Successful Speech Therapy Strategies for Working with Toddlers with Apraxia and Other Speech-Language Difficulties

I have received many questions about therapy techniques for toddlers with apraxia. Before I give you ideas that are specific to treating children with apraxia, I want to first outline what I believe to be the best treatment approach for all children who are experiencing difficulties learning language. These strategies can also be used at home by parents, who I believe are a child’s first and best teachers.

Before I talk about my treatment philosophies, let me send out a disclaimer for all of you who are working with SLPs or other early interventionists who may be taking a different approach with your child. There may be very valid reasons she (or he) has chosen to use other specific strategies with your child. There may be reasons that the approach I take may not be the best for your child or your family, (although I can’t think of any). Ask your therapist to have a frank discussion with you about her (or his) decision-making process in choosing techniques. Most therapists welcome this kind of discussion and are happy to talk about it with you, over and over if necessary to make you feel comfortable and empowered as an important member of the team for your child.

For children who are non-verbal or minimally verbal (less than 10 words), I believe that establishing communication and improving both receptive and expressive language skills are the primary focus for treatment. Specific speech sound practice and/or oral motor exercises need to be worked into playas a very FUN part of therapy, and are absolutely necessary for kids with apraxia. However, I do not feel that this should be the main focus for children who are non-verbal, even when they are non-verbal because of apraxia, and especially for those who are non-communicative.

By non-communicative, I mean children who lack interaction skills. These kids do not come to you to get the things they need. They do not point or use other gestures to make you understand what they want. He or she does not initiate social games with you. Many of them appear self-absorbed. They focus on their specific likes to the exclusion of more meaningful interaction. If this is your child, it is absolutely essential that you target social interaction and being “connected” to others FIRST, or at least WHILE, you are working on expressive language. Don’t kid yourself. If your child isn’t social, talking is not his main problem. Start with ideas on this site from the “Social Games” article, “Teaching Your Toddler to Listen and Obey”, and “Help! My Child Won’t Imitate Words” before, or at least WHILE, you use the strategies listed here.

If your child is social, but is not yet using gestures consistently to indicate wants and needs, and/or is not initiating interaction with you, this should also be a focus. Children who are social responders, but not social initiators, can be taught to do this. I might use another adult or older sibling to help model these kinds of things. For example, an older sibling can initiate jumping off the couch into my arms by climbing onto the couch and holding out his hands for me to begin the routine. Or I might take the child’s hand and place it on Mommy’s to help pull Mommy over to the counter to get a drink. I might sit behind the child and help him lean into take Mommy’s hands to initiate Peek-A-Boo or Row Row Your Boat.

I model pointing constantly with a child who can’t do this yet. Point to pictures in books, choices in play, clothing items, body parts, everything. I make it a big gesture. I work on pointing by making sure kids reach for things. If he’s not reaching, I hold toys he wants just in front of him to make him lean in. Sometimes I ask Mom to help him reach with hand-over-hand assistance. In play with toys and in books I also have kids pat, tickle, feed, and any other action I can think of to have them touch specific items. If this doesn’t work, I rely on a couple of oldie but goodie OT tricks. Have her practice touching a dot on a cup with her index finger with hand-over-hand assistance. When she perfects this and can do it on her own, pull the cup back just as she is about to touch it. Or practice stuffing a scarf through a hole with your finger. If this doesn’t work, talk to an OT!

Don’t get me wrong. A toddler with apraxia can still have issues with social communication, interacting, and even gesturing. However, in this kind of case, in my opinion, apraxia is not the main reason he’s not talking or communicating. More importantly, if he’s not following directions or doing other kinds of things to indicate that he understands language, direct lots of your efforts to improving language comprehension. For those of you who can’t help yourself, work on the other issues in at least the same amount of time that you spend working on saying words. See the article, “Teach Your Toddler to Listen and Obey” for ideas on improving receptive language.

The thing I do with all kids I see for therapy, and especially those with apraxia is absolutely, in the most fun way possible, REQUIRE them interact and respond. Children do not get to veg out in their own worlds, or direct all the play. (If this sounds like your child, please carefully read the next paragraph.) I do not follow children around simply narrating what they do “hoping” that they may imitate what I say. This kind of language stimulation approach is generally not successful for children with apraxia. If it were, these children would already be talking, because most good parents talk to their children in this way already. If you are using this approach, or (gasp) you have a therapist using this approach, please read on for what I believe is a better way to do things.

For children with limited social interaction skills or lower functioning cognitive skills, this “requiring a response” may not be achievable for a long time. For those kids we work on interacting during social games and participating with very basic cause/effect toys or foundational cognitive skills like object permanence. I also use Floortime techniques for at least part of the session to be sure we’re working on engaging at whatever level they can achieve. For more information on this technique, read anything by Dr. Stanley Greenspan. This approach is at the core of anything he’s written.

Back to the premise of my treatment philosophy – I require the child to respond. Their attempts can be off-target. If they can’t talk, they can sign, or use any other mode (such as gestures or pictures) they can. But they absolutely, positively MUST communicate. I don’t give any kid who can initiate or respond a turn with any toy, a piece of any snack, or let them do anything else, until he at least tries to ask for it using the highest level of communication he can. I’m not mean about it. In fact, I could possibly the most fun adult many of my little clients know, but I am VERY insistent that they respond.

Like I’ve posted on other sections (What Works / What Doesn’t Work), I play for most of my therapy sessions. For most toddlers I see over 15 months old or so, play means using toys. I like to use a combination of things we sit down to do and alternate them with movement activities.

Strategies for Toddlers with Apraxia

For example, we might start the session with a favorite toy that I know a kid likes. Initially most children are generally pretty eager to attend and play when I first arrive. I try to make this as upbeat and as fun as possible. You do this with your tone of voice (very animated and bubbly) and your facial expressions. Smile! Laugh! Act like you are having the time of your life!

For parents, this is essential. Begin your own play sessions with toys you know that he or she likes. Then move on to new things or things that are difficult. Lavish your child with affection and attention during this special play time. Let her know how crazy you are about her by how totally focused you can be during play. Don’t answer the ringing phone. Don’t constantly look over her head to watch TV. Those things can wait. Pay attention so she will!

BUT absolutely withhold or sabotage the activity by keeping the pieces of the toy until the child requests what he needs with words (if he’s verbal) or gestures/signs (if he’s not). Model what he should imitate if he’s not using spontaneous words or signs yet. Say the word or demonstrate the sign and wait.

As I’ve stated before on this site, I always give choices. Ask, “Do you want trains or cars?” Wait for him to pick one, either with a word or sign. If he can talk or sign, model the choice 3 to 5 times before giving in and playing. Take his hands and help him sign if he can’t/won’t do it on his own.

If he resists or becomes too upset, go ahead and play with what you think he wants. I think it’s too mean to hold out beyond this point. I want to keep the toddler engaged and wanting to play with me. I believe that it is counterproductive to have a toddler throw tantrum after tantrum in a session because he’s so upset. It should be the same during playtime with mom and dad too.

When kids are this upset, they don’t learn. Or the lessons he is learning are ones I don’t like. He either feels like, “This woman is so horrible to me that I don’t ever want to play with her again.” Or equally non-constructive, “This tantrum thing is working for me. All I have to do is scream and pitch a fit to get my way.”

When a toddler begins to exhibit these kinds of patterns, I do not use withholding or sabotage as my primary approaches. I still choose the activities so that I can make them fun and target language, but I do lots of modeling in an animated way with occasional withholding when he’s happy and can tolerate it. I use LOTS of praise and then immediately reward (with the toy or snack) when he’s participated in a positive way.

By praise I don’t mean a 5 minute lecture with language that’s over his head before I give him what he wants. Don’t “lose” the kid with this mistake. I do lots of smiling, laughing, tickling, and saying, “Yay!” I try to project sheer and utter delight that they have done what I wanted them to do with my facial expressions and actions as I am giving him what he wants (the real reward).

When we’ve done several sit-down play activities (or even one) and I sense that I may be losing him, I ask him if he’s finished and have him sign/say “All done,” or “Clean up,” or whatever other word or gesture he can use to indicate that he wants to move on. I always insist that kids help me clean up an activity. I am not a therapist who lets a kid drag out 7 or 8 different toys at a time. How in the world can a busy toddler stay focused on what we’re doing in that kind of clutter? Your child needs this kind of environment even during your special play times. It may be one thing to let him play as he pleases on his own, but when you are doing this together, specifically with teaching language in mind, it will help to limit his choices and clean up a bit so that he’s doing one thing at a time.

Several parents of children on my caseload save certain toys to use only when they play together with their child. They put them in bags or baskets and put them away in the closet until Mommy or Daddy can play too. The novelty alone will make your child want to interact. Think of the reaction you’ll get when you bring out the special bag! Playtime!

When my own children were toddlers, there were many kinds of activities that I never let them do alone. For example, play-doh, paint, crayons, markers, sand, etc… Get the messy theme here? If you have a child that continues to mouth toys, you may choose to introduce ones during this time that you’d never let him play with on his own while your attention is solely focused on him.

Back to my point about cleaning up – This cleaning up process does so much to help with transitions. It also prevents them from moving on to something else before you’re ready and keeps them engaged with what you’re doing. I sing the standard “Clean Up Song” from Barney so much, they ought to charge me, but it works. Have your child try to sing this with you. If a kid can say “up,” I sing, “Clean up, clean … ” and then pause for him to finish “up” once he’s learned the song.

If you have a child that hates cleaning up, you could pick up 3 or 4 pieces to his 1 piece. The point isn’t to be a tyrant or a neat freak. The point is that activities have a beginning, a middle, and an end. Children, especially those with short attention spans or transition issues such as wanting to play with a few preferred things exclusively and who freak out when an adult tries to move on, need practice with this concept.

Additional Tips for Toddlers with Apraxia

Other tips to make the clean up process work are using giant zip-lock bags for most of your toys. I use the 2.5 gallon size since almost anything can fit in there. At home try baskets or bins. If your child won’t help you, try making it more fun by “throwing” the pieces in. Practice saying, “Bye-bye” to each piece. If you’re just beginning to work on sequencing phrases, by all means, use this “Bye-bye ____” during clean up time because the child is usually so focused on this process that the phrases are easier to produce.

I always alternate sit-down play with movement activities, especially with energetic little boys (and girls) who thrive on heavy work and deep pressure. (These terms are borrowed from occupational therapy. This applies to the kid who is constantly moving or who needs to jump, crash, or in any other way “feel” his body in space to regulate. Kids who have systems like this usually display sensory integration differences.? For more on this, search this term on this site or the Kidpower site.)

My favorite movement activities for toddlers are bubbles, balloons, social games with movements (See the “Social Games” article), chase (like Get’cha, Get’cha in the “Social Games” article), and jumping off furniture or on the bed. I will “hide” and let them find me or vice versa, to be sure we can run around the house. Many children have plastic slides or swings in their homes, and I never neglect an opportunity to use those kinds of things.

For older 2’s, I might use games with movement such as bowling with plastic pins or Elefun, a game with an elephant that blows butterflies out of his trunk that we catch with nets. I routinely use puzzles and turn this into a running game or obstacle course. Put the pieces at one end of the room and the board at the other. Have the kid ask for each piece and then run, climb, crawl, etc… to place the piece in the puzzle. (This also works better for kids who can’t/won’t sit for a puzzle.) Do the same thing to retrieve the pieces and target language comprehension. Ask him to “Run and get the _______.” Run, crawl, or jump along with him to get the pieces and increase the fun. Toddlers LOVE to see their parents act in unexpected ways.

I might also use other movement activities a child’s OT or PT recommend such as swinging in a blanket or Lycra with help from Mom or bouncing on a therapy ball if Mom mentions that these help a child to regulate. However, if a child associates this with “therapy” time, I avoid it like the plague and stick to more “playful” movement activities.

During the movement tasks, I require them to talk or sign to request more turns to continue. Words I routinely use for this are “more” or “please,” or better yet what they are really doing, “Jump,” or “Go,” or “Swing.” Don’t let this turn into a “break” from talking or signing! I hear and read about therapists who use this kind of play as the reward with no therapeutic focus (aka – talking). I think that they are missing “prime time” for communicating.

