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Occupational Therapy

Occupational therapy (OT) treatment focuses on helping people with a physical, sensory, or cognitive disability be as independent as possible in all areas of their lives. OT can help kids with various needs improve their cognitive, physical, sensory, and motor skills and enhance their self-esteem and sense of accomplishment.

Some people may think that occupational therapy is only for adults; kids, after all, do not have occupations. But a child’s main job is playing and learning, and occupational therapists can evaluate kids’ skills for playing, school performance, and daily activities and compare them with what is developmentally appropriate for that age group.

According to the American Occupational Therapy Association (AOTA), in addition to dealing with an someone’s physical well-being, OT practitioners address psychological, social, and environmental factors that can affect functioning in different ways. This approach makes OT a vital part of health care for some kids.

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Screen time in Early Learners


             Use of technology with Early Learners’

Technology has transformed the way both adults and children live. Screens have dramatically changed the world of children’s play.  Nowadays, little ones spend more time watching television than playing outdoors. Children’s interaction with technology includes large variations such as watching television, playing digital games, using video chats or apps to communicate, or using digital tools to create content, etc. The question for us, as parents, educators, and pediatric professionals is what, how much, and at what pace should we introduce children to the various faces of electronic media.

How to find out what is developmentally appropriate for your little ones when it comes to technology?

Determining when and how to use various technology-based on Three C’S

  • Content—How does this help children learn, engage, express, imagine, or explore?


  • Context—What kinds of social interactions (such as conversations with parents or peers) are happening before, during, and after the use of the technology? Does it complement, and not interrupt, children’s learning experiences and natural play patterns?


  • The individual child—What does this child need right now to enhance his or her growth and development? Is this technology an appropriate match with this child’s needs, abilities, interests, and development stage?



David Elkind, author of “the power of play” explains media content as hot and cold depending upon the level of participation it can allow. For example- The sketch invites more participation than does a photograph. Now let’s consider several factors that make any content whether a computer game, TV program hot or cool. Additionally while considering what content is hot or cool for a specific child, every child would have varying responses and individual differences in their preference for hot and cool media.

Hot content
Cool content
·         Less participation, decreased active learning opportunity

·         Stimulating, visually arresting, fast paced

·         Violent and entertaining TV shows

·         For e.g., For infants and young toddlers, TV shows utilizing attention getting strategies such as bright colors, high pitch sounds and liberal use of repetitive large movements. Infants would prefer to watch such hot media but more likely to be entertained than to engage in active learning

·         More participation, increased learning opportunity

·         Quiet, slow paced, visually interesting

·         Educational TV shows

·         For e.g., For infants and young toddler’s TV shows with less intrusive visuals, soothing music, scan be used by parents and caregivers during their normal routine activities like diaper change, getting dressed etc.

Research corner

  • Results of a longitudinal study conducted on adolescent to find out the effects of their television viewing as preschoolers on their academic performance showed that adolescents who preferred watching educational programs (cool) earned higher grades, read more, had better creativity and were less aggressive as compared to the adolescents who watched entertaining and violent television shows as preschoolers.
  • Another research study conducted on two- to-three-year kiddos showed that kids who watched cool TV shows such as sesame street were better academically when tested on their reading readiness and vocabulary as compared to kids who watched hot entertaining TV shows.



The most imperative factor to be considered while understanding the importance of technology usage with young children is, the context in which the technology is used. It should help in increasing learning opportunities in children.

Passive and Active use of technology

Passive use of technology– It occurs when children are consuming content, such as watching a program on television, playing a game on a computer, without any active participation, accompanying reflection, imagination.

Active use of technology– It occurs when children use technologies such as computers, devices, and apps to engage in meaningful learning and active engagement.  Examples include sharing their experiences by documenting them with photos and stories, recording their own music, using video chatting software to communicate with loved ones, or using an app to guide playing a physical game. These types of uses are capable of deeply engaging the child, especially when an adult supports them.

Examples of active use of technology

  • Co-viewing with children

Families can promote the exchange of ideas and expand the child’s imagination by viewing various programs with young children and maximizing their learning opportunities. Most research on children’s media usage shows that children learn more from content when parents or early educators watch and interact with children, encouraging them to make real world connections to what they are viewing both while they are viewing and afterward.

  • Strengthen and promote relationships

Amid a global pandemic, the use of video-chat interactions has helped to promote relationships. Schools are virtual which gives an opportunity for children to connect and build positive peer relationship via video chats as well as with educators. While video chatting can be done at any age (as interactions tend to be brief and guided by an adult), new evidence shows that infants and toddlers can attend to and engage in joint attention during video-chat interactions but do so more effectively after approximately 16 months of age and with parental support.



