Children find describing What’s Wrong pictures to be a fun carryover activity for articulation, grammar and vocabulary.  An instant smile appears when a child is shown a picture of the Statue of Liberty holding an ice cream sundae!

This speech and language task also allows a child to demonstrate the ability to link visual and cognitive skills, which is crucial for pre-reading.  A child has to carefully examine a What’s Wrong picture, just as he needs to look closely at printed words to notice blends.

When a child focuses and attends to a silly picture and can explain why it is crazy a polar bear is on the beach, he is using reasoning skills and making inferences. 

Picture completion (pictures that have something missing) subtests appear on intelligence tests, such as the WPPSI (Wechsler Preschool and Primary Scale of Intelligence), the WISC-IV (Wechsler Intelligence Scale For Children) and the Stanford Binet (Picture Absurdities).  A child’s visual acuity and reasoning skills are measured when asked to identify a missing part of a familiar pictured object. 

Try What’s Wrong coloring books.  What’s Wrong? by Anna Pomaska is good to start with.  Then try What’s Wrong with this Picture? also by Pomaska.  I often provide these coloring books to children I work with so they can discuss one page a day with a parent as part of their homework.

An incredible set of silly photographs is a great informal activity / ice breaker at an evaluation.  You can read Wacky Wednesday by Dr. Seuss as a therapy activity or provide a few worksheets for homework from Super Duper’s 150 “What’s Wrong With This Picture?” Scenes.

Stephanie is a pediatric speech therapist in Manhattan.

May is Better Speech and Hearing Month.  Ever wonder what a pediatric speech therapist notices when she is walking the streets of Manhattan?  Children, their parents, caregivers, and sometimes, bad communication habits. 

What did I see this week?

1. A pacifier in a toddler’s mouth while he was happily walking around the playground.  He clearly wasn’t using the pacifier to sooth himself.  How could he even try to speak to a potential playmate?

2. I turn around to find a nanny named Katie speaking to her two year old ward Johnny.  She asks “Can Johnny throw the ball to Katie?”  If Katie used pronouns (e.g., Can you throw the ball to me?), Johnny would learn to use pronouns.

3. A parent sitting on a park bench complaining on her cell phone about her Mother-in-Law, while her adorable 6ish month old girl tries to get her attention.  You will never win with Mother-in-Law.  Why not use that precious time to speak with your baby, teach her something new and strengthen your bond?  Same goes for listening to your ipod, watching television and catching up on your emails.  Try to turn off technology and tune into your child.

4.  Eating at a sidewalk cafe, a young boy refuses to stay seated.  His dad tells his son ”You’re not going to get any lunch if you don’t sit down!”  Is he really not going to feed his child?  Empty threats are the worst, and everyone seated around you knows it too.  Effective communication with your child is critical.  Say what you mean and mean what you say!

5.  I’m waiting for the light to change and a man jogs up with his ipod blaring.  I am concerned for his hearing and safety.  I can hear Jennifer Lopez singing Let’s Get Loud.  She sings:

…You gotta prove it
You gotta mean what you say

Maybe he was playing his ipod loudly for the dad at the sidewalk cafe?

6. Have you ever seen a child too old to drink from a bottle using one?  When a child continues to use a bottle (or sippy cup or pacifier) past age one, he may develop a tongue thrust / lisp.  Step into any kindergarten classroom and you will quickly notice a number of children with tongue thrusts.

7.  In the bookstore, turned rainy day escape destination, an ambitious mother reads an exciting book to her son.  She has him so engaged in the story it’s impressive.  He starts to tell her something about the story and the mom says “Wait!  There’s more!  Listen to the whole story Adam!”  Poor Adam, he had something important to share.  Another missed communication exchange.
 
8. Also in the children’s section, Thomas the Train is up on a high shelf.  A little boy points toward Thomas.  Grandma, well intentioned, involved, and well-versed in Thomas the Train lingo isn’t sure if he is pointing to Thomas, James or Percy?!  Grandma points to Thomas and asks “Do you want this?” The boy shakes his head.  “Do you want this?” as Grandma points to James.  “NO!” says the boy.  “Oh, you must want THIS!”  Grandma then hands Percy to her grandson, who has been deprived of an opportunity to try to use the names of the trains and deprived of learning how to make a verbal request instead of just pointing.  Next time grandma could try offering choices.

9. I hop into the elevator with a mom, her toddler and another woman.  The woman speaks directly to the toddler and asks “What ‘s your name?”  The mother responds “Joe.”  The woman asks “What are you eating, Joe?”  The mom replies “A cracker, right Joe?”  Give your child an opportunity to participate in spontaneous conversation.   Afterall, the woman didn’t want to talk to you, she wanted to talk to your cute baby.

