The Art of a One-Sided Conversation

I have been monopolizing conversations with my daughter for years. I'm not rude. It is done out of necessity. At age 13, Jaycee is saying more and more words. Still, we can't have full conversations that most mothers and daughters do.

For a good 8 years, Jaycee was nonverbal. During those years, Jaycee communicated with a few words, sign language, and a communication device. During that time of her life, our conversations after school were something like:

Me: Did you like school today?

Jaycee signs: School

Me: Was it fun?

Jaycee: Grunts happily (I interpret as yes.)

Me: I missed you while you were at school. Mommy had to work.

Jaycee signs: Work

Me: We're going to go home and make dinner.

Jaycee signs: Home. Eat.

Jaycee signs: Pizza

Me: No, we aren't having pizza tonight.


There were few questions Jaycee could answer back then. There were no stories she could offer on her own. Getting information from her was next to impossible. Jaycee often repeated back words she heard me say. She wasn't able to express many things out of the blue. If she did, I struggled to understand what she was talking about.

There is an art to having conversations with a child who doesn't respond with many words. You have to know ways to keep the conversation going when words are few from your communication partner. It is possible to converse, but there's not much depth. 

Progress is a wonderful thing. Now, I can have better conversations with Jaycee though they are still mainly one-sided. A typical after school conversation is now:

Me: Was school good or bad today?

Jaycee says: Good (She also gives a thumbs up.)

Me: Who did you play with at school?

Jaycee says: Hope, Mikayla

Me: I'm glad you got to see your friends.

Jaycee says and signs: School. Friends.

Jaycee says: Bubba?

Me: We're going to the pharmacy first. Then, we'll pick your brother up from school.

Jaycee says: Uh-uh (as in no). Bubba!

Me: He's still in school. We have time to go to the pharmacy first.

Jaycee says and signs: Bubba. Home.

Me: First, we'll go to the pharmacy. Then we will get bubby. Then we'll go home. (I hold up a finger as I say each item, so she knows we are doing 3 things.)

Jaycee: Imitates holding up three fingers and babbles in an attempt to repeat what I said.


This is how we converse now. It's not the typical exchange for most teens with their moms, but it's our way. I am happy she can speak more now and not be so reliant on gestures or sign language. I'm thrilled she contributes her own thoughts to our conversations. Our talks aren't completely one-sided now.

When Jaycee was little, I wanted nothing more than to talk with her. I wanted to know what she is thinking and what happened during her day. Even now, I still want these things. However, I am grateful for the progress she's made. I'm happy to get glimpses into her thoughts.

I am also extremely grateful that there are several people in her life that know how to speak to her too. Grandma, cousin Gabby, Aunt Steph, and a host of other people have also mastered the art of the one-sided conversation. Jaycee has opportunities to converse with other people besides me. I'm grateful these people have figured out what questions to ask her and know how to pull information from Jaycee.

After all, Jaycee does have something to say. She doesn't need 30 minutes of non-stop talking like so many of us do. Sometimes, a short sentence and a big, firm hug can speak volumes.

Maybe one day Jaycee will be monopolizing our conversations. I would be thrilled to have that experience!

If My Daughter Could Really Talk

My daughter's communication skills have grown exponentially over the past 4 years. For 8-9 years, she was nonverbal. We first communicated with sign language and other nonverbal methods. Later, she used her communication device to expand her vocabulary and "talk" about more subjects. Then, much later than expected, she started trying to talk more and more.

Now at 12 years old, Jaycee's verbal speech continues to increase. There are some words she can say very clearly like mom, dad, bye-bye, hi, yes, and papa. I love these words. They are precious.

Some words are missing consonant sounds or have the wrong consonant. Some great examples of these words are:  Pi-a (pizza), hickles (pickles), ip-ops (flip-flops), goo- -ob- bubba (good job bubba), eh-he (spaghetti). As her mom and a pediatric speech-language pathologist, I have come to understand her speech patterns and know what she is saying most of the time. I'm happy she's attempting to talk after years of silence.

Because of Jaycee's speech and language delays, we do a total communication approach. She can sign, use her communication device, speak, or gesture to communicate. Still, it's not like I can converse with her about anything and everything. There are some things she literally cannot say.

