http://www.ldonline.org/ld_indepth/speech-language/whatswrong.html Getting Ready for School The Preschool Years COMMON MYTHS ABOUT EARLY LANGUAGE AND SPEECH PROBLEMS Some common myths about early development should be put to rest. The following statements may be true some of the time, but for the most part are false. Wait! He or she will outgrow the problem. We cannot be sure of this. Some will. Many won't. Children often benefit from immediate intervention. Parents can profit from suggestions for home management that encourage the development of communication. He or she is too young to be tested. This is never true. Hearing can be tested in infants; language comprehension, play behavior, and social interaction can be assessed even if the child is not yet talking. He or she is not talking so there cannot be a speech evaluation. But we can evaluate language comprehension and pre-speech behavior. Suggestions can be made for helping to initiate speech. Or the youngster may benefit from a parent- child or other early intervention program. The problem is that all needs are anticipated, so there is no need to talk. Actually, to communicate through language appears to be a fundamental human drive. It is as natural for a child to talk as it is to walk if the child is in a nurturing and stimulating environment. He or she is imitating an older brother with poor speech. A child is not likely to choose to imitate a defective speech model when correct models are present. He's a boy. Boys are later to speak than girls. Some studies do indicate that girls speak earlier than boys, but this does not mean by many months. If parents have concerns, preschool boys as well as girls should be seen for professional consultation. He or she is just stubborn. The child could do it if he or she wanted to. The seeming stubbornness may come from a child's failure with verbal communication and the frustration that results from such failure. He or she is deprived or disadvantaged. Deprivation, neglect, and abuse are always considered when children live in chaotic homes or when there is failure to thrive. Neglect or abuse can cause problems with all development including learning language and speech. However, children in such situations do need intervention and referral to appropriate educational resources while the other problems are being managed. It is important that dialect speech patterns, bilingualism, and cultural differences not be confused with disadvantage and deprivation. He or she is retarded and that accounts for the speech delay. Maybe- - but severe hearing impairment is still sometimes mistaken for retardation, so it is important to assess hearing in speech-delayed children. Also, there may be a discrepancy between mental ability and the understanding and use of language. Early specific help in language and speech may help mentally retarded children use their cognitive potentials in maximal ways. He or she is emotionally disturbed, which causes the speech problem. This may be true, but an assessment of speech and language functioning can be important to assist in an overall management plan. Emotional problems and language problems can co-occur. Also, documentation of language use can be helpful in later years when growth is being evaluated. It's just a developmental problem. This statement is used in so many ways that it has little value, and it can be harmful if it delays treatment. Developmental problems do not necessarily go away without any help, and you cannot count on a child's outgrowing a developmental problem. When a child has a developmental disorder, it does not imply that he or she will get better or outgrow the problem with no intervention. Wait until he or she gets to school. Early problems need immediate attention for optimal learning. Weak motor skills can be helped by physical or occupational therapy. Speech and language can be improved through a structured program, along with suggestions to parents for stimulating speech and language at home. Services for young children are available in public schools, but parents may need assistance to gain access to them. He or she is immature. This is not a helpful statement for parents. Immature in what way? Socially? Emotionally? Behaviorally? Linguistically? Spatially? Perceptually? Does this statement imply that maturity will appear without any intervention? Parents need to be sure what the words mean. WHEN PARENTS SHOULD SEEK PROFESSIONAL CONSULTATION If parents have concerns about their children's development they should seek help. The pediatrician is usually the first person to consult about a young child. Because developing a standard of what is normal and what is not takes experience with many babies and children, parents of young children are wise to have a pediatrician, family doctor, or nurse practitioner to whom they can turn. Such health-care professionals recognize normal development, and they are experienced in suggesting management at different stages of growth. Wonderful, agreeable babies do turn into terrors around the age of two, and at various times as they grow, children surprise parents with unusual behaviors and interests. Those who spend their lives working with children know how to interview them. They know what is outside the range of acceptability and can be helpful to both children and to their parents. They can reassure parents, suggest ways of encouraging development, tell whether additional professional consultations are necessary, and most of the time, they can refer the parents and child to appropriate community resources. A common complaint is that pediatricians do not identify language and learning problems. But ask parents if they have ever discussed the language or