other burning questions about starting a speech therapy program for your child, or to start tackling those 3am worries, reach out to schedule a complimentary phone consultation with us.

Hannah Mac 8/13/24 Hannah Mac 8/13/24

How Pediatric Speech Therapy Helps Children Develop Their Articulation and Phonology Skills

If your child’s speech is difficult to understand, or they use the wrong sounds sometimes, then read on.

What are articulation and phonology?

Fancy words! Articulation and phonology refer to the systems children use to form consistently clear speech. Articulation is what children are doing when they put their lips together to make the ‘M’ sound, or when they elevate the back of their tongue to make the ‘K’ sound. An example of an articulation error would be a ‘lisped’ S. The reason for a child’s articulation errors could be from a variety of causes that your speech therapist will explore

Phonology is less concrete than articulation. It refers to a system in the brain that organizes sound concepts. This system then gives children a map for how to use sounds in speech and while reading and writing. Difficulties with phonology are often linked to later challenges with literacy learning. When a child calls Lollipops, Wowipops, or says things like Titen for Chicken, they are making phonological errors.

Articulation and phonology are complex systems that can influence each other and they develop in phases during the toddler years. Until about three years of age, errors in articulation and phonology are expected, but if errors persist beyond that time it would be wise to book a call with a Speech-Language Therapist.

What will a speech therapist do to help children with articulation and phonology?

All therapy programs at Brooklyn Speech Therapy begin with a 30 minute consultation call where we listen to the concerns you have about your child’s speech, and we gather relevant information about their medical and developmental history and communication patterns. From there we begin to work with you and your child in a Diagnostic Therapy Session.

The first step in treating articulation and phonology challenges is proper diagnosis. We need to understand which of these two camps your child’s speech sound errors fall into, or if it is a mix of both. From there we need to determine the underlying cause, and what types of support your child responds to best. We do this all through play-it’s fun! This process typically can take anywhere from one-three sessions, but our detective hats are always on throughout our therapy programs.

Once we have a good sense of why, we get to word remediating the error patterns. We teach children about their mouth, how it moves to make sounds, and orient them to important parts of the mouth for speech (there is one called the *magic spot*). For difficulties with articulation, therapy is a bit more physical, with practice moving the tongue, lips, or jaw in new ways. For difficulties with phonology, therapy is a bit more conceptual and involves learning about groups of sounds and how they are different from one another. In either case we also teach you, their caregiver about their specific challenges, and how to support them outside of sessions.

How do we make this fun? Take a look at this blog: Anatomy of a Speech Therapy Session.

The very subtle, but very exciting element of this therapy is the boost it provides to a child’s pre-literacy and literacy skills. Learning about sounds as they relate to their speech gives children a nice boost for when it comes time to learn about sounds and their letter pairings.

Want to discuss your child’s articulation and phonology development with an expert? Click here to book a 30 minute complimentary call.

Hannah Mac 8/13/24 Hannah Mac 8/13/24

How Pediatric Speech Therapy Helps Children Develop Their Executive Skills

If your child is having trouble with focus, impulsivity, or completing tasks from start to finish, then read on.

What are Executive Skills?

Executive skills are what we in the biz are referring to when we say cognition. [This is not intelligence. I repeat: This is NOT intelligence]. Different from the brain functions for speech and movement that can be clearly observed, executive skills are invisible and act behind the scenes. I like to think of executive skills as our brain boss, or as the director of a play: They are there to develop a vision, make plans, keep everyone on task, manage time, and execute smoothly.

Executive skills are controlled by the front part of our brain, and include:

Attention
Inhibition
Planning
Organization
Problem solving
Time management
Self-awareness / self-monitoring

All of these non-verbal cognitive skills dictate the way we move, speak and remember information. Think about your adult self going grocery shopping for a moment. Ideally you make a list (plan, attend), possibly set that list up by food category, or place in the shop (organize), think about how much time you will need to travel and spend at the store (time management), substitute an unavailable item with another (problem solve), resist the temptation to buy something that you know will go uneaten (inhibition), keep your cart nearby to avoid blocking others (self-awareness, environmental awareness).