Once I think we’ve moved enough or read a toddler’s signals that he is ready, I go back to a sit-down play task. For many toddlers and even preschoolers, these movement breaks are absolutely essential. I cringe when I hear of therapists who make a 2 year old “perform” with several flashcards and then “reward” them with one turn from a toy or a lick from a sucker. BORING! Or more likely – FRUSTRATING!

A Word about Books with Toddlers with Apraxia

I only use cards and even books when it’s one of a toddler’s preferred activities. Otherwise, I don’t use them at all. You will NEVER catch me with a worksheet. Therapy is not as efficient as if I used cards or books, but what good is it anyway if a kid hates it? I do not see the value in this. It takes much more creativity on my part, and I may only get 5 productions of a word or sound vs. 10 attempts in the same amount of time, but again, what good is it if the child is miserable? In my experience, miserable children do not talk. When they do, it’s usually to scream, “No.” I will never see the point. I do not get my kicks from having power struggles with toddlers. I may win the battle, but not the war.? It’s just not worth it to me.

Again, I believe that specific sound practice is necessary for children with apraxia (or phonological disorders or whatever else you want to call it), but I rarely work on sounds without having a functional target. The way I work sound practice in is by seeing what sounds they do have and then getting them in words as quickly as possible. I practice new sounds vowels or consonants alone in isolation ONLY in the context of play. For example, if a kid doesn’t have an/m/, we do “mmm” when we eat snacks, pretend to feed babies, let the toy animals eat, etc… Then I move to a word with an /m/ such as “more” or “mine.” I set up situations so that he has to imitate the word to get what he wants for the next turn/snack.

I use lots of phonemic cues when we start to pay more attention to specific sounds. For example, I call a /p/ sound a “popper sound.” When I want to teach or practice this sound, I use an activity when saying this sound makes sense, such as bubbles with “pop.” Or we might play baby dolls for a child who is starting to potty-train, and we practice words like “pee” and “poo-poo.”

I work in oral motor practice, or for children with apraxia, oral sequencing practice, into play activities. I exaggerate facial expressions constantly in play and encourage children to imitate me. I do this with WORDS ONLY. If something is exciting or huge, I exaggerate, “Wooooow!” We’re beginning that word with a relatively closed mouth and opening up to a huge vowel sound. I use lots of “oooh’s” and “aaaah’s” when we’re playing. I do animal sounds, and my favorite is the monkey so we can practice “oo oo ee ee,” which really is practice sequencing vowels and alternating mouth movements. When we’re playing with play food, I lick my lips and say, “Yummy!” When we’re playing with farm animals, I ask my little friends if they can wag their tongues like the doggie’s tail. You get the drift. Put everything into play.

As I stated before, as soon as I hear a new sound in isolation or alone, I try to get it in a word as quickly as possible. When a child is good at imitating a word, I set up situations for him to use the word spontaneously, or on his own. We keep it at the single word level until he’s ready for phrases. (By ready for phrases I mean 50+ word vocabulary that he says spontaneously.)

One thing I emphasize with all children I see, and especially those with apraxia, is to set up play when I have to get multiple repetitions of the same word. Repetition is how children establish the motor planning necessary for and make the brain connections that result in intelligible and consistent speech. Don’t settle for one production of a word. I always play the “my turn/your turn” routines with toys, so that kids expect me to get even a favorite toy back, and they have to request. If you have to, steal the toy (playfully) and make them ask for it again (and again)! I never let a kid get something and then silently play for even 30 seconds before I’m prompting that word again, or another one. Join in. Make it communicative, and more importantly, keep it fun!

For vocabulary selection, I try to teach words that toddlers can use and ones that represent things they love. For more ideas on this, see the section on “Early Sign Vocabulary” and “First 100 Words.” Generally, I teach more nouns/names for people, toys, foods, and other objects first. I always begin using verbs/actions during play soon after, and I especially want to focus on these when a child’s vocabulary is near the 50 word level, so that he or she can have some words to combine with their nouns to make phrases. I work on prepositions/location words at that same time too.

Many therapists make the mistake of teaching parents the wrong way to “expand” a child’s from single words to phrases by emphasizing word classes out of sequence from the way typically developing children learn phrases. I sigh when I sit in meetings and hear SLPs suggest that parents expand their children’s vocabularies by offering “blue car” or “big truck” when their children say “car” or “truck.” This is not how typically developing children expand to phrases. For specific ideas for phrase practice (and ones that work!), please look for a new article on this topic in the next few days.

I do NOT target intelligibility or articulation as the primary focus of therapy until expressive (and certainly receptive) language is close to an age-appropriate level. For most of the children I see for early intervention, this doesn’t happen before they are discharged to school-based or private services at age 3. I focus on what they are saying (what they mean) and why they say it (their intent – for more information on this see the article titled, “Teaching Your Toddler Words to Change His World.”)

I don’t focus on how they say words, with specific sounds, unless they are really, really, really unintelligible and no one, including mom, dad, regular babysitter, or me, can understand them. Nothing is more humiliating to a new talker than a parent who overcorrects first word attempts. I can see this in their little faces. They look at me as if to say, “Why bother? My mom never thinks it’s good enough.”

What you can do is restate the word they intended to say correctly. But please, I am begging you here, don’t say, “No. You said it wrong. It’s ____. Watch my mouth. ______.” Please, for the sake of your little one’s self-esteem, avoid the temptation to overcorrect. This places too much pressure on your child. When I suspect this is happening too much at home, and especially for a child with apraxia, I put the parents on a strict “NO SPEECH” vacation. They are not allowed to prompt, cue, question, or correct anything their toddler says. They are only allowed to model and shower their children with praise. Most of the time a couple of week break is all everyone needs to restore balance and order again.

This article is terribly long, but I hope you’ve hung in there to read it all. I believe that this approach works for all children with expressive language delays, but especially children with apraxia, because you are making speech practice functional by teaching words he can use, integrating specific sound practice or oral motor work into play activities to make it age-appropriate, targeting vocabulary and utterance length in a logical and sequential order, and helping his sensory and alerting systems stay regulated and focused with regular movement activities so that he can pay attention and learn.

Whew! That’s a lot of information! If you have questions or need me to expand or give more ideas, please don’t hesitate to leave a comment below. This site is for you. Laura

++++Additional Comment – I forgot to add the value of using the “sing-song” voice I wrote about in the What Works article. This really works, and your kid won’t talk like this forever, I promise!

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Get my DVD specifically for parents of toddlers who are suspected to have apraxia. More info here!

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Comments

  1. Emily says

    Thank you so much for all of the information in this article. I feel like my son’s therapist has done everything you said should not be done and that I need to take a no speech break. My son has seen his therapist 7 times and this last time he hid behind me and cried. I felt terrible. I will definitely be making big changes to help my little guy.

  2. Laura says

    Emily- That’s why I launched this site. Many therapists simply don’t know how to work with toddlers. Instead of taking a break from speech, I’d recommend trying a different approach. You didn’t say how old your son is, but birth to 3 (and preschool) is a critical time for language development. Find someone who knows how to do it and can help you implement changes at home. It sounds like you’re on the right track by recognizing his signals that you need to do something differently from your current experience. Good luck! Laura

  3. Laurie says

    I am a Speech Therapist and the mother of a 3 year old child with apraxia. I decided early on that it was going to be too difficult to be both mother and therapist to my child, so I sought services through our state’s early intervention program. We were extremely lucky to have been referred to Laura for speech therapy. She worked with my son for a little over a year until he turned 3 and was no longer eligible for early intervention. During every session, Laura used most, if not all, of the therapy techniques she has outlined in her posting. Not only did my son make tremendous progress, but he LOVED speech therapy. As a therapist (and a mother), I was very skeptical that anyone could work as well with my child as I could. My standards are very high. Laura’s approach to therapy was beyond what I expected. We have since been through 3 therapists in the last 8 months. Although my son continues to make progress (sometimes not as quickly as we’d like), we are still looking for an SLP of Laura’s caliber. It can be very frustrating dealing with the day in and day out struggles of a child who has trouble communicating. I now know that from both a therapist’s and a mother’s perspective. Here are just a few suggestions that may help other parents struggling with Speech Therapy:
    – Dont’ give up and don’t be afraid to change therapists. If you don’t feel your child is making progress or he hates therapy, it is time for a change. In my case, I didn’t feel that the therapist’s goals or approaches were appropriate for my son’s disorder. (Therapists that my son has seen since Laura, that is).
    – Ask to observe therapy. What your child does in therapy should not be an isolated event. You are with your child the majority of the time and you need to be able to use the same strategies at home that are being used in therapy.
    – Ask for specific activities that you can do at home with your child. Any of the strategies outlined by Laura would be great but make sure they coincide with the primary focus of your child’s therapy.
    – Keep educating yourself. There are great resources available (such as this site) that will help you be your child’s best advocate. I’m constantly looking for new information.
    – Enjoy your child. Laura actually had to remind me of this several times. Don’t be so focused on your child’s disorder or the things that he can’t say that you miss out on all the cute and fun things that he can do and say.

    Thank you Laura for sharing your knowledge, ideas and expertise on this website.

  4. Bree says

    I appreciate the information that I learned from this site. I have a 34 month old with Prader-Willi Syndrome. His receptive speech is age appropriate but is behind in expressive speech. He is receiving speech therapy through early intervention but will soon be moving on to the Intermediate Unit. The problem that I am facing with his therapist is a lack of creativity and a lack of ability to control the session. It has gotten to the point where we have had a sort of fallen out over it. She does not plan any activities and she is not able to keep him focused. She needs me to constantly intervene, which I don’t mind, but find exhausting since I do not have to do this with his PT, OT, or Educational specialist. Also, it seems like every week she asks the same question, what does Nathan like to do? She has been working with hime well over 4 months now, she should know what he likes to do, especially since I am always telling her. I have complained to her supervisor about the situation and in turn she complained that I am not involved enough. My question is, how much should I be involved during the therapy session? I am there in the room with them during the session. I am listening and looking at what’s going on. I also implement what little is being taught to him during the week. Is there more that I should be doing?

  5. Laura says

    Bree – I am so sorry that you aren’t having a better experience with speech therapy. It’s quite a challenge when you see your child do well with 3 other clinicians and then struggle with the speech therapist. It sounds like changing therapists is not an option. If this is the case and you have to stay with your current SLP, I do think you need to keep intervening in the sessions, and not to make it easier for the SLP, but to make the session more fun and engaging for your child. Even if you dislike your therapist because of her flaws, try to squeeze every possible benefit from the session.

    One thing you might ask her to do for the next session is to take out his plan/report and review his goals and progress with you. Ask her EXACTLY what strategies she’ll use to accomplish each goal and then to tell you EXACTLY what activities you should do at home to work on these. When she’s given you suggestions, ask her to model HOW you should do these things at home. If she’s uncomfortable, ask her if you could play with him using the ideas she suggested with her interjecting and “coaching” to tell you how she would elicit what you’re trying to accomplish (his goals). You may be able to accomplish much more this way than if you sit back and wait on her to magically change her approach.

    It sounds like she is not comfortable with your child, and this is unfortunate, even for her. Your child can probably sense this and he balks. Over the years I have had a few children that I have not been able to “make the connection” with quickly, and it always KILLS me. I too pick a mom’s brain when this happens, but usually we can come up with something together that works, and hopefully I can remember these after a few suggestions from mom.

    Even if you dislike your therapist, for your child’s sake, make it work. You’ve tried complaining, and it sounds like you can’t make a change, so roll up your sleeves, dig your heels in, and do the hard work of making the session meaningful for your son. If you’ve found any ideas on the site that seem like they would work for him, feel free to print the article and share it with her. I LOVE it when moms bring ideas to the session or ask me specific questions about strategies and methods. Even if it seems like it’s not your job to “run the session,” do it anyway. You may teach HER a thing or two, and it sounds like she could use the help. I hope these suggestions are helpful, even if it means more work for you. Good luck! Laura

  6. Jody Lynson says

    My son, who is almost 3.5 yo started speech in Jan 2008. They had him just sit and repeat words back to them. One therapist played with him and he did good with her. The office felt our son needed to be in a preschool setting, as being around other kids, they said would help. So, they ended care with no transitional care. I am on a few waiting list and the schools cannot see him until the middle of May. My son has now gone 4 weeks with no care. He has done better at home by home play with me. I kind of feel the therapist violated the ASHA code.

