Language Development in the Digital Age

The digital age is changing our children's lives and childhood dramatically. New technologies transform the way people interact with each other, the way stories are shared and distributed, and the way reality is presented and perceived. Parents experience that toddlers can handle tablets and apps with a level of sophistication the children's grandparents can only envy. In Great Britain, a recent survey of preschoolers shows that a rising number of toddlers are now put to bed with a tablet instead of a bedtime story. In the USA, a telephone survey of 1,009 parents of children aged 2–24 months (Zimmerman et al., 2007a) documents that by 3 months of age, about 40% of children regularly watched television, DVDs or videos, while by 24 months the proportion rose to 90%. Moreover, with the advance and exponential use of social media, children see their parents constantly interacting with mobile devices, instead of with people around them. Still, research in the US indicates that assistive social robots seem to have a favorable effect on children's language development (Westlund et al.).

Existing theories of language acquisition emphasize the role of language input and the child's interaction with the environment as crucial to language development. From this perspective, we need to ask: What are the consequences of this new digital reality for children's acquisition of the most fundamental of all human skills: language and communication? Are new theories needed that can help us understand how children acquire language? Do the new digital environment and the new ways of interaction change the way languages are learned, or the quality of language acquisition? Is the use of new media beneficial or harmful to children's language and cognitive development? Can new technologies be tailored to support child growth and, most importantly, can they be designed to enhance language learning in vulnerable children?

These questions and issues can only be addressed by means of an interdisciplinary approach that aims at developing new methods of data collection and analysis in a longitudinal perspective. This type of research is however not yet documented.

Past and Current Research

The question of how the ecology of the child affects the acquisition of competencies and skills has been approached from different perspectives in different disciplines. In linguistics, the central question addressed concerns the specific role of exposure to language. Two influential types of theory have been proposed. One view is that the capacity to learn language is hard-wired in the human brain (Chomsky, 1965Pinker, 1994); linguistic input is merely a trigger for language to develop. From an alternative view, language acquisition depends on the linguistic environment of the child, and specifically on language input provided through child-adult communication and interaction (Tomasello, 2003). The latter view further specifies that factors in interaction are crucial for language learning to take place. Such views are aligned with overarching theories of human development in cognitive science and psychology. These theories (known as embodied and situated cognition theories) hold that knowledge is acquired by humans through rich physical and social interaction with their environment (Barsalou, 2008). This interaction leaves multiple traces provided by a number of modalities (auditory, visual, haptic etc.) and helps consolidate knowledge in the brain by strengthening the neural networks that support learning and the use of knowledge. Exactly how input received from multiple, and multi-sensory in nature sources, interacts in both knowledge acquisition and use is, however, still poorly understood.

A current theme in the fields of information technology, artificial intelligence and robotics is to create robots that develop, as children do, and to establish how embodiment and interaction support language learning in these machines. These artificial models will eventually inform us about child development and vice versa (Cangelosi and Schlesinger, 2015forthcoming). In the field of human-machine interaction, research is investigating whether using a physical robot, rather than a virtual agent or a computer-based video, has a positive effect on language development. Kennedy et al. (2015), for example, investigate how toy-like robots, such as, the Aldebaran Nao, are used in the classroom instead of, or together with, digital tools such as tablets, to show how a richer embodied technology method further improves language learning. Vogt envisage that, in the digital age, social robots will increasingly be used for educational purposes, such as, second language tutoring. They propose a number of design features to develop a child-friendly social robot that can effectively support children in second language learning, and discuss the technical challenges for developing such tutors.

In education research, the main question is the extent to which the use of tablets can facilitate learning to read and write, and how this type of learning compares to traditional learning. In this context, Guerra and Mellado observe that implementing information and communication technologies for educational contexts that have robust and long-lasting effects on student learning outcomes is still a challenge. They further suggest that any such system must be theoretically motivated and designed to tackle specific cognitive skills (e.g., inference making) supporting a given cognitive task (e.g., reading comprehension), and must be able to identify and adapt to the user's profile. Furthermore, a field that combines the concerns of education and digital technology is newly emerging, where one of the questions is how games should be designed to facilitate learning. Zhang et al. provide a review of the educational application of Massive Multiple Online Role-Playing Games (MMORPGs) based on relevant macroscopic and microscopic studies, showing that gamers' overall language proficiency or some specific language skills can be enhanced by real-time online interaction with peers and game narratives or instructions embedded in the MMORPGs. Mechanisms underlying the educational assistant role of MMORPGs in second language learning are discussed from both behavioral and neural perspectives, highlighting the role of attentional bias. Child-media interaction has also been approached in psychology, raising the issue of how new technologies change behavior and interaction, including values and communication patterns.

A recurrent problem in most recent research, however, is that the topic has been approached from a single disciplinary perspective, and often with a single theory in mind. Accounts are piecemeal and explain only one phenomenon at a time. Despite considerable advances in the past 20 years, we miss a holistic model of language development that also integrates the impact of digital technology on its outcomes. Such a model must take into account the weighting of all factors involved. One major challenge is the nature and amount of data that need to be collected and analyzed to build such a model. These data are, in their nature, multi-modal, complex, and dense. It then becomes mandatory to develop new analytic methods and to integrate the complex data needed in order to answer the following three fundamental questions:

  • How should traditional theories and models of language acquisition be revised to account for the multimodal and multichannel nature of language learning in the digital age?
  • How should existing and future technologies be developed and transformed so as to be most beneficial for child language learning and cognition?
  • Can new technologies be tailored to support child growth, and most importantly, can they be designed in order to enhance specifically vulnerable children's language learning environment and opportunities?

First Language Development

Early Research on the Mass Media and Language Development

Interest in the impact of the mass media on language development started as early as the late 70-ies. One of the questions that was asked was “Does the language of the mass media contribute a “new” language compared to traditional forms of communication (e.g., books or oral language)?” It was suggested that the new mass media (film, radio, TV) offer “new” languages whose grammar was yet unknown (McLuhan, 1964Willie, 1979), and, as such, were potentially qualitatively different form oral human-to-human communication. One specific aspect where this difference was particularly salient is the multimodal nature of media, such as television and film. It has been observed that the vehicles of messages in these media involve the marriage of two languages with completely different characteristics (auditory/oral & visual/pictures) (Willie, 1979).

Some results from this early research indicate that there are certain behavioral consequences. For instance, TV-viewing appears to lead to less reading, yet subject to individual variation (Himmelweit et al., 1960). Furthermore, TV-viewing leads to less listening to the radio, and, in particular, with more adverse effect for “brighter” children (greater loss). In contrast, a study on the popular children's programme Sesame Street found a positive effect of TV viewing on language development, however, only in combination with adult intervention (Winn, 1977). Other research suggests that TV viewing overall has a negative effect on the development of children's attention and cognition and the American Academy of Pediatrics has recommended that children below 2 years of age not watch any television (Anderson and Pempek, 2005).

A valid question if we should expect any impact of mass media on language development is the extent to which the content provided through the media is comprehensible. How much of what children view on TV do they understand? Studies have shown that comprehension tends to increase with age with only 20% understanding among 4-year olds. Also, since this kind of input is mediated through both modalities, the visual and the auditory, advance in language development ought to depend both on the child's non-verbal (visual cognition) and verbal cognitive status at point of exposure. As evidenced by the papers in the current volume, tailoring the features of the technology used to the individual level of cognitive and language skills of the learner is a major prerequisite for successful outcomes. Moreover, as argued by Acerbi, one needs to understand how cultural transmission processes (e.g., transmission biases), of which language learning is arguably one instance, function in the new context of digital media.

When comparing the effects of TV and radio exposure, there is a crucial difference between language experience that requires no reciprocal participation (radio, TV) in contrast to active exchange with another person. Furthermore, TV-images do not go through a complex symbolic transformation; the mind does not decode or manipulate information, as with other types of oral or written language input.

Later research has focused on the extent to which first language acquisition from exposure exclusively to the mass media (radio and TV) deviates from typical language acquisition through interaction with care-givers and peers. Several findings suggest that overwhelming exposure to the kind of input from the radio or TV can have adverse effects, especially for very young children (toddlers). Thus, in a longitudinal study, Zimmerman and Christakis (2005) document that early TV exposure in children younger than 3 years of age was associated with deletirious effects on cognitive development, such as reading at age 7, while infant exposure (between 8 and 16 months) to videos/DVDs was associated with a 16.99-point decrement in CDI score (Zimmerman et al., 2007b). Tanimura et al. (2007) studied 18-month old infants (n = 1,900) and found that those who engaged in frequent TV-viewing (>4 h per day), even when accompanied by parental talking, had delayed language development/speech production (in terms of meaningful words). An observational study of 14 pairs of children (age range 7–24 months) and parents videotaped while watching television together shows that both the quality and quantity of parental utterances (Child-directed Speech) significantly declined while the TV was on, and especially when the infants were watching. This also led to an increase of frequency of 1-word sentences, quite often only short phrases, such as nouns (names). From a broader perspective, there is evidence that educational programmes targeting infants and toddlers have not achieved their purported learning goals (cf. Hirsh-Pasek et al., 2015 for a review).

Given that what children watch is important for subsequent vocabulary development (Anderson, 1998Linebarger and Walker, 2005), and how children watch (with parent or not) is also relevant (Jordan, 2004Anderson and Pempek, 2005), such findings are extremely pertinent for current research to follow up on. Moreover, the results from the study by Zimmerman et al. (2007b) reporting a negative correlation between DVD viewing and vocabulary development have been challenged by a recent re-analyses of the data set from that study (Ferguson and Donnellan, 2014). This replication found that effect sizes were negligible between analyses for positive, neutral, and negative effects. Interestingly, infants exposed to no media had lower levels of language development compared to infants with some exposure. Thus, it seems that more variables are necessary to take into account in the equation.

From TV and Radio to Tablets and Robots

Modern digital technology has attracted the attention of scholars due to its favorable affordances. It allows for multi-sensory interaction and provides rich input in the form of visual, auditory, and haptic stimuli (Belpaeme et al., 2012). A recent study by Allen et al. (2015) exploits the multi-modal nature of the input provided by iPads. The main question addressed in that study is whether iPads might promote symbolic understanding and word learning in children with autism in comparison with age-matched typically developing controls. The hypothesis was that multiple, differently colored exemplars of target referents, as afforded by the iPad technology, might promote phonological pattern-meaning/referent associations, e.g., compared to single exemplars. The study included four conditions, contrasting the use of an iPad vs. a Book, and exposing the children to single vs. multiple exemplars of the target items. Participating children were tested on whether they would associate the word to a 3-D referent (real life object) and whether they would generalize it to another member of the same category, but shown in a different color. The results indicated no differences between the two types of media (iPad or book) in symbolic understanding and level of generalization. They further demonstrate that exposure to multiple exemplars increases the rate of extension from picture to 3-D object.

Other studies have focused on how technology can assist exposure to language through reading. Chang and Breazeal (2011) propose to combine a basic primer book with interactivity in order to support parent-child reading interactions during shared book-reading. The design targets very young children (2–5 years) and offers a variety of features: it enables physical proximity, is visually accessible, responds to touch, is navigable to both child and parent, and encourages vocal expression. One specific aspect deserves mention, the Multisensory Contextual Selections. Thus, speech and touch combine to alter the content, and the reader can change story elements using a combination of touch and speech, encouraging creativity and variation. This design is based on interviews and suggestions thereof with educational experts, designers and researchers and exploits the interactive affordances of digital technology. From the point of view of child-parent interactions, Kucirkova et al. (2014) suggest that multimedia story sharing resembles interactions similar to those when experiencing a piece of art in terms of its holistic nature. Furthermore, there is some evidence that personalization of digital multimedia formats leads to more spontaneous speech production in children (Kucirkova et al., 2014).

Second Language Learning

Westlund et al. (2016) investigated the role of social robots in second language learning. The study had two main goals. The first one was to test whether a socially assistive robot could help children learn new words in a foreign language more effectively by personalizing its affective feedback. The second aim was to demonstrate the feasibility of creating and deploying a fully autonomous robotic system at a school for several months. The design included a socially assistive robotic learning companion to support English-speaking children's acquisition of a new language (Spanish). In a two-month microgenetic study, 34 preschool children played an interactive game with a fully autonomous robot and the robot's virtual sidekick, a Toucan shown on a tablet screen. Two aspects of the interaction were personalized to each child: (1) the content of the game (i.e., which words were presented), and (2) the robot's affective responses to the child's emotional state and performance. The results from the study indicate that the children learned new words and affective personalization led to greater positive responses from the children.

Vogt et al. propose a number of features for an L2 robot tutor including ways to develop the robot such that it can act as a peer to motivate the child during second language learning and build trust at the same time, while still being more knowledgeable than the child and scaffolding that knowledge in adult-like manner. The authors suggest that the first impression of the child are crucial for building trust and common ground, thus supporting child-robot interactions in the long term. Other important features relate to the ability to adapt to the language proficiency level of the individual child, respond contingently, both temporally and semantically, provide effective feedback and monitor children's learning progress, as well as establish joint attention, and use meaningful gestures. There are a number of technical challenges associated with such an optimal design, such as, automatic speech recognition (ASR) for children, reliable object recognition to facilitate semantic contingency and establishing joint attention, and developing human-like gestures with a robot that does not have the same morphology as humans. The paper presents an experiment which investigates how children respond to different forms of feedback from such a robot.

Child-Robot Interaction

While we still lack in-depth longitudinal studies of the effects of current digital technologies on language learning, child-robot interaction has been studied recently. Breazeal et al. (2016) looked at children ranging from 3 to 5 years who were introduced to two anthropomorphic robots that provided them with information about unfamiliar animals. This study found that the children treated the robots as interlocutors: they supplied information to the robots and retained what the robots told them. Children also treated the robots as informants from whom they could seek information. Consistent with children's early sensitivity to an interlocutor's non-verbal signals, children were especially attentive and receptive to whichever robot displayed the greater non-verbal contingency. Selective information seeking is consistent with recent findings showing that although young children learn from others, they are selective with respect to the informants that they question or endorse.

Other research in this domain indicates that children readily treat anthropomorphic robots as social companions (Shiomi et al., 2006). Kahn et al. (2013) document that children often respond verbally to robots (beyond what one might give to an automated system). This research also shows that robots are often attributed mental attributes (emotions etc.), and further that young participants readily engage in verbal exchange with (e.g., speak to) robots.

Movellan et al. (2009) assessed learning from a robot. In that study toddlers (18–24 months) interacted with a sociable robot which displayed images of 4 objects. At pre-test the toddlers' choices were a little better than chance. Over a 2-week period a modest learning outcome was observed, in that there was a significant improvement on taught words, but no improvement on control words. Tanaka and Matsuzoe (2012) studied word learning in the context of a social robot in the age range between 3 and 6 years. The robot responded either correctly of incorrectly to test questions about the novel words. Children reacted and spoke to the robot, and tried to teach the novel words to the robot. Furthermore, they learned the meaning of some novel action words in the company of the robot. However, the results of this study remain unclear as the children's utterances were not analyzed.

All of the studies investigating Child-Robot interaction indicate that the features of the robot are important, and that children differentiate among potential informants. Thus, accent (Kintzler et al., 2011), familiarity (Corriveau and Harris, 2009), turn-taking behavior: contingent responsiveness (Murray and Trevarthen, 1985Nadel et al., 1999) have all been implicated as central for the interaction and learning outcomes. These findings are consistent with factors in early language development. Thus, contingent responsiveness has been shown to be essential for language learning in infancy (Kuhl, 2007), even though earlier studies have suggested that children acquire native competence regardless of whether spoken to by parents or not. Still, this topic has remained largely out of the focus of current research, and the role of child-directed speech is still to be assessed. Other factors with clear impact on language development are joint attention and accompanying gestures (Tomasello, 2006Esteve-Gibert et al., 2016). Thus, implementing those features in social robots is likely to have a positive effect on language learning as well.

Interim Summary

The current review has revealed the following findings. Children readily interact with robots. While current research has focused on child-parent interaction while engaging with tablets/iPads, as well as learning in educational contexts, little is known about interaction and language learning from digital devices when the child is the sole agent. The level and quality of interaction largely depends on robot features. As pointed out by Belpaeme et al. (2012), for robots to interact effectively with humans, they need to be capable of coordinated and timely behavior in response to social context. Moreover, they need to display adaptive behavior. Children are likely to interact and engage in verbal exchange (e.g., speak to robots), provided robots feature contingency of responses, provide effective feedback and monitor children's learning progress, as well as establish joint attention, and use meaningful gestures. Yet, very few studies document specific advances in language learning. Thus, so far we see only modest language learning and primarily restricted to vocabulary, but only in experimental settings (Westlund et al.). Nothing is known about “outside of laboratory settings.” Overall, there is almost no research on language development per se.

In a recent detailed review and discussion of educational apps and their affordances, Hirsh-Pasek et al. (2015) emphasize the role of experience and the environment in the process of acquiring knowledge in early development: whether involving language or not. In particular, the path from sensori-motor experience to symbolic learning, as envisaged in approaches influenced by the Piagetan tradition, appears to be of crucial importance for unpacking the impact of digital technologies on the language learning infant. Similar perspectives need to be in focus when assessing the role of tablets (iPads) in early education (Kucirkova, 2014).

