Should Parents Work on Their Child’s Speech Goals at Home?

Parents frequently ask us: “How much time do parents work on their child’s speech and language goals at home? What are parents’ roles and responsibility in speech therapy?”

In short: Parents should work on speech therapy skills daily with their children.

It doesn’t mean you have to sit down as soon as you get home and start drilling them with flashcards and work.

Though this may seem overwhelming after a long day, the more frequently your child is exposed to certain skills, means the more the skill learning carryover, which is the goal of speech therapy at home!

A child spends 2% of their awake time at speech therapy, and 98% of their time at-home with parents.

Your child’s speech-language pathologist should be giving you “homework,” and if not, please ask for ideas and strategies from them.

You should also be sitting in on therapy sessions, if your child is participating in early intervention services.

If your child only gets speech at school, please make sure you reach out to the speech pathologist often for updates to see if there’s anything you can do at home. 

Every opportunity is a speech opportunity! This means the smallest tasks, such as brushing your teeth, can be a chance to sneak in language, directions, asking questions, and having your child elaborate on things they say. 

What Can You Do at Home?

I worked as an early intervention therapist for seven years before I started my private practice, and I can tell you that the children whose parents are actively involved and participate move through therapy faster and see quicker results. These parents constantly asked me for progress notes and for things they could work on at home! It may seem like a lot, but chances are you are already doing some of the exercises that I’m going to talk about.

Use These Ideas to Start Working on Speech at Home

  • Read to your child for 5-10 minutes before bed. Make sure you are pointing at stuff, having your child point to specific objects, and asking questions. This reinforces how and what they’re saying (expressive language), as well as what they are understanding (receptive language). 
  • Narrate your day to your child.Use simple, easy to understand language, and make sure you keep it clear and to-the-point. When you are cooking, talk about what you are doing (e.g. “Mommy is stirring the soup”). When driving, you can say things like, “We just turned left.” 
  • Play games.Playing games is one of the most fun and interactive ways to use language. It works on social language, such as turn-taking, their ability to follow directions, and gives them plenty of chances to work on speech sounds.
  • Get together with family and friends. This gives other people in your child’s life the opportunity to engage and talk to them. These opportunities improve the chance they will retain the skills that you and the therapist are working to achieve, allows your child to be exposed to different words and contexts, and lets you know how easily understood their speech is to other people. 

So, because you are with your child far more than the therapist is, parental involvement in therapy is so very important. Every time is a good time to work on speech!

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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.


Teach Words That Matter: Why we should save pre-academic concepts for preschool

I recently had a post go “mini viral”. I’m not going to the Today Show, but over 800 people shared this post and it was viewed by over a hundred thousand people! I knew I had raised a topic that people found shocking, important, or maybe even vexing. The post (pictured above) emphasized the importance of focusing on *functional vocabulary* with young children before teaching pre-academic concepts like colors, numbers, letters, and shapes. Functional vocabulary means words that can be used to communicate for a variety of purposes including requesting, protesting, and commenting on the environment.

This feels like a trap…

It seems like every toy on the market for young children features colors, numbers, letters, and shapes. As parents, its feels natural to introduce these concepts in play as we talk to our child about the toy. Many people place value on learning these pre-academic concepts because they associate them with academic preparedness and future success. However, the most important thing you can do to prepare your child for school is to provide them with a strong foundation of language skills. Try using core words, descriptors, common nouns, and verbs to help your child engage with their environment. Model language for your child as you play and go about your daily routines. Research (Rowe 2019) shows that both quantity AND quality of input (the language your child hears) are important predictors of vocabulary skills. This means you want to talk a LOT, but also provide diverse input with a variety of word types and rare words.

These aren't “BAD” words…

By no means do you need to avoid using the labels for colors, shapes, numbers, and letters. It just helps to keep in mind that most kids under three are not ready to learn pre-academic vocabulary. Consider these timelines: most kids can label colors, identify shapes, and count to ten between ages 3 and 4. Children can typically identify and label letters between ages 4 and 5. I would expect a child to be using hundreds of words before they will consistently label colors or count to ten. Teaching vocabulary should be contextual and based on what your child sees and does throughout their day. It is most important that they use many words that allow them to communicate for a variety of purposes. This is a judgement free zone! When making decisions about how to introduce these concepts, it’s all about finding the balance that works for you and your child.

Before you throw away all of your toys, try this!

There is a high likelihood that many of the toys your child has seem like they were made for the sole purpose of teaching colors, shapes, letters, and numbers. However, if we introduce a bit of creativity we can easily use these toys to model a variety of functional vocabulary as well. Let's take a look at these common Melissa & Doug toys for toddlers and brainstorm some ideas for expanding the language we use while playing.

Instead of focusing on teaching colors and shapes, try hiding these pieces around the room or burying them in a bowl of rice or uncooked beans. Hide a piece and ask, “Where is it?”. Model “look” or “dig” along with simple vocabulary for where you find them (ex: “IN the box” or “ON the table”).

Instead of talking about colors and numbers, focus on words like “go”, “stop”, “drive”, “car”, and “house”. Practice putting cars “in”, taking them “out”, and stacking the garages “up”. Talk about which garage is “big” and which one is “little” and experiment with which cars fit into which garages.

Instead of focusing on letter names, practice building “houses”, “trees”, and “trains”. Talk about “building” towers and “knocking down”. Give blocks to family members including “mom”, “dad”, and “baby”. Put blocks on your “head” or “toe” or pretend to “eat” them using a bowl and spoon.

I have created a free PDF handout for Early Vocabulary Targets which you can access through my Members Only Section of the website. Just use the link below to sign up with your email and I will send you the password for access! I have also linked some of my favorite resources for supporting language development through play below!

Free Early Vocabulary Handout (PDF):

How to Select Toys from the Early Intervention Lab at Northwestern:

Playing with Purpose Book from Tandem Speech Therapy:

Learn how to use play to boost speech and language skills in everyday activities.

Understanding Your Toddler Book from Strength in Words:

Learn how to “do more with less”. Connect with your child and support development using materials you already have in your home.

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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.



Early Childhood Mental Health

As early experiences shape the architecture of the developing brain, they also lay the foundations of sound mental health. Disruptions to this developmental process can impair a child’s capacities for learning and relating to others — with lifelong implications. By improving children’s environments of relationships and experiences early in life, society can address many costly problems, including incarceration, homelessness, and the failure to complete high school.

Significant mental health problems can and do occur in young children. Children can show clear characteristics of anxiety disorders, attention-deficit/hyperactivity disorder, conduct disorder, depression, posttraumatic stress disorder, and neurodevelopmental disabilities, such as autism, at a very early age. That said, young children respond to and process emotional experiences and traumatic events in ways that are very different from adults and older children. Consequently, diagnosis in early childhood can be much more difficult than it is in adults.

The interaction of genes and experience affects childhood mental health. Genes are not destiny. Our genes contain instructions that tell our bodies how to work, but the chemical “signature” of our environment can authorize or prevent those instructions from being carried out. The interaction between genetic predispositions and sustained, stress-inducing experiences early in life can lay an unstable foundation for mental health that endures well into the adult years.

Toxic stress can damage brain architecture and increase the likelihood that significant mental health problems will emerge either quickly or years later. Because of its enduring effects on brain development and other organ systems, toxic stress can impair school readiness, academic achievement, and both physical and mental health throughout the lifespan. Circumstances associated with family stress, such as persistent poverty, may elevate the risk of serious mental health problems. Young children who experience recurrent abuse or chronic neglect, domestic violence, or parental mental health or substance abuse problems are particularly vulnerable.

It’s never too late, but earlier is better. Some individuals demonstrate remarkable capacities to overcome the severe challenges of early, persistent maltreatment, trauma, and emotional harm, yet there are limits to the ability of young children to recover psychologically from adversity.

“Most potential mental health problems will not become mental health problems if we respond to them early.”

InBrief: Early Childhood Mental Health

Even when children have been removed from traumatizing circumstances and placed in exceptionally nurturing homes, developmental improvements are often accompanied by continuing problems in self-regulation, emotional adaptability, relating to others, and self-understanding. When children overcome these burdens, they have typically been the beneficiaries of exceptional efforts on the part of supportive adults. These findings underscore the importance of prevention and timely intervention in circumstances that put young children at serious psychological risk.

It is essential to treat young children’s mental health problems within the context of their families, homes, and communities. The emotional well-being of young children is directly tied to the functioning of their caregivers and the families in which they live. When these relationships are abusive, threatening, chronically neglectful, or otherwise psychologically harmful, they are a potent risk factor for the development of early mental health problems. In contrast, when relationships are reliably responsive and supportive, they can actually buffer young children from the adverse effects of other stressors. Therefore, reducing the stressors affecting children requires addressing the stresses on their families.