Every child is unique and so would be their choices.  Considering the fact that nothing can replace the face to face interactions and the benefits of natural play for children, there are specific recommendations put forward by American Pediatric Association for various age ranges from 0-8 years with regards to technology usage in children.

Under the age of 2
      The American Academy of Pediatrics(AAP) has advised parents against television by children under two years of age.

      It can be used as a platform to support relationships such as video chatting with family members as a form of social interaction.

      Parents who are interested in using media with their children can start around 18 months with high-quality content but should always co-view content and use technology with their children.
Ages 2-5
      New recommendations in the American Association of Pediatrics AAP’s 2016 Media and Young Minds Brief suggest that one hour of technology use is appropriate per day, inclusive of time spent at home and in early learning settings and across devices
Ages 6-8
      Technology should be used as a tool for children at this age to explore and become active creators of content. If they are using virtual learning at school and have more than one teacher, those teachers should be aware of how much screen time is being used across subject areas and at home. Students should learn to use technology as an integrated part of a diverse curriculum.

      At home, parents should set limits they feel are appropriate for their children, understanding the differences between passive and active technology use as well as the benefits of using technology with an adult versus solo use.

      Parents should also be aware of how much technology is being used in the classroom, what is needed for homework, and how this fit into an overall picture of technology use for their child throughout the day.

      The AAP has created an interactive Family Media Plan Tool on HealthyChildren.org to help parents be thoughtful about media exposure for their children.




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Developmental Coordination Disorder

Clumsiness or more?- Developmental Coordination Disorder 

What is it?

  • According to American Psychological Association, Developmental coordination disorder (DCD) is a common neurodevelopmental disorder characterized by deficits in both fine and gross motor coordination which have a significant impact on a child’s activities of daily living or school productivity.
  • Children with DCD exhibit these deficits in the absence of identifiable medical or intellectual or visual impairment, or another motor disability, such as cerebral palsy.
  • It is thought to affect around 5% of school-aged, but despite its high prevalence, it remains one of the less well understood and recognized developmental conditions in both educational and medical settings. The prevalence rate is 5-6%, which is approximately 1 in every 20 children.
  • It is often co-morbid with other childhood disorders including attention deficit hyperactivity disorder (ADHD), dyslexia, speech/language impairment.
  • Frequently described as “clumsy” or “awkward” by their parents and teachers, children with DCD have difficulty mastering simple motor activities, such as tying shoes or going downstairs and are unable to perform age-appropriate academic and self-care tasks.


Signs and Symptoms

Parents are the initial evaluators to spot signs and symptoms of DCD in their child before anyone else. When they notice their little one is struggling, having challenges or lacking behind other children in movement skills, such as sitting up or learning to walk. However, sometimes signs and symptoms of DCD are not caught until a child starts school. Teachers may see that the child cannot play at recess or in physical education classes in the same way that other children do. They also may observe that it takes the child longer to complete schoolwork. Children with DCD show a lack of interest in playing with other children.

Children with DCD may have difficulty when they try to:

  • Run, skip, jump, hop on one foot, do jumping jacks, or perform other physical activities.
  • Use hand-held objects such as crayons or scissors.
  • Throw or catch a ball accurately.
  • Follow directions for movements that involve more than one step. (When they make a mistake or can’t do the next step, they will start all over again rather than with the most recent action taken.)
  • Know where their bodies are in space.

DCD at specific ages.

Has trouble throwing a ball
Plays too roughly or often bump into other kids by accident
Has difficulty sitting upright or still

Grade K-2
Has trouble holding and using a crayon, a pencil, or scissors
Doesn’t form or space letters correctly
Struggles with going up and downstairs
Frequently bumps into people by accident
Has trouble with self-care, like brushing teeth

Grade 3-7
Takes a long time to write
Has trouble cutting foods
Has difficulty with basic routines like getting dressed
Struggles to line up columns when doing math problems

Role of professionals in the treatment of DCD

Historically, parents have been told not to worry about their child’s clumsiness because the child will outgrow the problem. However, current researchers in the area of DCD report that the children do not outgrow clumsiness and that, without intervention, they will not improve.

A key treatment for DCD is occupational therapy (OT). There are many examples of how occupational therapists can work on challenging motor tasks. They might have kids trace letters on sandpaper to build handwriting skills, for example. Or use a lacing board with different colored laces to practice shoe tying.

