Category Archives: Speech

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Interactive Therapy Inc. hasn’t blogged in a while, so this post is a continuation of learning new words that was started in April, 2015.  These are more tips to help your child learn new words for improved communication:

6) Try to use meaningful situations at home to develop language learning.  For example, when your child wants or needs something, the child is more likely to pay attention to the word, or to try to say the word.

7) Repetition is very important.  It is possible to find many different responses to say a word in a given situation.  It may be necessary for your child to hear a word many times, in different phrases, before the child will try to say it.

8) Respond appropriately to your child.  Children acquire words because words bring results.  The big “payoff” for your child’s use of words is your natural and spontaneous response.  For example, your child might say, “More ice cream, please.” If you give more ice cream, the child is discovering that language gets results.

9) As your child learns new words, the pronunciation may not be correct.  It is important that you accept variations in pronunciation at first.  Encourage the use of the word without correcting the child’s pronunciation.  Pronunciation can be improved once a child has acquired a word and uses it without hesitation in appropriate situations.

10) Your child also needs to hear and see what the word is NOT.  Knowing what a hat is , is related to knowing that other things are “not hats.”  Putting different types of hats in a group is one way to help your child know what a hat is and for example that ” a shirt” is not a hat.  Point out to your child things that are not what you are currently working on.  In general, it is best to start by pointing out what something is before pointing out what it is not.

The above information was taken from “Communication Skill Builders”  and written by Leslie S. McColgin for instructional purposes and edited by me.

I would like to add that the target for increasing vocabulary from the time a child starts talking is to add 1-2 new words per week.  I want to reiterate that using objects in daily living repeatedly and in a variety of ways is the best way  to increase vocabulary.

Please check out to get more information about the speech/language services that Interactive Therapy Inc. provides. Please view Interactive Therapy’s face book page at Therapy Inc. and twitter @Pamela Hass to view interesting posts about speech language pathology.  If you like what you see on face book, please like Interactive Therapy Inc.

Pamela Hass, Speech Language Pathologist

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Teaching Tips for Parents on how to develop imitation skills in their children.

1. Frequently imitate your child including babbling, mouth movements, hand movements-any kind of movement, especially ones that the child does over and over.  Do this as often as you can throughout the day.

2.  Continue to imitate your child and change what you do just a little bit.  If your child babbles “pa-pa”, you babble “ba-ba”.  Be very enthusiastic, if your child imitates your “new” action.  Write down some of your child’s sounds and movements and how you are going to imitate them a little differently.  Put your list on the refrigerator or other obvious place as a reminder.

3.  Continue to imitate your child, but change your action a little more.  If your child says “pa-pa”, you say “pie-pie-pie”.  If your child claps hands together, you put your hands on the floor.  Praise your child and be enthusiastic when the child imitates you.  Write down your child’s actions and sounds and how you plan to imitate them.  Later write in how your child imitated you.

4.  Give your child toys that resemble things around the house: toy dolls, toy dishes, etc.  Let the child play with brooms, pots, and pans and “dress-up” clothes.  These will give your child opportunities to experiment with actions you perform during the day.  The child can dress dolls, “cook” food, sweep the floor, or “drive” cars.

5.  When your child begins to say words, add one other meaningful word to it to expand on his/her speech and language.

Write down each action your child imitates without seeing you do it at that time.  Write down ways your child does things that show the child is thinking-using an action that has been imitated before to solve a problem that requires a similar action.  The child who opened and closed a puppet’s mouth by relating an open and closed mouth (the familiar action) to opening the puppet’s mouth (similar action) is an example.  This helps you note and remember your child’s development. 

Written by Leslie S. Mccolgin.  Communication Skill Builders, 1988

Even though this information was written in 1988,  the principles hold true for present and future ages.- Pam Hass, Speech Language Pathologist

Consult your speech language therapist for more ideas on how to develop speech, language, and signing development to facilitate communication.

Please see my facebook page for updates at Interactive Therapy Inc.