learning problem with their pediatrician, and they often say that these are not medical problems, so of course are not discussed with the doctor. Even if they are not experts in language disorders, behavioral differences, or social- emotional difficulties in young children, primary health care providers can refer parents to appropriate community resources. Children with learning problems who regularly see one primary health provider, even when they are well, are better off than those who see a doctor only when they are sick. Knowing a family's expectations and values allows professionals to be of immediate help if parents have concerns. Health care and recommendations are more consistent when a child is seen by the same individual or group over time. Well-child visits are brief. Many pediatricians will arrange extended appointments, but parents must first express their concerns. Pediatricians and pediatric nurse practitioners know early development well and understand that parents need to ask questions. They recognize that this particular child is the most important child in the whole world for this set of parents. They are respectful of parents' questions. Most of the time they enjoy children and appreciate parents. But many do specialize and not all are expert in the many developmental disorders of young children; therefore, when parents feel they are not getting enough help from the doctor or nurse practitioner, they should ask for a referral to a professional who specializes in their area of concern. Under managed care in the health professions, limitations in making referrals may be imposed on primary-care providers. Parents may need to consider what is best for their child by way of consultation, rather than whether or not a service is covered by health insurance. Because a condition is not covered by health insurance does not mean the condition does not exist, and if a service for children is not paid for by health insurance it does not mean the service is unnecessary for a particular child. Often it is worth the financial investment to learn if a child is developing typically in understanding, in talking, or in learning, and, if not, what can be done to help. A speech-language pathologist is the appropriate person to consult if there is suspicion of a speech or language delay. Physical therapists can be of help with problems in motor development. Occupational therapists may also offer assistance for some fine motor skills that precede handwriting. Early childhood specialists are on school teams. Public school systems now have programs for children experiencing developmental difficulties in the years from birth to age three. Services do exist, but parents may need to be resourceful to find them. WHICH CHILDREN SHOULD BE DISCUSSED WITH THE PEDIATRICIAN AND/OR REFERRED FOR FURTHER ASSESSMENT? Children who are delayed in meeting such motor milestones as sitting at about six to eight months or walking by 12 to 16 months. Children who do not respond visually to objects and people in the environment. Children, who from birth, or at any age, show deviations in their responses to sound. They may not respond at all; they may respond inconsistently; or they may be hypersensitive to sound. Babies who show little vocal play in the early months of life. They should coo, babble, and show a wide variation of play with speech sounds. Babies who do not like to be held or who tense their bodies when held. Children who push adults away, who seem to have no interest in people. Children who are never still and seem never to be satisfied. Children with recurrent middle ear disease. Children who have no real words at age 2. Children who are not combining words by age 3. Children at 4 years of age whose speech cannot be understood most of the time by strangers. Children who "don't listen" or who have trouble following directions when compared with age-mates. We must be particularly aware of those who seem to follow directions only "when they want to." Such children may have basic problems with language comprehension but can at times interpret parts of the message. Children whose use of vocabulary is deficient when compared with peers. Children who repeat, or echo, everything they hear but with little understanding. Such children may recite the Pledge of Allegiance and know many TV commercials, may be able to read words in print, but cannot follow simple oral directions or understand words they read. Children who have difficulty in formulating sentences after about 4 years of age. They may omit words, leave off word endings, or confuse word order. Children who, when attempting to tell about something important, cannot retrieve specific words for use. They may give an associated response (for example, saying fork for knife), excessively use general terms (such as stuff and thing), give the function of the object (such as pounding thing for hammer), or mix up sounds (such as saying "rabby bunnit" for bunny rabbit). Or they might shrug their shoulders and walk away from communication situations. Children who talk spontaneously but do not respond in a give- and- take conversational way, respond to questions, or follow conversation when direct responses are expected. Children who never want to have stories read to them. Children who reject all puzzles, small blocks, and crayons or markers. Children of any age whose parents are concerned about their development of motor skills, hearing and vision, language, speech, learning, or about their relating to other children in age- appropriate ways. WHAT CAN PARENTS AND OTHER ADULTS DO? The following suggestions are for parents, day-care providers, teachers, nannies, and baby-sitters in their work with young children. General