New Research Agenda

The study of language learning in rich environments, including digital tools, poses specific challenges to theoretical and empirical research. Traditional theories of language acquisition emphasize characteristics of the learner, such as innate structures and maturational constraints, as well as of the input (its quality, quantity, and variation), but typically they do not take into account the different channels through which linguistic and contextual data are provided to the learner. The standard channel is human face-to-face interaction, accompanied by books or printed or recorded material later during childhood. However, the digital age is making new channels available to children earlier on. Each such channel provides input to infants and children through multiple sensory modalities simultaneously—not just hearing, but vision, touch etc. Should empirical research show that vocabulary or grammar learning modes or outcomes vary, depending on the channels through which the linguistic input is provided to the child, theories of language acquisition would have to be expanded, so as to include explicit models of how these effects come about. In particular, learning theories (modeling the input and learner) should be accompanied by transmission theories (also modeling the input's sources and transmission channels).

Research on language development in the digital age requires us to understand better the standard modes and channels of language transmission, i.e., vertical social learning. In most modern experiments on (artificial) language learning, the learner is exposed to linguistic or related stimuli that are “produced” by machines, e.g., a computer, not by other human beings. Implicitly, much research on language learning involving exposure or training phases is already research on learning from digital tools. There is research on language learning and use in social contexts (Tomasello, 2003), however these two lines of work have not yet been integrated: what is needed are experiments in which learning from others and learning from digital tools are directly compared, i.e., where the learning channel is an explicit experimental factor. This approach may help understanding the cognitive and behavioral consequences of learning in digital ecologies, while keeping other factors under experimental control. For example, one could directly test whether digital tools are simply increasing the amount of information that is made available to children, or whether instead they are facilitating or impeding learning (e.g., of new vocabulary) when information quantity is held constant. The same mutatis mutandis would hold for information quality and variation. A further set of questions is whether the effects of digital tools on learning are short-lived or long-lasting, and whether they manifest themselves invariably or only early during development: would the child's brain eventually adapt to the multiplicity of channels and respective modalities through which language is experienced? Longitudinal designs are necessary to answer such questions.

The development of robot tutors to support early language development, as well as L2 language acquisition, offers innovative ways of exploiting the digital age technologies for language tutoring purposes, and in general, for child-robot interaction. Research has consistently demonstrated that the physical presence (embodiment) of a robot (e.g., Kennedy et al., 2015Cangelosi and Schlesinger, forthcoming), as well as some of its anthropomorphic features (robot appearance with human-like shape; e.g., Walters et al., 2008) and behavior (shared gaze, gestures; e.g., Zanatto et al., 2016), improve the outcome of the tutoring and companionship objectives. Moreover, multimodal approaches to human-robot interaction, such as, those combining tablet-based interfaces with the robot's speech communication capabilities and behavioral feedback strategies, improve the acceptability and efficacy of robot companions (Belpaeme et al., 2012Di Nuovo et al., 2016). As such, future research directions in robot tutors for language development will benefit from the investigation of hybrid robot and digital technologies, strategically exploiting the benefits from the robot's anthropomorphic features.

Robot companions also offer the opportunity to support language acquisition in children with atypical development. Pioneering studies have looked at social assistive robotics for children with autism spectrum disorder (ASD) (e.g., Dautenhahn, 1999Scassellati et al., 2012). For example, Scassellati et al. (2012) suggest that the improvement of social skills development via robot interaction is the consequence of the fact that robots provide novel sensory stimuli to the ASD child. Robot companions have also been used for the support of children with diabetes (Belpaeme et al., 2012) and with mobility and motor disabilities (Sarabia and Demiris, 2013). Thus, future work combining robot tutors with populations with atypical cognitive and motor development will contribute to the challenges of language skills acquisition in children with disabilities.

Future research should harvest evidence of language development in interaction with digital tools (including social robots). It should compare children who are often exposed to ICT to children who are not. It should investigate how new media/digital tools impact on the development of lower level language skills (e.g., vocabulary, grammar); how new media/digital tools impact on the development of “higher” skills (e.g., discourse comprehension) and explore the development of dimensionality (Language and Reading Research Consortium, 2015), and specifically, the effect of digital technology on oral and reading comprehension, and figurative language skills. A broader and overarching issue is the effect of new digital environments on brain plasticity and learning (Bavelier et al., 2010). Future research on this topic is also in need of novel methods for data analyses.


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Where’s Your Tongue Supposed to Rest in Your Mouth?

Have you ever heard of something called tongue posture? How about tongue positioning? Chances are you probably haven’t, but it’s a very real thing that can cause some very real problems if done incorrectly. In this week’s blog, your dentist in Erdenheim covers what tongue posture is, why it’s important to have proper tongue posture, and a few ways to help improve yours if needed. 

What is Tongue Posture?
Tongue posture, also known as tongue positioning, is a fancy way of describing how our tongues are positioned in our mouths while at rest. Believe it or not, there’s actually a right way and a wrong way to rest your tongue. While this may sound silly or unimportant, the truth is that proper tongue posture can protect you from other whole-body concerns.

Risks of Bad Tongue Posture
Our tongues are incredibly strong and are connected to other areas outside of our mouths. This means that what you do with your tongue, including how you rest it, can affect the entire body. Bad tongue posture can have a negative effect on your eyes, nose, head, neck, shoulders, and of course, teeth. Improper tongue posture can contribute or lead to: 

  • Sleep Apnea
  • TMJ
  • Problems with Vision
  • Bad Body Posture
  • Tooth Damage

Incorrect Tongue Posture
If you find yourself resting your tongue on the bottom of your mouth or up against your teeth, you’re one of the 50% of Americans that have incorrect tongue posture. Constant pressure on the teeth can cause teeth to shift, become crooked, create a bad bite, and even result in habitual teeth grinding (which can create a whole host of problems on its own). Those who rest their tongues on the bottom of the mouth may suffer from more neck pain, jaw pain, and bad body posture overall. Additionally, bad tongue posture can change someone’s appearance and make the face take on a longer, flatter shape or cause the chin or forehead to jut forward.  

Correct Tongue Posture
As your dentist in Erdenheim will tell you, proper tongue posture can protect your oral health as well as your overall health. Practicing proper tongue positioning can lead to improved sleep, better breathing, and decreased neck, jaw, or head pain. So what exactly is the right way to do this? 

Focus on resting your tongue gently on the roof of your mouth and about a half an inch away from your teeth. To fully practice proper tongue posture, your lips should be closed, and your teeth separated ever so slightly. 

Can You Fix Improper Tongue Posture? 
Good news — you can work to improve your tongue posture. Your dentist in Erdenheim has a few tricks, and the first step in fixing bad tongue posture is to find the right spot where your tongue should rest. You can do that one of two ways: 

  • Slide – Place the tip of your tongue on the back of your top teeth and then slide it backward. You should feel a spot where the roof of your mouth slopes upward. The area right before that slope is the prime tongue resting spot. 
  • Smile – The other way you can find your ideal tongue position is to smile really wide (we’re talking about really cheesy smile), raise your eyebrows, and try to swallow without unclenching your teeth. You should feel your tongue rise to the roof of your mouth into its ideal resting position. 

Like any habit, don’t expect your tongue posture to change overnight. Keep practicing these two tricks to remind yourself to consciously rest your tongue in that ideal position. Over time, muscle memory will replace bad, old posture habits with new, proper positioning.


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The Company expressly disclaims any and all liability (including liability for negligence) in respect of the use of the information provided. The Company recommends you seek independent professional advice prior to making any decision involving matters outlined in these publications.



What is dyspraxia?

A person with dyspraxia has problems with movement, coordination, judgment, processing, memory, and some other cognitive skills. Dyspraxia also affects the body’s immune and nervous systems.

Dyspraxia is also known as motor learning difficulties, perceptuo-motor dysfunction, and developmental coordination disorder (DCD). The terms “minimal brain damage” and “clumsy child syndrome” are no longer used.

According to the National Center for Learning Disabilities, individuals with dyspraxia have difficulties in planning and completing fine and gross motor tasks. This can range from simple motor movements, such as waving goodbye, to more complex ones like sequencing steps to brush one’s teeth.

What is dyspraxia?

Dyspraxia is a neurological disorder that impacts an individual’s ability to plan and process motor tasks.

Individuals with dyspraxia often have language problems, and sometimes a degree of difficulty with thought and perception. Dyspraxia, however, does not affect the person’s intelligence, although it can cause learning problems in children.

Developmental dyspraxia is an immaturity of the organization of movement. The brain does not process information in a way that allows for a full transmission of neural messages.

A person with dyspraxia finds it difficult to plan what to do, and how to do it.

The National Institute of Neurological Disorders and Stroke (NINDS) describes people with dyspraxia as being “out of sync” with their environment.

Experts say that about 10 percent of people have some degree of dyspraxia, while approximately 2 percent have it severely. Four out of every 5 children with evident dyspraxia are boys, although there is some debate as to whether dyspraxia might be under-diagnosed in girls.

According to the National Health Service, United Kingdom, many children with dyspraxia also have attention deficit hyperactivity disorder (ADHD).

Symptoms of dyspraxia

Symptoms tend to vary depending on the age of the individual. Later, we will look at each age group in more detail. Some of the general symptoms of dyspraxia include:

  • poor balance
  • poor posture
  • fatigue
  • clumsiness
  • differences in speech
  • perception problems
  • poor hand-eye coordination

Diagnosis of dyspraxia

A diagnosis of dyspraxia can be made by a clinical psychologist, an educational psychologist, a pediatrician, or an occupational therapist. Any parent who suspects their child may have dyspraxia should see their doctor.

When carrying out an assessment, details will be required regarding the child’s developmental history, intellectual ability, and gross and fine motor skills:

  • Gross motor skills – how well the child uses large muscles that coordinate body movement, including jumping, throwing, walking, running, and maintaining balance.
  • Fine motor skills – how well the child can use smaller muscles, including tying shoelaces, doing up buttons, cutting out shapes with a pair of scissors, and writing.

The evaluator will need to know when and how developmental milestones, such as walking, crawling, and speaking were reached. The child will be evaluated for balance, touch sensitivity, and variations on walking activities.

Dyspraxia in children

Dyspraxia symptoms may vary depending on age. With that in mind, we will look at each age individually. Not every individual will have all of the symptoms outlined below:

Very early childhood

The child may take longer than other children to:

  • Sit.
  • Crawl – the Dyspraxia Foundation says that many never go through the crawling stage.
  • Walk.
  • Speak – according to the Children’s Hospital at Westmead, Australia, the child may be slower in answering questions, find it hard to make sounds, or repeat sequences of sounds or words; they may also have difficulty in sustaining normal intonation patterns, have a very limited automatic vocabulary, speak more slowly than other children, and use fewer words with more pauses.
  • Stand.
  • Become potty trained (get out of diapers).
  • Build up vocabulary.

Early childhood

Tying shoelaces can be a difficult task for children suffering with dyspraxia.

Later on, the following difficulties may become apparent:

  • Problems performing subtle movements, such as tying shoelaces, doing up buttons and zips, using cutlery, and handwriting.
  • Many will have difficulties getting dressed.
  • Problems carrying out playground movements, such as jumping, playing hopscotch, catching a ball, kicking a ball, hopping, and skipping.
  • Problems with classroom movements, such as using scissors, coloring, drawing, playing jigsaw games.
  • Problems processing thoughts.
  • Difficulties with concentration. Children with dyspraxia commonly find it hard to focus on one thing for long.
  • The child finds it harder than other kids to join in playground games.
  • The child will fidget more than other children.
  • Some find it hard to go up and down stairs.
  • A higher tendency to bump into things, to fall over, and to drop things.
  • Difficulty in learning new skills – while other children may do this automatically, a child with dyspraxia takes longer. Encouragement and practice help enormously.
  • Writing stories can be much more challenging for a child with dyspraxia, as can copying from a blackboard.

The following are also common at pre-school age:

  • Finds it hard to keep friends.
  • Behavior when in the company of others may seem unusual.
  • Hesitates in most actions, seems slow.
  • Does not hold a pencil with a good grip.
  • Such concepts as ‘in’, ‘out’, ‘in front of’ are hard to handle automatically.

Later on, in childhood

  • Many of the challenges listed above do not improve or only improve slightly.
  • Tries to avoid sports.
  • Learns well on a one-on-one basis, but nowhere near as well in class with other children around.
  • Reacts to all stimuli equally (not filtering out irrelevant stimuli automatically)
  • Mathematics and writing are difficult.
  • Spends a long time getting writing done.
  • Does not follow instructions.
  • Does not remember instructions.
  • Is badly organized.

Dyspraxia in adults

In adults, symptoms include:

  • Poor posture and fatigue.
  • Trouble completing normal chores.
  • Less close control – writing and drawing are difficult.
  • Difficulty coordinating both sides of the body.
  • Unclear speech, often word order can be jumbled.
  • Clumsy movement and tendency to trip over.
  • Grooming and dressing more challenging – shaving, applying makeup, fastening clothes, tying shoelaces.
  • Poor hand-eye coordination.
  • Difficulty planning and organizing thoughts and tasks.
  • Less sensitive to non-verbal signals.
  • Easily frustrated.
  • Low self-esteem.
  • Difficulty sleeping.
  • Difficulty distinguishing sounds from background noise.
  • Notable lack of rhythm when dancing or exercising.

Social and sensory – individuals with dyspraxia may be extremely sensitive to taste, light, touch, and/or noise. There may also be a lack of awareness of potential dangers. Many experience moods swings and display erratic behavior.

Researchers at the University of Bolton in England say that there is often a tendency to take things literally “(the child) may listen but not understand.”

Causes of dyspraxia

Scientists do not know what causes dyspraxia. Experts believe the person’s nerve cells that control muscles (motor neurons) are not developing correctly. If motor neurons cannot form proper connections, for whatever reason, the brain will take much longer to process data.

Experts at the Disability and Dyslexia Service at the Queen Mary University of London, U.K., say that studies suggest dyspraxia may be caused by an immaturity of neuron development in the brain, rather than any specific brain damage.

A report from the University of Hull in England says that dyspraxia is “probably hereditary: several genes have been implicated. Often, there are many members within a family who are similarly affected.”

Treatments for dyspraxia

Although dyspraxia is not curable, with treatment, the individual can improve. However, the earlier a child is diagnosed, the better their prognosis will be. The following specialists most commonly treat people with dyspraxia:

Occupational therapy

An occupational therapist will evaluate how the child manages with everyday functions both at home and at school. They will then help the child develop skills specific to daily activities which they find difficult.

Speech and language therapy

The speech-language pathologist will conduct an assessment of the child’s speech, and then implement a treatment plan to help them to communicate more effectively.

Perceptual motor training

This involves improving the child’s language, visual, movement, and auditory skills. The individual is set a series of tasks that gradually become more advanced – the aim is to challenge the child so that they improve, but not so much that it becomes frustrating or stressful.

Equine therapy for dyspraxia

In a study published in the Journal of Alternative and Complementary Medicine, a team of Irish, British, and Swedish researchers evaluated the effects of equine therapy (therapeutic horse-riding) on a group of 40 children aged 6-15 years with dyspraxia.

The children participated in six horse-riding sessions lasting 30 minutes each, as well as two 30-minute audiovisual screening sessions.

They found that riding therapy stimulated and improved the participants’ cognition, mood, and gait parameters. The authors added that “the data also pointed to the potential value of an audiovisual approach to equine therapy.”

Active Play

Experts say that active play – any play that involves physical activity – which can be outdoors or inside the home, helps improve motor activity. Play is a way children learn about the environment and about themselves, and particularly for children aged 3-5; it is a crucial part of their learning.

Active play is where a very young child’s physical and emotional learning, their development of language, their special awareness, the development of what their senses are, all come together.

The more children are involved in active play, the better they will become at interacting with other children successfully.

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Tourette syndrome?

Tourette syndrome is a neurological disorder. It causes repeated, involuntary physical movements and vocal outbursts. The exact cause is unknown.

Tourette syndrome is a tic syndrome. Tics are involuntary muscle spasms. They consist of abrupt intermittent twitches of a group of muscles.

The most frequent forms of tics involve:

  • blinking
  • sniffing
  • grunting
  • throat clearing
  • grimacing
  • shoulder movements
  • head movements

According to the National Institute of Neurological Disorders and Stroke (NINDS), about 200,000 people in the United States exhibit severe symptoms of Tourette syndrome.

As many as 1 in 100 Americans experience milder symptoms. The syndrome affects males nearly four times more than females.

What are the symptoms of Tourette syndrome?

Symptoms can vary from one person to another. They usually appear between the ages of 3 and 9 years old, starting with small muscle tics of your head and in your neck. Eventually, other tics may appear in your trunk and limbs.

People diagnosed with Tourette syndrome often have both a motor tic and a vocal tic.

The symptoms tend to worsen during periods of:

  • excitement
  • stress
  • anxiety

They’re generally most severe during your early teen years.