Similarly, there are some topics that I don't know if she understands. She has an Intellectual Disability, which affects how learns, remembers, and comprehends. This, too, impacts our ability to communicate. I try to simplify my speech for her, but it's hard to really know what she knows at times. With my son, he can ask questions to clarify or offer his own thoughts. This doesn't happen with Jaycee.

If, for a moment, my daughter could really talk like any other 12 year old, this is what I would ask her:

-I've told you that you are going to a new school in the fall. Do you have any questions or thoughts about that?

-What do you really enjoy doing besides watching movies and listening to music? What hobbies would you be interested in trying?

-Do you hate doing your medicine everyday?

-How does it feel to wear your bi-pap at night?

-What happens during a school day that you like? That you don't like?

-Sometimes you get really scared when we go to the hospital for a regular appointment. What are you thinking about? What scares you about it? How can I help you in the future?

-Sometimes you sit down and refuse to move when you walk for awhile. What's really going on when you do that? Does something hurt? Are you just tired? How can I help you?

-What do you really enjoy doing with me?

These are some questions that I would really love to have answered. I want to know more about what my daughter understands, thinks, fears, and feels. Maybe one day she'll have the ability to do it. Until then, I am grateful for the things she can express, and I'll keep interpreting her behavior as best I can.

After all, there was a time when I thought I'd never hear the word "mom." Now, she says it in several different tones all with their own meaning. Perhaps, one day these answers will come too. A mom can hope...

Therapy Tip: When is a Language Delay Something More?

Welcome to the Therapy Thursday on the blog! This is the day that I share a tip based upon my experiences as a pediatric speech-language pathologist and the mother of a child with special needs. Today's tip is:

When is a Language Delay a Sign of Something More? 

Last week, I wrote about factors that may contribute to a language delay. (If you missed it, click here.) From that, you know that there are many things that come into play that may contribute to a child having a language delay. As discussed, some children will make progress in therapy and eventually be discharged. Other children have underlying issues going on that will require intervention for years to come.

When your child is 2 years old and you're a worried parent, how do you know when a language delay is just late talking and when is it a sign of something else?

To answer this question, let's talk about red flags. Red flags in the therapy world are characteristics that may signal an underlying condition that has not yet been identified or diagnosed. When a child has red flags, it may indicate that something else is going on other than just a delay in language. There are many red flags I could discuss, but I'll go over just a few today. Here are some things I look for when working with toddlers in speech therapy that may indicate something more than just a language delay:

-Slow to no progress in therapy: Speech therapy is usually not a quick and magical fix for most kids. Change takes place slowly over time. If a child has been in speech therapy for 6 months, then I should see some progress. The progress will look different for every child because each toddler is starting out at a different point developmentally. However, at the six month mark, a child who has made little to no progress is a red flag for me. If we started out with one word, and still have one word six months later, then that's a huge red flag. Again, it's difficult to explain what constitutes as slow versus adequate progress in therapy because all children are starting with a different set of skills. A therapist who has been in her professional for a number of years will be able to make that judgment based upon experience. Don't be afraid to ask your child's therapist if their progress seems expected or slow. But slow-no progress is a red flag.

-Difficult to engage in therapy: There are some children who after just a week or two of therapy get excited to see me and want to see what activities we will do. They plopped down on the floor and are ready to start the session. This tells me that they are socially interested in me, have discovered our routine, and desire to play with toys. These are the responses I look for after I come for home visits for a month or two.

There are a few children who don't seem to acknowledge that I am there or notice my arrival despite our weekly sessions for months. There are some children that notice me but don't care. Little to no eye contact during activities may happen as well. All of these responses are atypical. On the flip side, a child who is excited about therapy but will only sit for a minute or two despite a few months of therapy is also atypical.

When I bring up concerns about poor engagement in therapy, parents are usually quick to remind me that their child is just 2. I understand that. I also have over 10 years experience with two year olds. I know when a 2 year old is acting like a 2 year old or having a bad day versus a child who is consistently showing poor engagement. If a child is never wanting to engage with me, that's a red flag. If I have to "work" to keep their attention, that's also atypical.

