Talking With Toddlers

TALKING WITH TODDLERS: A RESOURCE FOR PARENTS OF CHILDREN WITH LANGUAGE DELAY

Rick McKinnon, Ph.D.

A Step Ahead in Pierce County 9503 19th Ave. E. Tacoma, WA 98445 (253) 471-2727

Talking with Toddlers: A Resource for Parents of Children with Language Delay. (CC) 2004 Rick McKinnon, Ph.D.

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TABLE OF CONTENTS

PREFACE FOR PARENTS …………………………………………………………………………………… PREFACE FOR PROFESSIONALS ……………………………………………………………………… 1. GETTING INTO PLAY ……………………………………………………………………………………… Worksheet #1: Matching Words to the Child’s Play.

2. PLAYING WITH LANGUAGE …………………………………………………………………………… Worksheet #2: Now That’s Funny.

3. WHY CHILDREN USE BAD WORDS …………………………………………………………………

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Worksheet #3: Using Simple Language.

4. THE COMMUNICATION RAILROAD ………………………………………………………………… 21 Worksheet #4: The Parts of Language.

5. FROM T-BALL TO THE BIG LEAGUES ……………………………………………………………… 29 Worksheet #5: Translating Adult Language into Slow Pitch.

6. MIXING IT UP …………………………………………………………………………………………………

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Worksheet #6: Breaking Some Eggs for Communication.

7. WHO’S CALLING THE SHOTS? ………………………………………………………………………… 42 Worksheet #7: Using Simple Signs.

8. WAIT FOR IT …………………………………………………………………………………………………… 50 Worksheet #8: Opportunities for Waiting.

9. GAMES TODDLERS PLAY …………………………………………………………………………………… 54 Worksheet #9: Games Toddlers Play.

10. WE HAVE WAYS OF MAKING YOU TALK!……………………………………………………… Worksheet #10: Changing Questions to Statements.

11. RENEGOTIATING THE CONTRACT…………………………………………………………………… Worksheet #11: Activities That are Not Under Contract.

12. WHY BABIES BABBLE ……………………………………………………………………………………… Worksheet #12: First Syllables.

13. TRANSLATING TODDLERESE…………………………………………………………………………… Worksheet #13: Possible Words.

14. GETTING READY FOR READING ……………………………………………………………………… Worksheet #14: Reading the Pictures.

15. TOYS FOR TALKING? ……………………………………………………………………………………… Worksheet #15: Parts of Speech.

16. THE GREAT LEAP FORWARD …………………………………………………………………………… Worksheet #16a,b,c: Combinations to Model.

17. WHAT TO DO ABOUT TELEVISION………………………………………………………………… Worksheet #17: How Much TV Does Your Toddler Watch?

18. CAN I GET SOME HELP HERE? ………………………………………………………………………

59 63 68 74 83 89 95 103 108

Worksheet #18: Activities That Everybody Can Enjoy.

APPENDIX A: THE LANGUAGE OF COMMUNICATION …………………………………… 112 APPENDIX B: WORD PRODUCTION LIST………………………………………………………… 118 APPENDIX C: LANGUAGE LOG…………………………………………………………………………… 120

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Preface for Parents For most children, the journey to becoming a skilled communicator is a smooth trip. Most children babble as a baby, are producing their first words around the age of one, and are making combinations of words well before their second birthday. However, for reasons that are not entirely understood, some toddlers get off track in their development of speech and language. There are some things we can point to that may cause a child’s language development to get off schedule: the child may have had many ear infections during that crucial time when he was just beginning to learn new words. Speech may be particularly difficult for a child because he is having a hard time coordinating his oral-motor structures (i.e., apraxia; see Appendix A: The Language of

Communication for definitions to some of these unfamiliar

Communication delay causes a lot of frustration for children and parents.

words). In many cases, however, there may be no clear explanation for why communication is delayed, or the reason may not be immediately clear. For parents or caregivers, the frustration of waiting for a toddler to begin talking is the same, no matter what the cause.

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This workbook is specifically designed to help families get their little girl or boy back on track with communication. I want to emphasize right from the start that the most

Families are the key to the approach outlined in this book.

important word in the previous sentence is families. Families are the key to the approach outlined in this book. For some parents, this is a different way to think about how to help a child with a communication delay. The first response of many parents is to think about communication delay as a medical issue. Our system of medicine tells us that when we have a medical issue, we should seek a specialist who has the knowledge and experience to manage the problem. For example, a child may have very large tonsils and adenoids, making it difficult for the child to breathe through the nose, and causing a pattern of mouth breathing that has many negative consequences. If we take the child to a specialist (an ear, nose, and throat specialist, in this case), the specialist may recommend that the child have the tonsils and adenoids removed, giving the child less constricted airway and allowing him or her to breathe through the nose. I want to suggest that this kind of scenario does not work well when it comes to managing communication delay in a young child. In short, communication delay is usually not a “medical” issue. Medical issues, by definition, are about a single individual—the patient.1 The fact is, communication

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In the medical model, the entire focus is on the child’s “illness” or “deficit.” Children are “diagnosed” with delay under strict criteria. They are given “treatments” to remediate perceived v

difficulty with the majority of young children is not about a particular individual. This is because communication, by definition, requires at least two people—it is relational. We can address communication issues by supporting a change in the relationship between the people who are communicating. And for young children, their important relationships are with a particular group of individuals—their families. Thus, the approach advocated in this book focuses on the whole environment, maximizing the resources of the family and others by providing caregivers with specific information that helps them to adjust the communication environment for the child where he or she is to be found: a naturalistic setting such as the home or community. The efficacy of naturalistic approaches is well documented, and, in my experience, getting communication moving again is easiest when it includes the home environment. This is especially true for children who

Parents and caregivers are the most important people in a child’s life.

already have difficulty controlling their world due to a communication delay. Parents and consistent caregivers are the most important people in a child’s life, and they are the ones who will make the biggest impact on the child’s communication. Another reason why the medical approach doesn’t work well with communication delay in very young children is that there is too much focus on the physical aspects of speaking.

deficits. (One might get the impression from some SLPs that doing speech-language therapy is like transplanting a kidney—it requires an expert and it is best done in a hospital.) vi

This problem stems from a basic difference between “speech” on the one hand, and “language” on the other. Speech refers to the actual process of making sounds, using such organs and structures as the lungs, vocal cords, mouth, tongue, teeth, etc. Yet, there is much more to speaking than just making sounds—you need to have something to say. We form messages that we would like others to know, those messages get encoded into a set of words, and those words are placed in a particular order, before we start to produce sounds. These processes are what we refer to as language. If you think about it, language is a lot more important than speech. An individual who didn’t have speech could still write down his or her thoughts, use sign language, read books, and understand what another person was saying. But if someone didn’t have language, that person wouldn’t be able to do any of those things. It would still be possible to communicate some things

A “medical” approach tends to focus on speech, rather than language.

through pointing and mimicking actions, but it would be a lot more difficult, perhaps impossible, to communicate complex or abstract thoughts.2 For most children who are not speaking, the cause of their communication delay is usually not because there is something wrong with the physical process of forming speech sounds.3 Yet, since communication delay is usually

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Try expressing the message “I won’t be home to meet the cable guy tomorrow because I have to have take my sister to the dentist” without using language. 3 Children with cleft palate or other crainio-facial abnormality do indeed have unusual difficulty forming speech sounds and may require direct intervention with the physical structures in order vii

perceived as a medical issue, the medical approach is to look at the physical structures and how they work. Looking at relationships is not what our medical system is good at. This workbook is designed to help adults learn how to talk to children in a way that will cause them to talk more. It is written in short chapters that can be read while the kids are in the bath, or during the 3 minutes in bed before tired parents fall asleep after a long day of chasing children around. The main activity (apart from reading the chapters) will be to keep a daily log of the sounds and words that your child is making. There are certain things that all children do while learning language, but there are a lot of individual differences as well. Especially with early sounds, each child may have his or her own way. For this reason, it is very important that you

Put the language log on the fridge. Do it now. I mean it. I’m coming over to your house later to check.

use the language log at the back of the book (Appendix C) to track the sounds and words that your child is producing. It is no accident that this book is in a ring-binder—the pages can be removed. When there is little time in the day to go find the book and write something in it, it is crucial that pages be taken out and put on the fridge, where there is a reasonable chance that they will be looked at and used. In addition to the language log, each chapter is accompanied by a worksheet. The worksheets are important because they help make sense of the content of the chapters.

to speak. Children with apraxia of speech or fluency issues may also require a highly structured and specific program that addresses these difficulties. viii

Some of the worksheets depend on information that is collected on the language log. They transform information from the language log into usable strategies. They will help you decide what are the next steps (sounds, words, phrases) that your toddler is ready to take. You may choose to fill out the worksheets on your own, or you may choose to wait and do it with an educator or Speech Language Pathologist (SLP). In either case, they will help determine what is most appropriate to work on. Since some of the worksheets depend on information from the language log, it is all the more crucial that the child’s sounds and words be recorded. If your child is not yet producing much, read the early chapters (chapters 1-11) that focus on eliciting more expressive language. The techniques contained in those chapters will get the ball rolling, and give you something to record on the language log.

Appendix A:The Language of Communication contains a glossary of special terms that are helpful in talking about communication. If you are having difficulty understanding some of the words used in the chapters, look there for a description or definition.

A child with a communication delay can become very independent.

Some parents will have tried to work with their child on language development and found that he is resistant to participating. These parents may have also noted the ease with which others may be able to work with the child, and have concluded that therapy in a clinic is really the only way that anyone will be able to connect with their toddler. ix

Children with language delay can become so independent, especially at home, that half the work seems to be just in making contact, even before you can begin working on specific sounds and words. The suggestions in this book should allow you to make more progress with your child at home, where the child spends the most time, and where the most important relationships are. For those toddlers that first need to learn that it is useful to communicate at all, it is sometimes productive to start with an alternative way to communicate. This might be the use of a few signs, such as “more” and “all done.” Another way is to use some pictures of familiar objects, so that the child can make choices about what he wants by pointing. Even

A single sign or picture might entirely change the way a child thinks about communication.

just the use of a single sign or picture might entirely change the way the child thinks about communication (see Who’s

Calling the Shots? for more about this topic). Neither of these systems, signs or pictures, is a long-term solution to the problem. But they serve a very important role: they get communication back on track, and in doing so, build the motivation in the child to also use words as a means of getting what he needs or wants. Signs and/or pictures are like the grease that gets the system moving again. If everything goes well, they won’t be needed after there is sufficient momentum for communication. While this workbook is designed primarily for parents and families of children with a language delay, it could be used x

by practitioners of speech-language pathology in neurodevelopmental centers and hospitals, home based educators from early intervention or early head start agencies, and anyone who is willing to work outside the box (i.e., the little therapy room), to find different and ultimately better ways for promoting the development of expressive language. A final note: the incidence of language delay is not evenly balanced across gender, falling much more frequently on boys. Since there is some basis in reality for focusing on boys, masculine pronouns are used throughout the workbook. I hope the parents of girl children with language delay don’t find it too much of a burden to make the translation from “he” to “she”. Other books that you may want to have a look at: 

Beyond Baby Talk: From Sounds to Sentences—A complete Guide to Language Development. Apel, K., & Masterson, J. (2001). American Speech-Language Hearing Association.



The Late Talker: What to Do If Your Child Isn’t Talking Yet. Agin, M. C., Geng, L. F., & Nicholl, M. J. (2003). St. Martian’s Press.



It Takes Two to Talk: A Parent’s Guide to Helping Children Communicate. Manolson, A. (1992). Hanen Institute.

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A Parent’s Voice: “Use the Language Log.” Nicole (mother of Tillman): “Writing the new words that Tillman produced turned out to be very important to me. There were times when I was discouraged, and I felt stressed out about the progress that he was making. Then I would look at the language log and see that Till’ actually had 37 words. I had forgotten all the words that he had used, and looking at the language log would remind me that he was making progress. Then, later, I could look back and see—now he’s up to 53 words. Being able to see visible progress really helped me to feel less anxious at several points.”

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Preface for Professionals It is well understood that in most fields, a great many of the important things that you need to know in order to do your job are not taught in school—you have to pick them up after you enter the position (a.k.a. “learning by the seat of one’s pants”). In looking back at the training that I received as a graduate student in communication disorders at the University of Massachusetts, there are several classes I wish had been included in the curriculum. While there are now more courses in how to counsel people with communication disorders, little time is spent on actual techniques that work to connect knowledge with reality, especially when it comes to the very young population where family participation is so crucial.4 For example, it would have been very helpful to have some idea about how to interact with a child in a naturalistic way that would elicit more expressive language. Also, a class about techniques in adult education would have been important for transferring information to parents so that they could be 4

Systematic exposure to the birth-to-three population is still extremely rare in programs that train speech-language pathologists. This avoidance is probably related to the fact that the most frequent types of employment that SLPs are recruited for are with older populations in schools, hospitals, and clinics. xiii

active in their child’s program. These are skills that SLPs are left scrambling to learn when they already have a full caseload, and barely enough time to keep up with paperwork. Consider the dilemma of an SLP who is working in a hospital that routinely receives referrals for children with

Most toddlers don’t respond well to being in the little therapy room.

language delay who are between the ages of 18 and 36 months. What can you do with a child that young who has a communication delay? Most young children don’t respond well to being brought to the hospital once a week to work in a little therapy room for 50 minutes. It just isn’t developmentally appropriate to expect a 2-year old to have enough patience to sit still, follow directions, or really take an active, conscious role in their own intervention. And for some reason, known only to the bean counters, home visits for young children with communication delay are often not approved by insurance companies. Equally mysterious is the almost complete prohibition on paying for group communication therapy for this population. These facts place severe limitations on the types of

The SLP may have to work from the “periphery” in order to be effective.

service models that SLPs are allowed to employ. The result is that the role the SLP plays in the program for an infant or toddler with communication delay is often on the periphery. Working from the periphery entails transmitting knowledge to the family so that the caregivers can implement the program with support and consultation with the professional. Yet, working from the periphery is one of those things that gets left out of the graduate curriculum of most programs that train xiv

SLPs. The vast majority of SLPs are trained to work exclusively in a clinic, hospital, or school environment, and have little experience with types of service provision other than direct, one-on-one therapy.

The family is the primary “service provider.”

What is needed in this situation is an approach that uses the family as the main “service provider,” and offers support and guidance from a distance. This kind of approach doesn’t focus so much on the child, but focuses rather on the environment of the child, i.e., family, friends, childcare center, preschool, community, etc. As noted in the Preface for Parents, communication is, by definition, relational, and it is through supporting change in relationships that improvement in communication will occur. Thus, the approach advocated in this book focuses on the whole environment, maximizing the resources of the family and others by providing caregivers with specific information that helps them to adjust the communication environment for the child where he or she is to be found: a naturalistic setting such as the home or community. This workbook is an attempt to provide an approach that meets these criteria, and is also highly flexible. The program is readily adaptable to various uses such as monthly visits with a family, or a weekly group that gets together to practice the techniques with 5 or 6 families. It can be given to a family as a stand alone home program, or can be included in an ongoing program with periodic check-ins. As long as the family is using the language log, they will be able to track lexical development. xv

Use of the worksheets will yield more information, and sitting down with an SLP will obviously be the best way to track patterns and target specific strategies. But families can do a lot on their own, and providers should be careful not to assume that the family can’t perform some analysis on their own, without checking it out first. Indeed, assuming that the family is capable is probably the best way to get them closer to being there.

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1

GETTING

INTO

PLAY

This book contains everything that I know about how to get children to produce more expressive language. There are many specific techniques and strategies that I have found to be very effective, and I have seen many families learn and use them with dramatic results. But before we get our hands dirty (with Play Doh, that is), I’d like to make a few quick comments that will help you absorb the material to follow, and set you on the right path in learning how to talk with toddlers who have a communication delay. The most important fact about this book is that it is about how to play with a toddler. Play is how toddlers learn, and if we want a toddler to learn something in particular (for example, how to use more words), then playing is

Dignity is not a concept that toddlers understand. Get used to it.

the place to start. This means that if you want your toddler to use more language, then you are going to have to engage in many silly activities. Dignity is not a concept that toddlers understand, and it doesn’t fit well with the techniques and strategies described in this book. So give it up. If you want to be successful in helping your toddler to talk, you are going to act like a fool. Get used to it. 1

More about play: when an adult enters the play of a toddler, one of two things generally happens—either the play continues in more or less the same way as before the adult joined in, or the adult tries to change the play into something “educational.” Trying to make play into an educational activity usually disrupts it completely, leading to several negative consequences. The most immediate consequences can range from your toddler becoming disinterested, to full-blown tantrums. But the ultimate outcome is almost always the same: the game ends. The reason that play ends is because

“Educational activities” do not include enough fun to keep a toddler engaged.