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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.



10 Top Tips for At-Home Speech Practice

Focus on target sounds for rapid speech and language development.


1. It’s never too early to start. 

From day one, your baby is listening and looking at your face. Making sounds that your baby can look at and listen to is fun, interactive, and great for their early communication skills. 

2. Different sounds are perfected at different ages. 

We would not expect a 2-year-old to be able to produce a beautiful “sh” or perfect “th.” Nor would we expect a 4-year-old to always manage multi-syllable words with consonant clusters like “st” “thr” “pl,” etc. Many of your child’s errors could well be age-appropriate. This is important to bear in mind, as we want to support and model appropriate sounds for your child’s age that are within their ability to achieve. 

Have a look at the list below to get an idea of where you could start . . . (Norms taken from – Speech Sounds, Goldman-Fristoe Test of Articulation 2 (GFTA-2) (2000)):

2 yrs. – /b/ /h/ /d/ /m/ /n/ /p/

3 yrs. – /f/ /g/ /t/ /k/ /w/ /ng/

4-5 yrs. – /ch/ /j/ /l/ /s/ /ch/ /bl/ /j/ /r/

6 yrs. – /v/ /br/ /dr/ /fl/ /fr/ /gl/ /gr/ /kl/ /kr/ /pl/ /st/ /tr/  

7 yrs. – /z/ /sl/ /sp/ /sw/ /th/


3. Hearing and seeing. 

The best way for a child to learn or perfect a sound is by hearing it and seeing it over and over again. Avoid asking your child to say the sound. Instead show them. They will automatically repeat and practice in time. Get face-to-face and at eye level with your child to help them see your model. Turn off background noise to help them hear your model. 


4. Practice during play. 

Just like us, our kids much prefer to do things if they are fun and motivating! The great thing is, speech can be practiced during play. When they are playing with their toys or taking part in an activity, just add the sounds to the action . . . for example, if they are pushing cars . . . add “mmmmmm” to their driving, “ssssss” to filling up with petrol, “k-k-k-k” to the crane lifting. If they are playing with dolls . . . add “sssshhh” when washing hair, “t-t-t” when they walk, and add “zzzz” when they go to sleep.


5. Practice every day.

Sometimes getting down on the floor and doing 1:1 play with our child is something we want to do, but for which we don’t always have the time. Don’t worry. Instead, add sound play to the things in your daily routine, for example, repeat a ‘p’ sound on each step when walking up the stairs, model ‘sh’ when pouring water in the bath, model ‘k’ when chopping up their dinner, or model ‘z’ when brushing their teeth.


6. Where does the sound occur in the word? 

When playing with sounds, think about the sounds at the start of a word, but also the sounds in the middle, and at the end. For example, if you are working on ‘t,’ model it at the start “tea,” in the middle “water,” and at the end “cat.”


7. Start with single sounds. 

Start by modeling the sound on its own. Just like when a baby starts repeating single sounds when they babble, do the same by modeling the sound on its own, for example, “g – g – g.” Let them see your mouth, the shape of your lips, and the position of your tongue. All of these help your child improve the accuracy of their production.


8. Work on single words. 

Move on to modelling the sound in single words, when you name things in the world around your child. This allows the child to hear the sound clearly, for example: goat, goal, and game.


9. Try simple sentences. 

Boost the difficulty by creating simple, clear sentences and modeling the words. Looking at books is a great way to help your child use their new sound in sentences. Use short sentences to describe things in the pictures, e.g. “the dog is walking,” or “the baby is crying.”


10. When in doubt . . . guess! 

If your child speaks but you don’t understand, guess what they have said and say it back to them. First, this lets him/her know that you are listening; secondly, you may guess right and so your child will feel successful; thirdly, it’s an opportunity for your child to hear clear and accurate pronunciation. 

Speech sound development and language skills can be a long process, and will likely take weeks and maybe even months to see progress. If you have any questions, ask your local speech therapist for help with speech therapy at home. But keep your speech homework fun and simple, and keep going to get super speech started! 




Credit to:

El Robertson

Paediatric Speech and Language therapist BSC, London, UK



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.


Benefits and Options for Therapy

Wondering if therapy is right for you? You’re not alone.

Seeking help from a mental health expert is something many people consider, especially when:

  • facing a significant crisis
  • dealing with an extended period of anxiety or depression
  • coping with a major life transition
  • dealing with complicated family dynamics
  • grappling with problems in a relationship
  • trying to manage addiction or substance abuse
  • wanting to make changes for better mental and emotional health

Regardless of your reason, therapy offers a broad array of benefits for all of us. Here are six types of therapy and the benefits of each.

Benefits of talk therapy 

Talk therapy (aka psychotherapy) is a tool used by:

Talk therapy encourages open and honest dialogue about issues that cause you distress. Through your relationship with your therapist, you’ll work to identify and understand how these stressors are impacting your life, plus develop strategies to manage the symptoms.

If you’re still on the fence about the benefits of talk therapy, consider this: About 75 percent of people who participate in talk therapy experience some benefit, according to the American Psychological Association.

What can talk therapy help with?

Focused on communication, talk therapy allows you discuss concerns that range from stress management and relationship problems to depression and anxiety disorders.

Psychotherapy is a tool that therapists also use to facilitate counseling sessions. They can use this technique for individual, group, couples, or family therapy.

Benefits of individual therapy

In the case of individual therapy, the relationship between you and your therapist — which is fostered through talk therapy — is key to your success.

Individual therapy gives you a safe space to explore your thoughts, feelings, and concerns.

Unlike couples, family, or group therapy, individual therapy focuses solely on you. This allows for a deeper understanding of the issues and more time for developing coping strategies to help you handle difficult situations.

The goal of individual therapy is to inspire change and improve the quality of life through self-awareness and self-exploration.

Being in therapy can also:

  • help improve communication skills
  • help you feel empowered
  • empower you to develop fresh insights about your life
  • learn how to make healthier choices
  • develop coping strategies to manage distress

Benefits of family therapy 

When families face hurdles that seem a bit too high to conquer on their own, they may seek help from a family therapist. According to the American Association for Marriage and Family Therapy, a therapist can:

  • evaluate and treat mental and emotional disorders
  • evaluate and treat behavioral problems
  • address relationship issues within the context of the family system

Unlike individual therapy, treatment isn’t just for one person — even if that’s the only member of the family working with the therapist. Instead, the focus is on the set of relationships that make up the family unit.

Some of the most notable benefits of family therapy include:

  • improving communication skills
  • providing help treating mental health concerns that impact the family unit (such as substance abuse, depression, or trauma)
  • offering collaboration among family members
  • developing individual coping strategies
  • identifying ways to find healthy support


Traditional therapy – done online

Find a therapist from BetterHelp’s network of therapists for your everyday therapy needs. Take a quiz, get matched, and start getting support via phone or video sessions. Plans start at $60 per week + an additional 10% off.


Benefits of couples therapy 

Think couples therapy is only for people having problems? Think again!

Marriage and family therapists are the first to say that couples therapy is an effective way to keep a relationship on track before it goes off the rails. But if the strains are real and communicating is almost impossible, going to therapy allows couples to meet with a neutral party.

One of the foundational goals of couples therapy is learning how to improve interpersonal dynamics. A 2016 research reviewTrusted Source suggest that couples therapy is an effective treatment when a couple is experiencing individual and relational distress.

Couples seek therapy for a variety of reasons. Some of the more common benefits cited by couples include:

  • improving communication skills
  • resolving conflict
  • restoring lost trust
  • increasing shared support
  • restoring intimacy
  • learning how to support each other through difficult times
  • forming a stronger bond

Benefits of cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) is a blend of two other therapies: behavioral and cognitive.

Therapists use this technique to treat many conditions, including:

  • anxiety disorders
  • bipolar disorder
  • depression
  • eating disorders
  • substance abuse and addiction
  • obsessive-compulsive disorder
  • phobias
  • post-traumatic stress disorder

In CBT, your therapist will guide the sessions with an emphasis on the important role of thinking in how you feel and what you do.

In terms of effectiveness, CBT has proven successful as a treatment option on its own or as a supplemental therapy to medication for several mental health conditions, including:

  • anxiety disorders
  • bipolar disorder
  • depression

2017 research reviewTrusted Source found that CBT has a positive impact for people living with bipolar disorder by:

  • reducing depression levels
  • reducing the severity of mania
  • decreasing the relapse rate or how often people experience mania and depression
  • increasing psychosocial functioning, which means improving abilities and experiences in day-to-day activities and relationships

2015 reviewTrusted Source reports that CBT is the most consistently supported psychotherapeutic option for treating anxiety disorders.