Tics are classified by type, as in motor or vocal. Further classification includes simple or complex tics.

Simple tics usually involve only one muscle group and are brief. Complex tics are coordinated patterns of movements or vocalizations that involve several muscle groups.

Motor tics

Simple motor tics

Complex motor tics

eye blinking

smelling or touching objects

eye darting

making obscene gestures

sticking the tongue out

bending or twisting your body

nose twitching

stepping in certain patterns

mouth movements


head jerking


shoulder shrugging


Vocal tics

Simple vocal tics

Complex vocal tics


repeating your own words or phrases


repeating other people’s words or phrases


using vulgar or obscene words

throat clearing





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What causes Tourette syndrome?

Tourette is a highly complex syndrome. It involves abnormalities in various parts of your brain and the electrical circuits that connect them. An abnormality may exist in your basal ganglia, the part of your brain that contributes to controlling motor movements.

Chemicals in your brain that transmit nerve impulses may also be involved. These chemicals are known as neurotransmitters.

They include:

Currently, the cause of Tourette is unknown, and there’s no way to prevent it. Researchers believe that an inherited genetic defect may be the cause. They’re working to identify the specific genes directly related to Tourette.

However, family clusters have been identified. These clusters lead researchers to believe that genetics play a role in some people developing Tourette.

How is Tourette syndrome diagnosed?

Your healthcare provider will ask you about your symptoms. The diagnosis requires both one motor and one vocal tic for at least 1 year.

Some conditions may mimic Tourette, so your healthcare provider may order imaging studies, such as an MRI, CT, or EEG, but these imaging studies aren’t required for making a diagnosis.

People with Tourette often have other conditions, as well, including:

How is Tourette syndrome treated?

If your tics aren’t severe, you may not need treatment. If they’re severe or cause thoughts of self-harm, several treatments are available. Your healthcare provider may also recommend treatments if your tics worsen during adulthood.


Your healthcare provider may recommend behavioral therapy or psychotherapy. This involves one-on-one counseling with a licensed mental health professional.

Behavioral therapy includes:

  • awareness training
  • competing response training
  • cognitive behavioral intervention for tics

This type of therapy can help ease symptoms of:

Your therapist may also use the following methods during psychotherapy sessions:

You may find group therapy helpful. You’ll receive counseling with other people in the same age group who also have Tourette syndrome.


There are no medications that can cure Tourette syndrome.

However, your healthcare provider may prescribe one or more of the following drugs to help you manage your symptoms:

  • Haloperidol (Haldol), aripiprazole (Abilify), risperidone (Risperdal), or other neuroleptic drugs: These medications can help to block or dampen dopamine receptors in your brain and help manage your tics. Common side effects can include weight gain and mental fogginess.
  • Onabotulinum toxin A (Botox): Botox injections may help manage simple motor and vocal tics. This is an off-label use of onabotulinum toxin A.
  • Methylphenidate (Ritalin): Stimulate medications, such as Ritalin, can help to reduce the symptoms of ADHD without increasing your tics.
  • Clonidine: Clonidine, a blood pressure medication, and other similar drugs, can help reduce tics, manage rage attacks and support impulse control. This is an off-label use of clonidine.
  • Topiramate (Topamax): Topiramate can be prescribed to reduce tics. Risks associated with this medication include cognitive and language problems, somnolence, weight loss, and kidney stones.
  • Cannabis-based medications: There’s limited evidence cannabinoid delta-9-tetrahydrocannabinol (dronabinol) may stop tics in adults. There is also limited evidence for certain strains of medical marijuana. Cannabis-based medications should not be given to children and adolescents, and pregnant or nursing women.


Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that hasn’t been approved. However, a doctor can still use the drug for that purpose.

This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.

Neurological treatments

Deep brain stimulation is another form of treatment that’s available for people with severe tics. For people with Tourette syndrome, the effectiveness of this kind of treatment is still under investigation.

Your healthcare provider may implant a battery-operated device in your brain to stimulate parts that control movement. Alternatively, they may implant electrical wires in your brain to send electrical stimuli to those areas.

This method has been beneficial for people who have tics that have been deemed very difficult to treat. You should talk to your healthcare provider to learn about the potential risks and benefits for you and whether this treatment would work well for your healthcare needs.

Why is support important?

Living with Tourette syndrome may cause feelings of being alone and isolated. Not being able manage your outbursts and tics may also cause you to feel reluctant to participate in activities that other people may enjoy.

It’s important to know that there’s support available to help you manage your condition.

Taking advantage of available resources can help you to cope with Tourette syndrome. For example, talk to your healthcare provider about local support groups. You might also want to consider group therapy.

Support groups and group therapy may help you cope with depression and social isolation.

Meeting and establishing a bond with those who have the same condition can help to improve feelings of loneliness. You’ll be able to listen to their personal stories, including their triumphs and struggles, while also receiving advice that you can incorporate in your life.

If you attend a support group, but feel it isn’t a right match, don’t be discouraged. You may have to attend different groups until you find the right one.

If you have a loved one living with Tourette syndrome, you can join a family support group and learn more about the condition. The more you know about Tourette, the more you can help your loved one cope.

The Tourette Association of America (TAA) can help you find local support.

As a parent, it’s important to support and be an advocate for your child, which can include notifying their teachers of their condition.

Some children with Tourette syndrome may be bullied by their peers. Educators can play an important role in helping other students understand your child’s condition, which may stop bullying and teasing.

Tics and involuntary actions may also distract your child from schoolwork. Talk to your child’s school about allowing them extra time to complete tests and examinations.

What is the long-term outlook?

Like many people with Tourette syndrome, you may find that your tics improve in your late teens and early 20s. Your symptoms may even stop spontaneously and entirely in adulthood.

However, even if your Tourette symptoms decrease with age, you may continue to experience and need treatment for related conditions, such as depression, panic attacks, and anxiety.

It’s important to remember Tourette syndrome is a medical condition that doesn’t affect your intelligence or life expectancy.

With advances in treatment, your healthcare team, as well as access to support and resources, you can manage your symptoms, which can help you to live a fulfilling life.


What is a facial tic disorder?

Facial tics are uncontrollable spasms in the face, such as rapid eye blinking or nose scrunching. They may also be called mimic spasms. Although facial tics are usually involuntary, they may be suppressed temporarily.

A number of different disorders can cause facial tics. They occur most often in children, but they can affect adults as well. Tics are much more common in boys than in girls.

Facial tics usually don’t indicate a serious medical condition, and most children outgrow them within a few months.

What causes a facial tic disorder?

Facial tics are a symptom of several different disorders. The severity and frequency of the tics can help determine which disorder is causing them.

Transient tic disorder

Transient tic disorder is diagnosed when facial tics last for a short period of time. They may occur nearly every day for more than a month but less than a year. They generally resolve without any treatment. This disorder is most common in children and is believed to be a mild form of Tourette syndrome.

People with transient tic disorder tend to experience an overwhelming urge to make a certain movement or sound. Tics may include:

Transient tic disorder doesn’t usually require any treatment.

Chronic motor tic disorder

Chronic motor tic disorder is less common than transient tic disorder, but more common than Tourette syndrome. To be diagnosed with chronic motor tic disorder, you must experience tics for more than a year and for more than 3 months at a time.

Excessive blinking, grimacing, and twitching are common tics associated with chronic motor tic disorder. Unlike transient tic disorder, these tics may occur during sleep.

Children who are diagnosed with chronic motor tic disorder between the ages of 6 and 8 don’t typically require treatment. At that point, the symptoms may be manageable and can even subside on their own.

People who are diagnosed with the disorder later in life may need treatment. The specific treatment will depend on the severity of the tics.

Tourette syndrome

Tourette syndrome, also known as Tourette disorder, typically begins in childhood. On average, it appears at age 7. Children with this disorder may experience spasms in the face, head, and arms.

The tics can intensify and spread to other areas of the body as the disorder progresses. However, the tics usually become less severe in adulthood.

Tics associated with Tourette syndrome include:

  • flapping arms
  • sticking the tongue out
  • shrugging shoulders
  • inappropriate touching
  • vocalizing of curse words
  • obscene gestures

To be diagnosed with Tourette syndrome, you must experience vocal tics in addition to physical tics. Vocal tics include excessive hiccupping, throat clearing, and yelling. Some people may also frequently use expletives or repeat words and phrases.

Tourette syndrome can usually be managed with behavioral treatment. Some cases may also require medication.

What conditions may resemble a facial tic disorder?

Other conditions may result in facial spasms that mimic facial tics. They include:

  • hemifacial spasms, which are twitches that affect only one side of the face
  • blepharospasms, which affect the eyelids
  • facial dystonia, a disorder that leads to involuntary movement of facial muscles

If facial tics start in adulthood, your doctor may suspect hemifacial spasms.

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What factors can contribute to facial tic disorders?

Several factors contribute to facial tic disorders. These factors tend to increase the frequency and severity of tics.

Contributing factors include:

How is a facial tic disorder diagnosed?

Your doctor can usually diagnose a facial tic disorder by discussing the symptoms with you. They may also refer you to a mental health professional who can assess your psychological status.

It’s important to rule out physical causes of facial tics. Your doctor may ask about other symptoms to decide whether you need further testing.

They may order an electroencephalogram (EEG) to measure the electrical activity in your brain. This test can help determine whether a seizure disorder is causing your symptoms.

Your doctor might also want to perform an electromyography (EMG), a test that evaluates muscle or nerve problems. This is to check for conditions that cause muscle twitching.

How is a facial tic disorder treated?

Most facial tic disorders don’t require treatment. If your child develops facial tics, avoid drawing attention to them or scolding them for making involuntary movements or sounds. Help your child understand what tics are so they can explain them to their friends and classmates.

Treatment may be needed if the tics interfere with social interactions, schoolwork, or job performance. Treatment options often don’t completely eliminate tics but help reduce tics. Treatment options can include:

  • stress reduction programs
  • psychotherapy
  • behavioral therapy, comprehensive behavioral intervention for tics (CBIT)
  • dopamine blocker medications
  • antipsychotic medications like haloperidol (Haldol), risperidone (Risperdal), aripiprazole (Abilify)
  • anticonvulsant topiramate (Topamax)
  • alpha-agonists like clonidine and guanfacine
  • medications to treat underlying conditions, such as ADHD and OCD
  • botulinum toxin (Botox) injections to temporarily paralyze facial muscles

Recent studies have shown that deep brain stimulation may help treat Tourette syndrome. Deep brain stimulation is a surgical procedure that places electrodes in the brain. The electrodes send electrical impulses through the brain to restore the brain circuitry to more normal patterns.

This type of treatment can help relieve symptoms of Tourette syndrome. However, more research is needed to determine the best area of the brain to stimulate for improvement of Tourette syndrome symptoms.

Cannabis-based medications might also be effective in helping reduce tics. However, the evidence to support this is limited. Cannabis-based medications should not be prescribed to children and adolescents, or to pregnant or nursing women.

The takeaway

While facial tics usually aren’t the result of a serious condition, you may need treatment if they interfere with your everyday life. If you’re concerned you may have a facial tic disorder, talk to your doctor about treatment options.

What is transient tic disorder?

Transient tic disorder, now known as provisional tic disorder, is a condition involving physical and verbal tics. The Diagnostic and Statistical Manual, 5th Edition (DSM-5) renamed this disorder in 2013. A tic is an abrupt, uncontrollable movement or sound that deviates from a person’s normal gestures. For example, a person with tics may blink rapidly and repeatedly, even if nothing is irritating their eyes.

Every person experiences tics differently. They may suffer from either uncontrolled movements or noises. Tics are common in children and may last for less than one year. A child with transient tic disorder has noticeable physical or vocal tics. The American Academy of Child and Adolescent Psychiatry states that tics affect up to 10 percent of children during their early school years.

The most notable tic disorder is Tourette syndrome, in which both physical and verbal tics occur in the same individual, often at the same time. Transient tic disorder also involves both types of tics, but they often occur individually.

What causes transient tic disorder?

There is no known cause of transient tic disorder. Like Tourette syndrome and other tic disorders, a combination of factors influences it.

Some research indicates that tic disorders may be inherited. A genetic mutation can cause Tourette syndrome in rare cases.

Abnormalities in the brain may also be responsible for tic disorders. Such abnormalities are the cause of other mental conditions, such as depression and attention deficit hyperactivity disorder (ADHD).

Some research suggests that transient tic disorder could be linked to neurotransmitters. Neurotransmitters are the chemicals in the brain that transmit nerve signals to your cells. However, no studies offer complete proof of the role neurotransmitters play. Medications to treat transient tic disorder alter neurotransmitter levels.

What are the symptoms of transient tic disorder?

Tic disorders include Tourette syndrome, chronic motor or vocal tic disorder, and transient tic disorder. Your doctor may diagnose your tic disorder as nonspecific if your symptoms don’t fall exactly into one of those categories.

Tics are often confused with nervous behavior. They intensify during periods of stress and don’t happen during sleep. Tics occur repeatedly, but they don’t usually have a rhythm.

People with tics may uncontrollably raise their eyebrows, shrug their shoulders, flare their nostrils, or clench their fists. These are physical tics. Sometimes a tic can cause you to repeatedly clear your throat, click your tongue, or make a certain noise, such as a grunt or a moan.


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How is transient tic disorder diagnosed?

There is no foolproof test to diagnose transient tic disorder and other tic disorders. They are difficult to diagnose, as tics are sometimes associated with other conditions. For example, allergies might be a cause for a repeated sniffing or twitching of the nose.

If you have tics, your doctor will begin your medical evaluation by performing a physical exam (especially a neurological exam) and complete medical history. This will help to rule out an underlying medical condition as the cause of your symptoms.

Your doctor may need to order other tests, such as brain CT scans and blood tests, to determine if the tics are a symptom of something more serious, such as Huntington disease.

You must meet all the following conditions to receive a transient tic disorder diagnosis:

  • You must have one or more motor tics (such as blinking or shrugging your shoulders) or vocal tics (such as humming, clearing your throat, or yelling a word or phrase).
  • Tics must occur for less than 12 months in a row.
  • Tics must start before 18 years of age.
  • Symptoms must not be a result of medication or drugs, or of another medical condition such as Huntington disease or post-viral encephalitis.
  • You must not have Tourette syndrome or any other chronic motor or vocal tic disorder.

How is transient tic disorder treated?

Transient tic disorder in children often goes away without treatment. It’s important that family members and teachers don’t call attention to the tics. This can make the child more self-conscious and aggravate their symptoms.

A combination of therapy and medication may help in situations where the tics affect work or school. Because stress can make tics worse or more frequent, techniques to control and manage stress are important.

Cognitive behavioral therapy is also a useful way to treat tic disorders. During these sessions, a person learns to avoid self-destructive actions by controlling their emotions, behaviors, and thoughts.

Medication can’t completely cure tic disorders, but it can reduce symptoms for some people. Your doctor may prescribe a drug that reduces the dopamine in your brain, such as haloperidol (Haldol) or pimozide (Orap). Dopamine is a neurotransmitter that may influence tics.

Your doctor could also treat your tic disorder with antidepressants. These drugs help treat symptoms of anxietysadness, or obsessive-compulsive disorder, and may help with the complications of transient tic disorder.

What is the long-term outlook?

Living with transient tic disorder can be frustrating at times. However, the condition is manageable with proper treatment. Try to keep your stress at reasonable levels to help reduce your symptoms. Therapy and medication can help relieve symptoms in some cases.

Parents of children with transient tic disorder play an important role in providing emotional support and helping ensure that their child’s education doesn’t suffer.

Typically, tics disappear after a few months. ResearchTrusted Source seems to indicate that children experiencing tics who had none over a year ago have a favorable outlook. However, these children have only about a one in three chance of remaining completely tic-free over the next 5 to 10 years.

Parents should keep a watchful eye on changing symptoms regardless. In some cases, transient tic disorder can develop into a more serious condition, such as Tourette syndrome.

Nose Twitching


Involuntary muscle contractions (spasms), specifically of your nose, are often harmless. That being said, they tend to be a bit distracting and may be cause for frustration. The contractions can last anywhere from a few seconds to a few hours.

Nose twitching may be caused by muscle crampsdehydration or stress, or it may be an early sign of a medical condition.

Causes for nose twitching

Vitamin and mineral deficiencies

To maintain optimum health and proper muscle function, your body needs key nutrients and vitamins. Vitamins and minerals ensure proper blood circulation, nerve function, and muscle tone. Important nutrients your body needs include:

If your doctor believes you to be vitamin deficient, they may recommend dietary supplements. You may also need to incorporate a more nutrient-rich diet.


Certain medications can trigger muscle spasms throughout your body and on your face. Some medicines causing muscle cramps and spasms include:

If you begin to experience nose twitching or muscle spasms while on prescribed medication, contact your doctor immediately to discuss treatment options that avoid adverse side effects.

Nerve damage

Issues with the nervous system may also lead to nose twitching. Nerve damage from conditions (such as Parkinson’s disease) or injuries can trigger muscle spasms.