Recommendations Use repetition. Repetition is needed for learning by all children, but especially for children who do not learn easily. Through practice, skills become automatic. Children who have problems may take longer to master a task or may show no interest initially, and so must be encouraged in small steps. Provide a rich environment. Have objects available that encourage exploration through the senses- things to see, hear, touch, smell, and taste. Avoid overstimulation, having too much going on at one time such as talking or loud music. Everyone, even a young child, needs quiet time. As a parent or playful adult, be careful of dangerous practices such as throwing babies up in the air, holding them upside down, shaking them, or yanking them by their arms. These activities can be harmful to young children even if the intent is playful. Encourage hiding things and finding them. For example, cover a toy with a blanket and encourage the child to look for it under the blanket. This gives practice in the notion that objects have a permanence, that out-of-sight does not mean the objects no longer exist. Encourage imitation. Use pat-a-cake, body movements, facial grimaces, and games of "you do what I do." Encourage imitation of speech sounds. If the baby makes a sound, parents should repeat it immediately. This parental imitation of a baby's speech sounds encourages him or her to make more speech sounds. Encourage your child to notice things- to find all round things or square things, red things, hard things, soft things. You cannot and should not stop a developing preschooler from being curious, from noticing things, from exploring, from finding out how things work. Children with learning problems often need help in noticing how things look, sound, and move. They may also require help in learning how to play- to use objects, to recognize cause and effect, and to pretend. Stop any activity before your child becomes tired. Provide tools and materials that can be used in multiple ways to encourage fantasy and imagination. One- purpose toys do not allow for such learning. Allow exploration, but teach new skills. Children cannot be creative until certain skills are present. The ability to roll clay, move a pencil, cut with scissors, or hold a brush are necessary before a child can go further in imaginative ways. Some learning disabled children may never learn if allowed to progress at their own rate. They need intervention and help to learn what is easily mastered by most children. If a child shows no interest in objects, put them away for two weeks or a month, but do get them out again. When tasks are hard, there is a human tendency to avoid them. Children acquire this pattern at a young age. Exploring the world of the senses and exploring play with language are essential parts of growth and of building a foundation for later learning in school. A child who was never interested in Dr. Seuss at a young age may love the books later, either to be read aloud by parents, or to read on his or her own. The same is true of blocks. The child who was not interested in small plastic building blocks at age 4 may be mesmerized by them later. Continue to re-introduce activities that have at first been refused. Children need organization and consistent schedules so they can begin to learn the value and importance of organization. Without organization there is chaos. From early on, teach clean up. Show that appropriate containers hold objects and provide appropriate shelves for books and toys. This helps children begin to develop organization skills. As a child becomes part of a group in day-care or nursery school, be sure he or she understands the language used- not in imitation, not because gestures or pictures are used, not because it is time for juice and cookies- but because of a real understanding of vocabulary, commands, and instructions. Many children who have trouble learning are very bright, attractive youngsters from advantaged homes. Care must be taken that these problems are not denied because "such children do not have learning problems." Take time to have fun with young children. If you have a single- parent household or if both parents work outside the home, there is a tendency to take time only for essentials. Spend some time- if only 10 minutes a day- for activities that are a pleasure for both you and your child. Unlike older children, preschoolers have a sense of egocentrism, of believing themselves to be the center of the universe, so they demand attention. Stimulating Speech and Language When children show articulation problems and do not say sounds correctly, consult with a speech-language pathologist. There are different kinds of problems with articulation. Some errors with saying sounds are appropriate for a particular stage of development. When a 3-year-old child says all sounds correctly, except for /r/ as "wabbit" for rabbit, we are not concerned. But if a 3-year-old has many incorrectly produced sounds, then speech therapy may be necessary. Preschool children require speech therapy if they show deviations in production of speech sounds- if they do not correctly say sounds expected for their developmental age. Be sure the speech-language pathologist comments on intelligibility of speech- how well the child is understood. Speech is communication. It has little value if it is not understood by others. It is important that the speech pathologist who works with preschool children is experienced with children of this age. If your child has marked problems with speech production, teach him or her stock phrases such as "Help me," "I want - - -," "please," "I hurt my - - -," "Give me - - -," so he or she can communicate needs in ways