-Delayed gesture development: Poor use of gestures is another red flag. If a child is not talking, then I always want to know about what types of gestures and nonverbal communication the child uses. Pointing and waving are important early gestures that toddlers need to communicate a variety of functions. Nonverbal communication like leading an adult to a desired object or bringing a cup to an adult to indicate thirst show attempts that the child is trying communicate. The fewer the gestures and nonverbal communication, the more concerned I am that something else is going on besides just a language delay.

-Poor imitation: Poor imitation comes in many forms. There can be poor word imitation, which would be expected when speech therapy first starts. Eventually though, the child should start to imitate words. There can also be poor play imitation. If I show a child how to push a train around a track, then I expect the toddler to imitate it. If a child can't imitate actions that I do, motions to songs, or play movements, then this is a red flag. Again, this is something that I don't expect immediately when therapy starts but it should come fairly soon after some intervention starts.

If I have a child on my caseload who is having red flags, then generally I will make a referral to a developmental pediatrician or speak with the child's physician. They might diagnose a child with a developmental delay, autism, or run further medical tests. If I feel the language delay may be a specific speech disorder (i.e. childhood apraxia of speech), then I may decide the child needs more intensive tests performed by me.

The most important thing a parent can do if you see some of these red flags is to ask your child's therapist about them. Open communication is key in these situations. If you are getting no where with your child's speech therapist, then talk to your child's pediatrician or get a second opinion with a different speech-language pathologist.

Therapy Thursday is for educational purposes only and not intended as therapeutic advice.

Therapy Tip: Why Does My Toddler Have a Language Delay?

Hey there! It's Therapy Thursday on the blog. This is a day that I share knowledge based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs. Today's tip is:

Why Does My Toddler Have a Language Delay? 

I've been working in my state's birth-three program for over 10 years now. I have had numerous conversations with families. Often parents want general reassurance that their child's speech and language delay is not an indication of a life long problem. For some children, their delays are short term and go on to do well in school. (I know this because I have been able to follow up with some of these kids later.) Some parents will flat out ask me on my first appointment if their child has something wrong with them to explain their lack of verbal speech. Usually, autism is specifically asked about.

Many parents simply want to know why their toddler isn't talking. This is a hard question for me to answer. Sometimes, there are things in the history that can contribute to a delay in language development. I'm saying contribute to a delay because there are many factors at play in a child's life as you'll read below and it's just not always easy to absolutely find a "cause." 

There are some children who have no one single thing that I can pinpoint to as WHY they have a delay. They just do. There are some questions in life that can't be answered nice and neatly. However, there are some things can contribute to a speech and language delay requiring speech therapy.

Let's look at some.

1. Prematurity
Premature births can lead to some delays in language and other areas of development. Babies born prematurely can have delays in motor skills and language, especially if their prematurity resulted in a lengthy or complicated NICU stay. Usually, we will adjust a child's age to account for their prematurity until they are age 2. After age 2, we don't necessarily "blame" the prematurity as the reason, but it is one thing to consider. 

2. Hearing Issues
Known hearing loss will no doubt cause delays in language. Repeated ear infections can also contribute to delays in language because ear infections mean the child's hearing is not 100%. Not every child with ear infections will have a language delay, but it is one thing to follow up on and consider. If a child on my caseload has a history of ear infections, I strong recommend a hearing evaluation. If there is no history of ear infections, then I still tell parents a routine hearing screen is a good idea, but I leave it up to them to decide if/when to pursue it.

3. Environment
Some toddlers grow up in very language rich environments. Other children do not. Some babies and toddlers grow up with little interactions from their caregivers, too much time in front of screens, or too much time being contained alone in seats, swings, or playpens. Environments that offer little social interaction can contribute to a language delay.

4. Family Dynamics
Sometimes, the baby of the family talks and advances to keep up with their siblings. Other times, the baby of the family is treated like a baby. Helpful siblings will get things for the child who never has to utter a word. Family dynamics do not necessarily cause language delays but they can contribute to a child's lack of verbal speech.

5. Personality
There are some children I have on my caseload that are just quiet kids by nature. Their personality is passive or shy. This doesn't really cause a language delay, but it may be harder to get quiet-by-nature kids talking and making strides in therapy. They simply aren't as motivated to talk as some other children.