“educational activities” usually do not include enough fun to keep a toddler engaged. If the game ends, it means that there is less time for interacting with your child, and therefore, less opportunity to work on the goal of helping him to talk more. If, however, the adult enters the play in such a way that continues the game that the child was playing, there are different consequences, the most important of which is that the play continues, offering more opportunity to practice talking. Another consequence of continuing the play is that the child will get the message that the adult is supportive of what the child is doing. When a child feels supported in an activity, the child is in control. You will learn as you read the rest of this book, when children feel in control, they are much more likely to communicate freely and spontaneously. When a child does not feel in control of an activity, there is a very well known set of responses that gets triggered, responses that every parent is 2

familiar with, the most notable of which is the hard-headed refusal to participate in any activity that the adult offers. These responses block children and families from communicating, so we want to work hard to avoid them. There are specific techniques for how to approach a child in a way that will not trigger the “stubbornness reaction” that I just described, and put the child in a position that will make it easier to communicate. Some of these techniques are described in the chapters of this book (e.g., We Have Ways of

Making you Talk, Renegotiating the Contract, and Who’s Calling the Shots?). The main point is: find a way to show your child that you are not going to take over the whole show. Join the

Don’t feel that you have to bring something new to the party.

play that the child is already engaged in. Don’t feel that you have to bring something new to the party. The thing that you will bring is language, and that is something that can fit with any activity. All you have to do is get in a situation with a toddler where he is willing to let you do use some words, hopefully in a way that he will find interesting and will want to imitate. The goal of this book is to give parents and caregivers the tools to interact with young children in such a way that they will want to talk on their own. In the previous paragraph I said that it is essential not to trigger the “stubbornness reaction,” but it is equally important that you give children the opportunity to use words to express something that they actually want to say. This happens by setting up situations 3

where words fit with something that is already in the child’s head. (Incidentally, this is another good reason for entering the child’s play without changing it too much—the child already knows what the game is, all you have to do is add the language). For example, the game that your toddler happens to be playing right now is rolling cars on the coffee table and bonking them into each other. If you do the same thing, and just add the word “bonk” (yes—“bonk” is a perfectly good word), then you have created an opportunity for the child to use a word in a way that is easiest for him to succeed. He already has the concept; all he has to do is match it with the sound. And finally, in order for children to get that communication in general (and language in particular) is actually good for something, it is important that all attempts at communication are noticed and responded to in an appropriate manner. You don’t have to jump up and down, just do what seems appropriate in the situation. If the child is making an attempt to request something by making the first sound of the word, that is worthy of praise—reinforce that child for the hard work that went into producing that sound (when previously he would have just pointed). If the child produces a word,

Don’t worry about exact pronunciation at this point.

respond to it in a way that encourages the child to produce even more words. Don’t worry about exact pronunciation at this point. There will be plenty of time for worrying about such things later. At present, it is crucial that all attempts at

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communication be met with a reason for continuing to communicate. Thus far, I’ve described three parts of the process. If we arrange them visually, they might look something like the following:

Neutral Entry into Play

Set Up Compelling Situations

Respond and Reward Communication Attempts A More Words!

You will read about many techniques and strategies in the pages of this book. However, they all stem from these three simple principles. If you are able to master these principles, the outcome will be more attempts at communication, and ultimately, the production of more words.

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Worksheet #1: Matching Words to the Child’s Play. The following are short descriptions of play situations that you might encounter with a toddler. Read the description, then think of words that you could model that would be appropriate for the activity that is described.

1.

Your toddler is dropping toys into the kiddie pool as it fills with water in the back yard. Each time he drops a toy, it makes a splash.

Words to model: _____________________________________

2.

Your toddler is pushing a big Tonka truck around in the kitchen, bumping (gently) into the cabinets and the fridge.

Words to model: _____________________________________

3.

Driving in the car is very exciting for your toddler, and he is fascinated by the street signs and lights.

Words to model: _____________________________________ 4.

All the Tupperware is out of the cabinet and on the kitchen floor again. Your toddler is trying to open and close the containers.

Words to model: _____________________________________

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2

PLAYING

WITH

LANGUAGE

In the previous chapter, I set out some principles for how to enter into the play of a child in such a way that you don’t disrupt the activity too much. This allows the opportunity to use words that match with what the child is already doing. But sometimes you’re just hanging around the house, and your toddler isn’t involved in any particular game at the moment. What do you do then? Here are some suggestions about how to start a conversation with your toddler. Toddlers can be tricky conversational partners because they are interested in talking about a small number of topics. In most cases, all they really want to talk about are things that are interesting to them. As this changes pretty frequently (about every 5 seconds), finding out what kinds of things

Humor can be a good way to start a conversation with a toddler.

interest a toddler usually requires some time spent observing them in their natural habitat (see Chapter 9: Games Toddlers

Play for more on how to do this). However, one way to jumpstart an activity that will lead to more language is to use something that most toddlers share: a well-developed sense of

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humor. The jokes that really get toddlers excited usually include some form of physical humor. If you do something really odd and especially silly with an object, you will have the undivided attention of your toddler. For example, crashing cars into one another usually is a big hit with those toddlers that are vehicle obsessed. Take an activity that you do every day and add a little spice to it. For example, putting coats on in the morning as everyone is headed out the door. I’ve found that the following jokes reliably get big laughs: “Where does it go?” Try forgetting where shoes go on your body. Try putting your shoe on every part of your body (except your foot, of course). Attempt, in all earnestness, to put it on your elbow, your knee, your shoulder, your ankle, etc. Ask for help. “Where does it go?” Toddlers are typically amused by this process, and will gladly assist the poor, helpless adult to find where to put on the shoe. “Is this my coat?” As you’re going out the door, take your toddler’s coat and try to put it on. Wow! “Doesn’t fit. Too small.” What a surprise. Take another little coat. “THIS is my coat.” You might get “me” or “my” at this point. Say, “Oh, right. TOO small. Where’s MY coat?” Try another coat, perhaps a different adult’s coat. This might get you a word like “Mama” or “Dada”, depending on who you are and whose coat you’re trying to steal. “This must be my hat.” Again, while you’re getting dressed to go outside—say, “Oh, here’s my hat.” And put a bag on your 8

head. This should produce a resounding “NO!” from the peanut gallery. Then pick up a sock and put it on your head. This might even get more words, something like, “No, sock!” Continue the above for as many interesting and funny objects as you can find. Most toddlers will try to aid the obviously deranged adult by naming all the objects that are mistaken for hats. Here are some more topics that are likely to be a hit in

Toddlers like to talk about: bugs, dirt, your tongue, whatever’s behind the couch, trains, trucks, bulldozers, or any other machine which resembles a dinosaur in any way, actual dinosaurs, and bubbles.

sparking a conversation. They include: bugs, dirt, your tongue, whatever’s behind the couch, cars, trains, trucks, bulldozers, or any other machine which resembles a dinosaur in any way, actual dinosaurs, and bubbles. What are the topics that toddlers will consistently avoid? These include: anything about you (except your tongue), what’s in their diaper, bedtime, bath time, dinner time, or any other routine activity which their parents would like them to participate in without fussing. OK, you get the point. Humor is the universal language of toddlers, and a little bit of humor goes a long way to earning the trust and respect of a toddler. In fact, having a sense of what is interesting for toddlers to talk about will greatly improve your status in the toddler world, and increase the chance that a toddler will say something to you. One thing to beware of is that not all kinds of humor are fully appropriate for toddlers. There are lots of things that adults think are funny that toddlers do not. This is because many adult jokes depend on knowledge that toddlers just don’t have, such as the fact that some words have two meanings. 9

Also, in talking with a toddler, you may have to get in the habit of waiting for a period of time without talking (I know this is difficult). Sometimes toddlers don’t process things very fast. They need time to make a connection, notice a joke, or catch on to a game. Practice waiting for some time after you model a word (see Chapter 8: Wait For It for more on this topic). Say it four times as you do some activity, and then see if they will use the word on the fifth time.

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Worksheet #2: Now That’s Funny! Add your own activities that a toddler might find interesting. 1. Funny things to do in the bedroom: a. Example: Dress up stuffed animals. Put them in human-like positions (e.g., reading a book, having a party, riding a horse, etc.). Suggested words: “LOOK! Bears! Reading books! Bear on! Riding horsie! Puppies drink!” b. ______________________________________________________________ c. ______________________________________________________________ 2. Funny things to do in the bathroom: a. Give (waterproof) toys a bath. Put band aids on pretend owies. Suggested words: “Where owie? Owie here? On arm? On leg? On nose?” Etc. b. ______________________________________________________________ c. ______________________________________________________________ 3. Funny things to do in the kitchen: a. Take Tupperware out of cabinets. Transfer objects (blocks, cars) from container to container. Suggested words: “In! Out! Empty. Full. More in. No more!” b. ______________________________________________________________ c. ______________________________________________________________ 4. Funny things to do in the living room: a. Take cushions off the couch and put them on the floor. Throw an old blanket over the cushions to make an obstacle course. Suggested words: “Whoa! Careful! Climb over. Go under.” b. ______________________________________________________________ c. ______________________________________________________________

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A Parent’s Question: “What is a syllable?” Have you ever noticed that it’s hard to say a consonant without a vowel sound creeping in there? Try saying just a “b” sound. Hard, isn’t it? That’s because it is natural to combine the two sounds together. The combination of a consonant and a vowel is a syllable. The syllable is a natural-sized unit of language that contains at least one vowel (V) and possibly also a consonant (C) at the beginning and/or at the end. As adults, we’ve spent most of our lives thinking of words as being made up of individual sounds like letters of the alphabet. However, if we could turn back time to when we were learning out to talk, we’d remember that syllables were the first chunk of language that we noticed. Thinking of words as consisting of single sounds is something that we learned when we began to read (well after we could already talk). In fact, the syllable is the first thing that we learn about our language in a process that begins before we are born. In the womb, we hear our mother’s voice, as well as the voice of others. But the thing that we pick up on in these voices is not the individual sounds. Think about the times you’ve heard the music played very loud in another car when its windows are rolled up. What do you hear? The bass, right? It’s the same when a fetus is in the womb listening to what’s going on outside: it is the rhythm of the language that comes through—most of which is carried by the vowels. Vowels are especially important to syllables because they carry most of the sound. Consonants work to break up the sound that vowels make. (If we didn’t have consonants, human speech would sound like dogs do when they want something REALLY bad: “WAAOAAOOAOOAOAOO.”)

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3

WHY CHILDREN USE BAD WORDS Take a moment and put yourself in the shoes of a toddler who is not yet using many words. What could adults do to help you use more language? Well, as a toddler, you tend to learn a lot of new skills through imitation. You see your older brother clap his hands, and you think, “Hey, maybe I can do that.” Then you try it. You see your sister throw her food on the floor, and you think, “That looks fun, let’s give it a try.” Food goes

Toddlers learn a lot about the world through imitation.

everywhere. You see people put things in the toaster, and pretty soon the Fire Department is paying a visit to your house. This process of observing others and using those observations as a model for behavior is the most basic mechanism we have for learning. Children will invariably attempt to do what they see others do. The same is true in language development. Imitation appears to be just as important for learning to make words as it is in learning to make trouble. So, imagine yourself as a toddler, what words can you imitate? Most language that adults say to each other is not very easy to imitate. For example, at this moment, mom seems to be asking what you want for breakfast. 13

She says, “If I give you oatmeal, you have to promise not to put it in your hair this time, OK?” Dad is saying, “I’m late for the bus so give me a kiss, Bye!” And brother is saying, “You are a

Adult-speak is difficult for toddlers to imitate.

poopy-head and I’m not letting you play with my Batman ever again!” What do you notice about all this language that people are saying to you? First, it is fast—way too fast for you to try to imitate. It is so fast that all the words seem to run together. Then, there are so many words, and none of them repeat so that you can hear them again. Finally, most of the words don’t sound familiar, or sound like they’re about anything that you particularly want to talk about anyway. Sometimes you hear a word used all by itself. Unlike other words directed toward you, this word is not so fast. In fact, it is often long and drawn out, and repeated several times. The meaning is also very obvious—you can pretty much work out from the context why the person is saying it. For example, dad was trying to get brother to stop balancing on the coffee table, shouting “NOOOO!” Then there was the time when you were pushing little sister’s stroller out the door and grandma said “STOP! STOP! STOP!” And then there was this other time when mom dropped a can of tomatoes on her toe and said “#$&%*!” Now THESE words ARE easy for you to imitate. Let’s look at why this is true: 1) The word is used by itself, so you don’t have to separate it from other words in the utterance. This means that you have a good idea about what the word is. Often it is repeated many times, which helps to 14

reinforce the word. 2) Words used as an exclamation are usually longer and more stretched out so you can hear all the sounds in the word very clearly: you can hear the sounds at the beginning, middle, and end of the word. And 3) a word spoken in this context is often louder than normal, and has a lot more emphasis on it than other words, thus giving you a lot more help about how to imitate it. For all of these reasons, exclamations are very easy to imitate, and the accessibility of these words explains why they are the first words that you will begin to use. Another feature of using bad words is that you get a big rise out of your parents when you do. This is an added incentive that reinforces their use—everybody gets SO upset when you do. I invite you now to step out of those little shoes, and revert to being the adult. What can adults do to make language more accessible to a toddler who is experiencing difficulty using words? The brief example above points toward several important adjustments that we can make in how we talk to toddlers: Use fewer words. By breaking up the sentences into bitesized pieces, the use of single words will have the immediate affect of allowing your toddler to isolate each word, and begin to imitate them. Use simpler words. Use words that consist of a single syllable. For example, “book,” “car,” and “milk” all have one

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syllable. The words “carpet,” “blanket,” and “table” have two syllables. Stretch your words. Make the vowel sound longer and easier to identify. Speak with more emphasis. Make the language you use more interesting to listen to. Use more stress than one would normally put on words. Use different kinds of emphasis while repeating the same word. Accentuate the syllables and stress in the word, both of which are crucial for children in learning new vocabulary. These strategies should lead to many (hopefully appropriate) new words.

Simplifying your language is the single most important thing you can do to help a toddler with a communication delay.

The bottom line is: use simple language and express more with the intonation and emphasis that we use with individual words. There will be a lot more about how to simplify language (and why it’s important) later in this book. It is the single most important thing you can do to make language more accessible to a child. Think of it as rule number one in this project (rule number two: don’t forget rule number one). Here are a few initial examples of situations that you might find useful in adjusting language directed to your toddler: 

As he is sitting in his highchair, your toddler reaches for the container of yogurt on the table. Your first impulse is to say something like, “Oh, you want some more yogurt, don’t you?” Instead of this long and complicated sentence, try saying: “MORE?”. You want MORE! Here’s MORE.”

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

Your toddler is squirming to get out of his highchair. Instead of saying, “I see that you want to get down. Are you all done?” say, “DOOOWWN?” As you help him down you say “DOOWWN!” This time with a different emphasis.



While playing with a ball in the living room, the ball rolls under the couch. Instead of saying, “Where’d the ball go? The ball rolled under the couch!”, try saying, “BALL? Where BALL?” As you look under the couch you say, UNDER. BALL UNDER?” While many parents report that limiting themselves to a

single word (or maybe two) is a big challenge, it will open up a whole new world of language for your toddler. It breaks up language into bite-sized pieces, small enough for little tongues. Experiment with using less language. See how many words your toddler will imitate if you focus the language you are using down to single words. Compare this to other times when your toddler is exposed to normal (adult) language.

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A Parent’s Voice: “Using simple language works.” Karissa (mother of Evan): “Using fewer words with Evan had made a big difference in the amount of imitation that he produced. Before, Evan wasn’t attempting many words. Now that we model single words, and repeat the same word several times during an activity, he is imitating much more. Now he even imitates automatically. It’s as if he knows that that’s what he’s supposed to do—when I say a word, he says the word.”

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Worksheet #3: Using Simple Language. The following are examples of language that an adult might use with a toddler. Read the example, and come up with a simpler way of saying the same thing.

1. “It’s time to put coats and shoes on and get ready to go outside.”

Simplification: ____________________________________.

2. “I want you to get down from your chair and pick up the food you dropped on the floor.”

Simplification: ____________________________________.