that can be understood. Talk about what you are doing while you are engaged with your child in such activities as eating, bathing, and playing. Continuing to feed in language means that your child will develop understanding of vocabulary even before he or she can say the words. You must continue to stimulate language even if the child does not use speech in return. Work to establish the idea of imitation if your child does not readily imitate. Establishing imitation of non- speech activities is an important prerequisite for children who cannot yet imitate speech. Activities could include some of the following. These imitations can be without words; encourage actions. Put your hands up. Put your hands down. Bend over. Bend to one side. Bend to the other side. Clap hands. Shut your eyes. Then later, again without words: Open your mouth. Close your mouth. Still later, encourage imitation of a sound such as saying, "ah": Then you can repeat it several times. "Ah.""Ah.""Ah." and ask the child to imitate. The "ah" can then be combined with a consonant to form "bah," "mah," etc. Time the presentation of language. Say a word or words along with the relevant experience. Say "juice" while pouring juice, "open" as a carton (or bag or the mouth) is opened. Reduce the length of what is said to the young child as in "time to eat," "time for bed," "put toys away" rather than using a lengthy sentence. Say "no" without long explanations to young children who may have difficulty understanding language. Use private time with a child as an opportunity for language development. Provide many repetitions of names of things that can be pointed to such as body parts (including elbow, neck, and knee after eyes, nose, mouth), common objects (toys, furniture, eating utensils), and parts of objects (sleeve of shirt, laces on shoes, button on coat, handle of cup). Teach verbs to be associated with such actions as eating, bathing, play- time, and other daily activities (eat, drink, chew; swallow, cough, sneeze, yawn; splash, spill; roll, hit, pat, throw). Expand words that are used consistently. A child who says "cookie" can be encouraged to say big cookie, broken cookie, all- gone cookie. Additional expansions could include: cookie, please, juice, please. A child who consistently says "ouch" (or "ow") when sick or hurt could be encouraged to say tummy ouch, finger ouch, knee ouch. Use correct verb forms to talk about something that will happen and after it is over that it happened (We will walk to the store. We are walk-ing. We walked). Teach words for feelings at appropriate times (happy, and sad, but also angry or mad, disappointed, scared, worried, excited, tired, etc.) With basic words available to inform parents and teachers of needs, a child's frustration can be reduced a bit. Having words tied to both negative and positive feelings can replace striking out or whining or a high activity level of excitement that can lead to tears. Teach the language of manners, discipline, turn- taking, and seeking help. Teach common sensory adjectives (as hot- cold, big-l ittle, hard- soft, rough- smooth, etc.). Begin work on matching answers to question words (including: who? what? how many? where? why?). When the question word "who" is used, the answer must be the name of a person; "where" requires a location. The goal is to establish the idea that a certain question word requires a certain kind of response. For example, when an event is occurring you could ask, "Who is at the door? Daddy is at the door." "Who will go in the car? Mommy will go in the car" "Who woke up? Michael woke up." "Who fell down? Timmy fell down." Or you could ask: "Where is the ball? The ball is on the chair." "Where is the ball? The ball is on the table." "Where is the ball? The ball is on the floor." "Where is the ball? The ball is under the chair." Vary the questions for the type of response required: single word, phrase, or sentence. Don't ask all questions requiring yes or no or one-word replies once children have mastered the single-word stage. Provide models of word combinations. Expand what the child has said. If the child says "Cat" say "Big cat," "White cat," "Cat says meow," "Cat is soft," "Pat the cat." If the word said is "car" one can say, "Big car," "Daddy's car," "Mommy's car," "Ride in the car," "New car," "The car is new," "Car broken," "Fix the car." If there is a delay in combining two words, many, many models of two words need to be presented with imitation encouraged. Be sure your child understands language before you expect him or her to carry out a request or command. Teach meanings of first and last visually (first thing in line, first picture in a row) with objects and pictures the child can see, and auditorily (first name, first word in sentence or story) as the child listens. Do not try to teach or correct language when the child is in the midst of communicating, when he or she is telling something of importance. During these times, communication is more important than correctness. Categorization and Classification Develop the notion that things go together, fit in groups, and can be classified. Sort laundry (big socks-little socks, Daddy's shirt-Michael's shirt). Sort groceries (to shelf, refrigerator, freezer) From early on, teach that blocks go in a bag, books on a shelf, and cars in a box. Sort objects into groups of the same colors. Sort objects according to shape. Sort objects according to function - things to eat, things to drink, things to wear, things for play, things for work. Once facility is developed with objects you can use pictures for sorting. Pretend Play Encourage and foster pretend play. Children develop a sense of "as- if" and behave as if things were something