6. Delays in Other Areas
If a baby achieves motor milestones later than expected, then delayed language wouldn't be out of the ordinary. If the baby has significant feeding issues or delays in any other area of early development, then language delays may happen too. Child development is usually sequential, so we generally expect things to happen in a certain order. If some milestones happen later than expected, then that may mean language may come a bit later too. However, delays in multiple areas for more than a couple of months is something that would be worth looking into more closely to find a reason for the delays via a developmental pediatrician.

7. Underlying Diagnoses (Identified or Unidentified)
There are many underlying diagnoses that are associated with language delays. For example, Down syndrome or a brain injury are both known to have delays in language. There are some diagnoses that are not evident at birth but may become more pronounced by the time the child is 2 and not developing as expected. These are the toddlers I see with large delays in language and display other red flags that signal that something else may be the cause of the delay. Diagnoses like autism or childhood apraxia of speech, for example, may start to become visible in 2 or 3 year olds. So yes, a language delay may be because of another bigger diagnosis besides just "language delay" that may or may not have been diagnosed when the child starts speech therapy.


In all, there are many things that may contribute to a child's delay in language or explain the delay. It is often hard to exactly say "why" it is occurring and give the worried parent reassurance that their toddler will catch up and improve. Time will tell just how the child will progress. Even though we may want to understand why a child is experiencing a language delay, the important thing is to seek intervention and follow suggestions of the treating therapist.

Therapy Thursday is for educational purposes only and not intended as therapeutic advice.

Scriptures I Pray for my Child with Down syndrome

If you are a person of faith, prayer is hopefully an important part of your life. When my daughter was born years ago, I wasn't exactly sure how to pray for her, and I wasn't sure what scriptures to use to support my prayers. Over time, I have found a few scriptures, and I discovered how to use them in prayer for Jaycee, especially when she has been sick or struggled with verbal speech. Today, I'm sharing them with you and a sample short prayer. I hope this helps you in your prayers for your loved one with Down syndrome! 

²⁶ Then God said, “Let Us make man in Our image, according to Our likeness; let them have dominion over the fish of the sea, over the birds of the air, and over the cattle, over all^[b] the earth and over every creeping thing that creeps on the earth.” ²⁷ So God created man in His own image; in the image of God He created him; male and female He created them. Genesis 1:26-27 NKJV

Father God, I know that Jaycee was created in your image and that your spirit rests inside of her. Help me to see You in her, and help me to bring out the best parts of her that You created. I also know that the things you create are made with purpose. Let me know your purpose for Jaycee so that she can live the life you intended her to live. Help me not to be distracted by the things that she can't do, but let her abilities be at the forefront of my eyes so I don't get sidetracked. Amen! 

⁹ In this manner, therefore, pray:

Our Father in heaven,
Hallowed be Your name.

¹⁰ 

Your kingdom come.
Your will be done
On earth as it is in heaven.

¹¹ 

Give us this day our daily bread.

¹² 

And forgive us our debts,
As we forgive our debtors.

¹³ 

And do not lead us into temptation,
But deliver us from the evil one.
For Yours is the kingdom and the power and the glory forever. Amen.^[c

Matthew 6:9-13 NKJV

God, your word in Matthew 6 is powerful! I am thankful that your kingdom is life-giving and life-changing. I pray that your kingdom come in Jaycee's life and your will be done just as it is in heaven. Sickness cannot abide in your kingdom, so let sickness not be part of Jaycee's life. I pray that she'll walk in victory here in earth just as she would in heaven. Let everything she struggles with on earth turn into a victory through you working in her life. Let your will be done in Jaycee's life so that she can show others your kingdom as well. Amen. 

¹⁰ Then Moses said to the Lord, “O my Lord, I am not eloquent, neither before nor since You have spoken to Your servant; but I am slow of speech and slow of tongue.”

¹¹ So the Lord said to him, “Who has made man’s mouth? Or who makes the mute, the deaf, the seeing, or the blind? Have not I, the Lord? ¹² Now therefore, go, and I will be with your mouth and teach you what you shall say.” Exodus 4:10-11 NKJV

God, I love your response to Moses in the Bible. Moses discounted Your calling because of an imperfection in his life. You saw beyond it though God. You chose to make him a leader despite his speech issue. I thank you God that you encouraged Moses, because I know you can do the same for my daughter. Lord, you know my daughter struggles with verbal speech, but I know you have made her mouth. I know you can use her regardless of her limited speech. Teach Jaycee supernaturally what to say and let her speech improve. Help people to have the ability to see beyond her shortcomings in her speech too so they can see You in her life. Amen. 