Kids with DCD may also work with physical therapists on balance and muscle tone.

Occupational therapy and Physical Therapy assist with helping the child with DCD develop movement strategies that increase coordination, motor planning, balance, strength and body awareness resulting in a decrease in overall clumsiness and increased ability to perform functional activities at home, school and in the community.

Speech and language therapy may also be required to help the child with the oral motor skills required for swallowing, chewing and speech.


Harrowell, I., Hollén, L., Lingam, R., & Emond, A. (2018). The impact of developmental coordination disorder on educational achievement in secondary school. Research in developmental disabilities72, 13-22.

Kirby, A., & Sugden, D. A. (2007). Children with developmental coordination disorders. Journal of the royal society of medicine100(4), 182-186.


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Phono Processes

Substitution Process:

When one sound is substituted by another sound in a systematic fashion

Phonological Process Definition Age Example
Affrication Fricatives are replaced by affricates 3;0
(Peña-Brooks & Hedge, 2007)
[dɔr] -> [jɔr]
Alveolarization Non alveolar sound is replaced with an alveolar sound 5;0
(Peña-Brooks & Hedge, 2007)
[ʃu] -> [tu]
Backing Sounds are substituted or replaced by segments produced posterior to , or further back in, the oral cavity than the standard production No information available [sɪp] ->[ʃɪp]
Deaffrication Affricates are realized as fricatives 4;0
(Peña-Brooks & Hedge, 2007)
[tʃɪp] -> [ʃɪp]
Depalatization Palatal sounds are realized as sounds produced further forward in the oral cavity 5;0 [fɪʃ] -> [fɪt]
Fronting Velars are realized as sounds produced further forward in the oral cavity 3;6
[go] -> [do]
Gliding of liquids Liquids /l,r/ are replaced by a glide /w,j/ or another liquid 5;0
[lif] -> [wif]
Labialization Nonlabial sound is replaced with a labial sound 6;0
(Peña-Brooks & Hedge, 2007)
[taɪ] -> [paɪ]
Stopping Fricatives and/or affricates are realized as stops 5;0
[piʧ] -> [pit]
Vocalization Liquids or nasals are replaced by vowels /f/&/s/ =3;0
/v/ & /z/ =3;6
[teɪbəl] -> [tebo]
Denasalization Nasals are replaced by homorganic stops 2;6
(Peña-Brooks & Hedge, 2007)
[naɪs] -> [daɪs]
Glottal replacement Glottal stops replace sounds usually in either intervocalic or final position No information available Tooth->
Prevocalic voicing Voiceless consonants in the prevocalic position are voiced 3;0
[teɪbəl] -> [debi]
Devoicing of final consonants Voiced obstruents are devoiced in final position 3;0
[dɔg] -> [dɔk]



When one sound in the word becomes similar to another sound in the word

Phonological Process Definition Age Example
Assimilation (consonant harmony) One sound is replaced by another that is the same or similar to another sound within the word 3;0
(Peña-Brooks & Hedge, 2007)
[dɔg] ->[dɔd]
Velar Assimilation A nonvelar sound is assimilated to a velar sound because of the influence, or
dominance, of a velar
(Peña-Brooks & Hedge, 2007)
[dʌk] -> [gʌk]
Nasal Assimilation A non-nasal sound is assimilated and replaced by a nasal because of the influence, or dominance, of a nasal consonant 3;0
(Peña-Brooks & Hedge, 2007)
[læm] -> [næm]
Labial Assimilation A nonlabial sound is assimilated to a labial consonant because of the influence of a labial consonant. 3;0
(Peña-Brooks & Hedge, 2007)
[bɛd] -> [bɛb]
Alveolar Assimilation Non-alveolar sound is changed to an alveolar sound 3;0
(Peña-Brooks & Hedge, 2007)
[tos] -> [tot]


Syllable Structure /Patterns:

Phonological processes that affect the syllable structure

Phonological Process Definition Age Example
Consonant Cluster Reduction Deletion of one element of the cluster 4;0
[stɑp] -> [tɑp]
Epenthesis A segment, often the unstressed vowel, is inserted 8
(Peña-Brooks & Hedge, 2007)
[blæk] ->[ bəlæk]
Reduplication A syllable or a portion of a syllable is repeated or duplicated, usually becoming CVCV 3;0
[dæd] -> [dæ dæ]
Weak/Unstressed Syllable Deletion Deletion of the unstressed syllable 4;0
[tɛləfon] -> [tɛfon]
Final Consonant Deletion Deletion of the final consonant in the word 3;3
(open and closed)
[kæp] ->[ kæ]
Consonant Cluster Simplification A consonant cluster is simplified by a substitution for one member of the cluster 4;0
Metathesis There is a transposition or reversal of two segments (sounds) in a word No information available [bæskət] -> [bæksɪt]
Coalescence Characteristics of features from two adjacent sounds are combined so that one sound replaces two other sounds No information available [swɪm] ->[ fɪm]


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SLP Milestones

What should my child be able to do?

