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Targeted Word Lists for Speech Therapy Practice

The speech therapy word lists are perfect for anyone who needs practice with speech and language concepts . For any type of practice...

...you need words to get started .

Now I don't know about you, but when I need to think of targeted words to use...

...I suffer from spontaneous memory loss , or SML.

It's more common than you might think ;)

This page has words for anyone to practice articulation, apraxia, language, phonology, or stuttering principles . They will help children and adults be successful meeting their goals. 

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Each list of articulation sounds contains words with the target sound in the beginning, middle, and end position, including blends when applicable, as well as words that...

• are common and functional (words we use all day...everyday)
• are mostly 1 syllable (multi-syllabic words are more difficult)
• have a phonemic context that don't interfere with production of the target sound (most words)

If "R" is the problem sound using the word "Rope" makes saying the "R" sound harder because the "O" sound is considered a round vowel.

A round vowel is one where you round your lips to say it. Go ahead...try it by saying "O" as in "boat". You rounded your lips didn't you? I thought you might.

Children who have difficulty with the "R" sound tend to say the "W" sound...they say "Wabbit" instead of "Rabbit".

The "W" sound is considered a rounded sound too. Try saying the "W" sound without rounding your lips...you can't because that is how the sound is made.

So by pairing the "R" sound with the "O" sound like in the word "Rope", this makes the word extra difficult for a child who has a problem saying the "R" sound because the "O" that follows the "R" will naturally make them want to round there lips.

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Functional Words To Teach Your Toddler First

In this article we will discuss:

Functional Words are Usually Verbs

10 common functional words to teach your toddler, common goals for speech therapy.

When your toddler is just beginning to produce words, they might show frustration when they can’t express what they want and need. That is why it is important to introduce functional words first. Teaching your toddler these essential words will give them the tools they need to communicate effectively. We will be giving you 10 common functional words you can teach your toddler and tips on how to teach them at home for better speech and language development!

Functional Words in Early Language Development

When babies start talking, they usually produce nouns first (ex. “mama”, “doggy”, etc.). The average age a baby says their first word is around 1 year old. Hearing the nouns that babies produce helps caregivers know what they are attending to and what interests them.

By 18 months old, a shift occurs and children begin to produce more verbs than nouns (“go”, “eat”, etc.).

The average age a child says their first sentence is around 2 years old. This increase in verb production indicates that children are beginning to understand that words can be used to connect nouns and actions.

Researchers found that although nouns were acquired earlier than verbs, there was a steeper decline in noun production from 2 years to 3 years for the SLI group.

In other words, nouns were acquired early on but there was a greater loss of nouns over time. Verbs, on the other hand, were produced at lower levels than nouns throughout the study but there was not as great of a decline from 2 years to 3 years. This suggests that even though nouns may be acquired earlier, they are not as stable or durable as verbs when it comes to long-term development.

If you are worried about your child’s language development, check out Children’s Language Development Milestones Chart to learn more about normal language development.

For toddlers, it is more important to prioritize learning verbs vs. nouns because they are more likely to be understood and can get their needs met more easily. The difference between noun and verb is that verbs are also easier to understand than nouns. For example, the verb “jump” is easier to understand than the noun “elephant.” Another example is the verb “eat” is easier to understand than the noun “food.”

What is a verb?

Verbs are words that describe an action. For example, some common verbs include “run,” “jump,” and “eat.”

What is a noun?

Nouns are words that name a person, place, thing, or idea. These include words such as “dog” “ball,” and “table.”

Why is it more important for your toddler to learn verbs before nouns?

Even though nouns may be acquired earlier, they are not as stable or durable as verbs when it comes to long-term development. The difference between noun and verb is because verbs are more important for communication and serve a vital purpose in early language development. Therefore, it is more beneficial for your child to focus on learning verbs vs. nouns in early speech and language development. This will help them get their needs met more easily and decrease frustration.

For early learners, goals for speech therapy include introducing verbs vs. nouns. When your child is beginning to talk, it is more important for them to learn verbs such as “jump” and “run.” These are called functional words because they help us communicate our needs and wants. It can also be used in different contexts.

Now, teaching nouns vs. verbs is NOT that wrong. However, it limits the child to use words in more context. For example, the verb “jump” can be used when your child wants to jump on a trampoline or in the car. The verb “run” can be used when your child wants to run outside or in the park.

The Use of Verbs with Nouns

When toddlers learn the difference between noun and verb, they are one step closer to being able to put together two-word phrases. These phrases are important for communication because they allow toddlers to express more complex ideas. For example, verbs with nouns such as “ball jump” are more complex than just the word “jump.” This is because it tells us what the child wants to do with the ball.

Noun phrases are more difficult than verb phrases for children with SLI. This may be because nouns are more abstract than verbs and require children to hold two pieces of information in their mind at the same time (the noun and the modifier).

Nouns phrases such as “the big red ball” are also important for communication. However, they are not as important as verbs with nouns because they do not tell us what the child wants to do with the noun. For example, the noun phrase “the big red ball” does not tell us if the child wants to jump with the ball or throw the ball.

As parents, you may be wondering what words to teach your babies first. A good place to start is with functional words. Functional words are those that help your toddlers communicate their daily needs. These are the first words they learn as they serve an important purpose in communication such as requesting and expressing what they want without easily getting frustrated.

The following are ten functional words that are common goals for speech therapy and why they are important:

No can be hard for parents to hear. However, it is one of the most important words to teach your toddler to learn and understand the concept of boundaries. They can also express their preference such as choosing what food to eat without getting frustrated why mommy gave her a cucumber instead of milk!

More indicates a desire for more of something. It can be used to request more food, drink, or anything else that your child may want. An example of how this word can be used is when you are eating and your child needs “more” food.

This word helps toddlers understand the concept of ownership and can be used to request items that they want. It is also a useful word for communicating with others about what belongs to them without whining.

Toddlers like to be carried right? Instead of pulling your clothes to indicate the desire to go up, teaching them to say UP can be used to request . It can also be used to ask for something to be handed to them or to indicate a desire to move something else.

If toddlers want to be carried, they also want to go down, especially when at the park! DOWN indicates an immense desire to go down or to move something down.

When mommy plans to go to the grocery, your toddler might want to go and ride in the car with you! COME is important for communication because it indicates to request someone to come closer, to ask someone to come with you, or indicate a desire for something else to come closer.

READY, SET, GO! GO is important for communication can be used to give directions. It is also a very versatile word to use as a command, an exclamation, and more.

When you tickle your toddler, they may start to squirm and say “Stop!” This is a way of teaching them the concept of personal space and boundaries, as well. It is also a good way to show them that we need to respect the wishes of others.

If the desired toy is out of reach, your child may need assistance to get what they want. They might cry out of frustration or get a chair to reach for it. Yikes, that’s dangerous. That’s why it is important to teach HELP for them to request help when they need help with something when they see someone else who needs help or to ask for help in general.

Please is a magic word. It can help you get what you want from others, including your toddler. It also shows that they are polite and respectful.

These are just a few examples of functional words that are important for early language development. Many other words can be added to this list, but these ten are a good place to start. You can support the development of functional words by teaching them in context and using them frequently in everyday conversation.

Tips on How to Teach Functional Words at Home

Now that we know the common functional words you need to teach your child first and the difference between nouns and verbs in early language development, here are tips on how to apply them at home.

Sing action songs! Songs like “Wheels on the Bus” are a great way to teach your kids new verbs. Not only will they have fun singing along, but they’ll also be learning important language skills. Try incorporating some of these songs into your daily routine and watch your little ones transform into little linguists in no time!

Here are a few other action songs that are sure to get your kids moving and learning:

“The Itsy Bitsy Spider” – This classic nursery rhyme is perfect for teaching your kids about verbs like “crawl” and “climb.”

“Row, Row, Row Your Boat” – This timeless tune is perfect for teaching your kids about rowing and other water-related verbs.

Encourage your child to use verbs vs. nouns to request. For example, if they want a snack, have them use the verb “ask” or “give” instead of just reaching for it. This will help them understand how to use their words in a functional way.

Read books that contain a lot of action words. This will help your child learn new verbs and how to use it in sentences. Books such as “The Cat in the Hat” and “Green Eggs and Ham” are examples of books that can teach your kids some actions. When reading a book, it is important to act out the action songs to help your child understand and learn the new verbs faster.

Use toys that have moving parts to teach verbs. For example, you can use a toy car to teach the verb “drive” or a toy train to teach the verb “chug.”

Take your child for a walk! Not only is this great exercise, but you can also point out all the different things that you see along the way. This is a perfect opportunity to teach your child about verbs such as “walk,” “look,” and “point.”

Encourage your child to use verbs when they are playing. For example, if they are playing with a ball, encourage them to throw or catch the ball. If they are playing with blocks, encourage them to build or knock down the towers. You can also try these activities at home to improve language development at home.

As your child begins to learn verbs with nouns, it is important to continue using both in everyday conversation. By frequently using nouns and verbs, you can help your child develop their language skills and improve their communication. Use descriptive words when talking to your child. For example, instead of saying “the dog is big,” say “the dog is huge” or “the dog is enormous.” This will help your child understand the meaning of the word “huge” better.

If your child is having difficulty acquiring nouns and verbs, a speech therapist for toddlers can help. In speech therapy, we target verbs before nouns as early goals because they are functional words. Functional words are important for better communication. Eventually, a speech therapist will work on developing your child’s vocabulary and teaching them how to use nouns and verbs in sentences. They can also help develop your child’s ability to understand and use two-word phrases.

Some common goals for speech therapy include:

Increasing your child’s understanding of nouns and verbs

Teaching your child new nouns and verbs

Helping your child use nouns and verbs in sentences

Improving your child’s ability to understand two-word phrases

If you think your child would benefit from speech therapy, feel free to contact Better Speech. We would be happy to answer any questions you may have! At Better Speech, we offer online speech therapy services convenient for you and tailored to your child's individual needs. Our services are affordable and effective - get Better Speech now.