If you have been diagnosed with a nerve disorder, your doctor may recommend medication and treatment to improve associated symptoms and reduce spasms.

Facial tic disorder

Nose twitching or spasms may be a symptom of facial tics — uncontrollable facial spasms. This disorder can affect anyone, though it’s most prevalent among children.

Other than nose twitching, people diagnosed with a facial tic disorder may also experience:

  • blinking eyes
  • raising eyebrows
  • tongue clicking
  • clearing the throat
  • grimacing

Facial tics often require no treatment, and in some cases, resolve on their own. If they begin to affect your quality of life, your doctor may recommend treatments that might include:

  • therapy
  • medication
  • botox injections
  • stress reduction programs
  • brain stimulation

Tourette syndrome

Tourette syndrome is a neurological disorder that causes you to experience involuntary movements and vocalized tics. Early symptoms are often noticed during childhood.

Common symptoms associated with Tourette syndrome include:

  • rapid eye movements
  • nose scrunching
  • head jerking
  • sniffing
  • swearing
  • repeating words or phrases

Tourette syndrome often requires no medication, unless it begins to affect normal mental and physical functioning. If you have been diagnosed with Tourette syndrome, discuss effective treatment options with your doctor.


Nose twitching may be a common side effect of your recent medication or diet.

However, severe twitching or associated tics may be symptoms that require medical attention.

If you begin to notice worsening spasms or experience adverse reactions, contact your doctor to discuss the reactions and treatment alternatives as well as to schedule a visit.

Tic Disorders in Kids Are Often Overlooked: How to Spot the Signs

Share on PinterestSome common child behaviors such as throat clearing, coughing, or an inability to sit still can sometimes be an indicator of a tic disorder. Getty Images

  • Tic disorders and Tourette’s syndrome affect about 1 in 100 children.
  • Many people with tics experience a physiological feeling that urges them to do the tic.
  • Comprehensive Behavioral Intervention for Tics (CBIT) is used to treat tic disorders.

The average person’s awareness of attention deficit hyperactivity disorder (ADHD) and anxiety in children has improved in recent years. However, strides in awareness of tic disorders and Tourette’s syndrome haven’t been as strong — despite that they affect about 1 in 100 children.

“There is still a stigma with tic disorders and Tourette’s syndrome. We often see Tourette’s syndrome only associated with coprolalia, which is the technical term for [involuntary] swearing. However, that is one of the rarest symptoms of a tic disorder,” Katrina Lindsay, PhD, a pediatric psychologist at Akron Children’s Hospital, told Healthline.

Because swearing and inappropriate behavior are perceived as the most telling sign of tic disorders, Lindsay says many parents may miss other more common symptoms.

“Families may not realize that some of the functional behaviors we do every day like throat clearing, coughing, sniffing, or blinking are considered the most common tics,” she said.

Is it a tic, nervous twitch, or allergy?

To better understand if your child has a tic, Jerry Bubrick, PhD, senior clinical psychologist and director of the obsessive-compulsive disorder service at Child Mind Institute, says it’s important to understand what a tic is.

While tics are defined as an involuntary movement, he says many times they are voluntary.

“A lot of people who have a tic disorder will have a premonitory urge — a physiological feeling you get in the body that precedes the tics,” Bubrick told Healthline.

He says the best comparison is the tingly feeling that occurs in your nose right before a sneeze.

“The only time it comes is when a sneeze is going to come and the only thing that makes the feeling go away is the sneeze. Many people who have tic disorders will have that kind of sensation in their body, usually where the tic is about to occur, and doing the tic makes that feeling go away,” he said.

While nervous twitches are similar to tics, Bubrick says the difference tends to be that when a person can identify the feeling in their body before the tic or twitch comes and if doing the twitch makes them feel better, they are experiencing a tic. If doing the twitch or tic does not make them feel better, a nervous habit may be the cause.

“It’s not just the behavior of the tic or twitch we are looking at, it’s the function of the behavior that’s important,” said Bubrick.

As far as allergies go, Lindsay says many allergies can trigger physiological symptoms that resemble a tic, such as eye blinking, coughing, throat clearing, or sniffing.

“A lot of times if parents see these symptoms, they might first go to their pediatrician and then when that initial intervention doesn’t work, they see a specialist. I have a lot of children come to me who have spent a lot of years on allergy or pulmonology medicine and treatment to find out that they had a tic disorder all along,” she said.

Seeing a pediatrician first makes sense because determining the cause can be difficult, adds Lindsay.

For instance, she explains that a child may take allergy medication for throat clearing or coughing that is thought to be related to pollen in the autumn months, yet the symptoms continue during other times of the year when pollen is low.

After seeing an allergist and receiving no relief, Lindsay says, “We may determine that in fact [the symptoms] are related to the excitement and stress of a new school year not leaves falling. So we look at the pattern of behavior and how long it’s lasted,” she said.


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How are tic disorders diagnosed?

Bubrick says it’s common for children to experience transient tics in childhood for a few weeks at a time. However, a pediatrician can assess whether or not your child should see a specialist.

“We can’t diagnose it as a tic disorder unless we know for sure that something medical isn’t explaining [the symptoms]. It is somewhat common to go to a neurologist or allergist or ENT to verify there is nothing medical going on that is causing the symptoms. If medical tests show nothing is going on it’s easier to diagnose as a tic disorder,” said Bubrick.

If it’s determined that a child may have a tic disorder, they are referred to a behavioral health provider, such as a pediatric psychologist or therapist.

When a child is referred to Lindsay, she determines if they have any comorbidities often associated with tic disorders, such as anxiety, obsessive-compulsive disorder (OCD), or ADHD. Then she diagnoses the type of tic disorder.

She says that a tic disorder means the child has either motor tics only (any body movement, such eye-twitching or shoulder rolling) or vocal tics only (anything that makes a sound, such as coughing or throat clearing).

Tourette’s syndrome is a type of tic disorder in which the child has multiple motor tics and at least one vocal tic. For instance, the child might do a chin roll, touch their hair, and then clear their throat.

“When I work with families, a lot of times they think Tourette’s syndrome might be the most serious of the conditions. But that is not true. I work with kids who cannot sit in a chair because their motor tics are so bad, but they never make a sound,” she said.

How are tic disorders treated?

The treatment for tic disorders and Tourette’s syndrome is the same–Comprehensive Behavioral Intervention for Tics (CBIT), which focuses on giving children the skills to manage their tics.

Bubrick says there are three phases to the therapy:

  1. Awareness training

This teaches the child to understand how the tic looks and feels and what triggers it.

“Does it occur more in math class because the child struggles there or because there is a kid making fun of them or does it happen in stressful or crowded situations?” says Bubrick.

To become more aware of how their body feels when the tic happens, Bubrick says he walks children through exactly what their body is doing.

“I might say, ‘I noticed that the first motion that happened was that your eyes blinked hard, and then you brought your shoulder up to your ear, and then you grunted. Did you notice that order?’ The child might say they noticed the grunt but not the eye and so I’ll ask them to pay more attention to what happens to their body when they have the tic the next time,” he said.

  1. Relaxation strategies

This includes deep breathing techniques and guided meditation.

“No one tics when the body is relaxed during sleep. Stress and tics are best friends. When you get stressed out your body becomes very tight and when your body becomes very tight, you’re more likely to have a tic. It’s not cause and effect, but they are related,” said Bubrick.

  1. Finding a competing response

This is so that the muscles used during a tic are used in a different way when the urge to tic arises.

“When a child has a tic, the brain… sends signals to the eyes for example, and says, ‘We need to feel the eye muscle move quickly and when we feel the eye muscles move quickly, we can move on with our day,'” explained Bubrick.

CBIT teaches a way to trick the brain in a simplified way, he adds.

“Instead of closing the eye rapidly, we are using the same muscle in the eyelid to open the eye wide and we keep it there until the urge to do the tic passes. So the brain gets a signal from the eyelid muscles and thinks it’s not quite what I had in mind but it’s good enough and we move on,” said Bubrick. “Opening the eye wide is a little more socially acceptable than blinking rapidly.”

Both Bubrick and Lindsay say CBIT takes practice, but gets easier over time, and is effective.

In some cases, medication may be prescribed to children in addition to therapy.

“There are not specific medications for tics, but sometimes providers might use anxiety or ADHD or even blood pressure meds to help children with tic disorders,” said Lindsay.

Bottom line

If you’re concerned your child may have a tic disorder, both experts say the sooner your child gets help, the better.

“And don’t let the negative association and stigma around tics keep you from seeing a doctor. Parents should know that they didn’t do something bad that warranted this condition for their child,” said Bubrick. “If your child is diagnosed with a tic disorder, be proactive and educate yourself just as you would if you learned your child had a condition like diabetes.”

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The Company expressly disclaims any and all liability (including liability for negligence) in respect of the use of the information provided. The Company recommends you seek independent professional advice prior to making any decision involving matters outlined in these publications. 



Child Development – Supporting Neurodiverse Children in Times of Stress and Crisis

Article originally from 2017.  It is being posted now, in light of recent events, in hopes that it can help families and professionals support neurodiverse children in their understanding.

The recent national and international events, including those in Charlottesville, are heavily covered in the media and are difficult to understand and process, even for adults. Though they may not understand the full scope of these events and what they mean, many children are significantly affected and experience heightened stress as a product of exposure to media and adult discourse around such events.

Neurodiverse children, including those with developmental and intellectual disabilities and autism spectrum disorder, may experience acute stress in response to grief, loss, tragedy, and crisis. Because children with neurodevelopmental disabilities may have delays and challenges with language and communication, understanding and responding to emotion, and regulating behavior, acute stress responses may present differently than those of other children. However, little research exists on how individuals with neurodevelopmental disabilities respond to crisis and traumatic experiences, and even fewer empirical studies address how families and clinical service providers can support children.

The following tips and resources are offered to families, educators, and clinical providers to support efforts in addressing stress responses to crisis and traumatic experiences in neurodiverse children:

  1. Be aware of how acute stress may look: Common stress responses in children include emotional changes (sadness, irritability, crying, silence), physical changes (startle easily, jumpy, headaches and stomach aches, change in appetite or sleep), social isolation, increased challenging behavior (aggression, impulsivity, outbursts, repetitive questioning), or regression to past problematic behaviors or routines.
  2. Help your child process the event/stressor:
    • Talk about the event with your child.
      • Answer questions in a simple, honest, developmentally appropriate manner. Be concrete in your use of language.
      • Validate and normalize your child’s feelings. Explain the range of feelings that others are likely experiencing.
      • Don’t avoid talking about the event or stressor. Inquire about what your child knows about the situation and how they have understood it. Explain as fully as appropriate so that your child does not misinterpret reality. Be prepared to repeat yourself.
      • Read simple books about tragedy with your child and use the books as an opportunity to expand discussion and understanding
        • Remind your child that he or she is safe in his or her environment and there are trusted adults in their life. Review who those people are with your child. Avoid excessive reassurance or protection.
        • If your child is at the age where he or she will learn about events from peers, find opportunities to talk with them before they learn about it elsewhere.
        • Allow your child to process the event in their own way. Some will ask excessive questions or tell the story over and over, others may draw images they are playing over in their head or reconstruct the situation in their play. Join in this process with your child.
        • Limit your child’s exposure to media and news related to tragic events.
        • If your child is not verbal or has communication delays, consider using visual supports to identify their emotions and/or create a simple social story to help your child understand the event ( There are existing social stories to help children with tragedies (e.g., ) and death (e.g.,
      • Remain consistent in your child and family’s routine as much as possible. Continue a sense of normalcy.
      • Model calm behavior and engage your child in coping exercises such as taking deep breaths, exercise, enjoying a favorite activity together. Be a role model and narrate out loud how you cope with stress.
      • Find ways for your child to make meaning and develop some control over the event or stressor. Children feel better when they can do something. This may include engaging in creative artwork or being part of a volunteer group with a mission related to the event or tragedy.
  1. Know when to seek help for your child and family.
    • Consult with local family organizations to find out what others are doing and saying.
    • Consult with a professional if your child is experiencing distress that is affecting their day-to-day routine or persists for more than three months.


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The Company expressly disclaims any and all liability (including liability for negligence) in respect of the use of the information provided. The Company recommends you seek independent professional advice prior to making any decision involving matters outlined in these publications.


Social Communication (Pragmatics)

Social communication or pragmatics refers to the way in which children use language within social situations.

It has three components including:

  1. The ability to use language for different purposes (e.g. to greet, inform people about things, demand, command, request).
  2. The ability to adapt language to meet the needs of the listener or situation (e.g. talking differently to a baby versus an adult, talking louder when there is lots of noise, being aware of the listener’s knowledge and giving more information or less when needed).
  3. Following the often “unspoken” rules of conversation and storytelling (e.g. taking turns in conversations, looking at the speaker, standing at an appropriate distance from the speaker, using  facial expressions and gestures). The rules of conversation are often different across cultures, within cultures and within different families. It is therefore important for a person to quickly understand the rules of the person with whom they are communicating.

Children with a diagnosis of an Autism Spectrum Disorder (ASD, including Asperger’s Syndrome) and Pervasive Developmental Disorder (Not Otherwise Specified) have difficulties with social communication (pragmatic skills).


Why is social communication (pragmatics) important?

Social communication (pragmatics) is important in order to be able to build social relationships with other people. It is also important academically, as many curriculum based activities rely on working in groups and communication between peers.


What are the building blocks necessary to develop social communication (pragmatics)?

  • Receptive (understanding) language: Comprehension of language.
  • Expressive (using) language:The use of language through speech, sign or alternative forms of communication to communicate wants, needs, thoughts and ideas.
  • Pre-language skills:The ways in which we communicate without using words and include things such as gestures, facial expressions, imitation, joint attention and eye-contact.
  • Executive functioning:Higher order reasoning and thinking skills.
  • Self regulation:The ability to obtainmaintain and change one’s emotion, behaviour, attention and activity level appropriate for a task or situation in a socially acceptable manner.


The stages of development of social communication (pragmatics) are as follows:



0-18 months

·        Brings objects to an adult to show them.

·        Tries to gain attention by using sounds, gestures, grabbing them by the hand.

·        Waves to say hello or goodbye or says the word “bye”.

·        Requests things using gestures, sounds or words (e.g. reaches for the biscuits in the cupboard).

·        Protests by shaking head, vocalising or pushing an object away.

·        Comments on an object or action by getting the adult’s attention, pointing, vocalising or saying a word (e.g. pointing to the dog and saying “woof woof” with the intention of showing the dog to the adult).

·        Looks at the speaker or responds with facial expression, vocalisation or word/s when someone speaks.

18 months – 2 years

·        Uses words or short phrases for various language functions (e.g. greeting: “hello”, “bye bye”; protesting: “no”, “mine”; making a statement: “ball blue”; giving a direction: saying “ball” while pointing for you to get the ball).

·        Uses phrases like “What’s that?” to get attention.

·        Names things in front of other people.

·        Engages in verbal turn taking.

2 – 3.5 years

·        Can take on the role of another person within play.

·        Engages in a greater number of turns within interactions with others.

·        Begins to recognise the needs of other people and will speak differently to a baby versus an adult.

·        Acknowledges their communication partner’s messages by saying things like “yeah”, “ok”, “mm”.

·        Begins using language for fantasies and make believe.

·        Requests permission to do things (e.g. “Mummy, can I please go outside?”).

·        Begins to correct others.

·        Is able to engage in simple story telling and is beginning to make guesses at what might happen in a story (inferencing).

4 – 5 years

·        Can use terms correctly, such as ‘this’, ‘that’, ‘here’ and ‘there’.

·        Uses language to discuss emotions and feelings more regularly.

·        Uses indirect requests (e.g. “I’m hungry” to request food).

·        Telling stories is developing and the child can describe a sequence of events (e.g. “The man is on the horse and he is going to jump over the fence and then he is going to go home”).

5 – 6 years

·        The ability to tell stories develops and the child is now able to tell a story with a central character and a logical sequence of events, but still may have difficulties with the ending (e.g. “Once upon a time there was a little boy called Joe who has a sister and a brother and likes to go fishing. One day …….”).

·        Beginning to make threats and can give insults.

·        May praise others (“Well done, you did it”).

·        Beginning to be able to make promises (e.g. “I promise I will do it tomorrow”).

How can you tell if my child has problems with social communication (pragmatic skills)?

If a child has difficulties with social communication they might:

  • Have difficulty remaining on topic in conversation.
  • Not try to gain the attention of adults because they do not know how to or does so inappropriately.
  • Tend to stand too close to the speaker and is unaware of personal space.
  • Tell stories in a disorganised way.
  • Have difficulty looking at the speaker or may look too intensely at the speaker.
  • Dominate conversations and does not listen.
  • Does not ask for clarification when they haven’t understood.
  • Be unable to interpret the tone of voice in others (e.g. does not recognise an angry versus a happy voice).
  • Use language in a limited way (e.g. only gives directions or makes statements but doesn’t greet or ask questions).
  • Have difficulty understanding another person’s point of view.
  • Have difficulty making friends.

* It is not unusual for children to have pragmatic or social communication difficulties in a few situations. However, if they occur often or seem inappropriate for their age there may be reason for concern.