  7. Kacy says

    My 21 month old son has about 30 words in his speaking vocabulary but he is leaving off the consonant sound at the beginning of his words, For example: milk is ilk. I don’t want this to become a habit for him and was wondering if you advised that I see a speech therapist before he is 2 years old. How do I go about finding a good speech therapist? His peditrician says he may grow out of it, but I don’t want to wait too long.

  8. Laura says

    Kacy – Leaving off initial consonant sounds is not as typical as leaving off ending sounds at this age. That being said, I probably still wouldn’t see an SLP for an assessment until after 2 1/2 because the work he’ll need is for articulation/phonology, and children really aren’t ready to work on that until they are a little older.

    You do want to keep working on increasing his vocabulary so that he hits that 35-50 word milestone soon, so he can begin phrases. This is actually more important at his age than having speech sounds that are 100% accurate.

    However, at home you can facilitate these initial consonant sounds by practicing the sounds he is omitting in isolation (alone). This helps him develop an awareness of the sound. Then you can try to plug them back into words. You can also practice saying syllables with a consonant vowel pattern – me me me, mo mo mo, moo moo moo, in a playful, silly way. I always do this in play, not for the sake of practicing speech. For example, take a plastic figure and have him make it walk saying, do do do, dee dee dee, dah dah dah, etc…. This helps him learn to include initial consonants with a vowel, and more importantly, sequence them in syllables to prepare for phrases.

    As far as finding a speech-language pathologist, start by asking around. Ask moms with older children if they have used an SLP or know of someone who has. Word of mouth referrals are generally more reliable than any other way of finding a great therapist. You can ask your pediatrician’s office, call a children’s hospital, or even check with your insurance company to see who is listed, but again, you’d rather have an endorsement from a happy family than a name from a list.

    You can also call your state’s early intervention program, but again I’d wait until he’s a little older. With 30 words at 21 months, he is likely not going to qualify for services now thru early intervention, but he may later after 2 if his phrases don’t come on in, or he’s still struggling with intelligibility.

    In the meantime, keep reading for ideas to help him at home! Laura

  9. Shaffon says

    *SIghing with relief*
    My son will be 4 at the end of august and my husband and i have always been concerned with his speech. We were on a waiting list for the states early intervention program but lucky we got insurance and he was referred to a speech therapist. He tends to leave of the ends of words and sometimes doesn’t say the beginning of words also. For example instead of “fish” or “four” we would hear “ish” or “our”. I’m normally with him outside of him being in preschool and i usually correct him ( i don’t tell him NO u said it word) by telling him to look at momma’s mouth and say what i say. He also speaks fast and jumbles his words or uses sounds sometimes to fill in the words. The thing is i can understand him and others can to (depending on what he says) an extent but atleast he is making sentences. For example he would say I *then mumbled fast words* beach. I know he said i want to go to the beach, but what i don’t understand is if i tell him to slow down and ask him what do you say” he would say it slowly and clearly. He doesn’t do it all of the time, but as another mom said her son would just say milk, or juice. He tends to do that also, but he corrects himself if we tell him to say it properly. If we ask him a question he usually answers yes or no and sometimes its followed by No i want this or yeah i want that etc.

    So i don’t know if i should really be considered or not. My son has been seeing a SLP for a month and at our last session she said she wanted to send him to see a developmental pediatrician. My mouth dropped and i began crying because it’s only been a month. When i asked her the reasons behind it she said just to rule out any other underlying problems and then asked me to read the 14 signs if autism. I got defensive immediately and decided to calm down and explain to her tha my son is in school and they have no issues with him. He’s very friendly and is smart. He knows how to work the computer, play online educational games, write his name, shapes number and alphabet. She then said if i could video tape him to more or less prove to her that he’s different at home. Is that even right to ask? I know that i’m writing a lot but i’m also 38 weeks pregnant and don’t sleep well because i’m up stressing and worrying about my son. I personally don’t think he needs to see one neither does his pediatrician, but laura what do i do from here on out. This website and all of the information you have given along with the other parents have been a sigh of relief because i felt alone.

    My goodness i didnt realize i wrote so much, but i just had to let it out. What should we do? Is he making progress? I also do my own fun activities at home, in the car etc with him. Any advice would help and thank you again for reading.

  10. Shaffon says

    Oh laura she also said she notices echolalia, but its not all of the time either. He can express himself at times and other times he whines. I was told by his pediatrician he will outgrow that and he understands that another child is on the way and it actually has eased a lot. His pediatrician also said that children tend to correct themselves overtime with speech and by 5 he should be better. Is that true? Am i just over reacting and jumping the bullet or am i doing the right thing?

  11. Laura says

    Shaffon – TAKE A BREATH! I can tell that you are soooooo worried and worked up about your son. I never tell moms not to worry because I think that God gives us that inner nudge that lets us know when something isn’t quite right, and usually, we should listen to that voice. That being said, I hope you can take a deep breath while I give you my opinion on this in an effort to help you try to sort all of this out.

    First of all, I can tell that you are totally freaked out by even the mention of the word autism. It is so scary to hear the possibility of this diagnosis, let alone process what it could mean for your son, and for you. This has to be an incredibly difficult thing for you to hear – not only because you love your son dearly, but also because you’re about to have a second baby. I am sure your hormones and protective instincts are all in over-drive right now! This has to be an incredibly stressful time for you, and I hope you are getting the support you need for this.

    However, that being said, I would go ahead and pursue the additional appointment with the developmental pediatrician. Best case scenario is that the doctor will tell you that it’s not autism. Less than best, but still good, is that he’ll say he IS on the spectrum AND point you in the right direction as far as pursuing additional treatment options. There is not a BAD outcome for going ahead and having this assessment. Actually I think the only bad outcome would be not having it done because the possibility of autism would loom over you until you get the evaluation and have it ruled out. Then your cycle of worrying will continue on and on without resolution, and you’ll completely second guess yourself for a long time.

    Waiting for a child to improve at a magic age is often a huge mistake that parents regret since you may lose valuable treatment time. However, you already have your son in therapy, so it sounds like you’re doing everything you can to help him, with or without a diagnosis. If your SLP is providing the same treatment she would for his challenges regardless of what it’s called, there is no harm in waiting. However, if in waiting you don’t give him the time, effort, and specific interventions his issues deserve, you’ll be doing him an injustice. Does that make sense to you?

    I wish you all the best as you sort this out! Let me know if I can help you in any other way – Laura

  12. Shaffon says

    *Breathing, but now with tears*

    Thank you laura for responding so quickly!! My tears are most likely my hormones being all over the place and yes the word Autism scares me. I’ve read so much on it that i don’t know what to believe he has or not. The only symptoms he has is the repeating if u ask him a question, but what gets me is he doesn’t do it all of the time. I may ask him what do you want and he may repeat it but then i might ask and he answers me and say I want to sleep. Since being in the sessions i think he talks a lot more. He actually likes to talk on the phone now and he asks questions such as where is daddy or grandma? If u ask him where something or someone is he can respond it’s over there or i don’t know. Laura i definetly have a worrying complex but because i get so much information on autism my brain is over loaded and emotionally it’s draining. But i will speak with her on tuesday and his doctor as well and begin his journey to get evaluated by a developmental pediatrician. And if he isn’t autistic then normally how long do children have to have speech therapy? Thanks again

  13. Holly says

    Hi Shaffon I just wanted to drop a few lines as a mom who’s been where you are now. I believe, not certain, that they always test all other aspects once they are receiving help in one area. My son too was tested by a developmental specialist and an OT and a PT and anyone else you can think of :) I know in my state they mandate it once a child is receiving any time of special ed I don’t know if it’s the same in yours too maybe. I know it’s very hard especially when you’re pregnant. My son was diagnosed with apraxia when I was pregnant with my second child as well. You just have remind yourself to stay strong for your child and things will work out:) I don’t remember seeing what ‘type’ of speech delay your son was diagnosed with? or maybe I just missed it. The reason I ask is because I know with apraxia where it’s a motor planning issue sometimes the child will repeat themself especially if what they are trying to say isn’t coming out right or you’re not understanding what they’re saying. I wish you the best and hang in there it’ll get easier:)

  14. Shaffon says

    Hi Holly Thanks for responding. I was told that he has an articulation and language problem. He tends to repeat what you may say sometimes, but we can have a conversation. I’m going to stay strong because i know that i have no choice. I just think the way the SLP went about talking to me got me upset because she was cold and forward. My husband and i are willing to do whatever needs to be done in order for our son to get the help he needs. He is also happy that i stayed up until 330 am(eastern time) to read and write comments. So holly what therapy is your child in? How long has it been and have you seen results?

    Right now my son goes once a week for 30 mins and she shows him cards and asks him to say what he see’s and whatever sound he isn’t pronouncing clearly she corrects him and he repeats it. It’s been a month but we see changes. I still would love to know why he speaks fast and jumbles his words at times. Thanks again holly, look forward to your response.

  15. Administrator says

    Ashi – I have sent you a private e-mail with questions and instructions regarding the DVD. All international orders for the DVD should be handled this way by sending an e-mail to johnny@teachmetotalk.com. Thanks so much for your interest! Laura

  16. Luz Gonzalez says

    Hi, I have a 25month toddler who was diagnosed with verbal apraxia. The therapist who initially evaluated him, move to another state, and through the early intervention program he was assigned to another one. My son can say 2 words, correctly pronnounced, and 4 approximations. I’m extremely concerned because the therapist told me (on the 3rd therapy session), that he is already two, a big boy according to her, and that he needs to begin expressing sentences such as: I wan’t juice, My name is Erick, when he can’t say these words in isolation. I also told her about the previous evalution, and she told me is too early to make a diagnose.

  17. Luz Gonzalez says

    Continuation of previous comment…

    My son exhibits ALL the typical characteristics of children with apraxia: he never babbled as a baby, he said some words (juice, ball) when he was 22 months, but we have never heard them again, when repeating sounds he tends to make inconsistent errors, he deletes, ommits, substitutes sounds and has come up with his own hand gestures that represent different things, he is capable of imitating some words such as yes, but can not say it on his own, he’s understanding on the language is far greater than his expressive language. I tried to express all of this to the therapist, but she said that for the diagnosis I have to wait until he is three and again said we have to focus on sentences,because he will be far behindhis peers when he gets to preeschool. I just don’t know if I’m overeacting, after all she is the one with the Master’s Degree in speech pathology.

  18. Amy says

    Luz, I know I’m not a therapist, but my son is 26 months old, and he was diagnosed with apraxia of speech just days after his 2nd birthday. Your son sounds like mine. Please do not think you’re over-reacting….usually, our mommy- or daddy-gut is right. I know mine was. Keep advocating for what your son needs. It will pay off in the end.

  19. Laura says

    Luz – I read your comment this morning before I left for my busy day of “mom” stuff, and I have thought about it all day long. So here goes my lengthy response to you…….

    First of all, let me say that 25 months is young, but not TOO young, to diagnose apraxia. Any SLP who believes it’s too young must not have worked with toddlers for very long OR must be very reserved in using her clinical judgment and diagnostic skills with this population.

    As far as this SLP goes, I actually believe that she must not have ANY clinical judgment because to work on phrases or sentences with a child who has only 6 words is well, stupid, to put it frankly. In my opinion, she lacks not only clinical judgment, but common sense! How can you get phrases when it’s still a struggle to get words???? Even therapists who are reluctant to “diagnose” apraxia in a toddler understand that a child MUST have a base vocabulary in order to be able to combine words to phrases. That’s a pretty basic concept, even if you’re not an SLP!

    Secondly, please understand that a masters degree alone does not make an SLP “good.” You seem to understand more about apraxia and language development than she does!!! Just like there are bad auto mechanics and bad hairdressers and bad salespeople, there are unfortunately bad SLPs. What would you do if you got a bad haircut or sub-par work done on your car? You wouldn’t go back to that person again. That’s the same advice I’ll give you for this SLP. Move on. Find someone else who understands apraxia and how to work with toddlers since this person clearly doesn’t.

    If you want to try and educate her, recommend this website, the apraxia-kids.org website, the book The Late Talker, and the book Becoming Verbal with Childhood Apraxia. These resources are invaluable for parents and for educating therapists. On this site, she should start with the oldest article in the apraxia section and read forward. On the apraxia-kids site, she could read the professionals section, but she probably should start with the basics in the parents section since she seems pretty clueless to me!!! Another idea is buying Teach Me To Talk – The DVD and loaning it to her. It sounds like she needs the help!

