Banter Speech & Language

Sydney speech pathologists helping adults and children speak for themselves.

Language

Once upon a… ‘who’?

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Just in case you need a laugh, here’s me being a bit silly on a free oral language video resource. Back in the late ’90s, I would not have imagined spending my Saturday night this way. Strange times!

If you think you can do a better soundtrack than me, the PDF is available to download here.

Also, part of our Once Upon a… series, is our Once upon a…where? resource.

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

I want to help my late talker to speak, but I’m stuck at home. What can I do?

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Which words should I choose? How should I target them? How many times should I say them?

Are you at home with a 2-3 year old who doesn’t speak or speaks only in single words? Here are five evidence-based suggestions to help encourage your late talker to start talking:

1. Follow your child’s natural interests and take an active interest in what they are looking at and doing 

2. Copy everything your late talker does, including any speech sounds, and add sound effects!

3. Use lots of gestures, especially pointing

language stimulation tip of the week more pointing

4. Make a list of words to work on: here’s how!

Make an initial list of 10-15 words that you would like your late talker to say. There is no formula for choosing words, but the evidence tells us we should choose a variety of words, including words that:

  • you are confident your late talker understands but is not yet attempting (e.g. names of household items, animals);
  • start with a sound that your child can make. You can read more about the order in which most kids learn their consonants here. For many children, first sounds include vowels, and consonants like /m/ and /b/, like:
    • ‘milk’, ‘moo’, ‘more’, ‘mama’; and
    • ‘bath’, ‘bear’, ‘bottle’, ‘ball’, ‘bird’, ‘bubbles’, ‘book’; ‘balloon’, ‘baby’;
  • are motivating for the child to say (e.g. the name of a loved toy);
  • are important to you (e.g. ‘mama’ or ‘dad’);
  • can be used with natural gestures (e.g. ‘up’, ‘open’);
  • include at least a few ‘all-purpose’ verbs to help with word-combining (e.g. ‘open’, ‘put’, ‘go’, ‘make’, ‘do’); 
  • include some social and commenting words, (e.g. ‘hi’, ‘bye’, ‘nigh nigh’, ‘uh-oh’, ‘owie’); 
  • include some describing words (e.g. ‘big’, ‘hot’, ‘dirty’);
  • include some protesting words (e.g. ‘no’);
  • include some ‘sound-effect’ friendly words (e.g. ‘grr’, ‘choo choo’, ‘woof woof’, ‘vroom’, ‘baa-baa’, ‘moo’, ‘baa-baa’); and/or
  • will be relevant to many daily routines that happen during the day (e.g. when getting dressed, at bath time, when eating, bed time, or when playing).

5. Choose 3 or 6 words to work on at a time

While playing face-to-face with your child, say each of the words you have chosen many times in short, grammatically correct sentences.

This kind of approach – where the parent provides all the input – has been found to improve expressive language skills in late-talking toddlers (e.g. Alt et al., 2014; Alt et al., 2020). 

How many words should you work on at a time? How many times should you say each word? How long should each play “session” go for?

These are really important questions to be answered if you are trying to help your late talker. The research (and common sense) tells us that:

  • you don’t want to try too many words at the same time, so start with 3 or 6 words to target;  
  • late talkers benefit from lots of repetitions; and
  • play sessions shouldn’t go for too long, so start with a target of around 30 minutes.

What recent research tells us

A recently published study looked at two different ‘dose’ formats for a 30 minute play session run by a speech pathologist:

  • 3 different words, each said 90 times; or
  • 6 different words, each said 45 times.

In both cases, that’s a total of 270 ‘doses’ in 30 minutes, or 9 ‘doses’ a minute – one target word every 6.7 seconds in a short grammatical sentence, while playing!  That’s a lot of repetitions!

The program went for around 8 weeks, with two 30-minute sessions a week. Speech pathologists worked with families to choose 10 target words. These words were words that the families wanted their children to say, and included words from different classes (e.g. nouns, verbs, adjectives) but there was no formula for choosing the word classes. 