About the Author

Mikee Larrazabal

I am a Speech-Language Pathologist with 14 years of experience working with children and adults who have communication difficulties. I completed my Bachelor of Science degree in Health Science at Cebu Doctors' University and have been helping people overcome their communication challenges ever since.

I have worked with individuals of different ages, including toddlers, preschoolers, school-aged children, adults and seniors. I'm passionate about speech therapy and take great satisfaction in helping people overcome their communication challenges and improve their lives through better communication skills. In my spare time I like reading books, going hiking in nature and taking care of my dog Locas.

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Speech Therapy for Toddlers

What is speech therapy.

• Language Development
• Signs of Delay
• Speech Therapy Activities
• A Parent's Role

Frequently Asked Questions

Speech therapy is a treatment led by a speech and language pathologist (SLP) or speech therapist. It helps a person communicate and speak more clearly. Toddlers may develop language or speech impairments due to illness, hearing problems, or brain disorders.

This article covers speech and language milestones, causes of speech disorders, diagnosis, what happens in speech therapy, and how parents can help their toddlers. 

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Speech therapy is a treatment that helps a person speak or communicate more effectively. It is performed by specially trained speech and language pathologists (SLPs) or speech therapists. They help their patients better understand others, pronounce words clearly, or put words together. 

There are different types of speech therapy and their use will depend on the age of the child and what they are experiencing. For example, therapy practices vary for children with apraxia (difficulty pronouncing different syllables), stuttering, aphasia (difficulty speaking due to damage to the brain), and difficulty swallowing, and for late talkers.

Language Development (Newborn to Toddler)

While delay does not always mean there’s a problem, it’s important to recognize when a toddler misses a developmental milestone. The following are general guidelines of speech and language development for babies and toddlers:

Newborns communicate through crying. Their cries may sound the same at first but start to vary as they grow. They also cry to express emotions, and parents begin to understand what different cries mean.

High-Pitched Crying

A high-pitched cry not resolved by comforting or eating may mean that an infant is experiencing discomfort or pain.

Newborns pick up on rhythms of speech and their parents' voices within the first few weeks of life. Between 1 and 4 months old, they become more alert to sounds and may startle more easily or turn to look for the source of the noise. 

Around 2 to 3 months old, infants start smiling and cooing, which often sounds like "ah" or "eh." Babies begin laughing by 3 to 4 months old.  

By 5 or 6 months old, infants imitate adult sounds produced by babbling or shrieking. Babbling involves repeating sounds such as "ba," "ma," or "ga."  

7–12 Months

Seven-month-old infants hear words as distinct sounds and try to repeat them. By 9 months old, they start to understand expressions and simple commands like "no," recognize words for objects, and respond to their names.

Ten- to 12-month-olds follow simple commands such as "give mommy your cup." They also begin to say simple words such as "dada" or "bye-bye."

A Toddler's First Words

Most 1-year-olds can say a few words such as “up” or “dog” but do not put words together in a sentence.

13–18 Months

By 18 months, a toddler puts two words together and says phrases such as "push it." They often communicate in gestures that get more complex over time.

Toddlers this age start recognizing objects, body parts, pictures, or people. For example, if you ask, "Where is your nose?," they will be able to point to it.  

19–24 Months

By 24 months old, toddlers know and say 50 or more words. They start to form two- to three-word sentences. Two-year-olds can usually communicate their needs, such as “I want more milk,” and follow two-step commands.

Speech and Language Developmental Timeline

Children develop at different speeds and may not follow the typical timeline. If you are concerned about the delay, contact your pediatrician or healthcare provider as soon as possible. Early treatment can make a difference.

Signs of Speech or Language Delay in Toddlers

The following are general guidelines to help parents know if they should have their young child evaluated for speech or language problems:

• A baby who does not vocalize or respond to sound
• A 1-year-old who does not use gestures, such as pointing
• An 18-month-old who would rather use gestures than sounds
• An 18-month-old who has difficulty imitating sounds or understanding simple requests
• A 2-year-old who imitates speech but doesn’t talk spontaneously
• A 2-year-old who can say words but not communicate more than their immediate needs or follow simple directions
• A 2-year-old who has a raspy or nasal-sounding voice

Understanding the Words of a Toddler

Parents and regular caregivers usually understand about 50% of a toddler’s speech by 2 years old and 75% by 3 years old.

Speech or language delays can occur due to problems with the structures of the mouth, head injuries, chronic illnesses, or brain disorders.  

If the cause is a brain disorder, it can be difficult to coordinate their tongue, lips, and mouth to make sounds or words. 

Hearing problems can make it difficult to imitate or understand language. This is not always a problem that is apparent at birth. Chronic ear infections can cause hearing damage in one or both ears.

A speech therapist will perform tests with your toddler to check the following:

• What your child understands
• What your child can say 
• Clarity of speech
• How the structures in their mouth work together to form words and eat

The following are diagnostic tests or scales a speech therapist may perform with your toddler:

• Bayley Scales of Infant and Toddler Development (Bayley-III) : Bayley-III is used worldwide to measure all aspects of development from birth to 42 months. A speech therapist administers the language portion by watching the child follow instructions and identify people and objects. It helps them know if the child is on track or needs further evaluation. 
• Preschool Language Scales–Fifth Edition (PLS)-5 English : The PLS-5 is an interactive screening tool designed for infants and young children. Speech therapists measure all areas of language through a play-based approach. 
• Differential Ability Scales Assessment–Second Edition (DAS-II) : The DAS-II provides a scale to help speech therapists better understand how a child processes information. This allows them to develop appropriate activities for therapy.
• Goldman-Fristoe Test of Articulation 3 (GFTA-3) : The GFTA-3 involves asking a child to identify colorful drawings and measures their ability to pronounce consonants.
• The Rossetti Infant-Toddler Language Scales: This test is specifically designed for children from birth to 36 months old. It involves a parent interview, as well as observation of the child performing tasks.

What Happens During Speech Therapy?

The speech therapist will plan and perform activities to help your toddler with skills based on their specific needs. Therapy may occur in small groups or individually. 

Language building activities include using picture books, repetition, talking, and playing. If a toddler has difficulty pronouncing certain words, the therapist will teach them how to make the sound or say specific words. 

Sometimes speech therapists help toddlers with speech mechanics. This involves teaching them how to move their mouth or tongue to pronounce a word. They may also prescribe lip, tongue, or jaw exercises to continue at home.

What Concerns are Addressed During Speech Therapy?

Some of the concerns that SLPs may address during speech therapy include:  

• Speech mechanics
• Word pronunciation
• Volume or quality of speech
• Social communication skills
• Trouble swallowing

How Can Parents Help?

It helps to talk and read to your child frequently. Use correct names and speak in a slow and clear voice. When giving direction, keep things simple. Kneeling to their level can them focus on what you are saying.

If your child points at a glass of water, help them connect the gesture and language by asking, “Do you want water?” When they don’t pronounce words accurately, emphasize the correct pronunciation when responding.

Waiting for a Response

When asking a question such as “Do you want a drink?,” try waiting for a response. This helps your toddler learn to communicate back to you. 

Chronic illnesses, brain disorders, and hearing problems can cause a toddler to have delayed speech or language development. Speech therapy can help them learn to communicate more effectively. 

Parents can help by talking to their children often, speaking clearly, and emphasizing correct pronunciation. If your child is in speech therapy, it’s helpful to perform exercises prescribed by your speech therapist at home.

A Word From Verywell

Not all children follow a typical timeline for speech and language development. Sometimes they are focused on learning a new task, such as walking, and put language development on the back burner. They often catch up later. 

If your toddler is experiencing a language or speech delay, talk with your child’s healthcare provider. If there is a problem, getting help early can make a difference.

A toddler should start speech therapy any time after 3 months old if they experience developmental delays in speech or language. This may seem young, but a speech therapist can monitor the signs if there is a delay. Early intervention can make an impact. 

The estimated national average cost for the United States is $218 per session. However, many insurances and most state Medicaid programs cover speech therapy. It can be helpful to find an in-network clinic to decrease your out-of-pocket expenses. 

Nemours Kids Health. Delayed speech or language development . KidsHealth.org.

Durkin MJ. From Infancy to the Elderly: Communication throughout the Ages. Nova Science Publishers; 2011.

Meadows-Oliver M. Pediatric Nursing Made Incredibly Easy. 3rd Edition. Wolters Kluwer; 2019.

University of Michigan Health. Speech and language milestones, birth to 1 year .

Centers for Disease Control and Prevention. Important milestones: Your baby by nine months .

American Academy of Pediatrics. Language delays in toddlers: Information for parents . Healthychildren.org.

Nemours Kids Health. Communication and your 1-to-2 year old . KidsHealth.org.

NAPA Center. Speech therapy for children: What are the benefits? .

Garro, A. Early Childhood Assessment in School and Clinical Child Psychology . Springer; 2016.

Ross, K. Speech-Language Pathologists in Early Childhood . Plural Publishing; 2015.

DeVeney SL. Clinical challenges: Assessing toddler speech sound productions . Semin Speech Lang. 2019 Mar;40(2):81-93. doi: 10.1055/s-0039-1677759.

NAPA Center. 5 tips to help your toddler’s speech development by a speech therapist .

Wooster Community Hospital. At what age should speech therapy begin? .

MDsave. Speech therapy visit .

American Speech-Language-Hearing Association. Introduction to Medicaid .

By Brandi Jones, MSN-ED RN-BC Jones is a registered nurse and freelance health writer with more than two decades of healthcare experience.

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15 Best Speech Therapy Activities for Toddlers

1. SplashLearn

2. singing songs, 3. animal sounds, 4. name that item, 5. bubble blowing, 6. stacking blocks, 7. puzzle solving, 8. feather blow, 9. hide and seek with objects, 10. matching games.

Is your toddler babbling a storm but not quite forming words yet? There’s a lot you can do to help your toddler develop their speech skills in fun and playful ways. This blog post explores engaging speech therapy activities for toddlers that you can do at home!

