How to Turn Soap & Water into HOURS of Play (From a Pediatric SLP!)

It’s summer. It’s hot. There is not enough coffee & the kids are ready to PLAY! From one mama to another, here are my top ways to turn soap & water into HOURS of play (and buy you a few moments of peace!)

Turning Soap & Water into HOURS of Play
from a pediatric speech-language pathologist

  1. Make a “Bath” for Favorite Animals & Toys: Grab a Tupperware, washcloth/sponge, water & soap and toss in your child’s favorite toys to “give them a bath!”

    ** Take this activity up a notch by drawing on them first with dry erase marker!

  2. Go Underwater Treasure Hunting: Swirl the soap in the water to create a bubbly/foamy top layer and drop in “treasures” for your child to reach in to find! Let them use their hands for a sensory experience, or incorporate nets to add in a little coordination challenge!

  3. Make an Ocean: Collect sea animals, kinetic sand, shells - anything ocean related - and lay them out for your little one. Let them choose which items to add into their “ocean”! Add some soap to create foamy “waves”. Make the animals “swim,” “crash,” “splash,” etc!

  4. Make Rainbow Water: Add some food dye to give a pop of color to your water play! Give your child different colored items and let them sort into the corresponding colored water. Or just let them splash around and enjoy the rainbow!

  5. Practice Cleaning: Believe it or not… kids love cleaning! Give your little one some of their non-breakable plates, utensils, cups, etc and let them practice “washing” their dishes! This is not only a functional skill, but great pretend play (tupperware = sink,) and full of language opportunities, like “wash,” “wet,” “dry,” “dirty,” “clean,” etc!

  6. Make a “Car Wash”: Grab your child’s favorite toy cars, trucks, buses & trains and let them get messy! Roll them in dirt, paint, sand, food… whatever you choose! Then give them their bin of soapy water & washcloth/sponge and BAM! Carwash created!

  7. Make a “Themed Bin”: Drop in some green food dye and add frogs, dinos, alligators, etc. to make a cool themed water play box! Try the same for yellow (ducks, lions, fish,) or any other color/theme combo your heart desires!

  8. Go Fishing!: if you have a fishing game, toss the fish into the water and bring it to life! We have the rotating pond fishing game (from way back when!) and those plastic fishies & rods are great for the real water. Don’t have a game? Make your fishies using cut up sponges, plastic cups, or anything relatively water-proof!

  9. Act Out A Song: Put on your favorite water song and splash along! Some ideas include: 5 Little Duckies (grab some duckies and take them out and in with the song!) Baby Shark, and 5 Green and Speckled Frogs!

  10. Give a Baby A Bath: Work on body parts by washing your child’s favorite baby doll! This game is also great for helping your child get used to things like hair washing if it’s something they have difficulty with! Allowing your child to “be in charge,” and wash the baby’s hair can help them gain comfort with the activity, and hopefully, transfer to their own bath time!

I hope you & your little one have as much fun with these ideas as we do! Happy Summer!!

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Jackie Anderson, MS CCC-SLP

Jackie is a pediatric speech-language pathologist with over 8 years of experience working with neurodiverse & birth-three populations. She is the owner of Ascend Pediatric Therapies in New Jersey, which provides in-home speech therapy and occupational therapy for families in Ocean County and Monmouth County, NJ. Jackie also provides virtual consultation services for all families, everywhere!

10 Ways to Use Bubbles To Boost Speech & Language Skills

We all know that kids LOVE bubbles! Adding them into any activity is guaranteed to up the engagement and excitement. Here are 10 ways to target speech & language skills while playing with bubbles, from a pediatric speech-language pathologist!

10 Ways to Use Bubbles to Boost Speech & Language Skills

  1. Pointing: Children typically start to point with an isolated index finger between 9 and 14 months of age. Help support this gesture development by popping bubbles!

  2. /B/ & /P/ sounds: Practice early developing consonant sounds like B and P by facing your child (so they can see your mouth!) and exaggerating Bubble! and POP! Encourage your child to use these sounds & words on their own by making it a routine: say the same thing every time, and PAUSE to allow your child the chance to fill in! (Example: “Pop… Pop…. Pop…. (pause)….. POP!” “Blow the…(pause)…Bubbles!”)

  3. Requests: Hold onto the bubble container and close after each time you blow bubbles. Show your child it’s closed to encourage them to make a request like, “open,” “more", “bubbles,” etc! Model the words for your child if they are not yet using them; it’s important to avoid telling them, “Say Open!” while withholding. This can result in frustration, anxiety, and your child not wanting to continue the interaction!

  4. Comments: Talk about what you see! “I see bubbles!” “Big Bubbles!” “A lot of bubbles!” Modeling this kind of language can help your child build descriptive language skills, and encourage them to make comments themselves!

  5. Body Parts: Label body parts by blowing bubbles on them! “Bubbles on your…. head!” “Bubbles on your… belly!” If your child SHOWS you the body part they want, label it for them!

  6. Turn Taking: Model phrases like “my turn,” and “your turn,” when blowing the bubbles to practice turn taking!

  7. Following Directions: If your child is able to independently handle bubble materials, practice giving simple directions within your activity. 1-step directions: give to me, open, close / 2-step directions: close & give to me, blow & put in the bottle

  8. Opposites: Introduce opposites like big/small, wet/dry, full/empty when talking about your bubbles and materials! Example: “the bubbles are empty! all gone! lets fill it up!” “those are SMALL bubbles! Let’s blow BIG ones.” “My hands are WET! Let’s dry them off.”