3. “We only have time for one book before bed. Which one do you want: Winnie the Pooh or Green Eggs and Ham? ”

Simplification: ____________________________________.

4. “We have to pick up all the blocks and cars that are on the floor in the living room before we can have a snack in the kitchen.”

Simplification: ____________________________________.

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A Parent’s Question: “Why do other books say to talk more?” If you have picked up a book on language development, chances are that it says something like the following: “If you want your child to use more language, then you should speak to them in full, complex sentences. Introduce lots of new words that will expand the child’s vocabulary. Ask lots of questions that will stimulate the child to use his language.” So the advice that you read in the last chapter to use less language may seem odd to you. The fact is that the message to use lots of new and complex language is aimed primarily at parents who have children that are not experiencing a communication delay. It is good advice, but only for children that are on track in developing language. It doesn’t work so well for children that have gotten off track. For children with communication delay, the goal is to get things moving. In order to do so, the language that we use must be simple and focused. In order to develop vocabulary, children must be exposed to a small set of words in very meaningful contexts. When I say, “use less language,” I don’t mean “speak less often.” I want you to use language more often when interacting with your child. What I mean is “use fewer words to say what you mean.” Don’t despair. There will be a time when you will have to be concerned about expanding vocabulary for your child. That time is in the future. See the chapter, From T-ball to the Big Leagues, for more on why we modify our language when working with children who are experiencing delay.

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4

THE COMMUNICATION RAILROAD In thinking about how to help a toddler with a communication delay, it is useful to have a picture of how communication works in general. Another reason is that there is an awful lot of specialized vocabulary that is used in discussing speech, language and communication. In this chapter we will take a step back and look at the big picture. In order to do so, I’d like to draw an analogy that may help

Language is complex. It requires some special vocabulary to talk about it.

us see the nuts and bolts of how communication works. I think of communication as a process that is much like moving things by train from one city to another. Indeed, the train delivers cargo in much the same way that language delivers a message. For example, with cargo, the trip begins in a warehouse, say in Chicago, and ends up in a store in Fresno. With communication, a thought starts out in the mind of one person, and ends up in the mind of another. We can follow the analogy further: trains deliver goods from one place to another because people want to buy them. Oranges that are grown in Florida are moved to New York. Salmon that are caught in Alaska are shipped to 21

Minnesota. Thus, different parts of the country can have a variety of foods that don’t occur locally. This principle drives a great deal of economic activity, and causes businesses to ship their products all over the country. The function of communication is similar: my life is a lot easier if I have a way to tell you something that I’m thinking. Likewise, you can tell me something that is on your mind. By communicating, we are able to help each other, to the benefit of both of us.

It takes a lot of preparation to transport cargo on a train. Many things have to work right for cargo to move across the country. Tracks have to be laid down that the train can run on. In fact, there must be a continuous line of tracks that goes between Chicago and Fresno. Likewise, it also takes a lot of preparation to communicate a message— many things have to work right for a thought to be communicated between two people. Language also needs to be carried somehow, either by sound or by sight. Speech is

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the track for verbal language and sign is the track for visual

Speech is the track for language; sign is the track for visual language.

language. The train’s engine uses a lot of moving parts (i.e., pistons, gears, crankshafts) to turn coal into steam power so that it can move on the tracks. People use a system of articulators to shape sounds into speech (or hand movements into signs) so that they can transmit messages from one person to another. In language, this process of shaping sounds into speech is called phonetics. For example, to make a [p] sound, we have to move our lips together to block the air from passing out of our mouth. At the same time, we have to close the passage to our nasal cavity to prevent air

Phonetics is about how sounds are articulated.

from escaping through the nose. This creates pressure that we release with a puff of air as we part the lips. The [p] sound is articulated very differently from the [s] sound, which is made by bringing the tongue close to, but not touching, the ridge right behind the teeth (alveolar ridge). Then we force air through this small space, creating turbulence that make a hissing sound. The train’s engine can’t carry everything all by itself.

Phonology shows how sounds are arranged into words.

It must be connected to other cars that actually carry the load. The cars are arranged in a line, one after the other. In language, we take sounds and arrange them into words. This is called phonology. For example, we take two consonant sounds, [k] and [t], and one vowel sound [a], to make the word [k]-[a]-[t] (i.e., “cat”). With the train, cars 23

can be arranged into different orders. With language, sounds can be arranged in different orders as well. For example, we can rearrange the same sounds we used above to make other words such as [t]-[a]-[k] (“tack”) and [a]-[k][t] (“act”).

Morphology is about words and their parts.

The cars in the train are not all the same—they each have a different function. Some are designed as freight cars to hold boxes, tankers for liquids, flat cars for containers, special cars for logs, coal, and even refrigerated cars. These are like the different kinds of words that we see in language. We use nouns to refer to many different objects such as people (“Spongebob”), places (“park”), things (“cow”), concepts (“love”), etc. We use verbs to refer to actions. We use prepositions to indicate where something is or where it is going. We use adjectives to describe nouns and adverbs to describe verbs. We use articles, pronouns,

conjunctions, and other grammatical words to glue everything together. Putting words in different categories (like noun, verb, adjective…) is called morphology. Morphology also tells us how to create new words such as

Syntax is about how words are arranged into phrases and sentences.

“cat” + “s” = “cats.” If the train is going to carry a lot of cargo, the engineer has to know how to connect up many cars. In communication, expressing even a simple message requires the connection of several words into phrases and sentences. We have to know how to hook words together in the right 24

order; this is called syntax. Syntax is important because a sentence with one sequence of words such as “Mikayla splashed Joshua” has a particular meaning that is different from the same words in a different sequence such as “Joshua splashed Mikayla”. Words and sentences have meanings, and semantics is what helps us understand where meanings come from. For

Semantics is about the meanings of words and sentences.

example, how is it that some words, such as “bank,” have many different meanings, but we usually don’t notice the different meanings when we are using the word? And what is it about the meanings of “big” and “small” that makes it possible for a big mouse to be smaller than a small elephant? If the train breaks down, and it is prevented from making its deliveries, then the engineer might need help from a mechanic to get things working again. If the development of communication breaks down, and a child is delayed in reaching his language milestones, parents and caregivers may need special information to get development back on track. Because most children stay on schedule, no repairs are necessary. This means that most parents and caregivers don’t usually get the opportunity to learn and practice these specialized skills. When confronted with the situation where a child is being evaluated, it may be necessary to be familiar with the terminology outlined above. For example, when a speech pathologist talks about a “speech” delay, what that person 25

means is that there is a problem with the child’s phonetic or phonological development. When the SLP says that there is a “language” delay, he or she is referring to morphological, syntactic or semantic development. With trains, or most kinds of complex machinery, it does really take a specialist like a mechanic to fix things. It is my belief that this is not true about communication. The information about how to fix communication isn’t so specialized that only a few important people can do it. I suggest that this is where the train analogy ends: everyone can be a mechanic when it comes to communication delay, and this workbook is the manual that you need to get communication back on track.

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Worksheet #4: The Parts of Language 1. The study of word order in language is called ________________. a. Phonetics. b. Phonology. c. Morphology.

d. Syntax. e. Semantics.

2. The study of word parts is called ________________. a. Phonetics. b. Phonology. c. Morphology.

d. Syntax. e. Semantics.

3. The study of how words are created from sounds is called ________________. a. Phonetics. b. Phonology. c. Morphology.

d. Syntax. e. Semantics.

4. The study of the meanings of words and phrases is called ________________. a. Phonetics. b. Phonology. c. Morphology.

d. Syntax. e. Semantics.

5. The study how sounds are articulated is called ________________. a. Phonetics. b. Phonology. c. Morphology.

d. Syntax. e. Semantics.

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A Parent’s Question: “What is Language?” Language is a very complex system that has evolved for communication in humans. Language allows us to do something incredibly useful: it allows us to transfer an idea that one person is thinking into the mind of another person. If you think about it, this is an amazing feat. So amazing that no other animal species has developed this skill (although animals can communicate lots of things without using language, as cats do when they rub up against your leg to tell you to FEED ME NOW!). Here are some other things that linguists have figured out about language over the last century:  Wherever you find people on this earth, you will find language. No group of people has ever been found without language.  All languages have about the same ability to express concepts; that is, there is no such thing as a primitive language.  The vast majority of languages that have existed have never had an alphabet or been written down. This means that speech is the most important expression of language (as sign is for those who have a hearing loss).  For most children, the process of learning a first language is pretty effortless. This is because children know a lot about language even before they are born. If typically developing children hear language, they will learn it. These facts suggest that language is a kind of instinct for humans, just the way that building a web is an instinct for a spider. Momma spiders don’t have to teach their babies how to spin a web, they already know how. Contrary to much of what you may have heard, human parents don’t have to teach their children how to learn language—they already know how. All they need is to be exposed to a language (or two, or three), and they can learn them without much help. When language development gets off track, then it falls to the parents and other caregivers to help in the process. But because most children begin talking without explicit instruction, adults usually don’t have experience with helping a child acquire language—the parents need help in order to help their child. (I suspect that momma spiders probably wouldn’t be much help teaching their babies how to spin webs if they don’t already know: nature just hasn’t prepared them for this possibility).

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5

FROM T-BALL

TO THE

BIG LEAGUES

It requires a lot of adjustment on the part of most adults to change the way we talk when we are trying to help a toddler to use words. We learned in previous chapters that one thing we can do to help children to use more words is to simplify the language that we use with them. Perhaps you’ve tried some of the techniques mentioned in the previous chapter, and you noticed that talking with a toddler in this way is a serious

If you don’t feel like a complete fool, you aren’t doing it right.

workout, and that it feels really silly. My feeling is that if you don’t feel like a complete and total fool, you aren’t doing it right. The fact is, adults get used to communicating with other adults—and most adults (although not all) are helpful in making sure that communication is successful. Most adults will meet you half way in putting a thought into words. They will wait for you to make a point, and will tell you when they don’t understand. Because most adult listeners are willing to help in the process of communication, it allows us to do some pretty amazing things. For example, it is not uncommon for adults to listen to 8, 10, 12, even 15 words at a time before we feel we need to say 29

something. Another adult will let you get away with saying something like “perforation of the membranous undersurface degraded the organism’s ability to maintain homeostasis,” and not bat an eye. In fact, it seems that the rules of adult conversation say that the bigger the words you use, the smarter you are. Another amazing thing about adult conversation is that it’s so fast. Some people talk so fast that I sometimes wish I could switch them into slow motion. (Maybe we talk fast because we don’t want anyone to interrupt us in the middle of a sentence. Everybody knows that if you stop talking for too long, someone else will continue the conversation for you—nature abhors a vacuum—oops, there’s another one of those two-dollar words again!) Finally, an amazing thing about adult conversation is that it contains so much talk about things that are not even in the room when people are talking about them. We talk about last week’s birthday party, the stressful situation at work, about what we need for dinner tomorrow night, and then of course, there’s the weather. Here’s the problem: adult language is not well designed

Adult language is too fast, complex, and it’s not really about what toddlers want to talk about.

when it comes to helping a toddler to use more words. It’s too fast, too complex, and most of the time it’s not really about what toddlers want to talk about. Even so, some folks think that children should be spoken to like adults. They say: “Don’t baby talk him. It just holds him back. Talk to him the way that you want him to talk.” In fact, many parents have the experience of a toddler that understands much of what is said 30

to him, but who still doesn’t produce much language at all. Sometimes this is interpreted as laziness on the child’s part. The parents can speak to the child in long, complete sentences, and the child understands and follows directions. Because the child can follow directions (when he feels like it, of course), figures out difficult problems with ease (like how to load the VCR), and has advanced social knowledge (like exactly how to aggravate his sister), parents know their little guy is a smart cookie. But he still isn’t producing any words! What’s going on here? The reason why a child can understand much more than

Language develops at two different levels— expressive and receptive.

he produces is because language really develops at two different levels. One kind of language skill—what speechlanguage pathologists call receptive language— refers to a child’s ability to understanding what you say to him. This kind of language development may be happening at a normal (or near normal) pace. What is delayed for the child described above is what we call expressive language. Expressive language refers to the child’s ability to produce words and phrases. The question is: what will help to develop the child’s expressive language skills? When people talk to their child as if he were an adult, they are talking at his receptive language level. What I encourage parents to do is talk to his expressive language level rather than to the child’s receptive language level. If the goal is to get more expressive language cooking, then it is here that our efforts should be focused. 31

Here is one way to think about it: consider the way children learn how to play baseball. A young player doesn’t start out in the big leagues, swinging at big-league pitches. Rather, he starts out in the back yard with the t-ball (a device that allows the child to hit the ball suspended motionless, directly in front of him). Then the child progresses to swinging at a moving target: i.e., mom or dad pitching in the back yard. How do mom and dad pitch? They adjust the speed and the delivery of the pitch—much slower, perhaps underhand—so that he can see the ball. You would try to place the ball just where the child usually swings the bat. You would also make an exaggerated wind-up, so that he knew exactly when the ball is coming and he could time his swing. Then comes more and more challenging ways of playing (for example, having the coach do all the pitching), and finally to a stage where our developing player can perform in a “real-world” situation: little league. The point is: t-ball is constructed to make it easier for little people with developing motor abilities to play. If you really want the child to make contact with the ball, you have to simplify the process. A young child doesn’t have the coordination to be able to hit a big-league fastball. If you want the child to be successful, you make pitches that he can hit. Talking slowly, using few words, and making the meaning clear, are all techniques that will help a child to improve his expressive language skills.

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A Parent’s Voice: “Baby Talk is OK.” Anna (mother of Aaron): “I used to think that baby talk was a bad thing—that it would limit my children’s development of language. But when my son had trouble with expressive language, I saw how important it is to slow down, to use more emphasis, and to simplify the language that I used with him. He was able imitate so much more when I adjusted my speech to fit where he was expressively.”

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Worksheet #5: Translating Adult Language into Slow Pitch. Think of some “adult-speak” that you use with your child. Then find alternative words that you could use that would be easier for a child to produce. Fast Pitch: I want you to come to the table for dinner. Slow Pitch: ___________________________________

Fast Pitch: ___________________________________ Slow Pitch: ___________________________________

Fast Pitch: ___________________________________ Slow Pitch: ___________________________________

Fast Pitch: ___________________________________ Slow Pitch: ___________________________________

Fast Pitch: ___________________________________ Slow Pitch: ___________________________________

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A Parent’s Question: “When is a Word a Word?” The chapters in this book may have been helpful in getting your toddler to produce more words. But, the production of more language might raise another equally frustrating problem: some (or most) of the words may be impossible to understand. Now the work becomes learning how to make sense out of the words that are now beginning to flow. It may be the case that no adult word fits very well with what the child seems to be saying. The child persists in saying the same thing, but it is difficult to tell what the meaning is. In this case, it is necessary to examine general aspects of the situation. The most important clue is to look at the context in which it occurs. For example, your toddler may be running around in circles in the living room and saying “nana…nana…nana”. In this context, “nana…nana…nana” means “I’m running around in circles in the living room.” Tomorrow, “nana…nana…nana” might mean “I’m digging holes in the sandbox.” But when he is sitting in his highchair, reaches toward the banana on the table and says “nana”, he is using these sounds as a word. What makes this a true word, and not just a group of sounds, is the fact that the same sounds (“nana”) refer to the same object (banana). In this case, we would expect him to use the same sounds to refer to the same object tomorrow and (with some adjustment) until his last day. This reliable connection between things and sounds is the basis of all language, and underlies other language skills that your toddler will be learning. Too frequently, parents get bad information about what counts as a real word. For example, one parent reported that a doctor told her that names and “little words” like “hi” and “bye” don’t really count. This is complete nonsense (doctors may know a lot about how the body works, but they are notorious for giving bad information about language development). What makes a word a word is just that connection between sound and meaning. When children use “sound effects” to refer to an object, such as “mooo” for cow and “choo-choo” for train, they are making a stable connection between a sound and a meaning—in other words—words! These have exactly as much right to be called words as other words that we use every day like “splat” and “bonk” do. Sometimes children produce words that are very different from adult words. So different, in fact, that it appears that the child has invented their

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own words for some meanings. These are called pseudo-words. A pseudo-word is not an attempt at an adult word (like “banana”); it is an entirely new invention. A pseudo word is like when the child uses “momo” to refer to their pacifier. Nobody knows why he calls it “momo”, but that’s what he calls it. This can be confusing, especially when the child is insistent about using the pseudo-word, and the parents can’t figure out what “momo” means. The parents make the natural assumption that the child is trying to approximate an adult word, and they are searching for something that sounds remotely like “momo”. Little do they know that this “word” the child is producing is not related to any adult word—the toddler just made it up! The interesting thing about pseudo words is that the child may believe he is using adult language (it has a meaning to him), but nobody else seems to get it. Luckily, because it can be frustrating for parents and children, this phase doesn’t usually last very long. So how do we tell the babble from the words from the pseudo-words? The important thing is just that parents and caregivers are able to notice that the child is producing words that have specific meanings, whether they are true words or pseudo-words. It doesn’t really matter which it is, if the child can use it reliably and the parents and caregivers can understand what it means. Using a pseudo-word as if it were a true word is a perfectly fine thing to do. It won’t delay him further in his language development. The crucial part is that the child receives a response that makes it clear that the production of more words (either pseudo or true) will be a useful thing to do.