What other problems can occur when a child has social communication (pragmatics) difficulites?

When a child has social communication difficulties, they might also have difficulties with:

  • Behaviour:The child’s action, usually in relation to their environment (e.g. a child may engage in behaviour, such as refusing to go to social events including birthday parties or engage in inappropriate behaviour, such as tugging on a peer’s hair or yelling at someone to get their attention).
  • Sensory processing:Accurate registration, interpretation and response to sensory stimulation in the environment and one’s own body.
  • Completing academic work(e.g. the child may misinterpret verbal or written instructions for tasks and/or struggle with imaginative writing).
  • Planning and sequencing:The sequential multi-step task or activity performance to achieve a well-defined result.
  • Working memory:The ability to temporarily retain and manipulate information involved in language comprehension, reasoning, and learning new information; and to update this information as change occurs.
  • Receptive (understanding) language:Comprehension of language.
  • Expressive (using) language:The use of language through speech, sign or alternative forms of communication to communicate wants, needs, thoughts and ideas.
  • Articulation:Clarity of speech sounds and spoken language.
  • Fluency:The smoothness or flow with which sounds, syllables, words and phrases are produced when talking.
  • Play skills:Voluntary engagement in self motivated activities that are normally associated with pleasure and enjoyment where the activities may be, but are not necessarily, goal oriented.

What can be done to improve social communication (pragmatics)?

  • Working collaborativelywith preschool or school staff to set up joint communication goals and develop strategies to help support the child within the classroom setting.
  • Play dates:Setting up play dates with peers from school, preschool, child care and extra curricula groups to expose the child to appropriate ways to interact with their peers.
  • Social skill groups: These are groups are that run with the express purpose of teaching social interaction skills.


What activities can help improve social communication (pragmatics)?

  • Role play:Engage in role play activities with adults and other children to simulate social situations (e.g. going shopping, going to the park, visiting grandparents).
  • Turn-taking games:Engage in turn taking games, such as board games to teach the child that it is ‘okay to lose’.
  • Facial expressions:Look at facial expressions and discuss the feelings associated with the facial expressions.
  • Miming:Practice through miming making faces that show different feelings.
  • Describing activities:Look at pictures together to encourage descriptive language about a topic or thing, with the adult prompting to keep the child on topic.
  • Puppets:Take part in role play or puppet shows after watching a modeled situation.
  • Comic strips:Use appropriate comic strips that illustrate social situations (do’s or don’ts) and talk explicitly about what is happening.
  • Social skills groups:Work with the school to set up small structured groups where social skills can be practiced (e.g. turn taking, waiting, responding, staying on topic, questioning).
  • Social stories:Develop social stories that depict how to behave and respond in certain social situations.
  • Greetings:Encourage your child to say ‘hello’ and ‘goodbye’ in social interactions.


Why should I seek therapy if I notice difficulties with social communication (pragmatics)?

Therapeutic intervention to help a child with social communication skills is important to help the child:

  • Learn how to engage appropriately with others during play, conversation and in interactions.
  • Learn how to make friends at school and when accessing out of school activities (e.g. playing a sport, attending a group such as Scouts).
  • Mmaintain friendships with peers.
  • Learn how to respond appropriately during interactions with familiar people (e.g. parents, siblings, teachers, family friends) and unfamiliar individuals (e.g. adults and children they may need to engage with during excursions or when visiting places such as the park or swimming pool).
  • Develop an understanding and awareness about social norms and to master specific social skills (e.g. taking turns in a conversation, using appropriate eye contact, verbal reasoning, understanding figurative language).
  • Some children who have pragmatic skill difficulties require explicit teaching about how to interact and communicate with others as these skills do not come naturally to them.


If left untreated what can difficulties with social communication (pragmatics) lead to?

When children have difficulties with social  communication, they might also have difficulties with:

  • Making new friends.
  • Maintaining friendships with peers.
  • Engaging appropriately with unfamiliar individuals (e.g. shop owner) and with professionals you need to see for appointments (e.g. doctor, dentist).
  • Being perceived as ‘rude’ by others.
  • Interacting with colleagues in the work environment.

What type of therapy is recommended for social communication (pragmatics) difficulties?

If your child has difficulties with social communication, it is recommended they consult a Speech Therapist.

If there are multiple areas of concern (i.e. beyond just social communication) both Occupational Therapy and Speech Therapy may well be recommended to address the functional areas of concern. This is the benefit of choosing Kid Sense which provides both Occupational Therapy and Speech Therapy.




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The Company expressly disclaims any and all liability (including liability for negligence) in respect of the use of the information provided. The Company recommends you seek independent professional advice prior to making any decision involving matters outlined in these publications.



What is Applied Behavior Analysis?

Applied Behavior Analysis (ABA) is a therapy based on the science of learning and behavior.

Behavior analysis helps us to understand:

  • How behavior works
  • How behavior is affected by the environment
  • How learning takes place

ABA therapy applies our understanding of how behavior works to real situations. The goal is to increase behaviors that are helpful and decrease behaviors that are harmful or affect learning.

ABA therapy programs can help:

  • Increase language and communication skills
  • Improve attention, focus, social skills, memory, and academics 
  • Decrease problem behaviors

The methods of behavior analysis have been used and studied for decades. They have helped many kinds of learners gain different skills – from healthier lifestyles to learning a new language. Therapists have used ABA to help children with autism and related developmental disorders since the 1960s.

How does ABA therapy work?


Applied Behavior Analysis involves many techniques for understanding and changing behavior. ABA is a flexible treatment:  

  • Can be adapted to meet the needs of each unique person
  • Provided in many different locations – at home, at school, and in the community
  • Teaches skills that are useful in everyday life
  • Can involve one-to-one teaching or group instruction

Positive Reinforcement

Positive reinforcement is one of the main strategies used in ABA.

When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change.

First, the therapist identifies a goal behavior. Each time the person uses the behavior or skill successfully, they get a reward. The reward is meaningful to the individual – examples include praise, a toy or book, watching a video, access to playground or other location, and more.

Positive rewards encourage the person to continue using the skill. Over time this leads to meaningful behavior change. 

Antecedent, Behavior, Consequence

Understanding antecedents (what happens before a behavior occurs) and consequences (what happens after the behavior) is another important part of any ABA program.

The following three steps – the “A-B-Cs” – help us teach and understand behavior:

  1. An antecedent: this is what occurs right before the target behavior. It can be verbal, such as a command or request. It can also be physical, such a toy or object, or a light, sound, or something else in the environment. An antecedent may come from the environment, from another person, or be internal (such as a thought or feeling).
  2. A resulting behavior: this is the person’s response or lack of response to the antecedent. It can be an action, a verbal response, or something else.  
  1. consequence: this is what comes directly after the behavior. It can include positive reinforcement of the desired behavior, or no reaction for incorrect/inappropriate responses.

Looking at A-B-Cs helps us understand:

  1. Why a behavior may be happening
  2. How different consequences could affect whether the behavior is likely to happen again


  • Antecedent: The teacher says “It’s time to clean up your toys” at the end of the day.
  • Behavior: The student yells “no!”
  • Consequence: The teacher removes the toys and says “Okay, toys are all done.”

How could ABA help the student learn a more appropriate behavior in this situation?

  • Antecedent: The teacher says “time to clean up” at the end of the day.
  • Behavior: The student is reminded to ask, “Can I have 5 more minutes?”
  • Consequence: The teacher says, “Of course you can have 5 more minutes!”

With continued practice, the student will be able to replace the inappropriate behavior with one that is more helpful. This is an easier way for the student to get what she needs!

What Does an ABA Program Involve?

Good ABA programs for autism are not “one size fits all.” ABA should not be viewed as a canned set of drills. Rather, each program is written to meet the needs of the individual learner.

The goal of any ABA program is to help each person work on skills that will help them become more independent and successful in the short term as well as in the future.

Planning and Ongoing Assessment

A qualified and trained behavior analyst (BCBA) designs and directly oversees the program. They customize the ABA program to each learner's skills, needs, interests, preferences and family situation. 

The BCBA will start by doing a detailed assessment of each person’s skills and preferences. They will use this to write specific treatment goals. Family goals and preferences may be included, too.

Treatment goals are written based on the age and ability level of the person with ASD. Goals can include many different skill areas, such as:

  • Communication and language
  • Social skills
  • Self-care (such as showering and toileting)
  • Play and leisure
  • Motor skills
  • Learning and academic skills

The instruction plan breaks down each of these skills into small, concrete steps. The therapist teaches each step one by one, from simple (e.g. imitating single sounds) to more complex (e.g. carrying on a conversation).

The BCBA and therapists measure progress by collecting data in each therapy session. Data helps them to monitor the person’s progress toward goals on an ongoing basis.

The behavior analyst regularly meets with family members and program staff to review information about progress. They can then plan ahead and adjust teaching plans and goals as needed.

ABA Techniques and Philosophy

The instructor uses a variety of ABA procedures. Some are directed by the instructor and others are directed by the person with autism.

Parents, family members and caregivers receive training so they can support learning and skill practice throughout the day.

The person with autism will have many opportunities to learn and practice skills each day. This can happen in both planned and naturally occurring situations. For instance, someone learning to greet others by saying “hello” may get the chance to practice this skill in the classroom with their teacher (planned) and on the playground at recess (naturally occurring).

The learner receives an abundance of positive reinforcement for demonstrating useful skills and socially appropriate behaviors. The emphasis is on positive social interactions and enjoyable learning.

The learner receives no reinforcement for behaviors that pose harm or prevent learning.

ABA is effective for people of all ages. It can be used from early childhood through adulthood!

Who provides ABA services?

A board-certified behavior analyst (BCBA) provides ABA therapy services. To become a BCBA, the following is needed:

  • Earn a master’s degree or PhD in psychology or behavior analysis
  • Pass a national certification exam
  • Seek a state license to practice (in some states)

ABA therapy programs also involve therapists, or registered behavior technicians (RBTs). These therapists are trained and supervised by the BCBA. They work directly with children and adults with autism to practice skills and work toward the individual goals written by the BCBA. You may hear them referred to by a few different names: behavioral therapists, line therapists, behavior tech, etc.

To learn more, see the Behavior Analyst Certification Board website.

What is the evidence that ABA works?

ABA is considered an evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association. 

“Evidence based” means that ABA has passed scientific tests of its usefulness, quality, and effectiveness. ABA therapy includes many different techniques.  All of these techniques focus on antecedents (what happens before a behavior occurs) and on consequences (what happens after the behavior). 

More than 20 studies have established that intensive and long-term therapy using ABA principles improves outcomes for many but not all children with autism. “Intensive” and “long term” refer to programs that provide 25 to 40 hours a week of therapy for 1 to 3 years. These studies show gains in intellectual functioning, language development, daily living skills and social functioning. Studies with adults using ABA principles, though fewer in number, show similar benefits.

Is ABA covered by insurance? 

Sometimes. Many types of private health insurance are required to cover ABA services. This depends on what kind of insurance you have, and what state you live in.

All Medicaid plans must cover treatments that are medically necessary for children under the age of 21. If a doctor prescribes ABA and says it is medically necessary for your child, Medicaid must cover the cost.

Please see our insurance resources for more information about insurance and coverage for autism services

You can also contact the Autism Response Team if you have difficulty obtaining coverage, or need additional help.

Where do I find ABA services? 

To get started, follow these steps:

  1. Speak with your pediatrician or other medical provider about ABA. They can discuss whether ABA is right for your child. They can write a prescription for ABA if it is necessary for your insurance.
  2. Check whether your insurance company covers the cost of ABA therapy, and what your benefit is.
  3. Search our resource directory for ABA providers near you. Or, ask your child’s doctor and teachers for recommendations.
  4. Call the ABA provider and request an intake evaluation. Have some questions ready (see below!)

What questions should I ask? 

It’s important to find an ABA provider and therapists who are a good fit for your family. The first step is for therapists to establish a good relationship with your child. If your child trusts his therapists and enjoys spending time with them, therapy will be more successful – and fun!

The following questions can help you evaluate whether a provider will be a good fit for your family. Remember to trust your instincts, as well!

  1. How many BCBAs do you have on staff?
  2. Are they licensed with the BACB and through the state?
  3. How many behavioral therapists do you have?
  4. How many therapists will be working with my child?
  5. What sort of training do your therapists receive? How often?
  6. How much direct supervision do therapists receive from BCBAs weekly?
  7. How do you manage safety concerns?
  8. What does a typical ABA session look like?
  9. Do you offer home-based or clinic-based therapy?
  10. How do you determine goals for my child? Do you consider input from parents?
  11. How often do you re-evaluate goals?
  12. How is progress evaluated?
  13. How many hours per week can you provide?
  14. Do you have a wait list?
  15. What type of insurance do you accept? 

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The Company expressly disclaims any and all liability (including liability for negligence) in respect of the use of the information provided. The Company recommends you seek independent professional advice prior to making any decision involving matters outlined in these publications.



Why Multisensory Learning is an Effective Strategy for Teaching Students How To Read

One of the most important challenges that educators face is how to teach early or struggling students literacy skills. While students meet academic milestones at different paces, incorporating certain strategies in your classroom can help you prepare as many students as possible for reading readiness. And recent developments in reading curriculum suggest that multisensory learning is one of the most effective methods for doing so.

Multisensory activities are based in whole brain learning, which is the belief that the best way to teach concepts is by involving multiple areas in the brain. By adding auditory or visual components to reading assignments, like illustrations or online activities, you can help students develop stronger literacy skills. Multisensory reading strategies also tie into more established educational methods, particularly Gardner’s theory of multiple intelligences, which is explained further below.

Interested in using multisensory learning to help students in your classroom develop stronger reading skills? Discover the science behind whole brain learning and how you can incorporate multisensory activities into your school curriculum.

Which Reading Skills Should Students Learn in Early Elementary?

Before students even enter elementary school, they’re already learning skills that will lead to reading readiness later on. These foundational reading skills like print or letter recognition will prepare them to develop literacy as early as kindergarten or first grade. The earlier that essential reading strategies for elementary studies are introduced into their curriculum, the stronger their long-term reading skills will become later on.[1]

Reading and pre-reading skills that are connected with early literacy development include:[2]

  • Phonological and phonemic awareness
  • Vocabulary
  • Reading comprehension
  • Print recognition
  • Alphabetical recognition and decoding

Alphabetical decoding in particular is a key skill for developing reading fluency in early elementary.[3] This skill refers to the knowledge and application of letter-sound relationships, which helps students learn to recognize and sound out different words. Without the ability to translate letters into sounds, students cannot develop more advanced skills later on.

Multisensory Learning: What It Is and Why It Works

To understand why multisensory learning is one of the most effective student engagement strategies, it’s important to understand how our minds work. The human brain has evolved to learn and grow in a multisensory environment.[4] According to the whole brain learning theory, all brain functions are interconnected for this reason.[5] We remember how to do things best when the directions we’re given engage multiple senses.

The definition of multisensory learning, then, is using the neuroscience behind how we learn to teach lessons that engage two or more senses. Most educators add audio or visual multimedia into their assignments, but multisensory learning can also include tactile, smell, and taste-related materials.[6] As long as the activity engages multiple areas of the brain, it can help students develop stronger memories around how to do it.

You could, for example, have students form alphabet letters out of clay or hand out chocolate Easter eggs while learning springtime vocabulary words.[7] As long as the sensory materials are in some way related to the subject being taught, they can help students learn important concepts. Many students rely on some senses more than others so varying your multisensory activities can help you make sure you reach all children in your classroom.

Literacy in particular is an inherently multisensory skill that benefits from differentiated reading instruction. This is because reading involves both recognizing written words and translating them into their corresponding letter sounds.[8] For struggling students or those with reading disabilities, particularly dyslexia, multisensory learning can help them learn to use all of their senses while reading a book and rely on their strengths.[9] Whether using it for classroom instruction or remedial assignments, multisensory learning can help all students develop or strengthen their literacy skills.

Educational Research Proves Multisensory Instruction Strengthens Reading Skill

The benefits of multisensory learning have been verified by contemporary research in cognitive science. A 2018 study using fMRI technology, which measures brain activity by detecting changes in blood flow, found that children with the strongest literacy skills had more interactivity between different regions in their brain.[10] This suggests that reading is a whole-brain skill and that future developments in literacy instruction should use a multisensory approach.

One emergent literacy skill that multisensory learning can help teach is connecting print letters with the oral alphabet. Educational researchers have found that multisensory activities can teach students to associate letters or words with sounds faster.[11] As mentioned earlier, this is one of the foundational reading skills that, if you can nurture in young students, can promote strong emergent literacy. Using multimedia activities to engage students is a great way to help students reach their reading potential.

For older grades, multisensory activities can also help teach more complex reading skills like critical thinking or advanced reading comprehension.[12] You could, for example, take turns reading pages from a novel or textbook aloud as a class to engage their auditory and visual senses. Even little activities that involve multiple senses can teach students to use their entire brain while reading or writing.