⁹ I am the door. If anyone enters by Me, he will be saved, and will go in and out and find pasture. ¹⁰ The thief does not come except to steal, and to kill, and to destroy. I have come that they may have life, and that they may have it more abundantly. John 10:9-10 NKJV

God, your word is clear. You give life. Your desire is for your children to live an abundant life. I recognize that any health issue with Jaycee that tries to steal her breath, damage her organs, or make her life restricted isn't from you. I recognize that you don't want these for Jaycee, so God I pray that you give restoration life to every part of her body that is not functioning at its best. Touch her lungs and heart, so that they can be strong to give her a full and long life. Amen!

Therapy Tip: Building Language with Your Christmas Tree

It's Therapy Thursday!

You know the drill...this is the day that I share a tip based upon my experience as a pediatric speech-language pathologist and the mother of a child with special needs. Today's tip is:

4 Ways to Build Language Using your Christmas Tree

I love incorporating language goals into natural things around the home during the holidays. If you have a Christmas tree in your home, then this tip will be of interest to you. Here are 4 things you can do with your early language learner (ages 2-4 depending on the child's abilities) utilizing your family's Christmas tree.

1. Colors:
If you have different colored ornaments, decorations, or lights, you can target colors with your child. You can point to a particular color and ask the child to find the same color on the tree. ("Here's a blue light. Can you find one?") You can ask your child to point to a specific color on the tree. ("Find a green light.") Finally, you can simply talk about the different colored items on the tree.

2. Spatial Concepts:
Use items on the tree to describe where they are. Use words like on top, middle, on, under to describe the location of the items. The presents are UNDER the tree. The star is ON TOP of the tree. The lights are all AROUND the tree. The tractor ornament is in the MIDDLE of the tree. To make it harder, ask your child to tell you where specific things are to see if they will use these spatial words too.

3. Vocabulary:
If you have a lot of different ornaments on the tree, use them to build vocabulary. My tree is full of Disney characters, super heroes, holiday items like a candy cane, and more. All of these different types of ornaments can be located to build vocabulary ("Can you find the fire truck ornament?"). But, you can also point out things to the child and discuss them ("Here's a candy cane ornament. It's red and white.")

4. Answering Questions:
Ask your child questions about things on or around the tree. Think about questions you can ask that start with where, who, what, why. Where's the star? What is this ornament? What is your favorite one? If your child is saying simple sentences, ask harder questions such as: How does the ornament stay on the tree? Why do you like this ornament? How many lights do you think are on the tree?

Now go enjoy some therapy time around your tree!

Therapy Thursday is for educational purposes only and not intended as therapeutic advice. 

Therapy Tip: Gift Guide for Early Speech-Language Learners

Welcome to Therapy Thursday! This is the day that I share a tip based upon my experience as a parent of a child with special needs and a pediatric speech-language pathologist.

Today's tip is:

Christmas Shopping? Early Speech-Language Learners Gift Guide

Christmas will be here in a few weeks. Oh the joy!!

About this time of year, parents often ask me about appropriate Christmas presents for their toddler who I am treating in speech therapy. Everyone wants their toy to be useful and help their child develop skills they are building in therapy.

Today, I am offering my ideas for gifts in case there are parents, friends, or grandparents who are buying toys for a child with speech or language delays and need help. I am hesitant to place an age on this gift guide because an older child with significant language delays may benefit from things on this post. Therefore, this is written for those children who may be working on saying single words up to 3-5 word phrases. 

In general, almost any toy can be used to build language (i.e. increase vocabulary or encourage words/phrases/sentences). When I am looking for a toy, I go by this rule of thumb in general: The more basic the toy, the better.

Toys that make noise or sounds or are motorized USUALLY result in less talking since the child is busy pushing buttons or watching the toy. So, I try to avoid most noise making toys or moving toys for children that have very little language. These types of toys have their uses, but if you are specifically looking for something that will help promote verbal speech, look for toys that do not have the extra bells and whistles. I want the child to make the noise and the sound effect, not the toy.

