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Speech Issues

Speech Issues

Here is where you find resources for: Gesture-Phoneme Cues, Augmentative Communication, Voice & Accent Reduction, Neurological topics for Parkinson's, Verbal/Oral Apraxia, and Early Intervention.

Speech Pathology has a wide Scope of Practice

Yes, everyone thinks of us as the “s and r, waskily wabbit” remediation folks, but wait, we are far much more than just a resource for those challenges. Most of my consultations end up with me sharing about verbal and/or oral apraxia as well as cognitive and swallowing topics.

However, that is not to say that all speech therapists choose to have a wider scope of practice. Some have become ‘laser-focused’ on one or a few areas defined in the list and that is just fine. 

Speech Intelligibility

Whether a person is understood depends on numerous factors. Is it a noisy environment? Does the communication partner have a hearing/cognitive challenge? The speaker’s speech rate, loudness, vocal quality, ability to produce precise movements of the lips/tongue, the memory/attention and cognition to organize the sentences with appropriate vocabulary, are just for starters. Scroll down to the 1st Purple Bar area of this page for more on this topic.

Language Disorders

I share the example that “There millions of ways to convey that you need to go to the bathroom.” And because of all the variations, pinning down language disorders is a challenge. Then you add what is developmentally appropriate for vocabulary and understanding grammar, or having a head injury, and it is even harder. But knowing when we use certain words and when we don’t is the basis of language. Scroll down to the 2nd Purple Bar area of this page for more on this topic.

Augmentative Communication

This area has grown exponentially with the apps out there for a person’s phone and tablets. There are pluses and minuses as to whether the good old paper icons on a velcro strip is the way to go versus the fancy apps. This isn’t the place to go into that but suffice to say that they all have their time and place. Contact me do discuss those. Scroll down to the 3rd Purple Bar area of this page for more on this topic.

Accent Reduction

I took the Compton Accent Reduction course years ago and have had a few clients. This type of therapy usually comes up when a person feels they are not rising in the ranks at work because people have a hard time understanding them because of their present ‘accent’. It isn’t easy to change one’s voice to the point that their mother is wondering what is wrong with them, but it has it place in consideration. Scroll down to the 4th Purple Bar area of this page for more on this topic.

Voice Disorders

There are all types of reasons a person’s voice goes ‘wonky’. Vocal nodules, strained strangled voice from hollering in loud environments, paralyzed vocal folds from some type of injury, and the list goes on. I’m a big promoter of voice amplifiers that now are made the size of a deck of cards and allow even a grandfather to holler at the refs at a grandson’s t-ball game. Yep, been there.  Scroll down to the 5th Purple Bar area of this page for more on this topic.

SPEECH INTELLIGIBILITY CONCERNS.

What's the difference between Apraxia and Articulation?

Apraxia is best described as ‘inconsistent’ pronounciations not because a person doesn’t know how to make the articulation movements, but they cannot seem to consistently organize them or other movements get substituted. Articulation challenges are consistent substitutions or disrtortions of phonemes (sounds of the alphabet). Examples: distorted /s/ as in frontal/lateral lisp, fronting the /k/ and /g/ as a /t/ and /d/ as in /tat/ for ‘cat’ and /go/ for ‘doe’. The following article link is VERY IMPORTANT because it shares why a therapist should not be ‘blowing bubbles’ to get a child to talk better: Logic, Theory, & Evidence Against the Use of Non-Speech Oral Motor Exercises to Change Speech Sounds

What's the difference between verbal, oral and limb apraxia?

Verbal Apraxia Characteristics may include: If the person does have a strength it is in repeating the last word heard, may omit the beginning of a word, have minimal vowel varieties, may say a sentence length utterance with repetitions of one or two words. Some may have a very small vocabulary that they use even when it is not pertinant to the conversation. Some may say ‘no’, ‘uh’, over and over to make a sentence.

Oral Apraxia Characteristics may include: Moving another body part or not quite following the motor pattern when imitating a person licking their lips or wiggling their tongue they may move their jaw back and forth or close their eyes.

Limb Apraxia Characteristics may include: Moving another body part or not quite following the motor pattern when imitating a person moving their fingers in a particular manner or when grasping a pen.

Websites re:Apraxia

When reviewing information re: apraxia please remember there are varying degrees of severity (mild, moderate, severe) & DO NOT assume the worst….therapy can assist in giving ideas to address/improve.