SplashLearn: Most Comprehensive Learning Program for PreK-5

SplashLearn inspires lifelong curiosity with its game-based PreK-5 learning program loved by over 40 million children. With over 4,000 fun games and activities, it’s the perfect balance of learning and play for your little one.

If you are looking for some screen time that doubles as speech therapy, SplashLearn is a one of the best speech therapy activities for toddlers online. Tailored for toddlers, SplashLearn uses interactive games , songs , and stories to introduce new vocabulary, practice letter sounds , and build basic grammar skills. Plus, the engaging characters and colorful graphics keep little ones entertained while they learn. It’s a win-win for parents and toddlers!

Objective: Improve language through rhythm and repetition.

Music is one of the most fun speech therapy ideas. Choose simple songs that feature repetitive phrases and easy melodies. Sing along with your toddler, encouraging them to join in. Repetition of these catchy tunes helps reinforce language patterns and boosts memory. 

Objective: Develop vocal skills through playful sound imitation.

Animal sounds are not just fun; they’re educational. This game is a hit in toddler speech therapy games, where mimicking animals’ noises—like a cow’s “moo” or a cat’s “meow”—helps toddlers practice different vocal pitches and sounds. Engage with your child by taking turns to guess the animal.

Objective: Expand vocabulary.

‘Name That Item’ is a straightforward yet powerful speech therapy activity for three-year-olds . Gather various everyday objects and place them in front of your toddler one at a time. Ask them to name each object. This not only builds their vocabulary but also enhances object recognition skills. It’s a simple and effective way to help them connect words with their corresponding objects, fostering cognitive and language development.

Objective: Stimulate motor skills and sound production.

They learn to control their breath as they blow bubbles, which is crucial for speech clarity. Encourage them to pop the bubbles while saying “pop” or asking for “more.” This activity supports motor skills through blowing and popping and introduces new sounds and words, making it a favorite among speech games.

Objective: Foster language through structured play.

Stacking blocks is a dynamic part of speech and language therapy. As you and your toddler build towers or create designs, narrate each action. Say things like, “Now I’m adding a blue block on top!” Encourage your child to make specific requests, such as asking for a certain color or size. This interaction helps them learn to use language to express their needs and desires while they play.

Objective: Enhance spatial reasoning and descriptive language.

Puzzles are a fantastic tool for developing both language and cognitive skills. Sit with your toddler and tackle a simple puzzle together. Discuss each piece, describing its colors and shapes, and discuss where it might fit on the board. This practice improves their spatial reasoning and enriches their descriptive vocabulary, making it one of the best speech therapy games.

Objective: Improve breath control, which is vital for speech production.

Feather blowing is an excellent toddler speech therapy exercise focusing on breath control, an essential aspect of speech clarity. Have your toddler try to blow a feather across a table or the floor, using only their breath. Guide them to take deep breaths and control the exhale. This activity is fun and teaches them how to regulate their breath, which is crucial for speaking clearly and confidently.

Objective: Build prepositional and spatial language.

Turn learning into an adventure with a game of hide-and-seek using your toddler’s favorite toys. Hide objects around the room and describe their locations using prepositions like “under,” “behind,” or “next to.” This 2-year-old speech therapy activity encourages toddlers to understand and use spatial terms, enhancing their grasp of language and environment.

Objective: Develop cognitive and language skills.

Matching games are excellent activities for improving speech and overall cognitive abilities. Use cards with images of common items or various objects. As you play, discuss the attributes of each item, such as their colors, shapes, and sizes. Encouraging your toddler to articulate these features enhances their vocabulary and helps them connect words and meanings.

11. Follow the Leader

Objective: Encourage imitation of actions and sounds.

“Follow the Leader” is a playful and interactive way to develop communication skills. Perform simple actions or make sounds and have your toddler mimic you. This activity makes learning fun and improves their ability to listen and replicate sounds, which is crucial in early speech development.

12. Interactive Storytelling

Objective: Engage multiple senses for comprehensive language learning.

Storytelling is an engaging way to develop language skills. Make it interactive by using different voices for characters, adding facial expressions, and incorporating hand gestures. Ask your toddler to guess what happens next or mimic the characters’ actions or sounds. This immersive approach stimulates their imagination and encourages them to use language in varied and creative ways.

13. Simple Commands

Objective: Practice comprehension and execution of verbal instructions.

Integrating simple commands into daily routines is a straightforward way to enhance your toddler’s understanding and responsiveness. Commands like “Please bring me the ball” or “Can you touch your nose?” help toddlers associate actions with words, fostering comprehension and verbal skills.

14. Rhythm and Rhyme

Objective: Improve phonemic awareness and verbal memory.

Engage your toddler with simple rhyming games or rhythm clapping. These activities are not just entertaining—they are also powerful tools in speech therapy. They help toddlers recognize sound patterns, essential for developing reading and speech abilities. The repetitive nature of rhymes enhances memory, making this a fun and effective learning tool.

15. Mystery Bag

Objective: Enhance sensory vocabulary and descriptive skills.

The “Mystery Bag” is a simple yet effective tool in our toolkit of speech therapy activities for toddlers at home. Fill a soft, opaque bag with various small, safe household items. Have your toddler reach in and pick one item without looking. Encourage them to feel, squeeze, and manipulate the item and describe it using words like “smooth,” “bumpy,” “cool,” or “flexible.” 

5 Benefits of Speech Therapy Activities for Toddlers

Speech therapy activities for toddlers offer numerous benefits that are crucial for early childhood development:

• These activities help toddlers learn new words, improve their pronunciation, and form complete sentences, facilitating better communication at a young age.
• Engaging in speech therapy activities stimulates thinking, problem-solving, and memory. Toddlers learn to follow instructions, identify objects, and match their attributes, which boosts their overall cognitive abilities.
• As toddlers learn to express themselves more clearly, they gain confidence in social settings. Participating in group activities and games enhances their social interaction and turn-taking skills.
• Through interactive and repetitive exercises, toddlers improve their ability to listen carefully and understand spoken instructions and stories, vital skills for academic success.
• Speech therapy activities are designed to be fun and engaging, making learning a positive and enjoyable experience. This encourages toddlers to love learning and participating in educational activities.

Incorporating speech therapy activities into your toddler’s daily routine can significantly enhance their communication and cognitive skills in a fun and engaging way. By fostering these skills early on, you’ll provide your child with a strong foundation for successful learning and interaction in their future years.

Frequently Asked Questions (FAQs)

What are nonverbal communication games for kids.

Nonverbal communication games for kids include activities like charades , where children guess the word or phrase acted out without speaking, and emotion cards, where kids identify and mimic emotions displayed on cards. These games enhance understanding of body language and facial expressions.

How can I help my toddler with speech sounds?

To help your toddler with speech sounds, engage in activities like mimicking animal noises, reading books aloud emphasizing certain sounds, and singing songs that focus on repetitive phonetics. These playful interactions promote accurate articulation and sound recognition.

What are gesture games for speech?

Gesture games for speech involve activities where children use hand movements to communicate ideas or words. Games like “Simon Says” or creating a story using only gestures help children associate actions with words and improve their ability to express themselves without verbal cues.

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Speech Therapy for Toddlers [Games and Printables]

Language delays can happen at any age and they aren’t necessarily a reason for concern, but finding some fun and engaging activities to provide some speech therapy for toddler s at home can never hurt. In this post, I have rounded up 5 fun and engaging printables and activities to promote language skills and new words in toddlers and preschoolers.

Speech-language pathologist will love these ideas too. I’m always looking for new ways to provide language development skills in an organic way while teaching.

Expressive language games

Are you looking for the best way to provide some social skills and receptive language program to your child or a group of students you tutor?

Something as simple as some highly engaging speech therapy materials like the ones below added to an early intervention program can do wonders.

Even if you’re in private practices, these games and ideas can work well on improving language disorders.

Speech disorders are not always noted in the first two or three years of development, however sometimes parents can tell whether their child is lisping, not saying many words for their age or development and more.

Word association game therapy

This game below will prove highly engaging for speech language pathologists and is perfect for a child’s speech development.

Each puzzle piece contains simple words that the child can associate with the other to build the puzzle piece.

Laminate these and use them in therapy sessions or add them to a treatment plan, they can be used over and over again. Articulation disorders can also be targeted through different games and activities, I will link to some below.

There are different ways you can target language skills and word associations.

Speech therapy activities

Young children will love these games listed below. Just choose the ones that suit your group of students and you’re good to go.

Sometimes, children will have trouble understanding the words on each picture cue, just have them repeat it once you read it out to them.

Get this FREE printable game at the end of this post.

These can also be used in small groups or during a speech therapy session.

Add them throughout the school year and in your daily routines to help the kids develop their language skills.

You don’t necessarily need a speech therapy service right away if you’re a parent, try these games listed below as they are very simple and easy to setup and will go a long way with your child if you’re trying to build their speech and language skills.

Signs of speech delay

Sometimes children will show some obvious early communication challenges, for examples they might struggle to acquire simple phrases and stick to simple words, it also depends on the child’s needs and the years of age.

You can even try online speech therapy at first if you feel that your child will benefit from it.

Therapy sessions do not need to be held in person. Online therapy can work wonders and you’ll be saving a lot of time on the commute. It’s a great place to start!

Speech therapy techniques

When you first start a child speech therapy program, you have to incorporate a child’s needs and speech sounds.

If those aren’t targeted yet, buy some books and soon enough the child will have a favorite book and you can add that to their individual education plan to help them along in building speech and language skills.

Speech Therapy Parent hand out for toddlers and preschoolers.

Get these FREE from the Gift of the Gab .

From the author: These free handouts are unlike any other!  Each  parent friendly  page teaches caregivers how to implement a speech therapy strategy at home. These handouts also contain  practical tips  from a real-life SLP-Mom and  guides parents  through implementing each strategy with their  individual child .

Speech Therapy for Toddlers: Common First Words Spoken.

This list is such a great start to when you need some quick reference to what words toddlers should be able to say at this age.