    If you’re not wanting to “go there” with her, and you do decide to cut your losses and find someone else as quickly as possible, at least tell your service coordinator that the reason you are firing her is that she did not recognize apraxia and was incompetent in her approach. This way she’ll at least know and hopefully begin the path of self-analysis and re-education.

    I hope you’ll find the articles on this site informative and helpful for home until you can get an SLP who can help you and your son one-on-one at home. No child progesses with apraxia without high-quality speech therapy. I wish you all the best as you pursue this for your son!

    Let me know if you need anything else! This site is here to help!Laura

  20. Luz Gonzalez says

    Laura,Thank You for your quick response. Unfortunately, here in kissimmee FL, we don’t have too many SLPs, and very few specialize in apraxia. I’m currently on 4 waiting lists, and still looking for other options. I’m trying to do everything I can to help my son at home, I’m currently doing activities suggested in the book: “Easy Does it for apraxia preschool”, and I will definetely buy the DVD to keep reinforcing at home his expressive language. In regards with the speech therapist we have now, we will not take him there anymore.
    After you posted your comment I discussed it with my husband and he told me that the SLP was teaching him some words in English and others in Spanish, supposedly some words are easier in one language and other easier in the other and eventhough we are bilingual I specifically told her one language. This reasured me, that I must cancel the therapies with her.

    Again Thank You!!! This website has been a blessing!!!!

  21. Trumom says

    Found this site today. Toddler (boy) turns 3 in a month. Slow at speech and follows instructions he likes or others when I insist or he feels like. Sometimes he gives a weak or no response. Does not respond much to conversation cues and does little initiation of conversation. In recent months, started responding yes or no when asked to choose from a list of things to eat. Sometimes he will pull you to the refridgerator and say the word of the item he wants to eat. He will tell you computer or “Dot com) when he wants to use the computer, open it for food, help me, let’s go or bye. Before he was even a yr old, he would call his dad “Da” and repeat some words or even phrases. We moved from one country to the another when he was 17 months and he started saying one or two phrases when he first moved. I had another baby when he was 25 months and by then I noticed that his speech wasn’t expanding much. Mentioned it to a new pediatrician who sent me to research autism. That was 9 months ago and my world has been a spiral since then. I have gotten contradicting opinions from every doctor I have seen. Almost at 3, he has expanded his vocab, saying a few 2 and 3 word phrases – “try again, help me, good job, good boy, oh boy, Let’s see – some of which he picks up fromhis compurer games but uses in the right contect. He sometimes calls us mommy and daddy now which he didn’t do before – he will call us mommy or daddy especially if there is a stranger around. He says hi and bye to most things that interest him – animals, objects and for persons he tells some people hi when he sees them. trying not to give you my entire child’s history. however we had pushed to the back of our minds that he may need therapy, but compared to other 3 yr olds he is not interactive enough with speech or communicating – interacts and plays well with peers and his baby brother – forces you to give him eye contact sometimes(physically)when he wants parent attention or if he wants you to hear what he has to say. He counts very well in english and Spanish counts objects and tells you the number as an example “5 dogs, 3 fish etc”. He loves sing a long and stories. Used the singing voice to call him before he was 2 – that’s mostly what he would respond to then.

    Still worried. Have decided to engage a Speech therapist to determine if there is any help we can give him and with much anticipated fear whether we should do further development testing for conditions such as autism. His dad is quiet and most of his family members have a special skill of “zoning” out other persons when they are involved with other activities.

    Sharing my experience as my toddler is my first child and I don’t have much prior experience to go by. The second child is extremely engaging active and responsive. With the exception of teething, he has reached his social and physical development milestones quite early and may even be the source of helping my toddler to speak. Welcome your comments

  22. Laura says

    Trumom – You can’t go wrong having him evaluated by an SLP. He definitely is not meeting his expressive language milestones for a child who is turning 3 soon. It’s great that he’s making so much progress without intervention, and that leads me to believe you’d see even MORE progress if you had a professional be able to help you tweak things you already do at home to help him in addition to working directly with him.

    I know you’re scared to death that someone might say he has autism. It’s a very unsettling feeling. But they might NOT say that too, and you’ll never know unless you have him professionally assessed. I would rather know than not know if he were mine, but I understand your very real feelings. Even if he does turn out to fall somewhere “on the spectrum,” chances are he’s going to do okay anyway because he’s moving along and making progress now without any sort of therapy. ALL of the literature tells us that children who are diagnosed early or who receive intervention early for communication issues, with or without a diagnosis of autism, do MUCH better long term than those who don’t. So my advice is pursue speech therapy for him. It’s certainly not going to hurt, and waiting might. Laura

  23. momtorrr says

    Thanks for the informative article. My question is about my 26 month old son. He has been receiving quality speech therapy for a significant expressive language delay for the last year (using many of the strategies you suggest). His progress is slow but certainly present. He tests very well in everything else, including receptive and cognitive/social, across the board. He is using about 5-10 word approximations (very loose approximations, but still consistent attempts to communicate verbally) and quite a few signs. Our SLP is great and and has said she suspects he might be apraxic. However, our local specialist apparently does not diagnose until 3. That said, do you have regional/local recommendations for private therapists with the same philosophies as you? I don’t want to waste this valuable time for additional therapy (even though we don’t have a formal diagnosis) while we still have great EI services. Thanks for all the tips and any additional suggestions you have.

  24. Laura says

    Momtorrr – Have you asked your EI SLP or your service coordinator who else locally/regionally might diagnose him before age 3? Sometimes you can get a neurologist or even a multidisciplinary evaluation team at a regional center to make the diagnosis at 2 with a very detailed progress note from your SLP stating why she believes that’s an appropriate and accurate diagnosis for him. Our regional team and local pediatric neurologists will make this diagnosis when they have gotten enough info to “make the case.”

    Unfortunately, I do not have a list of regional/local sources other than for where I live and practice, but if you want to leave a comment here on the site with your location, you may hear from another reader who could suggest someone. I get lots of e-mails from SLPs and other pediatric therapists all over the country (and world) who read this site regularly.

    Until then, I would encourage you to keep following the ideas your SLP gives you since treatment, not a diagnosis, is what’s most important for him. You’ll likely need a diagnosis before he’s out of EI in order to file insurance to help cover the cost of private therapy, but you’ve still got some time.

    I will also let you know that my 3rd DVD, Teach Me To Talk with Apraxia and Phonological Disorders, is currently being filmed and is on schedule to be released in late October/early November (pending any problems with filming I haven’t antipated!). This DVD will build on ideas from the first DVD, Teach Me To Talk, but will be more specific to the special challenges of diagnosing and treating toddlers and young preschoolers who have been diagnosed with or are suspected to have apraxia.

    Thanks so much for your comments! I’m glad you’re enjoying the site! Laura

  25. momtorrr says

    Thanks for your note. I am in Pittsburgh, PA if you hear of anyone in this area. The only reason I would want an early diagnosis (or rule-out) is that if there are special treatments/services/programs only offered to children with an apraxia diagnosis, I don’t want to miss those opportunities. I will certainly continue to follow through with our SLP and EI suggestions and I will look forward to the new DVD! Thanks for the kind reply!

  26. Laura says

    Momtorrr – Lucky for you that you live in such a big city with excellent resources! There’s an apraxia guru in Pittsburgh at Children’s Hospital. His name is David Hammer, and he led one of the best training courses about childhood apraxia that I’ve ever attended several years ago. He probably doesn’t officially diagnose apraxia until 3 since I think he prefers the term “suspected” apraxia until then, but if there’s any way you could get your child seen by him, either now, or closer to 3, I’d do it. Get on a waiting list if you have to, but in my opinion, it would be worth it. Laura

  27. Stephanie says

    Thank you so much for this information. My 28 month-old son, Connor, was evaluated by our state’s early intervention program and he was diagnosed with apraxia. However, his receptive speech is spot on. It’s his expressive speech that we need to work on. He is at a 15 month-old level in this area. We will start our therapy sessions next week, and I am really looking forward to finding out what I can do, here at home, to help him.

  28. Lori says

    Laura,
    I am a speech pathologist who sees outpatient pediatrics and adults in a hospital setting. I evaluated a little boy today who’s CA is 3-9. The only consonant sounds he uses are /b/ and /p/. His language is WNLs, but he only uses vowel sounds. He speaks in complete sentences, but obviously intelligbility is very poor. He appears to have a phonological processing disorder, but with such severity I don’t know where to start! I thought you may have some suggestions of a particular method or approach. Any help would be greatly appreciated! Thanks so much.
    Lori

  29. Laura says

    Lori – Thanks for the great question! Your little guy sounds tough, but he’s not unlike many of the children on my caseload at any given time!

    I want to direct you to another article on the site called “Working Toward Intelligible Speech…” You can find it in the articulation section. It outlines how I approach intelligibility treatment decisions in toddlers and young preschoolers.

    I would still use mostly a play-based approach since he’s still really young, and I’d get really creative to be sure all the toys I offered as options included his target sounds.

    I would also check for stimulability to see if final consonant sounds may be easier than initial consonant sounds for him to imitate. The conventional wisdom is to start with initial consonants, but sometimes ending sounds are more stimulable.

    If he doesn’t consistently include /p/ and /b/ in all words, I’d also look at what words he produces correctly that include /b/ and /p/ and look for phonetically similar words so that he can feel some initial success. For example, if he can say, “bye-bye,” try “bubble” and “baby” since these are very similar CVCV patterns. If he can approximate “pop” with an initial /p/, I’d try other verbs like “push” and “pull.” If he’s producing initial /p/ and /b/ correctly in all words, try to get an /m/ in the initial position (or final if it’s easier for him) since it’s also a bilabial and pretty easy to facilitate with tactile and visual cues.

    I do still try to elicit most consonant sounds in isolation first, then get them into functional words pretty quickly. Best practice guidelines encourage getting sounds into words rather than the traditional way of mastering a sound in isolation first. If I can get it in isolation a couple of times with some visual and tactile cues, I try to move it to a word lickety-split. If he can only do it in isolation, I use that sound LOTS in vocal play as a sound-effect so that he’s still “using” it functionally. For example, if he can only say /t/ in isolation, this is the sound my character would make as he walked or ate or did any other fun action.

    Another thing is to work toward is an approximation of a word that’s more intelligible than just vowels, even if the consonant isn’t correct, but a typical substitution. For example, I’d take “pish” for “fish” since this would be an acceptable substitution in a younger child. You can check out Nancy Kaufman’s apraxia tools for help in doing this.

    If you need more ideas, write me back! Laura

  30. Kelly says

    My husband and I are looking for a therapist to work with our 2 year old on speech and language. Please provide us with referrals and contact information in the Murrysville/Pittsburgh area. Thanks so much! We are currently working with the IU but would like additional services that we are willing to pay for.

  31. Laura says

    Kelly – I don’t have any direct contacts from there. I have looked thru my e-mail list and don’t have a name for you. There is an apraxia expert at Children’s in Pittsburgh, so you could try there. Laura

  32. Tricia says

    Hi there Laura, I’m so happy I found your site! I have a 16 month (almost 17 months) son who isn’t talking yet. Our pediatrician is a bit concerned and referred us to EI at his 15 month appt. I called and wasn’t comfortable with the information I was given and decided to wait it out, hoping he would have a language explosion soon.

    He makes tons of sounds all day long, in fact- I joke that if I knew Chinese, I’m sure we would have some great conversations. But nothing that he says is understandable. He comprehends what you are saying and can do what is asked of him, (ie: do you want milk? *runs to the refrigerator and waits, Sit down so we can get your shoes on! *sits down and holds his feet up for you… etc) but he isn’t saying even basic words yet. I know he is young and I just want to know if I should really be concerned yet, I’m getting mixed opinions everywhere I look.

    I’m a stay at home mom and going to try several of the things you’ve suggested here. I’m really hoping that he is just waiting until he is good and ready, but I still can’t help but worry.

    Thanks so much, any opinions or advice you can offer would be greatly appreciated and wonderfully welcomed!