What this research points to most of all is that there isn’t a “one size fits all” method of teaching literacy. Different students respond to different activities, and the best way to reach all of your students is through multisensory learning. Pay attention to what is or isn’t working for your students, and try to find an activity that clicks for struggling readers.[13] With practice and the right strategy, any student’s reading skills can improve.

How Multisensory Learning Connects with the Multiple Intelligences Theory

The strategies behind multisensory learning are supported by decades of research, particularly Gardner’s theory of multiple intelligences. This theory, which was developed by Harvard professor Dr. Howard Gardner, states that the traditional notions of learning and intelligence are too limited. Gardner proposes that people can have proficiencies in different kinds of intelligences, and that teaching students in a way that matches their intellectual strengths can help them grasp tough subjects.

Children as young as four- or five-years-old have already developed strengths and weaknesses corresponding to Gardner’s intelligences.[14] These eight intelligences as defined by Dr. Gardner include:[15]

  • Linguistic intelligence: the ability to understand, read, and write words
  • Logical-mathematical intelligence: the ability to think conceptually and solve abstract problems
  • Spatial intelligence: the ability to visualize in thought and analyze images
  • Musical intelligence: the ability to understand and manipulate pitch, rhythm, and timbre
  • Bodily-kinesthetic intelligence: the ability to control your body movements or objects in your grasp
  • Naturalistic intelligence: the ability to recognize and care for plants and animals
  • Interpersonal intelligence: the ability to understand and care for the needs of others
  • Intrapersonal intelligence: the ability to analyze your own thoughts, feelings, and beliefs

When teaching reading strategies and other academic skills, schools rely heavily on linguistic and logical-mathematical intelligences.[16] But reading strategies for struggling readers or young students can be more effective if you incorporate some of their strengths. Teachers who use several different types of intelligence strategies to teach academic skills often notice that their students understand concepts better and retain more knowledge down the road.[17]

To use multiple intelligences in the classroom, try linking your lesson plans to at least two different types of intelligences and sensory strategies. You could, for example, teach your students a song about the alphabet. Not only would this pair musical and linguistic intelligences, but it would also engage your students’ auditory and visual senses while learning about letters. Making the most of multisensory learning and the multiple intelligences theory is a great way to help all of your students learn in a way that plays to their strengths.

How to Boost Student Engagement with Multisensory Reading Activities

Using multisensory activities to teach reading skills can help engage students in your lessons, particularly if you’re teaching struggling or reluctant readers.[18] Depending on the student, you can try a variety of fun reading activities that involve multiple senses.

Try these five reading strategies to teach literacy skills with the best elements of whole brain learning:

  • When reading a book as a class, try putting on an audio recording or watching a clip of a storyteller performing it [19]
  • Have students build vocabulary words using letter magnets as a tactile activity [20]
  • Instead of always assigning students print books to take home, try giving audiobook or video assignments as well [21]
  • Have students make their own illustrations to accompany vocabulary words or simple sentences that they write
  • Teach students to sound out words while pointing at each letter to solidify a link between sounds and print letters [22]

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Auditory Processing Disorder

Auditory processing disorder (APD) is a hearing problem that affects about 3%–5% of school-aged children.

Kids with this condition, also known as central auditory processing disorder (CAPD), can't understand what they hear in the same way other kids do. This is because their ears and brain don't fully coordinate. Something interferes with the way the brain recognizes and interprets sounds, especially speech.

With the right strategies, kids with APD can be successful in school and life. Early diagnosis is important. If the condition is not identified and managed early, a child is at risk for listening and learning problems at home and school.

Trouble Understanding Speech

Kids with APD are thought to sense sound normally because they usually can hear sounds that are delivered one at a time in a very quiet environment (such as a sound-treated room). The problem is that they usually don't easily recognize slight differences between sounds in words, even when the sounds are loud enough to be heard.

These kinds of problems usually happen in a poor listening situation — such as when there's background noise or in a reverberant room like an auditorium — which often is the case in social situations. Kids with APD can have trouble understanding what is being said to them when they're in noisier places like a classroom, playground, sports event, school cafeteria, or party.

What Are the Signs & Symptoms of Auditory Processing Disorder?

Symptoms of APD can range from mild to severe and can take many different forms. If you think your child might have a problem processing sounds, ask yourself:

  • Does my child often mishear sounds and words?
  • Are noisy environments overwhelming when my child is trying to listen?
  • Does my child's listening behaviors and performance improve in quieter settings?
  • Does my child have trouble following verbal directions, whether simple or complicated?
  • Does my child have trouble with spelling or phonics?
  • Are verbal (word) math problems hard for my child?
  • Are conversations hard for my child to follow?

APD is often misunderstood because many of its symptoms are similar to those found in other disorders. Also, APD symptoms can be hidden by other problems, like speech-language delays, learning disabilities, attention deficit hyperactivity disorder (ADHD), and depression. Auditory memory deficits, auditory attention problems, and sound sensitivity are not symptoms of APD, but also may involve trouble with using sound information correctly. Seeing an audiologist, and other related specialists, can help parents understand these conditions.

What Causes Auditory Processing Disorder?

Often, the cause of a child's APD isn't known. Evidence suggests that children with head trauma, lead poisoningseizure disorder, or chronic ear infections are more at risk. Sometimes, there can be more than one cause.

How Is Auditory Processing Disorder Diagnosed?

If you think your child is having trouble hearing or understanding when people talk, have an audiologist (hearing specialist) examine your child. Only audiologists can diagnose auditory processing disorder.

The most common way to diagnose APD is to use a specific group of listening tests. Audiologists often look for these main problem areas in kids with APD:

  • Auditory figure-ground:This is when a child has trouble understanding speech when there is speech babble or ambient noise in the background. Noisy, loosely structured or open-air classrooms can be very frustrating for a child with APD.
  • Auditory closure:This is when a child can't “fill in the gaps” of speech when it is more challenging. This can happen in a quieter situation but is more common when the speaker's voice is too fast or is muffled, making it hard for the child to make sense of the sounds and words.
  • Dichotic listening:This is when a child has trouble understanding competing, meaningful speech that happens at the same time. For example, if a teacher is talking on one side of the child and another student is talking on the other side, the child with APD cannot understand the speech of one or both of the speakers.
  • Temporal processing:This is the timing of a child's processing system, which helps them recognize differences in speech sounds (such as mat versus pat). It also helps them understand pitch and intonation (for example, asking a question instead of giving a command), understand riddles and humor, and make inferences.
  • Binaural interaction:This is the ability to know which side speech or sounds are coming from, and to localize sound in a room. Although less common, this problem happens in children with a history of brain trauma or seizure disorders.

Most traditional APD tests require a child to be at least 7 years old. So, many kids aren't diagnosed until first grade or later. Newer electrophysiology tests (which use noninvasive electrodes to check the body's response to speech) can give some early information about the central auditory system in kids younger than 7.

How Can Parents and Teachers Help?

The auditory system isn't fully developed until kids are about 14 years old. Many kids diagnosed with APD can develop better listening skills over time as their auditory system matures.

There's no known cure, but different strategies may help with listening and also improve the development of the auditory pathway over time, especially when started at younger ages. These include:

  • physical accommodations to improve the listening environment
  • individual therapies
  • help from other professionals to manage non-listening symptoms. For example, a child may benefit from:

One common physical accommodation is a remote microphone system, previously known as a frequency modulation (FM) system. This assistive listening device emphasizes a speaker's voice over background noise, making the voice clearer so a child can understand it. The person talking wears a tiny microphone transmitter, which sends a signal to a wireless receiver that the child wears on the ear or to a speaker box.

Other physical accommodations often focus on optimizing a kid's access to speech. Optimizing speech means reducing the interference of other things, like background babble, sound and sight distractions, and poor classroom acoustics. In a classroom, for example, the teacher might slow down their speech, speak clearly and deliberately (Think Mr. Rogers!), and seat the child where they can see and hear them better.

Some individualized therapies also may help kids improve the growth of their auditory pathway. These usually are recommended by the audiologist based on the results of a child's tests and concerns. Several computer-assisted programs are geared toward children with APD. They mainly help the brain do a better job of processing sounds in a noisy setting. Some schools offer these programs. If your child has APD, ask school officials about what's available.

Strategies used at home and school can ease some of the issues associated with APD.

At Home

At home, these strategies that can help your child:

  • Reduce background noise whenever possible.
  • Have your child look at you when you speak. This helps give your child visual clues to “fill in the gaps” of missing speech information.
  • Use strategies like “chunking,” which means giving your child simple verbal directions with less words, a key word to remember, and fewer steps. 
  • Speak at a slightly slower rate with a clear voice. Louder does not always help. (Again, think Mr. Rogers!)
  • Ask your child to repeat the directions back to you to ensure they understand.
  • For directions to be completed later, writing notes, keeping a chore chart or list, using calendars with visual symbols, and maintaining routines can help.
  • Many kids with APD find using close captions on TV and computer programs helpful.

Encourage kids to advocate for themselves. Telling adults when listening is hard for them can help. But shy kids might need to use agreed-upon visual cards or signals for coaches, parents, and teachers.

Most important, remind your child that there's nothing to be ashamed of. We all learn in different ways. Be patient. This is hard for your child and takes time. Your child wants to do well, and needs patience, love, and understanding while they work toward success.

At School

Teachers and other school staff may not know a lot about APD and how it can affect learning. Sharing this information and talking about it can help build understanding about the disorder.

APD is not technically considered a learning disability, and kids with APD usually aren't put in special education programs. Depending a child's degree of difficulty in school, they may be eligible for an accommodation plan such as an individualized education program (IEP) or a 504 plan that would outline any special needs for the classroom. Accommodations for APD often fall under the disability category of “Other Health Impairment.”

Other helpful adjustments are:

  • strategic (or preferential) seating so the child is closest to the main person speaking. This reduces sound and sight distractions and improves access to speech.
  • pre-teaching new or unfamiliar words
  • visual aids
  • recorded lessons for later review
  • computer-assisted programs designed for kids with APD

Stay in touch with the school team about your child's progress. One of the most important things that parents and teachers can do is acknowledge that the APD symptoms your child has are real. APD symptoms and behaviors are not something that a child can control. What your child can do, with the help of caring adults, is recognize the problems from APD and use the strategies recommended for home and school.

A positive, realistic attitude and healthy self-esteem in a child with APD can work wonders. Kids with APD can be as successful as their classmates. With patience, love, and support, they can do anything they work toward.



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What is Social and Emotional Development

Children grow and develop rapidly in their first five years across the four main areas of development. These areas are motor (physical), communication and language, cognitive, and social and emotional.
Social and emotional development means how children start to understand who they are, what they are feeling and what to expect when interacting with others. It is the development of being able to:

  • Form and sustain positive relationships.
  • Experience, manage and express emotions.
  • Explore and engage with the environment.

Positive social and emotional development is important. This development influences a child’s self-confidence, empathy, the ability to develop meaningful and lasting friendships and partnerships, and a sense of importance and value to those around him/her. Children’s social and emotional development also influences all other areas of development.
Parents and caregivers play the biggest role in social/emotional development because they offer the most consistent relationships for their child. Consistent experiences with family members, teachers and other adults help children learn about relationships and explore emotions in predictable interactions.
To nurture your child’s social and emotional development, it is important that you engage in quality interactions like these on a daily basis, depending on the age of your child:

  • Be affectionate and nurturing: hold, comfort, talk and sing with your baby, toddler and child.
  • Help your baby experience joy in “give-and-take” relationships by playing games like “peek-a-boo.”
  • Provide your toddler with responsive care, letting them practice new skills while still providing hands-on help.
  • Support your child’s developing skills; help him/her, but don’t do everything for your child, even if it takes longer or is messy.
  • Teach social and emotional skills, such as taking turns, listening and resolving conflict.

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What Is Posttraumatic Stress Disorder?

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.

PTSD has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II, but PTSD does not just happen to combat veterans. PTSD can occur in all people, of any ethnicity, nationality or culture, and at any age. PTSD affects approximately 3.5 percent of U.S. adults every year, and an estimated one in 11 people will be diagnosed with PTSD in their lifetime. Women are twice as likely as men to have PTSD. Three ethnic groups – U.S. Latinos, African Americans, and American Indians – are disproportionately affected and have higher rates of PTSD than non-Latino whites.

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

A diagnosis of PTSD requires exposure to an upsetting traumatic event. However, the exposure could be indirect rather than first hand. For example, PTSD could occur in an individual learning about the violent death of a close family or friend. It can also occur as a result of repeated exposure to horrible details of trauma such as police officers exposed to details of child abuse cases.

Acute Stress Disorder

Acute stress disorder occurs in reaction to a traumatic event, just as PTSD does, and the symptoms are similar. However, the symptoms occur between three days and one month after the event. People with acute stress disorder may relive the trauma, have flashbacks or nightmares and may feel numb or detached from themselves.  These symptoms cause major distress and problems in their daily lives. About half of people with acute stress disorder go on to have PTSD.

An estimated 13 to 21 percent of survivors of car accidents develop acute stress disorder and between 20 and 50 percent of survivors of assault, rape or mass shootings develop it.

Psychotherapy, including cognitive behavior therapy can help control symptoms and help prevent them from getting worse and developing into PTSD.  Medication, such as SSRI antidepressants can help ease the symptoms.

Adjustment disorder

Adjustment disorder occurs in response to a stressful life event (or events). The emotional or behavioral symptoms a person experiences in response to the stressor are generally more severe or more intense than what would be reasonably expected for the type of event that occurred.

Symptoms can include feeling tense, sad or hopeless; withdrawing from other people; acting defiantly or showing impulsive behavior; or physical manifestations like tremors, palpitations, and headaches. The symptoms cause significant distress or problems functioning in important areas of someone’s life, for example, at work, school or in social interactions. Symptoms of adjustment disorders begin within three months of a stressful event and last no longer than six months after the stressor or its consequences have ended.

The stressor may be a single event (such as a romantic breakup), or there may be more than one event with a cumulative effect. Stressors may be recurring or continuous (such as an ongoing painful illness with increasing disability). Stressors may affect a single individual, an entire family, or a larger group or community (for example, in the case of a natural disaster).

An estimated 5% to 20% of individuals in outpatient mental health treatment have a principal diagnosis of adjustment disorder. A recent study found that more than 15% of adults with cancer had adjustment disorder. It is typically treated with psychotherapy.     

Disinhibited social engagement disorder

Disinhibited social engagement disorder occurs in children who have experienced severe social neglect or deprivation before the age of 2. Similar to reactive attachment disorder, it can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments.

Disinhibited social engagement disorder involves a child engaging in overly familiar or culturally inappropriate behavior with unfamiliar adults. For example, the child may be willing to go off with an unfamiliar adult with minimal or no hesitation. These behaviors cause problems in the child’s ability to relate to adults and peers. Moving the child to a normal caregiving environment improves the symptoms. However, even after placement in a positive environment, some children continue to have symptoms through adolescence. Developmental delays, especially cognitive and language delays, may co-occur along with the disorder.

The prevalence of disinhibited social engagement disorder is unknown, but it is thought to be rare. Most severely neglected children do not develop the disorder. Treatment involves the child and family working with a therapist to strengthen their relationship.   

Reactive attachment disorder

Reactive attachment disorder occurs in children who have experienced severe social neglect or deprivation during their first years of life. It can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments.

Children with reactive attachment disorder are emotionally withdrawn from their adult caregivers. They rarely turn to caregivers for comfort, support or protection or do not respond to comforting when they are distressed. During routine interactions with caregivers, they show little positive emotion and may show unexplained fear or sadness. The problems appear before age 5. Developmental delays, especially cognitive and language delays, often occur along with the disorder.

Reactive attachment disorder is uncommon, even in severely neglected children. Treatment involves the child and family working with a therapist to strengthen their relationship.

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What is a stammer?

A stammer is a disorder of speech. There are stoppages and disruptions which interrupt the smooth flow and timing of the speech. These stoppages may take the form of repetitions of sounds, syllables or words – like saying da-da-daddy. There may also be prolonged sounds – so that words seem to be stretched out – like saying mmmmmummy. It can also involve silent blocking of the airflow of speech, so that no sound is heard. As a result, the speech may sound forced, tense or jerky.Stammering can be mild, and not cause much of a problem, or severe, when it becomes a serious communication disorder. The stammer can also vary for the same person. A person might find that they have periods of stammering, followed by times when they speak without a stammer.

People who stammer may avoid certain words or situations which they know will cause them difficulty. Some avoid or substitute words to such an extent that people in their lives may not realise they have a stammer. This is known as covert stammering. The affected person may even avoid talking whenever possible.

What causes a stammer?

To speak in a flowing way (fluently), a child's brain must develop many different nerve pathways. These pathways must interact in very precise and rapid ways. Stammering usually emerges in childhood as a symptom that the brain's pathways for speech are not being wired normally. Most young children grow out of their stammer – but the longer the stammering symptoms persist, the more difficult it is to change the brain's wiring.

Stammering usually starts when a child is developing speaking skills, and is therefore referred to as developmental stammering. Family genetics are relevant in some cases – someone with stammering in the family seems more likely to develop their own stammer. In rare cases, stammering can start in adult life, when it is known as acquired or late-onset stammering, and is most commonly caused by a stroke, resulting in damage to the brain. It may also be caused by head injury or severe emotional upset.