Other websites that address verbal apraxia:
Please remember that verbal apraxia varies from mild, moderate, and severe and one can never be too sure when reading information from parents and therapists on websites what degree of challenges they are referencing.

Websites re:Articulation
What is dysarthria? (slurred speech)

There are many types of dysarthrias and just suffice to note they relate to various parts of the brain being involved with the oral movements necessary to produce clear precise articulation of speech.

What are some websites for Parkinson's Disease and other disorders?

When reviewing information re: dysarthria & neurological challenges that can produce slurred speech there are varying degrees of severity (mild, moderate, severe) & DO NOT assume the worst…..therapy can assist in giving ideas to address/improve.

lsvtglobal.org

What's the difference between Apraxia and Articulation?

Apraxia is best described as ‘inconsistent’ pronounciations not because a person doesn’t know how to make the articulation movements, but they cannot seem to consistently organize them or other movements get substituted. Articulation challenges are consistent substitutions or disrtortions of phonemes (sounds of the alphabet). Examples: distorted /s/ as in frontal/lateral lisp, fronting the /k/ and /g/ as a /t/ and /d/ as in /tat/ for ‘cat’ and /go/ for ‘doe’. The following article link is VERY IMPORTANT because it shares why a therapist should not be ‘blowing bubbles’ to get a child to talk better: Logic, Theory, & Evidence Against the Use of Non-Speech Oral Motor Exercises to Change Speech Sounds

What's the difference between verbal, oral and limb apraxia?

Verbal Apraxia Characteristics may include: If the person does have a strength it is in repeating the last word heard, may omit the beginning of a word, have minimal vowel varieties, may say a sentence length utterance with repetitions of one or two words. Some may have a very small vocabulary that they use even when it is not pertinant to the conversation. Some may say ‘no’, ‘uh’, over and over to make a sentence.

Oral Apraxia Characteristics may include: Moving another body part or not quite following the motor pattern when imitating a person licking their lips or wiggling their tongue they may move their jaw back and forth or close their eyes.

Limb Apraxia Characteristics may include: Moving another body part or not quite following the motor pattern when imitating a person moving their fingers in a particular manner or when grasping a pen.

Websites re:Apraxia

When reviewing information re: apraxia please remember there are varying degrees of severity (mild, moderate, severe) & DO NOT assume the worst….therapy can assist in giving ideas to address/improve.

Other websites that address verbal apraxia:
Please remember that verbal apraxia varies from mild, moderate, and severe and one can never be too sure when reading information from parents and therapists on websites what degree of challenges they are referencing.

Websites re:Articulation
What is dysarthria? (slurred speech)

There are many types of dysarthrias and just suffice to note they relate to various parts of the brain being involved with the oral movements necessary to produce clear precise articulation of speech.

What are some websites for Parkinson's Disease and other disorders?

When reviewing information re: dysarthria & neurological challenges that can produce slurred speech there are varying degrees of severity (mild, moderate, severe) & DO NOT assume the worst…..therapy can assist in giving ideas to address/improve.

lsvtglobal.org

What's the difference between Apraxia and Articulation?

Apraxia is best described as ‘inconsistent’ pronounciations not because a person doesn’t know how to make the articulation movements, but they cannot seem to consistently organize them or other movements get substituted. Articulation challenges are consistent substitutions or disrtortions of phonemes (sounds of the alphabet). Examples: distorted /s/ as in frontal/lateral lisp, fronting the /k/ and /g/ as a /t/ and /d/ as in /tat/ for ‘cat’ and /go/ for ‘doe’. The following article link is VERY IMPORTANT because it shares why a therapist should not be ‘blowing bubbles’ to get a child to talk better: Logic, Theory, & Evidence Against the Use of Non-Speech Oral Motor Exercises to Change Speech Sounds

What's the difference between verbal, oral and limb apraxia?

Verbal Apraxia Characteristics may include: If the person does have a strength it is in repeating the last word heard, may omit the beginning of a word, have minimal vowel varieties, may say a sentence length utterance with repetitions of one or two words. Some may have a very small vocabulary that they use even when it is not pertinant to the conversation. Some may say ‘no’, ‘uh’, over and over to make a sentence.

Oral Apraxia Characteristics may include: Moving another body part or not quite following the motor pattern when imitating a person licking their lips or wiggling their tongue they may move their jaw back and forth or close their eyes.

Limb Apraxia Characteristics may include: Moving another body part or not quite following the motor pattern when imitating a person moving their fingers in a particular manner or when grasping a pen.