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6

MIXING IT UP Parents spend so much of their time and energy trying to control chaos in the typical household with small children, it is almost inconceivable to consider asking them to make more chaos voluntarily. I am now going to ask you to conceive of it.

Wait! Before you pitch this book in the trash, let me tell you a bit more about what I’m suggesting. Here’s the reason to mix things up a little: routine is the enemy of communication. Think

Routine is the enemy of communication.

about the meaning of the word “routine.” We call things routine if they happen without talking or negotiating. In general, routines are good things. They make life easier, and less stressful. But one result of having routines is not so positive— the more routine life is, the less opportunity there is to communicate about it. Put another way: when everything is running smoothly, there is no strong incentive to rock the boat. Consider this situation from the point of view of a child with a communication delay. He needs practice using language (either signs or words), but there is nothing really to discuss because it is all happening so automatically. How then is he going to

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practice the skills of commenting, requesting, or protesting when there is nothing to comment, request, or protest about? Another feature of an efficient household can also block communication: anticipation. Many parents have become experts in knowing what their child needs before they need it. (As a member of the International Association of Infants and Toddlers, your child has trained you through much tantruming to anticipate exactly what he needs before HE even knows what he needs; see Renegotiating the Contract for more on this issue.) Again, consider this from the perspective of a toddler

Break up some of those efficient habits and routines you’ve developed.

who isn’t communicating. How are you going to learn to use words for requesting if everything you need magically appears exactly when you need it? So what I’m asking you to do is break up some of those beautifully efficient habits and routines you’ve developed. There are a couple of things that you can do to change habits and routines in your day that won’t result in the end of civilization as we know it: 1) change a few routines, 2) don’t anticipate every need, and 3) violate expectations every once in a while. Let’s go through each in turn. The first option involves taking a little bit of the burden of deciding what’s happening during the day off of routine and placing it on to communication. Many parents shy away from this option because it can cause tears and tantrums. But changing a routine doesn’t have to be a traumatic event. Take getting ready in the morning. Would it be a catastrophe if we 38

had breakfast before getting dressed? Does it start a conversation to put socks on first instead of last? The second way to create opportunities for practicing communication is to make a little distance between what the child wants and the object of their wanting. Consider a child who is learning to crawl. If every thing they need is placed within the child’s reach, he never has a need to move. If, however, a really fun looking toy is put across the room, that might be motivation enough to get him to crawl, roll, scoot (or whatever it takes), to get over there and get the toy. This kind of technique works with communication as well. Try putting the really fun toy on top of the fridge, and see if that creates an opportunity for communication. Hide the “special” blanket, and then spend some time looking for it. This is likely to create some words, and will also bond you and your toddler through a common goal—finding the “lost” blanket. The third opportunity, violating expectations, includes things like dumping the toys out of the bucket (before the kids do anyway). This creates the opportunity to pick them all up again, practicing the word “in.” And then—go crazy!—dump

Make some mistakes (on purpose), such as saying the wrong animal sounds.

them out AGAIN! This kind of activity doesn’t fit well with the adult sense of order, but toddlers love it. Here are a few other suggestions: 

Make some mistakes (on purpose), such as saying the wrong animal sounds while singing “Old McDonald’s Farm.”

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

Sit in the wrong chair at the dinner table. Sit in the chair that your toddler usually sits in (if it isn’t too gross, that is).



Give milk when the child asked for juice.



Put on Sesame St. when the child asked for Blues Clues. One story that I love is the mom who returned to the

kitchen to see that her toddler had spilled milk all over the floor. Instead of responding in a predictable way by getting out the mop and bucket, she sat down and started drawing pictures in the milk. This kind of activity is difficult to think of in the moment, but can make a big impression in the language skills of a toddler. The moral of the story for me is: you have to break a few eggs to make a communication omelet.

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Worksheet #6: Breaking Some Eggs for Communication. Examples of routines that you could change/violate: 1. Routine: Getting ready to go in the car. What it looks like now: ______________________________________ __________________________________________________________ What could you do differently? ___________________________________ ___________________________________________________________ 2. Routine: Lunchtime. What it looks like now: _____________________________________ __________________________________________________________ What could you do differently? ___________________________________ ___________________________________________________________ 3. Routine: Bath and bedtime. What it looks like now: _____________________________________ __________________________________________________________ What could you do differently? ___________________________________ ___________________________________________________________ 4. Routine: ____________________________________________________ What it looks like now: _____________________________________ __________________________________________________________ What could you do differently? ___________________________________ ___________________________________________________________

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7

WHO’S CALLING

THE

SHOTS?

Think for a moment about how useful it is to talk. Think about how often you use words in the day to let others know what’s going on in your head. Now imagine what life would be

If you can’t talk, you are completely dependent on other people to know what you want.

like if you were a toddler who couldn’t talk. If you couldn’t talk, you would be completely dependant on the people around you to know (or guess) what you wanted or felt. You’d probably try some other way of communicating, such as leading others to what you want, but even that doesn’t work for a lot of things that you might like to say. How do you express that you would really like a strawberry fruit roll, and that you hated the blueberry because it tastes like cardboard? Or more importantly, you have no way to say (except through behaviors) how it makes you feel when your new baby brother gets all the attention. Not being able to communicate really doesn’t allow much control over some pretty important issues. Even if a toddler has a few words, parents often find that they don’t get used. It seems that any attempt to get him to do more communication is torture, and causes large amounts of whining and sometimes full-blown, screaming tantrums. It is 42

as if the child has gotten stuck in a pattern that he can’t get out of, and he doesn’t know how to ask for help (if he did, then communication wouldn’t be such an issue). This can be discouraging for parents, because it gives them the feeling that their child is not motivated to use the words he has, and is just being “lazy” or “contrary”. Frustration builds, in both child and parent, and the possibility of positive communication becomes less and less (also see Renegotiating the Contract for more about how to avoid frustrating situations). One recommendation for parents in this situation is to begin using an alternative mode of communication. This might include using signs to communicate some simple messages such as “more” or “all done,” as well as some specific requests such as “eat,” “drink,” and “play.” It may also include using pictures of

Signs and pictures offer the child a way to communicate that works better than speech.

objects to allow the child to make more specific choices, such as “cheerios” vs. “banana.” Signs and pictures offer the possibility of communicating in a way that works for the child better than speech. With an alternative system, communication depends on the hands and eyes (manual/visual), rather than the mouth and ears (oral/aural). As noted in the Preface for

Parents, the use of signs and pictures is often a good option for children who are stuck with no workable way to express themselves. Why use an alternative communication system when speech is the goal? Imagine that your son is learning how to play basketball. Now, it seems obvious that the best way to 43

learn how to play basketball is by doing just that—playing basketball. But, there are many things that your son could do in addition that would make him a better basketball player. For example, he could practice running fast and stopping quickly; he could practice jumping hurdles; he could play another sport like baseball or football. Such activities would help because they would improve his skills in areas that are also important in playing basketball, such as: having good hand-eye coordination, excellent balance, accurate peripheral vision, and teamwork. In other words, these activities would help develop skills that are not exactly the same as basketball, but which would make him a better basketball player. In just the same way, alternative communication helps children learn how to talk. It does this by developing skills in a child that they need in order to express what he wants. It allows the child to make a communication (using a sign, or pointing to a picture) and have the positive experience of being

The use of sign teaches children that it is worth making the effort to communicate.

understood. It expands the child’s vocabulary. It teaches him that it is worth making the effort of communicating. All of these skills are necessary and important when it comes to learning to use words, and there is no reason to wait until the child can speak in order to work on them. Communication lays the groundwork for talking, and has the added benefit of lessening frustration in the meantime. As speech becomes more available to the child, he or she will always use it instead of signing—it’s far more efficient to use words than to sign (for 44

children who are not hearing impaired). Signs are a short-term way to practice the skills of communication until the words start flowing. Why is it so important to find another way for your toddler to communicate? The danger is this: if the no-way-tocommunicate situation lasts too long, the toddler might begin to wonder whether there is any point to this whole communication thing. He might make a decision that many toddlers come to, a decision that would make a lot of sense to all of us, if we were in a similar situation. The toddler-logic goes like this: “If I

What began as a communication delay can grow into something bigger.

can’t tell anyone what I want, then I’m just going to go and get it myself. I’ll get what I want to eat from the fridge. I’ll get what I want to play with from the cabinet. I’ll get what I want to wear from the closet.” This is the sort of child who does for himself, and generally fights everything that is suggested to him. In the extreme, an independent toddler with language delay won’t even let you look at him. It seems that such a child would rather walk the plank than ask for help (even in a dangerous situation). For this independent toddler, what began as a language delay has now grown into something bigger. The child may have become so good at being independent that communication seems irrelevant. Toddler-logic has concluded communication is basically useless. He has learned (through frustrating experience), that “if you want something done right, you have to do it yourself.” The result is a child who can’t talk, and, even 45

worse, has no motivation to try. This commitment is the direct outcome of not being able to say what he wants and needs to others. In fact, he will usually perceive direct attempts to communicate by others as an attempt to prevent him from getting what he wants. So, what was originally a language delay has expanded into a control issue. In addition, the independent toddler now has developed an interaction style with the world that is combative, and therefore not conducive to interacting with others (a requirement for learning how to communicate), even if he were motivated to do so.

By having a way to communicate a few different things, the child won’t give up on communication.

Rather than delaying language more, the use of signs and/or pictures can prevent this from happening. By having a way to communicate a few different things, the child won’t give up on communication. The use of signs and pictures can also help a child out of this situation if it has already occurred. When a toddler has given up trying to make contact with the outside, simply working on speech, without addressing the overall communication and control issue first, will likely lead only to more frustration for you and the toddler. The first task really should be to give the toddler a sense that there is value in trying to make a connection. Using an alternative system for communication offers a way to make communication relevant for the independent toddler, and thus get him back into thinking that he can get what he wants by letting someone else know. It helps him learn that communication is worth the trouble, and will result in more control, not less. Using an 46

alternative communication system allows your toddler to call at least some of the shots. Once they see the advantage to using signs, parents still often have a few questions: 

How long will signs be necessary? Will he use signs for the rest of his life? Answer: No. Signs are necessary only until it becomes easier to use words. This can take anywhere from a few weeks to a year or more, depending on the reason for the language delay. If apraxia is one cause of delay, then progress tends to be slow, and signs may be necessary for some time. If the cause is chronic ear infections, then progress in using speech is likely to be more rapid, and signs may only be necessary for a short time.



Will our family have to learn a whole new language? Answer: In order to reduce the level of frustration, it is usually necessary to learn only a few signs (5-10). Some families get a lot of enjoyment out of using signs, and they may learn 50 or more.



What kind of sign should we learn, American Sign Language (ASL) or Signed Exact English (SEE)? Because signs are a short-term solution, it is not so important what kind of signs you choose to use. It is important that the signs be easy for toddler hands to make. Some toddlers make up signs on their own, and it is fine if adults use these signs as well.

47

A Parent’s Voice: “Using signs reduces frustration." Kristine (Mother of Nelson): “Learning simple sign language was such a positive tool and I know it was a relief for Nelson to be able to ask for ‘more juice’ rather than screaming and pointing at the kitchen as I rush around trying to guess what he needs and feeling BOTH of our frustration levels grow. Initially, we had to explain to Nelson’s grandparents that learning sign language was an alternative way for him to tell us what he needed. They were concerned that if he could get what he wanted through sign language, it would delay is speaking even more. Through this program, we were able to understand (and then explain to the grandparents!) that Nelson’s communicating with sign language allowed us to maintain a closer bond and he could trust that (for the most part) we could respond to his needs quicker and more effectively than just guessing at what he meant by his grunting sounds. I just know that using sign language decreased his frustration at us and at himself tremendously. As his verbal language skills have improved and as he becomes more fluent, his sign language usage has decreased.”

48

Worksheet #7: Using Simple Signs. Circle the food items that your toddler would use a sign to request: apple

cookie

popsicle

banana

crackers

sandwich

cereal

drink

toast

cheese

milk

yogurt

Toys that my toddler use a sign to request: animals

book

doll

ball

bubbles

paint

bike

cars

pens

blocks

crayons

play doh

Songs and activites that my toddler would use a sign to request: climbing

itsy bitsy spider

row your boat

computer

jumping

swimming

go to park

old McDonald

swinging

hide-and-seek

peek-a-boo

watch video

Routines that my toddler would use a sign to request: bath time

cooking food

leaving the house

bed time ritual

feed animals

vacuum carpets

brush teeth

getting dressed

wash hands/face

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8

WAIT

FOR

IT

There is a lot of frustration for a child who has a language delay. As noted in the previous chapter, it is really difficult to ask for what you want if you don’t have the words for it. But there is also frustration for the parents. Apart from the day-to-day difficulty of negotiating with a child who doesn’t have the tools to communicate, there is the longer-term frustration of waiting for signs of progress. It can take weeks and weeks for a child who is stuck with no functional communication skills to “get it” that using words is a good thing. This period can be excruciating for parents. It may seem that

Sometimes the right thing to do is nothing at all.

your child is not the least bit interested in communicating. (He probably isn’t—that’s why we have to give him some good reasons.) If you try to help your child talk, all you get for your trouble is a more resistant and angry toddler. Parents would be justified in wondering whether there is any point in continuing to try. It turns out that with communication, sometimes the right intervention is NOT doing something. In fact, it might be that waiting is the key.

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What does waiting look like? You may see your child struggling to open a package of fruit snacks. You know that he will not be able to get it open. Your instinct is to say, “Bring it here. I’ll do it.” Resist this urge! Instead—wait. Don’t say anything. The first time this happens, the child may have a meltdown, throwing the snacks (unopened) on the floor and crying. Now you move in and say, “You need HELP.” It may be difficult for you to witness this scenario, especially when you know how to solve the problem. But if you can push through, the result may be that your toddler finds a good reason to communicate.

A look is a communication.

The next time this occurs, your child is trying to open a container of Play Doh. He is beginning to get frustrated, but then a light goes on—he looks at you. Even though he may not have used a word, a look is a communication—it is a signal for help. This is a good start on the path toward using words. In this case, it is important to respond by saying, “You need HELP.” Because you used the word “HELP,” which he remembers hearing the last time when you opened the fruit snacks, your toddler knows that you are going to help him reach his goal. This response reinforces the usefulness of communicating. On the next occasion, you can raise the bar a little. When your toddler struggles with something, and looks at you, you say, “HELP? You need HELP?” (with the rising intonation that you use with a question). This should elicit a sound or perhaps the word “help.” 51

The situation I’ve described may not naturally occur with your child. However, it is such a good opportunity to practice communication skills, that you may want to think of ways of creating it artificially. For example, choose a package or

There are many ways to create opportunities for communication every day.

container that you know that your toddler can’t manage on his own. Give him the water bottle with the top on, instead of opening it first. Or, hand him the banana with the skin on. There are many ways that adults facilitate events for children, and each of these events is an opportunity for communication. One warning: be careful not to be too demanding about helping with certain things that are important to your toddler. Some kinds of help are non-negotiable, as we will see later in Chapter 11: Renegotiating the Contract.

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Worksheet #8: Opportunities for Waiting. Identify situations in which waiting might cause more language.