From the author: An easy to read handout to give to parents, grandparents, teachers, and educators listing the most commonly spoken first words. 

Get this list from Scanlon Speech Therapy

Speech Therapy Printable Worksheets for Preschoolers and Toddlers.

From the author: Speech therapy printable worksheets are a fun way to target virtually any goal! These open-ended reinforcers have a winter twist to make speech practice fun for toddlers and preschoolers.

Get these FREE from Eva Lee SLP .

Click the link between the >>> <<<< to get your copy of these super fun printable puzzles.

Before you grab your free pack you agree to the following:

• This set is for personal and classroom use only.
• This printable set may not be sold, hosted, reproduced, or stored on any other website or electronic retrieval system.
• Graphics Purchased and used with permission from
• All material provided on this blog is copyright protected.

More speech therapy resources:

• Social Pragmatic Goals Speech Therapy (Free Printable Goal Sheets)
• 20 Best K Words Speech Therapy Printables and Games
• S Sounds Speech Therapy Feed the Fox Game Printable

>>> Word Associations Speech Therapy Puzzles <<<

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10 Speech Therapy Activities You Can Do at Home With Your Toddler

Believe it or not, your child’s speech development isn’t confined in a speech therapist’s office. In fact, speech therapy activities are best done at home, where your child is comfortable. After all, where else would your child want to be than at home with you?

Even if you don’t have a speech therapist yet, nothing’s stopping you from encouraging your child to talk. Here are some recommended speech activities and routines that you can do together at home.

Speech and Language Activities While Bonding with Your Toddler

1) read books or magazines.

One of the best toddler speech activities goes back to the basics: reading. Reading aloud to your child will help them listen to how you form words and develop their vocabulary. Learning through reading may even lead your child to be an avid lover of books. They might even request their favorite book from time to time.

When they are already able to form words, encourage them to repeat the words from the book after you. This will help strengthen their articulation and literacy over time. Eventually, you can leave out some words and pause so that your toddler has a chance to speak up and fill in those words.

For the reading materials, you don’t even have to limit yourself to books. Some educational and children’s magazines can also be a good source of reading time. Magazines that are full of pictures are great for looking at together. You can also point at the pictures and ask them “What’s that?” to get them to engage.

2) Play With Your Child

Extra perks come with learning through a fun activity. Some of them include motor skill development, enhanced imagination, and better social skills with less pressure to speak up.

Toys are an amazing way to facilitate play. But, steer clear of battery-operated ones when choosing toys. You want your child to make sounds, and having toys that do it for them will not help with their development. This is especially true for those experiencing speech delays. Stick to toys that encourage:

• social interaction and communication
• usage of motor functions
• imagination and creativity

One classic way to play is using flashcards and blocks. Images and colors printed on these materials encourage word association.

You can also have your child group the cards or blocks together by various categories (animal, fruits, etc.). This will introduce the idea of related words. Plus, moving cards and blocks around will improve your child’s motor skills too.

Don’t forget to let your child lead during playtime. You will help them be confident with making choices on what to play with. It will also be easier to start conversations with them when they are having fun with it.

3) Use Hand Gestures and Sign Language

At around 8 to 9 months of age, children should start using gestures. Teaching them gestures or signs won’t cause a language delay, especially when you link them to spoken words. In fact, it is an effective tool for late talkers to start communicating .

You can start with waving and saying ‘hello’ and ‘goodbye’ for simple gestures. You can also create gestures for actions that your child loves doing. For example, you can say “hug” and wrap your arms around you to connect that word with the gesture.

One of the things you can also do to take this further is to teach your child sign language. Focus on words that are easy and functional, like more, help, please, thank you, and even Mom or Dad. Think about which signs would help your child the most.

Signs that are functional to them will encourage your toddler to use them daily. They can start using it to request items they want or need like milk, blanket, or even their favorite toys.

4) Singing and Rhyming

Nursery rhymes and songs can help improve your toddler’s language skills. Singing stimulates a different part of the brain, and the rhythm of songs helps your child remember words better. Some classic nursery rhyme songs you can use include:

• Twinkle Twinkle Little Star
• Row, Row, Row Your Boat
• Old MacDonald Had a Farm
• The Itsy Bitsy Spider
• Mary Had a Little Lamb

Songs accompanied by gestures are also excellent for motor skills. Don’t even worry if you’re not a good singer, what’s important is facilitating this interaction with your toddler.

If they can already sing along with you, leave out some of the words, pause and wait for your child to sing the missing words. It gets even better when they can already sing the entire song on their own.

Day-to-Day Speech-Language Practices

Speech learning needs a parent’s support during learning and playtime. But what about other times around the house with your toddler?

You can incorporate many things in your daily lives that can help your child develop their language skills. Here are a few of them:

5) Speak Slowly and Clearly

You can help improve your child’s speech skills when you practice speaking to them slowly and clearly. With the proper articulation, they will pick up on the right sounds to make from the get-go .

Eye contact also helps with communication. Making a proper facial expression helps too, as children also pick up on this and they will imitate it.

6) Introduce New Sounds and Words

As your toddler grows, so does their ability to learn new words. By gradually introducing them, your child won’t feel overwhelmed in remembering them.

You can do this by pointing or picking up items and saying what they are, like lifting a toy ball and saying “ball”. Pointing to yourself and saying “Mommy”/”Daddy” works too, so they can associate the words with the person.

You can also help them learn new words by adding them to learned ones . For example, adding the new word “big” to the learned word “ball” will help them link the words together. Use two to three variations with the same word (“soft ball”, “green ball”) to build further vocabulary.

7) Tell Them What You’re Doing

Whether it’s cleaning the home or even getting dressed, tell your toddler what you are doing . The most ordinary things to you are absolutely new to a learning child. You can also talk about how something looks, tastes, and feels. This will improve their listening skills as well.

When you describe what you are doing, keep it short . You want to speak in phrases that are as long as they can manage to say. Speak and repeat when necessary. It will take patience, but children learn best with repetition.

8) Turn Off the TV

Prevent slow learning by turning off your TV especially when your toddler is in the room. Much like battery-operated toys, it will not help when your child is not repeating what they hear.

TV doesn’t only affect your child: it can also draw your attention away from them. That means less time for you to communicate and bond with each other.

In a study published on JAMA Pediatrics, each hour of TV exposure with sound resulted in fewer vocalizations in children. The study discouraged Tv viewing for children under 2 years in the conclusion. They instead suggest that parents focus on creating an interactive play environment.

Remember: Children are in their best learning state when they are talking to real people at home.

9) Teach Them to Ask For Things

Your toddler most likely wants a lot of things. Whether it’s food or toys, start teaching them to ask for it by letting you know what they want.

One of the ways to get your child to start communicating is to put things out of reach. Place their toys on a shelf or food on an unreachable counter. This will prompt them to call for your help.

Remember to reinforce and enhance the interaction when they do ask for something. If they ask for a banana by pointing, you can confirm “Do you want the yellow banana?” and introduce “want”, “yellow” and “banana” into his vocabulary.

There will be times that your toddler is unsure of what they want, or is having a hard time using words to describe what they want. In cases like this, you can help them with the process by giving them a choice (“Do you want a red apple or a yellow banana?). That way, you make it easier for them to think of words especially when they can imitate what you just said.

10) Repeat and Expand

Earlier we discussed how to introduce new words by linking them with already learned ones. You can also use a similar method to help with new words, which is repeating and expanding.

Repetition is crucial to language learning. Repeat what your child says, and expand on the topic. For example, if your child says, “Dog run!” you can reply with “Yes, the dog is running. He is running very fast.”

Try to keep the expansion sentences as correctly as possible. Like we said earlier, it’s important to speak clearly for your child to learn the words right from the get-go.

What if your child is using baby words? There’s no harm in starting with baby words but you should expand on what they are saying and say the correct word. If your toddler says “ba-ba” while pointing at their bottle, you can repeat (“Do you want ba-ba? Yes, here’s your bottle.)

Nowadays, speech-language pathologists can also be accessible online at home. If you’d like to learn more about how online speech therapy can help your family at home, get a consultation from us. No commitments, no contracts!

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Should I be concerned that my 2-year-old doesn't say many words and is hard to understand?

Talk to your child's health care provider if you can understand only a few or none of your 2-year-old's words. A delay using words or talking can be an early sign of other issues. Your toddler's provider can refer you to health professionals who test children for these issues.

Every child grows and develops at their own pace. But toddler speech development tends to follow a fairly set path. For example, by age 2, most children can:

• Use simple two-word phrases, such as "more milk."
• Ask one- or two-word questions, such as "Go bye-bye?"
• Follow simple commands and understand simple questions.
• Speak about 50 to 100 words.
• Be understood at least half the time by adults who don't know the child.

Between the ages of 2 and 3, most children:

• Speak in two- and three-word phrases or sentences.
• Use at least 200 words and as many as 1,000 words.
• Ask questions that start with who, what, where or why, such as "Where is mommy?"
• Say their first name when asked.
• Refer to themselves with pronouns, such as I, me, my or mine.
• Can be understood most of the time by familiar listeners, such as family members.

If your child might have a condition that causes a speech delay, your child's health care provider may suggest that you see a hearing or speech professional.

For example, hearing problems are checked by an audiologist. A speech-language pathologist checks for communication problems. If your child hears or speaks two languages, see a bilingual speech-language pathologist so your child can get tested in both languages.

In the United States, you can get your child tested through a government-funded early intervention program. This offers services and support to children with delays in development or disabilities. Each state and territory has an early intervention program, and some programs include speech therapy.

The way speech delay is treated in toddlers depends on the cause. When treated early, these delays and the problems that can cause them often get better over time.

Jay L. Hoecker, M.D.