Toys and activities were pre-planned to make it easier for the speech pathologists to use the targets many times. For example, if a target words were ‘milk’, ‘mum’ and ‘go’, the speech pathologist would use grocery shopping activities or preparing cereal, and use a range of objects, e.g. play milk bottles, real milk, pictures of milk, a colouring page of a milk carton, and a children’s book featuring milk.

Target words were addressed in treatment until the toddler attempted the word at least one time per session across three sessions. Some of the kids heard the same 3 words across all treatment sessions, and some heard all 10 of their words in sessions.

The program was tested on 24 mainly-monolingual English-speaking late-talkers, aged between 25-41 months. None of the children had autism, hearing loss or any other diagnosis other than being a late talker.

Over the roughly 8-week treatment period, most (15/24) of the children began producing targeted words; and at least a third of the children appeared to ‘learn how to learn’ words, gaining, on average more that 13 new words per week. Interestingly, there was no significant difference in the outcomes achieved by the toddlers who received 3 target words a session and those who received 6 target words a session. 

6. What can I do when my child starts talking?

Big topic, and one worthy of its own article. But if I had to choose two of my favourite techniques, they would be build-ups and breakdowns, and recasting:

You can read a bit more about recasting here.

Clinical bottom line

Speech pathologists are trained to train parents and carers in a variety of techniques to help late talkers, including focused stimulation. But you are the expert on your child, and probably the centre of his or her world. 

We hope this article has given you some practical tips for choosing words and helping your late talker to use them. Evidence-based techniques, like those summarised in this article, are safe and can be fun for you and your child in natural play activities and routines – even if you can’t quite manage 270 repetitions in 30 minutes! 

Related articles:

Principal source: Alt, M., Mettler, H.M., Erikson, J.A., Figueroa, C.R., Etters-Thomas, S.E., Arizmendi, G.D., Oglivie, T. (2020). Exploring Input Parameters in an Expressive Vocabulary Treatment with Late Talkers, Journal of Speech, Language, and Hearing Research, 63, 216-233.

Technical resource for speech pathologists looking to help parents choose first words: Wordbank, an open database of children’s vocabulary development: http://wordbank.stanford.edu/.

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Vroom through your Zooms with another free Banter Speech Blank’s resource

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Telehealth fatigue is a definitely a thing. 

For those of you on the front line, our speech pathology team have whipped up another free resource to help stay the course. 

Combining interesting pictures with scripted Blank’s Level 3 and 4 questions, this resource is designed to be used for a variety of speech and language goals, including understanding of questions, complex sentence formulation, verbal reasoning, and speech sounds at the sentence level, and speech fluency.

free Blank’s level 3 and 4 picture resource

If you find this resource useful in your practice, please let us know in the comments!

For more Blanks resources, check out our:

You can also read about the benefits of Blank’s language levels framework in our blog here.

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Preposition “On”: A No-Prep Preposition Pack with Animated Examples

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Teaching prepositions without movement is really hard, especially when you’re doing it by telehealth.

Here’s our solution for the preposition “On”.

Our new Powerpoint resource with animated examples is now available from our store:

Preposition “On”: no-prep pack with animated examples

Check out our video for more information:

We have had good success using this resource via telehealth in our speech pathology clinic. We hope you do, too.

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

“There is a time for many words, and there is also a time for sleep.”* Why enough sleep is essential for speech and language learning

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When assessing and treating children and adults with communication disorders, speech pathologists need to ask more questions about sleep.

Why?

Sleep is critical for mental and physical health. Both sleep quality and quantity are important for memory and learning (Antony & Paller, 2017). Memory and learning ability are, in turn, essential for speech-language therapy to work (Morrow & Duff, 2020).