  9. Descriptor Words: Introduce descriptor words like “yuck!” “sticky!” “wet!” “big!” etc. to build vocabulary skills beyond initial functional vocabulary. Say these words emphatically to encourage your little one to imitate! (“Uh oh!” when bubbles spill, very exaggerated!)

  10. Action Words: Talk about what’s happening with the bubbles and materials: Blow, pop, spill, clean up, etc. to work on expanding verb vocabulary!

*Remember: it’s important to model these words naturally, and without expectation. Meaning, it’s best to say these words repeatedly within context rather than demanding your child repeat the word or say the word on command. This will help your child learn the language in a stress-free way!

Here are my favorite non-spill bubbles that are PERFECT for little ones & toddlers who are insistent on independence in their bubble play!

Happy Playing!

Jackie Anderson, MS CCC-SLP
Pediatric SLP

Jackie is a pediatric speech-language pathologist and owner of Ascend Pediatric Therapies. She provides in-home speech therapy for families in Ocean County and Monmouth County, NJ and virtual consultation services for all families.

SLP-Mom Approved Gift Guide: 0-1 Year Old

My daughter recently turned 1 year old (I’m still in denial!) and many people asked, “What do I get for a 1 year old that they can actually use?” Of course, my SLP brain kicked into gear and I started putting together a list of my favorite language-encouraging books and toys that are developmentally appropriate for children around 1 year old. I hope this list is helpful as you shop for your very lucky 1 year old!

*These items are linked to my Amazon Affiliate Page

Books

Books that Focus On Labeling:

Books for the Bath

Books that Focus On Speech Sounds:

Books that Focus On Fill-Ins:

Books that Focus On Song Routines:

Toys

Toys for New Babies

Cause/Effect Toys

Pretend Play Toys

Problem Solving Toys

Sensory Play Toys

Happy Shopping!

SLP-Mom Approved Gift Guide: 2 - 3 Year Olds

Here is a list of my favorite language-encouraging toys and books that are developmentally appropriate for children between 2-3 years old! I hope this list helps make this holiday season even more magical!

*These items are linked to my Amazon Affiliate Page

Toys for Pretend Play

Toys for Functional Play

Problem Solving Toys

Toys for Active Littles

Bath Toys

Games

Books

Gift Guides

Click the links below to choose your guide by age/event! All items are favorites of mine as a speech-language pathologist and a Mom! They encompass favorite therapy materials as well as picks that have been approved by my daughter. You won’t find many electronic toys on these lists; the more traditional play, face-to-face time, and reading we can do, the better for early development! Happy Shopping!

Ascend Product Recommendations

SLP-Mom Approved Gift Guide: Baby Shower

As a SLP, one of the most common questions asked by friends is, “I have a baby shower coming up, what should I get?” Here is a compiled list of some of my (and my daughter’s!) favorite baby items! These items are linked to my affiliate page on Amazon!

Books For Baby:

Here are some of my favorite books for reading to our brand new bundles of joy! These books incorporate simple, repetitive lines, concrete and colorful pictures, gesture and functional language information!

Books For Parents:

These books are sentimental and wonderful keepsakes for new parents. They are also great books to read as our little ones grow!

Toys:

Here are some of our favorite toys for early development!

Feeding/Teething:

  • EzPz Tiny Cup: Did you know, developmentally speaking, there’s no need to use a sippy cup when introducing water? We love this silicone open cup, developed by a SLP feeding specialist!

  • Silicone Plates with Suction: These plates portion out 3 sections, perfect for introducing your baby to a variety of foods! The silicone material makes it easy to wash, and the suction feature will slow even the quickest baby from picking it up and sending their meal across the room :)

  • Prespoons: These early utensils are perfect for encouraging independent feeding with purées and chunky purées!

  • Bumpkins Smock: This is an absolute must have in our home! This long sleeved smock is perfect for keeping your baby squeaky clean, no matter how messy their meal is. Perfect for exploring first foods, and later for arts and crafts!

  • Teetherpop Fillable Ice Pop Mold: We have 4 of these in my house! We have filled these with breastmilk, water, and fruit purees/yogurt which have been amazing for teething and exploring new foods!

  • Honey Bear Straw Cups : The classic therapist recommended introduction to drinking from a straw!

  • ComoTomo Silicone Teether

  • Teething Straws

Happy Shopping!

Childhood Apraxia of Speech

I am thrilled to feature this guest post by Alyssa Gilligan, M.S., CCC-SLP. Alyssa is the founder/owner of Crescendo Speech Therapy in Baltimore, Maryland. She specializes in treating children with autism spectrum disorder and motor speech disorders with a focus on early intervention. She graduated with her masters in speech-language pathology from Towson University and has been a speech-language pathologist for 6 years. www.crescendospeechtherapy.com

May is Apraxia Awareness month! Childhood apraxia of speech (CAS) is a congenital, neurological motor speech disorder that impairs a child’s ability to motor plan the oral movements needed to produce words. Children with CAS typically have a good understanding of language but are not able to express themselves and approximately 1 in 1000 children will be diagnosed with CAS.

The act of speaking is actually quite complicated! It starts with an idea that is formulated into words and/or phrases. Your brain then has to decide what sounds and in what order are needed to say each word. Your brain sends that information to your muscles in your mouth that are needed to move. Then you move your muscles! Children with CAS have difficulty sequencing the sounds in the correct order and then sending that message to their muscles.