Benefits of online therapy 

The way we seek help is changing as more providers move to online platforms. Just the idea of having options is one of the benefits of online therapy, or teletherapy.

Not only does this allow you to meet with a therapist from wherever you might be, it also gives you the freedom to choose the delivery method of that therapy. In other words, you can reach a therapist from your phone, an app, or online.

This may make it easier for you to find a counselor you connect and communicate well with.

The ability to get help for mental health this way means more people have access to therapy than ever before. It also helps minimize the stigma attached to mental health, and it gives you options.

If you’re worried about online therapy not being as effective as the in-person kind, consider the results from this small 2014 study. Researchers found that internet-based treatment for depression was equally beneficial as face-to-face therapy.

While over-the-phone and online therapy may not work for everyone in all situations, it’s an option to try.

Ways to find a therapist

Just as there are options to speak with a therapist over the phone, voice chat, and online, there are:

If you’re looking into therapy, another place to start is by talking with a general physician about getting a referral.

Online therapy options

Read our review of the best online therapy options to find the right fit for you.

The takeaway

Working with a psychologist, therapist, or counselor in a therapeutic relationship gives you an opportunity to explore your thoughts, feelings, and patterns of behavior.

It can also help you learn new coping skills and techniques to better manage daily stressors and symptoms associated with your diagnosis.

Benefits of counseling

  • Explore thoughts, feelings, and worries without judgment.
  • Develop coping strategies for different situations.
  • Practice self-reflection and awareness.
  • Work on habits you’d like to change.
  • Improve, understand, and communicate about relationships.



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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 psychotherapy?

Psychotherapy can help treat challenges and symptoms relating to mental health and emotions.

Also known as talk therapy, psychotherapy aims to help a person understand their feelings and equip them to face new challenges, both in the present and the future.

Psychotherapy is similar to counseling, and the two can overlap. However, the former tends to look more deeply, addressing the underlying causes of a person’s problems as well as how to solve them.

To see positive results, a person will usually need to understand the need for change and be willing to follow the treatment plan as the specialist advises. They will also need to find a suitable therapist they can trust.

Psychotherapy can help when depression, low self-esteem, addiction, bereavement, or other factors leave a person feeling overwhelmed. It can also help treat bipolar disorderschizophrenia, and certain other mental health conditions.

People often, but not always, use both psychotherapy and medication.

In this article, learn more about what psychotherapy involves.

What to expect

There are many approaches to psychotherapy.

Some forms last for only a few sessions, while others may continue for months or years, depending on the person’s needs. Individual sessions usually last for around 45–90 minutes and follow a structured process.

Sessions may be one-to-one, in pairs, or in groups. Techniques can include talking and other forms of communication, such as drama, story-telling, or music.

A psychotherapist may be:

  • a psychologist
  • a marriage and family therapist
  • a licensed clinical social worker
  • a licensed clinical professional counselor
  • mental health counselor
  • a psychiatric nurse practitioner
  • a psychoanalyst
  • a psychiatrist

Who can benefit?

Psychotherapy can help people in a range of situations. For example, it may benefit someone who:

  • has overwhelming feelings of sadness or helplessness
  • feels anxious most of the time
  • has difficulty facing everyday challenges or focusing on work or studies
  • is using drugs or alcohol in a way that is not healthful
  • is at risk of harming themselves or others
  • feels that their situation will never improve, despite receiving help from friends and family
  • has experienced an abusive situation
  • has a mental health condition, such as schizophrenia, that affects their daily life

Some people attend psychotherapy after a doctor recommends it, but many seek help independently.


There are several styles of and approaches to psychotherapy. The sections below will outline these in more detail.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) helps a person understand and change how their thoughts and behaviors can affect the way they feel and act.

CBT can help people with many issues, including:

Interpersonal therapy

Under this approach, a person learns new ways to communicate or express their feelings. It can help with building and maintaining healthy relationships.

For example, if someone who responds to feeling neglected by getting angry, this may trigger a negative reaction in others. This can lead to depression and isolation.

The individual will learn to understand and modify their approach to interpersonal problems and acquire ways of managing them more constructively.

Psychodynamic therapy

Psychodynamic therapy addresses the ways in which past experiences, such as those during childhood, can impact a person’s current thoughts and behaviors. Often, the person is unaware that this influence is even present.

Identifying these influences can help people understand the source of feelings such as distress and anxiety. Once they identify these sources, the psychotherapist can help the person address them. This can help an individual feel more in control of their life.

It is similar to psychoanalysis but less intense.

Family therapy

Family therapy can provide a safe space for family members to:

  • express their views
  • explore difficult feelings
  • understand each other
  • build on existing strengths
  • find solutions to problems

This form of psychotherapy can be useful when problems stem from family relationships, or when a child or young person is facing difficulties.

In fact, one 2019 articleTrusted Source suggests that family therapy may help adolescents with mental health problems. It may also improve family cohesion and enhance parenting skills.

Relationship therapy is another type of psychotherapy. It is very similar to family therapy, but a person may instead wish to present to therapy with their partner to address issues within a relationship.

Group therapy

Group therapy sessions usually involve one therapist and around 5–15 participants with similar concerns, such as:

  • depression
  • chronic pain
  • substance misuse

The group will usually meet for 1 or 2 hours each week, and individuals may also attend one-on-one therapy.

People can benefit from interacting with the therapist but also by interacting with others who are experiencing similar challenges. Group members can also support each other.

Although participating in a group may seem intimidating, it can help people realize that they are not alone with their problem.

Online therapy

Many people are now opting for online therapy, otherwise known as telehealth. This can have many benefits, especially for someone who:

  • has mobility problems
  • cannot find a suitable specialist in their area
  • has difficulty fitting therapy into their schedule
  • does not feel comfortable with face-to-face communication

Tools include video meetings and messaging services.

Although online services have helped “normalize” psychotherapy, making it easier to integrate into daily life, a person should check carefully before choosing a provider.

For example, they should consider:

  • the qualifications and experience of the therapist
  • the online and other security measures the provider has in place
  • using a company that psychologists run and that has links with professional associations

Other types

There are many other types of psychotherapy, including:

  • animal-assisted therapy
  • creative arts therapy
  • play therapy


Each person’s experience of psychotherapy will be different, and the time it takes to see an improvement will also vary.

Some people will notice a difference after around six to 12 sessions, while others may need ongoing treatment for several years.

Psychotherapy can help a person by:

  • giving them someone to explore their problem with confidentially
  • enabling them to see things in a new way
  • helping them move toward a solution

Participants can:

  • learn more about themselves and their goals and values
  • identify causes of tension in relationships
  • develop skills for facing challenges
  • overcome specific problems, such as a phobia

To benefit from the process, a person needs to:

  • have a desire to participate
  • engage actively in treatment
  • attend appointments and complete any assignments between sessions
  • be honest when describing symptoms and situations

Effectiveness can also depend on:

  • the reason for seeking therapy
  • the skill of the practitioner
  • the relationship between the therapist and the individual
  • any support the person may have outside the therapy sessions

A trusting relationship between the individual and the therapist is also essential to the process.

A good therapist

According to the American Psychological Association (APA), the qualities of a good therapist include such factors as:

  • having a developed set of interpersonal skills
  • taking time to build trust with the individual
  • having a treatment plan in place and keeping it flexible
  • monitoring the person’s progress
  • offering hope and realistic optimism
  • relying on research evidence

Choosing a suitable therapist

People seek psychotherapy for a wide range of reasons, and each individual is different. Providers should have training in dealing with a wide range of situations, but some can meet more specific needs.

For example, a practitioner may specialize in counseling for survivors of sexual abuse.

A person who has experienced trauma due to raceTrusted Sourcesexual orientation, or human trafficking, for example, will need to find someone who understands where the person is starting from. They will also need appropriate training.

After identifying a therapist who seems suitable, the individual should ask plenty of questions before starting therapy to make sure that this is the person they want.

A doctor, online community, or local support group can often recommend a suitable therapist.

Risks and cautions

Psychotherapy can offer many benefits, but there are some cautions to be aware of before starting. The following sections will outline these in more detail.

Unexpected effects

During psychotherapy, some people may experience changes they had not expected or did not want.

Recalling past events can sometimes trigger unwanted emotions. Addressing and resolving these emotions is an integral part of therapy, but it can be challenging.

It is essential to find a trusted and qualified psychotherapist who is skilled at guiding people through these situations in a constructive way.