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• Kliegman RM, et al. Language development and communication disorders. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Jan. 24, 2023.
• One to two years: What should my child be able to do? American Speech-Language-Hearing Association. http://www.asha.org/public/speech/development/12.htm. Accessed Jan. 24, 2023.
• Speech and language concerns. Pediatric Care Online. https://publications.aap.org/pediatriccare. Accessed Jan. 24, 2023.
• Is your toddler communicating with you? Pediatric Patient Education. https://publications.aap.org/patiented. Accessed Jan. 24, 2023.
• Kliegman RM, et al. The second year. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Jan. 24, 2023.
• Hoecker JL (expert opinion). Mayo Clinic. Feb. 22, 2019.
• Important milestones: Your child by three years. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-3yr.html. Accessed Jan. 24, 2023.
• What is early intervention? Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/parents/states.html. Accessed Jan. 27, 2023.
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27 Nov Speech Therapy for Younger Children

Speech therapy for younger children, apraxia: speech therapy and treatment for toddlers and young children.

Original article written by Sharon Gretz, M.Ed.

Revised and updated by Megan Overby, PhD, CCC-SLP (Note: Members of the Apraxia Kids Professional Advisory Council have reviewed this article.)

Introduction

There are questions whether children under age 3 should be given the diagnosis of apraxia of speech. If a diagnosis is made (or suspected), the issue of how to treat such a young child arises, especially because many children who later receive a confirmatory diagnosis of CAS will have additional speech and language therapy goals in addition to those targeting speech production. The purpose of this article is twofold: to review current recommendations for initial diagnostic procedures when identifying young children who may have CAS and to briefly discuss some speech therapy techniques that may benefit the speech production and expressive language skills of young children suspected to have CAS.

Diagnostic Indicators

Much work needs to be done in characterizing the early speech sound development of infants and toddlers later diagnosed with CAS, but studies (Highman, Hennessey, Leitao, & Piek; 2013; Highman, Hennessey, Sherwood, & Leitao, 2008; Overby & Caspari, 2015; Overby, Caspari, Schrieber, in review) offer some preliminary diagnostic indicators for children aged two and younger.

Not all infants and toddlers later diagnosed with CAS will present with these possible indicators, nor is it known how many of these possible indicators, or which ones, are most concerning. Nevertheless, at age 2 and younger, a risk of CAS may be associated with:

• Few consonant and vowel sounds so that the child seems less vocal and more quiet than typically developing infants and toddlers
• No recognizable consonant by 12 months of age
• Lack of canonical babbling onset between 7 – 12 months of age
• Three or fewer recognizable consonants by 16 months of age
• Five or fewer recognizable consonants by 24 months of age
• Lack of “back” sounds (such /k/ and /g/) and favoritism of sounds that are anterior (bilabials and alveolars, such as /m/ and /d/) by 24 months of age
• Favoritism of stops and nasals over a diverse manner, with possible absence of fricatives or glides by 24 months of age
• Dependency on vowels at 13 – 18 months with little use of consonant-vowel syllable shapes

All young children are highly variable in their speech sound development. Therefore, the diagnosis of CAS in a child who is younger than three, or who has little expressive ability, should be made only by a speech-language pathologist with specific experience in assessing the speech sound skills of young children.

Other descriptive speech sound characteristics of CAS in infants and toddlers later diagnosed with the disorder have been suggested (Davis & Velleman, 2000, p. 182; Fish, 2016), including:

• The child may have acquired some later developing sounds while be missing earlier developing sounds.
• Limited variation of vowels and the use of a centralized vowel in a multipurpose way.
• Vocalizations may have speech-like melody but syllables or discernable words may not be present.
• Words may seem to disappear from use more than would be expected for a typically developing child of the same age.
• Predictable utterances may be easier than novel utterances

Nonspeech characteristics that could also indicate apraxia of speech in the young child include: homemade gestures or signs, some feeding difficulties such as eating mixed textures, drooling, late development of motor skills overall, and oral motor incoordination.

If there is uncertainty about a diagnosis of CAS in a very young child, active monitoring of the child’s speech sound development over the course of a few months may yield additional information. However, because the trajectory of speech sound development in children with CAS appears to be much slower than that of children with typical development or with other types of speech sound disorders (Overby & Caspari, 2015; Overby, Caspari, & Schrieber, in review), early intervention for children with suspected CAS is important.

As children mature, they are better able to participate in assessment of their speech sound skill. More information about the child’s speech sound capabilities can be obtained when the child can attempt to imitate utterances varying in length and/or phonetic complexity (such as imitating /i/, then /mi/, then /mit/ or /o/, then /no/ then /nop/) (Strand, 2003). Strand (p. 77) offers five potential diagnostic characteristics of apraxia in young children who are able to make such imitative attempts:

• Difficulty in achieving and maintaining articulatory configurations
• Presence of vowel distortions
• Limited consonant and vowel repertoire
• Use of simple syllable shapes
• Difficulty completing a movement gesture for a phoneme easily produced in a simple context but not in a longer one

Speech Therapy and the Two-Year Old with Possible Apraxia

There is little literature about treatment in very young children with apraxia of speech and no studies have compared the effectiveness of treatment approaches in this population. Nevertheless, for children who are two years old and under, but are considered high-risk for CAS because, for example, they have no consonants and are not babbling, treatment should not be delayed. Although therapy should always be individualized to each child, some experts (Fish, 2016; Velleman, 2003) suggest intervention for very young children could include:

• Large motor movements (such as clapping)
• Actions with objects (banging two blocks together)
• Imitating vocal play (e.g., raspberries, squeals)
• Imitating oral-facial movements (e.g., licking lips, blowing kisses)
• Vocalizing visible early sounds such as /m/, /b/, or /d/ (e.g., /mmmm/, “muh” or “buh”)
• Vocalizing to get attention (e.g., “uh” and pointing to a cookie)
• Sound effects: animal noises (e.g., “grr”, vehicle sounds)

As children gain the ability to say a sound or sounds, therapy can focus on simple words such as:

• Words with distinctive pitch patterns (e.g., “uh-oh,” “wow,” “whee,” “yay”)
• Words with strong emotional meaning
• Words or vocalizations that can be paired with actions (e.g., “whee”, “hi,” “oops”)
• Sound effect words (e.g., “woof’, “beep,” etc.)
• Verbal routines (e.g., songs, rhymes, favorite predictable books)
• Speech or singing in unison with others
• Words with very early consonants (e.g., [h], glides) and simple syllable shapes (e.g., “hi,” “uh-oh,” “wow,” “whee,” “yay,” “me”)

Regardless of how many sounds the infant/toddler has, speech therapy should include:

• Support to the family
• Use of props such as puppets, stuffed animals, etc.
• Use sounds already in child’s repertoire to build simple productions (e.g., if a child has /m/, can he learn to say “ma,” “me,” or even “muh” as an approximation of “more”)
• Maximizing the child’s gaze to the speaker’s mouth by putting toys or objects of interest near the speaker’s mouth during imitation tasks

In summary, two primary treatment goals for young infants and toddlers with suspected apraxia of speech are, according to Davis and Velleman (2000, p. 184):

• It is important that the child and his communication partner(s) agree what a gesture, sound, picture, or word approximation represents or means.
• The child needs to develop and consistently use oral communication. Using alternative communication such as sign language, gestures, or computer-based icon programs can be very helpful in moving a young child toward oral communication by relieving frustration and establishing a consistent, reliable means of communication (Fish, 2016). Efforts should be made to develop the child’s ability to use oral sounds to communicate, using the goals suggested above, as soon as the child is capable of doing so.

Speech Therapy and the Older Toddler with Possible Apraxia

Once a child has consistently begun to use vocalization to communicate, it is more important for a child to use sounds and to work towards expanding his sound and syllable repertoire than to be accurate in producing them. Experts (Davis & Velleman, 2000; Fish, 2016; Overby, Caspari, & Schreiber, in review) suggest therapy goals for a child with the ability to vocalize should focus on:

• Expansion of sounds
• Expansion of syllable structures

Suggestions for expansion of sounds are:

• To acquire a diverse set of consonant and vowel sounds. This means the child should be able to say sounds produced in different parts of the mouth. Acquiring sounds in the posterior part of the mouth can be difficult and may require a lot of effort by the child and the clinician.
• Producing sounds with varied pitch and loudness levels

Suggestions for expanding structures:

• Focusing on syllables rather than individual phonemes
• Reduplicated CV.CV (“bye-bye” or “no-no”)
• Vowel harmonized CV.CV (“TV”) or consonant harmonized (“mommy”)
• Variegated CV.CV (“bunny”)
• Harmonized CVC (“pop”)
• Variegated CVC (“top”)
• Harmonized CVCVC (“pop up”)
• Non-harmonized CVCVC (“peanut”)
• Words containing clusters
• Goals should target EITHER new structure or a new sound, not both at the same time
• Syllables should represent, when possible, a variety of nouns, verbs, adjectives, and other meaningful productions

Working at any one level of syllable shape does not mean drilling the same word over and over. The idea is to help the child learn new motor movements by building on current skills. So, for example, one could first work on the same syllable repeated, (e.g., “ma ma ma ma”). Next, introduce one change at the end of the repeated syllables, e.g., “ma ma ma moo” or “moo moo moo do”. Alternating the syllables takes the activity one step further, i.e., “ma, moo, ma, moo” or “moo, do, moo, do, moo.” As competence is built with these activities, practice with syllables moves further so that the child produces varied syllables/sounds: “ma, moo, may, my, mow”. In young children, the approach will need to be fun, silly, and engaging in order to elicit the child’s attention, involvement, and effort.

Speech Movement Goals and Training

Goals, such as those described above, are only one component of the speech therapy program for CAS. A speech therapy program must address the underlying nature of the problem of apraxia – which is the ability to plan accurate, well timed speech movements from sound to sound, and syllable to syllable, in order to produce old and new words. Clinicians need to provide therapy opportunities that allow young children to build flexibility into their motor systems.

In clinical practice, it is suggested that speech-language pathologists incorporate principles of motor learning: the need for many repetitions and practice, distributed vs. massed practice opportunities, appropriate use of feedback to the child to enhance motor learning, etc. (Maas, Robin, Hula, Freedman, Wulf, Ballard, & Schmidt, 2008). Even toddlers can be involved in therapy opportunities maximizing conditions for motor learning but adapted to their needs as very young children (Davis & Velleman, 2000; Strand & Skinder, 1999;).