What Do Executive Skills Look Like in Childhood?

Executive skills develop in childhood through communication and play. They are present at every developmental level, and can be observed across most activities. Here are some examples:

The length of time a child will sit for an art activity in preschool, or for some more basic dump-and-fill play in the early years is a function of their attention
The elaborateness of their block tower, and the imaginary world created around it is a function of a child’s planning, organization, attention, and problem solving
A child’s ability to keep a conversation on topic showcases their attention, inhibition, and self-awareness
Sharing and kindness are obvious when a child breaks their cookie in half to share with their friend, but it is the executive skill of problem solving that guiding this action

As children get older, they further develop their executive skills and become aware of how and when they need to move more quickly, slow themselves down, or prioritize tasks properly to complete assignments. Without the executive skills of self-awareness or self-monitoring, children cannot take charge of their own growth and learning.

We all struggle with our executive skills from time-to-time, and compensate in our own ways (Lists! Timers! KeysPhoneWallet!). But more pointed intervention is often essential for individuals whose brains are wired in ways that make attention and regulation difficult.

What Do We Do in Speech-Therapy to Support Executive Skills?

Several of us on the Brooklyn Speech Therapy team have expertise in rebuilding executive skills for children who are recovering from strokes and brain injuries. Therefore, support for executive skill development is embedded into all of our speech therapy sessions regardless of a child’s primary communication challenges. Here are some examples:

We make “play plans” that require children to focus slightly longer than their baseline while employing frequent reward and reinforcement systems. This nudges them to the next level and keeps them going with a positive spirit.
Self-monitoring is subtly and consistently encouraged in speech therapy (“hmm does that sound like the right sound to you?”; “wait do we say “ranned”, or ran?”)
Our sessions revolve around lightly structured play that often follows a sequence of steps (we love obstacle courses), and encourages children to move through tasks with organization in mind.
For little ones, we work to expand their play routines to involve more steps, or imagination. Read more here about how expanding play improves communication.
For some of our older kids, who need more executive skill support we design neighborhood scavenger hunts with lists to tick off, or go on executive skill “outings” to learn about time management and map skills

Therapy Teams Improve Executive Skill Development

While our speech therapy sessions support healthy development of executive skills for all of the children we see, sometimes executive skills are the primary goal. Speech, language and communication challenges for children who are neurodivergent (e.g., those with ADHD, ASD, or sensory processing disorder) are very often due to their system of executive functioning.

For neurodivergent children to benefit from speech therapy and improve their communication, we need to help their executive skills flourish. Doing so requires understanding what keeps them regulated at the “just right level” for learning, what they need to boost their physical endurance, and what can be done to support them in school.

This is where therapy teams come in! We build and work within teams of Occupational Therapists, Physical Therapists and teachers to make sure we are not treating speech and language in a silo. We love to learn from our therapy colleagues about how best to help children make lasting progress with their communication.

Hannah Mac 8/13/24 Hannah Mac 8/13/24

How Pediatric Speech Therapy Helps Children Develop Their Language Skills

If your child isn’t talking enough, having difficulty making sentences or following directions, then read on.

What is Language?

Language is the content of our messages: Our vocabulary, grammar, sentence structure and story organization. Children use language expressively when they talk and write. They use language receptively when they listen and read. An important portion of our brain is designed to make and process language no matter which one(s) we speak at home. Learning spoken language is inherent for all humans, but there is variety in how language develops.

How do you know if your child needs support with their language development?

Sometimes, a child’s language development is delayed, or follows a different course than most. The signs of this often include:

A lack of talking, a small vocabulary or difficulty relaying clear and organized stories
Grammar errors in speech and writing that persist despite proper instruction
Difficulty understanding spoken directions
Challenges mastering letter and sound pairings when learning to read and write
Difficulty understanding the meaning of readings and formulating written information

Language development is a deeply complex and multi-faceted process that occurs for children in a series of milestones and phases. When a child is under three years of age, it can be difficult to know if skills need more time to emerge, or if they need support. Early intervention is essential to getting children on the right language learning track, so if you have a doubt, trust your gut and consult an expert.