else. Children seem to pretend first with objects (a block can be a car, an airplane, a sandwich, a birthday cake) and then place themselves in roles by pretending they are mommy or daddy or other adult. They can act out scary events and happy ones. Provide dolls that represent people- babies, adults, boys and girls, of your own race and other races. Provide housekeeping toys such as a tea set, pots and pans, brooms, lawn mowers, and toy furniture. Give them cars, trucks, and airplanes. Provide toy furniture, gas stations, airports, fire houses, and garages and/or encourage them to use blocks to construct such buildings. Have dress-up clothes available. Hats of various occupations are generally available, store easily, and can be used for pretending. Other Play Provide safe places for play. Provide a place where it is acceptable to make a mess. Provide places for sand and water play with containers to fill and spill. Help children notice that water or sand that fits in one container may be too much to fit in another one. Make available chalk, paints, pencils, markers, finger paints, and a surface that can be used playfully without harming the child, objects, or floor covering. Practice motor activities. Some children will need help to learn to jump, run, and skip-motor skills that other children acquire easily. Words can be associated with the actions. Practice activities with a ball- rolling and bouncing it. This encourages waiting and anticipating, as well as language learning. Help children notice that when they perform a certain act, something else happens. For example, when a toy car is pushed across a table, it will fall off the edge; when a bell is moved, it will produce a sound; when too much liquid is poured into a container, it will spill; when a glass is dropped, it will break, but when a ball is dropped, it will bounce. Provide practice with big motor movements that leave a visible mark. Marks can be made in the sandbox, in a baking tray filled with sand or salt, by using a brush with water on a chalkboard, by moving finger over a dirty chalkboard, by using fingers in finger paint or shaving cream. The motor movement combined with a mark that is seen helps establish visual-motor associations. As the child shows interest in crayons, teach correct grasp. Pencil grasp becomes a habit quickly so learning to hold a pencil or crayon early is important. Provide blocks, at first large sturdy cardboard ones, then large plastic ones, moving to smaller plastic or wooden ones when the child discriminates between what may go in the mouth and what should not. Blocks can be used to stack, knock down, build up again, and to construct walls, bridges, trains, garages, and houses. Present wooden or plastic jigsaw puzzles, gradually introducing ones with more pieces. Develop matching skills- visually at first. Provide opportunities for children to find a picture or shape that is just the same as a target or designated one. They could be asked to match geometric forms of circles, triangles, and squares of different colors and then the same colors; to match same colored shapes; to match a number of objects (such as a number of different dogs); to find objects that are all a particular color (with the color being presented visually, not with its name alone); to match pre-letter forms (the various horizontal, vertical, and diagonal lines as well as circular forms that will later form letters). Finally, letters and numerals can be used for matching. Once children can match, encourage them to discriminate or to find the one from an array that is different. For instance, they could see a triangle, a square, a triangle, and a triangle arranged in a row. They could then be asked to choose the one that does not belong with the others. Colors, and later, letters and numbers can be used. Discrimination, or picking out one that does not belong with a group or set, is an important preschool skill. Once visual discrimination skills are established, provide practice with words that children hear. Any time children must listen, auditory memory becomes a factor. Once said, a sound, word, or sentence is off in time. In contrast visual materials can stay in front of children as long as they want them there-until a decision is made about them. When they listen, the sound or word is immediately gone. For listening, children can be presented with a word. Then other words can be said with their being encouraged to indicate every time the same word is heard. For example, children could hear "dog" and then be asked to indicate by raising a hand, dropping a pellet into a container, or pushing a button, every time the word "dog" is presented in a group of words such as: "dog, cat, lion, dog, tiger, cow, horse, dog." Such activities can prepare preschool children for later listening for words that rhyme and those that begin or end with specified sounds. Provide visual memory practice- to remember when an object is no longer present, how it looked, where it was- to begin developing imagery. Using Pictures Be careful when using pictures. Be sure your child understands that a picture represents, or stands for, an object. Some children with delays in language may not know that pictures represent real objects. Real objects should be used first. Later photographed objects, from commercial materials or from magazines, could be used. Finally, line drawings may be presented. Preparing for Print "Children who are not spoken to by live and responsive adults will not learn to speak properly. Children who are not answered will stop asking questions. ... And children who are not told stories and who are not read to will have few reasons for wanting to learn to read.'' At home, read