1. Situations in which the child can’t open something by himself.

2. Situations in which in which the child can’t reach something.

3. Situations in which the child can’t operate a device.

4. Situations in which the child can’t find something that he wants.

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9

GAMES TODDLERS PLAY What’s a game? When many people think of a game, they think of something that you buy from the store—it comes in a box, has rules, and a board (e.g., Clue, Monopoly, Chutes and

Ladders, or checkers). For toddlers, these are not games—they are more of a hazard, in fact—opportunities to chew (and possibly choke) on the little pieces. For toddlers, games are a whole different concept. Games are anything you can do, right

Toddlers are always on the lookout for a new game—the crazier the better.

now, that happens to be fun. Toddlers are always on the lookout for a new game—the crazier the better. How do you know what kind of game a toddler will be interested in? This requires a bit of investigation. The best way to understand toddler behavior is to become an anthropologist for a day: observe him in his routines and customs. Notice activities he tends to engage in. For example: 

Does he like to play with bears and a tea set, or crash

cars into block towers? Is he fascinated by what’s under the carpet, or does he want to give the cat a big hug? You probably already have a sense of this, but if not, watch the play activities that your child gravitates towards. 54



What is it about the activity that makes it fun?

Typically, young children are captivated by some aspect of an activity, something that catches their imagination. Sometimes there is a sensory component to the activity—it males a cool sound when he pulls on the metal blinds; it feels nice to bounce on the couch; or playing with the flashlight makes neat patterns on the ceiling. Once you have identified the kinds of play your child likes, break it down a little and think about the fundamental feature of the activity that he is drawn to. 

Think of other activities that include the same features

that you have observed in the play that your toddler is attracted to. If the activity that your toddler is drawn to is too messy/dangerous/difficult, often you can find an alternative activity that is acceptable for everyone. Here’s an example: you’ve noticed that your toddler is always dropping toys behind the couch, and watching them fall.

You want to preserve the fundamental feature of the play that makes it fun.

Up until now, this activity is has seemed like more of an annoyance than a game. One reason why it doesn’t seem so fun is that you have to keep pulling the couch away from the wall to retrieve the toys. How can you join the play, while preserving the basic structure of this activity? First, you want to preserve the fundamental feature of the play that makes it fun, but expand in just enough to let you play too. You’ve reasoned that the dropping of toys is a crucial part of this activity, not just hiding them behind the couch. What might happen of you pulled the couch out from the wall a bit, and put a bin behind it 55

so that the toys fell into the bin? A quick experiment would tell you whether this captured the spirit of the game for you child. Try the same activity from the back of another piece of furniture, say a chair (which might have the added advantage of being more accessible for retrieving toys). If this example, or something like it, results in a game that you and your toddler can share, then: congratulations! You have succeeded in establishing a connection. You have allowed your toddler to choose the activity, adjusting it minimally so that it can include another person. In doing so, you’ve taken the first step in establishing that you might have something to communicate about. Control is not an issue because this is an

Your toddler will produce more in this context because he was able to contribute to the creation of the activity.

activity that you both are participating in as equal contributors. Since you have made a connection without triggering a defensive response, there is the possibility that communication could happen. In fact, if communication does occur during this activity, it will have a different quality for your toddler than most other forms: he will be motivated to contribute more to the communication in this context because he was able to contribute to the creation of the activity itself. Having his interests catered to has allowed him to have a degree of control in the situation that he would otherwise normally not have. In addition to making a nice space for communication, this technique has another advantage: it will give more opportunity for focusing on a particular set of words. (Words 56

that would be appropriate to target in this activity for a child that is just beginning to produce single words include up, down,

boom, and more.) Because this is a FUN game, your toddler will want to do it longer, and more often. Think of the benefit that he will get from hearing these words used multiple times during an activity that he is enjoying! The learning is amplified when you can find several such games that target the same small set of vocabulary.

If you’re not successful at first, keep trying.

If you try this technique and were not successful in establishing a game with your toddler, don’t despair. It often takes some time for a toddler who is experiencing a communication delay to feel comfortable enough to let another join in a game. See Chapter 7:Whose Calling the Shots and Chapter 11: Renegotiating the Contract for more about how and why toddlers develop such independence, as well as what to do about it.

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Worksheet #9: What’s the Game? Observe you child during the day, and take note of the kinds of activities that he tends to be drawn to. Describe the activities below and answer the questions provided about each one. 1. Activity: _____________________________________________ a.

What is it about this activity that is fun/exciting/interesting for your toddler? _________________________________

b. Does the activity need to be adjusted for safety/messiness/convenience? _______________________ c.

What words would be appropriate to model with this activity? ______________________________________________

2. Activity: _____________________________________________ a.

What is it about this activity that is fun/exciting/interesting for your toddler? _________________________________

b. Does the activity need to be adjusted for safety/messiness/convenience? _______________________ c.

What words would be appropriate to model with this activity? ______________________________________________

3. Activity: _____________________________________________ a.

What is it about this activity that is fun/exciting/interesting for your toddler? _________________________________

b. Does the activity need to be adjusted for safety/messiness/convenience? _______________________ c.

What words would be appropriate to model with this activity? ______________________________________________

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10

WE HAVE WAYS

OF

MAKING

YOU

TALK!

The parents of a child with communication delay are often very worried about what the future holds. They wonder if their kiddo will ever begin speaking, and they’re also thinking long-term about reading and academic success. These parents can see the frustration that their child is experiencing on a day-to-day basis, and they are worried about him being left behind. In short, the parents are usually doing their best in a difficult situation, with little guidance about what is the right approach for helping their child. Not surprisingly, parents are looking for any clue about how to promote more expressive

Parents and caregivers often adopt a proactive approach. This is a good first step.

language. Many parents and caregivers adopt a proactive strategy in helping their child to learn how to talk. The first strategy that many parents and caregivers start with is to engage their child in conversation by asking a whole bunch of questions. “What color is that?” “Where is the green block?” “What does the cow say?” This sometimes sounds like they are interrogating their toddler as if he were a captured spy: “What is your name, rank and serial number??” “Where have you hidden the secret codes??”

59

Why do parents adopt this strategy? One theory is that this is what parents saw when they took their child in to have a speech and language evaluation. The speech-language pathologist had a book with a lot of pictures in it. The majority of the evaluation consisted of asking the child to name pictures in the book. I think some parents make the common-sense assumption that asking questions is what you do with a child who has a communication delay. (This can’t be the whole story, however, because the asking of questions occurs even with parents who haven’t had their child in for an evaluation.) The problem is the following: questions like the ones that the SLP used are good if you want to find out what someone else knows

Questions tend to reduce the amount of language that children will produce.

(especially spies), but are less effective at helping a toddler to use their words. In fact, questions like these usually have the opposite effect—they tend to reduce the amount of language that children will produce. Imagine that you are already having trouble with using words, and now someone is asking you to answer specific questions that also require you to think! For most children, this results in no response at all. Worse: questions like this reduce overall communication because the toddler is unable to produce a response, and therefore begins to ignore the questions. As outlined in previous chapters, imitation is the chief mode of learning at this age, and if your toddler is ignoring what you are saying, that means that they are not going to attempt to imitate your language. 60

Instead of asking questions, try using other kinds of language that will not put a toddler on the spot. Here are some examples: 

Sound Effects: Any verbal accompaniment to an action that might add interest, such as “Uh oh!” (spilled), “Splash! Boom! Crash!” Etc.



Exclamations: Any language which is used when something special, different or surprising happens. For example, “Wow!”, “Ouch!” (See Chapter 3: Why Children Use Bad

Words to learn about why these are particularly easy for children to imitate.) 

Requests: Language that is used to get someone to give something or give help. For example, “more juice”, “that one” and “cookie, please!”.



Statements. Any language that describes something about the world is a kind of statement. For example, “big truck!”, “juice gone”, “there’s Elmo!”, and “my shoe”.



Imperatives: Language that is a command or instruction to do something. For example, “look!”, “go!”, “stop!”, and “in here!”

Model the behavior you want your child to imitate.

In short, if you want a child to be able to point to pictures and name them, then that is the behavior you should model for them. If you want him to request by saying please, then he needs to see other people doing it. You do what you want your toddler to do. You’ll find that your toddler will be more responsive, and will learn more words as a result! 61

Worksheet #10: Changing Questions into Statements. Read the list of questions below. Change each one into a statement that includes the same information. 1. “What’s that?” (a bus) Statement: _________________________________________. 2. “What color is that?” (blue) Statement: _________________________________________. 3. “Where’s the farmer?” (in the barn) Statement: _________________________________________. 4. “How many sheep?” (three) Statement: _________________________________________. 5. “What’s the kitty doing?” (sleeping) Statement: _________________________________________. 6. “Which one is big?” (that one) Statement: _________________________________________. 7. “What’s the bear got?” (a spoon) Statement: _________________________________________. 8. “Where does the car go?” (in the garage) Statement: _________________________________________. 9. “Where’s the yellow cup?” (on the table) Statement: _________________________________________. 10. “What does the duck say?” (quack) Statement: _________________________________________.

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11

RENEGOTIATING

THE

CONTRACT

Play is crucial because it prepares children for the world by allowing them to develop the skills they need in a safe and enjoyable manner. Play can be ESPECIALLY important when it comes to developing communication skills. The reason for this is found in the difficulty that frequently arises when caregivers try to tamper with the daily routines that get formed with children who have a language delay. One way to think about these routines is as a kind of “contract” about who does what and when in everyday situations. Your toddler has built up

Routines are a kind of “contract” between a parent and child.

expectations about what is expected of him to get what he needs from the world. It is written in this contract that when he fusses and pulls on your hand, it is understood that you will interpret this as meaning “I want some more juice now.” If you try to demand more communication from your toddler when he has always gotten everything he needs by pointing and whining, you are in for a struggle; that is because you are trying to RENEGOTIATE THE CONTRACT! Of course he protests, goes on strike, and generally makes a big stink—any self-respecting member of a large union (the International 63

Association of Infants and Toddlers) would do the same. The contract has been built through the repeated occurrence of your toddler making the least amount of communication possible, and you filling in the rest. (Remember that this dynamic is facilitated by adults who will respond to a minimal amount of communication. It’s not just stubbornness or laziness on the part of your toddler. It is equally important to note that parents of children with special needs often have great reluctance in demanding more effort in communication, because their child is medically fragile, and can do nothing more in many circumstances. Often, this feeling persists even after their child is able to do more to communicate—in this case the contract was negotiated when the child was very ill, and has not changed, even though he is

Play is not under contract, so union rules don’t apply.

much healthier now.) The existence of the contract explains why play can be so important in developing communication: it offers an opportunity to interact, and hopefully communicate, about something else that is outside of the contract. Play is not under contract, and so union rules don’t apply. There are no expectations about who does what and when, especially if the play is improvised. Improvised play is play that is invented on the spot. Some examples of improvised play: 

Improvised Game #1: Your toddler picks up some packing material you’ve just dumped on the floor and begins to look at it. This is an opportunity! You’ve 64

noticed the initial interest, and you think about how to take advantage of it. You quickly grab a couple of containers from the cupboard and start scooping the material up with one container and dumping it into the other one. While doing this, you repeat the words in and

out in an exaggerated and interesting manner. Within the first few repetitions, your toddler is imitating your actions, as saying “iiii” and “aaauuu.” 

Improvised Game #2: A sticker on a toy is starting to peel off. Your toddler has become fascinated by this, and is trying to pull the sticker off. You notice her interest, and actually HELP her get the sticker off (who cares about a sticker on a toy?). In fact, you pull ANOTHER sticker off for yourself. Then you capitalize on this event by sticking the sticker to lots of different objects in the house, each more interesting to your toddler than the last (thus holding their fascination with the game). With each sticking on you say push as you exaggerate the motion of pushing the sticker to the chair, TV, big brother, etc… When you take the sticker off, you say pull.

By the third or forth repetition, she is

saying “uuuusshh” and “uuuuuwww.” 

Improvised Game #3: As you are pushing cars on the floor with your toddler (and not getting much imitation from this activity), you notice that a phonebook under one end of the coffee table makes a very cool ramp for 65

the cars to go down. You let the cars go from the top of the ramp and watch them roll off the end. To enhance fun, you stack some blocks on the floor at the end of the ramp that the cars can crash into. As the cars go down the ramp you say down and then as you push them back up the ramp you say up. Within 10 minutes of beginning this game, your toddler is imitating you by saying “doooww” and “uuuu”. She may also be imitating you as you countdown (“1, 2, 3, goooooo”) before you let the cars go from the top of the ramp. One thing to notice about these games is that they make

New and interesting games can be invented in every situation. Special toys or elaborate preparation are not necessary.

novel use of everyday objects. This is important because it demonstrates that new and interesting games can be invented in every situation. Special toys or elaborate preparation are not necessary! In fact, they will tend to slow down the process— toddlers are notorious for moving from one activity to another rather quickly. If you take a long time to initiate the game, they will be on to something else, and the observation you’re trying to capitalize on will no longer be interesting (see Chapter 15:Toys for Talking for more on this topic). Notice also that the more weird and strange a game is, the more interesting it will be. Go forth and invent! You will be rewarded with many new words from your toddler. You just might even have some fun in the process!

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Worksheet #11: Activities not Under Contract. What activities are so important to your child that he will not negotiate about them? Make a list. 1. ____________________________________________________ 2. ____________________________________________________ 3. ____________________________________________________ 4. ____________________________________________________ 5. ____________________________________________________

What activities could you create that would not be “under contract?” Make a list of games that you could initiate which would allow for more communication.

1. ____________________________________________________ 2. ____________________________________________________ 3. ____________________________________________________ 4. ____________________________________________________ 5. ____________________________________________________

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12

WHY BABIES BABBLE There is a definite order to the stages when children learn to walk. First they learn to roll over (first from back to front, then from front to back), then to hold their head up, push up on their arms, move into sitting, transition onto all hands and knees, crawling, pulling up to stand, cruising along furniture, walking with support, and finally, taking independent steps. Walking is such a complex skill that requires the integrated movement of many muscles, along with the help of the vestibular system for balance and the visual system to keep from bumping into things. It would be too complicated to try and do all at once. That’s why children go through stages—they need to practice the skills one-by-one before putting them all together in a highly coordinated activity.

Babble is to speech as crawling is to walking.

Learning to talk works the same way. Babble is to speech like crawling is to walking: it is like speech, only constructed to make it easier for infants and toddlers with developing oralmotor abilities to be able to produce it. This is because speech sounds are not easy to produce. The articulators must move with an incredible amount of precision to make a speech sound 68

that you can understand. Infants and toddlers start out on the road to speech by cooing, during which they will produce mostly vowels and a few gurgling consonants. Then children’s productions take the shape of syllables. The following list contains the first syllables that infants and toddlers are likely to produce, arranged by where they are articulated:

Front:

[ma]

[ba]

Middle:

[ni]

[di]

--

[gu]

Back:

Now, it is no accident that I used examples with front, middle, and back sounds. These are three important places where the consonants are made. The lips in the front of the mouth (labial sounds like “b” and “m”) are a place where infants and toddlers learn to make early sounds. Another place where early consonants are made is in the middle of the mouth.

Most children start with front and middle sounds.

Consonants are made here by touching the tongue to the ridge right behind the teeth (alveolar sounds like “d” and “n”). In the back of the mouth, consonants are made by touching the back of the tongue with the back of the throat (velar sounds like “g”). Usually children will start out with the front and middle sounds, and then begin using the back sounds a bit later. After making these syllables, children will branch out to make other 69

syllables (see Worksheet #12). First, children will usually produce single syllables. Then babble goes through some

Babble is the production of simple syllables, over and over and over again.

definite stages. The first consists of early combinations of syllables (called “canonical babble”), with the same syllable repeated over and over again (bababa, mamama, dididi, etc.). For obvious reasons, it is easier to produce the same syllable many times. The next stage of babbling (called variegated babble) is slightly more challenging. It consists of different syllables combined together (badidiba). Finally, children reach a stage of babble where they put more emphasis on one syllable than the others. This is called jargon, and is the stage where caregivers often have the sense that the child is speaking their own language (baDIdiba). Just as there is a sequence of stages within babble, there is a sequence of stages in learning to produce words and phrases. Beginning at around 12 months, children begin to use the syllables they can produce to approximate adult words. Very often, the adult words are changed significantly in the process (see Chapter 13: Translating Toddlerese for more on this topic). There may be a period during which babble and words overlap. After the child begins to produce more words, the production of speech sounds becomes more systematic. Up until this point, words were learned as solid chunks of sound made up of syllables. Now, as the vocabulary grows, the patterns begin to emerge and words become collections of individual sounds. Thus, words become more adult-like, there is 70

less babble or jargon, and the child is much easier to understand. The typical sequence of development in moving from babble to words to phrases is shown graphically below:

Typical Development phrases

**************

words babble time

***************************************** ********************************** 6

*

8

*

10

*

12

*

14

*

16

*

18

*

20

(months)

Many children with speech delay are very late to begin babbling, or don’t really babble at all. What happens in this case is that the articulators do not get the practice that they

Children with delayed (or no) babble don’t get the practice they need in using the speech articulators.

need in order to make clear and intelligible speech sounds. It is as if the child has been taken out of little league and thrown directly into a major league baseball game. The oral motor skills are just not developed yet to produce articulate speech. But development doesn’t stop because there was no babbling. The child’s receptive skills continue to grow, and at some point, there is the motivation to begin producing words. What then? The child still needs to go through all the stages and get all that practice moving the articulators before he will be able to make speech sounds that can be understood. Thus, it often happens that a child with delayed speech is actually trying to produce words far in advance of their ability to make the 71

speech sounds required. In this case, the child has to learn how to articulate sounds at the same time that he is beginning to produce actual words. This can often be a frustrating experience for children and parents (unless the parents can give the child another way to expresses some wants and needs). This situation is represented below. Notice that the babble stage and the first words stage are overlapping:

Delayed Babble phrases

********

words

*********************

babble

************************

time

6

*

8

*

10

*

12

*

14

*

16

*

18

*

20

(months)

Babble is important, and children who don’t do much of it often end up with immature speech—their articulators just haven’t had as much practice making speech sounds. When first words—meant for communication—are being produced at the same time as the toddler is catching up on babbling, the result is a mishmash of speech and jargon that is difficult to understand. A child with speech delay still needs to go through all the stages and get all that practice moving the articulators before he will be able to make speech sounds that can be understood.