Hearing and Understanding Talking
Birth-3 Months

  • Startles to loud sounds.
  • Quiets or smiles when spoken to.
  • Seems to recognize your voice and quiets if crying.
  • Increases or decreases sucking behavior in response to sound.
Birth-3 Months

  • Makes pleasure sounds (cooing, gooing).
  • Cries differently for different needs.
  • Smiles when sees you.
4-6 Months

  • Moves eyes in direction of sounds.
  • Responds to changes in tone of your voice.
  • Notices toys that make sounds.
  • Pays attention to music.
4-6 Months

  • Babbling sounds more speech-like with many different sounds, including p, b, and m.
  • Chuckles and laughs.
  • Vocalizes excitement and displeasure.
  • Makes gurgling sounds when left alone and when playing with you.
7 Months-1 Year

  • Enjoys games like peek-o-boo and pat-a-cake.
  • Turns and looks in direction of sounds.
  • Listens when spoken to.
  • Recognizes words for common items like “cup”, “shoe”, “book”, or “juice”.
  • Begins to respond to requests (e.g. “Come here” or “Want more?”).
7 Months-1 Year
• Babbling has both long and short groups of sounds such as “tata upup

  • Uses speech or non-crying sounds to get and keep attention.
  • Uses gestures to communication (waving, holding arms to be picked up).
  • Imitates different speech sounds.
  • Has one or two words (hi, dog, dada, mama) around first birthday, although sounds may not be clear.
One to Two Years

  • Points to a few body parts when asked.
  • Follows simple commands and understands simple questions (“Roll the ball”, “Kiss the baby”, “Where’s your shoe?”).
  • Listens to simple stories, songs, and rhymes.
  • Points to pictures in a book when named.
One to Two Years

  • Says more words every month.
  • Uses some one- or two- word questions (“Where kitty?”, “Go bye-bye?”, “What’s that?”).
  • Puts two words together (“more cookie”, “no juice”, “mommy book”).
  • Uses many different consonant sounds of the beginning of words.
Two to Three Years

  • Understands differences in meaning (“go-stop”, “in-on”, “big-little”, “up-down”).
  • Follows two requests (“Get the book and put it on the table”).
  • Listens to and enjoys hearing stories for longer periods of time.
Two to Three Years

  • Has a word for almost everything.
  • Uses two- or three- words to talk about and ask for things.
  • Uses k, g, f, t, d, and n sounds.
  • Speech is understood by familiar listeners most of the time.
  • Often asks for or directs attention to objects by naming them.
  • Asks why?
  • May stutter on words or sounds.
Three to Four Years

  • Hears you when call from another room.
  • Hears television or radio at the same loudness level as other family members.
  • Understands words for some colors, like red, blue, and green.
  • Understands words for some shapes, like circle and square.
  • Understands words for family, like brother, grandmother, and aunt.
Three to Four Years

  • Talks about activities at school or at friends’ homes.
  • Talks about what happened during the day. Uses about 4 sentences at a time.
  • People outside of the family usually understand child’s speech.
  • Answers simple, “who?”, “what?”, “where?”, and “why?” questions.
  • Asks when and how questions.
  • Says rhyming words, like hat-cat.
  • Uses pronouns, like I, you, me, we, and they.
  • Uses some plural words, like toys, birds, and buses.
  • Uses a lot of sentences that have 4 or more words.
  • Usually talks easily without repeating syllables or words.
Four to Five Years

  • Understands words for order, like first, next, and last.
  • Understands words for time, like yesterday, today, and tomorrow.
  • Follows longer directions, like “Put your pajamas on, brush your teeth, and then pick out a book.”
  • Follows classroom directions, like “Draw a circle on your paper around something you eat.”
  • Hears and understands most of what is said at home and in school.
Four to Five Years

  • Says all speech sounds in words. May make mistakes on sounds that are harder to say, like l, s, r, v, z, ch, sh, th.
  • Responds to “What did you say?”
  • Talks without repeating sounds or words most of the time.
  • Names letters and numbers.
  • Uses sentences that have more than 1 action word, like jump, play, and get. May make some mistakes, like “Zach got 2 video games, but I got one.”
  • Tells a short story.
  • Keeps a conversation going.
  • Talks in different ways depending on the listener and place. May use short sentences with younger children or talk louder outside than inside.