You can book a commitment free, complimentary consult call with a speech-language therapist here.

What will a speech therapist do to improve language skills?

The first step in treating language challenges is proper diagnosis. Your speech therapist will be looking to answer several questions, such as:

Is the difficulty expressive, receptive, or both?
Are the challenges limited to one area of language?
Are there external factors like regulation or inattention influencing their development
Does this child have a different learning style for language development entirely (e.g., Gestalt Language Learning)

From there we need to determine what types of support your child responds to best. Support can be in the form of visual cues, adding tactile experiences to language, or making our adult communication styles more developmentally encouraging. We do this all through play-it’s fun! This process typically can take anywhere from one-three sessions, but our detective hats are always on throughout our therapy programs.

Regular, weekly intervention that incorporates family and caregiver training is essential to remediating the developmental language challenges we identify. We’ll design play, or game based scenarios to systematically target language gaps. Language intervention programs are not like medicine. Improvements sometimes happen quickly, but are more often gradual. A therapy program with Brooklyn Speech Therapy to support language development is thorough and collaborative. Helping your child to speak easily and comfortably is our #1 goal, with empowering you to understand their needs and support them coming in at a close second.

Want to discuss your child’s language development with an expert? Click here to book a 30 minute complimentary call.

Hannah Mac 8/13/24 Hannah Mac 8/13/24

How Pediatric Speech Therapy Helps Children Develop Their Literacy Skills

If your child is having trouble learning their letter-sound pairings, or has difficulty producing clear speech, then read on.

What are Pre-Literacy Skills?

Pre-literacy skills are the often overlooked powerhouse behind reading and writing. Contrary to common belief, reading and writing does not begin with the process of matching printed letters to their sounds. It begins much earlier with the pre-literacy activities of late toddlerhood, including:

Creating and identifying rhymes
Counting and segmenting syllables in words
Recognizing the sounds at the beginning and end of spoken words

Pre-literacy skills develop and solidify, so that by age five children have the tools to get to the next step, the main event if you will.

What are Literacy Skills?

In short: Being able to read and write. Reading and writing are forms of language, but unlike spoken language that develops naturally, we need to be explicitly taught how to read and write. Equipped with the pre-literacy skills gained in the preschool years, children embark on their literacy journey by learning:

Letter and sound pairings (the letter B says /b/)
Blending letters and sounds together (the letters BE say “bee”, /bi/ if you want to go there)
How to sound out whole words (B-E-E-T says “beet”, /bit/- I see you nerds)
How to write letters
How to combine letters to make sounds aka spell (when I write the letter B and E next to each other, it says /bi/)
How to read and write sentences

The goal is for the mechanics of reading and writing described above to be mastered, so that children are able to read and write to learn and convey their knowledge.

What will a speech therapist do to help children with pre-literacy & literacy skills?

Due to our training in phonetics and early childhood language development, speech-language pathologists are uniquely equipped to teach pre-literacy and literacy skills the way science proves effective: through systematic and phonics-based methods. Learning to read and internalize early literacy concepts can be tricky for any child, but even more so for children with language learning difficulties or histories of speech delay.

In therapy, we combine science-backed phonics curricula with play, movement, and sensory activities to give children a holistic experience with literacy. Our sensory and movement based approaches break with traditional classroom teaching methodologies and open up new ways for students to explore sounds and letters. Because of its importance for communication development, literacy elements are also incorporated into all of our therapy sessions as secondary or reinforcement goals.

Want to discuss your child’s literacy development with an expert? Click here to book a 30 minute complimentary call.

Hannah Mac 8/12/24 Hannah Mac 8/12/24

Moving to India Taught Me To Be An In-Home Speech Therapist

A surprise gig as a live-in speech therapist in Delhi transformed me personally, and opened my eyes to a better way of practicing speech-therapy.