Common symptoms of CAS include highly inconsistent speech with frequent vowel errors and will often say the same word many different ways. They may have prolonged pauses between sounds or syllables as well as inappropriate stress on syllables or words. You may also notice “groping” behaviors in which you may notice your child struggle to achieve the correct mouth posture to produce the word. CAS may be diagnosed by a speech-language pathologist that has experience with motor speech disorders. You can find an experienced SLP on the Apraxia-Kids.org website!

CAS requires a special type of speech therapy that is specific to motor speech disorders and often involves multi-sensory cues including touch cues, visual cues, and auditory cues. Additionally, it is recommended that they participate in intensive speech therapy for at least 2-4 days a week.

Interventions specific to CAS include Dynamic, Temporal, and Tactile Cueing (DTTC), Rapid Syllable Transition Training (ReST) and Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) therapy.

With the right speech therapy and the support of the entire community, children with apraxia can and do make amazing progress in the ability to speak!

-Alyssa S. Gilligan, M.S., CCC-SLP

Early Signs of Autism: A Different Perspective

I am thrilled to feature this guest post by Megan Myatt, M.S., CCC-SLP, speech-language pathologist and owner of a speech-language pathologist and owner of Growing Together: Speech-Language Therapy. She provides speech-language evaluations and therapeutic supports for young children and their families in Carroll County, Maryland. www.growtogetherslp.com

In honor of Autism Acceptance Month, and in anticipation of Better Language and Communication Month, I’d like to talk about the benefits of early identification (and resulting therapeutic supports) of autism. But first, let’s go over a few definitions...

What is autism? 

The DSM-5 defines autism as “persistent deficits in social communication and social interaction” paired with “restricted, repetitive patterns of behavior, interests, or activities” that cannot be better explained by other disorders/disabilities (e.g., intellectual disability).  

While this definition provides specific insight into the social and behavioral presentation of autism, I find it to be somewhat negative. It implies that autistic individuals have “deficits” or “atypical behaviors,” when really, they’re just wired differently. 

Over the years, I’ve noticed that some parents (definitely not all) avoid early identification, or quickly seek to change their child’s “deficits,” in fear of what they perceive autism to be. 

As a parent of an autistic child, I completely understand this fear. Our society has long supported the notion that autism is a bad thing. The media presents only the best and worst parts of autism. Parents want the best for their children- whether that be love, acceptance, happiness, you name it, and autism may be viewed as a barrier to those experiences. 

So let’s talk about another definition: 

What is ableism? 

Ableism is defined as the “discrimination and social prejudice against people with disabilities and/or people who are perceived to be disabled. Ableism characterizes people who are defined by their disabilities as inferior to the non-disabled.”

The diagnostic criteria for autism is clearly written from an ableist perspective. And it’s time to shift our language and views to celebrate and embrace the differences that autistic individuals have to offer. This change is not going to happen overnight, but I believe it starts with the early identification/diagnostic process. 

I propose the idea of using different, strengths-based language to talk about autism. Limiting words like “deficits,” “impairments,” “atypical,” or “odd.” As professionals and/or parents, we can still acknowledge our child’s social, communication, and behavioral challenges, and leave out the ableist terminology. 

So- back to the main topic: are you concerned about your child’s development? Do you notice differences in their communication, social interaction, play, and behavior? Here are some early characteristics or traits of autism (Please note- this is not an all-inclusive list, and not all traits are necessary for an autism diagnosis): 

  • Differences in language and communication

    • May demonstrate challenges with verbal communication (e.g., may not use words, or may repeat phrases)

    • May prefers physical communication (e.g., pulling/guiding)

    • May use fewer communicative gestures (e.g., pointing)

    • May not always respond to their name

  • Differences in social communication

  • May prefer to be the leader in their own play (i.e., may play next to other children rather than with them)

  • May show differences in social reciprocity (e.g., may not understand the social expectation of responding to hello/goodbye)

  • May demonstrate differences in gaze/eye contact and facial expressions (e.g., may not give everyone eye contact)

  • May not show and share interests as expected (e.g., pointing out interesting toys, sharing objects for play)

  • Differences in play and behavior

  • May find different ways to play/use objects (e.g., aligning toys)

  • May be detail-oriented (e.g., notices blemishes on preferred toys)

  • May prefer repetition and routine

  • May demonstrate special interests in certain topics or objects 

  • May have different sensory experiences (e.g., sensitive to lights or loud noises) 

  • May express emotions in physical ways (e.g., flapping hands)

So, what’s the benefit of early identification/diagnosis?

Early identification leads to early intervention, which can provide your child with the opportunity to build engagement and connections with others, grow their communication skills to advocate for their wants, needs, and interests, and begin to learn how to regulate their emotions and sensory experiences in this world. 

It also provides answers- for parents, families, etc. Early identification may lead to a greater understanding of autism- helping parents to understand their child, communicate with them, understand their behaviors and meet their sensory/emotional needs, and connect on a deeper level.  

The risk of “wait and see” and/or the fear of diagnosis plays into the ableist perspective. It may also prolong communication challenges for autistic children- particularly in a world that wasn’t designed for them (at present time). Autism does not have to be negative, and it does not need to be “fixed.” Early interventionists can identify and foster your child’s strengths, and support your family in meaningful ways. 