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Bilingualism in Young Children: Separating Fact from Fiction

Note: “bilingual” refers to someone who speaks two languages; “monolingual” refers to someone who speaks one language

The Facts: What We Know About Bilingualism

Our world is becoming increasingly multilingual. Consider some of the following statistics:

In Canada….

  • 11.9 % of the population speaks a language other than English or French at home (1). In Toronto, 31% of the population speaks a language other than English or French at home (2).

In the United States….

  • 21% of school-age children (between ages 5-17) speak a language other than English at home (3). This number is projected to increase in the coming years (4).

Worldwide, it is estimated that….

  • there are more second language speakers of English than native speakers (5).
  • there are as many bilingual children as there are monolingual  children (10).

These trends mean that many children are being raised as bilinguals.  Sometimes bilingualism is a necessity, as a child’s parents may not be fluent in the majority (dominant) language spoken in the community. Therefore, the child may learn one language at home and another at school. But sometimes bilingualism is a choice, and parents may wish to expose their child to another language, even if they do not speak a second language themselves.  This could be due to the many benefits of being bilingual.

Benefits of Bilingualism

  • Bilingual children are better able to focus their attention on relevant information and ignore distractions (7, 8). For more information, click here for our article “Are Two Languages Better Than One?”.
  • Bilingual individuals have been shown to be more creative and better at planning and solving complex problems than monolinguals (9, 10).
  • The effects of aging on the brain are diminished among bilingual adults (7).
  • In one study, the onset of dementia was delayed by 4 years in bilinguals compared to monolinguals with dementia (10).
  • Bilingual individuals have greater access to people and resources (9).
  • In Canada, employment rates are higher for French/English bilinguals than monolinguals (7).
  • Canadians who speak both official languages have a median income nearly 10% higher than that of those who speak English only, and 40% higher than that of those who speak French only (7).

The cognitive advantages of bilingualism (e.g . with attention, problem solving, etc.) seem to be related
to an individual’s proficiency in his languages (10). This means that a person will benefit more from his
bilingualism (cognitively) if he is more proficient in his languages.

How children learn more than one language

Bilingual acquisition can take place in one of two ways:

  1. Simultaneous Acquisition occurs when a child is raised bilingually from birth, or when the second language is introduced before the age of three (10). Children learning two languages simultaneously go through the same developmental stages as children learning one language. While bilingual children may start talking slightly later than monolingual children, they still begin talking within the normal range (11). From the very beginning of language learning, simultaneous bilinguals seem to acquire two separate languages (10). Early on, they are able to differentiate their two languages and have been shown to switch languages according to their conversation partner (e.g. speak French to a French-speaking parent, then switch to English with an English-speaking parent) (12, 13).
  2. Sequential Acquisition occurs when a second language is introduced after the first language is well-established (generally after the age of three). Children may experience sequential acquisition if they immigrate to a country where a different language is spoken. Sequential learning may also occur if the child exclusively speaks his heritage language at home until he begins school, where instruction is offered in a different language.

A child who acquires a second language in this manner generally experiences the following (10):

  • initially, he may use his home language for a brief period.
  • he may go through a “Silent” or “Nonverbal” Period when he is first exposed to a second language. This can last from a few weeks to several months, and is most likely a time when the child builds his understanding of the language (14). Younger children usually remain in this phase longer than older children. Children may rely on using gestures in this period, and use few words in the second language.
  • he will begin to use short or imitative sentences. The child may use one-word labels or memorized phrases such as “I dunno” or “What’s this?”. These sentences are not constructed from the child’s own vocabulary or knowledge of the language. Rather, they are phrases he has heard and memorized.
  • eventually, he will begin to produce his own sentences. These sentences are not entirely memorized, and incorporate some of the child’s own newly-learned vocabulary. The child may use a “formula” at first when constructing sentences and insert his own word into a common phrase such as “I want…” or “I do….”. Eventually the child becomes more and more fluent, but continues to make grammatical mistakes or produce sentences that sound abbreviated because he is missing some grammatical rules (e.g. “I no want eat apple” instead of “I don’t want to eat an apple”). Some of the mistakes a child makes at this stage are due to the influence of his first language. But many of the mistakes are the same types of mistakes that monolingual children make when they learn that language.

