Preverbal and Joint Attention Skills

Preverbal skills are skills that are required before a child starts communicating intelligibly. These skills are eye contact, attention and concentration. Yes, in that order. Why? Well, in my opinion when a child is able to maintain eye contact or even look at the speaker when the speaker is talking or smiling, the child would like to pay attention to the activity that is being conducted and would then be able to concentrate entirely on a task when you (the speaker) have gotten the child’s attention. Imitation skills, gestures and learning of facial expression is only possible if the child maintains eye contact, attention and concentration with the speaker.

How can this be done? From my own experience, as a Speech Language Specialist, I would engage the child in a play activity. Toys such as bubbles, teddy bear, alphabet or number mat, that are colourful would attract their attention. We often forget that the things around us such as the tree, birds, butterflies, sun, cloud, anything around us are things that can be used as a tool to engaging a child to a conversation by saying ‘hey, look I see a bird, it’s black in colour!’ by pointing at it, in this way, you are showing the child what a bird is , the colour of it and you have gotten the child to listen and look. 

Once you have gotten the child’s attention toward an activity, the child will be able to concentrate as they have maintained eye contact. Then we can move on to Joint attention skills. Joint attention skills are skills that involves those preverbal skills(i.e. eye contact, attention, concentration) with an addition of language skills. One of my favourite activity for joint attention skills are 

1. Playing with bubbles - It may seems like a normal toy but it works as a tool for interaction.

e.g. After blowing the bubbles, you may get the child’s attention by popping the bubble ‘ pop, goes the bubble’ - you may either sing it out or say it out aloud with very different intonation. 

You may continue by saying ‘big bubble is going to pop’, and show the action of the bubble being popped so the child may be able to imitate the action as well. 

2. Playing with a ball - This activity is like playing throw and catch but at a closer proximity at the beginning of time especially if the child has no experience in playing with a ball. This activity would be better when it is done on the floor with the child seated facing you. 

e.g. You may instruct the child to catch the ball by using a loud voice to get their attention, slide the ball down to the child and observe what the child does, they may pick the ball up to see what it is at the first time round. You may describe the ball as ‘wow, the ball is big! It is round and it is blue in colour!’ This would allow the child to comprehend what is the object he/she is holding. After a few trials, the child would be able to throw the ball to you and catch it, this would indirectly be working on gross motor skills. 

So, as you see teaching a child to play and communicate isn’t a difficult task. All that is needed to be is to be creative with the activities or toys that your child have around the house. 

Childhood Apraxia of Speech (CAS)

What is Childhood Apraxia of Speech?

Childhood apraxia of speech (CAS) is a motor speech disorder whereby a child’s brain has difficulty coordinating the complex oral movements needed to create sounds into syllables, syllables into words, and words into phrases. Muscle weakness is not the culprit behind this disorder but rather the poor coordination between the brain signals and the muscles around the mouth area.

 

A common example will be when the child is trying to say the word but cannot seem to get it out or that the child said the word once but seems unable to repeat it again. Children with CAS are often described as being very difficult to understand.

 

There is currently no cure for CAS and the child cannot outgrow it. However, children with CAS can make great progress in terms of their speech and language skills with a lot of hard work and support.

 

Symptoms:

Not all children with CAS exhibits the same symptoms. Your child may show some or all of the symptoms below. You should always consult your doctor and see a Speech Therapist if your child is older than 3 years and:

-    does not always say words the same way every time

-    tends to put the stress on the wrong syllable or word

-    distorts or changes sounds

-    can say shorter words more clearly than longer words

Children with CAS may experience other difficulties such as:

-    difficulty with fine motor skills

-    delayed language

-    problems with reading, spelling, and writing

Treatment:

Treatment for CAS should be a prolonged and intensive one whereby the goal of treatment is to help your child say sounds, words, and sentences more clearly. Research and evidence have shown that the following exercises do benefit children with CAS:

-      making multiple repetitions of sound sequences, words and phrases

-      using “touch” cues — e.g. putting their finger on their lips when saying the “p” sound as a reminder to close the lips

-      using “visual” cues — e.g. looking into a mirror when making sounds to understand the mouth movement better

-      using “listening” cues — e.g. practicing sounds with a recorder and then listening to hear if the sounds were made correctly

-      co-production i.e. having the child say the word at the same time as you

 

Although CAS is a difficult condition to manage, with active and intensive commitment and involvement by the family and the adults around the child, the child can reap the maximum benefits from the therapy sessions and make significant improvements to their speech and language skills.

Phonological Processes and Phonological Disorders

People tend to mix up the terms phonological processes and phonological disorders. But what is the difference between these two terms? 

Firstly, we have to understand what phonology means. Phonology is the study of sound (phoneme). Phonological processes are patterns of sound errors that typically developing children use to simplify speech as they are learning to talk. This may happen because they may not have the ability to coordinate their tongue with their teeth, jaw, palate and lips in order to produce clear speech.

For example, they may reduce a consonant cluster e.g. butterfly for bu….fly, missing out the sounds of ‘tter’ or even delete the weak syllable in a word e.g. nana for banana.

The presence of phonological processes in children are considered fairly common and a normal process of a child’s development. However, if such phonological processes persist beyond a certain age, it will be classified as a phonological disorder. For example, if a 4 year old child is using phonological process of reduplication e.g. saying ‘wawa’ for ‘water’, this would be considered as a delay because children normally should stop using that process by the age of 3 years old.

Below is a chart that was given by ASHA (American Speech and Hearing Association). It gives examples of the various phonological processes and the age by which these processes should be eliminated by.