If you’ve noticed any of the above signs/traits of autism, reach out to your local early intervention program or related professionals. And remember, acceptance starts with you. Neurodiversity is beautiful. 

Realistic Screen Time Recommendations

Cellphones, iPads, TVs, and computers are all around us these days. They are integrated into our every day lives in a way that many couldn’t have even imagined 20 years ago! Screen time is a hot topic that I’m often asked about, and is associated with a lot of parent guilt; is it REALLY that bad? How can we work it into our day? Here are my go-to tips surrounding screen time.

The “official” recommendation: The American Academy of Pediatrics recommends 0 screen time for children under 18 months with the exception of interactive video calls, limiting to only educational programming with a parent 18 months - 24 months, and limiting screen time to 1 hour on week days, 3 hours on weekend days for children 2-5.

The “why”: Research shows that increased screen time is correlated with expressive language delays; here’s some data:

  • A study from the Hospital for Sick Children in Canada followed almost 900 young children between six months and two years of age [2]. They found that the toddlers who were exposed to more handheld screen time were more likely to have delayed expressive language skills (i.e., the child’s ability to say words and sentences was delayed). They also found that for every 30-minute increase in daily handheld screen time, there was a 49% increased risk of expressive language delay.

  • Another study surveyed over 1,000 parents of children under the age of two. They found that toddlers who watched more videos said fewer words. For each additional hour of videos that eight- to 16-month-old infants watched in a day, they said an average of six to eight fewer words.

  • Additional problems associated with screen time: Sleep problems, academic difficulties, weight problems, mood problems, poor self-image and body image issues

How to plug in: We know that the AAP’s recommendation is a lofty goal in realistic parenting. While it’s good to always aim for minimal screen time, (this is especially true if your child is already presenting with a language delay,) not all screen time is created equal. A goal here can be “joint media engagement,” meaning that you interact with your child around screens just like you would interact with your child around any kind of media (books, arts and crafts, etc). When you read a book, you point to pictures and label. Try the same for on-screen visuals! When you paint, you talk about the colors, actions and show what you’ve made. Talk about actions in apps or in shows, and carry over concepts into real-life activities (e.g., Daniel Tiger pretends to be a doctor, you play doctor!) Opt for video calls with family, open-ended apps (“choose your own adventure,” “fill in the blanks,” etc.) and TV shows that allow for fill-ins and movement opportunities (think, “you try it!”). The biggest factor that makes screen time more beneficial for your child is parent involvement. If you can watch a show with your child, add comments as you’re watching! “The boy is running! He’s so fast!” “They’re dancing! Let’s dance, too.”

The Take Away: Always aim for minimal screen time. We know that children learn best through every day interactions and traditional play, so that should always be the focus! That being said, all screen time is not created equal. An episode of educational programming here and there is not likely to harm your child, and there’s no need to feel guilty for allowing it! Join in whenever possible to add language models, interaction opportunities, and movement breaks to make screen time more beneficial, and choose your content carefully.

Jackie Anderson, MS CCC-SLP is the owner of Ascend Speech Therapy, LLC, and a licensed speech-language pathologist. Jackie provides in-home speech therapy services in Ocean County, New Jersey and Monmouth County, New Jersey, and offers teletherapy for all of New Jersey and Maryland.

Book-Linked Play: The Why and The How!

Before we get started… Ascend Speech Therapy has moved! We are thrilled to be offering services in Ocean County, New Jersey and Monmouth County, New Jersey. We will continue to offer teletherapy to all of Maryland and New Jersey area! Now, let’s get to it!

It is well known that reading to your children from birth (and even before!) can help to develop early literacy and language skills. Adding in toys that match characters or objects within your book is a great way to take the language concepts from the story and bring it to life! Allowing your child to have this multi-sensory experience while hearing the vocabulary that matched what they are experiencing is a perfect recipe for language learning and generalization (taking a skill from one context, and applying it in another!) It’s also an excellent way to model and practice pretend play, another big player in language learning and development!

You’d be surprised at how many items you have around the house already that will be helpful to use when reading a book! For example, if you’re reading a book with a Lion, look around for a lion toy or figurine. If you’re reading a book about fruit, grab a real apple or a toy apple! As you read each page, model the words and actions from the book with your toy (“the lion is jumping! jump, jump, jump!” “the lion is sleeping, shhh!” “He is eating the apple!” ) Remember to keep your language concrete (“jump, jump, jump!” vs. “honey, look over here at the lion jumping so high!”) Encourage your child to play along, and enjoy this new twist to your story time!

Jackie Anderson, MS CCC-SLP is a certified speech-language pathologist, and owner of Ascend Speech Therapy, LLC.
Ascend Speech Therapy offers in-home and community based pediatric speech therapy and evaluations in Ocean County, NJ and Monmouth County, NJ,
in addition to teletherapy services for all of New Jersey and Maryland.

Picky Eating: When is it a Problem?

Allie Gutleber, M.S., CCC-SLP is a speech-language pathologist who works with pediatric patients encompassing a wide variety of speech, language and feeding difficulties. She works at an outpatient center through Children’s Specialized Hospital in New Brunswick, NJ. 

Did you know? SLP’s not only specialize in speech and language disorders, but they also can guide caregivers in difficulties with mealtimes. Anywhere from infants who have trouble latching to toddlers who refuse to progress to chewable foods, an SLP can provide assistance within their scope of practice. As a disclaimer, if your child has feeding difficulties, it is always best to speak with your pediatrician first and then visit your local SLP or another healthcare provider, depending on the nature of the feeding difficulty.