Websites re:Apraxia

When reviewing information re: apraxia please remember there are varying degrees of severity (mild, moderate, severe) & DO NOT assume the worst….therapy can assist in giving ideas to address/improve.

Other websites that address verbal apraxia:
Please remember that verbal apraxia varies from mild, moderate, and severe and one can never be too sure when reading information from parents and therapists on websites what degree of challenges they are referencing.

Websites re:Articulation
What is dysarthria? (slurred speech)

There are many types of dysarthrias and just suffice to note they relate to various parts of the brain being involved with the oral movements necessary to produce clear precise articulation of speech.

What are some websites for Parkinson's Disease and other disorders?

When reviewing information re: dysarthria & neurological challenges that can produce slurred speech there are varying degrees of severity (mild, moderate, severe) & DO NOT assume the worst…..therapy can assist in giving ideas to address/improve.

lsvtglobal.org

What's the difference between Apraxia and Articulation?

Apraxia is best described as ‘inconsistent’ pronounciations not because a person doesn’t know how to make the articulation movements, but they cannot seem to consistently organize them or other movements get substituted. Articulation challenges are consistent substitutions or disrtortions of phonemes (sounds of the alphabet). Examples: distorted /s/ as in frontal/lateral lisp, fronting the /k/ and /g/ as a /t/ and /d/ as in /tat/ for ‘cat’ and /go/ for ‘doe’. The following article link is VERY IMPORTANT because it shares why a therapist should not be ‘blowing bubbles’ to get a child to talk better: Logic, Theory, & Evidence Against the Use of Non-Speech Oral Motor Exercises to Change Speech Sounds

What's the difference between verbal, oral and limb apraxia?

Verbal Apraxia Characteristics may include: If the person does have a strength it is in repeating the last word heard, may omit the beginning of a word, have minimal vowel varieties, may say a sentence length utterance with repetitions of one or two words. Some may have a very small vocabulary that they use even when it is not pertinant to the conversation. Some may say ‘no’, ‘uh’, over and over to make a sentence.

Oral Apraxia Characteristics may include: Moving another body part or not quite following the motor pattern when imitating a person licking their lips or wiggling their tongue they may move their jaw back and forth or close their eyes.

Limb Apraxia Characteristics may include: Moving another body part or not quite following the motor pattern when imitating a person moving their fingers in a particular manner or when grasping a pen.

Websites re:Apraxia

When reviewing information re: apraxia please remember there are varying degrees of severity (mild, moderate, severe) & DO NOT assume the worst….therapy can assist in giving ideas to address/improve.

Other websites that address verbal apraxia:
Please remember that verbal apraxia varies from mild, moderate, and severe and one can never be too sure when reading information from parents and therapists on websites what degree of challenges they are referencing.

Websites re:Articulation
What is dysarthria? (slurred speech)

There are many types of dysarthrias and just suffice to note they relate to various parts of the brain being involved with the oral movements necessary to produce clear precise articulation of speech.

What are some websites for Parkinson's Disease and other disorders?

When reviewing information re: dysarthria & neurological challenges that can produce slurred speech there are varying degrees of severity (mild, moderate, severe) & DO NOT assume the worst…..therapy can assist in giving ideas to address/improve.

lsvtglobal.org

What should my child be doing communication-wise for his age?

There are a zillion websites that have developmental milestone information. Go to the Sensory Integration webpage of my site for other information. Please don’t wait too long to get an evaluation and gather information so you can make a decision regarding making changes in your communication relationship because Early Intervention drops a kids “like a hot rock” when they turn 3 years old and if we start at 2 1/2 years old, that doesn’t give us much time if you go through EI for services.

Normal Communication & Motor Milestones

How do I use Gesture-Phonemes?

First the person needs to understand the concept of imitation. If you need to further encourage them to ‘try’ and be sure and set up a type of behavior modification ritual where you state that you will ‘wait until you try’. The goal is use the hand movements along with saying the word and saying it in a melodic, calm pace and for the person to use them as they try and say the word. Eventually you want to be able to just show the gesture to cue the person to correct how person organized the word and not use a direct ‘say what I said’ ritual. You do not have to use my gestures; any consistent visual sign will work.