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Reference: by Leslie S. McColgin
Communication Skill Builders, Inc

What is imitation?

Imitation is the ability to copy the behavior of another person.

How do imitation skills develop?

1.  One of the earliest forms of imitation is called “mutual imitation”.  This means that your child imitates you only when you have imitated the child first.  Parents often play “babbling games” with their child.  The child says “ga-ga” and the adult imitates “ga-ga”.  The child enjoys this response and tries again; “ga-ga”.  The child has just engaged in mutual imitation.  Motor actions can be imitated in the same way.  At first, you will have to let your child start the imitation game.  As your child develops, you can start the game by babbling or making some action that you have heard or seen your child do often.  Your child still isn’t ready to imitate a sound or action that the child does not already know.

2.  Next, your child begins to imitate sounds and actions that are similar, but not identical to the child’s own.  For example, a child might babble “pa-pa.”  The adult playing with the child might open and close the mouth without making any sound.  At first the child might imitate this by babbling “pa-pa” again.  However, this may soon change to the child opening and closing the mouth just like the adult model.  The child will  “figure out” how “pa-pa” and opening  and closing the mouth are similar.  then the child will be able to imitate this “new” action.  This is the beginning of having a “thought” that is symbolic.

3.  Now the child experiments and explores with sounds and actions to make them more like the adult model’s.  The child imitates the adult more and more exactly.  Soon the child will be able to imitate sounds and actions that the child has never tried before.

4.  In the final stage, the child learns to imitate without a model.  This is called deferred imitation.  For example, a child once wanted to get a necklace out of a matchbox with a small opening.  First, the child tried turning it upside down and shaking it with no success.  Finally, the child sat down, mouth slowly opening and closing.  The child had imitated this movement before.  Mentally, the child saw how opening and closing the mouth and the matchbox were similar.  The child immediately opened the box!  The child didn’t need a model to imitate.  Instead, the child used a similar action to the one the child had imitated before.  At this stage children will imitate “housework” with toy brooms and dishes and perform many actions similar to those of Mommy and Daddy.

Part II will consist of teaching tips for parents in how to develop imitation skills in their child.

Refer to my facebook page for updated information.  The link is on my website at

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Being a parent is a very special role.  Parents are responsible for teaching their children about life and how to live it fully.  This can be a very big job, especially if your child has communication difficulties.  Parents often need information about how to best meet the needs of their child.

Your child’s speech and languge pathologist can give you helpful information about your child’s speech and language development.  The speech language pathologist can also suggest specific activities to help your child learn at home.  In addition, there are a few basic guidelines on teaching and learning which can help you and your child succeed.

Tips for Parents:

1.  Let your child feel loved.  Touching, hugs, kisses, gentle words, or an approving smile will help your child feel relaxed and confident about learning.
2.  Remember that your child is just a child.  It’s important to keep your expectations appropriate to your child’s abilites.  Ask your speech language pathologist about your child’s language abilities.  That way, you won’t expect too much-or too little.
3.  Give your child approval.  Appreciate any success in learning your child accomplishes.  Compliments will encourage your child to continue to learn.  Let your child know that you accept both your child’s strengths and weaknesses.
4.  Help your child to feel important.  Take time to do things with your child.  Your child will appreciate your time and attention.
5.  Remember that learning can be fun.  Have a good time with your child.  If you do not enjoy what you are doing with your child, neither will your child.  Follow your child’s lead in f inding fun things to do.
6.  Talk to your child.  Talk often about what you are doing together.  Give your child time to respond.
7.  Really listen to your child.  Get down to your child’s eye level, and look at your child as you are listening.  Respond to what your child says. 
8.  Share your ideas and experiences with your child’s speech language pathologist.  Let her/him know about situations which may affect your child’s learning, such as illnesses or problems at home.
9.  Take an interest in your child’s schoolwork or therapy.  Help your child learn to be enthusiastic about learning.  Talk about school and therapy in a positive way.