Picky eating can be FRUSTRATING for parents. Mealtimes are no longer an easy routine of the day but can turn into a stressful and challenging time. With a picky eater, parents often find themselves ‘hiding’ nutrition into other types of food, allowing children to eat in front of the TV or tablet, letting mealtimes take an hour +, or even worse, beginning to force feed. As SLPs, we get it. Parents are just trying to do what’s best for their child and help them gain enough nutrition to continue to flourish and allow their brain to develop well. But, with a little guidance from an SLP, picky eating can be a thing of the past. Keep reading for some helpful tips on how to make mealtime less stressful and improve your picky eater’s food repertoire.

1.Play with your food! 

I know, it goes against everything parents were taught as children and I bet was never something you would have imagined we would recommend. But it’s true! Food play is a great exploratory tool to allow children to become more comfortable with new foods and creates positive exposures. It allows them a full sensory experience to immerse themselves in the food - from visually exploring the food, feeling the food between their fingers and smelling the food to (hopefully!) then wanting to taste the food with a lick or bite. When presenting a new food, parents should take some time to play with the food with their child without the expectation of consumption. Let’s face it - new foods can be intimidating! Label the different attributes, make the food into silly faces on the tray/table, pretend a blueberry is a fast car or turn yourself into a walrus with carrot stick tusks. Need ideas? Check out this awesome list by Jamie at Hands On As We Grow: https://handsonaswegrow.com/edible-sensory-play-ideas/

2.Create a hunger cycle

If kids aren’t hungry, they sure aren’t going to eat, right? Think about it. If a child is constantly snacking or ‘grazing’ throughout the day, why would they want to sit down and eat a meal. One of the first steps is creating structured mealtimes and snack times. Toddlers should be eating three structured meals per day (i.e., sitting at a table without distractions to consume breakfast, lunch and dinner) and two snacks. Make sure there is sufficient time in between each snack and meal so that they actually feel hungry and WANT to eat. If a child is hungry and wants to eat, present 2-3 novel foods for them to try before presenting their preferred, familiar foods. 

3. Limit distractions

I’ve heard it from numerous parents - that their child will only eat if they are in front of the TV or iPad or playing with toys - and I can’t fault them. They are doing the best they can to ensure their child is getting adequate nutrition to continue growing. However, mealtime distractions are actually not great, even if it gets a child to eat brussel sprouts. Distractions are not solving the root of the problem, but rather masking it. When kids are ‘present’ during mealtimes, they are viewing appropriate models from other mealtime partners (i.e. parents and siblings), having valuable exposures to new foods (even if they are not yet eating these foods!) and participating in the full sensory experience (i.e., obtaining all the sensory aspects of taste and touch as well as feeling ‘full’). It is important that children are fully participatory in the positive mealtime experiences, as it will help them to expand their food repertoire and engage with others in the process. So, try to limit distractions and put down the iPad.

4. Try! Try! Try!

When a child does not consume a new food presented the first 2-3 times, it can be disappointing or frustrating. However, do not give up! Research has shown that a child needs to be exposed to a new food anywhere from 10-15 times before they will eat it. Now, that doesn’t mean 10-15 servings, but 10-15 times being exposed to it. That can mean things such as food play, watching mom/dad eat the food or helping to cook the food. Making your child into your little ‘sous-chef’ can be a fun experience for you both and thus, begins positive experiences with food interactions and increases exposures. Remember to eliminate the pressure to consume the food and increase the exposures to the food. Being exposed to the food is just as important as eating it.

5. Share a meal!

Family mealtimes are super important. They allow for children to have appropriate food models, positive mealtime experiences and even promote language skills! Research has also shown improved mental health, increased family bonds and even better grades in school are a result of family mealtimes. So make it a priority to have shared family mealtimes a few times a week and make sure everyone is eating the same foods, just don’t always expect consumption. Modeling eating is just as important and encourages children to try a new food like mommy or daddy eat. And remember - please don’t use the “you can’t get up until you clean your plate” strategy. I promise, it doesn’t work. 

6. 30 minute max

For picky eaters, mealtimes can take a long time and can be stressful. Often times, children don’t want to eat a specific presented food and if a parent has implemented the ‘clean plate’ strategy (“you can’t get up until your plate is empty”), the child will then sit there for an hour or more avoiding it. Therefore, start using some of the tips and tricks from us! Remember to play with the food, limit the distractions, make sure they are actually hungry, try new foods multiple times and share mealtimes! While using all these strategies, try to keep the ‘30 minute maximum’ for mealtimes. After 30 minutes, mealtimes can get more stressful - for both the parent and the child! So set a timer for you both to keep it 30 minutes or less and start creating those positive mealtime experiences for everyone. 

7. Positive mealtimes

Mealtimes should be a positive experience for kids. When they become stressful and aggravating, children can sense it and then in turn become anxious or behavioral resulting in refusals. Try to create a positive environment where mealtime is fun and relaxing and in turn, creates a positive relationship with food. A lot of the time, mealtime can be about control. Share that control! Parent can decide on the “what” (food), “when” and “where” and kids can decide on the “how much” and “if” they will eat. Provide options for kids to pick - just remember that parents get to decide on the options! Give options of what you want them to try. And just remember to keep mealtimes lighthearted and positive experiences, even if your child did not consume that new vegetable you presented. Celebrate the successes, like if they interacted with the new food by touching it or smelling it! 