From Medical Speech Therapist to “In-Home, Ex-Pat” Speech Therapist

In the summer of 2014 I was a young clinician enjoying the challenging and stimulating environment of my dream job. I was a speech therapist at NYU’s Rusk Institute of Rehabilitation Medicine, helping children who struggled with communication and cognitive skills after brain injuries and strokes. It was hard, but I loved it; and I felt so grateful to have a position on an elite team of therapists and doctors.

While on a vacation in California, I received an email from a cousin of my then roommate. He and his wife lived in Delhi, but were with their 27 year old daughter in Philadelphia while she recovered from a severe traumatic brain injury. She was receiving intensive cognitive rehabilitation. She was re-learning how to talk, could no longer read and had difficulties with memory and impulse control. Now she was getting discharged, and they had to move back to Delhi with her where there was no speech therapy.

They heard about the work I did, and in what I imagine they thought was a long shot, asked me if I would be interested in living with them for three months. They wanted me to provide intensive, around-the-clock speech-language therapy for their daughter, Avanica.

I said yes, and those three months turned into three years of me living in Delhi and discovering that there are better ways to be a speech therapist.

Integrating Speech Therapy into Everyday Life

Ten years after that email, the element of my live-in speech therapy program at Chez Khosla that comes up most often in our reminiscing is of me putting post-it notes printed with “Shhhh” up-and-down their staircase. These were a visual cue to remind Avanica that we need to avoid conversations on the stairs so that she can focus on her balance.

Avanica’s parents Arjun and Shibani welcomed me as a family member into their home. We ate meals together, I had my own bedroom, I attended family gatherings and celebrated Diwali with them; we went to the movies and ran errands together. Shibani helped me tie a sari, and Arjun warned me against eating raw vegetables to avoid Delhi-Belly. In these moments I was a guest in their home, but a speech therapist to Avanica. I learned to be an expert and a guest, a skill I practice daily here in Brooklyn as a speech therapist who makes house calls.

Avanica and I had daily, intensive 1:1 therapy sessions where we worked on her expressive language skills, and learned the basics of reading with content that interested her: A cool 27-year old working in global economics. I would rewrite tweets on paper in large font, and we practiced sounding out the words to figure out what the tweet meant. We eventually progressed to short news articles, poems and stories. I would support Avanica in bringing up these topics in conversation over dinner that night, or during our car-ride to the market.

Now, Avanica loves to joke about how little she liked me: I was pushing her and I was always there (eye-roll)!

Building Therapy Connections

Working in the hospital instilled in me the necessity of developing a team around a patient/client…or in the case of Avanica: my housemate? As it came time for my three-month stay to end, my priority was finding professionals in Delhi who could continue to help Avanica with her cognitive-linguistic goals.

I branched out into the community to meet a reading specialist with extensive international training who ran a learning center; I befriended the wife of a Canadian diplomat working as a teacher who was able to help Avanica with language practice and social communication. Avanica’s parents spearheaded this team building, and made it their mission to ensure she continued to receive the support she needed.

The best therapy programs are made of these elements: Collaborating professionals who are willing to think outside of the box, and a family dedicated to learning.

Avanica and her parents are my forever inspiration.

Breaking From Speech Therapy Convention

“Maybe I should move to Delhi…”

Building a therapy network for Avanica laid bare the need for this “niche” service of speech-language therapy in Delhi, and India more broadly. Everyone I met knew of someone whose child was struggling with communication development, but had nowhere to turn aside from the daunting prospect of going to London or the U.S. for a therapy program. The opportunity to be able to help local families, and continue to work with Avanica lured me in, so I moved to Delhi permanently in 2015.