Fiction: Some Myths about Bilingualism

#1. Bilingualism causes language delay.

FALSE. While a bilingual child’s vocabulary in each individual language may be smaller than average, his total vocabulary (from both languages) will be at least the same size as a monolingual child (10, 15). Bilingual children may say their first words slightly later than monolingual children, but still within the normal age range (between 8-15 months) (11). And when bilingual children start to produce short sentences, they develop grammar along the same patterns and timelines as children learning one language (5). Bilingualism itself does not cause language delay (10).  A bilingual child who is demonstrating significant delays in language milestones could have a language disorder and should be seen by a speech language pathologist.

#2. When children mix their languages it means that they are confused and having trouble becoming bilingual.

FALSE. When children use both languages within the same sentence or conversation, it is known as “code mixing” or “code switching”. Examples of English-French code-mixing: “big  bobo” (“bruise” or “cut”), or “je veux aller manger tomato” (“I want to go eat..”) (10). Parents sometimes worry that this mixing is a sign of language delay or confusion. However, code mixing is a natural part of bilingualism (17). Proficient adult bilinguals code mix when they converse with other bilinguals, and it should be expected that bilingual children will code-mix when speaking with other bilinguals (5).

Many researchers see code mixing as a sign of bilingual proficiency. For example, bilingual children adjust the amount of code-mixing they use to match that of a new conversational partner (someone they’ve never met before who also code mixes) (5).  It has also been suggested that children code-mix when they know a word in one language but not the other (13). Furthermore, sometimes code-mixing is used to emphasize something, express emotion, or to highlight what someone else said in the other language. For example, “Y luego él dijo STOP” (Spanish mixed with English: “And then he said STOP!”) (10). Therefore, code-mixing is natural and should be expected in bilingual children.

#3. A person is not truly bilingual unless he is equally proficient in both languages.

FALSE. It is rare to find an individual who is equally proficient in both languages (16). Most bilinguals have a “dominant language”, a language of greater proficiency. The dominant language is often influenced by the majority language of the society in which the individual lives (6). An individual’s dominant language can change with age, circumstance, education, social network, employment, and many other factors (16).

#4. An individual must learn a second language as a young child in order to become bilingual.

FALSE. There is a “Critical Period” theory that suggests that there is a window of time (early childhood) during which a second language is most easily learned. This theory has led many people to believe that it is better to learn a second language as a young child. Young children have been found to achieve better native-like pronunciation than older children or adult second language learners. And they seem to achieve better long-term grammatical skills than older learners (10).  But other findings have called the idea of a critical period into question. For example:

  • older children (in middle elementary school) have been shown to have advantages when learning “academic” English. “Academic” language refers to the specialized vocabulary, grammar, and conversational ability needed to understand and learn in school (10). This is likely easier for older children because they learn their second language with more advanced cognitive skills than younger children, and with more experience with schooling and literacy (10).
  • older children and adults seem to be advantaged when initially learning vocabulary and grammar (10, 16, 18).

Therefore, while younger children seem to become more “native-like” in the long-term, older children may pick up vocabulary, grammar, and academic language more easily in the initial stages of language learning.

#5. Parents should adopt the “one parent-one language” approach when exposing their child to two languages.

FALSE. Some parents may choose to adopt the “one parent-one language” approach, where each parent speaks a different language to the child. While this is one option for raising a bilingual child, there is no evidence to suggest that it is the only or best way to raise a child bilingually, or that it reduces code mixing (10). Parents should not worry if they both speak their native language to the child or if they mix languages with their child (19), as it has been recognized that children will mix their languages regardless of the parents’ approach (10). Many approaches can lead to bilingualism. Parents should speak to their child in a way that is comfortable and natural to them.

#6. If you want your child to speak the majority language, you should stop speaking your home language with your child.

FALSE. Some parents attempt to speak the majority language to their child because they want their child to learn that language, even if they themselves are not fluent in the majority language. This can mean that conversations and interactions do not feel natural or comfortable between parent and child. There is no evidence that frequent use of the second language in the home is essential for a child to learn a second language (10). Furthermore, without knowledge of a family’s home language, a child can become isolated from family members who only speak the home language. Research shows that children who have a strong foundation in their home language more easily learn a second language. Children are also at great risk of losing their home language if it is not supported continually at home.