  33. Laura says

    Tricia – Try some signs to get him going with learning to DO something specific to GET something specific. I would also start with animal sounds, play sounds, etc… to have him try to imitate those rather than real words. If you’re not having success with reading the ideas, check out the clips for Teach Me To Talk the DVD so you can see some of those strategies in action. Sometimes seeing someone else implement the strategies gives you new ideas which in turn, will give him a real jump start! If he’s not moving along in a few months, I’d seriously reconsider the whole early intervention route! Hope these ideas help! Laura

  34. Hazel says

    Hi Laura,

    I am a newly qualified SLT and I’m working with a 2.08 year old. As of now this boy has some vowel sounds and [b] inconsistently. This child is very active and a has a very low attention span. We have been working on the bilabial sounds [b], [p], and [m] with toys [b] (ie practicing [b] when rolling the ball). Just wondering if you have any other ideas? Receptive language is WNL. Also should I target activities to improve attention levels e.g. listening activities.
    Thanks

  35. Laura says

    Hazel – Use his movement to stimulate sound production with FUN activities that are HIGH ENERGY. I’d jump with him, throw the ball, kick the ball, bounce on the ball, etc… Rolling is probably too low key and may not result in anything. If you’ll get his “motor running” from a sensory perspective, he’ll likely become much more verbal than with sit down/listen activities. Look at my article in the Great Toys section for ideas for other movement activities.

    The other thing I do with active two-year olds is to model play sounds like uh-oh, oops, whee, whoosh, animal sounds, vehicle sounds, etc… because these are much more likely to elicit imitations than words or isolated speech sounds. Look at the article called “Help! My Child Won’t Imitate Words” for more ideas. I think it’s in the expressive language category.

    One more piece of advice I learned the hard way – Often with 2 year olds if you change your focus so that LANGUAGE is the goal as opposed to speech sounds, you’ll get so many more word attempts and he’ll have lots more fun. See the articles Successful Speech Therapy Techniques and the What Works article for more specific ideas about this topic.

    Good luck and welcome to this wonderful field! Hope you love it as much as I do!!! Laura

  36. miriam says

    my son is 29 month old and he say only
    dada,papa and baba.there is hope one day he will talk?or what kind of help that he need?please advise me .miriam

  37. Laura says

    Miriam – You should have him evaluated by a speech-language pathologist through your state’s early intervention program if you are in the USA. You can find this program through a Google search by entering your state’s name and the phrase “early intervention.”

    If you are not in the USA, you should talk with your pediatrician and have him referred to someone who can help you figure out why he’s not talking yet. The best professional to assess communication is a speech-language pathologist.

    More importantly, YOU need to be learning how to teach him at home. This website is full of articles to explain ways to do this, so keep reading. I would also recommend that you check out the DVDs to decide if these would be helpful to you.

    Having only 3 words at nearly 2 1/2 indicates a significant language delay, and he very likely needs special intervention from a professional AND again more importantly, from you, so that he can learn to communicate. Good luck! Laura

  38. tasnim says

    I wish icould get speech therapy of my 23 months old son who does not speak even a single comprehensible word though he understands few words like ‘no’, milk,come here.Most of the times he does not pay any attention when we speak with him.He is so attention deficit that he even does not responds to his name.His pediatrition suspects ADHD.I consulted speech therapists and had two sessions with him but not satisfied the way he treated my son as he made my son cry.I am very upset and looking for another speech therapist.By the time I find a suitable I want to help the child at home in receptive language. Can you pl. give me some tips. Thankyou

  39. Laura says

    Tasnim – Keep pursuing a new SLP who can establish a good relationship with your son AND you. They’re out there – so keep looking! You might ask around for some more names of who the “experts” are in your city.

    Secondly, keep reading here on the website, particularly the articles in the receptive language section, for ideas for working with him at home.

    If you need to SEE the strategies in action, check out my DVDs Teach Me To Listen and Obey 1 and 2 which will SHOW you how to work with a child with difficulties understanding language.

    Many times children are misdiagnosed with ADHD when the problem is a social interaction problem (like autism), a severe receptive language delay (he does not understand spoken words), or a sensory processing disorder. In my opinion, two is way too young to diagnose ADHD. From what you’re describing, your son more likely would be diagnosed with developmental delay. Please pursue additional therapists who can teach you how to work with him so that he can learn to learn.

    In addition to speech, I would recommend that he be evaluated by an occupational therapist to look at the way he’s processing incoming messages. Refer to this article for more information:

    http://teachmetotalk.com/2008/10/19/sensory-processing-disorder-resources-for-parents-with-toddlers-with-language-delays/

    I hope this information helps you! Laura

  40. Laura says

    Laura,
    I am so excited to try your sound techniques. My son is 2 years old. He communicates very well by pointing and TRYING to say the word of what he wants. However, he is not articulate on most words. For instance, he calls me “ba-ba” instead of “mama”. Sometimes I will go along with him but here lately I have been saying “no, I’m not baba I’m mama” Should I stop doing this or not. We do read alot and he points to the pictures and says what he sees incorrectly on most things. Please help me. The last thing I want to do is discourage him. He is so sweet and tries very hard.

    Thank-you for your time,
    Laura

  41. Laura says

    Laura – Keep modeling what how he should say words without the “No” or obvious corrections for a while. As he gets close to or older than 3, then try the minimal pairs technique – “Did you say baba or mama?” One other thing to try is exaggerating that first sound, but I caution you not to do this too often, or he’ll start to imitate that! I think it’s important that you praise his attempts so that he knows you are recognizing his efforts.

    You didn’t really comment on his overall language skills. Is he using words to tell you what he wants on his own, or is he still just repeating you? If not, this may be more than a speech sound problem. If he’s not using more than 50 words and lots of 2 word phrases on his own, you should go ahead and have him evaluated by your state’s early intervention program or another speech-language pathologist. If it is just a prounciation problem, you could hold off for a little while, but if he’s not really “talking” on his own, then go ahead and pursue services. The SLP will not only help him, but help you by teaching you how to work with him to facilitate those early words, and eventually get all of those sounds in the right places! Good luck!! Laura
    Thanks for your question! Laura

  42. Christine says

    Laura,

    My daughter is 15 months old. She is currently on the waiting list to see speech, physical and occupational therapists (she will not be seen for at least another 3 months). Because of the wait, I want to start doing something now to help her in every way that I can.

    She used to make “aa” noises and 3 months ago completely stopped. She attempts to talk, but opens her mouth and nothing comes out. We have been trying to teach her sign language for 3 months now and she is unresponsivve.

    Your articles are very helpful, but I’m just not sure where to begin. What do I start with first? Do I work on her speech or her fine motor skills? (She does not point or wave and rarely uses her pincher grasp).

    Thank you so much!
    Christine

  43. Laura says

    Christine – Always start with working on social skills/interaction first, then comprehension, then gestures/signs in conjunction with verbal speech. If you start by making sure her foundational skills are covered, then you’re not “missing” anything. Many parents jump straight to working on having a child vocalize when she’s not even interacting with them and when she understands very little.

    Have you worked on signs by helping her perform the sign for things she really, really wants (like food)? If you need help and need to see exactly how to do this, check out my DVD Teach Me To Talk. It outlines basic expressive communication techniques SLPs use with language delayed children. If this is mostly a speech issue (she can’t vocalize), then you’ll want to take a look at my upcoming DVD Teach Me To Talk with Apraxia and Phonological Disorders. It’s a comprehensive guide to teaching speech at home. My podcast last week (#45) also outlined therapy ideas for non-verbal toddlers. You can listen by clicking on the blogtalkradio icon in the right hand column.

    If you discover that comprehension skills are an issue for her, check out Teach Me To Listen and Obey 1 and 2. You can see clips of these to decide which techniques might be helpful to you at home. I admire that you’re wanting to start to work with her at home, even before therapy starts. Good luck, and let me know if you need more help! Laura

  44. Michele- Stressed out mom says

    Hi! I have a daughter who is 2 and 1/2 years old who has been diagnosed with an expressive speech delay…. She is seen once a week by our local infant and toddler progam and once a week by a private speech pathologist….Progress has been slow and I would love to get more information for more resources for my daughter…I feel she needs to be seen more and am not able to pay our private speech therapist because she is not covered under my insurance…. I would love to see a pediatric neurologist…I live in baltimore maryland and would love to find the best doctor and more programs for my daughter.

  45. latoya says

    Laura,

    My 15 month old son has a vocabulary of 4 words papa,go,wow,and bye. He does not point to things that he wants, he will mimic (not all the time)when prompted. He plays peek a boo and claps his hands. However he will not bring toys or any other items to me. For instance I will request and item by saying “let mommy see it” and he will simply throw the item. He seems to understand the word no, when he is into something such as the cabinet, and he hears me say no he will take off running. Other than the pointing,limited vocabulary and not bringing requested items he has reached all of his milestones on time so far. Not sure if I’m over reacting but i want to address these issues right away, what suggestions, if any do you have for me reguarding where to begin.

    Thank you

  46. Laura says

    Michelle – My advice is to network with other moms who have or who have had children with delayed language skills who can make recommendations about helpful physicians. Your service coordinator/case worker through your local EI program should be able to give you more information about other local programs.

    I also hope you’ll continue to read info here on the site, especially in the expressive language section. There are dozens of articles that are relevant to things you can do at home with your daughter. I also don’t know if you’ve gotten a chance to look at clips from my DVD Teach Me To Talk. This outlines practical ways you can work with your daughter at home. Children who have parents who are actively involved in their treatment programs have much better outcomes than they would if her SLPs are the only ones targeting those language skills. Keep looking for additional ways you can help her at home since you are with her far more often than you could ever pay someone to see her for therapy. Good luck as you look for more ways to help her!! Laura

  47. Laura says

    Latoya – Keep working on the things that he can’t do at home with him. It’s great that he’s met his other milestones, so I wouldn’t be too concerned just yet. However, following directions is the biggest, most practical way kids demonstrate that they understand language, so you do want to keep working to make sure he understands what you say. Try to elicit this kind of task in play too and try to make it fun so that he wants to cooperate with you. If you’re still concerned in a few weeks or months and he doesn’t seem to start to respond more consistently, I’d recommend that you have him evaluated by your state’s early intervention program.

    In the meantime keep reading ideas here on the website in the receptive language section for ways to work with him at home. If you’re more of a visual learner, or those things don’t make sense to you, check out my DVDs for receptive language – Teach Me To Listen and Obey 1 and 2. On there you’ll SEE exactly how to work with a young child who is having difficulty consistently responding and understanding what you say. Hope these ideas help! Laura

  48. Michele says

    Laura thanks so much for your advice…It is very discouraging because I do all of the advice that I am given and on your dvd (which is awesome)…I am not getting anywhere with other programs available in my area…My Daughter is 2 1/2 and has a 20 word vocabulary…Everything I’ve read talks about eary intervention and children with apraxia getting intensive services and I feel lost trying to obtain more services…Their was an article in prevention magazine(september 2009) about a toddler who started taking omega 3 supplement every morning in her orange juice and after a month she is talking up a storm…Any thoughts on the omega 3 defiency and how it relates to speech? I talked to my pediatrician and private slp who think it is worth a try….
    All other moms who I talk to feel that the county slps put a blame on us for not doing something at home….Where we feel we try everything…It is very hurtful! I work full time and would love to quit my job to be home with my kids but that is not an option… I would love to go back to school to become an slp and stop discouraging families who are trying everything but their is something else wrong!

  49. Laura says

    Michele – First of all, I’m so glad you like the DVD. Thank you very much!

    Secondly, please, please, please know that I am NOT a mom-basher and started this website and filmed the DVDs to give all moms (stay-home moms and working moms like me!) very practical, hands-on, REAL strategies that work to help their kids learn to talk. Most of the children I see and I suspect most of the moms who write into the site are doing everything humanly possible to help their children learn to communicate. Occasionally I have seen moms who weren’t doing much of anything, but that is truly the exception, and certainly not the rule. Sorry you’re in an area where your efforts are not recognized and supported by professionals. My advice would be to keep looking for an SLP who wants to be a “team” with you to help your daughter.

    As far as frequency of services goes, I will tell you this, most of the children I see through my state program, even those with suspected apraxia, are just seen once weekly. At most, some children are seen twice weekly. I know that more frequent visits are recommended, and if you can get it great, but if not, do what you can with what you have.

    To answer your other question, I have had moms who swear by omega 3s and moms who feel it didn’t make much difference, so that’s something I definitely leave to parents to decide. If I were the parent of a child with apraxia, you better believe I’d give it a try!!

    Also, hang in there with your daughter!! Apraxia is very, very, very difficult to treat! But keep doing what your SLP recommends and continue to gather reliable treatment strategies you can use at home. I just released my new DVD which specifically deals with the challenges of treating apraxia in toddlers, so you may want to check that one out as well.