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Worksheet #12: First Syllables Syllables beginning with front sounds: wih ___

weh ___

wah ___

waa ___

waw ___

wuh ___

bih ___

beh ___

bah ___

baa ___

baw ___

buh ___

mih ___

meh ___

mah ___

maa ___

maw ___

muh ___

Syllables beginning with middle sounds: dih ___

deh ___

dah ___

daa ___

daw ___

duh ___

nih ___

neh ___

nah ___

naa ___

naw ___

nuh ___

Syllables beginning with back sounds: gih ___ i as in miss

geh ___

gah ___

eh as in bet

gaa ___

ah as in hot

gaw ___

aa as in cab

guh ___

aw as in saw

uh as in cut

Syllable combinations: Canonical Babble Example 1 __________________ Example 2 __________________ Example 3 __________________ Variegated Babble Example 1 __________________ Example 2 __________________ Example 3 __________________ Jargon Example 1 __________________ Example 2 __________________ Example 3 __________________

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13

TRANSLATING TODDLERESE When children with language delay finally do begin to produce words, it is sometimes difficult to tell. A toddler with communication delay will often begin using a “word,” but no one seems to know what it means. The child is intent on using it so you think it must have a meaning. He says the same thing over and over, insisting that you listen to him. Parents experience frustration trying to understand their child, and spend a great deal of time and energy trying to guess the meaning of the

It is no laughing matter when you have a toddler on your hands who is asking for something that you can’t decipher.

word, often with little success. They are left wondering whether what they are hearing are real words at all. Some parents even claim that their child is speaking a different language: toddlerese. While families will be able to look back on this period and laugh about the funny situations created by their child’s difficulty producing intelligible speech, it is no laughing matter when you have a toddler on your hands who is asking for something that you can’t decipher because it doesn’t sound like any word in English that you’ve ever heard of. The trouble doesn’t stop there. Even when you’re sure that the child is using actual words, the fun just continues. 74

This is because children will frequently modify a sound in a word when it is too difficult to pronounce. The result is not only difficult to understand, it can be embarrassing for parents.

Parents report a particularly unfortunate variation on the word “truck,” which just happens to be the favorite word of many children.

For example, one child had difficulty producing the “k” sound and would often substitute a “d” sound in its place. He would also substitute a “b” sound if the “k” was in the middle of a word. This resulted in the production: “Mama, I want doobie” [target: cookie]. (This was all the more awkward because the boy’s father worked in drug enforcement.) Parents also report a particularly unfortunate variation on the word “truck,” which just happens to be the favorite first word of many children. This situation occurs when there is a mismatch between a child’s ability to make speech sounds and his other areas of development: he has things he wants to say (appropriate cognitive skills), he knows the words and tries to say them (emerging language skills), but hasn’t yet got the motor coordination to make the sounds so that the words are understandable to others (delayed speech skills). This is similar to how a person from another language might sound when they are learning to speak English (or any other non-native language). A Japanese person learning English will often produce r and l sounds in different ways than English speakers. In Japanese, there is no distinction between r and l, so it is difficult for speakers of Japanese to learn the right places to use r and the right places to use l. This behavior with r and l (along with a few other particular sound changes) is what we refer to as a 75

Japanese accent (and you better believe there is such a thing as an English accent in Japanese!). It is the same for a toddler learning his first language. He is not yet able to produce all the sounds of the language, so he modifies the sounds he hears to fit the sounds he can make, especially if there are very few (like two or three). Even for typically developing toddlers, there is a lot of similarity between the late babble and jargon that they produce and the

Children modify the words they know to fit the sounds they can produce.

early production of words. Since these two stages tend to overlap, children often produce a mixture of jargon and words. And, because children can’t make all the different sounds in a language, they modify the words to suit the sounds they can make. These modifications not only make the words difficult to identify, but cause them to sound a lot more like babble. When the toddler accent is severe, every word sounds the same. In truth, there are probably many words in the jargon that toddlers produce. But, in order to find the words, we need to know how they’re disguised. Luckily, there are a few predictable ways that children with immature speech tend to modify words, and by observing these patterns we can often tell what they are actually trying to say—we can find the words that are hidden in the babble and jargon. We need to know the rules of toddler speech (babble and jargon), so that we can discover what words are hidden by the accent. The following are some of the ways that toddlers modify words to fit the sounds they produce. 76



Substitution of Familiar Sound: The first modification that any toddler is likely to make is to use sounds that they have as opposed to sounds they don’t have. The kinds of sounds that children are using as they babble determine which words are easiest to say. That is, if the child is using the “d” sound during babble, then it is more likely that words beginning with the letter “d” (like “dog”) will be first. It is also likely that words beginning with other sounds (like “car”) will be produced with a “d” sound (“dar”). Some sounds are more difficult than other sounds, and we don’t expect children to produce them until they are school-aged. These are sounds like “f”, “th” (voiced and unvoiced), and “zh” (as in “pleasure”). The “r” and “l” also tend to be difficult for many children. Consequently, we wouldn’t expect toddlers to produce words beginning with these sounds (at least not without major modification—substitution of an easier sound for a harder one).



Simplification #1: As discussed in the previous chapters, babble has a definite sequence. One thing that is very common in babble is the use of one kind of syllable: the CV. Since the toddler is used to these kinds of syllables, he might modify words to fit this shape. This has several implications. One implication of the preference for this kind of syllable is that syllables with more than one consonant at the beginning (CCVC) will be simplified to (CVC). Thus, blue becomes bu, and truck becomes tuck.

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

Simplification #2: Another simplification is that syllables with a consonant at the end may lose it. Thus, book becomes booh,

push becomes puuh, and mine becomes maaee. Adults think of this as leaving off the ends of words, but to someone who speaks toddlerese, it is just saying the word with tools that he has: CV syllables. 

Syllable Repetition: Another feature of babble is the use of the same syllable over and over again. Early babble contains a lot of repeated syllables. If someone who speaks toddlerese tries to say a word with two syllables, it is likely that it will come out with one syllable repeated twice. In this way, carrot becomes kehkeh, bottle becomes baba, and cracker becomes

kaakaa. 

Voicing: Toddlerese likes to have syllables that start with consonant sounds that use the vocal cords, such as “b”, “d” and “g”, rather than sounds for which the vocal cords are not used, such as “p”, “t” and “k”. (Put your hand on your throat and make the “z” sound. Now make the “s” sound. Feel the difference? That is the difference between a speech sound that includes the vocal cords and one that doesn’t). This preference that toddlers have for using initial sounds that include voicing makes sense if you consider that it is easier just to keep the vocal cords vibrating through the whole syllable, rather than trying to turn them off for the consonant sound and on for the vowel. This will result in “push” sounding more like “buuu” and “cat” sounding like “gaaa”. 78

Interesting things happen when you put some of these modifications together. Take the word apple, for example. In toddlerese, this might becomes pehpeh. The first modification changes the first syllable from VC (ap…) to the kind that toddlers like: CV (peh), and the second modification was to repeat the syllable (thus, pehpeh). The following are some words that have been disguised using the rules of todderese. You will see how several processes can be working at the same time, making it very hard to understand the words:

Example 1: Adult word

Simplification#1

Simplification #2

Repeat

Final Product

Brother

CCVC CVC

CVC  CV

CV CVCV

baabaa

Example 2: Adult word

Simplification #1

Familiarization

Repeat

Final Product

cracker

CCVC CVC

kd

CV CVCVC

dader

Example 3: Adult word

Voicing

Simplification #2

Repeat (partial)

Final Product

candy

kg

CVC  CV

CV CVCVC

gagi

Adult word

Familiarization #1

Familiarization #2

Repeat (partial)

Final Product

ice cream

VC  CV

sn

CV CVCVC

naenee

Example 4:

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Worksheet #13: Possible Words. Translate some adult words into toddlerese by performing some of the modifications described in this chapter.

Adult word

Modification #1

Modification #2

Modification #3

Toddlerese

bubbles little pudding

Translate some toddlerese words into adult language by un-performing some of the modifications described in this chapter.

Toddlerese

Modification #1

Modification #2

Modification #3

Adult word

popo dice niiya

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A Parent’s Question: “Is ‘whereditgo?’ a word or a phrase?” When people say things at a normal rate of speed (that is to say— fast), it sometimes happens that the hearer doesn’t get exactly what the speaker meant to say. However, in some cases, the hearer doesn’t even realize that she’s not understanding what the speaker was saying. The brain will do a lot of work to get some meaning from what it hears; it will even create something that wasn’t in the original message. This kind of thing commonly happens when listening to the lyrics of songs. A famous example comes from the Jimi Hendrix song, Purple Haze. The words Jimi said were, “ ’scuse me while I kiss the sky.” But what many people heard was, “ ‘scuse me while I kiss this guy.” These two different meanings can be confused because the way they are said turns out to be exactly the same. Take the following sentence for example: “listen to the night rain.” Now compare it to “listen to the night train.” Or, “I’ve known sadder days in this town.” and “I’ve known Saturdays in this town.” When either of these sentences is said naturally, it would be easy to hear one or the other. Mis-hearing a few words like this isn’t likely to get you into much trouble, but it can create confusion sometimes. Something similar happens a child who is just learning about the words of his language. He is hearing everything for the first time, and sometimes he thinks he’s got a word, when actually he’s got a couple of words that are stuck together. For example, some common examples that your toddler probably hears around the house are: “all gone,” “thank you,” and “want up.” Your toddler might even be repeating some of these (or similar) phrases, and you might be tempted to think that he is beginning to use combinations of words. If you have been waiting a long time for the appearance of phrases, this may seem like the real deal—time to pop the champagne. Unfortunately, there are good reasons to think that your toddler hasn’t reached to two-word stage just yet. The toddler is doing essentially what adults did in mis-hearing the song lyrics. He has lumped two words that he always hears together as one word. As with adults, mishearing a few words is not going to harm your toddler, but it might push back the day on which we break out the champagne and celebrate the emergence of twoword combinations. Here’s how it works: when your toddler is sitting in his high chair, and he starts squirming around, you stand up, hold your hands out, and say, “want up?” The

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toddler hears this many times, always the same two words together, and not yet knowing the words individually, assumes that “want” and “up” are just one connected chunk—“want-up.” Another example that frequently occurs is when parents tell their child to wave bye-bye to someone who is leaving. They point to the person who is leaving and say, “say bye.” Eventually, the child comes to the conclusion that “say-bye” is a word, and it is what you say when someone is leaving. The point is: if you are a toddler and you are hearing everything for the first time, you don’t know what’s a word and what’s a phrase. The only information you have to go on is what seems to be stuck together. Because “want-up” and “say-bye” always seem to appear together, the child comes to the conclusion that they are attached as one word. How can you tell when your toddler really is using two-word combinations? The best indicator is when he begins to use a word, for example “my,” in combination with a bunch of different words, such as “my car,” “my juice,” “my mommy,” and so on. This means that whether or not your toddler is producing true combinations can be judged more accurately by looking at groups of utterances, rather than a single use. Another way to tell is by looking at the kinds of words that he is using. It is likely that he will begin combining certain kinds of words. The most popular combinations seem to consist of a set of “social words” (such as “my,” “that,” “no,” “more,” etc.) used with nouns, or with prepositions used with nouns or verbs. It is important that you model a variety of different categories of words for your toddler, including verbs, prepositions, and adjectives. Toddlers always get to hear a lot of nouns, so it usually isn’t necessary to focus on them specifically. If you want to get your toddler using some true combinations, focus on one social word, “more” for example, and use it with a couple of other words. Model its use in different contexts: “more juice,” “more tickle,” “more cars,” and so on. This will give the child the evidence he needs to move from the one-word stage to the two-word stage. It will clearly show him what is a word, and what is a phrase. In this way, he will have the tools to allow him to produce words in true combinations, rather than chunks of language that happen to contain several words.

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14

GETTING READY

FOR

READING

When a child has a language delay, it seems that he will use a book for anything but reading. He may make roads, tunnels and bridges that cars can drive on, over and through. Big books make a great garage to park the cars in. He may use board books to build houses that he can knock down. He may

Many children like to use books as building material.

even use the encyclopedia to construct steps so that he can reach restricted areas in the house. The use of books as building materials may be cute for a while, but eventually we would like to sit with our toddlers and get into the stories that are contained in the books, and parents and caregivers often wonder how they will ever get their children to treat books as books rather than as bricks. Yet, for most toddlers with a communication delay, sitting and reading with an adult is even more difficult than not pushing over a big tower made of books. This is complicated by the fact that when you have tried to open a book and read a few pages with your toddler, he behaved as if you were raking hot coals over his body. Even if the response was not this dramatic, as the reader of books for a toddler, you did notice that not much was being understood by 83

the readee. The fact that he is not showing much interest in books may increase an already present anxiety. The child is already behind in communication and language, and falling behind in reading just puts him that much further behind in getting ready for school. And since literacy is so important in our society, the child with a reading delay seems so far from being able to start the process of becoming an independent learner. Besides, books are an important as a bonding experience for children and caregivers. Reading together is an experience that everyone wants to provide for children, and family or people in the community can sometimes be insensitive when they

Our culture places a lot of emphasis on reading. This can be awkward for a parent of a child who doesn’t like books.

notice that a child with a communication delay doesn’t really like books. Parents might feel a sting when someone gives a book or offers to bring books to the house that you know the child won’t be interested in. It is difficult to explain that you REALLY HAVE tried to sit down and read to the child, and that it has just never been a pleasant experience. Take heart, because there is hope that books will become interesting to your toddler, and the activity of reading with your child can be the basis for a lifelong relationship with books. The fact is that toddlers who are experiencing a communication delay are not yet ready to focus on the content of books. If you think about it for a moment, there are many things we (as adults) know about books that toddlers haven’t figured out yet. They don’t know that the words on the page represent speech. They don’t get that there is a story 84

contained in the book. They’re not thinking about narratives. They might be interested in the pictures, but that is about as far as it goes. For now, that is. Facing this reality will go a long way to making it possible to change the process of reading into something that you both can share. If reading with an adult seems like slow torture to a toddler, this means that the activity is not connecting with anything that the toddler can recognize as fun. It means that just reading the words that one finds on the page is probably not appropriate for the developmental level of the child that you are reading to. This can be frustrating, especially because there may not be appropriate books that are readily available. (Don’t take this as a suggestion to run out and spend a lot of money on books. Reading the New York Times can be interesting to a toddler, if you learn how to do it in a way that is fun and engaging.) These suggestions should improve the

Let go of reading the words on the page.

reading experience for you and your toddler: 

Don’t feel too attached to the words on the page. If

your toddler is not yet producing words, or is just beginning to produce single words, then you should use the same strategies that have been discussed in previous chapters of this workbook: use single words, emphasize and exaggerate each word, make them interesting to listen to and imitate. Your goal at this point is to develop an understanding in your toddler that books are fun, and contain interesting stuff. You should not be too focused on print at this point (there is plenty of time for that 85

later). What you want to convey is the sense of excitement at seeing interesting pictures and talking about them. 