Another important thing to remember when purchasing a toy is the child's developmental age. The development age describes where the child is functioning versus their chronological age. Many toys have suggested ages on the box. If you have a child with large delays, these ages will not match up for what they child may need. For example, a box may say 24 months. Now, if you have a child with Down syndrome who is 24 months, their developmental age may be closer to 12 if they have just started walking. So choosing toys with a 12-18 month age listed on a toy's box may be more appropriate than the one with 24 month age listed.

Here's some more specific ideas: 

Toys for children developing vocabulary, working on phrases, or using verbal speech: 

-Any type of food related toy can work on basic words like eat/drink and naming foods. There are many pretend food sets and play kitchens that spark imagination and allow good vocabulary to be developed. 

-Any board book or flashcard set can be used to promote language. I especially love books and cards that have real photographs versus cartoon drawn pictures. If the child loves a particular character on tv, books with those familiar characters are often good to spark language or an interest in books in general. 

My First Words Available Here

 

I Can, Can You? Available Here

-Baby doll sets with a few accessories can be great for early language. A baby doll with a bottle, brush, or diaper can target action words (brush, drink, eat) and other basic words. Baby doll play also allows moments for imitation. For example, you can pat the doll's back and see if the child imitates you. 

-Car sets with a garage or ramp are great too. This allows you to work on action words (go, stop), descriptive words (fast, slow, green), and spatial/location words (up, down, in, out). 

-Non-motorized train sets are great too! Trains have been very popular with young toddlers and preschoolers, which is wonderful since they can target many of the same words as the car sets. Trains also give an opportunity to work on sound effects (choo-choo). I do not like the battery powered trains as young children in therapy tend to watch the train move rather than play with the train and engage with it.  

-Animal sets/toys in any form is another good gift. Basically, any toy that has animals on it can be used to work on naming animals or repeating animal sounds. Puzzles, puppets, small figures, books, etc. are all great to target this early developing skills. 

-In general, I like the Melissa & Doug wooden toys. There are a variety of these products that can be used to work on action words, spatial concepts (in/out), and basic vocabulary (go, up, more). Melissa and Doug toys are durable and cover a range of different topics. You can't go wrong with a Melissa and Doug toy. 

A puzzle made by Melissa & Doug. 

-Of course, I love bubbles. With bubbles, you can work on words like pop, more, dip, bubble, my turn, your turn. 

For children working on articulation/speech sound development:

-I love the Leap Frog Letter Factory DVD for teaching letters & sounds. I have had kids really pick up on sounds watching this DVD.

-Many Leap Frog toys in general are good for teaching letter/sound connections. The sooner the child with articulation errors can get this, the better off they will be for school.

-Bath foam letters allow for a way to work on producing the sounds of letters during bath time. I also like to squirt water on glass doors and stick the letters to the glass to use the foam letters in a different way.

-Bath paints or markers can be used to write words or letters with the sound your child is working on. You could also draw pictures of things with the sound your child is working on. For example, if your child is working on /b/, then you can draw a ball, boy, or boat to practice this sound.

-Alphabet puzzles allow for the sound/letter connection and a chance to practice your child's difficult sounds in isolation by themselves.

-Letter magnets again allow for the sound/letter connection or sound practice. Besides sticking them on a refrigerator, you can buy a small cookie sheet to stick the magnets on.

-Alphabet stamps or alphabet stickers again allow for sound play and letter/sound connections in a variety of ways.

Hope this gives you some ideas for Christmas. Remember, you can always ask your child's therapist if you need more specific ideas. Happy shopping! 

Therapy Thursday is for educational purposes only and not intended as therapeutic advice. 

When Kids Notice My Daughter's Limited Speech

I have always been amazed at how quickly children pick up on Jaycee's limited verbal skills. It isn't her Down syndrome necessarily that gets their attention first; it is her lack of words.

A few years ago, I took Jaycee to her brother's pre-school orientation. Jaycee was previously in this pre-school class, so she took her seat on the floor with all the 3-4 year old children while the teacher gave her short speech. I was listening to the teacher but watching Jaycee nestled in between all the younger children that didn't know her.

Jaycee was smiling and babbled happily, "Ba ba ba," as she often did.

One of the pre-school children said, "Do you talk?" Jaycee replied with a smile. The pre-school student looked at the child next to him and said, "I don't think she can talk." There was a brief discussion between the two of them about her speech, or lack there of, as they tried to figure out why this older child was babbling to them.