I divide the “communication intent” into 2 parts: 
1. decide from the choices given in picture form and place the picture/icon
2. now that the decision part is done, now all they have to focus on is trying to say the icon choice (with varying amounts of assistance ie imitation, gesture-phoneme, and/or melodic intonation (discussed on the gesture-phoneme page)

Why do I use this with toddlers? Well, you are probably being dragged around the house to the place the child wants to communicate his needs/wants. The picture request system/notebook allows the discussion to be made at the couch; the way you did when you asked your mother for a glass of juice or something to eat. You didn’t drag you mother to the refrigerator and stand with the refrigerator door open forever and hearing “What do you want?” and when you picked out something (nonverbally) and heard “No, you can’t have that” and then tantrummed with the refrigerator door still open……..now we do all the negotiating ‘on the couch’. I do not recommend leaving icons on the refrigerator door and in other rooms. Then the kid has to go out to the kitchen and bring it into the parent and that is too much work. This way, the entire notebook can go ‘anywhere’ ie grandma’s house, daycare, restaurant.

How do I know what gestures to use for a word?

I try and limit the gestures to 1 or 2. Example: for the “Grandma”, I would gesture the /r/ and the /m/.Your content goes here. 

Click here for a pdf of the gesture-phonemes-----

gesturePdf    Click here for a .pdf of the gesture-phonemes that I use

S—trace the letter ‘s’ (like a snake) with your pointer finger in the air
M–bring three fingers up to physically close your mouth to assist in producing the sound
N –ring two fingers up to lip area
R–show arm muscles and big smile showing teeth
F–press index finger against lower lip to assist in producing the sound 
V–press index finger against lower lip to assist in producing the sound 
O–place index finger to lips to pucker around lips
E–stretch lip corner to smile-like position
P–tap index finger at the corner of the lips
B–tap whole hand against cheek
T–tap index finger on teeth
D–tap index finger on teeth
K–tap index finger near ear
G–tap index finger near ear
L–sweep hand in the air like tongue would be inside your mouth 
TH–place thumb between index & middle finger like the tongue between the teeth
SH–place index finger in front of lips as you would to indicate ‘shhhh, be quiet’
CH–same as ‘sh’ except bounce your finger off your lips 
J–same as ‘ch’ except use fist instead of index finger 
Ny–touch your knee (as in ‘bunny’ )

All Done–use ‘sing song-like’ stating while moving forearms back and forth
More–use ‘m‘ gesture and then go into ‘more’ sign language

When do I use gesture-phonemes?

Whenever you want a person to restate a word bigger, better, brighter. If you want to emphasize the articulation or the movement from one sound/phoneme to another.

Use gesture-phoneme along with picture request system

Go here to learn how to make a picture request system.Your content goes here.

What's the difference between apraxia and ariticulation and phonological disorders?

People with apraxia:

  • if they do have a strength it is that they can imitate the sounds of the alphabet and have a sound for one word but not have that same sound in other word
  • usually omit the beginning consonant sound.
  • may have vowel fidelity challenges and only have the “schwa” sound that sounds like /uh/ and maybe one or two other correct sounding vowels.
  • usually can repeat a word or a phrase that we say like it is one word, but can’t say it without hearing it first.
  • will have one word utterances and expect the listener to fill in the
          blanks and then graduate to a limited number of automatic phrases. 

    Phonological disorders can look like an apraxic disorder or even be in concurrence, but:
    Phonological disorders have a certain number of similar errors. Some of which are called: final consonant deletion, cluster reduction, fronting…..
             Example: uses /t/ and /d/ instead of /k/ and /g/, omits all
            /s/ sounds, or consistently substitutes one sound for another (but
             that sounds is consistently the one used where as in apraxia it is inconsistent). 

    Articulation disorders can look like an apraxic disorder and a person can have both, but:
    Articulation disorders have a certain distortion (like with /r/) or lisp (with /s/)

 

Is there a lot of apraxia out there?

YES! I see it all the time in ‘youngsters’. And if grade school speech therapists saw these kids when they were 0-3 years old, they’d appreciate that they started with not being able to find their lips with both hands before coming to school. There are school therapists that think apraxia doesn’t exist and sorry to say…….they don’t know what they are talking about. Here’s a pdf file listing all the symptoms a person can have in regards to apraxic-like symptoms. The diagnosis is that a person needs to have a significant number of characeristics. 

What would we do?

We’d show you how to use gesture-phoneme, melodic intonation, and picture request to set up situations for you to present “I’ll wait until you try” to say whatever it was that they chose in picture form along with giving them support strategies of the gesture-phonemes and melodic intonation. See some videos I have done showing some of the techniques.