With all these strategies, the most important thing to keep in mind is to make mealtime a positive experience and to end mealtime on a positive note. I know it can feel like a slow process, but with practice and over time, your picky eater will begin accepting some new foods.

Applied Behavior Analysis (ABA) and Speech Therapy: What's the Difference?

Guest post! Alyssa Gilligan, M.S. CCC-SLP is a speech-language pathologist specializing in the treatment of children with Autism. She works at an ABA center in Hunt Valley, Maryland and works very closely with the ABA team!

"Applied Behavior Analysis (ABA) is an intervention strategy commonly used with children with Autism Spectrum Disorder. ABA involves the use of research proven, behavior based strategies to teach communication, life skills, social skills, and academics. It focuses on the principles of motivation and reinforcement to increase positive behaviors and decrease negative behaviors.

An ABA program is developed by a Board Certified Behavior Analyst (BCBA) who supervises a Registered Behavior Technician (RBT) that works with the child under the direct supervision of the BCBA. The program development is based on detailed analysis of data collected by the RBT and goals are added and modified based on that data!

ABA and speech-language therapy have a lot in common. An SLP and a BCBA working together can make miracles happen! The SLP provides knowledge and expertise of developmental milestones that assist the BCBA in developing new goals. For example, providing education on which grammatical markers the child should be using, knowing what play skill the child needs to learn next, or knowing at what stage of narrative language the child is. Alternatively, the BCBA can assist the SLP in identifying motivators and developing custom reinforcement systems to increase the child's participation in therapy.

ABA is also excellent at helping with generalization! The SLP might teach a new skill to a student but may not have the opportunity to work on it outside of the therapy room. The BCBA would then make similar goals and practice the skill in the natural environment.

In short, ABA and speech make a really powerful team!"

Alyssa S. Gilligan, M.S. CCC-SLP

Speech vs. Language: Defined

You may hear the terms “speech delay” or “language disorder” thrown around and used interchangeably. To a speech therapist, issues with speech and language can be two separate difficulties, requiring specific interventions!

Speech: the expression of language through articulated sounds. Someone with a Speech Delay may be under the age of 3 and not acquiring early speech sounds in the expected time frame. Someone Speech Sound Disorder may be older than 3 years old and may understand and produce language appropriately for their age, but have difficulties pronouncing specific sounds.

Language: a system for communicating; involves expressively communicating (e.g., asking for things, commenting, using a variety of word forms and tenses,) and understanding spoken/written language. Someone with Mixed Receptive-Expressive Language Disorder (MRELD) may be older than 3 years old, and show deficits in using and understanding language effectively in day to day life. A person with Expressive Language Disorder may only show difficulties with communication, and not in comprehension.

It‘s also possible for someone to have a Speech Sound Disorder and Language Disorder! In that case, understanding language and using language to communicate with others is a difficulty in addition to clearly producing speech sounds.

Parents: You Know Best

Missing early language milestones is one of the first observable signs leading to parent concern about their child’s development. Parents are often comforted by well-intentioned friends, family and (unfortunately,) healthcare professionals to “wait and see if they grow out of it.” There will always be a story, intended to ease parental nerves, of a neighbor’s cousin’s friend’s son who didn’t speak a word “until they were 4” and now is totally fine! He never needed speech therapy or anything special, so I’m sure your child won’t either.

As a parent, trust your gut. Know the signs, and push for a referral from your pediatrician, even if your concerns are being dismissed. One study from the University of Oregon found that a simple 15-minute parent questionnaire submitted before or after a doctor's appointment resulted in a 224-percent increase in referrals of one-year-old and two-year-old children with mild developmental delays in a yearlong study. This means that without parent input, 53 of 78 referrals would not have been made by the pediatrician’s observations alone. The study also indicated that physicians had a greater difficulty identifying delays at 12 months compared to 24 months. Neural circuits in the brain, which create the foundation for learning, behavior and health, are most flexible (or able to be molded,) during the first 3 years of life. Missed signs between 12 and 24 months equates to 1 whole year (excluding any potential wait lists,) without early intervention services, which over 40 years of research has shown to be crucial to short and long term gains.

The bottom line is, always air on the side of caution and ask for a referral, regardless of the opinion of others… even your pediatrician. You are the expert on your child!

Here are a few myths associated with Early Intervention (EI):

  • Therapy is too expensive: From birth to three years old, your child qualifies for free early intervention evaluations and services, in every state in the U.S. Here is a list of early intervention providers by state. You don’t need to wait for a referral from your doctor for an evaluation with EI- go ahead and call today! EI can be provided in-home or in an outpatient center, depending on your location. You may choose to add additional private therapy depending on your child’s needs.