    Thirdly, we have a delay filter on comments, so that’s why what you write doesn’t immediately appear. We do this so that the site is not over-run by spam. Everyday we get about 50 “comments” which are not related to this site at all. Since I am a real-live working SLP with a real-live caseload, I’m not at the computer all day long, and sometimes not at all! It usually it takes a day or two for a comment to appear. Believe me, you want it this way!

    Hope I’ve answered your questions, and again sorry for the delay – I was doing my REAL job!! Laura

  50. Kelly says

    Hi Laura,
    First of all I read this whole article and am on my way to read through your entire site and its already given me SO MUCH more insight. :) Thank you.
    I’m a mom of 1, his name is noah and he just turned 2. He had his 2yr check up a few days ago & our Ped was very concerned about my son having hardly any words. He told me most kids his age have at least 40-50 words and making 2-3 word sentences. My son does not.
    He has mama, dada, deda, papa “papaw”, he did say nin-e “pronounced nin-ee when he took a bottle and wanted it” now we are trying to teach drink, & bite for when hes hungry…he does say bi-bi sometimes for bite. He also says MMM when he is loving on you or our dogs.
    He grunts for what he wants mainly, he will point or try his best to show me what he wants, but never tells me. He babbles to me or just in general A LOT esp when hes excited running through the house but it doesn’t come out as words, its more like looonger sounds like for instance I can be making him a drink and he will be excited so he will make weird sounds like dodaloodaloo haaaaahhhh low pitched and high pitched sounds. He can follow tasks like put the milk back, get One Juice out of the fridge, put that in the garbage, Lets go inside..etc.. I HAVE had him saying words like for instance it took two days to get him to say apple, I could show him in a book about 5months ago an apple and he would finally say Apple! It was never used as what it really was, I couldn’t show him a real apple and he would say apple, but he did use it randomly and then the word was lost.
    I feel like some of it all is MY fault because I haven’t worked with him one on one with speech. But I’ve ALWAYS told him what things were as we went a long. I tell him dog when we play with our dogs, He has and does say jake “comes out jaa” which is his golden retriever.,..or if were playing with his ball I will tell him that’s his ball…etc..
    His Pediatrician recommended Speech Therapy, I myself want to hold off a little myself he just turned 2, I mean it just seems a little early for me. BUT, My husband and I talked and decided we could work on things ourselves and get ideas from a Speech therapist & online & if no progress in 1-2months then yes we will proceed with therapy & other programs.
    I am a full time stay at home mom and my friend told me who is an RN, thinks that our main problem is that Instead of giving him a chance to talk and tell us what he wants we just give him what he wants. For example if he wants a drink I know him so well I just give it to him instead of going through the process of seeing if he tries to tell me in his own way, or asking if he would like some juice?…things like that. I’m not sure, We go the 30th to get his hearing tested. And our pediatrician also talked about Autism because he shows other signs like spinning he said, loves to line anything up but hes always loved to build blocks/Legos and line them up, He also stares off sometimes its for a few seconds and Ill admit sometimes it can be hard to gain his attention back, he interacts normally for not getting much other kid attention I think he will try to initiate play & get so excited to see kids but if they aren’t interested or mean to him then he usually wont try again or maybe once more. If they push him or hit him he will try and do it back..etc..
    Well I see I have really left you a huge comment. I am so stumped what is wrong with my son, and I question if its my fault? What path should I take next? I’m going through all these different speech sites and writing down things I think can help, I’m so lost. I hope maybe you could give me a little insight about where I should go from here, and what you think I should do as of next?

    Thank you Laura :)

  51. Laura says

    Kelly – Thanks so much for your comment. I love to read your stories!!

    I applaud your pediatrician for being so proactive and recommending speech therapy for Noah. By age 2, the MINIMUM number of words a child should say and be considered typically developing is 50, and the pediatrician is right in saying that toddlers who are turning 2 are using those words to frequently say 2 word phrases.

    That being said, it doesn’t mean that Noah is doomed for a life time of failure since he’s a late talker. AND let me just stop you right now and say, his delay is most certainly NOT YOUR FAULT!! Most of the time, children do pick up words just from hearing it with little or no effort on their parents’ parts. Language just happens.

    In some cases, probably like Noah’s, words are slower in coming and parents need to be a little more directed in HOW they go about teaching him to say new words. Your friends ideas were a good starting place. It is a good idea to have children ask for what they need. However, if he’s not been a good imitator of words during play, he may not be able to get it out in a high pressure situation like when he wants to ask for something he really wants.

    Keep reading the website for more ideas. Try to read all of the articles from 2008 since that’s where most of the real “how-to” articles are.

    You may have also taken a look at the DVDs for sale on here. I filmed these DVDs for parents who are EXACTLY like you – those who are wanting to work with their children at home – eitiher before speech therapy starts or in addition to having him in speech therapy. The DVDs are great since you can hear my explain HOW to work with him and then SEE exactly what to do with several different examples/children per technique. You can take a look at the short clips to get an idea if this is something that could help you.

    I’d also HIGHLY recommend that you follow your pediatrician’s advice and get a speech therapy eval. Not only will an SLP help Noah, but she’ll help you know what to do with him at home so that he can catch up as quickly as possible.

    Regardless, I’m glad you’re finding the info here on the website helpful. Let me know how he continues to do for you! Laura

  52. Kelly says

    Laura –
    I just wanted to say the last 2days I’ve read your website & listened to some of your BlogRadio audio clips & They’ve REALLY helped! I’ve got TONS of notes for ideas with how to approach him with new words, sounds & I plan to keep reading and get all the information I can. I also am going to be buying your DVD.
    I can happily say that with your methods we have gotten Bite, Bye Bye “when his papaw was leaving, my dad and I really made him pay attention and he said it” & a very good try at drink TODAY! I even think He tried ball, but I couldn’t be 100% on that, we also played with his Blocks & his Mega Blocks and I tried to incorporate more words into our play time.
    Noah has many of his sounds like m, b, d, n, p and a few more I had in my head that I can’t think of but he’s not forming them into words. Noahs biggest problem is that he just doesnt want to pay anymore attention once hes done, In a nut shell once hes done, HES DONE! So I put up his baby gate and we stayed in his room so he couldnt get away, and I’d pull out another toy and I talked to him. To be honest something I don’t do enough.
    Today we really worked on B’s and the B sound. I asked Noah if he wanted a Bite, I pulled out a snack and he really wanted it, He reached for it I pulled it a way a little he got a little upset but I smiled and happily asked asked him if he could tell me what he wanted? He told me “Bi” :) I said YAY! Great Job Noah! hugged him while he enjoyed his snack. I also made sure that he seen how I did the B sound with my mouth. I do know this doesn’t mean we are out of the woods of anything yet, & if we don’t see significant results with in 1-2months or sooner, then yes we will be calling and getting him into see a speech therapist.
    Tomorrow I plan to get a few more Educational toys I can keep put up only for when we do Our Play Speech sessions together.
    I am going to be buying for DVD :) I watched some of your clips on youtube and really liked them.
    Thanks so Much Laura! I’m so thankful like Many other moms that you are willing to put all of this wonderful Information on here to help. =)
    I’ll keep you posted, and I’m going to continue to read, read, read!!

  53. Laura says

    Kelly – I’m so glad the site is helping you!!! Keep us posted on how he (and YOU) continue to progress!! Thanks so much! Laura

  54. Hillary says

    Laura, I have a 20 month old son and have been concerned about his speech and vocabulary since he began trying to talk because he says very few words and will not use them consistently. I try to encourage him to use words while we play but he will just giggle or point. I know he knows the words because if I ask him where the block is, he will get it. He can show me several parts of his body when asked and seems to learn new things everyday. I have never considered a therapist but after reading this article I wonder if I should look into something like that for him. I know he is very young but I want to do what is best for him. His vocabulary pretty much consists of the following: car, vroom vroom, ball, shoe, door, phone, “moan” (come on), bye, uh huh (yes), dog, and eat and mmmmm (yum). I would really like to know what your professional opinion is. Thank you in advance.

  55. Meredith says

    Hi Laura,

    First of all, Thank you for this site, I can tell you really dedicate a lot of time, and that you truly care about helping others in what you do!

    I have a 3y/o DD who was dxed with PDD-NOS. She is receiving services through our school district. She’s been doing very well with her speech, but she has picked up this habit of using “filler” when she can’t exactly figure out what to say. For example, she will want to ask for something, and she will say “youyouyouyyouyou eat, a CRACKER!”

    I’m glad she can express herself but how can I reduce the filler so that she can more effectively express herself? I do try to repeat to her, “does (name) want crackers? Say “I want crackers, please”.

  56. Laura says

    Meredith – It could be that she’s not using “filler” at all, but that she’s going thru a period of dysfluency which happens to lots of preschool children who are trying to bump up to the next level of conversational speech. I would follow the guidelines SLPs recommend for treating dysfluency rather than treating it like it’s something else. I’m going to be talking about your question on this week’s podcast on Thursday, November 19 at 2 p.m est. Hope you’ll join us then!

  57. says

    Hi, I referred my 22-month-old son myself to ECI because of a speech delay. He has been evaluated and found to be delayed by 7 months.

    Now that I have done a bit of research, I have found that he has several of the symptoms of verbal apraxia….he uses the ‘bah’ sound to mean almost everything, although he will say a few other words. I think his total word count is around 10 or 12 words.

    He has a few words that he used to say that he said a few times and then never said again.

    I can sometimes get him to repeat sounds after me, but he doesn’t say them on his own, even when tried to pair with words (of things he’s interested in) that begin with the sound he just repeated. As in, this morning he repeated the ‘p’ sound, but didn’t try to say ‘purple’ when we were doing stickers.

    He has VERY few speech sounds.

    My question is: Is it stilll early to think this could be apraxia, do we still have time that this may be something else?

    Thank you for your response,
    Jana

  58. says

    I should say that he is very social…off the charts in the ‘self-help’ section of the evalutaion, and that he has about 20 or so signs.

    He was actually at or above age level on the other parts of the evaluation….except for receptive language, he was a few months behind in that.

  59. Jana Green says

    One more thing. One thing that really has me worrie-and I have no research to prove one way or the other-but except for Mama, ALL of his words are sounds….rmmmmm, for car, ‘moo’, ‘baa’, ‘caa,caa’ (for quack quack).

    He does not have ANY object words…..no cup, ball, car, bed, bath.

    That, honestly, has me worried more than anything. You say we have a gut feeling for a reason, but could I be wrong about this.

    I should point out that I have worked with kids for over 20 years, including in the preschool setting and in infant and toddler stages.

    Thank you for your time,
    Jana

  60. Laura says

    Jana – Thanks so much for your great questions! Yes – 22 months is still very early for apraxia to be officially diagnosed since he is not even 2. Many experts don’t like to diagnose children with apraxia until after age 3, and some not until a child has had at least 6 months of speech therapy. So many of these early speech-language delays do look alike, so you’re doing the right thing by starting speech therapy. It doesn’t really matter what the diagnosis is at this point either. That advice sometimes doesn’t resonate very well with parents or professionals, but it’s really the truth. Just get in there and get going with language facilitation strategies and don’t worry too much about working on specific sounds until his language is closer to an age-appropriate level. You want WORDS, or at least word attempts, no matter how he sounds at this point. I’d also drop the focus on specific sounds and go for WORDS, even if they’re off-target at this point.

    This is even more important for children with receptive language delays. Comprehension is waaaaaay more important than what sounds he can and can’t say at this point. You need him to understand language so that he can meaningfully use words. I’d pour all of your energy into making sure that he learns to link meanings with words – especially those object words – so that he really “gets” language.