From 2015-2018 I worked as a speech therapist at a preschool, ran a private practice from my home, and eventually worked with a team to start one of India’s first early intervention centers. I quickly realized how inessential the energy-draining, behind the scenes work of a speech therapist in the U.S. actually is. We are trained to write and treatment-plan according to the bureaucratic demands of large school systems, hospitals and insurance companies. For instance:

You can’t work on that goal because insurance won’t cover it
You can only spend ten minutes with that family because hospital admin needs you to see 15 patients today
You can’t take your student to practice their speech at the coffee shop because it is a legal issue
You need to test, diagnose, and write a seven page report about a child after only spending two hours with them

I could go on.

Paving my own way in Delhi allowed me to shed the weight of these structures, develop my own systems and get to work more efficiently in ways that really mattered. I wrote session notes like journal entries to myself (How can I do this better next time?), rather than maps for insurance companies. I took my young clients out in the community for practice and motivation, visited them at home, and worked with them in my own home. We practiced language and executive skills in the kitchen, did social skills groups in the park, and articulation drills while on a neighborhood walk.

Speech-Language Therapy Transformed…Back in Brooklyn.

There was no way for me to turn back from this way of practicing. Returning to the U.S., solidified that conviction, and thus Brooklyn Speech Therapy was born. Here in Brooklyn I am a house guest/therapist on a smaller scale (60 minute play visits!), but I still stick post-it reminders in people’s stairways, love an outing, and build therapy teams around my little clients.

Brooklyn Speech Therapy has since grown to include a team of therapists who delight in the freedom from clinical procedures that would otherwise bog down their creativity, or take time away from connecting with parents. Our therapists share a spirit of bucking convention and working with a family rather than an individual child.

TheraPals…

…is the title of an entry Avanica Khosla herself wrote on her blog about her brain injury recovery. Avanica and me: Therapist and client, but also pals. She is my “sister from another mister” (her words), and I am so blessed to be able to have a second family in hers. Avanica, Arjun, and Shibani blew my world open in the best way, and were the nudge I needed to create a speech therapy practice here in Brooklyn that simply works better.

Hannah Mac 8/5/24 Hannah Mac 8/5/24

Understanding the Early Phases of Your Child’s Play and Language Development

Did you know that a trained eye can predict the way a child is communicating by observing their play skills, and vice versa?

Childhood is a magical time marked by rapid growth and discovery, especially in areas like play and language development. We might not put much thought into the development of what appears to be such a natural part of childhood, but when children need a little support moving through these key stages, it raises the question: How does this all work? Here is where we come in! Understanding these early phases is crucial for parents and caregivers to support their child's development in a holistic fashion. Let's delve into how play and language intertwine during these formative years.

What is Important to Understand About Play Development?

To quote an educator with a lot of street cred: “Play is the work of the child” - Maria Montessori.

Play is not merely a pastime for children; it's their primary mode of learning and exploration.

Through play, children develop crucial cognitive and social skills which lay the foundation for language and verbal communication.

Let’s explore the types of play development, and what skills they are facilitating behind the scenes:

1. Sensorimotor Play (0-2 years):

Description: Babies and toddlers explore the world through their senses and physical actions.
Key Activities: Grasping objects, mouthing toys, shaking rattles, exploring textures.
Developmental Goals: Developing motor skills, understanding cause-and-effect, sensory integration.
Relationship to Language: Cause-and-effect is the cognitive foundation to communication. It teaches babies that when they do something, something specific happens. For instance,

When I shake mommy’s container of mints they make a fun sound!
When I throw my spoon, daddy picks it up- control!

Language is also cause-and-effect:

When I say “baba” my bottle appears; When I say “my shoe” my grandma picks out the right ones for me.

2. Symbolic Play (2-4 years):

Description: Children begin to use objects to represent other things and engage in pretend play.
Key Activities: Role-playing, using toys creatively, imitating adult behaviors.
Developmental Goals: Enhancing imagination, practicing social roles, early problem-solving.
Relationship to Language:

Playing with a wider variety of toys, or objects facilitates vocabulary growth. For young children, words represent toys, just as toys represent actions in pretend play (e.g., the word “spoon” represents a Spoon, which in turn represents stirring, cooking, or eating in play).
Interestingly, when a child uses two objects together in play (a hammer and a block; a hairbrush and a baby doll), they are beginning to combine two words together in speech.
As children learn to play with their toys in new ways, their brains apply those creative processes to forming the right kind of sentence to get their messages across.