Hopefully this information has improved your awareness about communicating with your child.  If you feel you would like personalized strategies to maximize communication exchanges with your child, please email me and we can set up an appointment.  I work with children and their families in their homes on the Upper East Side of Manhattan.

The American Speech – Language and Hearing Association (ASHA) has posted Stephanie’s article entitled Why is it Important that Children Learn to Rhyme? on their ASHAsphere blog.

Check it out here!

Stephanie Sigal is a proud member of ASHA and works as a speech therapist on Manhattan’s Upper East Side.  You can learn more about Stephanie and her work at sayandplayfamily.

Wordless picture books are an essential part of a speech therapists bag of tricks.  Please read my previous blog entry about encouraging details in conversation for background information.

I recently began using the “Jack” books by Pat Schories with 3 and 4 year-old children.  They are great for addressing vocabulary, grammar, word finding, sentence building, describing scenes and feelings and predicting what will happen next. 

These books are also an excellent tool to bridge the gap in articulation therapy between sentence level and conversation.  Sometimes a child can say a target sound (e.g., “S”) in sentences, but can not say the sound correctly in conversational speech.  Wordless picture books are an in-between step because children will describe the scenes with consecutive sentences using the picture scenes for support. 

While the Jack books do not need to be read in any particular order, the following order works nicely: 

Breakfast for Jack
Jack Wants a Snack
Jack and the Missing Piece
Jack and the Night Visitors
When Jack Goes Out

Children learn and become excited about the characters in Jack’s life that appear in at least two books each in the series – the boy, his sister and the night visitors!  It is fun to search the detailed pictures and the search helps with visual scanning too.

Stephanie Sigal, M.A. CCC-SLP is a speech language therapist practicing on the Upper East Side of Manhattan, NYC.  She works with babies, toddlers and school age children with expressive language delay and articulation disorders.  Stephanie provides home based speech therapy and encourages parents to facilitate their children’s speech and language skills.  To learn more about Stephanie, please visit http://www.sayandplayfamily.com/.

In the August 18, 2010 New York Times article Looking for Baby Sitters: Foreign Language a Must, by Jenny Anderson, we learn Dr. Ellen Bialystok, a professor of psychology at York University in Toronto, has found bilingualism may help with cognitive development, but “It doesn’t make kids smarter”.  


Highlights of the article include:

• Bilingual children may have a smaller vocabulary in English than monolingual peers, but a larger vocabulary if you include words from both languages
• Bilingual children tend to use simpler vocabulary words
• It may take a bilingual child a fraction of a second longer to access a word
• Bilingual children do better at complex thinking tasks
• Speech therapy may be recommended if there is a delay in verbal language development
• Bilingualism does not help in the competitive Manhattan private school admissions process
• While a nanny can help a child learn a second language, will the child have anyone else to speak the language with?

More information on bilingualism and language delay can be found here.

A bill that required a dental decay warning label on sippy cups and baby bottles was vetoed by Governor David Paterson yesterday.  The label would have alerted parents that there is a risk of tooth decay from prolonged use of a “vessel with a duckbilled lid, bill-shaped extension or bill-shaped spout”.


In his veto message, Governor Patterson wrote: “Brief warning labels are simply not the best vehicle to convey detailed information about general parental practice and proper use of a product that is not inherently dangerous.”


Sippy cups and prolonged bottle use may cause more than dental issues, they may cause speech delay / articulation delay.  Each time I speak with parents of a new client, I always ask what type of drinking cup their child uses.  Children age 4 or younger often use a sippy cup because it is convenient for the parents (the cup won’t spill liquid) and toddlers and young children love it because the suckling motion used to remove the liquid is soothing and organizing.  


When a child suckles from a sippy cup, bottle, breast or on a pacifier, thumb, etc., the jaw, lips and tongue all move simultaneously.  This movement is repeated over and over when a child drinks from a bill-shaped spout or sucks on a pacifier throughout each day.  This does not allow  the jaw, lips and tongue to work separately, which is what is necessary for clear speech.  


Children with tongue thrusts have often used a sippy cup or the like way past age one, when their usage should have been eliminated.  This of course should not be the case if nutrition is compromised.  When the tongue thrusts forward, it may push against and displace the front teeth resulting in orthodontic issues.


What type of cup should your child use instead?


Teach your child to drink from an open cup, which they should use while seated at the table.  Encourage your child to take sips with only his or her lips on the cup, not the teeth / jaw.


When you are outside, you can try having your child drink from a straw cup (preferably one without a one-way, spill preventing valve).  Although it is very likely he will suckle on the straw (he may place an inch or so of straw between his teeth and pump the liquid into his mouth with help from the jaw) you can encourage him to only place the tip of the straw between his puckered lips and not to use his teeth. 