Unhelpful therapy

Most people feel better as a result of therapy, but it can take time to work — and sometimes, the approach the therapist takes is not suitable. In fact, according to some research, around 10% of people feel worse after starting therapy.

Some experts have expressed concerns about potentially harmful therapies. These could be techniques that leave a person feeling worse rather than better or approaches that may actually slow an individual’s progress.

Some approaches may not have enough research evidence to support their use. In some cases, the approach or “chemistry” between the individual and the therapist may not be suitable.

However, if the practitioner monitors the person’s progress regularly and asks for feedback, the risk of therapy not working or having a negative impact will be lower.

Using an interpreter

Not everyone can find a psychotherapist who speaks their primary language. This can pose a challenge for people who are already at a disadvantage in society.

One option is to find an interpreter, but it is essential to find someone who understands the complex issues that treatment is likely to involve.

Ideally, the person should also have the skills and training necessary for managing the specific dynamics the relationship will involve.

Cost in time and money

Psychotherapy can be expensive and time consuming. This is another reason that it is essential to find a qualified practitioner.

If a health professional considers treatment necessary, the Mental Health Parity Act requires that insurance companies pay for mental healthcare in a similar way to paying for physical medical care.

It is worth noting that the definitions of “reasonable and appropriate” or “medically necessary” may vary.


Psychotherapy can help people with various mental health needs, ranging from overcoming stress to living with bipolar disorder.

A doctor will often prescribe it alongside medication, though some people may only benefit from psychotherapy.

It is essential to find a professional. The person should be well-qualified and experienced, and they should inspire a person’s trust and confidence.

Family physicians can usually recommend a suitable psychotherapist, or a person can find a suitable practitioner through a register, such as the APA’s psychologist locator.



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When caregivers start asking questions about their child’s language development and late talking, speech-language pathologists hear answers like this all. the. time.

  • “Don’t worry – he will talk when he’s ready.”
  • “She’s just a late talker, she will catch up.”
  • “Boys talk later than girls, he’s fine.”
  • “She’s just letting big brother talk for her.”

While these responses may provide temporary comfort, they actually dismiss very valid concerns and perhaps do an extreme disservice to our children. I feel it’s my responsibility to ensure the concerns of caregivers are heard. I believe parents are the experts on their children. They know what is typical for their child. I trust that if a caregiver has a concern or uneasy feeling about how their child is developing, it is worth my concern too.

Read more about the dangers of “wait and see” here.

Who is a “late talker?”

A “late talker” is a toddler, age 18-30 months, who:

  1. Hasn’t started using words by age 18 months [OR]
  2. Has less than 50 words [AND/OR]
  3. Is not combining words together [AND]
  4. Otherwise has typical development

Late talkers typically appear to have good understanding of what is said to them, engage in appropriate, but often quiet play, and interact well with others using gestures.

By 18 months, a child should use at least 20 different types of words, such as:

-Nouns (doggie, milk)

-Verbs (go, eat)

-Prepositions (up, down)

-Adjectives (big, hot)

-Social words (hi, bye)

By 24 months, a child should use at least 100 words and combine two words together, such as “where shoe?” or “drink milk.”

You can find more information about language milestones here.

If you have concerns about late talking, please talk with your pediatrician and request a hearing screening to rule out hearing loss. 

So, what are the facts about late talkers?

1.       We don’t know why some children are late talkers.

Research has not yet been able to determine a cause for why some children are late to talk. However, some children may be at a higher risk of delayed language if they have the following red flags:

  • Child does not use many sounds – Is a “quiet baby”
  • May not use many gestures
  • Does not imitate many sounds or actions
  • May only use few basic words, but does not continue to expand vocabulary
  • Have difficulty understanding directions or vocabulary expected for their age
  • Have a family member with history of language delay
  • Prematurity and/or Low birth weight
  • History of ear infections

(Ellis & Thal, 2008; Olswany, Rodriguez & Timler, 1998).

Children who have physical or developmental delays (such as Cerebral Palsy, Autism, Down Syndrome, Childhood Apraxia of Speech, or receptive language disorder) are not considered “late talkers,” but rather as having a language delay or disorder.

      2. Late talkers may continue to struggle with language even if they “catch up” on their own.


70-80% of late talkers will catch up by kindergarten without intervention, BUT research indicates these children may have lower skills in language (vocabulary and grammar), literacy (reading and writing), social turns, behavior and listening comprehension, and executive function (Dale, Price, Bishop, & Plomin, 2003; Hawa & Spanoudis, 2014).

This means 20-30% of young children will NOT catch up to their peers without intervention. Unfortunately, we cannot reliably predict who will catch up on their own yet. Is waiting a risk worth taking? If your child had a 30% chance of losing their ability to walk, would you just wait and see?

3.       Early intervention works.

Research indicates intervention sooner, rather than later, yields increased language growth, literacy gains, improved social skills, behavior, and attention, as well as executive functioning (e.g., planning, organizing, attention, problem-solving), and overall academic achievement. Providing early intervention to “late talkers” can decrease the impact of future difficulties or lasting effects of delayed language (Capone Singleton, 2018; Olswany, Rodriguez & Timler, 1998).

Pediatricians are often responsible for screening children for speech and language delays at the child’s well check. However, pediatricians have only a general knowledge about speech and language development. Speech-language pathologists (SLPs) are the experts and have more specific education and training to help identify children who need help. Find a certified SLP in your area here.



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About Childhood Apraxia of Speech (CAS)

In order for speech to occur, messages need to go from your brain to your mouth. These messages tell the muscles how and when to move to make sounds. When a child has apraxia of speech, the messages do not get through correctly. The child might not be able to move their lips or tongue in the right ways, even though their muscles are not weak. Sometimes, the child might not be able to say much at all.

A child with CAS knows what they want to say. The problem is not how the child thinks but how the brain tells the mouth muscles to move.

CAS is sometimes called verbal dyspraxia or developmental apraxia. Even though the word “developmental” is used, CAS is not a problem that children outgrow. A child with CAS will not learn speech sounds in typical order and will not make progress without treatment. It can take a lot of work, but the child’s speech can improve.

Signs and Symptoms

Not all children with CAS are the same. Your child may show some or all of the signs below. You should talk to your doctor and see an SLP if your child is older than 3 years and

  • does not always say words the same way every time;
  • tends to put the stress on the wrong syllable or word;
  • distorts or changes sounds; or
  • can say shorter words more clearly than longer words.

Children with CAS may have other problems, including

  • difficulty with fine motor skills;
  • delayed language; or
  • problems with reading, spelling, and writing.


Most of the time, the cause of CAS is unknown. In some cases, damage to the brain causes CAS. Damage may be caused by a genetic disorder or syndrome, or by a stroke or traumatic brain injury. 

Seeing a Professional

Testing for CAS

An SLP can test your child’s speech and language skills. Many children with speech sound disorders also have language disorders. Find an ASHA-certified SLP in your area by using ASHA ProFind  .

To test for CAS, the SLP will look at your child’s oral–motor skills, speech melody (intonation), and how they says different sounds. To test how your child says sounds, the SLP will

  • check how well your child says speech sounds alone and combined in syllables or words and
  • check how well others can understand what your child says.

You should also talk to your doctor, who can check for any medical problems. It is important to have your child’s hearing checked by an audiologist. A child with a hearing loss may have more trouble learning to talk.

Treatment for CAS

A child with CAS should work with an SLP. Your child may begin with therapy 3–5 times per week. As speech improves, treatment may be less often. Individual or group therapy may be appropriate at different stages of treatment.

See ASHA’s information for professionals on the Practice Portal’s Childhood Apraxia of Speech page.

Treatment Goals

The goal of treatment is to help your child say sounds, words, and sentences more clearly. Your child will learn how to

  • plan the movements needed to say sounds and
  • make those movements the right way at the right time.

Doing exercises to make the mouth muscles stronger will not help. Mouth muscles are not weak in children with CAS. Working on how to move those muscles to say sounds will help.

Your child must practice speaking to get better at it. It helps to use all the senses when learning how to say sounds. Your child may use

  • “touch” cues, like putting their finger on their lips when saying the “p” sound as a reminder to close the lips;
  • “visual” cues, like looking into a mirror when making sounds; or
  • “listening” cues, like practicing sounds with a recorder and then listening to hear if the sounds were made correctly.

Other Ways to Communicate

In order to communicate, your child may learn sign language or may learn to use picture boards or computers that talk. This is called augmentative and alternative communication (AAC).

Some parents are afraid that their child will only want to use AAC systems and not try to talk. There is no evidence to support this idea. AAC systems support communication and help your child as they work on their speech with the SLP.