3. Cooperative Play (4-7 years):

Description: Children start playing with others, learning to cooperate, and following rules.
Key Activities: Group games, make-believe scenarios with peers, structured activities.
Developmental Goals: Understanding social norms, empathy, teamwork.
Relationship to Language:

Play is getting more complex. Kids have the building blocks (apologies for the pun) with vocabulary and basic sentence structures; but now they put it to use with others.
Coordinating games with peers fosters conversational skills, while generating make-believe scenarios bridges from basic sentence-length productions to richer and well organized story-telling.

What is Important to Understand About Language Development?

We now know how play supports language development, but language development is granular in its own way, with several distinct stages. Each one builds on the other to develop fully effective communication skills and there are specific toys and games which help that along.

Let’s explore the phases of language development, and how they are seen in play:

1. Pre-linguistic Stage (0-12 months):

Description: Babies communicate through cries, gestures, and facial expressions.

Key Milestones: Babbling, imitating sounds, responding to simple instructions.
Developmental Goals: Understanding basic language cues, developing listening skills
Supporting Play Activities:

Peek-a-boo
Bubbles
Interacting with flap books
Using cause-and-effect toys (think: jack-in-the box, but maybe less scary)
Babbling while crawling after a ball.

2. One-Two Word Stage (12-18 months):

Description: Children begin using single words to convey whole sentences' meanings.
Key Milestones: Saying first words (e.g., "mama," "ball"), understanding simple questions.
Developmental Goals: Vocabulary expansion, basic understanding of to build sentences
Supporting Play Activities:

rolly-polly with a big ball
games that involve filling up a container with toys or blocks then dumping them out…and doing it all over again..and again…and
finger painting
play with objects that represent people or animals (e.g., a basic farm set)

3. Basic Phrase Stage (18-24 months):

Description: Toddlers combine two or more words to form short sentences.
Key Milestones: Using simple phrases (e.g., "want cookie," "big doggie"), following more complex instructions.
Developmental Goals: Grammar development, basic sentence construction.
Supporting Play Activities:

Simple board puzzles
Caring for a baby doll or pet with another object such as a brush or a bottle
Building a block tower
Using “tools” to fix other toys, or similarly using “cooking utensils” to stir and cut

4. Multi-Word Stage (3 + years)

Description: Toddlers and young children speak in expanding sentences and begin to tell stories
Key Milestones: Incorporating pronouns (I, me, you) and grammar forms other than nouns and verbs, such as: and, the, is, are etc.
Developmental Goals: Perfecting grammar and sentence structuring; expanding vocabulary, telling stories
Supporting Play Activities:

more elaborate pretend play games with things like kitchen and tool sets
using more sophisticated building materials (e.g., magnatiles, or lego), and adding meaning to structures (“it’s a water slide!”)
playing imaginary games with other children that require some turn-taking and coordination (e.g., “let’s play dinosaurs…you run, and I’m going to catch you”)

How Does Speech Therapy Help Play and Language Development?

The term “play-based” in the realm of childhood therapies and education is ubiquitous for a reason- one which you are now privy to. Therapeutic play is the way we close developmental language gaps and help young children begin to talk if they are not doing so at the right time.

In therapy we use these trained eyes of ours to assess your child’s communication level and design play programming to get them climbing higher. As your child’s favorite playmate, you are pivotal in this process, so we aim to give you all the tools you need to create developmentally supportive play opportunities in your home. If concerns about your child’s communication and/or play lead you to working with us, we will sit criss-cross with you on your rug, and get to “work”.

Hannah Mac 8/5/24 Hannah Mac 8/5/24

What Can You Expect When Hiring a Therapist From Brooklyn Speech Therapy?

Peace of mind, we hope! But let’s talk about how speech therapy works.