If you feel that your child already has articulation issues, and you have eliminated the use of sippy cups, etc., it may be best to meet with a speech therapist who can guide you on good speech habits, including therapeutic straw drinking.


I provide private speech therapy in children’s homes in Manhattan /  NYC’s Upper East Side.  You can contact me, Stephanie Sigal, M.A. CCC-SLP, at sayandplay@yahoo.com or 646-295-4473.


Read the article from Crain’s.

McFarlane Toys
Rhyming is an early phonological awareness (listening) skill children use to distinguish units of speech.  Recognizing rhymes is crucial to reading development.


Understanding how we have syllables within words and the ability to discern phonemes (sounds) in syllables are also phonological awareness skills that facilitate literacy.


If you would like to encourage your child’s rhyming skills, here are some fun activities to practice:

• Read rhyming books – Once your child is familiar with one of the books listed below (or similar level rhyming book), have her try to fill-in the rhyming word.  For example, Dr. Seuss’ The Foot Book begins:  Left foot, Left foot, Right foot, Right – Feet in the morning, Feet at _____ (child should say “night”).  For a rhyming challenge, read an unfamiliar rhyming book with your child in the same manner.

• Songs and Nursery Rhymes – Use the same technique – leave off the rhyming word to encourage your child to fill it in.  As a challenge, alter the rhymes (e.g., Twinkle Twinkle Little Car).

Motown – I Heard It Through The Grapevine, My Girl, Good Lovin’, Joy To The World, The Tracks Of My Tears, Ain’t Too Proud To Beg, I Want You Back, ABC

Barenaked Ladies and James Taylor have many songs with rhyming lyrics.

• Play “I Spy” with rhymes – For example, “I spy with my little eye something that rhymes with bear!”

• Try a rhyming puzzle.

• Try a rhyming game with objects.

Read how Pediatrician Perri Klass, M.D., discusses how difficult determining a language delay in toddlers can be in The New York Times article When to Worry if a Child Has Too Few Words published February 8, 2010.

• Repeats parts of words, prolongs a sound, or breaks up words
• Often repeats part of the word about 3 times
• During repetitions, the child substitutes an uh vowel  (tuh-tuh-tuh-table)
• May use a broken rhythm during repetitions (b.b…..b..boy)
• Has 10 or more disfluencies every 100 words
• Opens mouth to speak but no sound comes out
• Has other family members who stutter

• Often repeats whole words or phrases
• Typically repeats part of the word no more than 1 or 2 times
• During repetitions, the vowel sound remains the same (ta,ta,table)
• Rhythmic repetitions
• 9 or fewer disfluencies every 100 words
• Starts speech easily; keeps speech going

Find helpful tips for parents of preschoolers that stutter from the Stuttering Foundation of America.

Attend a Stuttering Group For Kids that Meets At Brooklyn College

What Are Some Board Games You Recommend For Preschoolers?

While pretend play is extremely important for your two year old, it is also a great time to introduce board games.  Games can enhance attention, concentration, turn taking, sharing, following directions and having fun!  

Children with articulation delay often have fine motor delay.  At times, a consultation with an occupational therapist (OT) is necessary.  Other times children may simply need to be exposed to the types of activities listed below to encourage development of the hand muscles.  

Encourage the writing fingers (see picture above) to do the work during precise fine motor activities.  While holding a marker or crayon, encourage a proper grip (see picture at right).   


During writing and many other fine motor tasks, the writing fingers (thumb, pointer and middle fingers) are active, while the pinky and ring fingers stay tucked in, secure against the palm.


Proper use of the fingers lays the foundation for higher level fine motor skills like writing letters and tying shoes.

• mix grammar rules between the languages
• use vocabulary from the different languages in the same sentence

• first words by age one
• two-word phrases by age two

• Speech (articulation) is the production of sounds that make up words and sentences.
• Language refers to the use of words and sentences to convey ideas and express our wants and needs. 

• Talk and read to your child face to face
• Eliminate background noise
• Get your child’s attention before you speak
• Use a normal loudness level
• Confirm that your child is understanding what you are saying 

Many children make predictable developmental sound substitutions as they are learning to talk.  Articulation errors may involve substituting one sound for another (“tar” for car), omitting a sound in a word (“boo” for blue), or distorting a sound.

• Respiration (abdominal air)
• Phonation (larynx / vocal cords)
• Resonation (mouth / nose)
• Jaw, lip, tongue and abdomen strength and stability

Everyday misuse of the voice is problematic. Bad habits can lead to swelling of the vocal cords and growths called nodules or polyps, which may result in a poor vocal quality.

Voice therapy only helps if bad habits are eliminated.

Vocal abuse involves straining the vocal cords by screaming, yelling, coughing, or clearing the throat. It is abusive when one speaks too much, talks with excessive force or “pushes” the air out. Straining the voice to imitate noises like car and plane engines, sirens and screeching brakes is also abusive.