  • My child is over 3 years old, it’s too late: For children who have not received EI by 3 years old, contact the Child Find program through your local public school system (google “Child Find“ and your state). Children ages 3-21 with suspected delays are entitled to free evaluations and services through the school system. You may choose to add additional private therapy depending on your child’s needs. You can find local speech therapists in your area using the American Speech-Language Hearing Association (ASHA)’s ProFind Tool: www.asha.org/profind/

  • My child attends private school; they don’t have therapists there: Even if your child attends a private school, they are still entitled to a free evaluation and services through Child Find. A speech-language pathologist from the public school system where your child’s private school is located can push-in to your child’s school to deliver services. You may choose to add additional private therapy depending on your child’s needs (See above for links for a previous post on school/private services and to find local therapists)

  • I have concerns for Autism; EI or Child Find is enough: Though EI and Child Find can assess for Autism through a multidisciplinary evaluation with a psychologist, an educational classification of Autism is not the same as a medical diagnosis. If your child is identified as having Autism through EI or Child Find, it will entitle them to services within school; it will not cover private services through your insurance company. The National Research Council has determined that a minimum of 25 hours per week of early, intensive intervention is best practice for children with Autism; this means that a combination of school and private services is usually the best bet for long term gains. If you have concerns regarding Autism, contact an Autism Center in your area for a multidisciplinary evaluation; because Autism is a large “spectrum,” disorder (meaning it presents in different ways, with varying degrees of severity,) it’s important to see specialists when determining an Autism diagnosis. If you’re unsure if you have concerns about Autism, check out the following resources:

  • Parent Questionnaire that assesses for level of concern for autism (M-CHAT)

  • Videos comparing typical play development in toddlers vs. toddlers with Autism

  • Additional developmental milestone information

The moral of the story is: you, as a parent, are your child’s best advocate. Pushing for referrals early on may feel overly cautious; however, research shows that the earlier the intervention, the greater the outcomes. In terms of your child’s development, it is always better to be safe than sorry. Trust your gut, know the signs, act early, and keep rocking parenthood!

Jackie

How much Speech Therapy is "enough"?

Every child is different, as are their individual needs- so, there is no blanket determination on how much speech therapy children should receive weekly. A question that comes up often is “My child gets speech in school - is private therapy really necessary?” Though the research on service intensity is all over the place (due to all of the variables that come with the large population who need speech therapy!) in the world of therapeutic services, the general rule of thumb is more and earlier is always better. This is based on over 40 years of research, which supports that early intervention is crucial during the early brain development period (before 3 years old) for short- and long-term progress.

School speech-language pathologists (SLPs) and private SLPs achieve the same degrees, pass the same qualifying exams, and are held to the same license maintenance requirements; the biggest difference is the environments in which they work. Three big factors that should be considered when determining your child's therapy plan are case load, service delivery/ individualization of instruction (is your child being instructed in the ways that allow them to learn best?) and parent involvement.

Full Disclosure: I am a private SLP. I will offer my thoughts and personal practices, where appropriate, in the "private SLP" sections below. I worked as a graduate student clinician in a public school for one semester many moons ago; so while I have had some exposure to the inner workings of the school SLP system, my personal experience is limited. The following information is pulled largely from available research in the field, which is linked below!

Case Load: School Speech Therapy

According to the The American Speech-Language Hearing Association (ASHA) 2018 School Survey, the median monthly caseload size of ASHA-certified, school-based SLPs working full time was 48 students, with a range from 3 students to 145 students. This means that in some school settings, one clinician can have up to 145 students to provide speech therapy to and complete all required documentation. This is B-A-N-A-N-A-S! (insert Mockingjay gesture to all my school SLPs out there!) and very impressive to me. SLPs are Super Heroes!

Case Load: Private Speech Therapy

A private SLP's caseload is decided by the SLP! Personally, I try to see no more than 4-5 children per day, in order to leave ample time to prepare materials, complete documentation, track data and confer with parents! (see below!)

Service Delivery/Individualized Instruction: School Speech Therapy

In school settings, SLPs may push into the classroom and co-teach with the general education teacher, pull a small group to a separate area within the classroom, pull out a small group into a speech therapy room, or they could see your child individually. Most often, children are seen in small groups within the school setting. If your child is working on social skills, or presents with a mild language or articulation disorder, small group instruction may be exactly what they need! However, ASHA reports that, “caseload size, rather than student characteristics, frequently influences recommendations about program intensity and/or model of service delivery. Larger caseloads may necessitate the use of service models that are not appropriate for some students and that may affect the SLP's ability to provide Free Appropriate Public Education (FAPE)” as is mandated by IDEA.

This means that in order to serve all of the children who need them, school SLPs are often forced to determine which kind of therapy your child receives and how often they will receive it based on time constraints, rather than what may be most beneficial to your child. If your child presents with a moderate-severe language disorder, attention deficit difficulties, sensory difficulties, or significant speech-sound disorder, exposure to small group therapy may be beneficial to promote social skills and take advantage of group learning activities; however, TheraCare poses that if your child is in a 30-minute group with 3 other children, they may end up receiving about 10 minutes of direct therapy specific to their targets per session. Individual therapy may be beneficial to add to ensure they are receiving intensive and individual attention to their language needs.

Service Delivery/Individualized Instruction: Private Speech Therapy

In private therapy your child receives individual therapy with their SLP. The flexibility of a private SLP's caseload allows for the sessions to be tailored to your child's individual needs and goals.

Parent Involvement: School Speech Therapy

Collaboration with parents and SLPs in the school remains difficult for many reasons, including a) parents are not present in school b) large caseloads of the SLP and c) privacy restrictions on electronic communication. School based SLP’s may send home homework sheets to be completed at home, fill out a communication log to review what was targeted in session, or send out monthly newsletters to review highlights from sessions. Data and progress review are typically reserved for quarterly progress reports and Individualized Education Plan (IEP) meetings, which usually happen annually.