Davis and Velleman (2000, p. 187) offer ideas for gaining multiple repetitions from toddlers:

• Use of counting books but instead of counting the objects on a page, simply point to the object and repeat its “name” each time it appears on the page. For example, a counting book of animals has 4 dogs on the page for the number 4. Instead of counting “1, 2, 3, 4”, you can guide the child to point to each dog and say “pup, pup, pup, pup” or if the child is more skilled, “doggie, doggie, doggie, doggie”.
• While playing “house” and setting the table, each time a cup is put down saying “cup, cup, cup”.
• Pretending to eat: “yum, yum, yum”

Functional vocabulary books are another way to elicit practice from the child and can also incorporate parents or other communication partners. According to Hammer (Apraxia Kids website), the vocabulary book should consist of photos or pictures of meaningful people, toys, and objects in the child’s life as well as words that contain initially targeted sound sequences. This book often serves as a child’s first success at expansion of functional communication interactions with significant others.

Fish (2016) also provides a list of activities to elicit repetitive practice that can be motivating and fun. A few activities include:

• “ Hop to it” where the child hops to the target, saying the target with each hop
• “Paper chain” in which the child repeats the target word or phrase written on strip of paper, and then glues or staples the paper together to form a link in a paper chain
• “Feely box” where there are small objects (with the target sound in the name) inside a closed box with hole large enough for the child’s hand, and the child tries to find the object

Providing Motivation/Keeping the Child’s Attention

Play presents many opportunities for these repetitive sequences and parents and therapists can be creative in this way. The idea is to help the child into practice by making their therapy experience not just fun but also successful for them. Even very young children with apraxia have gained the understanding that speech is difficult for them and so may avoid or resist expressing themselves with oral communication. An astute, engaging clinician can use low-pressure opportunities and engaging play to help children with apraxia take risks with their speech attempts (Hammer, 2003).

Experts (Fish, 2016; Strand & Skinder, 1999) offer the following ideas for providing motivation and keeping attention of young children with apraxia:

• Ideally, incorporate movement into treatment, or at least after 10-20 practice trials (rocking, bouncing, marching, swinging arms, etc.)
• Change inflection (stress on different words, low pitch, high pitch, exaggerate the target word or phrase)
• Use various dolls, puppets, animals that the child can speak for; change the selection after a number of practice trials
• Incorporate music into treatment (make up tunes or use familiar ones to practice a word)

Remember that while clinicians must make therapy fun and engaging, it is not sufficient to be able to say the child enjoyed the therapy session or that the session went well because the child cooperated. That alone will not effectively provide what the child needs, which is the opportunity for a high number of repetitions of speech targets and the clinician’s thoughtful feedback about performance and results. If the child isn’t saying much in the therapy session, the clinician is not going to be able to achieve this goal (Strand & Skinder, 1999).

Other “take home” points about speech therapy for toddlers with suspected apraxia of speech include:

• Children with apraxia may not follow the typical “developmental” sequence for acquiring new sounds (Davis & Velleman, 2000; Hammer, 2003; Overby et al., in review)
• Children with apraxia of speech need some early success with speech. They need to know it is worth it to trust and cooperate with the clinician (Hammer, 2003).
• Children with apraxia seem to have periods where sometimes they seem to ‘plateau’ and show little growth (Davis & Velleman, 2000; Overby et al., in review)
• Play is the medium for these young children to learn speech movement training (Hammer, 2003).
• Parents need help and direct mentoring to understand their role and how they can effectively practice with the young child at home (Hammer & Stoeckel, 2001).
• Break up sessions into several activities that have repetitive practice vs. one long activity (Davis & Velleman, 2000; Strand & Skinder 1999).
• Just as with older children with apraxia, younger children need feedback about their performance such as knowledge of results (did they get the word right?) and more specific knowledge about performance (for example, “you need your lips out for that”) (Davis & Velleman, 2000; Hammer, 2003; Strand & Skinder 1999).

Parents as Collaborators

At the outset, clinicians need to involve parents in therapy opportunities for children with apraxia, to the greatest extent they are able and willing. Parents can share essential information from the home and community environments and are important informants on the likes, dislikes, and personality characteristics of their children. Additionally, because many repetitions of speech movement patterns are necessary for motor learning to occur, parents are valuable speech practice partners for their children in their everyday life experiences together (Stoeckel, 2001).

Hammer and Stoeckel (2001) listed the following responsibilities for the speech-language pathologist in working with parents of children with apraxia of speech:

• Educate parents re: CAS and intervention
• Educate parents re: networking/support availability
• Teach child needed skills in a flexible, productive manner
• Assure high expectations from the child
• Be able to explain goals and changes in therapy strategies
• Assure periodic observations either on-line or via videotape
• Work with parents to motivate and reinforce child’s learning

Setting Expectations: Children as Risk-takers

In typically developing children, early sound play and communication attempts bring a great deal of fun and excitement, but by the time a young child with suspected apraxia of speech arrives in speech therapy treatment, he or she may already have experienced a great deal of failure in efforts to communicate orally. Additionally, families may also feel somewhat like failures in helping their child to communicate (Hammer, 2003). Clinicians can help by creating carefully planned small steps toward success in the earliest phase of therapy. Additionally, it is important for clinicians to set early expectations around communication exchanges. Sometimes children with CAS must be encouraged to take “risks” in talking.

Children with apraxia of speech need to feel as if they can trust in the therapeutic process and have success. Reasonable expectations for oral communication, based on the capability of the child’s speech motor system, need to be implemented and reinforced so that the child uses and practices what he/she can produce (Hayden, 2002).

Apraxia or Something Else?

Once a period of therapy has commenced and the speech-language pathologist has experience working with a child, she can better determine if the primary difficulty lies in speech motor planning and programming. According to McCauley (2002), if a child does not respond well to treatments in which the goal is to teach phonologic patterns (e.g., the Cycles Approach or minimal pairs) or to traditional articulation training, the clinician should consider whether there are possible motor factors in speech learning.

Even if a child does not receive an apraxia diagnosis, the therapy recommendations outlined above may be useful in the child’s treatment plan. A speech-language pathologist experienced in the differential diagnosis of CAS from other disorders can be of assistance to families seeking diagnostic information about their child.

In summary, while it is difficult to diagnose children with apraxia of speech at very young ages, there are some emerging possible diagnostic indicators that, with additional research, may facilitate the diagnostic process. Furthermore, even without a clear diagnosis, it is still possible to provide speech therapy to young children who are at-risk for a motor-planning component to their speech production difficulties. Attention to increasing overall communication and oral communication, expanding sounds and syllable shapes, gaining multiple repetitions of syllables and words for speech movement practice, focusing on functional communication, and encouraging parent involvement are key treatment considerations for young children suspected to have apraxia of speech.

Davis, B., & Velleman, SL. (2000). Differential diagnosis and treatment of developmental apraxia of speech in infants and toddlers. The Transdisciplinary Journal , 10(3), 177 – 192.

Fish, M. (2016). Here’s how to treat childhood apraxia of speech (2 nd ed). San Diego, CA: Plural Publishing.

Hammer, D. (2003). Apraxia of speech in young children. Presented at the Childhood Apraxia of Speech Association/Hendrix Foundation workshop. Houston, Texas.

Hammer, D. Brief thoughts about therapy. Apraxia-Kids website. https://www.apraxia-kids.org/slps/hammer.html

Hayden, D. (2002). How do we help children with apraxia become ‘risk-takers’ with their speech and communication? The Apraxia-Kids Monthly , 3(10) .

Hammer, D., & Stoeckel, R. (2001). Teaching and talking together: Building a treatment team. Presentation at the annual convention of the American Speech Language Hearing Association, New Orleans, Louisiana.

Highman, C., Hennessey, N., Leitao, S., & Piek, J. (2013). Early development in infants at risk of childhood apraxia of speech: A longitudinal investigation. Developmental Neuropsychology , 38(3) , 197–210.

Highman, C., Hennessey, N., Sherwood, M., & Leitao, S. (2008). Retrospective parent report of early vocal behaviors in children with suspected Childhood Apraxia of Speech (CAS). Child Language Teaching and Therapy , 24(3) , 285–306.

Maas, E., Robin, D., Hula, S., Freedman, S., Wulf, G., Ballard, K., & Schmidt, R. (2008). Principles of motor learning in treatment of motor speech disorders, American Journal of Speech-Language Pathology , 17 , 277-198.

McCauley, R. (2002). What if a child isn’t formally diagnosed with Childhood Apraxia of Speech (CAS), but appears to be having motor planning difficulties similar to children who are? The Apraxia-Kids Monthly , 3(7) .

Overby, M. & Caspari, S. (2015). Volubility, consonant, and syllable characteristics in infants and toddlers later diagnosed with childhood apraxia of speech: A pilot study. Journal of Communication Disorders , 55 , 1654-1669.

Overby, M., Caspari, S., & Schreiber, J. (in review). Volubility, consonant emergence, and syllabic structure in infants and toddlers later diagnosed with CAS, SSD, and typical development: A retrospective video analysis. Journal of Speech, Language, and Hearing Research.

Stoeckel, R. (2001). Why is it important for parents of children with Childhood Apraxia of Speech (CAS) to be involved in their child’s speech therapy? Apraxia-Kids Monthly , 2(9) .

Strand, EA. (2003). Childhood apraxia of speech: suggested diagnostic markers for the young child. In Shriberg, LD and Campbell, TF (Eds), Proceedings of the 2002 childhood apraxia of speech research symposium . Carlsbad, CA: Hendrix Foundation.

Strand, EA, and Skinder, A. (1999). Treatment of developmental apraxia of speech: integral stimulation methods. In Caruso, AJ and Strand, EA (Eds.), Clinical management of motor speech disorders in children . New York: Thieme.