People who stammer are no different in intelligence or intellectual or emotional ability. But they are often stereotyped as being nervous, shy, self-conscious, tense, sensitive, hesitant, introverted or insecure. There is no evidence to support this. However, many people who stammer are nervous about speaking, especially in public.

How common is having a stammer?

Stammering (stuttering) is common and can occur in childhood and persist into adulthood. It is estimated that about 1 in 20 children under school age may have a stammer at some time. Two out of three children who stammer will naturally grow out of it. One child in three will not. An estimated 1 in 100 adults stammer. Between 3-4 men stammer for every woman who stammers.

The number of people who stammer does not appear to be increasing or decreasing. Research studies indicate that these figures are the same worldwide and that stammering occurs across all cultures and in all social groups. In the UK, around 720,000 children and adults stammer.

Is there any treatment for a stammer?

For most preschool children with a developmental stammer (stutter), the stammer goes away without any treatment. If it is needed, treatment is much more effective for preschool children than for older children and adults. Stammering that persists into school age tends to be harder to treat.

How can you help your own child?

If you have any concerns about a young child’s speech, it is important to obtain advice as soon as possible. This is known as 'early intervention'. Speech therapists, who provide treatment for stammering, are based in local health centres and hospitals. You may be able to refer your child directly or you can ask your doctor or health visitor to do this for you.

It is reasonable to ask if the therapist specialises in stammering and what can be expected from therapy. If possible, see a specialist who works regularly with stammering and keeps up to date with the latest approaches to therapy. If there is no specialist available in your local NHS speech and language therapy department, it may be worth asking if you can be referred to another department nearby.

If you are told to wait to see if the stammer will go away, because your child will probably grow out of it, the person is unlikely to be experienced in stammering. It is true that the majority of children recover naturally from stammering, but you should still be given guidance on how to support your child, and they should be actively monitored.

You can help children who stammer by:

  • Providing a relaxed home environment that allows many opportunities for your child to speak. This includes making time to talk to each another, especially when your child is excited and has a lot to say.
  • Not reacting negatively when the child stammers. Give any corrections in a gentle way and give praise when your child speaks without a stammer.
  • Speaking in a slightly slow and relaxed way.
  • Listening carefully when your child speaks and waiting for them to say the intended word. Don't try to complete the sentences for them.
  • Helping your child to be confident that they can communicate successfully even when they stammer.
  • Providing consistent feedback to your child about their speech in a friendly, non-judgemental and supportive way.
  • Talking openly about stammering if your child wants to talk about it.

What are the treatments that can be provided?

Treatment programmes for children involve further ways to help your child feel more relaxed and confident when speaking.

There are many different treatments for stammering. The choice of treatment will depend on the age of the person and their individual difficulties and needs. The different types of treatment for stammering include:

  • Parental involvement (the Lidcombe approach), which involves the rest of the family helping the child to speak slowly, praising the child when they don't stammer and occasionally correcting when the child speaks with a stammer.
  • Stuttering modification, which helps by reducing the fear of stammering and improves confidence.
  • Psychological therapies, which can be used for adults and those with acquired stammering. These therapies don't treat the stammer. The treatment is designed to reduce stress and anxiety, which make the stammer worse.
  • Feedback devices, which can help by changing the way the voice is heard. Electronic devices can help people control their speech by giving them sound feedback. These devices change the way the person speaks, such as slowing down the speed of speaking. The device may make the person speak more slowly to keep the speech they hear through the device sounding clear.

What is the outcome?

Without treatment, about 1 in 100 older children, teenagers and adults will have developed a persistent stammer (stutter). Many people with a stammer learn to control the stammer but still have problems if they feel stressed or speak in public.

EMIS would like to acknowledge the contribution of the British Stammering Association in the authoring of this leaflet.


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Developmental Language Disorder: The Childhood Condition We Need to Start Talking About

Using language is a skill that allows us to share our ideas and feelings, to learn in school, and to understand the world around us. Unfortunately, using and understanding language is not easy for everyone—especially for people with developmental language disorder (or DLD). DLD is a hidden but very common condition affecting about 1 out of 15 children. DLD has been given different names in the past, which has sometimes made it confusing for professionals to talk about the condition and for children with DLD to get help. Researchers have studied the different factors that may contribute to DLD, the different types of language problems children with DLD might have, and how children with DLD can be helped. It is very important that we raise awareness for DLD so that the condition will become less mysterious and the lives of the many children who have DLD will become easier.

Humans use language The use and understanding of spoken words, written words, or sign language to communicate. to share ideas and feelings as well as to understand the ideas and feelings of other people. Most of us use language every single day without ever stopping to think about it. Now imagine what it would be like to struggle to understand what people are saying to you or to put your thoughts into words. Think about how hard it would be to share stories, to understand what your teacher is asking you to do, or to explain to your friends why you are feeling upset. This is how it might feel if you had a developmental language disorderA hidden but common condition that causes difficulty using and/or understanding language..


Developmental language disorder, or DLD for short, is a hidden but very common condition that means a child has difficulty using and/or understanding language. Children with DLD have language abilities that fall behind those of other children their age, even though they are often just as smart. Having trouble with language means that children with DLD may have difficulty socializing with their classmates, talking about how they feel, and learning in school [1]. DLD is very common. If your class at school was made up of 28 students, there would be about two students in your class with DLD. It is a life-long condition. Even though DLD is usually first discovered and treated in childhood, it usually does not go away as a child grows up. There are many adults with DLD, too [2].



Throughout history, language problems in children have been given many different names. For example, these children have been said to have a “specific language impairment,” a “language delay,” or a “language disorder,” among other labels [3]. Because there were so many different labels being used to describe language problems in children, it was really hard for professionals (like doctors, psychologists, and speech-language pathologistsA professional who assesses and treats patients of all ages who have speech, language, communication or swallowing disorders.) to talk to each other about these problems, because everyone was using different names. The use of multiple terms for the same disorder also meant that it was difficult for researchers to investigate how to help these children. In 2015 and 2016, a group of experts from around the world came together to solve this problem [4, 5].

The experts agreed that the term “language disorder” should be used to describe severe language problems that will most likely not go away. These language problems make it hard for children to communicate or to succeed in school [5]. Many children have a language disorder along with another disability, like Down syndrome or autism spectrum disorder. Other children, however, could have a language disorder without having any other disability. For these children, the experts agreed that the label “developmental language disorder” should be used [5]. Many people have never heard of DLD, even though it is very common, and that is why it is so important that information about the condition is shared.



The answer to this question is very complicated. Although there is a lot of research on DLD, we do not know why some children have it and others do not. DLD is probably the result of a mixture of different factors, including:


Biology: a child's physical makeup may play a role in whether he or she has DLD. DLD often runs in families, meaning that the genes a child gets from his or her parents may influence whether that child has DLD. The way that a child's brain is made up and how the different parts of the brain talk to each other may also play a role.

Cognition: every child is different in how he or she learns new information, thinks about that information and uses that information. These processes are called cognition. Some children are fast thinkers, while some are slow. Some children have really good memories, while some do not. These differences in cognition may play a role in whether a child has DLD.

Environment: the environment that a child grows up in may also play a role in whether that child will have DLD. A child's environment can either increase or decrease the risk of the child having DLD. There are some people who believe that a child will have DLD if his or her parents do not talk to the child enough—this is not true.

There is no recipe of biology, cognition, and environment that guarantees that a child will have DLD or that a child will not have DLD. When a child does have DLD, it is probably the result of different factors interacting with each other [6].


To really understand the kinds of challenges that someone with DLD faces, it is important to know that language is very complex and that there are many different ways that language can be impaired. A child with DLD will have a very unique profile, meaning that he or she will face a unique set of language challenges. This profile may look very different from other children with DLD and the profile may change as the child gets older. Even though every child with DLD is unique, there are some language problems that are very common among children with DLD.

Many children with DLD have trouble using proper grammar. For example, a child with DLD might say the sentence, “he play outside yesterday,” instead of “he played outside yesterday.” In this sentence, the child has not added the -ed to the end of the word play to show that it occurred in the past. A child with DLD might say “I walking to school,” instead of “I am walking to school.” In this sentence, the child has not included the form of the verb “to be” that fits in this sentence [7]. GrammarThe structure and rules that are followed in a language. errors, like these examples, are very common for children with DLD.

Many children with DLD have trouble with sounds. This type of difficulty is especially common when children are very young. There are many different ways that a child may have trouble with the sounds in words when he or she is speaking. For example, children with DLD might leave sounds out (saying “nana” instead of “banana”). Children with DLD might also use the wrong sounds in certain words (saying “wed” instead of “red”).

Many children with DLD know fewer words than other children their age. The number of words you know is called your vocabularyThe total number of different words that a person knows.. Problems with vocabulary will look different as a child grows up. Very young children with DLD may say their first words later than other children. It may also take children with DLD longer to learn and remember new words. Even if a child with DLD has learned a word, it may be hard for him or her to remember that word when talking. This problem is called word-finding difficulty. As children with DLD get older, they may not properly learn that some words have more than one meaning (like the word “cold,” which can mean a low temperature, a sickness, or being unfriendly [6]).

Many children with DLD have problems properly using language in social situations. Children with DLD might have trouble staying on topic, taking turns in a conversation, or understanding long sentences. These children may have trouble sharing information and telling stories [8]. It might be hard for children with DLD to use words to talk about how they are feeling. This difficulty with making people understand a problem they are having can make children with DLD feel frustrated or angry, and act in ways they are not supposed to.

Although these language problems are common in children with DLD it is very important to remember that no two children have the same language skills, communication, or learning abilities.


It is very important to know that support from professionals, like speech-language pathologists and teachers, can make a huge difference in the lives of children with DLD. The first step in getting help for a child with DLD happens when someone recognizes that there is a problem. DLD will look different in different children. However, we also know that there are some DLD warning signs that parents and teachers should remember. One DLD warning sign is when a child has problems in school. Language is important for every single subject, so a child with DLD may struggle to understand what he or she is learning, might feel frustrated at school, and might get bad grades. Another DLD warning sign is when a child has language skills that are less advanced than other children the same age. There is a large amount of evidence showing that providing help, also called intervention, for children with DLD can be very effective and can improve that child's language skills. Although many children with DLD will always have language skills that fall behind their peers, getting help can maximize a child's communication and learning potential [1]. By creating greater awareness about DLD, the condition will become less mysterious and children will be helped sooner. We all have a responsibility to share what we know about DLD so that researchers and professionals can continue to work hard every day to help make the lives of children with DLD easier.


The article, Developmental Language Disorder: The Childhood Condition We Need to Start Talking About, describes the language problems that may be observed in children with Developmental Language Disorder (DLD). The descriptions and examples of language problems in the article primarily focused on standard English. This addendum adds the important point that the common language learning problems observed in DLD will be different for speakers of other languages or other English dialects. An English dialect is a particular form of the English language that a group of people from a specific region or group speak. Some of the common errors that people with DLD make when they are speaking standard English may not be a sign of DLD for someone speaking an English dialect. For example, he play outside yesterday, which was given in the original article as an example of a grammatical error in Standard American English, would be a perfectly grammatical production by a speaker of African American English [9]. It is very important for professionals, like speech-language pathologists, to understand the specific dialects that may be spoken in their communities in order to properly identify DLD.

Credit to:


The Company expressly disclaims any and all liability (including liability for negligence) in respect of the use of the information provided. The Company recommends you seek independent professional advice prior to making any decision involving matters outlined in these publications.



Current Challenges for Speech Therapists in Telepractice

As a teacher, I’ve seen the magic that speech therapists do. They garner and utilize the forces of science, child development, parental concern, and the love of helping children to focus on something most of us take for granted. By that I mean, speaking, communicating, and socializing with others.

Still, you can’t really appreciate what they do until you know the whole story. This blog is an attempt to describe some of their challenges and is based on an unpublished survey of c. 200 speech and language pathologists (SLPs).

In This Article

What Kind of Magic Do Speech Therapists Do?

First, a speech therapist serves parents and children. The American Speech-Language-Hearing Association (ASHA) says they “. . . work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults.”

No big deal, right? Come on, they are like an amazingly well-educated combination of a pediatrician, teacher, speech expert, and behaviorist who works long hours to improve your family life. They listen, observe, coach, cuddle, cajole, teach, and help a child improve in ways that they don’t even know they’re getting help.


Where Can I Find a Speech Therapist?

Other than the ASHA website here are usually four places to get their help:

  1. As a part of your child’s school day;
  2. In private office sessions;
  3. At health institutions like nursing homes or hospitals; or
  4. At home via teletherapy.

From my experience, their spaces in schools look like tiny closets, because of the one-on-one or small group-sized sessions. At my school, a pull-out session lasted about 30 minutes, but they can be shorter or longer depending on the demand in that school.

That’s about 14 sessions/day, and all before 3:30. Then they go to their private practices or to their home offices for even more sessions. It’s little wonder that SLPs get burned out. 

Current SLP Concerns

What are some of the concerns SLPs have nowadays? With this pandemic, face-to-face (F2F) sessions have been rare or non-existent. In addition, there has been a skyrocketing growth of online therapy, or teletherapy sessions, or telehealth, or telepractice (which all mean the same thing, basically). And so, this blog specifically talks about the concerns of SLPs and their virtual practices.

A survey was given to over 200 speech therapists in Texas to focus the content of a webinar on telepractice. These are the results:

Results of the Survey

Question 1: What are your two most current concerns about remote therapy/virtual services?

The top 5 answers included:

  1. The challenges of engaging parents during a session, 
  2. The problems caused by a lack of internet or the appropriate devices in clients’ homes, 
  3. Finding free evaluations and available virtual resources for therapy for kids aged 3–6
  4. Because many parents can only be involved after work, the day is very long for speech therapists
  5. Distractions (other kids, TV is on, not a separate space for the session)

Question 2: What are your two most current concerns with SLP blended/mixed services? 

  1. Scheduling services for both populations
  2. Supporting severe populations
  3. Solid literacy-based activities for a whole month’s worth of planning
  4. Making sure that all students are being serviced with proper PPE and procedures in place for F2F sessions
  5. Students don’t consistently attend

Question 3: Which platform are you using for Virtual SLP Services? (Teletherapy)

  1. Zoom (the overwhelming majority)
  2. Google Meet
  3. Microsoft Teams
  4. WebEx
  5. Schoology

Question 4: What two topics would you like covered in a workshop focusing on Teletherapy?

  1. Reinforcers or reinforcing activities/games
  2. Interactive platforms
  3. Ideas on ways to make therapy more interactive/entertaining for EE and younger students AND AAC ideas
  4. Gaining and sustaining attention AND organizing all digital content
  5. Scheduling for dual face-to-face and teletherapy services, AND How to successfully treat students with limited focus and severe disabilities

We here at Speech Blubs are very aware of the challenges speech therapists face day-to-day. We plan to continue helping spread the good word about these incredible professionals and telehealth services. Stay tuned to some of our upcoming podcasts for more awareness-raising.


Credit to:

Robert McKenzie

MA, Fifth grade teacher

New York, New York



The Company expressly disclaims any and all liability (including liability for negligence) in respect of the use of the information provided. The Company recommends you seek independent professional advice prior to making any decision involving matters outlined in these publications.



21 Kids Activities to Encourage Speech Development

From day one, your baby is listening to you intently to eventually communicate with you. Those listening skills will then turn into eye contact, cries, smiling, giggling, babbling, and more. In fact, your baby’s first communication begins with crying.

Have you ever noticed your baby cries differently for different needs? Different cries are baby’s way of communicating with you!

But how do a baby’s cries develop into speech? By the age of one, your baby will develop both nonverbal and verbal language skills to communicate. To help your baby develop essential language milestones, here are 21 kids’ speech activities to foster listening skills and speech development for your baby!

One-Year-Old Speech and Language Milestones

During year one, most babies develop the following language milestones:

  • Recognizes familiar voices
  • Responds to familiar voices by smiling and laughing
  • Coos, squeals, shouts
  • Has different cries for different needs
  • Communicates through gestures (points to a bottle to tell you he/she needs more milk)
  • Repeats sound or actions/gestures
  • Responds to simple instructions (“Come here please”)
  • Repeats words
  • Recognizes the names of common objects
  • Shows interest in reading books


21 Kids Activities for Speech and Language Development

  1. Animal Jam

Simply say phrases like:

  • A cow goes‘moo’
  • A duck says ‘quake’
  • A chicken goes ‘cluck’

This helps your baby recognize the names of common animals along with their unique sounds. The best part about Animal Jam is it can be done anywhere, even in the car!

  1. Sound Stories

Storytime is a wonderful time to bond with your baby. But it is also a way to enrich your baby’s language development. To learn speech skills, your baby also needs to learn nonverbal communication and sounds in response to everyday things. Instead of reading through a book, make reading fun by adding facial expressions, voice inflections, sound effects, and animal sounds.