Parent Involvement: Private Speech Therapy

At the end of each session, parents are updated on progress. SLPs have the opportunity to model strategies and activities and instruct parents in a 1-1 setting. Parents have the opportunity to ask questions face-to-face and can receive parent training as needed and requested! Increased collaboration opportunities with their child’s SLP often helps parents to feel more empowered and confident in their ability to help their children at home. Parent involvement has also been shown to enhance outcomes of speech therapy; therefore, this is a big area of focus after my sessions!

To wrap this post up, TheraCare said it best: “Giving your child the ability to receive therapy services in public schools and in a private setting maximizes their ability to make progress early. That means less services will be needed later on, when school coursework becomes more complex. Basically, the more therapy your child receives early on, the fewer services they will need later on! Public school services combined with private sessions makes for a one-two punch that tackles your child’s therapy needs early on.”

For a more visual explanation of differences between school and private therapy models, check out this blog by a former school SLP!

Jackie

Echolalia and Jargon: Defined

First of all, what are echolalia and jargon?!

These terms are often thrown around when talking about early development, but not always clearly explained.

Echolalia ("echo-lehl-ee-yuh"): repeating others' words and phrases with the same intonation and inflection. Echolalia can be immediate, (imitating what you say or ask,) or delayed (this is also sometimes called "scripting," and refers to repeating lines from T.V. shows, videos, or previously heard language repetitively). Here's an example of echolalia.

When echoing, children may be able to produce language that is more complex than what they are able to use functionally. Parents often (understandably,) express confusion about this when asked how their child communicates; "My child can speak in sentences...but it's only ever things he's heard before, and not all the time." For example, children may produce 3-5 word sentences that they've heard before, or sing songs in their entirety, but are unable or have significant difficulty using their own words spontaneously to express their wants and needs in an age appropriate way ("juice" or "I want some juice," to request). This tells us that though these children are able to repeat language they hear, (with an impressive amount of memory and mimicry!) they are not fully understanding the words as individual units that can be combined to communicate with others.

Jargon: strings of vowels and consonants with conversational intonation, without or with minimal production of meaningful words. Sometimes this sounds like, "bhjfblsdkhf mama fhdiskdf!!" :) The recent viral video of that adorable baby having a "conversation," with his father is a great example of jargon (if you haven't already watched it, you're welcome!)

What's "typical"?

Echolalia: Some echolalia is typical starting around 1 year, 6 months of age. Your child is actively absorbing language from their environment; you might hear them repeat your language as they are learning new words or concepts. For example, they may seem really interested in a new snack choice. You say, “These are grapes!” Child says, “Grapes!!” excitedly. Your child is repeating your words because they’re attributing it to this new object of interest. At this stage, your child should still be producing their own, non-echoed language in the majority of cases.

The occasional use of echolalia is usually eliminated by age 3. When a child produces primarily jargon and the majority or entirety of their intelligible language is echoed from others, it can be considered a red flag for developmental disorders, including Autism Spectrum Disorder, (otherwise known as "Autism," or "ASD"). Though echolalia is not the sole diagnostic indicator of ASD, research has found that up to 85% of verbal children with Autism exhibit echolalia in some form. There will be future posts on early warning signs of ASD, but in the mean time, here are videos and explanations of other "Red Flag," behaviors indicating concerns for Autism.

Jargon: Between 1 and 1 year, 6 months old, children produce jargon frequently! They are observing our inflection patterns, and attempting to participate in the conversation. The use of jargon should be eliminated by age 2. By 2 years old, your child should produce more novel (non-echoed,) words than jargon, and speak with about 50% intelligibility.

How do we help?

Echolalia: When a child is repeating your language frequently, avoid asking questions. Your child repeating what you’re asking is a sign that they a) don’t understand what you’re asking and/or b) don’t have the language to give you a response just yet! Repeating the questions repetitively often results in frustration… for the child and the parents! Here are some specific recommendations based on situation and type of echolalia you may be seeing:

*Avoid telling your chid, "Say ____." Your child will, inevitably do exactly what you ask.. and say, "Say, hi!" or "Say, bye bye!" It's best to model language exactly as your child would say it ("Hi, Mom!" "Want more snack.")

*Instead of asking questions, try leading with the answers. Consider: “Truck!” instead of “What is it?” when reading a book, “I’m eating!” instead of “What are you doing?” “I’m sad.” Instead of “Why are you crying?”

*If your child is repeating your language when they are sad or hurt, ("You're okay," while crying, "It's okay, come to Mommy!" when scared,) model language for them that fits the situation ("I fell down," "I hurt my hand," "I'm okay," "I'm scared")

*If your child is scripting language, and using it functionally ("Oh no! What will we do?" when something breaks,) offer a more flexible model ("The car broke. I need help.")

If your child tends to use the same phrase every time when requesting (“I want ____,” or “____, please,”) model different ways they can ask! Try things like “More ___, please!” or “Can I have ___?”

Jargon: The most important thing is to respond to your child's productions! Just as our rock star Dad did in the viral conversation video, responding to your child when they produce jargon is a crucial step in their development; you are teaching them reciprocity and encouraging engagement. If your child is producing jargon and is giving you a clear indication of what they are interested in or are trying to say, say it for them! For example, your child reaching towards bubbles and producing jargon while looking at you. Model, “Bubbles!” or “Want bubbles!” for them before engaging in the bubble activity. Repeat this model and then start to pause to allow your child the opportunity to fill in!

Happy Chatting!

Jackie