How to Support your Bilingual Child

There are many ways to support your child’s bilingualism:

  • Do what feels comfortable for you and your family. Don’t try to speak a language with your child if you are not comfortable or fluent In that language
  • Don’t worry if your child mixes his two languages. This is a normal part of becoming bilingual Provide your child with many opportunities to hear, speak, play, and interact in your home language.
  • If you think your child has a language delay, consult a speech language pathologist for advice regarding the best ways to help your child learn more than one language.
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Augmentative and Alternative Communication (AAC)

About AAC

You may have seen someone write in a notebook to answer a question. Maybe you have seen people using sign language or other gestures. You may have seen someone push buttons on a computer that speaks for them. These are all forms of augmentative and alternative communication, or AAC.

AAC includes all of the ways we share our ideas and feelings without talking. We all use forms of AAC every day. You use AAC when you use facial expressions or gestures instead of talking. You use AAC when you write a note and pass it to a friend or coworker. We may not realize how often we communicate without talking.

People with severe speech or language problems may need AAC to help them communicate. Some may use it all of the time. Others may say some words but use AAC for longer sentences or with people they don’t know well. AAC can help in school, at work, and when talking with friends and family.

Types of AAC

Do you or your loved one have difficulty talking? There are options that might help. There are two main types of AAC—unaided systems and aided systems. You may use one or both types. Most people who use AAC use a combination of AAC types to communicate.

Unaided Systems

You do not need anything but your own body to use unaided systems. These include gestures, body language, facial expressions, and sign language.

Aided Systems

An aided system uses some sort of tool or device. There are two types of aided systems—basic and high-tech. A pen and paper is a basic aided system. Pointing to letters, words, or pictures on a board is a basic aided system. Touching letters or pictures on a computer screen that speaks for you is a high-tech aided system. Some of these speech-generating devices, or SGDs, can speak in different languages.

Working With A Speech-Language Pathologist

An SLP will test how well you or your loved one can speak and understand. The SLP can help find the right AAC system for you. You may use a basic system first and may need it for only a short time. This may happen if you had mouth surgery or a stroke and your speech comes back.

It may take some time to get a more high-tech system, if you need one. Not every device works for every person, so it is important to find the right one for you. The Information for AAC Users webpage has more information about finding the best AAC system. Insurance or other funding can help you pay for your AAC device.

See ASHA information for professionals on the Practice Portal’s Augmentative and Alternative Communication page.

Written by team-admin

Age-Appropriate Speech and Language Milestones

The ability to hear is essential for proper speech and language development. Hearing problems may be suspected in children who are not responding to sounds or who are not developing their language skills appropriately. The following are some age-related guidelines that may help to decide if your child is experiencing hearing problems.

It is important to remember that not every child is the same. Children reach milestones at different ages. Talk your child’s healthcare provider if you are suspicious that your child is not developing speech and language skills correctly. The National Institute on Deafness and Other Communication Disorders and other experts list the following age-appropriate speech and language milestones for babies and young children.

Milestones related to speech and language

Birth to 5 months
  • Coos
  • Vocalizes pleasure and displeasure sounds differently (laughs, giggles, cries, or fusses)
  • Makes noise when talked to
6 to 11 months
  • Understands “no-no”
  • Babbles (says “ba-ba-ba”)
  • Says “ma-ma” or “da-da” without meaning
  • Tries to communicate by actions or gestures
  • Tries to repeat your sounds
  • Says first word
12 to 17 months
  • Answers simple questions nonverbally
  • Says 2 to 3 words to label a person or object (pronunciation may not be clear)
  • Tries to imitate simple words
  • Vocabulary of four to 6 words
18 to 23 months
  • Vocabulary of 50 words, pronunciation is often unclear
  • Asks for common foods by name
  • Makes animal sounds, such as “moo”
  • Starting to combine words, such as “more milk”
  • Begins to use pronouns, such as “mine”
  • Uses 2-word phrases
2 to 3 years
  • Knows some spatial concepts, such as “in” or “on”
  • Knows pronouns, such as “you,” “me” or “her”
  • Knows descriptive words, such as “big” or “happy”
  • Uses 3-word sentences
  • Speech is becoming more accurate, but may still leave off ending sounds. Strangers may not be able to understand much of what is said.
  • Answers simple questions
  • Begins to use more pronouns, such as “you” or “I”
  • Uses question inflection to ask for something, such as “my ball?”
  • Begins to use plurals, such as “shoes” or “socks” and regular past tense verbs, such as “jumped”
3 to 4 years
  • Groups objects, such as foods or clothes
  • Identifies colors
  • Uses most speech sounds, but may distort some of the more difficult sounds, such as l, r, s, sh, ch, y, v, z, th. These sounds may not be fully mastered until age 7 or 8.
  • Uses consonants in the beginning, middle, and ends of words. Some of the more difficult consonants may be distorted, but attempts to say them
  • Strangers are able to understand much of what is said
  • Able to describe the use of objects, such as “fork” or “car”
  • Has fun with language; enjoys poems and recognizes language absurdities, such as, “Is that an elephant on your head?”
  • Expresses ideas and feelings rather than just talking about the world around him or her
  • Uses verbs that end in “ing,” such as “walking” or “talking”
  • Answers simple questions, such as “What do you do when you are hungry?”
  • Repeats sentences
4 to 5 years
  • Understands spatial concepts, such as “behind” or “next to”
  • Understands complex questions
  • Speech is understandable, but makes mistakes pronouncing long, difficult, or complex words, such as “hippopotamus”
  • Uses some irregular past tense verbs, such as “ran” or “fell”
  • Describes how to do things, such as painting a picture
  • Lists items that belong in a category, such as animals or vehicles
  • Answers “why” questions
5 years
  • Understands time sequences (for example, what happened first, second, or third)
  • Carries out a series of 3 directions
  • Understands rhyming
  • Engages in conversation
  • Sentences can be 8 or more words in length
  • Uses compound and complex sentences
  • Describes objects
  • Uses imagination to create stories
Written by team-admin