Velleman, SL. (2003). Childhood apraxia of speech resource guide . Clifton Park, New York: Delmar Learning.

Reviewed 11-5-19

Practicing Speech Sounds, Syllables, or Words Multiple Times with Preschoolers

We believe in making speech practice fun and play-like whenever possible. One way to do this is to think about what types of activities your child enjoys and how to incorporate speech practice into those activities. This encourages your child to be emotionally invested in the practice and more “in control”. You’ll get better cooperation this way and find practicing a lot less stressful. Below are some examples of different activities for speech practice. Keep practice sessions short and fun when possible. As much as possible, do what fits into your lifestyle and daily schedule. Let siblings and friends participate in the activities with everyone practicing the speech targets. You don’t have to use the practice sheet the therapist gave you. Write the words on 3 x 5 cards and have your child draw a picture on each (they don’t have to be great), or you do this. Then use these in fun activities or games during the day.

Get on the Move: Use Movement Activities to Encourage Speech Practice.

• For example, write or draw pictures of the speech sounds, syllables or words on 3 x 5 cards. Scatter these around a room or outside. Have your child run or hop or skip to a card (let your child pick what type of physical movement he/she wants to do to go get the cards). The child says the word on the card three times, then runs, hops or skips back to you. He/she says the word three more times, then can put the card into a basket or small paper bag. Do this for all the cards.
• Do the same in a hide-and-seek activity. “Hide” the cards and let your child search for one at a time. When he finds one, he says the word three times, then brings it back to home base (you). He tells you the word three times, then goes to find another card. Play again, but this time let him hide the cards and you search for them. When you bring a card back to him you both must say the word three times.
• Throw or bounce a ball back and forth, practicing a word each time before the ball is thrown. Do the same for throwing a basketball through the hoop.
• Go to the playground or park. Push your child several times on a swing, catch the swing, have your child say a word three times, then resume pushing. Play on the slide. When your child is sitting at the top of the slide put your arm across the top of the slide in front of him to make a barrier and say “stop”. Have him say a practice word after you three times. Lift your arm and cheerfully say “go” and let him slide down.
• Play “Red Light-Green Light”. This is a fun game to play with several children. The children line up across the lawn from you. The object is to be the first one to arrive at the base (you) without getting caught. You turn your back and say “green light,” at which time the children can take big steps toward you. When you say “red light” they must stop moving completely before you turn around. Anyone caught moving has to go back to the starting line. Each person must say a speech practice word before you can turn around to say “green light” to resume the game.
• Make an obstacle course with a word card in front of each obstacle. For example: have a large cardboard box laying on its side that is open on both ends that the child can climb through, a pillow she can roll over, a chair she can crawl under, a wrapping paper roll she can jump over, etc. She has to say the word on the card before attempting each obstacle. This is great for motor planning also.
• Write a movement activity on each card below the practice word. Put all the cards in a paper bag. The child reaches in and pulls one out, says the word several times, then performs the activity (e.g., “say your practice word 2 times, then turn in a circle 2 times). You take a turn too.

Use Pretend Play Activities to Encourage Speech Practice.

• Do you have left over party bags or boxes? Hide a practice card in each one and play birthday party. Use a dialogue thats appropriate for a pretend party. Make a cake out of playdoh, letting your child practice a word in order to put a candle on the cake. Then let him/her open one present at a time. He says the practice word 3 times to put it in his present pile.
• Set up a play scenarios such as, Lets pretend Barbie is going to the beach. Lets pack a suitcase for her. (This can be a small suitcase or a shoe box). Get out a bunch of Barbie clothes and equipment. The game goes this way. Each person gets a turn – on your turn you pick a speech word, say it 3 times, then you get to put something in the suitcase. Each player does this multiple times. You can use 2 suitcases and see what the other one packs. You can make this funny, I think Barbie would want to swim in this long ball gown, so Im going to pack that.

Use Board Games or Building with Blocks to Encourage Speech Practice.

• Play Hi-Ho Cherry-O, Shoots and Ladders, Bingo, any child board game. Each player picks a speech card or points to a speech word on the practice sheet, says the word, then gets to roll the dice, pick a game card, do the spinner, etc.
• Blocks, Legos and Duplos are great for this – you take turns saying words to get to add another piece onto the structure. You can also do this with puzzles.

Preacademics

• Buy a book with simple coloring and preschool activities. These are available at Wal-Mart, K-Mart, or the grocery store. Let your child pick a picture in the book. When she says a word 3 times she can color one part of the picture. Then you take a turn to say a speech word and color a section of the picture. Take turns until the picture is completed. Hang proudly on the refrigerator. This is fun to do with dot-to-dot pages also.
• Make an alphabet book. Write an alphabet letter at the top of each page of a spiral notebook. Add pictures (clip art, cut from magazines, hand drawn) with a written word under each for each speech practice word. This is cumulative – you keep adding new words to the book each week. This is a great way to review speech words and build literacy early skills.

Use the Computer

• Help your child type a speech practice sound, syllable, or word on the computer using a fun, large font. Have her say the word 3 times, then copy and paste it on the computer. She can do this multiple times, saying the word each time its pasted. Print this out and mail it to Grandma. You can use different fonts, different colors, or print it on colored paper to add interest.
• Use a clip art program to print multiple copies of a picture of a target word on a page. Each time he pastes a picture on the page he has to say the word 3 times.

Make a Photo Album

• Use a small photo album that holds single pictures on each page. Take pictures that represent speech targets, using the child in as many of the pictures as possible. Write the target sound, syllable, word, or phrase on a file folder label and put it on the bottom of each picture. That way everyone who looks at the book with the child will know what word to practice. This also encourages early literacy skills. For syllables you could have pictures to represent mo for more, wa for want, ba for ball. For reduplicated syllables have a picture of 2 balls for ba-ba, people (mama, dada, nana), or animals (moo-moo, woof-woof, neigh-neigh). If child is practicing initial /b/ words for example, take a picture of a big ball with a friend whos a boythere you have words such as big, ball, boy, and bye. Our children love looking through their picture books and showing them to friends and family. This is a great way to build a core vocabulary and to practice repeatedly on words that are important to your child such as his name, his friends names, or his favorite activities, toys and foods.

Make it Predictable: some children like to know their practice schedule and how long they will spend practicing.

• Set up a routine practice time each day. Draw boxes on a piece of paper, one for each word the child will practice. Tell him the rules”I’ll put a star in a box each time you practice one of your words. When you have 3 stars in a box, well color that box. When all the boxes are colored, we’re finished!”

Reward System: Set up a reward system. All of us enjoy a reward for a job well done.

• Use the box system above, but now draw a happy face when your child has finished practicing his words for the day. When he has 5 to 7 happy faces he can pick a prize from a special toy box. Have a variety of small prizestoys from McDonalds, a matchbox car, a coupon for lunch out, a piece of Barbie clothes, a coupon for a trip to the park or library, sunglasses, toy jewelry, crafts activities, stickers, markers, etc., etc. One child I worked with loved tools so I bought a set of toy tools and tool belt for the toy box. Every time he earned a trip to the toy box he could pick any one of the tools he wanted. He became excited about practicing his “speech homework” because he was working toward something meaningful and fun for him.
• This system works well when your time for practicing is limited or your child is reluctant to practice.

Practice in New Places: you can practice anywhere.

• The car is a great place to practice. Put the speech words on 3 x 5 cards, punch a hole in one corner of each card and put them a special key ring for your child. Every time you stop at a red light see if you and your child can say one of the words 3 times before the light changes. Make it into a game called “Beat the Light.”
• Mealtime is a great way to incorporate the whole family into practice. Have your child “hide” a card under napkins as you set the table. She has to say the word 3 times to hide the card. When everyone sits down to eat, each person lifts their napkin to find a card. Your child tells them what the word is and they must repeat it after her one to 3 times before they can eat dinner.
• Put practice cards on doorways around the house. To go through the doorway each person must say the “magic” word 3 times.

Truly respect that speech is difficult for him, but that you have faith in his abilities. Let him know you will help him through any difficulties. For example, tell him you will write down any “hard” words to give to the therapist to come up with special tricks to make them easier. Always praise your child for attempting speech targets, even when he wasn’t fully correct. You can tell him “good try,” “I like the way you were watching me,” or “Wow, you got really close that time.” Then model (say) the word again using helpers such as touch cues and have him try again.

Just remember that if we make practicing fun, playful and rewarding both you and your child will enjoy it.

(Robin Strode, M.A., CCC-SLP, has been a practicing speech-language pathologist for 28 years, currently specializing in serving preschool children with a large variety of special needs. She and her partner, Catherine Chamberlain, have presented numerous workshops throughout the United States on the topics of Developmental Verbal Apraxia and Oral-Motor Facilitation of Speech Skills. They also serve as consultants to speech-language pathologists, teachers, schools, and families. She and Ms. Chamberlain have written seven joint publications for LinguiSystems, including three best sellers: Easy Does It for Apraxia and Motor Planning, Easy Does It for Apraxia: Preschool, and Easy Does It for Articulation: An Oral-Motor Approach. Additionally, Ms. Strode is a member of the Childhood Apraxia of Speech Association’s Professional Advisory Board.)

© Apraxia-KIDS℠ – A program of The Childhood Apraxia of Speech Association (Apraxia Kids) www.apraxia-kids.org

A Dozen Tips for Supporting Early Speech Development in Children with Severe CAS

(Note: Apraxia-KIDS thanks the author and Pediastaff , where this article originally appeared, for permission to reprint.)

Young children with suspected childhood apraxia of speech (CAS) and children with very severe CAS present unique challenges to speech-language pathologists. When children begin to develop some volitional control over the production of syllables, the speech-language pathologist can help to shape increasingly complex speech movement sequences and support the child’s acquisition of a complete phonemic repertoire. For children who do not imitate speech reliably, however, other treatment strategies need to be utilized. Following are several strategies to support the development of more reliable volitional imitation and early speech in children who are nonverbal or minimally verbal.