Family Support

CAS treatment takes time, and your child will need your support. Practice what your child learns with the SLP to help them make progress. Take breaks when your child is tired and make practice as much fun as possible. Tell your child’s SLP what happens at home so you can all work together to help your child succeed.



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

Humans use language 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 disorder




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 pathologists) 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 [45].

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:

  1. 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.
  2. 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.
  3. 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.

  1. 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 errors, like these examples, are very common for children with DLD.
  1. 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”).
  1. Many children with DLD know fewer words than other children their age. The number of words you know is called your. 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]).
  1. 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.


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Families often ask how long their child will be in speech therapy. While there is no set answer to that question, research does indicate that frequency, intensity and duration of treatment impacts outcomes. For purposes of research review, ASHA (American Speech-Language and Hearing Association) defined intensity as the amount of time spent in each treatment session, frequency as the number of treatment sessions over a set period of time (usually a week) and duration as the length of treatment received (whether a child attended therapy for two months or six months).* The ASHA review found that six out of seven studies favored a greater amount of treatment. A study by Law, Garrett and Nye (2004) found treatment results were better when duration was over eight weeks.

Many children who need speech therapy have an articulation or phonological processing disorder. The typical time to correct a speech difference is 15-20 hours (Jacoby et al, 2002) with typical frequency for articulation treatment being two times weekly for 30 minute sessions (ASHA 2004). Based on this information it could be assumed that if a disorder was mild to moderate, with the child attending treatment consistently and families practicing homework between sessions, duration of total treatment could be about four to five months. The actual time in treatment will also be relative to how many sound errors are being addressed in the treatment plan. The more sounds in error, the longer the duration of treatment.

Language Disorders, which have to do with cognition, expressive/receptive language skills as well as pragmatic language skills may take a longer period of treatment, depending on the number of goals identified by an evaluation.

When thinking about length of treatment, it is important for families to understand the importance of parent involvement in home practice. The speech-language pathologist (SLP) should provide specific targets for practice with articulation or motor speech therapy goals. SLPs should also provide training for families in facilitating generalization of new language skills. Research demonstrates that children make faster progress when parents also utilize strategies to target growth in language skills (Roberts, et al. 2011)* A pediatric therapist should spend time each session reviewing goals addressed and providing insight and training for families to help improve the rate of progress on targeted goals.




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The Link Between OCD and Autism

Many children diagnosed with Autism Spectrum Disorder (ASD) show ritualistic behaviours, such as obsessing over stock-taking and making sure things are in order. These symptoms of Autism tend to overlap with Obsessive Compulsive Disorder (OCD). A study by Meier et al. (2015) observed that individuals diagnosed with ASD were twice as likely to be diagnosed with OCD later on, and those with OCD were four times as likely to have ASD.

This article will further discuss what OCD is, the overlap between ASD and OCD, and ways to help a child who has been diagnosed with both disorders.

What is Obsessive Compulsive Disorder (OCD)?

OCD is a disorder where an individual experiences obsessions and compulsions. Obsessions can be described as unwanted thoughts, images, and/or impulses that are repetitive and intrusive. These obsessions are often accompanied by feelings of fear, disgust, or anxiety.

Some common obsessive thoughts in children and teens include (What Are Signs of OCD in Children and Teens?, 2013):

  • Fear of dirt and germs
  • Fear of contamination
  • Of germs, diseases, body fluids
  • Symmetry, order, precision
  • Religious obsessions
  • Obsessive concern with being right/wrong about morals
  • Lucky and unlucky numbers
  • Fear of harm or illness to self or relatives
  • Intrusive sounds, words, or images

Subsequently, compulsions can be described as repetitive behaviours that an individual engages in to counteract, neutralize, or make their obsessions go away. Engaging in these compulsions can also be used to avoid a situation that may trigger an obsession.

It has to be understood that not all repetitive behaviour that an individual engages in does not necessarily become a compulsion or ritual. Many children have to practice some tasks repetitively to be able to learn a new skill (such as writing, or how to kick a ball) – these are part of daily life. However, in OCD, compulsive behaviours are used to escape or reduce anxiety. Compulsive behaviours can be very time consuming (for example, washing hands for an hour straight), and can be very disrupting to daily life.

Some common compulsive behaviours in children and teens include (What Are Signs of OCD in Children and Teens?, 2013):

  • Washing and cleaning
  • Repetitively washing hands, showering, brushing teeth, grooming
  • Repetitively cleaning the house
  • Repetitive rituals
  • For example, turning on and off the lights a certain number of times, going in and out of the door again and again, needing to move in a special way, rereading, erasing and rewriting
  • Checking rituals
  • Repeatedly checking if the door is locked, their homework, or if an appliance is turned off
  • Arranging or placing objects in order
  • Having to arrange their toys, books, personal belongings, and other objects in a certain way
  • Counting Rituals
  • Having to count objects over and over again – as a means of stock keeping
  • Hoarding
  • Collecting and keeping items that have no significant value

OCD and Autism

Those diagnosed with ASD may experience and carry out repetitive behaviour, which can be seen as similar to OCD rituals. However, the overlap is still unclear in research. It has been observed that individuals with either disorder experience anxiety and/or have unusual responses to sensory information. The behaviours and characteristics in both OCD and ASD can be very difficult to distinguish, hence the higher rates of missed diagnosis of either disorder (Yuhas, 2019).

With a missed diagnosis of OCD or ASD, it may be difficult to apply the most effective treatment or therapy for the individual.

Ways to Help

Exposure Response Prevention (ERP), a type of Cognitive-Behavioural Therapy (CBT), can be beneficial for children diagnosed with OCD and ASD (Gorbis & Dooley, 2017).

During ERP treatment, individuals are exposed to the thoughts, images, impulses, or situations that triggers anxiety under the guidance of a therapist. During the exposure period, the therapist assists the individual in managing their anxiety responses and teaches them skills to regulate their emotions when they have an intrusive thought or impulse. Over time, the child is able to learn how to manage their own symptoms and commit to not engage in their compulsive behaviours. As they stop doing the compulsive behaviours, they would typically experience a drop in anxiety levels [Exposure and Response Prevention (ERP), 2018].

Although treating individuals who are diagnosed with OCD and ASD would require more intense intervention and time, it has been observed that these individuals are able to retain their improvement well (Gorbis & Dooley, 2017)!


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How lockdown has affected children’s speech – and what parents can do to help

The pandemic means many children will have spent the best part of a year interacting much less than normal with teachers, friends and family. One of the big questions is how this will have changed the way they have learned to speak. Have lockdown and other COVID-19 measures affected how children acquire the speech and language skills so vital to their academic and social development? And if children’s speech has been held back, what can parents do about it?

recent survey of schools and parents, conducted by the Education Endowment Foundation, has found that children who started school in autumn 2020 needed more support than in previous years.

The findings suggest that the greatest area of concern was communication and language development, in which 96% (55 out of 57) of schools said they were either “very concerned” or “quite concerned”. Close behind were personal, social and emotional development (91%) and literacy (89%), skills which are heavily reliant on the development of strong speech, language and communication abilities.

Impact of lockdowns

Parents have done an amazing job through the pandemic to keep their children safe and healthy. Having few activities available to them and restrictions on seeing extended family has been a challenge for many.

But this has reduced children’s exposure to new vocabulary – to words we might use when we visit the farm, say, or go to see grandma. This is important as we know that vocabulary levels at age two predict children’s performance at school entry, which itself is predictive of later outcomes.

Impact of mask wearing

Widespread mask wearing during the pandemic has also made us realise how much we rely on lipreading. Not being able to see lips move during speech, combined with the dampening effect that wearing a mask has on the sound produced, has made it difficult for us to understand what other people are saying. This is particularly a problem for the many children who experience glue ear, which can lead to temporary hearing loss, in early and middle childhood.

In school and pre-school, children may struggle to differentiate between similar sounds, such as “p” and “t”, when their teacher is wearing a mask. That can impact on a child’s speech development or their phonological awareness, which is the ability to break down words into speech sounds to assist with early reading and spelling acquisition.

Masks also obscure facial expression, which contributes to how we understand the meaning behind the words we hear. When this is taken away, not only is the potential for misunderstanding (and mislearning) increased but there can also be an impact on children’s development of social and emotional skills.

Access to therapy

While lockdown has affected opportunities to promote speech and language development for all children, those who were already most at risk are likely to have been disproportionately affected. Many of these will be children who require speech and language therapy.

report by the Royal College of Speech and Language Therapists found that 62% of children who needed speech and language therapy (from a survey of over 400 parents) received none during the first lockdown. Where possible, services were provided remotely. However, the same survey found that 19% of children did not like having speech and language therapy on video, while 12% could not cooperate with it.