Early Intervention

What Is Early Intervention?

Children grow and develop at their own rate. Although some children walk and talk early, others may be delayed in learning certain skills. If you have any concerns about your child’s development, the earlier you seek help, the better.

Early intervention is for children ages birth to 3 and their families. Early intervention is available in every state under federal law. In some states, early intervention programs may continue until a child is age 5.

Families and professionals, including audiologists and speech-language pathologists, are part of an early intervention team. They help children develop skills such as

  • cognitive skills (thinking, learning, problem-solving);
  • communication skills (gesturing, talking, listening, understanding);
  • physical and sensory skills (crawling, walking, climbing, seeing, hearing);
  • social–emotional skills (playing, understanding feelings, making friends); and
  • adaptive or self-help skills (eating, bathing, dressing).

Early intervention is different for each child and family depending on the child’s needs and the family’s priorities. The most important step is to start early.

How Can I Get Early Intervention Services for My Child?

Health care providers, parents, child care staff, teachers, and social service workers are just some of the people who can refer an infant or toddler for early intervention.

If you are concerned about your child’s development, you may contact your local early intervention program directly to ask for an evaluation. Families do not have to wait for a referral from professionals.

You can find your community’s early intervention office by

  • asking your child’s pediatrician, child care provider, or teacher for a referral;
  • calling your state department of health or education;
  • reaching out to the Parent Training and Information Center in your state;
  • contacting the pediatrics department of a local hospital; or
  • visiting the Early Childhood Technical Assistance Center’s state-by-state contacts page.

What Happens After My Child Is Referred for Early Intervention?

After your child is referred to your local early intervention program, a service coordinator will meet with you and your child to gather information and explain next steps. They will evaluate your child’s skills to see if your child and family are eligible for services. They will ask you for written consent before they begin.

If your child is eligible for services, a more in-depth assessment (i.e., tests, observations, interviews) will be completed. This assessment determines how early intervention can help your child and family.

Next, the early intervention team writes an Individualized Family Service Plan. This plan includes goals, services, and supports for your child and family. You are part of the team, and you help decide what is included in the plan.

Early intervention services must be in the language(s) your child and your family use. If necessary, an interpreter will work with you and the early intervention providers.

What Happens When My Child Turns 3?

A few months before your child’s third birthday, you and the early intervention team will develop a transition plan to meet the needs of your child and family. Part of this plan involves deciding if your child needs services after age 3.

Some states will extend early intervention services beyond your child’s third birthday if needed. Children older than 3 may be eligible for services from the local school district.

What If My Child Is Not Eligible for Early Intervention Services?

If your child does not qualify for services, but you feel they still need help, let the team know right away. You can request another evaluation at that time or in the future. You can also seek services outside of the early intervention program. These services are usually billed to you or your insurance.

If your child is already 3, you can still get help through your local school district. Each school district has a program called Child Find that can help.

A lot happens in the first few years of life. For children who are not where they need to be with development, getting help early can make a big difference.


ASHA Resources

See these ASHA resources for more information about typical development and early signs of speech, language, and hearing disorders:

You can also browse ASHA’s Online Store for brochures and booklets related to infants and toddlers.