    Hope I’ve answered all your questions. If not, write me back! Keep me posted on his progress too! Laura

  61. Alicia D. says

    Hi!
    I am sooo glad I found this article! My son has been having a lot of language/sensory/social issues for months, and it’s been a struggle to get help for him. He is now 30 months old and just had his evaluation through Early Intervention. They placed him at 9 months old for both his receptive and expressive speech (near 70% delay), at 15 months for social issues, and having several different sensory issues, mainly auditory/auditory-language. I haven’t seen the reports yet, but the therapists told me that he needs sensory stimulation, but that his threshold to handle it is very low. They weren’t sure exactly what “sensory techniques” would work for him.
    That being said, the waiting lists for therapy (OT/ST/developmental) are long, especially speech therapy (being about a 6-12 month wait), so they would like him to see a child psychiatrist (also a 2-3 month wait) and then are preparing him to start with a preschool program when he turns 3.
    I want him to get all the benefit he can NOW because to me, his delays seem extreme, and I know the earlier he gets intervention, the better the outcome. I’ve done so much research my eyes are spinning, and I keep coming down to the fact he has autistic tendencies. I just don’t know how to help him with language when he has the sensory issues as well. Will the suggestions in this article work for him? If I can’t get him into speech therapy right away, I want to try everything at home with him that I possibly can!
    We’re starting to sign with him as well, and he’s learned the sign for “more” so far and is resisting the others. He has several words he uses as well when he wants something, but usually they consist mainly of sounds that we understand but no one else does. He’s obsessed with the alphabet and numbers (anything sequential; likes to line everything up as well). He loves flash cards and used to read all the letters off them and say most of the words (also could read words without pictures present), but lately has stopped doing that and is just saying “ah, ee” for every card and lining them up on the floor, the bed, the table, and around his room. He gets very frustrated when his 9 month old brother says words from the flash cards.
    Sorry this is so long! I just really want to help him somehow and help his frustration. He’s a sweet, loving boy, but he hasn’t made progress in so long and is regressing in many ways. Do you have any suggestions?

    Thanks!
    Alicia

  62. Chloe says

    Hi Laura,
    I love your website! I have been reading it and will order your Teach Me To Talk and TMTT Apraxia videos. My daughter is now 18.5 months, 16 months adjusted (her developmental age). She has mild right-sided CP because of her premature birth, and I have read that damage to the left side of the brain can cause language problems like apraxia because that is where the language center is. Right now, Zoe says seven words- “hi, eye, hot, yeah, this, that, dada”, some approximations-“hot” for hat and heart, “ott” for out and up, “vvvupp” for book, “boof” for boob, “rye” for fly, “di”(permanently shortened from “daydee”) for baby and “diedie” for bye bye. My concern is that she makes mistakes with vowel sounds (can’t say hat) and easy consonant sounds (won’t say bye bye properly even though she says “ba” for ball and sheep noise. I admit I was getting so frustrated by that and “ut” instead of up that I had begun chastising her about it until I read what you wrote about not correcting their pronunciation. I am also worried because she normally prefers to make sound effects rather than try to say words- she says “mmmm” before meals, “vroom” for cars and trucks, “mama” for kitty (every time I get excited that she’s calling me mama, I look around and-yes- there’s a cat. D’oh!), etc. She would spend all day doing animal noises if she could but won’t try to repeat words that I say, even ones that seem like they would be easy. She will be evaluated by EI next month (hopefully), but I’m worried she won’t get ST because of budget problems where I live (NYC). So my question is, is there such a thing as mild apraxia, and could Zoe have it? She has never had big feeding problems like some kids with CP though she is somewhat picky about textures. Also, she is in OT and PT and just started walking a couple of weeks ago. My biggest fear is that Zoe does need help with speech but no-one will admit it until she gets much farther behind. Also, I wish I had never taught her “this” and “that” because I’m all ” Zoe, do you want the apple? App-le!”. And she’s all (pointing)-“that!”. Frustrating!
    Thanks for listening to my rambling,
    -Chloe

  63. Laura says

    Alicia, Chloe, and Jana – I’ll be answering your comments on tomorrow’s podcast (“Teach Me To Talk with Laura and Kate” episode #69 on March 25, 2010) at 2 pm eastern time. Listen in (or better yet, CALL IN) for answers to your questions. I will also be doing my best to respond to all of the recent comments this weekend. Sorry for the delay – it’s been quite a week around here! Laura

  64. Laura says

    Chloe – Thanks for calling in to the show today, and I hope we made you feel better and not worse!! Let us know how she continues to progress, and write me or call us back with any other questions! Laura

  65. Laura says

    Alicia – I hope you got a chance to listen to the podcast and hear our recommendations for you. Thanks so much for taking the time to write! Let us know how it’s going and write in or call the show with any other questions! Laura

  66. Alicia D. says

    Laura and Kate,
    Thank you so much for the suggestions on the podcast! I tuned in an hour too late :( but I just finished listening to it tonight.
    Besides being helpful in a lot of ways, it made me smile to hear some of Kate’s comments because they described my son very well. He LOVES music, always has, and we sing a lot and often use music to try to learn something new (ex. “Head, Shoulders, Knees and Toes” for body parts). He also is sensitive to some loud noises (like the vacuum or the hair dryer, although he seems to be a lot better around them now) but not to other loud noises. Loud noises don’t seem to be a really big issue for him. He does tend to tune us out when he’s focusing on something, like an activity or lining up things, and there’s never really been “two-way conversation”. He will come to me to show me something he’s excited in, like a toy (for example, a teddy bear, he’ll hug it, smile at me, jump up and down and said “Bee” for bear, I smile and say “Bear! That’s right!”, hug him, and he’s off again).
    He also does like to take my hands to do a task for him (like Kate mentioned). When we first started the sign for “more”, he would take my hands to help his hands to make the sign, and then he progressed to using one of his hands against one of my hands to complete the sign for “more”, and now he can sign “more” on his own.

    I did have a few questions about some of the suggestions and how to implement them. You recommended trying to get away from the alphabet and the numbers and the flashcards, getting him involved in more social activities. I’m wondering how to do this, as he often uses the alphabet or numbers to calm down when he’s frustrated. (I’m wondering if it has to do with the sequential nature of the alphabet and numbers, kind-of like lining up all his toys) Also, the only time that he does flashcards is at night with his dad before bedtime (it’s a part of his routine). He always does the flashcards in the same order by his choice(color/shape word cards, ABC cards, word cards, rhyme cards, and Pooh/Tigger cards) We would need something to fill in the slot for this usual activity, because we have tried to skip it on occasion, and he gets frustrated.
    You also mentioned echolalia, and I had a question about that. I had thought that echolalia was something that I definitely had not noticed in him (I had understood it to be that when you say something, he repeats you instead of answering the question). But you also mentioned something about echolalia involving repeating scenes from movies, etc. without really understanding it. I have noticed this with him, that he can babble along with a movie or even a second or two before they say a word, and occasionally I’ll hear a syllable that corresponds to the movie, so I know he’s actually imitating what they’re saying. Is this echolalia? He can memorize parts of songs/movies, etc. after only hearing them once or twice.
    Last question (I promise!!!): On the eval they placed him at the 9 mo. level for expressive/receptive speech. I’m wondering how accurate this really is, especially in the receptive speech area. I also have a 9 mo. old son, and I can tell that my 2 1/2 year old understands more than a 9 mo. old. For example, if I tell him (my 2 1/2 year old) to go and get his special bowl, he’ll get it. If I tell him to shut the door (on the refridgerator), he’ll do it. If I say, “Now go and get a spoon!”, he can. And I don’t think a typical 9 mo. old would understand those things.

    Again, thank you so much for all the suggestions and help! I really, really appreciate it!

    Alicia

  67. Diane says

    Laura, please help! How can I make a 3 year old turning 4 this October 2010 say the vowel sounds? Thanks so much

  68. Laura says

    Diane – I’m not sure I understand your question. What do you need help with? Is he not talking at all? Are his vowel sounds “off” and he’s using substitutions for vowel sounds such as an “eee” sound for an “ay” sound? Or is he just not repeating certain “letters” when you ask him? Clarify for me, and then I hope I can help answer your question. Laura

  69. Melissa says

    I like you sooo much, Laura.!!!!!!!!!!
    I have a 15 mth old who refuses to talk
    won’t make eye contact, and I’m worried
    about it.

  70. amanda says

    Hello all,
    I have a 32 mth old boy and he can talk but its not consistent its every blue moon as in every few days he lacks socilization skills due to me not working so when he plays with other childeren or when he goes in public he doesnt always interact with other childeren the way i think he should for his age. i have began to work with him at home and he has an appointment with his doctor this week but is there any tips out there that can help me help him hes full of energy and hes very loving,i just want to know what can i do to help untill he gets therapy and is there anyone else out there experincing what i am experincing.

    Thanks,
    Amanda

  71. Trish Krueger says

    I absolutely loved your strategies for toddlers with apraxia. We have switched therapists a couple of times thinking that we just weren’t getting the proper treatement. Our daughter who is turning 4 in a couple of months probably has 100-200 words and I asked the therapist the other day if we could start working on phrases and she said they would be too difficult, I disagree. So I am trying on my own and would love your suggestions for how to start simple phrases, please.

    Thank You

    Once again this was an excellent article!

    Trish Krueger

  72. Laura says

    Trish – Thanks for your question. Start by combining words that she already says pretty well. Patterns I like are “bye bye + ____” or “more ____” or even “my ____” and fill in the blank with a word that’s easy for her. Use it in context meaning that don’t say “bye bye” to someone/something who’s not even there!

    I would certainly go ahead and begin phrases with her now since she has so mamy words. If it’s too hard,you’ll know because she won’t be able to do it and she’ll even be more frustrated.

    My DVD Teach Me To Talk with Apraxia is a pretty detailed DVD with examples of lots of children with motor planning issues and techniques to help them move to phrases. There’s currently a 20% off sale going on too, so hurry while you can get the discount.

    Laura

  73. Trish Krueger says

    Laura thank you for your response. I just have another quick question, from my research I have read that the therapy should be intense and frequent with apraxia, as I have seen regression in my daughter when she was learning a new sound and we took 10 days off, we had to start all over. We have currently been doing speech 4 times for 30 minutes each per week as well as the 2 sessions per week with the school. But at the same time I have also read that if we work with the child at home it really helps to complement the sessions. I would like to cut our therapy down to 2 days per week because I actually work with my daughter at home and the therapist has acknowledged that and has seen the progress due to my time with my daughter. Our therapist uses the flashcard drill method which doesn’t always thrill my daughter and I use the play approach. Their approach is for single words and sounds and mine is for the phrases. I think she is finally at the stage where she will try to say anything, yeah. So what I would like to know, is it ok to go down to 2 days per week, as I need her for guidance? It sure would make it easier on our pocket book as insurance doesn’t want to cover her therapy. I am also finding now that I don’t get much time for the one on one time with her in therapy almost each morning and at school in the afternoons.

    Sorry if I rambled on, but we have been in therapy since she has been 2 and the progress seems to be slow and very frustrating.

    By the way, I just ordered your cd and from what I’ve read so far on this site, I am sure it is going to help and inspire me, so I can help my daughter; it just can’t get here fast enough.

    Thank you soooo much!

    Trish Krueger

  74. Laura says

    Trish – What a great question, and I wish I could be more thorough, but here’s my short answer – that’s A LOT of therapy!!! Of course since I can’t see her, I can’t advise you as to what frequency would be best. You’ll have to judge what seems to work. If you back off the formal sessions and do more play-based things at home and she regresses or has a big plateau, then you’ll know you need to amp it back up to the frequency you had before.

    The experts do believe that short, frequent sessions are best and that there does need to be some element of drill, meaning “mass practice.” I happen to think we can still do this in a play-based approach with very young kids, and I think you’re already seeing those results with your little girl. Watch the DVD and then you’ll know how I “drill” within the context of play. Just so you know – there are no flashcards in my therapy bag!

    Take care – Laura

    P S – Your DVD shipped today – I remember your name from this afternoon. I actually had to help today since we had lots of orders over our long weekend :)

  75. haifa says

    my son is going to be 3 by jun but i just notesed him repetting the first word more tha one time is that normal and will it go away as he gets older ????????