Children born with cleft palate are one of several groups at high risk of problems with speech development. To investigate the impact of the first lockdown, researchers at the University of Bristol asked parents of children affected by this condition about how effective remote speech and language therapy provision had been.

Of 212 responses, 26% reported it was very effective while the remainder said it was somewhat effective (67%) or not at all effective (8%). Some parents reported that they felt the video appointments were “better than nothing”.

What can be done to help?

There are several key things that parents can do to support their child in learning to speak. From day one, talk to your baby about whatever they show an interest in. Use simple sentences and make your voice sound interesting by using lots of intonation and facial expression. Babies and toddlers like and need lots of repetition so if your child is looking at a bus then say lots about the bus, describing what it looks like, talking about how it moves and saying the word “bus” over and over again.

The same principles apply as children get older. Talk to them about the things which interest them. Respond to what your child says and does, so that they start to link words and sentences with meaning. Now that restrictions are easing, look for opportunities to develop your child’s vocabulary by visiting places such as libraries, city farms, parks and gardens and meeting up with friends and family.

For more ideas and support, organisations such as I CAN, the children’s communication charity, of which I am a trustee), have developed resources for parents to help pre-schoolers and primary-aged children with their speaking and listening. The Talking Point website is another source of information for both parents and professionals who may be worried about a child’s speech and language development.

Most children will respond quickly. But for those who continue to struggle, talking to a health visitor or teacher and a speech and language therapist will help determine whether more support is needed.


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Supportive Living for Young Adults With Autism

When Susan Senator’s son Max was racing toward the high school finish line, he joined the rest of his classmates for the usual rites of passage. He took the ACT and applied to good schools, landing at New York University’s prestigious Tisch School of the Arts.

But things couldn’t have been more different for Max’s brother, Nat. Senator, a blogger, memoir writer and novelist, had to take into account the fact that her profoundly autistic older son, while very competent when it comes to self-help skills like showering and dressing, is also limited verbally, cannot handle money and still doesn’t look both ways when crossing the street.

In other words, she knew he needed a 24-hour caregiver to be safe. But because the infrastructure and services aren’t in place to create the type of living arrangement she wanted for Nat after he came of age, she joined the growing ranks of parents who are struggling to make short- and long-term provisions, often taking matters into their own hands.

Parents whose children were among the first wave diagnosed with autism—as well as those with younger children who see the future fast approaching—are confronting new challenges for their kids’ adulthood. They’re facing the harsh reality that when these children—200,000 of them over the next five years, according to one estimate—reach 21 or 22, depending on the state, all the educational supports and services they have been receiving under the federal Individuals With Disabilities Education Act (IDEA) will vanish.

Aging out of services

This forced transition, called “aging out,” pushes them into the woefully lacking system for disabled adults. And it’s not just those with more severely disabled children who are worried. Parents whose children are termed “high-functioning,” including those with an Asperger’s diagnosis, have reason to be concerned that their kids—who may be dealing with things like ADHDanxiety and sensory issues in addition to their social and communication delays—are not going to magically stop needing support after they reach a certain chronological age.

Liane Kupferberg Carter’s autistic son Mickey turns 20 in July and, Carter, who has written much about the challenges of raising a child on the spectrum, admits to floundering.”I don’t know how to do this,” she says. “When our son Jonathan was preparing to leave home for college, we had a whole shelf of books to guide our family.” But there’s no such book guiding Carter as she faces the next step with her verbal but cognitively challenged son, diagnosed with PDD-NOS. “We’re making it up as we go,” she says. Carter is certain of only one thing for Mickey, who likes to camp it up in a pair of Groucho Marx glasses: Due to his cognitive challenges and autism-related epilepsy, which is only partially controlled by medication, he will always need a supervised living situation.

Kristina Chew, whose 14-year-old son, Charlie, is on the more severe end of the spectrum, proposes that school should continue for the developmentally disabled until they are 25, which would take into account their delays and help families “staring at an abyss” when a child turns 21. “We have learned so much more about autism and the different developments, abilities and needs of autistic individuals in this past decade,” she writes. “Let us try to use this knowledge to provide the best outcomes and the best lives for individuals with developmental disabilities at every age.”

Planning starts at 14

Senator says parents often begin panicking when their kids hit 14 and transition planning starts coming up. IDEA requires every state to begin this process for all students with an Individualized Education Program (IEP) by age 16, and some states require that school districts start the process as early as 14. During the annual IEP meeting, the focus shifts to more specific planning and goal-setting for the transition into young adulthood. Goals might include things like post-secondary education, vocational training, and independent living. Autism Speaks also provides a Transition Tool Kit, which offers guidance on everything from housing to Internet safety.

When it came to Nat, Senator created a shared living arrangement. It’s like a group home, except that there’s a live-in caregiver, which Nat qualifies for due to his level of disability, as opposed to rotating staff. “The idea is that it’s just like home,” Senator says. “He’s got to do the groceries, clean and do the laundry,” assisted by another part-time caregiver. Nat shares a house not far from his family with another young man with similar issues; that man’s family owns the house and Nat rents from them.

The families secured donated furniture; the rest was paid for out of the two young men’s budgets. Friends have been able to watch Nat’s story unfold—complete with pictures—on Senator’s Facebook page, including their shopping trip to Pier 1 for a pillow, a lamp and a rug. “Nat chose aquas, very wild stuff!” Senator says. “I had no idea!” Other parents have followed the project closely, seeing it as a possible template.

Working with a job coach

Nat works three days a week, sharing a job coach with two other young men. This coach, paid for by a state allocation, looks out for Nat at his job at CVS stocking coolers, making sure he understands what he is expected to do and stays on task. He’s also about to start a trial run at a second job retrieving shopping carts at a grocery store. Currently Nat spends the other two days in DayHab, short for Day Habilitation Services, meant to help people with developmental disabilities improve or maintain their independent living skills.

“DayHab is often babysitting,” Senator says, “table top activities, coloring, television or sheltered workshops, with very little out in the community, and there’s a mixture of disabilities.” This isn’t true of Nat’s program, she says; all of his “colleagues,” as Senator terms them, are developmentally or intellectually delayed, possibly due to autism or Down syndrome.

Half of Nat’s funding comes from the state, half from Medicaid. After he’s given a budget for rent, living expenses, transportation and his job coach, the family works with Nat’s service provider to “come up with ways to stretch the money,” Senator says. The family pays for extras like a recent three-day outing with a social group to New Hampshire.

Group homes create families

Barbara Fischkin also helped create a home for her son Dan. She first shared the story of his “miracle” group home—funded by the U.S. Department of Housing and Urban Development and run by the Nassau County Chapter of AHRC, a nonprofit group—two years ago. Then, she described it as a “newly renovated house on Long Island—a place I call the frat house. Actually, it is a beautiful and smartly designed home that could be a model for such endeavors nationwide. And the guys, who are in their 20s and 30s, are all at the age when leaving home and family and striking out on your own—even if you need lots of staff to help—is something one yearns to do.”

Two years later, she reports that Dan, now 24, and his three housemates “become more like a family all the time. The guys look out for one another.” Dan is still not verbal and has an aide most of the time “but is making great progress with independent typing.”

Laura Shumaker is another parent who has successfully transitioned her autistic son, Matthew, whose childhood and adolescence she recounts in her memoir A Regular Guy: Growing Up With Autism. Matthew, now 25, lives in the Camphill Community in Santa Cruz, a supported living program Shumaker describes as “flexible and dynamic.”

Matthew has been in a day program with social skills help, volunteer work and vocational training outside of Camphill, but is soon transitioning to two days’ a week job training for garden/landscape work and three days’ a week work with a job coach. “We are also building social activities into his program,” Shumaker says. The program is funded through the nonprofit Regional Center of California, but given the state’s budgetary problems, the family needs to make a sizable donation each year.

Options include day programs

Meanwhile, some parents of young children are already researching options. Chew has put Charlie on a waiting list for state housing but is thinking the ideal immediate plan will involve a part-time job with a good day program.

She writes that her new “‘hobby’/obsession” is finding something comparable to the county school for autistic children, which he loves and where he learns daily living and vocational skills. But this appears to be difficult if not impossible, she says. “I know the day that yellow bus does not pull up in front of our house will be a tough one.”

Chew is well aware that funding shortages make her idea of extending special-needs services to 25 a pipe dream. But she also knows that the dearth of options leads many parents to keep these young people at home, often idle and lacking the structure, routine and calm those with ASD need to do their best.