Sleep supports memory

To remember and use something you have learned, you need to:

  • encode it: convert the information into a new memory or mental representation that can be stored by the brain;
  • consolidate it: strengthen and stable the memory in the neocortex; and
  • retrieve it: access the memory.

Sleep may play a role in all these phases of memory, but it seems to be particularly important to the consolidation of newly learned information (e.g. Anthony & Paller, 2017; Stickgold, 2005). 

Sleep disturbances affect learning

Sleep disturbances of any kind have been linked to brain changes and associated disturbances in functional cognition. People with even mild sleep problems or poor sleep habits may have problems with cognition. For example, sleep quality and quality have been linked to student learning capacity and academic performance across settings and age groups (e.g. Curcio et al., 2006; Eliasson et al., 2002; Sadeh et al., 2000; and Trockel et al., 2000).

Memory supports language learning

Some researchers think that language learning depends on two learning and memory systems, which have been co-opted for language:

  • declarative memory, associated with explicit learning and knowledge that is available to conscious awareness, underlying knowledge about words (semantic memory) and events (episodic memory); and
  • procedural memory: associated with implicit, unconscious learning and processing of a wide range of perceptual, motor and cognitive skills and tasks (e.g. Kamhi, 2020, and Ullman, 2016). 

There is a growing body of research suggesting that developmental language disorders in children may be caused by a deficient procedural memory system. This would explain, for example, some of the difficulties many children with language disorders have understanding and applying the rules that comprise syntax, morphology, and the phonology of a language (e.g. Ullman & Pierpont, 2005).

However, the two systems interact with each other in complex and, as yet, not well understood ways, and some researchers do not agree with the procedural-declarative memory account of developmental language disorders (e.g. Goffman & Gerken, 2020).

In any event, research suggests that sleep supports nearly every type of memory, including:

  • declarative memories and language learning (e.g. Antony & Paller, 2017; Batterink & Paller, 2017; Cousins & Fernandez, 2019); and
  • procedural memories (e.g. Huber et al., 2004; Tamaki et al., 2008).

Taken together, this evidence suggests that undisturbed sleep plays a critical role in speech-language therapy success, including learning and retaining new vocabulary (e.g. Dumay & Gaskell, 2007) and complex language tasks, like full narratives (e.g. Antony & Paller, 2017).

Sleep disturbances and communication disorders often co-occur

Although there is good research linking sleep and learning in typically developing individuals, more studies are needed looking at the effects of sleep disturbances on people with communication disorders. 

We know that individuals with impaired development and/or brain injuries are at an increased risk for sleep disturbance. Sleep disturbance frequently co-occurs with:

  • Developmental Language Disorder (e.g. McGregor, 2014; McGregor & Alper, 2015);
  • Autism Spectrum Disorder (e.g. Liu et al., 2006; Schreck et al., 2004);
  • Down Syndrome (e.g. Carter et al., 2009);
  • Parkinson’s Disease (e.g. Chaudhuri et al., 2006; Kumar et al., 2002); and
  • Neurogenic disorder such as:
    • dementia with Lewy bodies (e.g. Murray et al., 2013);
    • traumatic brain injury (TBI), with up to 50% of TBI patients having a sleep disturbance (e.g. Dachtyl & Morales, 2017; Lundine et al., 2019; Mathias & Alvaro, 2012); and
    • stroke (e.g. Hermann et al., 2008).

Speech therapy is dependent on memory and learning ability. As such, sleep disturbance can interfere with our clients’ ability to participate in therapy.

What should we ask more about? Clinical symptoms of possible sleep disturbance

When assessing and treating clients, speech pathologists should ask more questions to probe whether the client exhibits any of the following symptoms of a possible sleep disturbance:

  • Difficulty falling or staying asleep.
  • Daytime somnolence (excessive tiredness or falling asleep during the day).
  • Shortness of breath or headaches on waking.
  • Irregular sleep and wake cycles.
  • Anxiety or irritability.
  • Difficulties concentrating.