Vocal misuse is speaking too loudly or at a pitch that is too low or high, or shouting to be heard over background noise.

Here are some practical, universal suggestions for “vocal hygiene”. These suggestions may protect one’s voice:

1. Talk in a voice that is soft, but not a whisper. This kind of voice allows the vocal cords to come together gently.

2. Clear your throat only when you must, and then do so gently. Hum first…then gently clear your throat.

3. Drink plenty of water throughout the day. A moist throat is better protected from irritation while talking. This also helps avoid problems which lead to coughing and throat clearing.

4. Avoid foods that may cause reflux (chocolate, tomato-based, citrus) especially before lying down. Eating small meals may be helpful. It may be beneficial to elevate the head of your bed.

5. Try a humidifier or vaporizer at home. This helps to maintain humid air to breathe. Keep it clean.

6. Warm up your voice before singing by humming gently.

7. Limit talking when you have an upper respiratory infection, laryngitis, or a cold. See a Pediatric ENT if hoarseness persists after a cold is gone.

8. Regular aerobic exercise is important for an optimal voice. Try not to grunt.

9. Avoid background noise and noisy places as you may have a tendency to shout. Avoid talking from room to room.

10. Avoid smoky / dusty places.

11. Breathe through your nose, not your mouth.

12. Reward good vocal habits. 

NYC Speech Therapists that Specialize in Voice Therapy:

Please note this list does NOT include me, as I specialize in language and articulation / oral motor therapy with children.  Good luck!!

Phil Schneider
3333 Henry Hudson Parkway
Suite 7
Riverdale, NY 10463
718.549.0433
phil@schneiderspeech.com

Jeannette LoVetri
317 West 93rd Street #3B
New York, NY 10025
212-662-9338
lovetri@thevoiceworkshop.com

Thomas Murry
tm2103@columbia.edu
180 Fort Washington Avenue, 7th floor
New York, NY 10032
Phone: 212.305.1602
Fax: 212.305.3975
or
16 East 60th Street,
Suite 470
New York, NY 10022
Phone: 212.326.8475
Fax: 212.326.8585

Latimer Kells
NYU Voice Center
530 First Avenue
HCC 3C
New York, NY 10016
Phone: 212.263.3705
Fax: 212.263.8490
E-mail: voicecenter@med.nyu.edu

On November 10th I spoke with a group of motivated educators at The Children’s Aid Society. The dialogue revolved primarily around articulation, language, and oral motor development, along with practical tips that could be easily used daily in the classroom. We discussed activities they were already doing (e.g., circle time, reading books) and enriched them with vocabulary and grammar tricks. The participants mentioned how they have noticed many of their children have articulation delays. We discussed prevention methods (e.g., eliminating sippy cups and thumbsucking) and simple oral motor exercises that can be done in the classroom (blowing bubbles the right way). The participants felt that it would be incredibly helpful to teach these techniques directly to the parents, as carryover is always key!  Check out the Children’s Aid Society’s Blog.

Stephanie Sigal Volunteers with Baby Buggy to Teach Families at the Child Center of New York to Maximize Children’s Speech and Language Skills

New York, NY – May 1, 2009 – Speech-Language Pathologist Stephanie Sigal M.A. CCC-SLP, and Baby Buggy held a Say and Play Communication Enrichment Conference on April 21, 2009 at the Child Center of New York Sonia Strumpf Clinic. The conference was arranged by Nura Poursharif, the Program Director at Baby Buggy, and Patricia Hart, the Project Director of the Child Center.

The Child Center of New York helps Queens families with children ages five and younger to better manage their lives by offering parenting guidance, counseling, home visits, day care, early intervention, vocational training and legal aid. This Say and Play lecture was provided for families with children between approximately 12 and 24 months. Specific tips were presented regarding improving communication skills while parents read books, sing, play, use sign language, and feed / eat with their child. Recommendations were made to help parents use language effectively with their child during personal daily events and routines.

“The families at the clinic were really engaged in what Ms. Sigal had to say because the information was beneficial and practical,” said Nura Poursharif, the Program Director at Baby Buggy. “Ms. Sigal has an incredibly animated personality, and she offered tips that were easy to implement. She showed the participants ways to interact with their children that are fun, and the lessons will help them bond with their children and create strong and productive long-term relationships.”

“While attending my first Baby Buggy benefit a few years ago, I wanted to be actively involved with Baby Buggy’s mission, but I couldn’t quite figure out where I would best fit in,” said Ms. Sigal. “After attending a second benefit last year, I heard a number of Baby Buggy recipients say that they wanted to be the best mothers they could be. I knew that I could help them meet that goal, because that is the foundation of my early language programs.”