You are your child’s first, and most important, teacher.  You set an example for your child of how to listen and talk with others.  You can make a big difference in how well your child develops communication skills.  As your child uses new skills in everyday activities, you can feel proud of your child’s success.

Even though this information is from 1988, it is timeless information.  These are basic building blocks for developing your child’s communication.  No amount of technology will replace what parents give their children as they go their day.

Pam Hass
Speech Languag e Pathologist

Margaret Schrader, M.S. CCC/ Speech Language Pathologist
Communication Skill Builders (1988)

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Reference: Advance for Speech-Language Pathologists and Audiologists  Sept. 19, 2011

Stuttering affects 3 million Americans and four times as many men as women.  Approximately 5 percent of young children go through a period of stuttering that lasts six months or more.  The majority recover by late childhood, leaving only about 1 percent with a long-term stutter.

Adolescent and adult stutterers have a different awareness of the disorder as a result of a lifetime of disfluency.  Of particular interest to Courtney Byrd, PhD, assistant professor in the Department of Communication Sciences and Disorders, College of Communication, at the University of Texas in Austin, is seeing if the unique behaviors she has identified in young children at the onset of stuttering persist into adulthood.

Learning how stutterers select and organize the sounds they use to make words helps researchers identify the obstacles that result in stuttering and develop therapies to overcome them.  In the Developmental Stuttering Lab, which she established at the college five years ago, Dr. Byrd and her team of graduate and undergraduate students evaluate how typically developing presechoolers acquire language and learn how to put sounds together fluently.  These evaluations range from observing parents laying and talking with their children, to analyzing characteristics of disfluent speech, to measuring speech fluency as a child describes a picture, to asking children to identify words based on partial sounds.  The data are used to create benchmarks against which to compare children who stutter and pinpoint the breakdown in fluency.

Children who stutter take longer to select sounds because they are not efficiently organized, which means stuttering is not strictly motoric, or a speech behavior, but there is a linguistic component as well, Dr. Byrd’s research suggests.

Up until about age 2-and-a-half, she said, children’s speech consists of a constellation of unrelated but familiar words, such a mommy, daddy, baby, milk,  and book.  During a vocabulary growth spurt by age 3, they start to organize language into global syllable shapes, or neighborhoods, of words that differ by only one individual sound segment, such as back, bath, bag, bad, and bat.

“This global syllable shape selection strategy enables 3-year-olds to efficiently organize and access their limited vocabulary,” said Dr. Byrd.  “However, by age 5 an expanded vocabulary compounded by faster utterances and longer, more complex phrases makes it inefficient for typically developing children to rely on this strategy.  In fact, it inhibits their ability to produce speech fluently.”

In contrast to typically developing children and adults, she said, “‘my research has shown both children and adults who stutter continue to rely on the global syllable shape organization system, which is inefficient and slows their ability to access the individual sound segments that represent the words they’re trying to say.  The outcome is what we perceive as stuttered speech.”

She hopes her research will lead to the identification of key etiological factors that could be used to transform treatment.  “But stuttering is a complex disorder,” she said.  “It waxes and wanes, and its origins are unclear.”

“While we work with clients to improve their fluency through speech therapy, we also give them practical coping mechanisms.  For example, the simple act of self-disclosure can ease the burden and make the stutterer and others feel comfortable,” Dr. Byrd stated.

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Reference: Advance for Speech-Language Pathologists and Audiologists (Oct. 3, 2011)

Mild Hearing Loss
Linked to brain atrophy in older adults

Declines in hearing ability may accelerate gray matter atrophy in auditory areas of the brain and increase the listening effort necessary for older adults to comprehend speech successfully, a new study has shown.  When a sense is altered, the brain reorganizes and adjusts.  In the case of people with poor hearing, researchers found that the gray matter density of the auditory areas was lower in people with decreased hearing ability, suggesting a link between hearing ability and brain volume.

“As hearing ability declines with age, interventions such as hearing aids should be considered not only to improve hearing but to preserve the  brain,” said lead author Jonathan Peelle, PhD, a research associate in the Department of Neurology, Perelman School of Medicine, at the University of Pennsylvania in Philadelphia.  “People hear differently, and those with even moderate hearing l0ss may have to work harder to understand complex sentences.”