Don’t feel that you have to finish a book. As we all know,

toddlers have little tolerance for sitting still (especially if they are experiencing a language delay). If they have tolerance for three pages, then that is where you start. The more interesting you make the process, the longer they’ll stick around. 

Don’t ask questions about the pictures that you see.

Instead, point and name the objects and actions that you see in the book. If the goal for your toddler is to point and name pictures, then the best way to help him is to model this behavior yourself. Questions tend to reduce the amount of language that children will produce, and may take the excitement out of reading books altogether (see Chapter 10:We

Have Ways of Making You Talk! for more information). 

Move as fast as you need to in order to keep your child interested.

Don’t spend a lot of time on one page. Stick to one or two

words per page (unless he is expressing special interest in a particular page, in which case you might use single words to talk about several aspects of the pictures on that page). Many people regard books as sacred. This is a feeling that has grown out of a long history of positive experiences with books. The steps outlined above may violate your rules about how words in books should be treated. If this is true, keep in mind what the goal is at the moment: to find some interesting thing to talk about, build familiarity with books and 86

reading, and to have a nice time in the process. Toddlers with a communication delay don’t yet value books as objects because they don’t yet know what they can offer. Over time, with some extra help and support, they too will develop such a relationship with books.

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Worksheet #14: Reading the Pictures. Take a book that you are familiar with and try to read the pictures. Don’t look at the words, just the pictures. Write down as many simple words as you think your toddler will be interested in. 1. Book: Goodnight Moon. Words: ________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ 2. Book: __________________________ Words: ________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ 3. Book: __________________________ Words: ________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ 4. Book: __________________________ Words: ________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________

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15

TOYS FOR TALKING? When it comes to modeling language for a toddler with communication delay, it is important to stay flexible. The previous chapters in this book detail many ways of adjusting to new situations and taking advantage of spontaneous events. I hope that now, when your toddler exhibits interest in particular activity such as lining up the video tapes to make a “road,” you are jumping in and using that game as an opportunity to model

Engagement is what kids love, and it is the best way to support language development.

some words. You are saying “MORE” every time you place another video to extend the road and you have found a couple of cars or trucks that can go “ON” the road. In fact, you have expanded the game to include building a “bridge” that will allow you to use words like “UNDER,” “OVER,” and “AROUND.” This is the kind of engagement that kids love, and it is the best way to support the development of communication and language. Children respond best when adults focus attention on them in ways that the children initiate and control. That’s why you have to stay on your toes looking for new “games” if you want to get a child to use words.

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Yet, many parents still feel pressure to get specialized equipment that will help with language development. Very often, parents say: “My child’s birthday is coming up. What toys should I buy him to help him talk?” It is true that advances in technology have produced many toys that talk, sing and dance. Are these toys useful? Let’s consider a few different examples and see if common sense tells us anything about whether they’d be helpful in promoting expressive language. First, let’s examine the “Chicken Dance Elmo” type of toy. This kind of toy

“Chicken Dance Elmo” is really just a one-trick pony.

typically has one switch that the child pushes to activate the toy. When the toy is activated, it sings a song and perhaps moves around. Such toys have a small repertoire—perhaps a few different songs— so they are not actually exposing the child to many new words. The language that it uses is not really appropriate to any particular communication situation, so there is no real function to the toy except to perform its act. What do children do when exposed to this kind of toy? Some cry. But most just sit and stare at it. I have never seen this kind of toy cause a child to use much language. In fact, it tends to elicit more language from adults, who say things like “Can you turn that *&$#@% thing off!” Another kind of toy that uses language is the superfancy, computer-like, keyboard thing with the alphabet or lots of buttons with animals and shapes. Let’s call these the “concept” toys. Again, think about the toddler’s experience of this kind of toy. It has lots of buttons with pictures or symbols 90

on them. If you press a button, it makes an animal sound, says a color name, or the name of a shape. What is being taught here? The activity is making associations between pictures and sounds or words. In other words, matching is the concept being taught. This is in addition to any learning about language. So, in essence, you have given the child two things to learn at the

A super-fancy new toy may be introducing too many concepts at once.

same time. That is, you are asking him or her to walk and chew gum simultaneously —i.e., the child must learn a new concept and the language to go with that concept. Introducing a superfancy new toy asks the child to do too much, and probably won’t help with language development. (This also means that if you really do want to teach about shapes and numbers for the first time, don’t expect a lot in the way of language to happen.) Now, let’s look at another type of toy that is more successful in causing expressive language. This kind of toy is “low tech,” meaning it doesn’t rely on buttons or switches to activate, and it usually doesn’t produce any sound by itself. (This also means that it doesn’t need any batteries.) Examples of these toys are Play Doh, blocks, cars, or ping-pong balls and a basket. Think about the experience of a child with these toys— the Play Doh, for example. Play Doh is great because it can be used in so many different ways. You can roll it, cut it, squeeze it, squish it, stamp it, stretch it, and poke it. Notice how the child playing with Play Doh is the one being active, not the toy. This is crucial. If the toy is doing more work than the child, then something is wrong. Now notice that there are so many 91

fun words that one can use when playing with Play Doh. All the words listed above are also associated with an action, which makes them more fun to imitate and easier to learn. What about flexibility? Pretend for a moment that

Low-tech toys tend to be more flexible and conducive to imaginative play.

you’ve noticed that your toddler is especially interested in snakes at the present moment (or bugs, fish, planes, cars, etc.). Play Doh allows you to take advantage of this interest by making some snakes. Roll the Play Doh into a long, thin roll, and then make a mouth and put a couple of eyes in it. Voila! You’ve got a snake. Bugs a big hit? Get a few plastic bugs and put them inside the Play Doh. Kids love to dig them out. In fact, you can put any kind of plastic toy in lumps of Play Doh and children will dig them open to find out what’s inside. You see how different this is from playing with a hightech toy? The high-tech toy only has a fixed number of uses, while the low-tech toy is adaptable to many different interests. This is generally true of most low-tech toys—they are much more responsive to the momentary interests of a toddler. You can pretend that a block is just about anything. Unfortunately, it is hard to pretend that Chicken Dance Elmo is anything but Chicken Dance Elmo. What kind of stuff do children need in order to develop language? It turns out that it’s not toys. Rather, it’s nouns, verbs, adjectives and prepositions—the stuff of language. Toys are only useful in as much as they help us use these words.

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A Parent’s Question: “What are the Parts of Speech?” The next worksheet is designed to help identify good word combinations for modeling. In order to do so, first put words from the language log in the columns according to the grammatical category (a.k.a., part of speech). Sometimes people have difficulty placing words in grammatical categories. The following should help you decide which category a word belongs in. Nouns. A noun is any word that you can put in the following frame: [the _________] (for example, [the book], [the apple], [the party]) Verbs. A verb is any word that you can put in the following frame: [to _________] (for example, [to run], [to jump], [to tickle]) Adjectives/Adverbs. An adjective is any word that can fit in the following frame: [the ________ car] (for example, [the purple car], [the heavy car], [the wet car], ) An adverb is any word that ends with “-ly” such as quickly, shortly, briefly. Prepositions. A preposition is any word that you can put in the following frame: [put the book _________ the desk] (for example, [put the book on the table], [put the book in the desk], [put the book under the desk])

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Worksheet #15: Parts of Speech (lists). Nouns

Verbs

Adj./Adv.

Prep.

Soc. Words

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16

THE GREAT LEAP FORWARD Take a moment and consider what we need to grow. The body needs protein to build muscle, carbohydrates for energy, H20 for hydration, calcium to build bones, electrolytes to process energy, (and chocolate, of course, for complete mental health). Now think about language as if it were like the food the body needs to grow. What are the ingredients for making

Just as the body needs a variety of nutrients, language needs a variety of words.

language? In the same way, the brain needs to hear different kinds of words in order to develop well-rounded language skills. Verbs (go, stop, jump, run) are the backbone of any language, they indicate what the action is. Nouns (cow, horse, boy, tree) say who’s who and what’s what. Adjectives (red, big, wet, tall) add information to nouns, and adverbs (quickly, gently, clearly,

boldly) add information to verbs. Prepositions (up, down, in, out) tell us where things are or where they’re going. It turns out that the analogy with the human body goes a little farther. What happens if a person only eats one kind of food? It doesn’t matter really what kind of food it is, if there is no variety in the diet, there will be serious problems. The body won’t get what it needs and will begin to suffer. This is

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also true for language development. If the brain doesn’t hear a variety of different words, it has a difficult time constructing combinations. Many children are fed on a steady diet of nouns. This is because adults are very good at naming all kinds of things. “There’s the cow. See the cow? The cows are in the barn. That’s a big cow!” Notice that this language consists primarily of nouns. Most of the other little words are what are commonly referred to as function words (the, a, that, is). Function words are usually pronounced quickly, and without much stress. This means that the nouns are the most emphasized words in these sentences. Nouns are useful words. They are great for naming things, learning about concepts, and beginning to categorize the world. But one thing that they are not good for is combining with each other to make simple phrases. Let’s try a simple experiment. Take the following nouns and try to make some sensible combinations from the pairs:

duck

barn

pig

cow

?

?

?

horse

?

?

?

farmer

?

?

?

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The sorts of combinations that one gets from combining nouns are not very informative. Let’s try cow pig. This combination could mean a lot of different things, including

The cow is by the pig, The cow is in front of the pig, The farmer is feeding the cow and pig, etc. The reason that a combination of nouns is not very meaningful is that we get a lot of the meaning of a sentence from verbs and prepositions. Consider the kinds of combinations that can be made from the following collection of nouns and prepositions:

on

in

out

cow

cow on

cow in

cow out

horse

horse on

horse in

horse out

farmer

farmer on

farmer in

farmer out

There are lots of informative combinations that we can make from these words. Horse out has just one plausible meaning, i.e., that the horse is out of the barn. On

horse also has just one reasonable meaning, i.e., someone (probably the farmer) is on the horse. The same is true for verbs:

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push

ride

feed

cow

cow push

ride cow

feed cow

horse

horse push

ride horse

feed horse

farmer ride

farmer feed

farmer farmer push

Verbs give us even more information about what is happening in a sentence. Ride horse implies a lot of extra information, including the farmer and the preposition on, because it is likely that the farmer is riding the horse, and it is equally likely that the farmer is riding on the horse and not under it. What happens when children don’t get a balance of different words in their linguistic diet? As we’ve seen, it would be very difficult for them to make their way from using single words to using word combinations. It will help children to make useful, informative combinations if they have a number of different word categories to draw from. And we want children to have useful and informative communication because this is the best way to insure that they will continue to produce more. Here’s the key to the communication game: use a variety of different kinds of words when modeling language to children. The trick is in adjusting the language of adults in the toddler’s environment so that he can gain access to 98

words through imitation. The motivation to use language flows from the loving bond that you share with your toddler. Watch your toddler carefully during play, and try to think about what they might want to have the tools to say. Pick an activity that is familiar to the child. Best, of all, let the child choose the activity. In this way, you know that your toddler has the concepts necessary for engaging in that activity. If you let your toddler choose the activity, then all he lacks are the words, which you will provide by modeling short, simple language (preferably single words), at the appropriate moment when the child needs them. Thus, try to identify what your toddler is interested in talking about, and give him the words they need to do so. Any activity can be used to practice language, as long as it is interesting, fun, and flexible enough to include the thoughts and feelings of your toddler.

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Worksheet # 16a: Combinations to Model. Verb-Preposition Combination Matrix UP

DOWN

IN

OUT

OFF

ON

UNDER

OVER

come go run walk push pull bounce jump drive roll slide climb dump fall

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BACK

Worksheet # 16b: Combinations to Model. Verb-Noun Combination Matrix BALL

CAR

BABY

BUBBLE

BALLOON

BLOCK

CUP

bounce roll squeeze cut wash bring draw dump shake see kick get pop tickle

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ROCK

Worksheet # 16c: Combinations to Model. Adjective-Noun Combination Matrix HAND

CAR

BALL

SHIRT

WATER

BLOCK

CUP

clean cold dirty fast green blue nice heavy hot red wet yellow slow funny

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ROCK

17

WHAT TO DO ABOUT TELEVISION Some children love to watch TV. So much so that they turn into little ghouls when the tube comes on, staring blankly into the screen, no longer responding to the world

Some children love “Elmo” as if he were a member of the family.

around them. Surely this can’t be a good thing. Yet, some children get so excited to watch particular programs. They appear to love “Elmo,” “Tubbies,” or “The Wiggles” as if they were members of their own family. In fact, some toddlers produce the most language of the entire day when it is time to turn on the TV. So it seems that something useful is happening, since the child is at least expressing a preference. Even though he isn’t yet able to say whether he’d like milk or juice, he is very clear on wanting “Bob the Builder” and not “Oprah.” For parents, a little time in front of the TV can be a very handy thing, a time to get a few chores done, take a shower, or just sit and stare out the window for a few precious moments of peace and quiet. Parent’s often worry about the amount of TV they let their children watch, and they ask if it is OK. I’m afraid you’re not going to like the answer: it depends. In particular,

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it depends on the programs that they are watching and the length of time spent in front of the tube. Most sources

TV can have good and bad effects on a child’s development.

indicate that watching television can have positive and negative effects on young children. The reasons why TV can have a positive effect on a young child are the same reasons why a person can have a positive effect on a young child. The effect is positive—either from TV or person—when the activity is stimulating, interactive, and fun. Fun people like to rough-house, play games, and have a good time. Boring people sit on the couch, drink their coffee, and talk, talk, talk. They never get down on the floor and mix it up. Children like it when adults can stop acting so adult-like. Television can be good for children if it is used in ways that activate their imagination and cause them to do things they wouldn’t have done anyway. For example, if your child starts naming things that are blue because of watching a certain blue dog, then, as Martha Stewart says, “it is a good thing.” If he dances and sings every time he hears the theme from Spongebob Squarepants, then that also expands his world. If a toddler sees Buzz Lightyear (or Spiderman, Yoda, Cookie Monster, etc) and incorporates that character into his play, then the time spent watching the tube is being put to good use. Television is not so good when is used so much that it excludes other activities. Think about it. You probably don’t want your child to be doing hours and hours of any single

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activity, even if it was obviously good for him. For example, we all believe that it is good to brush our teeth, but we wouldn’t want a toddler to brush 30 times a day, nor would we want him to brush continuously for 4 hours. Children

Children need to be doing different activities in order to learn and practice new skills.

need to be doing different activities in order to learn and practice new skills. Variety is the spice of life, as they say. Think also about what happens when a child watches TV— they get the passive experience of watching others do things. What’s missing? The children who watch TV don’t get the benefit of having done the things themselves. They don’t get the sensory, motor, social, cognitive or communicative experience of going through all the steps to make it happen on their own. The bottom line: videos that are left on all day displace the active, participatory process of playing and learning. One very important skill that children can practice when they have a variety of things to do (other than TV) is

transitioning from one activity to another. TV doesn’t really give an opportunity to practice this—the TV does everything for you. You just sit there and the TV brings you another program. No action is required. When playing, children have the opportunity—really the necessity—to learn how to make decisions about what they want to do next, and to know how to make that happen, either by communicating or doing it themselves. Either way, children have the chance to learn

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how to regulate how they feel about what’s happening and make decisions about it. Here’s the thing you have to remember about TV: children don’t learn language by watching it. They learn language from interactions with people. Even though the child’s imagination may be engaged by a TV program, and they may use a few new words, watching TV is not interactive enough for a child to learn the patterns and rules of language from it. Studies confirm this: children who watch more than four hours per day of TV, or who have the TV on more than eight hours, show a significant delay in their communication. TV must be used carefully, in order that your toddler can benefit from the positive aspects and not experience the negative ones.