I wasn't bothered by this exchange. The truth is that she has struggled with speech for a long time. Her biggest gains in talking have came in the past two years (she's now 11 years old), but she has a long way to go to get clear speech that anyone could understand. It is seemingly unnatural for a child not to be able to speak. Many adults have trouble comprehending why a child cannot produce words. This is evident by some remarks that try to make sense of the delays by blaming inadequate parenting or a lack of trying. But, some children with complex speech-language disorders do struggle. It's not innate for them to make sounds and put those sounds together to produce words.

Sometimes a child will ask me why my daughter can't talk. It doesn't bother me. I like to tell them why she struggles with speech, so they can have a better understanding of people like Jaycee. I try to explain it like this: Jaycee can say some words like mama. But speaking is hard for her. Her mouth doesn't work like yours or mine. But she does know lots of sign language and uses her device to talk with me. She's really smart!

When my son was around 4 years old, he started to notice Jaycee's speech delays as well. He started to make comments like, "Sissy hasn't said her first word yet."

I don't know where he got that idea or the phrase "first word," but I corrected him.

"Sissy has words, just not many. You know she says things like bubby, mama, dada, and bye bye."

He noticed a difference with her speech, but he didn't seem clear on what the problem was. Interesting enough, my son thought that all children with Down syndrome were nonverbal like his sister for years. He would be shocked when he saw a person with Down syndrome talking and sometimes argued with me if they had Down syndrome or not.

I think questioning why an older child doesn't speak is valid for a child (& adult). Explaining the interactions between muscle weakness from Down syndrome and muscle incoordination from childhood apraxia of speech is complicated. But, I have tried over the years to focus on what Jaycee can do and place a positive remark in the child's mind.

I hope that children can look beyond the words they don't hear and find something else. Jaycee is fortunate enough to have several people in her life that are able to do this. I hope every child struggling with words is able to find these people too!

This post is written for Down syndrome awareness month when bloggers write all 31 days in October for the 31 for 21 challenge. 

Therapy Trick Thursday

This month, I am kicking off something new on Thursdays. As a pediatric speech-language pathologist and a mother of a child with special needs, I have tried a variety of therapy techniques both professionally and personally.

On Thursdays, I will be featuring one little therapy technique or trick that I have found successful. By sharing, I hope that other parents or professionals can find something new and useful here.

Here's the trick for today:


Bottle Lid-Sticker Drop
This idea was featured in Cari Ebert's Power of Play seminar. (I highly recommend her seminars for professionals! They are so great!)

This idea is very simple, easy for parents to replicate, and is highly motivating for children.

Steps to do this yourself:
1. Collect a variety of plastic lids. I used milk jug lids, juice caps, or lids from a gallon water jug. It took me a few weeks to get the right amount collected.
2. After cleaning off any of the lids that may need it, choose one sticker to place on each lid.
More on how to choose stickers in a bit.
3. Recycle an empty plastic wipe container. You are ready!

Working with children for over 10 years, I have amassed a large collection of stickers. I have purchased some online or at dollar or craft stores. Stickers are easy to find, but I choose with purpose. When I look at stickers, I focus on the types of words or sounds that I can elicit from a sticker.

My target audience for this activity has been  2-4 year olds. This is used under supervision only due to the possibility that a child may put these in their mouth. With this age range in mind, the stickers I chose are some common words or sounds. In the picture above, my target words are: pig/oink, horse/neigh, choo-choo/train, drink/milk, butterfly/fly.

If a child is working on a specific sound, I select stickers to target the sound. These three lids are targeting the /b/ sound (bug, bock, bee). I try to collect 10-15 lids for a specific set of words or sounds.

Implementing this activity:

1. With toddlers, I hold on to all the bottle lids for safety purposes. The wipe container is placed by the child.

2. I hold up one bottle lid and either let the child tell me what the picture is or I model the word for the child to say.

3. When the child says the word or makes any attempt at the word, the child gets the lid and drops it in the wipe container.

This is very simple, but the children seem to love it! I hope that you give it a try and end up loving it too!



Come back next Thursday for another trick!

This information is for educational purposes only and is not therapeutic advice.  