aloud to children from picture books, at times talking about the pictures rather than reading the printed words that accompany the story. Have your child point to pictured objects and parts of objects. Ask questions. Expect responses. Children can point to pictures before they can say the word or words. Ask your child to predict what he or she thinks will happen. Have him or her help turn the pages. Once your child is ready to listen, having both the language to understand and the attention span to appreciate the story as written, you can read the story as the author has written it, rather than talking about pictures. It is important that children learn the sense of a story, that it is organized, that it starts and moves along until it reaches a conclusion. They learn that there is a predictability to stories. This sense of completion is important for learning. Children begin to learn how stories are structured by having stories read to them. You can read to infants, as you hold them, from the newspaper or any print material you happen to be reading. The baby gets to spend time in a positive relationship with you, and you can get some reading done. Reading to a child early establishes the notion that there is magic between the covers of a book, and that it will be wonderful to someday learn to read. Help children develop a sense that there is a purpose in reading printed materials. Call attention to print as you read directions to put things together, learn to program a VCR, read recipes for cooking, read for information, and read for pleasure. Reading is not just sitting down with a book. Teach common nursery rhymes, for example, "Jack and Jill," "Three Little Kittens," and "Humpty-Dumpty." These rhymes are a part of our culture. Rhythmic reading from Dr. Seuss books can be entertaining and can establish a sense of rhyme and rhythm. Do not become annoyed with the seemingly endless repetitions children want in having a favorite book read. The repetition allows them to predict what comes next in stories. Children enjoy the familiarity. They may need time to develop the notion that the story always comes out the same way. Read books with rhymes while having your child sit beside you. Help him or her notice the association between the printed and spoken words. Words that sound the same, as in rhymes, often look the same in print Talk about words. Point out words on pages of text so that children begin to have a sense of print representing speech. If your child does not like to sit still to be read to, use rhythmic rhymes accompanied by motor activities. Sing songs before sleep. Keep trying to hold attention for brief moments to look at books, hear captions under pictures, or listen to rhymes. Say names of letters on alphabet blocks and magnetic letters. Provide these activities with a sense of fun. Do not insist that children name letters or in any way "perform." Playing with Speech Sounds Encourage attention to rhyme during play. Carry out rhythmic games with made-up rhymes. Say rhyming words while splashing in the bathtub, driving in the car, eat-ing, getting ready for bed. Encourage the child to tell words that rhyme. Introduce words- real and nonsense- that start with the same sounds. Continue such activities, even if your child does not enjoy them, for brief periods of time. They need to hear such words, and with repetition, they will begin to try to carry out the word games. Numbers Count objects, beginning with body parts (one mouth, two eyes, five fingers, ten fingers). Count other objects. Teach concepts about number. Beginning with two, help children understand that two things are labeled with the word "two." Be sure that many objects are presented so they get the idea of what it means when we speak of "two." Continue with other numbers. Be sure that an array of objects is not always arranged in the same way to represent the number. For instance, three things should be shown in many different positions, not just in a horizontal line. Children need to learn that no matter what the position, three things are labeled as three. Counting without any idea of what the numbers represent has little value. Number books can be used for counting and establishing the concept of number. Many different books should be shared with the child so that he or she does not believe that four always refers to the four flowers in a certain number and picture book. Repetitively count objects around the house (socks, shoes, spoons, books, cups, shirts, etc.) beginning with two, then three and increasing as concept and counting are mastered. Use phrases such as let's count and how many? appropriately. Teach words related to space and quantity and time such as big, little, small, large, more, less, fewer, wide, narrow, as many as, another one, first, last, middle, before, after, most, least. Also teach the comparative form of words using -er (such as bigger than, smaller than). The comparative form of words is often difficult for children with language problems to understand. About the Author: Regina Cicci works with individuals having language and learning disabilities from preschool age through adulthood. She has been a clinical teacher and supervisor who has taught children and adults - and those who teach them - about using their language to speak, to read, and to write better. Her work in a medical center has allowed her to view learning and its disorders in a way that is different from some educators. She is a perceptive diagnostician and teacher whose respect for the children and their families is reflected in her writing as well as in her daily work. She is a welcome lecturer throughout the United States and Canada for both professional and parents groups.