In a pair of studies, researchers measured the relationship of hearing acuity to the brain, first measuring the response of the brain to increasingly complex sentences and then measuring cortical brain volume in the auditory cortex.

Older adults, ages 60-77, with normal hearing for their age were evaluated to determine whether normal variations in hearing ability impacted the structure or function of the network of brain areas supporting speech comprehension.

The studies found that people with hearing loss showed less brain activity on functional magnetic resonance imaging (fMRI) scans when listening to complex sentences. People with poorer hearing also had less gray matter in the auditory cortex, suggesting that areas of the brain related to auditory processing may show accelerated atrophy when hearing ability declines.

In general, research suggests that hearing sensitivity has cascading consequences for the neural processes supporting both perception and cognition.  Although the research was conducted in older adults, the findings have implications for younger adults, including those concerned about listening to music at loud volumes.

“Your hearing ability directly affects how the brain processes sounds, including speech,” said Dr. Peelle.  “Preserving your hearing doesn’t only protect your ears but also helps your brain perform at its best.”

Audiologists should monitor hearing in patients as they age, noting that individuals who still fall within normal hearing ability may have increasing complaints of speech comprehension issues.

Grants from the National Institutes of Health funded the research.

Peele, J.E., Troiani, V., Grossman, M., et al. (2011).  Hering loss in older adults affects neural systems supporting speech comprehension.  The Journal of Neuroscience, 31 (35): 12638-43


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Reference: Pediastaff Inc Pediatric and School Based Discussion Group April 20, 2011

According to the dictionary, a stutter can be defined as “distorted speech characterized principally by blocks or spasms interrupting rhythm.”  In the U.S. alone, over three million people are affected by this disorder says the Stuttering Foundation of America.  While this may be a reason for some to be shy or anti-social, often times this isn’t the case.  Many other people find ways to overcome this impairment.  Through classes, practice and other methods they prevent this from hinering their lives.  You probably wouldn’t think that theater and acting would be a potential solution; but one student here at Fredonia found this worked for him. 

Senior acting major Matt Nersinger of Webster, NY may be known for his stage roles but at one time his stutter defined him.  Since childhood, Matt struggled with a speech impediment that he wouldn’t address until late middle school.

Growing up, Matt never thought he would be an actor.  He assumed that his impairment would keep him down and prevent him from this art, or as he puts it, “I couldn’t even talk or form a sentence at the time.”  Before he discovered the stage, he admittedly didn’t think theater was for him and even mocked the art.

It wasn’t until his freshman year of high school that he got his first stage experience, sort of.  He decided to join his friends on stage crew for his school’s fall production.  This behind the scenes experience changed his attitude toward the stage for the better.  The upperclassman actors of the show treated him very kindly even as a younger crew member.  This kindness convinced him to try out for the school’s spring show.

This opportunity really broke him out of his shell.  Before this he rarely ever wanted to even talk to others, in fear of his stutter getting in the way.  While being on stage made him nervous, knowing what he was going to say helped him not fumble his words.  A combination of his speech therapy and acting roles allowed him to do this.

Another concept that helped Matt was the simple act of singing.  He figured out that when he sang his words he didn’t stutter as much and was more fluent.  This prompted him to puruse singing throughout his high school years.   He saw this as a type of “therapy” for his impediment.  There were times when he even sang within his household, although, “my sister hated that, she’d be like stop singing,” he said.

You might be wondering why he went to school for acting if he was more interested in singing.  It began senior year when he developed what he called calluses on his throat, similar to ones you would get on your feet or hands.  This prevented him from singing and even talking for a period of time.  He eventually dropped the idea for the sake of his voice and concentrated on his acting skills.

When choosing potential colleges for his acting future Matt didn’t take much time to look.  He became familiar with Fredonia through visits he made with friends while in high school.  “I didn’t really put the needed time into college searching,” Matt said.  While he somewhat regrets not looking more into this, he sees Fredonia as a blessing in disguise.