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Worksheet # 17: How Much TV Does Your Toddler Watch? Monday

Program: __________________ Program: __________________ Program: __________________ Program: __________________

Length: ______________ Length: ______________ Length: ______________ Length: ______________

Tuesday

Program: __________________ Program: __________________ Program: __________________ Program: __________________

Length: ______________ Length: ______________ Length: ______________ Length: ______________

Wednesday Program: __________________ Program: __________________ Program: __________________ Program: __________________

Length: ______________ Length: ______________ Length: ______________ Length: ______________

Thursday

Program: __________________ Program: __________________ Program: __________________ Program: __________________

Length: ______________ Length: ______________ Length: ______________ Length: ______________

Friday

Program: __________________ Program: __________________ Program: __________________ Program: __________________

Length: ______________ Length: ______________ Length: ______________ Length: ______________

Saturday

Program: __________________ Program: __________________ Program: __________________ Program: __________________

Length: ______________ Length: ______________ Length: ______________ Length: ______________

Sunday

Program: __________________ Program: __________________ Program: __________________ Program: __________________

Length: ______________ Length: ______________ Length: ______________ Length: ______________ Total: _______________ 107

18

CAN I GET SOME HELP HERE? Have you ever had the experience of being the only adult in a group of teenagers? Do you remember what that felt like? The teens are so busy looking at each other, an adult would probably have to stand on her head and sing “Yankee Doodle Dandy” just to get noticed. The attention that teens pay to each other is VERY IMPORTANT for learning about what’s cool to wear, what’s out, and what is sooooo—OH MY GOD!—like—y’know. While less conscious of current fashions, younger children watch each other in much the same way when you get them together. If you put a toddler in the vicinity of a slightly older child, say 4 or 5 years old, he becomes completely engrossed, and watches

Imitation can be used as a force for good.

every move of the older child. The toddler is watching and learning about the activities (or capers) that he will be participating in (or perpetrating) just as soon as he is able. You might be inclined to prevent this kind of contact, given the possibility of continuing the cycle of rascalism, but it can also be used as a force for good. In fact, it can be a crucial step in the process of getting the communication train rolling again.

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Indeed, many families who have a child with a communication delay have a hidden resource in the form of

Older siblings can be a huge help in getting a child to talk.

older children who have typical communication skills. (If you don’t happen to have any, you might consider renting a couple.) Older sibs can be a huge help in getting a child to talk. Not only are toddlers mesmerized by older children, but the simple fact is that adults are not that much fun to watch. We have to try really hard to capture the attention of a toddler (see Chapter 9: Games Toddlers Play). That’s because adults usually sit in one place, doing things like reading the paper, talking about what someone said to someone else, or watching some other bunch of people on the television talk to each other about what someone said to someone else—boring! Children have a natural ability to be silly, and thus, they enjoy watching each other. And, in doing so, they learn an enormous amount of useful stuff. You can tap this resource! Get a couple of kids together with your toddler who isn’t talking, and set the machine in motion. Here’s what you do: first model the words that you want your helpers to model. Sometimes the older kids may need a little coaching about how they can best help, so let them know that you want them to say EXACTLY what you say. After demonstrating a couple of times how you want them to talk, let them go at it. For example, if your toddler is in the sandbox, hitting the sand with a shovel, you pick up a stick and begin pushing it into 109

the sand, saying, “poke…poke…poke.” Then you tell your helpers that you want them to do things like that, and say the word while they do it. Give some suggestions about other words they might use, like “dig,” “dump,” “in,” and “out.” If your toddler is in the two-word stage, then you might model a couple of simple combinations such as, “push in,” “pull out,” and “dump out.”

It builds a sense of responsibility and nurturing in older children when they can help a little one say more words.

Most older kids are happy to lend a hand in helping a little one say more words. It makes them feel responsible, and fosters a healthy sense of nurturing. It also gives them a different way to interact with their little sibling or friend who isn’t using words. This may be important if the older sib is frequently asked to accommodate the younger one, because of the communication delay and behaviors which often come with it. Also, older sibs see it as a challenge, and they can be quite persistent, which is exactly the quality that is needed in this situation. It may also spread around some of the responsibility for doing all the work to get their toddler talking, taking it off the tired, beleaguered, harassed parents who can barely remember their own name by the end of the day. There are resources that you can draw on and they are sitting on the couch next to you watching the tube or playing down the street. You don’t have to do it all—put those siblings and friends to work!

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Worksheet #18: Activities that Everyone Enjoys. Think for a moment about the activities that your toddler enjoys. Is there a simple addition or modification that will allow other family members to participate in this activity? Write down your ideas. 1. Activity: Hide and Seek. Modifications: ___________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ 2. Activity: __________________________ Modifications: ___________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ 3. Activity: __________________________ Modifications: ___________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ 4. Activity: __________________________ Modifications: ___________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________

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Appendix A THE LANGUAGE

OF

COMMUNICATION

When parents are concerned about the ability of their child to communicate, and they seek help, it might seem as if it is not just the child that has to learn a new language. The parents are typically bombarded with many new and unfamiliar words. Providers often use this foreign vocabulary as if everybody knows it already, and it is difficult to stop the process in order to define a term or clarify a concept. The goal of this chapter is to give some definitions that may be useful in reading this book and working with a child who has a communication delay. 

Communication: This is a very broad term that refers

to any exchange of information. Humans are not the only communicators—animals, insects and even plants communicate by a variety of means including sound, scent, coloration, and behavior. Before they begin to speak, children also use a variety of means for communication, including looking, reaching, pointing, fussing, crying, and tantrums. Parents often become very good at reading and anticipating their child’s needs by watching behavior. 

Language: Language is the tool that humans use for

most of our communication. Language seems to be particular 112

to humans. While animals are able to send very simple messages to each other using sounds, they don’t have anything that is a system like human language. As noted, humans are also able to send messages (communicate) without using language (e.g., facial expressions, body movement). Language is usually divided further into Receptive and Expressive Language. Receptive Language refers to our ability to understand what is spoken by others in our environment. This includes overhearing others use words, and understanding when someone says something directly to us. Expressive Language is the words and sentences that we use to communicate what we think, need, and want. 

Speech: Speech is the specific way that most humans

use to transmit language. Sign language would be an example of a different way to transmit language. Speech requires the ability to make certain kinds of sounds (with our vocal tract) and the ability to hear these sounds (with our ears). Speech is therefore referred to as the oral-aural channel (as opposed to the manual-visual channel used by sign language). 

Articulators/Articulation: The articulators are those

parts of the mouth that we use to create speech sounds. They include the lips, tongue, velum (which raises and lowers to close and open the nasal sinuses to the throat), the teeth, and other parts of the mouth where the tongue touches such 113

as the ridge just behind the teeth (alveolar ridge). Articulation is the process of making speech sounds using these parts of the anatomy. 

Utterance: This is anything that a person says at one

time. It may be as little as a single sound, and it may be as long as several phrases if they are all said together. 

Communication Delay: There is a lot of variation

among different people. Some are tall, some are not so tall, and some are, let’s face it, short. For any kind of measurement like height, there is an overall average. Pretend for the moment that the overall average height for all people is 5 feet 6 inches. How would we know if someone was so tall (or short) that they fall outside the normal range of variation. In order to measure this, we have to say what “normal variation” is. To do this, we take a new average, an average of the differences that we find among heights. Some people are taller than the overall average, and some are shorter. A 5’ 10” tall person is 4 inches above the average. Someone who is 5’ 3” is 3 inches below the average. If we measure the amount of difference from the overall average for each person, and then take an average of those differences, we get what is called a standard deviation. (For the two examples above, the average difference is 4 +3/2 = 3 ½ inches. So, for this tiny sample, the standard deviation equals 3½.) Normal variation is usually measured as falling between 1½ standard deviations above or 1½ standard 114

deviations below the overall average. (Again, for the tiny sample above, normal variation would fall between 3½ inches below to 3½ inches above the average of 5’ 6”, or between 5’ 2½” and 5’ 9½”.) Having an idea about how much the average amount of difference is for a lot of people (a standard deviation) is very useful when it comes to something like the development of communication and language. If a child is not developing as fast as his or her peers (as demonstrated by scores on a standardized test), it is important to be able to tell if this delay is outside of the normal variation, in which case we should be concerned, or if it is just a part of the normal variation that we see in all kinds of growth and development. If the child’s score is 1½ standard deviations below the overall average for children his age, then that is outside the normal range and is usually referred to as a “significant” delay. Another way to judge when a delay is significant is when it is greater than 25% of the child’s age. To determine this, we measure the language or communication ability of the child (by using a standardized test), and compare this to a list of skills we expect at each age. This results in an age equivalency score. If the age equivalency score is more than 25% below the child’s chronological age, then we believe that there is significant delay, and therefore reason for concern. 

Speech-Language Pathologist/Speech Therapist: A

Speech-Language Pathologist (SLP) is a professional who is 115

trained to help children and their families cope with language and speech delay. The SLP has typically received a Masters Degree in Communication Disorders or SpeechLanguage Pathology, and has completed a clinical fellowship for one year with a qualified SLP. The training includes topics such as how the vocal tract produces sounds, how the brain processes language, how the ear and brain receive speech sounds, and how to help people that are having trouble talking, reading, hearing or understanding. Some SLPs have special training in how to develop alternative communication systems for children and adults that are having an especially hard time using speech. Some SLPs are also trained to help with feeding and swallowing disorders (called dysphagia). 

Language Facilitation: This refers to the techniques

and strategies that are used to help children produce more expressive language, including those described in this workbook. 

Linguistics: The study of language. This may include

the study of specific languages such as Swedish and Swahili, or the study of language in general as a psychological process. 

Apraxia/dyspraxia: Apraxia refers to a special kind

of difficulty that some children (and adults) have in producing speech. The problem occurs in the connection between the language system and the motor system that 116

controls the muscles. The child usually is attempting to use words, but the brain’s instructions to the muscles get lost, and never make it to their destination. Apraxia has the character of TV reception with interference. The TV station is sending the signal. The TV and the antenna are also working just fine. The signal is not getting through due to interference from the weather—a big electrical storm is causing it to become scrambled. 

Otitis media: This refers to an infection in the middle

ear. It occurs frequently in some children due to the poor functioning of the Eustachian tube that connects the middle ear to the throat. Sometimes the Eustachian tube is blocked, so that the middle ear space cannot ventilate. When this occurs, the tissues become inflamed and can become infected from a small amount of bacteria. If the middle ear becomes infected, this typically results in the production of a large amount of fluid. With no place to go, the fluid is trapped in the middle ear space. The fluid level fluctuates from day to day, and can cause a big disruption of speech and language development. As children grow older, the anatomy of the head changes, and the Eustachian tube usually works better.

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Appendix B WORD PRODUCTION LIST Circle the words that your child is using expressively. Put a square around words he signs. 1. Animals: bear (Teddy Bear) bee bird bug bunny cat chicken cow dog duck fish frog giraffe horse monkey mouse pig puppy sheep spider wolf 2. Vehicles: bike boat bus car motorcycle plane rocket train truck (dump, garbage) 3. Food and Drink: apple banana beans bottle bread cake candy cereal cheese chips coffee coke cookie cracker donut drink hotdog french fries grapes green beans gum hamburger ice cream juice lollipop milk orange pizza pop popcorn popsicle potato chip pretzel pudding raisin soda soup toast water yogurt 4. Clothes: bib boots button coat diaper dress hat hood jacket mittens pajamas pants (T) shirt shoe shorts sneaker sock sweater bathing suit underpants 5. Body Parts: arm belly button bottom chin ear eye feet finger hair hand head knee leg lips mouth nose penis shoulder teeth thumb toe tongue tummy vagina 6. Toys: baby ball balloon bat blocks book bubbles dinosaur doll game puzzle story toy 7. TV Characters/Shows/Movies: Barney Big Bird Blues (Clues) Burt Buzz Cookie Monster Coral Dory Lightyear Dipsy Elmo Ernie Grover Hulk Lala Luke Skywalker Marlin Mickey Mouse Nemo Po Pooh Sesame Street Snoopy Spiderman Superman Star Wars Teletubbies Tinky-Winky Toy Story Woody 8. Household: bath bed blanket brush buckle chair couch clock comb crib cup dish door DVD fork fridge garage garbage glass glasses hammer key kitchen knife lamp light money movie picture pillow plate potty purse radio soap spoon stairs stove table telephone tissue toothbrush towel trash TV VCR watch window 9. Outside: cloud farm flower garden grass house hospital ladder lawn McDonalds mower moon outside park playground pool rain rock sandbox school shovel sky slide snow snowman star stick store sun swing tree water wind wood work yard zoo 10. People: aunt babysitter’s name boy brother clown daddy doctor fireman friend girl grandma grandpa man mommy nana own name papa papi people policeman sister uncle 11. Actions: bath bite blow break breakfast bring brush build bump buy call change climb close comb come cook cry cut dance draw drink drive drop dry dump eat fall feed find fix get give go help hide hit hold hug hurry hurt jump kick kiss knock know let’s go lick look love nap put read ride run say scribble see shake share shopping show sing sit sleep smile spill splash stop swim swing take talk tear tell think throw tickle touch turn on/off wait walk want wash watch wipe wish work write

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12. Qualities: all another awake bad better big black blue booboo brown careful clean cold cute dark dirty dry fast good green happy hard heavy high hot hungry hurt little mad more new nice noisy old one orange ouch poor pretty quiet red sad scared sick sleepy soft sticky stuck some thirsty tiny tired wet white windy yellow yucky 13. Pronouns: he her here him I it me mine my that them there these they this those us we you your 14. Questions Words: how what when where which who why 15. Prepositions: around at away back behind beside down for in/side off on out/side under up 16. Articles: a the 17. Social Words: all done (gone) more stop no mine please hi bye nightnight don’t shhh boo thank you uh-oh

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Appendix C INSTRUCTIONS

FOR

LANGUAGE LOG

As described in the Introduction, it is very important that your child’s speech be recorded on the Language Log. Take each sheet out of the book and put it on the fridge, and when it gets filled up, put it back in the book. If you are away from home and you hear a new sound or word, write it on a napkin until you can put it on the Log. You may be asking yourself: “Do I have to record every single sound he makes? That’s impossible.” In fact, you don’t have to write down every time he says a sound or word, just the new ones. When you write the word, also try to note what was happening when the word was produced in the space marked “context.” This will help to determine what meaning he is attaching to the word, and whether it is a pseudo-word or a true word. You can also include who was there, where it was, what time of day, or anything else that seems like it might be relevant to the production of that word or sound. You might write down what you said that caused the production of a word or sound. Notice the place marked “freq.” This refers to the frequency of the word or sound in your child’s speech. Record the number of times that you’ve heard the word or sound by circling a number here. If you hear the 120

word more often you can circle a higher number. Finally, there is a list of different ways to use language at the bottom of each entry. This is a place to record what your child was trying to do with the sound or word. This is important for keeping track of his ability to use language for variety of different functions. Try to write the word in a way that sounds as much like the way your toddler said it as is possible. Just remember that some letters have different sounds (especially vowels). One way to overcome this is to write a word that rhymes with the word or sound that your child made. For example, if he produced something like “oobaa” for “school bus,” you might say that it rhymes with “scuba”. This will give more information about the exact sounds that he is able to produce.

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Pref ace for Par ent s

Language Log Date:__________

Time: __________

Place: __________

Freq. 1 2 3 4 5 6 7 8 9 10

Word(s): ______________________________ Sounds like: _____________________________ Function: Request Date:__________

Statement

Protest

Time: __________

Exclamation

Question

Place: __________

Imperative

Other

Freq. 1 2 3 4 5 6 7 8 9 10

Word(s): ______________________________ Sounds like: _____________________________ Function: Request Date:__________

Statement

Protest

Time: __________

Exclamation

Question

Place: __________

Imperative

Other

Freq. 1 2 3 4 5 6 7 8 9 10

Word(s): ______________________________ Sounds like: _____________________________ Function: Request Date:__________

Statement

Protest

Time: __________

Exclamation

Question

Place: __________

Imperative

Other

Freq. 1 2 3 4 5 6 7 8 9 10

Word(s): ______________________________ Sounds like: _____________________________ Function: Request Date:__________

Statement

Protest

Time: __________

Exclamation

Question

Place: __________

Imperative

Other

Freq. 1 2 3 4 5 6 7 8 9 10

Word(s): ______________________________ Sounds like: _____________________________ Function: Request Date:__________

Statement

Protest

Time: __________

Exclamation

Question

Place: __________

Imperative

Other

Freq. 1 2 3 4 5 6 7 8 9 10

Word(s): ______________________________ Sounds like: _____________________________ Function: Request Date:__________

Statement

Protest

Time: __________

Exclamation

Question

Place: __________

Imperative

Other

Freq. 1 2 3 4 5 6 7 8 9 10

Word(s): ______________________________ Sounds like: _____________________________ Function: Request Date:__________

Statement

Protest

Time: __________

Exclamation

Question

Place: __________

Imperative

Other

Freq. 1 2 3 4 5 6 7 8 9 10

Word(s): ______________________________ Sounds like: _____________________________ Function: Request Date:__________

Statement

Protest

Time: __________

Exclamation

Question

Place: __________

Imperative

Other

Freq. 1 2 3 4 5 6 7 8 9 10

Word(s): ______________________________ Sounds like: _____________________________ Function: Request

Statement

Protest

Exclamation

Question

Imperative

Other

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