(Mayo Clinic, 2019; Goel et al., 2009).

Common types of sleep disorders

Speech pathologists should be aware of the main categories of sleep disturbances:

  • Insomnias, an inability to fall asleep.
  • Hypersomnias, excessive sleepiness, falling asleep at inappropriate times.
  • Sleep-related breathing disorders, e.g. difficulties breathing during sleep, such as obstructive sleep apnoea.
  • Circardian rhythm sleep-wake disorders, meaning misaligned sleep schedules, e.g. where people do not sleep regular hours.
  • Parasomnias, being unwanted events or experiences that occur while falling asleep, sleeping or waking up.
  • Sleep movement disorders, being movements during or prior to sleep that make it difficult to fall asleep, stay asleep or get a restful sleep.

Clinical bottom line

Speech pathologists don’t treat sleep disturbances. But we need to know the signs and symptoms of possible sleep disturbances so that we can refer clients with suspected sleep difficulties to the right professionals to get the right help. 

Untreated sleep disturbances can get in the way of our clients achieving their speech therapy goals. Speech pathologists should:

  • ask about sleep as part of their clinical protocol, consider its clinical effects, and refer clients for medical follow-up as warranted (McGregor & Alper, 2015); and
  • help to educate clients, families and the general public about how sleep disturbances may affect memory and learning (including speech and language learning) (Morrow & Duff, 2020).

Related articles

Principal sources

Morrow, E.L, & Duff, M.C. (2020). Sleep Supports Memory and Learning: Implications for Clinical Practice in Speech-Language Pathology.  Am J Speech Lang Pathol. 2020 Mar 23:1-9. doi: 10.1044/2019_AJSLP-19-00125.

Kamhi, A.G. (2019). Speech-language development as proceduralization and skill learning: Implications for assessment and treatment. Journal of Communication Disorders 82, 105918. doi: https://doi.org/10.1016/j.jcomdis.2019.105918. Epub 2019 Jul 6.

More information

* “There is a time for many words, and there is also a time for sleep.” – Homer, The Odyssey

Related quotation: “It is a common experience that a problem difficult at night is resolved in the morning after the committee of sleep has worked on it.” – John Steinbeck

Image: https://tinyurl.com/rlt65v7

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Free Banter Telehealth Solidarity Support Pack: Picture Description Stimulus Resources for a range of language, speech, and stuttering targets at the sentence and discourse levels

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It’s tough being a speech pathologist in private practice at the moment. But we’re all in this together! 

To support the profession, and our collective clients, we are pleased to offer this free resource for instant download.

FREE PICTURE DESCRIPTION STIMULUS RESOURCE FROM OUR TEACHERS PAY TEACHERS STORE

This “no-preparation” pack features 30 interesting, high-quality photographs that can be used for picture description tasks at all levels – from single words, all the way up to making inferences.

The resource is suitable for face-to-face practice and telehealth. It can be printed, displayed on a computer, iPad or other tablet, phone or other smart device, or shared onscreen via telehealth video conferencing platforms such as Zoom, Coviu and Skype.

Obviously, you will want to pitch your questions about the pictures at a level that will promote your student’s or child’s language or fluency. To help find the right level of question to ask, we have adapted Marion Blank’s four levels of questioning.

Most of you will be Blanks experts. But, for those who are maybe not as familiar with the framework, this model is based on the idea that kids first learn to understand and use language in very concrete ways based on what they see, hear and touch, etc. As they develop, kids learn to use language to understand and express more abstract ideas (e.g. to make predictions, draw inferences, and to explain ideas and events that you can’t see, smell or touch). You can read more about Blanks framework here.

We’ve been using this resource in language and stuttering telehealth sessions for more than a year with good results.

 We hope you find this resource as helpful as we do. More importantly, stay safe and healthy during this difficult time!

FREE PICTURE DESCRIPTION STIMULUS RESOURCE FROM OUR TEACHERS PAY TEACHERS STORE