He started as a theater major and instantly fell in love with the program.  “People are what make this school,” he said.  “They are just so nice, welcoming, accommodating and accepting.  I was always terrified of auditioning because I would just get very nervous.  When my nerves, go, I start to stutter and that makes me more nervous,” Matt said.  Overcoming his stutter to get into the theater program was one of many steps he took toward self-improvement.

Aside from his stage roles, Matt is involved in other activities on campus as well.  He has been involved in another performance group, the Guerillas, for a few years now.  Since high school, he always wanted to be involved in an a capella group.  His time with the group has allowed him to expand his performance skills and utilize his previous passion of music.  He’s also a member of Alpha Psi Omega, an upperclassman honor society for theater students.  Another resource Matt utilized to help his speech is the Youngerman Center.  This on-campus speech clinic offers therapy to those who inquire.  At first he was not interested in this prospect.  “I did not want to think of my stutter as a handicap,” he said.  He slowly changed this view after his fluency began to take a tumble.

By his junior year he finally decided to inquire.  He made an appointment with one of their specialists and started the process of speech recovery.  These classes acted as a “refresher” course for him.  Combined with his theater lessons, he created his own sort of speech therapy.  One of his future missions is to open a theater therapy clinic to further assist those with stutters and impairments as a way to give back to the art that helped him so much.

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This is an older article from Jan. 11, 2010, but I found it fascinating.  It is taken from ADVANCE for Speech-Language Pathologists and Audiologists.  I have deleted some of the content due to time restrictions, but have included the main points of the article and the implications of the study. 

This study suggests that verbal apraxia symptoms are part of a larger syndrome.  It reveals that a new syndrome in children presents with a combination of allergy, apraxia and malabsorption.  Autism spectrum disorders were variably present.

Verbal apraxia had been understood to be a neurologically-based speech disorder, although hints of other neurological soft signs had been described.  The recent study suggests the symptoms of verbal apraxia are part of a larger, multifactorial neurologic syndrome involving food allergies, gluten sensitivity and nutritional malabsorption-at least for a subgroup of children.

“While it is critical to treat verbal apraxia symptoms that often include severe delays in expressive speech production with speech therapy, we need to start asking why these kids are having these problems in the first place so we can identify mechanisms we can target to treat the cause of the symptoms,” said Claudia Morris, MD, of Children’s Hospital and Research Center in Oakland, CA.  She conducted the study in conjunction with Marilyn Agin MD, a neurodevelopmental pediatrician at Saint Vincent Medical Center in New York.  The study takes a major step toward identifying the potential mechanisms that may contribute to apraxia symptoms. 

The symptoms that the children demonstrated were a common cluster of allergy, apraxia and malabsorption, along with low muscle tone, poor coordination and sensory integration abnormalities.  The children also revealed low carnitine levels, abnormal celiac panels, gluten sensitivity and vitamin D deficiency, among others. 

The data indicate that the neurologic dysfunction represented in the syndrome overlaps the symptoms of vitamin E
deficiency.  While low vitamin E bioavailability may occur due to a variety of different causes, neurological consequences are similar, regardless of the initiating trigger.

The study suggests that vitamin E could be used as a safe nutritional intervention that may benefit some children.  Growing evidence supports the benefits of omega-3 fatty acid supplementation in a number of neurodevelopmental disorders. 

Anecdotally, children with verbal apraxia often demonstrate leaps in speech production when taking high-quality fish oil.  The addition of vitamin E to omega-3 fatty acid supplementation in this cohort of children induced benefits that exceeded expectations from just speech therapy alone, according to parental report.

“While data from a case series is by no means conclusive, the results clearly point to the need for further attention to this poorly understood disorder and a placebo-controlled study to investigate the potential role of vitamin E and omega-3 supplementation in this group of childreen,” said Dr. Morris.