Step 1: A 30 minute, complimentary phone consultation

This is where you get it all off your chest: your concerns about your child’s communication, their developmental history, strategies you’ve tried to help them, and what you’ve been told by their doctors/teachers/your in-laws (let it out). We will do a lot of listening, but we will also chime in with a few questions. These can help us get a more specific idea about what is contributing to your child’s experience. We will then go through the basics of what a program could look like for you and your family. Lastly, we’ll chat about the logistics of meeting for an initial session if you wish to proceed.

Step 2: A 90 minute - 2 hour diagnostic therapy session in your home

All speech therapy programs begin with an evaluation of sorts. When working with a therapist at a school, clinic, or hospital these are typically centered around the administration of standardized assessments that score your child on a variety of measures. However, at Brooklyn Speech Therapy this isn’t our default. We feel that it takes more naturalistic interactions over a period of time to truly understand the nuances of what is happening for children when they are struggling. Our diagnostic therapy sessions kick-off this more informal evaluation process via play with your child that makes them feel comfortable and trusting of us. Typically this period of time is enough for us to get a good sense of the direction therapy should take, and some initial action items for your family so that we can hit the ground running with support!

Step 3: Regular, weekly 60 minute therapy sessions in your home

These sessions look different for every child and home. Our therapy sessions are always playful, but they can vary in the degree of caregiver presence throughout. Sometimes sessions are one-on-one with your child and their therapist, or sometimes caregivers join us for emotional support, or training. We always adjust along the way. All of our sessions include 50 minutes of direct intervention and 10 minutes afterward for a thorough debrief with caregivers. This is essential, as therapy is a blip of time in your child’s week. Our goal is to empower you to be mini speech-therapists so that you can support your child all week, and ease their progress along.

Step 4: Ongoing diagnostics + tips for skill carry-over

Throughout the weekly therapy process we keep our detective hats on. As your child responds to intervention and progresses in their goals, we must keep a keen eye to adjust our intervention and assessment of their needs accordingly. Maybe that means a new way of cuing them to get that word out; or maybe as we begin to hear their voice more, we have new revelations about the cause of their struggles. Regardless, we will always use our 10 minute debrief to share all of our insights, make sure you are clear on how your child is progressing, and where therapy will go next. Each week we share tips, or practice suggestions to keep their learning going after the session ends.

Step 5: Collaboration + Referral (if needed)

The more people in your child’s life who know how to support their speech the better! This is why we always reach out to the important people around them to let them know about what your child is working on in speech therapy, and how best to support them. Most commonly these important folks are your child’s classroom teacher, day care provider, grandparents, or other therapists.

Since we are always treating with a holistic eye, we can easily see if your child might benefit from additional developmental support services. If this is the case, we will guide you through a referral process. Sometimes children have difficulty with their communication and that is all; but sometimes a child’s challenges communicating exist in the context of developmental challenges more broadly. Maybe they have a weak core, impacting their breath support and gross motor function, so we call a Physical Therapist in to help; or maybe they struggle with sensory integration, so we call an Occupational Therapist. Referrals in this manner can also look like a suggested trip to the doctor, or an audiologist to have hearing checked.

Step 6: Graduation!

Yay! The reason why we’re here: getting those goals met and graduating from regular speech therapy. The timeline for this differs greatly from child-to-child and family-to-family. How long your child is in speech therapy depends on several factors, such as: the reason for a communication delay, responsiveness to intervention, your child’s attention levels, social-emotional world, behavioral patterns, and degree of caregiver involvement for carry-over.

All that being said, our weekly chats will give you a good sense of when your child is approaching the end of therapy. Once we know there will only be a few sessions left, we designate our last session to be a celebration with something super fun. This ensures that your child feels as proud as they should about working hard to overcome something challenging. After this party and a happy goodbye we set up a check-in call for 6 months later to make sure things are on track.

As we tell all of our speech therapy graduates: Make sure to say hi to us around the neighborhood! Seeing you at the playground, or grocery store makes our day.

If you’re ready to kick off this speech-therapy process with an initial consultation call, click here.