Someone Loves Me

If you come here often, you know that my daughter has limited verbal speech due to childhood apraxia of speech. Like any parent, I longed to hear her say the words "I love you." Sure, she could sign it in sign language and she could push the buttons on her talker to say it too. But I wanted to hear it from her own mouth and voice.

This summer I decided I would start to work on it causally during the day whenever it seemed like an appropriate time. I understood it would take repetition and practice in order for her brain and mouth to build a pathway to remember how to say it. So I took my time breaking it into chunks for her to repeat. I also know that Jaycee shuts down if she feels pressured to speak, so I didn't sit down and "work" with her. I just practiced it in natural situations.

I always started with, "I love you, Jaycee." This was a cue to her that I was expecting a response back.

Next, I said, "Jaycee, say love (pause) you (pause) mama."

Jaycee could already say "mama," so at first all she said was mama back. That was what I expected. If she would have said love or you the first few times I would have been completely shocked. But, we kept working.

I always said my phrase cue first of "I love you, Jaycee" then led her through the other words. I praised any attempt even if all she said was mama.

Eventually, Jaycee started to make vowel noises for love. It sounded like "uh" (nothing for you) "mama." It was exciting to see progress. I never expected her to say love correctly because I have never heard her make and L or a V sound. With apraxia, it is very important to take any approximations of words and work towards improving those attempts later.

Finally, after a few months. I said, "I love you, Jaycee." To which she replied, "uh oo mama." She did it! It was amazing! It was the best she could do, and it was great! The day she said it, we practiced it naturally after a hug or a kiss to build repetition to help her remember how to say it.

After a few successful times, I showed my husband, Jason. He was impressed. He said, "Jaycee, I love you." She didn't say anything back to him as I expected. He changed the phrase cue and he was changing mama to dada. That's too many changes for someone with severe apraxia.

I taught him to say the phrase cue first. Then, he broke up "love you dada" just like I did. Because she already had a motor plan set for love you, it didn't take her long to learn this new phrase.

Now, if we say "I love you, Jaycee" she can say "uh oo mama" or "uh oo dada" back to us. She has yet to say it first as she still depends on our phrase cue but I'm sure in time she will say it to us spontaneously.

It's been a big accomplishment for her, and we are proud of what she has learned to do. If there was ever any doubt, now I know that she loves me!

"Do you talk?"

From time to time, Jaycee is around a new group of children who don't know her. I am amazed that the primary characteristic they pick up on is Jaycee's lack of verbal speech.

Several months ago, I took Jaycee to her brother's school orientation. Jaycee was previously in this pre-school class, so she took her seat on the floor with all the other children while the teacher gave her short speech. I was listening to the teacher but watching Jaycee nestled in between younger children she didn't know.

Jaycee was smiling and babbled happily, "Ba ba ba," as she often does. One of the pre-school children said, "Do you talk?" Jaycee replied with a smile. The pre-school student looks at the child next to him and says, "I don't think she can talk." There was a brief discussion between the two of them about her speech or lack there of.

I wasn't bothered by this exchange and other similar situations. The truth is that she can't talk very much. Sometimes a child will ask me why she can't talk. I try to explain it like this: Jaycee can say a few words like mama. But speaking is hard for her. Her mouth doesn't work like yours or mine. But she does know lots of sign language and uses her device to talk with me. She's really smart!

I think questioning why an 8 year old doesn't speak is a valid question. Explaining the interactions between muscle weakness from Down syndrome and muscle incoordination from childhood apraxia of speech is complicated.  But, I try to focus on what she can do and place a positive remark in their minds.

Oddly enough, Elijah's brother (age 4) hardly ever brings up Jaycee's differences. He has grown up with his sissy being a certain way. I don't believe he knows any better. A few nights ago, he made a strange comment, "Sissy hasn't said her first word yet."

I don't know where he got that idea or the phrase "first word" but I corrected him.

"Sissy has words, just not many. You know she says things like bubby, mama, dada, and bye bye."

That satisfied Elijah. He was gone with no more questions about Jaycee's vocabulary size. I was left wondering just what he was thinking about. I guess he's finally noticing Jaycee's speech and language isn't "typical" but maybe doesn't know how to ask the right question.

Whatever the case, I will be here ready to answer questions, defending Jaycee, providing insight for little minds, and helping children see her strengths.