Children with an apraxia diagnosis also should receive a more comprehensive metabolic evaluation than what is current practice, she pointed out.  Many nutritional deficiencies like low carnitine, zinc and vitamin D are treated easily.  If nutritional deficiencies are not addressed, children will continue to experience significant medical consequences. 

The underlying cause of these deficiences and a fat malabsorption syndrome should be determined after deficiencies are identified and treated.  In the meantime, the new study provides the essential foundation for identification.

“By identifying the early red flags of this syndrome, we have provided a way to get these kids treatment at the earliest possible moment,” she said.  “While 75 percent of the kids identified as late bloomers are just that, the rest have a true pathologic condition.  To miss it is to miss critically valuable time for early intervention.”

Children who have all these symptoms are likely to fall into the 25 percent who have a condition that needs further evaluation and treatment, Dr. Morris stated.

Morris, C.R., Agin, M.C. (2009) Syndrome of allergy, apraxia, and malabsorption: Characterization of a neurodevelopmental phenotype that responds to omega 3 and vitamin e supplementation.  Alternative Therapies in Health and Medicine, 15 (4)

Atladottir, H.O., Pedersen, M.G., Thorsen, P., et al. (2009).  Association of family history of autoimmune diseases and autism spectrum disorders. Pediatrics, 124: 687-94.

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A researcher at Michigan State University, East Lansing, is hopeful that a recent grant from the National Institute on Deafness and Other Communication Disorders will lead to the development of better treatment options for children who stutter. 

Chang, PhD,CCC-SLP, assistant professor of communicative sciences and disorders, will use the $1.8 million grant to conduct a five-year longitudinal study on brain development in children who stutter.  She and colleagues will begin following the children’s development when they are between ages 4 and 6.  The goal is to find clues that explain how stuttering differs between males and females.

“Previous studies have shown that girls are more likely to recover from childhood stuttering,” Dr. Chang said.  “We know that at 2 to 4 years of age, boys and girls stutter more equally.  For some reason, there’s a change that occurs when they are 4-6 years old.  The girls start to recover within about two years, and often boys do not.”

She will study brain scans of the children to see whether development differs between genders to enable some to recover and others to go on to have chronic stuttering for the rest of their lives.

“This work will hopefully change the face of stuttering diagnosis and treatment,” she said.  “It’s the first series of studies to identify neural reasons for early childhood stuttering and gender differences that lead to recovery or persistence of stuttering.” 

Stuttering effects approximately 5 percent of children during the early stages of speech acquisition.  Many children recover naturally, but some do not, leaving about 1 percent of the population with chronic developmental stuttering.

“This is a speech disorder that is notoriously difficult to treat,” Dr. Chang said.  It can be debilitating for some people who might experience social or occupational rejection.

“There is a misperception that stuttering is caused by anxiety, that it is behavioral,” she stated.  “In the vast majority of cases, stuttering is not due to a psychiatric condition or low IQ.  We have strong evidence now that stuttering is caused by subtle neural deficits that disrupt interactions between different parts of the brain that are critical for fluid speech production.”

Her interest in the research comes from her training as a speech-language pathologist.  Her doctoral and postdoctoral research allowed her to conduct brain-imaging studies using MRI on children and adults who stutter.  Now she’s hoping to take stuttering research to a new level to help parents and children.

“Parents will be able to see their child’s brain growth in this study, and they will be contributing to treatment solutions for people who stutter,”  she said.  “We expect to learn more about the causes of this speech disorder and better ways to diagnose, prevent and treat it.”

The researchers are seeking participants for the study.  Parents who decide to participate can receive payment to offset time involved and to help with transportation costs.  In addition, the research team provides speech, language, hearing and IQ testing at no cost.  Children will be able to take home a picture of their brain.  The team will explain all procedures, including tests, risks and benefits.

Parents who have a child between the ages of 3 to 8 who stutters can obtain information about the study by calling (517) 884-2257 or (517) 432-1264.

This article posted in ADVANCE for Speech-Language Pathologists and Audiologists on Dec. 1, 2010.