  1. Talk Back

Babies communicate by crying, cooing, and squealing to get your attention. When he/she is communicating with you, start talking back. If your baby coos, coo back. If baby smiles at you from across the room, smile back while saying ‘Hello’ and waving.

Babies learn through imitation. Over time your baby will not only smile, but say ‘Hello’ back to you while waving.

  1. Name That Color

Everything is made of color. To help foster early color recognition, say the colors of everything you see.

For example: Name the colors of cars passing by while taking a walk to the park; tell your baby what color clothes he/she is wearing, toy colors, and more!

  1. Karaoke

Whether you can keep a tune or not, your baby doesn’t care! Singing is a perfect way to provide a language learning opportunity that includes voice inflections, new words, and facial expressions. So go ahead and make a silly face while singing at the top of your lungs!

  1. Monkey See, Monkey Do

“Monkey see, monkey do” is all about facial expressions. Facial expressions are an important aspect of speech development because they convey emotions. Research suggests that nonverbal forms of communication like facial expressions make up 60 to 65% of communication.

To encourage increased emotions through facial expressions, hold your baby in front of you and mimic his/her facial expressions. When your baby smiles, smile back. Better yet! Stick out your tongue, make a silly face, and watch to see if baby repeats your expressions.

  1. Mirror, Mirror

Since tummy time is an essential part of a baby’s physical development, take advantage of tummy time by using a mirror. Not only will baby enjoy his/her reflection, but each time a coo or giggle is made your baby can see where the sound is coming from and his/her facial expressions when ‘speaking.’

  1. Bicycle

After a diaper change or anytime your baby is on his/her back, take baby’s legs in move them in bicycle motions while singing a silly song or reciting a nursery rhyme. The bicycling motion will allow baby to focus on your face while you sing or speak to her/him.

  1. Face-To-Face

Face-to-face is one of my favorite fun activities for promoting speech development! Lay on the floor with your little one and face each other. Point to areas of her/his face while naming the parts of the face. This will help your baby not only learn hand/eye coordination, but early recognition of parts of the face.

Better yet, take this activity one step further by doing the following example:

  1. Point to baby’s nose and say ‘nose’
  2. Take baby’s hand and touch your nose while saying ‘nose’

Having baby touch your nose allows her/him to understand that everyone has similar body parts with the same names.

  1. Repeat after Me

This simple game works best when facing your baby. Start making babbling sounds AKA baby talk (especially with vowel sounds) and wait for your baby to repeat them back to you. Some common coos and babbling sounds include: Oohh/aww; mamma/dada.

This type of speech normally does not develop until four months of age. So don’t be upset if your one-month-old is not catching on, just give it time. Before long you and baby will be chattering back-and-forth.

  1. Say My Name

One of the biggest language developments a baby will make is learning/recognizing his/her name! While it’s different for every baby, most babies will recognize and respond to their names between 3 to 6 months of age.

To help baby along with this language development, say your baby’s name whenever possible. Some fun ways to say your baby’s name include:

  • Adding his/her name to a silly song,
  • Asking a question with his/her name,
  • Replacing the names of book characters with your baby’s name.
  1. Echo

To develop language babies need to repeat or ‘echo’ words. A great way to include new words and increase language skills is by adding expressive phrases to everyday situations.

For instance, if your baby drops his/her bottle on the floor say, “Oh no!”

I’ve found this activity also helps develop speech by adding sound effects to baby’s activities. Each time your baby jumps while holding him/her, add a sound effect like boing, boing.” While trying to calm your crying baby, rock him/her back and forth while saying, “swoosh, swoosh.”

Over time, baby will begin to “echo” what he/she hears.

I know it seems silly, and that’s because it is! Echo is meant to be a fun learning activity for babies, so the sillier you get with sound effects and funny phrases the more baby absorbs new words, sounds, and phrases.

  1. This Little Piggie

Next time, your baby is laying on his/her back, grab a foot and start saying the rhyme “This Little Piggie.” Since this game doesn’t number each of the five toes, the rhyme needs to be modified to help baby learn numbers.

Instead of saying “This little piggie went to the market” say, “The first little piggie went to the market; the second little piggie stayed home,” etc.

Another I’ve done the rhyme to help with number recognition is by saying the rhyme the following way:

  • “One little piggie went to the market”
  • “Two little piggies stayed home”
  • “Three little piggies had roast beef”
  • “Four little piggies had none”
  • “And five little piggies cried wee, wee, wee all the way home”

While this may give the rhyme much more little piggies, it still allows your baby to hear each number and count the number with each toe.

  1. Carpool

Carpool is an activity that’s perfect for crawling babies! While baby is crawling, get down and your hands and knees and teach baby how to push a car or truck as she/he is crawling. Your baby doesn’t have to keep a constant hand on the car, just a little push in between crawling motions.

To include speech development, add car sound effectstell a funny story about the car ride; sing “Wheels on the Bus/Car/Truck”; etc.

  1. Roll-A-Ball

This game if perfect for babies who can sit unsupported and have decent hand/eye coordination. Simply take a (medium- to large-sized) ball and roll the ball directly toward him/her. Incorporate language skills by saying phrases like “Here is your red ball!”

Roll-A-Ball can become more advanced by helping baby understand simple instructions and responding to those instructions. Try rolling a ball over to him/her and asking him/her to roll the ball back. 

  1. Count with Me

You can help your baby with learning numbers by counting out loud to him/her every day. This activity doesn’t require extra effort on your part, simply start talking and counting out loud.

The following are great ways to include number counting each day:

  • Count each stair step as you carry baby upstairs,
  • Count how many bananas you bought at the store,
  • Count baby’s fingers and toes.
  1. Disappear, Reappear

Instead of playing a regular game of peek-a-boo, try playing with your baby’s favorite toy or stuffed animal. Hide his/her toy from view. Wait and few seconds and say peek-a-boo.” You can also incorporate more speaking skills into the game by adding some creative dialogue!

Examples: “Peek-a-boo! There you are . . . Mister Bear missed you so much! Thank goodness you found him!”

  1. Finger Puppets

Small finger or hand puppets are an amazing way to help develop language skills for your little one! By using finger or hand puppets to tell a story you are showing baby the following language and speech skills:

  • Different facial expressions to show emotions when speaking
  • Creative dialogue between two or more puppets (similar to speaking between two people).
  1. Fruits and Veggies

Much of a baby’s speech development has to do with repetitive hearing and use of everyday words. One way to help with word recognition of common fruits and vegetables is by playing pretend with plastic fruits and vegetables.

Although baby will need to be supervised with pretend plastic food because of small pieces, he/she will learn how to recognize a banana, carrot, pear, and more! 

Also, don’t forget to count your fruits and veggies for number recognition!

  1. Picture This

One of the easiest ways to help develop language skills in babies is through flashcards. Flashcards with pictures and writing help your baby begin to recognize what the picture or action is on the card along with the corresponding word or phrase. 

While your baby won’t say the words out loud for a while, it helps him/her to recognize the picture with the associated word. 

  1. Build a Tower

Building a tower with blocks is perfect for developing hand/eye coordination. But this activity can also be used for encouraging language development in babies.

As you watch or directly help your child stack blocks, say the color of the block along with counting the blocks as the tower is being stacked. Many available baby blocks also have pictures in which you can describe the picture to your baby. For instance: If you have blocks with animals pictured on them, name each animal along with the sound the animal makes.

It’s a Process

Speech development is more than speaking words. It is a complex system of verbal and nonverbal communication. To express emotions and thoughts you baby will first begin to cry to communicate his or her needs to you.

After communication crying, the sky is the limit for speech development and your baby! 

But your baby needs your help along the way! The best way to develop language skills by year one is through imagination and play. 

Each of the 21 activities above combines:

  • Imaginative play,
  • Simple instructions for you and baby to follow,
  • Activities involving both verbal and nonverbal speech.

So start playing some of these fun speech and language activities to give your baby a head start before he or she turns one!


Credit to:

Liz Talton

Dallas, Texas

SAHM Blogger, Masters in Psychology



The Company expressly disclaims any and all liability (including liability for negligence) in respect of the use of the information provided. The Company recommends you seek independent professional advice prior to making any decision involving matters outlined in these publications.



World Down Syndrome Awareness Day

Every year, on March 21st, individuals with Down Syndrome, as well as their families, friends, coworkers, communities, and governments, celebrate their extra chromosome and advocate for other individuals like them.

As part of our goal to be a global voice for advocating for Down syndrome awareness, this blog presents the history of World Down Syndrome Day, an overview of what World Down Syndrome Day is, and how you can participate.


In 2012, World Down Syndrome Day officially became an internationally recognized day by the United Nations General Assembly. Its mission is to participate in activities that raise awareness for the “rights, inclusion, and well-being of people with Down syndrome.” Before this international declaration, many countries had been unofficially celebrating World Down Syndrome Day since 2006 as a way to spread awareness.  

March 21st was specifically chosen because ‘3/21’ represents the fact that individuals with Down syndrome have a third copy of the 21st chromosome.   

What is World Down Syndrome Day?

As I said before, it’s a day to advocate for the rights, inclusion, and well-being of individuals with Down syndrome. There are a lot of misconceptions about the value of life a person with Down syndrome, as well as what these individuals are capable of. This year’s event, World Down Syndrome Awareness Day 2020, is just one of many efforts to spread the word that individuals with Down syndrome have a voice and a valuable place in society. 

Each year, there is a theme for World Down Syndrome Day. For 2020, the theme was “We Decide,” meaning each individual with Down syndrome should have:

“Full participation in decision making about matters relating to, or affecting their lives.”

In 2021 the theme is #CONNECT. Watch virtual World Down Syndrome Day (WDSD) side event at United Nations Geneva!

The theme may change, but the main focus of World Down Syndrome Day stays the same. Its message is to encourage full inclusion in society, in classrooms, workplaces, community events, etc. This goal is achieved by making information accessible, with good support for individuals with Down syndrome, as well as education for others about what inclusion means.

Another major part of this is showing how to effectively incorporate inclusive practices into their communities. An important focus is to empower individuals with Down syndrome and their families to advocate for and access meaningful participation with their communities.

How Can I Participate?

There is no one way to participate in World Down Syndrome Day. Each community and family celebrate activities and events a little differently. This is beautiful in its own way. Celebrating diversity and differences is at the core of the message of World Down Syndrome Day. 

However, some common ways people celebrate are:

  • Wear socks, wear brightly coloured, mismatched socks. Why? Socks look similar to chromosomes. Chances are, if you proudly wear loud socks, someone will ask why. This action can open the door for discussing Down syndrome, World Down Syndrome Day, and what they mean.
  • Acts of Kindnessto spread joy and awareness.
  • Many communitieshold events to raise money and awareness to support the efforts of organizations dedicated to promoting the inclusion, rights, and well-being of individuals with Down syndrome.
  • Share information in the classroom, workplace or in your community about Down syndrome. This websitehas some good resources to use!
  • Support businesses owned by individuals with Down syndrome. Here are a few (there are many more!)”
  • John’s Crazy Socks
  • Sweet Heat Jams
  • DaBombs: Bath Bombs
  • Gracie’s Doggie Delights
  • Riverbend Galleries
  • Ashley Brickhead Art
  • Christian Royal Pottery
  • Allie Art Designs
  • Advocate and educate! Really, just sharing the message via social media or interactions with others is the main goal of World Down Syndrome Day. Educate yourself, ask questions, have discussions, then share with others.

So, this is an overview of World Down Syndrome Day. Please note that you are invited to join the effort to raise public awareness and advocate for the rights of individuals with Down syndrome, not only on March 21st but every day.


Credit to:

Kelli Green

Salt LakeCity, Utah


The Company expressly disclaims any and all liability (including liability for negligence) in respect of the use of the information provided. The Company recommends you seek independent professional advice prior to making any decision involving matters outlined in these publications.



Potential Impact of the COVID-19 Pandemic on Communication and Language Skills in Children

The COVID-19 pandemic has led to many unintended, long-lasting consequences for society. Preventative practices such as mask wearing, social distancing, and virtual meetings and classrooms to address contagion concerns may negatively affect communication, particularly in the pediatric population, as schools have begun to open this fall. Increasing awareness and creating innovative methods to promote communication and language learning in settings both in person and virtual is paramount. Although more studies are needed to characterize the pandemic’s impact on pediatric speech and language development, clinicians and parents should be cognizant of this phenomenon and proactive in facilitating an optimal communication environment for children.

Preventative strategies such as mask wearing and social distancing have become a part of everyday life in an attempt to reduce the risk of infection during the COVID-19 pandemic. As schools have begun to open this fall, there are increasing concerns over how the COVID-19 pandemic will affect the younger generation. For example, in-person classes have been canceled in favor of virtual meetings and classrooms due to contagion concerns. Increased use of masks, social distancing, and the quarantine of individuals exposed to or infected with COVID-19 have been encouraged to prevent the spread of the virus. Although necessary, these practices may have unintended consequences on children’s language and communication skills during their critical development years.

Disproportionate Impact on Communication in Children With Hearing Loss

Incidental features of the COVID-19 pandemic may have long-lasting effects on the development of communication skills. Masks are known to degrade the speech signal, serving as a low-pass filter by attenuating high frequencies spoken by the wearer; the decibel level of attenuation ranges from 3 to 4 dB for simple medical masks and close to 12 dB for N95 masks.1 In children with hearing loss, this seemingly small change may significantly affect speech understanding as compared with their normal-hearing peers. Speech perception also involves audiovisual integration of information, which is diminished by wearing masks because articulatory gestures may be obscured. Children with hearing loss may be more dependent on lip-reading; loss of this visual cue may exacerbate the distortion and attenuation effects of masks. Loss of such visual cues could also influence language acquisition in young children without developmental challenges. Salient visual cues contribute to speech processing during crucial periods of language and speech development.2

Children with hearing loss may be disproportionately affected by virtual education as compared with their normal-hearing peers. Individuals with a hearing impairment are particularly affected by what has been coined “Zoom fatigue,” which is due to the increased listening effort from difficulties interpreting nonverbal cues (eg, inability to lip-read because of pixelated video), poor audio quality, and audiovisual dyssynchrony.3 Studies have shown that listening becomes effortful in challenging auditory environments, such as a noisy background or when the listeners themselves have deficits in auditory processing. Studies supporting this “information degradation hypothesis” demonstrate short-term and possibly long-term effects of auditory processing on diminished cognitive performance in adults.4 This phenomenon has yet to be extensively studied in school-age children.

Impact on Social Interaction and Language Development

Social interaction is also essential for language development. Social distancing measures and restrictions on large group gatherings have affected school-age children from having meaningful, in-person interactions with peers. “Peer talk” is a crucial component of pragmatic development; this includes conversational skills such as turn taking and understanding the implied meaning behind a speaker’s words.5 Masks can also obscure social cues provided through facial expressions. The emergence of virtual and hybrid schools will ultimately result in fewer opportunities to exercise conversational and social skills in person rather than asynchronously or via virtual screens.

Mitigation Strategies

Several strategies can be employed to mitigate the effects of the COVID-19 pandemic on developing communication skills in children. These include the use of transparent masks to allow for visual input in an in-person setting. In virtual classrooms, educators should ensure optimization of the visual and auditory environment using adequate equipment, video chat capabilities (eg, chat, mute, and “raise hand” functions), as well as supplemental captioning, recording, and transcribing services. Zoom fatigue can be avoided by allowing the opportunity for students to “unplug” and obtain appropriate rest in between meetings.

Clinicians should be aware of the potential language and communication ramifications of the COVID-19 pandemic, particularly in the pediatric population. Health care personnel such as otolaryngologists, audiologists, and speech-language pathologists are the gatekeepers of communication. As such, these providers are in a prime position to facilitate primary and secondary prevention of communication impairment (ie, language delay). This can be achieved by educating parents (particularly those of children with hearing loss), teachers, and the general public and by providing strategies to mitigate the possible risk for developmental language delay. Scheduling teletherapy sessions via videoconferencing can help facilitate continuity of care during the pandemic. Speech-language pathologists can also provide useful strategies for parents to optimize the home environment for speech and language development.6

The COVID-19 pandemic continues to present many unintended consequences for society. Preventative practices such as mask wearing, social distancing, and virtual meetings and classrooms to address contagion concerns may negatively affect communication. Increasing awareness and creating innovative methods to promote communication and language learning in such settings of decreased environmental language input or unfavorable auditory environments is paramount. Although more studies are needed to characterize the pandemic’s impact on pediatric speech and language development, clinicians and parents should be cognizant of this phenomenon and proactive in facilitating an optimal communication environment for children. Although new research on telehealth, virtual parent training, and optimizing online teaching is needed, there are ample evidence-based strategies available to facilitate teaching, speech perception, and speech and language development to at least partially offset the adverse conditions that all are experiencing during this pandemic.

Credit to:

Sara A. Charney, manuscript drafting; Stephen M. Camarata, manuscript drafting; Alexander Chern, manuscript drafting



The Company expressly disclaims any and all liability (including liability for negligence) in respect of the use of the information provided. The Company recommends you seek independent professional advice prior to making any decision involving matters outlined in these publications.