LANGUAGE-LEARNING CONCERNS

What are "Language Disorders"
In real general terms, it has to do with grammar:
The sentence structure rules
The rules for plurals, past tense, pronouns
The rules for what vocabulary we use when
The rules for putting together a cohesive paragraph and story sequencing.
Other Website Resources

MichaelAnne Roberts has a great website where you can set up a game-like format to work on adult aphasia issues OR with your child on language and articulation: www.bstlearningdirect.com

Parrot Software has various software programs you can rent for aphasia therapy practice.

KahnAcademy.org has all types of resources for various subjects and age abilities.

 

Other Programs:

I have taken the Lindamood-Bell learning series and feel these really help address language issues from a visual-strategy viewpoint. Feel free to checkout their website and give me a call: www.lindamoodbell.com

Orton-Gillingham is another program that requires some type of certification in order to use.

Ideas for the 0-3 year old

Puzzle Activity:  hold up 2 pieces of the puzzle and ask which one she would like; if she doesn’t state the name of the object in the puzzle, state do you want the ‘____ or the ____?”; if she doesn’t state one of the names, tell her you will wait until she tries to tell you.  The final presentation style is to have her repeat the name of the object to receive the piece.  Praise her for using her words instead of grabbing for the pieces.

Book Activity: instead of reading to her, have her read and praise her throughout for ‘reading’.  Another venue is to point at objects in the pictures and have her state the names or have her point and you state the names (her stating the names if preferred). Asking who, what, where, when, questions in regards to the pictures also increases her vocabulary and comprehension.  If she doesn’t know what type of response to give, present it as “Is the ____ or _____?” with one of the choices obviously not even close to being an answer.

Craft Activity: hold up 2 choices of colors or names of pieces uses and state “do you want the ____ or the ____?”.  This includes color to choose for playdough, handing her cookie cutters by field of 2 choice instead of just grabbing for them.  

Free Play Choice:  ask where (which center) does she want to start her play.  If she doesn’t know the name of the centers (kitchen, book, paint center), give her a choice of 2.

Choice of toys also is a way to incorporate communication goals. Instead of saying a yes/no question ie “Do you want your blocks?”, ask “Do you want your blocks or a book?”.  Consider stating, “I’ll wait until you tell me.” and use pictures of the choices (even if they are rough hand drawings on paper) for the child to point to a choice and state the word.

 Use gestures along with the words for “I want” to encourage later for her to state from just watching you do the gesture.

 Have her imitate “my turn”, “move”, and “I want” phrases along with gestures in various interactions with peers.  

 Choice of drink:  “Do you want _____ or water?”. If no response state “I’ll wait until you tell me.” 

Utilize the picture request system, melodic intonation, and gesture-phonemes all references on.

otplan.com is a website to get ideas of tasks to do with kids. Check it out when you are wondering how to create tasks without having to buy anything. It asks you what types of things you have laying around the house and how to use them. Remember to create “I’ll wait until you try’ moments so the child has to say something in order to get the object.

What about the school providing services?

A school evaluation may not tell you all that you need to know
Contact me as to how you might approach the school speech pathologist, the IEP process, and the teacher. There may be reasons you aren’t thinking of as to why the therapist says your child is making progress but you don’t see it at home and the teacher doesn’t see it in the classroom. It takes a village to raise a child. If your child is left-handed……type in the search box ‘writing left handed so you and the teacher know how to present a piece of paper for the child to write upon. If the IEP process is overwhelming, request an advocate be provided. There is so much that you could and need to do in order for the IEP to be accountable for the things you are wanting to measure and just not what the school staff is wanting to measure.

When a person can't come up with the word:

We call that “anomia”–word finding. First of all, of this is going to be an ongoing challenge, discuss with the person if they wish to show a ‘hi sign’ with his hand that he still wants the floor to speak OR if he wants you to help with saying the word and get on with the rest of the conversation. Respect their wishes and tell friends and family of ‘the rule’ so it can be respected.

Instead of Open-Ended Questions:

You might want to give choices instead so there isn’t an amount of time needed for them to think of all the possibilities. Example: “Do you want your green or red shirt?”, “Do you want juice or water?”. This also has you staying away from yes/no questions all the time.

Refrain From Yes/No style Questions

These get boring and limit the opportunity for the person to communicate ‘they want something else’ or what else is there to consider before giving a final answer.

When you can't understand or hear what a person said

Instead of saying ‘what?’ and the person feels they have to state the whole thing again, you state what you think you heard and the other person then only has to repeat the part they feel you didn’t hear correctly or understand.