Because Charlie had a lot of ABA (applied behavior analysis), Chew says, he has more skills than he might otherwise. She envisions her athletic son, aided by a job coach, folding towels, sorting recycling items, or working in a park, sweeping leaves. But she feels he might also have “major behaviors. As a 6-foot-tall adult who can’t really read, I don’t think he’d be happy in a room with a TV set doing arts and crafts.” She worries he might end up in a setting like the “awful” after-school program she tried once: “It was a cinderblock building with old furniture. Half were kids, the other half really disabled adults who were there all day in a sheltered workshop.”

She’d be all right with Charlie living at home until he finds housing he likes, ideally in a group home in a community with 24-hour staff and two or three other disabled adults. But she also really likes a couple of other models she’s seen. One Texas couple plans to move out of their house and turn it into a group home for their child and other adults with disabilities. And in California, a group of families created a center in what she describes as a mini-condo complex. Two disabled adults live with one or two staff members; it’s not quite in a neighborhood but they have their own apartment. “It’s going to be created as you go,” Chew says of Charlie’s future living arrangement. “I’m relying a lot on my family. We’re Chinese, and we have the ethic of taking care of the family.”

Self-contained communities

Margrét Dagmar Ericsdóttir is another mother who wants to be sure that services are there for Keli, her 14-year-old nonverbal autistic son, when she’s gone. Her high-profile Golden Hat Foundation, founded and directed by actress Kate Winslet, is the result of that simple wish. Of course Ericsdóttir’s plans for a campus that will embrace nonverbal autistic children is a long way off; it’s in the early planning stages and much fund-raising must be done.

But the sort of self-contained campuses proposed by the Golden Hat Foundation are themselves the subject of debate. Self-advocates like Ari Ne’eman, president and co-founder of the Autistic Self Advocacy Network (ASAN), feel strongly that smaller, inclusive settings are better for their adult autistic population. Ne’eman finds the prospect of a segregated campus very concerning. Commenting online about the Golden Hat plans, he cited “a wealth of research which shows that people have less safety, less choice and less opportunity to interact with the broader community in such settings.”

With the number of children believed to have an autism spectrum disorder continuing to rise, it’s clear that more living, working and support options are greatly needed for them once they lose their special schooling and services. What’s also clear: Both adult self-advocates and parents must be part of the process, providing input as to what those options should be.



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Parents Guide to Speech and Language Pathology

Parents Guide to Speech and Language Pathology

 The purpose of this blog is to provide parents who are new to speech and language services of their rights according to federal law. I will also give you information about the evaluation process and what to expect.

As a speech pathologist in the high school setting, I have a huge range of parental involvement. I have parents who want to be a part of every single session and parents who don’t even attend their child’s IEP meeting. So what is the ideal situation, and what does speech and language pathology mean?

From an education program and professional standpoint, involvement is good, but don’t be a helicopter parent. Trust us to help your child. Hovering over your child only hinders their progress. They need to learn to be independent and they need to also trust us!

From a professional standpoint, involvement is good, but don’t be a helicopter parent.

That said, if the school district/agency doesn’t do what they are legally obligated to, then you HAVE to involve yourself and do it quickly. 



10 Facts about Speech and Language Pathology

When a new school year starts, some children receive referrals to the Child Study Team for a speech and language evaluation. As a parent, it’s important for you to understand the process and your rights.

Recent national polls commissioned by the American Speech-Language-Hearing Association (ASHA) and conducted by YouGov, found that 1 in 4 U.S. parents of children ages 0–8 have concerns about their childs ability to communicate ( 

Treatment for speech and language will not only help the child communicate successfully, but it will also lead to advancements in academic performance, as well.

The ASHA–YouGov polling also revealed that, of parents who have sought treatment for their childs communication difficulties, 8 in 10 perceived “a great deal” or “a good amount” of improvement (ASHA). 

1. Speech and language services are part of federal special education law.

The Individuals with Disabilities Education Act (IDEA), a federal special education law that guarantees all children receive free appropriate public education (ASHA), serves children aged 6-21 who have speech or language impairment – which is the second most common disability category. This means that children diagnosed with a communication disorder and their parents, receive legal protection, and have certain rights. 

2. Speech and language services address a wide range of disorders in the school setting.

A speech pathologist may work on social skills, articulation, grammar, comprehension, stuttering, voice, and more. 

3. As a parent, you have the right to be involved in every step of the evaluation process.

First, you must consent for your child to receive an evaluation. If you feel your child needs therapy, you should contact the Child Study Team. On the other hand, teachers and other professionals may call you to schedule a meeting if they feel your child is falling behind. 

4. Speech service will be conducted in your native language.

If your child gets a speech and language evaluation, or any evaluation, it will be conducted in their native language. Either a bilingual SLP will perform the evaluation or they will have an interpreter to relay information back and forth. 

5. A child’s needs and goals will be interpreted and distributed to school personnel in the form of an Individualized Education Plan (IEP).

The goals and modifications in the IEP will relate to how your child performed on their standardized evaluations and how their deficits are impacting their academic abilities. 

6. An IEP is highly specific and will be different for every child.

The goals will directly relate to your child and your child only. That said, if you feel like a modification is a necessity, don’t be afraid to share that information with the team at the eligibility meeting. 

7. IEP goals are designed to be met within one school year.

Your child receives a re-evaluation every three years to make sure their classification and goals do not need updating. 

8. Parents should get progress reports as often as necessary or as requested.

I have some parents who requested monthly reports on their child and some who don’t ask for updates until the IEP meeting

9. Schools must keep children with their peers as much as possible.

This “least restrictive environment” is the goal of education. Unless absolutely necessary, children receive placement in an academic setting that is inclusive. At the school where I work, we have different levels of classes such as special needs, learning disabled, resource, in-class support, and general education. Our students move up to the lesser supported class if they are showing the ability to function with fewer supports. 

10. Parents have the option to disagree with any component of the IEP at the end of the meeting.

This is your time to voice your opinion about your child’s education and modifications. Parents may call an IEP team meeting if something does not seem to be working. Contacting the school and providing as many details as possible will help the team understand the purpose of the meeting. When the family and school don’t agree, its important for both parties to try to reach a compromise – which may be temporary.

If a parent still isn’t satisfied, they can act on one of the next steps detailed in their parental rights packet (procedural safeguards). It’s in the best interest of the child to try to build a positive working relationship.

Don’t Be Afraid to Ask Questions!

An evaluation and subsequent process can be a very overwhelming and confusing process for parents to go through. It’s important to know your rights and the steps that will occur when getting your child classified.

Good communication between the school support staff and families is necessary for your child to grow and develop successfully. If you feel like something isn’t working, don’t be afraid to say something. You can talk to your child’s case manager and speech pathologist as often or as little as you need. 

Finally, ask us for more information! I love giving families handouts, suggestions and tips to work on in the home environment. The child study team will also have information that they can provide to you, if you want it!

Remember, we speech-language pathologists and Speech Blubs are here for you and your child!




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The Dreaded Waitlist for Speech Therapy

Mom's Question: “My kiddo stuttered a little bit at first, but it got better. Now, for the last few months the stutter has gotten so bad. We are stuck on a waitlist for a speech therapy. What can I do at home to help their speech?”

The first thing I want to address with this question is the stuttering question. All children go through a normal period of stuttering from about 2-5 years of age.

However, if by three your child is stuttering severely, there’s been a change in the frequency of the stuttering, or it’s impacting their ability to communicate, you should get into a speech pathologist as soon as you can. 

Secondly, I would shop around. A lot of therapists tell their future clients that the waitlists are long in other offices because they don’t want to lose you as a client. Even though it isn’t right, it’s a business tactic.

I’d recommend for you to check out all of your options:

  • Early intervention is a great option if your child is between the ages of 0 to three. The therapists will come to your home for the evaluation and subsequent treatment, if warranted.
  • University and college clinicstypically have lower wait list times or won’t have a waitlist at all. All of the students performing the evaluations and therapy are closely monitored by Speech-Pathologists who are licensed. 
  • Check with your child’s school district, day care, or preschool programto see if they contract with any therapists in the area. If they are in kindergarten or older, there will most likely be a therapist in the district that can provide therapy.

Another topic I want to address is that I wrote a blog recently about fluency and speech. In that blog, I gave some resources and ideas that you can do at home. That would be a great place to start. There are also other blogs on Speech Blub’s website that you can read regarding speech therapy materials for the home environment. I give books and games that you can use

Even if you don’t have specific books, the chances are that you can practice speech with any materials and books that you have!