  76. Laura says

    Hafia – Do you have a family history of stuttering? If not, it sounds like he’s experiencing a period of normal dysfluency and it should go away in a few weeks. The most important thing to do is NOTHING. Ignore it. Don’t tell him to slow down, to think about what he’s going to say, or anything else. The less attention you pay to it, the better. Just keep encouraging his language at other times and let him know hwo proud you are of him. Good luck! Laura

  77. PD says

    Thank you – this site is amazing. I am ordering the dvd’s now. I am very concerned for my 34 month old daughter. We had her in EI by 26 months for late talking and poor articulation; I was terrified from the internet it was apraxia. She never had the “language explosion”, when she did talk, she substituted easy sounds for her “words” that only we could understand. The EI eval showed her receptive language was very high and she communicated what she wanted/needed without words, so they thought there was just a developmental delay and she would catch up. With EI her language has been coming along nicely with lots of 3 word phrases and sentences emerging (I like, I want, I see). I see her struggling a lot, she has to really think about each syllable and word, and she has very deliberate speech when the sentences get longer or new words are used. She still seems very slow in her expressive language for a near 3 y/o, but I thought we were on the right track and her receptive continues to advance – she doesn’t miss anything…then all of a sudden the SLP started talking about apraxia this week – which they had all dismissed for months. SLP mentioned her “robotic” speech, and the persistent phonological problems. My question is how is this coming out of nowhere? did we just lose 6 or 8 months of key therapy time – i offered to hire private SLP’s for multiple days since i was so concerned about apraxia, they said it was not necessary. And honestly the robotic speech started when teh articulatino therapy started – she is over- enunciating each syllable to get it “right.” and she uses inflection in her voice to ask questions, makes a lot of facial expressions, etc. Any ideas for a paranoid mother?

  78. Laura says

    PD – I know you feel angry, but many times it’s difficult for an SLP to distinguish apraxia from an expressive language delay until a child acctually begins to talk. Many professionals won’t even think about an apraxia diagnosis until a child is closer to 3, but I understand your frustration since you’ve thought apraxia was the likely diagnosis all along.

    BUT let me try to redirect you a little – you haven’t lost therapy time since she’s been in speech therapy the whole time, right? From my own experience more therapy time at 2 doesn’t always guarantee faster progress for every toddler, so looking at it like you’ve lost time is not productive for you – it’s just going to make you more resentful, and you can’t do anything about that now.

    You’ve also said she’s continuing to make progress which is a great sign for her despite the new concern with apraxia. Many children with apraxia plateau at the single word and shosrt phrase phrases, and it sounds like she’s making nice, steady progress. Try to celebrate that realizing what an accomplishment this has been for her rather than wondering what might have been with more therapy. Even when I strongly suspect apraxia, I still stick to the one time weekly session for most of my clients. Many times toddlers can’t take an increase in frequency. I see them once weekly and then depend on mom and dad to carry-over the recommendations. It sounds like you’ve done that, and that’s likely the reason she’s doing so well.

    I’d probably place less emphasis on over-articulating every syllable right now which is likely increasing her “struggle” and take a more play-based approach to her therapy. I think it sounds like she’s feeling too much pressure for a little girl who’s not even 3 yet! If you’ve ordered the DVDs, you’ll see how you can work therapy in to play time. If her therapist isn’t doing it this way, at least you’ll know how to do it at home so that talking doesn’t become “a chore” a for her. I’d also recommend that you sing with her often to help her sound more melodic, and this will help with sequencing words into phrases and longer sentences too.

    Thanks for your great questions! Good luck to you all :) Laura

  79. PD says

    Sorry Laura – another question if you would indulge me. My daughter has had what can only be described as a “language explosion” in the past week since I wrote to you.

    She has been talking non-stop about everything she sees, trying to tell us stories, etc. I have not focused as much on pronunciation when she is trying to get a long sentence out – just model the right way casually as many times as possible, and move on. I am becoming very hopeful that she is just delayed.

    I also noticed when looking at the different word patterns, that other than very long multi-syllabic words, she tends to struggle the most with CVC – dog (sounds like gog), duck (guck). We can get her to imitate us but then it sounds like D…uck or d…..og.

    I also noticed however that any new CVC words that we teach her come out much better (for example when reading Dora books – spanish words). Do you think she just habituated some of these words and it’s going to be harder to “unteach”? Or is this a huge red flag for apraxia? She says words with different patterns fine (mama/dada, bubbles, elmo, open, choo choo train), and though we often have to correct her pronunciation with a new word, she does a great job imitating us now (which she couldn’t do well before at all). I know you can’t say without seeing her, but what do you think? Thank you again SO much!

  80. Laura says

    Thanks so much for your comments PD! Glad the Apraxia DVD is helpful for you AND that she’s moving right along. When she bumps up to using longer phrases, the more mature forms of questions will come on in. Until then, her rise in prosody is completely appropriate. Just continue to model the grammatically correct version for her. She’ll get it in time as her expressive language continues to develop.

    It is entirely possible that her older words that she mispronounces will continue to have errors and be less intelligible than her newer words. Just as you said, she established an incorrect motor plan that she’ll have to “un-learn.” This isn’t impossible; it will just take some time. Keep modeling and gently correcting those misarticulations, and they’ll come around.

    The errors in the CVC words you described are actually fairly a common pattern with toddlers. She’s using the same pattern for both the beginning and ending sounds. Again – keep modeling. Your SLP can also teach you some other techniques when she’s ready for that, but as we previously discussed, don’t place so much focus on articulation just yet. Keep targeting that expressive language just as you’ve been doing. Thanks again for your comments! Laura

  81. Amanda says

    Thank you so much for writing this article. My 18 almost 19 month old has been in speech therapy for about a month now, through Early Intervention. She was always really quiet as a baby and never really went through the “babbling phase” that most babies go through. She has never been in daycare or around any other children/babies, so I partially wonder if her delay is my fault. She still hasn’t said any words yet. She has started babbling a lot more since starting therapy which shows me that she must be making some progress. In addition she has learned the sign for “more”, she picked up on it right away and uses it all the time! Last week during her therapy session, the therapist mentioned that Chloe(my daughter)is showing a “gross motor delay” as well as symptoms of apraxia. I have to admit I had never even heard of apraxia before she mentioned it. After reading and doing some research online about it the more worried and scared for my daughter I get. I am so scared that she will be unable to live a normal life, I don’t want her to have to struggle through daily life just to communicate with people. I know she is intelligent, she seems to understand everything that I say, and even was able to perform some tasks during her evaluation that were beyond her age range. I just want to do everything I can to make sure my daughter has every opportunity any other child may have. If you have any suggestions for me please let me know. Again thank you for all the information.

  82. Laura says

    Amanda – Toddlers learn how to talk from adults, not other babies, so NOT going to daycare is not the reason for her delay. Making more noise is progress at this point in therapy, and so is signing, so she’s moving int he right direction. Don’t be too alarmed about apraxia since she’s so, so young. You may want to check out my DVD Teach Me to Talk with Apraxia so that you can see how to work with her at home. Try not to worry too much yet. You’ve done the right thing by getting her in therapy so early. Keep working with her and expecting her to do well. Let me know if you have other questions. Laura

  83. Tracy says

    My son was born completely and I do mean completely deaf (his dr described his sedated abr as flatline- his word) even with really strong hearing aids. He received cochlear implants at 11 months old and can now hear wonderfully. That was 7 months ago. He now says ah ah ah for monkey and moo for cow mama and dada and ssss and snake and cake and snack and out (sounds like owm) and tries to meow for cat, Mickey, and clock and will vocalize mmmmmm and aaaaaaa and eeeeee and nana and p p p and t t t. He has other too but they are still not heard too often. I was wondering if you have any specific speech therapy suggestions for us and also would love to know what you think of his progress considering he has heard for 7 months. No he does not sign, he lost interest after getting his cochlears despite the fact we still signed with him. Usually mommy speech therapy consists of playing with toys and trying to get him to ask for things and reading books and trying to have him point to the item I tell him about. His speech therapist usually has him sit in his high chair and reads to him to start he does love books and then will read to him on the floor or blow bubbles with him. Occasionally she will also play with some toys but not too often. He is a home child in that he stays home with me. He is not in daycare. We take him out to stores and ocasionally the park but he seems happiest at home. His speech therapist wants us to take him out more saying he is bored and he needs to do more out of the home (he also has a 3’acre yard he plays in). He goes out a couple times a week a couple hours each time. What are your thoughts/ suggestions. I would love to know. PS he has been in EI since basically birth.

  84. Laura says

    Tracy – I think you need to get him out of that high chair and play, play, play during therapy with lots of toys and lots of high energy and animated activity, both inside and outside the house. No wonder he seems a litle bored – I would be too!

    Have you taken a look at my DVD Teach Me To Talk? The DVD shows you how to use play-based activities to target language with toddlers. This is certainly appropriate for ANY child with language delays, regardless of the etiology. The clips are here on the website, so check it out. Also read ideas here in the expressive language category. The best “How To” articles are at the end of the category in the Older Entries sections. Keep digging to get the info you need to help him!

    You didn’t mention much about his receptive language. How is he following directions for you? I’d hope it’s frequent by now. If he’s not understanding language, then he’s certainly not going to use those words to talk, so you’ll need to make sure you’re targeting receptive language (how he understands) with as much emphasis as you are expressive language (how he talks).

    Good luck and let us know how he does with this change in approach. High energy play is often the one thing that toddlers need to begin to make progress with expressive language. Laura

  85. Sheila says

    Hello! I read your article and agree whole-heartedly with all that you wrote! I am an SLP and have been working with children for over 14 years. It is so frustrating when I observe SLPs work with kids in nonproductive ways, or when parents come to me with a negative “therapist experience”. It’s not rocket science to me!! In order to make progress, you have to keep a child’s attention and interest. I’m not a worksheet person during sessions, either. I’ve been described by some parents as unorganized. I think that is because I have a “plan” for each child but am super flexible depending on what is motivating to the child on that particular day. We may go to the gross-motor gym or the sensory gym. I may use food; we may walk to the kitchen area and get snacks and water out of the fridge. It’s not cookie-cutter which to some may seem odd, because I’m not sitting at a table across from the child with a tally and worksheet, like some parents expect. Anyhow, my point being, your information is refreshing. Thank you for the work you do, with your patients and the community you serve.

  86. neha says

    hi,my child is of 2 years, he is still not talking,he is not speaking even a word.what should i do.He is not even understand any gestures like,hi,bye.but he understands playing games.he easily play games.What should i do.

    plz help.

  87. Laura says

    Neha – He should be using gestures and words to communicate, so there is likely a language delay. If you have access to professional evaluation, I’d strongly encourage you to have him evaluated by a speech-language pathologist who works with very young children. Are you in the US? If so, every state has an early intervention program, and you can Google it to find out contact information. If you’re outside the US, start with your primary health care provider to get information about your next step. I’d also recommend that you read articles here on the website to give you new ideas for working with him at home. You may also want to check out my DVDs so you can SEE how to target language in play. Write me back with any more specific questions after reading through the posts here on the website. Good luck to you! Laura

  88. Sali says

    Hi! My son just turned 2. He knows A to Z and he does it with A-apple up to letter Z. He also knows 1 to 10 even if you rumble the numbers he can point the correct one. He also mimis whenever I ask him to say what I say like water, door, shoes, dog, car, bus, truck, flower, bowl,color, cup etc. But then he doesn’t say milk when I ask him to. he don’t call us Mommy or Daddy. But if you show him our family picture and ask him who is the one in the picture and he would say Mommy or Daddy with a whispering voice. He can say “me” when he sees himself in the mirror.Another concern is that, when he wants something he pulls my hand and point what he wants. He doesn’t say like I want milk or something. We already have him evaluated by early intervention but he is ineligible. they told us some tips to encourage him to talk by not giving what he wants if he does not say it. They are more concerned of his tantrums. As of now we are having a hard time doing it but we have started following their tips for us and how to handle his tantrums. We have also stopped giving him bottles at night/midnight and we were able to survive it.It is already 3 weeks after his early intervention evaluation and so far, he has progress with his behavior. He’s learnign how to calm down himself. But as much as talking is concerned we are still in the process. Can please tell if I should be worrying with my son? Is already delayed with his age as 2? Do I need to look for Speech pathologies/therapist? Please advise. Thank you so much.

  89. Jenny T says

    Hello –
    Can anyone recommend a pediatric ST for (possible) apraxia and is just really good in general with expressive language delays in the Seattle area?
    Thanks!

  90. Laura says

    Sorry Jenny! I don’t know anyone personally in Seattle. An expert is near there in Redmond – Pamela Marshalla. It’s worth a shot! Laura

  91. says

    Hello-
    My son just turned two years old. I have been debating on taking him to therapy. He still runs a lot of words together, making them difficult to understand or even at all. He has about a solid 100 word vocab. He still babbles sometimes though. He has a step brother that is five days younger and he talks so well and clear. My son talks plenty, it is just not very plain on some words. He does try to speak. Things like elephant come out all wrong and Daddy comes out da-day. Should I be concerned at this stage or should I give him a few more months?

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