To change a yes/no question quickly into verbal response of yes/no or a choice question

If you catch yourself always asking yes/no questions that you might say “Do you want more? SAY yes or no?” or “Do you want milk? or water”.

Use gestures, drawing, spelling, or a list to refer to common information

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     AUGMENTATIVE COMMUNICATION

Use gestures, drawing, spelling, or a list to refer to common information

A picture says a thousand words, sometimes. I’m not big on ‘sign language’ because it limits your communication partner to those that know your signs. It also requires ALL communication partners to know at least 500 signs and I haven’t known anyone that ambitious. Letter/word or picture communication systems have their place.

How do you create a Picture Request System?

You need a 3-ringed binder (1/2 inch or 1 inch), 3 or 4 colored felt squares that are 8×12, 2 inch clear packing tape, sticky back velcro strips, and a scissor to ruin cutting the velcro. Line up the felt squares to the rings of the binder and make scissor cuts to you can place the felt squares into the binder. On the front of the binder you want 2 stripes of the fuzzy (not the scratchy) velcro. The top row will be the “I want” line and the second row will be where you put the icons representing the choices. The felt squares is where you house the various icons you create. Create pictures to represent what you want to reference and “laminate” them on the front only (scratchy velcro sticks better if the back isn’t laminated) with the 2″ clear packing tape. Pull the backing off the scratchy velcro strip and cut small 3/8 inch pieces with the scissor you don’t mind ruining & place it along the top center of the icon/picture. I have probably confused you by now and you should call me to get it figured out.

Spelling Board pdf

I like this style of a spelling board (the vowels are all on the left side for quick reference). Sometimes the erase-end of a pencil is easier to use as a pointer than a finger:

A b c d 
E f g h 
I j k l m n 
O p q r s t
U v w x y z
1234567890 
Start Over

Ideas of tasks to do with your 0-3 year old child:

Puzzle Activity:  hold up 2 pieces of the puzzle and ask which one she would like; if she doesn’t state the name of object in the puzzle, state do you want the ‘____ or the ____?”; if she doesn’t state one of the names, tell her you will wait until she tries to tell you.  The final presentation style is to have her repeat the name of the object to receive the piece.  Praise her for using her words instead of grabbing for the pieces. Change this to using paper icons (aka Augmentative Communication Picture Request System) of each of the puzzle pieces.

Book Activity: instead of reading to her, have her read and praise her throughout for ‘reading’.  Another venue is to point at objects in the pictures and have her state the names or have her point and you state the names (her stating the names if preferred). Asking who, what, where, when, questions in regards to the pictures also increases her vocabulary and comprehension.  If she doesn’t know what type of response to give, present it as “Is the ____ or _____?” with one of the choice obviously not even close to being an answer. Change this to using small pictures of each book or paper icons for the Augmentative Communication Picture Request System).

Craft Activity: hold up 2 choices of colors or names of pieces uses and state “do you want the ____ or the ____?”.  This includes color to choose for play-dough, handing her cookie cutters by field of 2 choice instead of just grabbing for them.  Change this to using paper icons of the color choices or pictures of the cookie cutters for the Augmentative Communication Picture Request System.

Free Play Choice:  ask where (which center) does she want to start her play.  If she doesn’t know the name of the centers (kitchen, book, paint center), give her a choice of 2. Change this to paper icons denoting each play area for the Augmentative Communication Picture Request System.

Choice of toys also is a way to incorporate communication goals. Instead of saying a yes/no question ie “Do you want your blocks?”, ask “Do you want your blocks or a book?”.  Consider stating, “I’ll wait until you tell me.” and use pictures of the choices (even if they are rough hand drawings on paper) for the child to point to a choice and state the word. Change this to having pictures or paper icons of the choices for the Augmentative Communication Picture Request System.

 Use gestures along with the words for “I want” to encourage later for her to state from just watching you do the gesture.

 Have her imitate “my turn”, “move”, and “I want” phrases along with gestures in various interactions with peers.  

 Choice of drink:  “Do you want _____ or water?” . If no response state “I’ll wait until you tell me.”  Change this to having pictures or paper icons of the choices for the Augmentative Communication Picture Request System.

Utilize the picture request system, melodic intonation, and gesture-phoneme cues.

Your Title Goes Here

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Your Title Goes Here

Your content goes here. Edit or remove this text inline or in the module Content settings. You can also style every aspect of this content in the module Design settings and even apply custom CSS to this text in the module Advanced settings.