Process	Example	Likely Age of Elimination
Velar Assimilation	kack for tack guck for duck	3
Nasal Assimilation	money for funny nunny for bunny	3
Fronting	tar for car date for gate	4
Stopping	pun for fun tee for see doo for zoo berry for very chop for shop top for chop dump for jump dat for that	/f, s/ — 3 /z, v/ — 4 sh, ch, j, th — 5
Gliding	wabbit for rabbit weg for leg	6–7
Deaffrication	ship for chip zhob for job	4
Cluster Reduction	top for stop keen for clean	with /s/ — 5 without /s/ — 4
Weak Syllable Deletion	nana for banana tato for potato	4
Final Consonant Deletion	bu for bus no for nose tree for treat	3

Reference:

https://www.asha.org/Practice-Portal/Clinical-Topics/Speech-Sound-Disorders-Articulation-and-Phonology/Selected-Phonological-Processes/

Stimming: What it is and who it affects

Stimming is a short self-stimulatory behaviour, often used to calm yourself down or distract yourself through distractive actions. Although it is often observed in children with autism, you and I probably do it all the time as well! For example, tapping your nails on the table while waiting, twirling your hair, humming to yourself or even bouncing your knees while eating are categorised as stimming behaviour as well.

Stimming is a natural behaviour that one engaged in in order to express your boredom, anxiety or any form of discomfort. Therefore, though stimming is often observed in children with autism, it is, in fact, not a symptom of autism. It is simply a normal behaviour that is magnified and exaggerated in individuals with autism.

In autism, stimming becomes disruptive when it becomes excessive and interferes with daily living. For example, a child who engages in stimming behaviour where he runs back and forth in a straight line continuously will have his daily life affected when he refuses to sit still for schoolwork or even a meal. A child with autism may even exhibit self-injurious stimming behaviour such as smacking their heads and scratching themselves. 

In therapy sessions, the therapist often works on reducing the frequency of such stimming behaviour, especially if they are self-injurious and disruptive. However, if the stimming behaviour is harmless, therapists often allow the child to engage in them as it is a way of how the child expresses their feelings and/or calms themselves down.

If the stimming behaviour does not affect your child’s daily living and is not self-injurious, it will be better to work around it than to eliminate it completely. One way to work around it is to teach your child more coping methods in order to help them express and manage their emotions.

Do late talkers ever “grow out of it”?

Who are late talkers?

 

Late talkers are toddlers or children that are late to start using words to communicate even though they may have typical development. Despite being able to comprehend what is being spoken to them, be it through play or spoken language, the child’s vocabulary to express themselves is limited when compared to their biological age.

 

At the age of 3 years old, I was unable to express myself meaningfully. However, with intensive language stimulation given at home by my parents, here I am 23 years later, working and helping children who have speech and language delay. 

 

So, do late talkers ever “grow out of it”? Personally, I would say “Yes, they do”. This is only possible if they are given the necessary help or assistance.

 

How do we help late talkers?

 

1.     Early Intervention:

The best possible method is to identify the problem early and provide the appropriate intervention. By approaching a speech therapist early, the child is given the best possible chance of overcoming the problem. 

 

2.      Home Factors:

Parents are the primary language stimulator for children at home. They have a major duty in providing intensive speech and language stimulation at home. This can be done by describing the objects, things or even people surrounding the child. This is the simplest way to work on the child’s comprehension of their surroundings and also to increase the child’s vocabulary. Another method is to give multiple choices to aid them in phrasing their answers to questions. By doing so, they would feel more confident in answering questions and be more likely to speak up in the future when similar questions are posed to them.

Understanding Autism

 

Autism is also known as Autism Spectrum Disorder (ASD). People with autism have challenges with communication and social skills. They tend to have difficulty picking up social cues. Some children with autism may speak very fluently and there are some who may not speak at all. Generally, all children with autism will have challenges in making friends and communicating socially.

 

These children may have a specific interest and display repetitive behaviours. They could be attached to a certain type of toy, activity or even object.

 

Signs of Autism:

 

One can observe signs of autism in young children but it may not be very prominent or accurate. It may vary as the child gets older but the main challenge that a person with autism would have are in:

 

i)          Communication

ii)         Social Skills

iii)       Behaviour

 

 

i)         Communication:

 

When we talk about communication, it does not just mean expressing oneself but it also includes understanding what is being spoken, conversing with others, reading and writing. 

 

Children with autism may have difficulty in:

 

•    Their understanding and using of words

•    Following directions that consists of more than one step (complex commands)

•    Being able to read and write fluently — although some children with autism are able to read more advanced words at an earlier age, they may not be able to understand what is being read. This condition is known as hyperlexia.

•    Holding a meaningful conversation

 

 

 

 

ii)      Social Skills:

 

-     They may have challenges relating to others. This may appear to be like they are not interested in socialising but in reality, they simply do not know how to socialise.

-     Children with autism have difficulty in understanding emotions (e.g.: angry, sad, anxious, happy, irritated)

-     They may find it challenging to take turns during play or during a conversation.

 

iii)    Behaviour:

 

-     A person with autism tend to be hyper interested in only a few objects or topics.

-     They are very picky eaters. The texture, smell, colour and taste of certain food will unnaturally turn them off. They might even be particular about not letting the different food on their plates touch each other.

-     Children with autism may get upset by certain sounds and smells (e.g.: thunder, lightning, perfume, and etc.)

-     Children with autism tend to over-react when they are upset, angry or elated. This might result in a big outburst of emotions.

 

 

These are some basic signs that are commonly observed in children with autism. Each child will exhibit different signs and to a different degree. However, it must be noted that some of the lack of social skills that you observe might simply be due to the child having not been exposed to that specific situation yet. 

 

Kindly visit a Child Psychologist to enquire more information regarding your child’s development and to gain a better understanding before jumping to any conclusion