Games focus on vocabulary, social/pragmatic (e.g., turn taking), colors, numbers and formulating sentences.

Books give you a chance to work on receptive (words that are understood) and expressive vocabulary (words that you can produce). 


  • Richard Scaryreleased a new eye spy game that is great for building speech and language skills. It’s sure to keep your child engaged and focused for a long time!
  • Legos are a great option for speech. Depending on your child’s age and abilities, you can modify them appropriately to grow with their developing skills. For example, ask your child to pick up the green lego, count how many holes are on the lego, and then ask them to repeat a word that many times.
  • You can also use Legos to build sentences(if your child can read). Write words (verbs, pronouns, nouns, adjectives … ) on legos and start building sentences like you would build a tower.


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Stacie Bennett

Trenton, New Jersey



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What to Do When Insurance Won’t Cover Your Speech Therapy Costs

Your speech therapist told you to wait with therapy to get approval form insurance to continue working with your child. As many families you are financially limited. What to do now? What if your insurance doesn’t pay for services?

Unfortunately, our insurance companies run the show when it comes to reimbursement for speech and language services. They dictate what is and isn’t covered, which can be extremely frustrating when your child needs speech therapy. I’ve had many clients who needed the services desperately, couldn’t afford to pay out of pocket, but insurance kept denying claims. Here is some advice for when the insurance companies refuse to pay or continue services.


What are Your Other Options?

The first thing I’d suggest is early intervention. This is typically a free, or low-cost program that states have for children who are 0-3 years-of-age.

Once contacted, they come to your home to determine if services are warranted and how often they are needed. The cost is based on your income. I’ve been an early intervention therapist for many years and most of my families pay nothing for services. 

The catch? Not all children qualify for these services. I’ve also, unfortunately, had parents whose children definitely had a speech delay, but weren’t severe enough to qualify on standardized assessments. When this happens, the parents have no choice but to receive outside, private therapy OR wait until the child enters school – something I never suggest. 


Private Speech Therapy

I know private therapy can be expensive – especially if you aren’t going through insurance. As a private therapist, I work with families who cannot always afford the amount that is charged for an evaluation and subsequent therapy. I don’t offer my services for free, but I try to work with them to work out a payment plan in order to get their child the services they need.

I wish I could tell you that all private speech therapists do this, but they do not. If you’re looking into private services, make sure you ask the therapist/owner if they do accept payment plans. You might be surprised with their answer.

If you cannot find a private speech therapist that does payment plans, you may need to budget for 1-2 times a month. $50 a month, might be more doable than $200 and it’s worth your child getting speech and language therapy, if they really need it.

Speech Therapy at Colleges and Universities

Many colleges and universities that offer speech pathology as a major, have a student clinic. The therapists are college seniors or graduate students who are under the instruction of Master’s level (or higher) therapists who have been practicing for many years. These students receive weekly feedback regarding their therapy sessions and are advised as to how to proceed by their instructors. 

Most of the time, these clinics have a much lower charge than a typical private practice because it is students that are providing the therapy. They take all types of clients in order for the students to gain experience. Caution – waitlists can be long due to the fact that the cost is lower. 

 School System and Speech Therapy

If your child is in the school system, there should be free speech therapy that can be provided, if they qualify. These services will not cost you anything.

In order to receive therapy, they need to be evaluated by the teams SLP and a formal Individualized Education Plan will be formed to include therapy. The SLP will meet with your child either 1-2 times per week, depending on their diagnosis. Therapy can be provided individually or in a group setting. In addition, the therapist may see your child in their class OR in the speech therapy room. 

As a school-based speech-language pathologist (SLP), I see the majority of my students in the classroom! It allows me to see first hand what they are struggling with in regards to their curriculum. Then, when I see them in my office, I know what skills to target!

If All Else Fails . . .

I wish I could tell you that this problem with health insurance is going away, but it isn’t. It’s a daily fight for clinicians to receive authorization for therapy to be provided to their clients. On top of that, many companies are so inundated with referrals that they simply don’t get to them in a timely manner. 

If all else fails, there are things you can do at home to help your child be more successful with speech and language. This does not replace speech therapy services, BUT it can help until you can get into a therapist’s office.



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If your child with autism spectrum disorder (ASD) is having difficulty with the early stages of communication and language development, an augmentative or alternative communication system might help.

Augmentative communication and autism spectrum disorder

If your child has autism spectrum disorder (ASD) and difficulties with language or communication, augmentative and alternative communication (AAC) systems can add to his existing ways of communicating, including his speech, gestures or writing. They can also give your child new and different ways of communicating.

There are two types of AAC systems – unaided and aided.

Unaided systems 

These AAC systems don’t need any equipment. They use gestures and manual signing – for example, Key Word Sign and SgSL – to support speech, or as the main way of communicating.

Aided systems 

These AAC systems can be low-tech or high-tech. 

Low-tech systems use equipment like cards with pictures of objects, words or photographs that represent tasks, actions or objects. Children with ASD can learn to use the cards to ask for what they need, make comments and answer other people’s questions. PECS (Picture Exchange Communication System) is an example of this kind of system.

High-tech systems include speech-generating devices (SGDs). Children with ASD are often good at visual processing and they might be able to combine this ability with an SGD to improve their communication. 

Many ASD apps have been designed for use with iPads and Android devices to help children develop their communication skills.

Children who have a limited range of interests or who have repetitive behaviour can get ‘stuck’ on these devices, so it’s a good idea to think about your child’s behaviour before introducing electronic devices. Your child could have one tablet with only the AAC software on it, and a separate one to use for games and entertainment. 

Benefits of AAC systems for children with autism spectrum disorder

It’s claimed that AAC systems help children with ASD improve their ability to understand and communicate with others.

Children with ASD who might benefit from using AAC systems include those who have a lot of trouble understanding or using spoken language, or who might be a lot slower to develop language. AAC systems can also help children who have tried language development programs but still find it difficult to speak in an understandable way.

These systems can help children with ASD and their families in several ways.

They can be an effective way for children to learn early words because they put a spoken word together with a picture or gesture that represents that word – for example, saying ‘apple’ and holding a picture of an apple. Children remember the speech sounds and the visual image of the object, picture or hand movement that’s paired with the word. Children with ASD often respond best to information that’s presented visually, so this approach is likely to be especially helpful for them.

AAC systems can also improve children’s understanding of words. This is because speech on its own can be very quick, whereas a visual image lasts longer. Also, people tend to slow down when they’re using visual aids – to recall a specific sign, find the right picture, add emphasis, or ensure the child has seen the whole message. This all gives your child more time to understand the information and helps avoid information overload.

Finally, a visual prompt can encourage children to make eye contact by gaining their attention. Eye contact is a key part of communication and often needs to be taught to children with ASD.

AAC systems can reduce stress for both you and your child because they take the guesswork out of understanding your child’s behaviour. Less stress and better communication can add up to a better relationship between you, your child, your child’s siblings and other children and caregivers away from your home.

Choosing an AAC system for your child with autism spectrum disorder

The AAC system you choose will depend on a few things, including your child’s particular challenges, the current stage of your child’s communication development, and your ability to put the system into action. It’s good if your family and your child’s other caregivers are also able to use the system.

Here are some questions to think about when you’re choosing an AAC system:

  • Is the system a temporary support for your child until her spoken language develops, or is it likely to become her main way of communicating?
  • Is your child physically capable of using the system? For example, does he have the fine motor control for manual signs?
  • Is the system portable?
  • Can your child learn the system easily?
  • Are there financial considerations?
  • How likely is it that other people, like teachers and friends, will learn and use the system?
  • What systems are used at your child’s preschool, kindergarten or early intervention service?

Effects of AAC systems on speech development

Parents of children with ASD and some professionals might be concerned that using AAC systems might delay speech development.

But evidence suggests that these systems could help your child develop spoken language. Also, an electronic AAC device might help your child’s communication skills develop faster than low-tech systems.

If you introduce an AAC system as early as possible, your child is more likely to use it to communicate.

Other interventions to improve communication

Other interventions and therapies that might help develop your child’s communication skills include the following:

  • Visual supports and strategies: these use symbols, photographs, written words and objects to help children with autism spectrum disorder (ASD) improve their skills in processing information, using language, and understanding and interacting with their physical and social environment. 
  • Functional Communication Training (FCT): this focuses on replacing difficult behaviour with more appropriate communication that serves the same purpose as the behaviour.  For example, a child might have a meltdown when she wants a toy but can’t ask for it. In FCT, the child would be taught how to ask for the toy in a more appropriate way.
  • More Than Words®: this is also known as The Hanen Program. It focuses on promoting language development in children with ASD. 



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