Support Attainment of the Precursors of Motor Learning

The lack of speech imitation in children past the age of two years creates a great deal of anxiety for parents and caregivers. We as SLPs want to see those first words emerge, too; however, when children have not developed precursors to motor learning (Strand & Skinder, 1999), including (a) trust and motivation; (b) focused attention and effort; (c) an understanding that the goal of treatment is the practice of movement, and (d) an understanding of the tasks at hand, our efforts to elicit speech imitation may be futile. This does not mean that children need to be able to sit quietly and attentively in a chair for a period of several minutes before attempts to elicit speech are introduced. It does mean that the SLP needs to be sensitive to where the child is developmentally, and work to support the child’s focus, attention, direction following, simple imitation, and motivation to try challenging things. Speech therapy becomes much more productive if time is taken earlier on and throughout the treatment process to facilitate these precursors to motor learning.

Reinforce Vocalizations and Oral Movements

Before children begin to imitate vocalizations, they vocalize by cooing and babbling. It is important to provide positive reinforcement for children’s vocal productions, even when these productions are not volitional or imitative. Telling a child, “I love all those lip sounds you’re making!” may lead to an increase in babbling, and these sounds gradually can be shaped into volitionally produced, meaningful words.

Attach Meaning to Vocalizations

When we attach a meaning to a child’s sound productions, we help the child learn that their verbal behavior elicits certain responses. The child who says, “ma,” in the context of playing with a ball may be babbling, or may be trying to say, “ball” or “more.” By treating the vocalization as a meaningful word, the therapist links the child’s speech with a favorable response of receiving a desired toy. We can respond to the child’s production by enthusiastically saying, “Oh, you want the ball . Here you go!” thereby increasing the likelihood that the child will produce the same utterance again in hope of a similar response. Teaching parents and caregivers to begin to recognize their child’s sounds as meaningful is equally important to the therapy process.

Talk About Speech Movements

Children need to understand that the purpose of their therapy visits is to work on movement and sounds. When children stick out their tongues, talk about it; bring it to their attention and make movement and sound become the forefront of the sessions. Comments by the parents and clinician, such as, “Wow, I see your tongue,” “I love to hear all your noisy sounds,” or “I see you smacking your lips. You’re a great lip smacker,” help the child to recognize the importance of sounds and oral movement. Bringing movement to the forefront helps set the stage for what the speech therapy is all about, thus supporting attempts at further speech movements.

Facilitate Imitation

Prior to speech imitation readiness, children need to develop other types of motor imitation skills. When children engage in back and forth imitation, they are learning the important skill of “you do what I do,” an essential skill in the process of speech praxis treatment. Rather than pushing imitation of sounds and words, determine what types of movements the child is able to imitate and work from there. Refinement of imitation is a gradual process, and can be facilitated by beginning with whole body movement (rocking back and forth), imitation of actions during play (banging a drum, stacking blocks), smaller movement imitation (clapping, wiggling fingers, shaking head), imitation of oral/facial movements (sticking out tongue, smacking lips), vocal imitation (basic sound and syllable play), and, finally, imitation of true words. Although parents may be eager for their children to begin saying real words, it is important to help them understand the importance of developing a strong base of imitation prior to asking the child to say words, and to have them engage in these types of imitation routines at home.

If the child does not readily imitate body or vocal movements, one way to get the imitation turn-taking routine going is to imitate what the child is doing. When the child bangs on a table, makes tongue-clicking sounds, or vocalizes a neutral vowel, the therapist and parent can match the movement or sound, usually to the delight of the child. After the turn-taking routine is established with the child in the lead, the therapist or parent can change it by doing something a little different. If the child is banging on the floor, the therapist may bang on a chair instead. If the child is making tongue clicks, the therapist may, instead, make lip-smacking sounds. Praising the child for these imitative attempts is equally important to support the establishment of purposeful, volitional imitation skills upon which speech praxis treatment is based.

Use Toys That Reinforce Early Sound Effects and Simple Exclamations

Prior to the development of “true words,” children typically produce silly sounds and sounds effects, such as coughing, grunting, chewing noises, raspberries, and snoring. Animal and vehicle noises also are among the sounds children master in the context of play and book reading. Encourage production of these sounds by incorporating toys and activities that elicit these sounds. Toy animals, animal puzzles, vehicles, foods, cooking gadgets, and building tools, all serve to elicit repetitive modeling of playful sounds that the child can be encouraged to imitate. Linking a movement to a sound offers an additional cueing mechanism for the child. For example, each time the buttons on the microwave are pushed when “making” playdough cookies, the therapist or parent can say, “beep, beep, beep.”

Pause with Expectation

For children who are quite delayed in babbling and sound imitation, lack of vocal responsiveness becomes an expectation. After children have begun to develop some ability to imitate some vocalizations, a shift should occur on the part of the therapist and family that helps the child recognize that being passive during turn-taking routines is no longer the expected response. Pausing and looking at a child expectantly lets the child know that some response is expected. Offering positive reinforcement when the child takes the risk of making a vocal response further solidifies shared enjoyment in the turn-taking process, paving the road to continued effort and continued success.

It is beneficial to model the target sound effects and target words during therapy using a focused stimulation approach (Ellis Weismer & Robertson, 2006). During focused stimulation, the therapist or parent produces the target sound or word frequently and in a way that brings a heightened awareness of specific phonemes or sounds. Treatment targets can be emphasized by (a) pausing just before the target word is produced (e.g., “Here’s a … ball, and here’s another … ball … and here’s another …ball”); (b) increasing the duration of the vowel of the target word or prolonging a consonant (e.g., “Yummy banana. Mmmmmmm” or “The airplane is going higher. It goes uuuuup, uuuuup, uuuuup.”); and (c) securing the child’s visual attention prior to modeling the target word or sound. Using amplification tools, such as an echo microphone, Toobaloo®, or even a paper towel or wrapping paper roll, may help to focus the child’s attention and generate interest in repetition of sounds and words.

Reduce the Number of Target Utterances Per Session

Strand and Skinder (1999) recommend limiting the number of target utterances in the stimulus set introduced during a therapy session to no more than five or six utterances. In this way, blocked practice of a small number of treatment targets could be accomplished. This repetitive practice of a small number of targets supports the child’s ability to master new movement plans in the earlier stages of learning.

Use Tactile and Proprioceptive Input

Ayres (2005) suggests that many children with apraxia demonstrate reduced tactile and proprioceptive processing. By providing additional tactile and proprioceptive cues, the child’s ability to make sense of the somatosensory input is enhanced. PROMPT® treatment, described by Hayden (2008), incorporates specific tactile cues that offer the child a more salient way of sensing what a movement sequence should feel like, thus helping the child to connect the feeling of the movement gesture with the accompanying acoustic information. Strand and Skinder (1999) also recommend incorporating tactile cues as needed to support imitation when visual and verbal cues alone are not enough to help the child perform the targeted speech movements. In addition, body movements, gestures, and manual signs can be associated with speech movement gestures to create associations between speech movements and other movement cues.

Practice Skill Refinement

It is important to help children move from broad to more narrow distinctions between sounds. For children who do not reliably turn on their voice to produce sounds, praise will be provided when a child produces an undifferentiated vowel sound volitionally. As treatment progresses, purposeful movement of the lips or tongue will be facilitated, and then gradually building up to making distinctions between lip versus tongue sounds, nasals versus non-nasals, stops versus continuents, one versus two syllables, and voiced versus voiceless phonemes. Grading and differentiating of vowels based on tongue position (high/low/mid; front/central/back) and lip shape (open/round/retracted) also should be facilitated. These distinctions are gradual and take time, and children’s achievement of these motor speech skill refinements should be praised each step of the way.

Incorporate Music, and Books into Treatment

Music and carefully chosen books support attainment of speech in children with severe CAS, because they offer opportunities for repetitive practice of target utterances. Music also provides opportunities to practice varied and exaggerated intonation patterns, simple sound effects, and early developing sounds and words. Reduction of rate during songs offers the child the time to achieve initial articulatory configurations of target sounds and words. Making up little tunes with repetition of simple treatment target sounds and words to accompany the activities in the speech session can help to engage the child in the repetitive practice necessary for initial learning of treatment targets. Creation of simple, personalized books can support opportunities for repetitive practice of a simple sound effect or a small number of target utterances. For example, a book with pictures of people or things dropping, falling, and crashing, could be the perfect tool for practice of the exclamation, “uh oh.” Fish (2010) provides several book and song lists, including lists of books to target sound effects and early word production.

Provide Access to AAC

Children need a means of communication. When speech is slow in coming, the use of manual signs and gestures, low tech picture boards, and/or voice output communication devices will help support a child’s ability to express a wider range of ideas, and to establish greater social communication skills. Parents may need to be reassured that the verbal mode of communication will continue to be addressed, but that helping children find a way to establish positive communication patterns is very important for overall development.

References:

Ayres, A. J. (2005). Sensory integration and the child: Understanding hidden sensory challenges. Los Angeles, CA: Western Psychological Services.

Ellis Weismer, S., & Robertson, S. (2006). Focused stimulation approach to language intervention. In R. McCauley and M. Fey (Eds.), Treatment of language disorders in children (pp. 175-201). Baltimore, MD: Paul H. Brookes.

Fish, M. (2010). Here’s how to treat childhood apraxia of speech. San Diego, CA: Plural Publishing.

Hayden, D. A. (2008). P.R.O.M.P.T. prompts for restructuring oral muscular phonetic targets, introduction to technique: A manual (2nd ed.). Santa Fe, NM: The PROMPT Institute.

Strand, E. A., & Skinder, A. (1999). Treatment of development apraxia of speech: Integral stimulation methods, In A. Caruso & E. Strand (Eds.), Clinical management of motor speech disorders in children (pp. 109-148). New York, NY: Thieme.

Featured Author: Margaret A. Fish, M.S., CCC-SLP

Margaret Fish is a speech-language pathologist working in private practice in Highland Park, Illinois. She has 30 years of clinical experience working with children with severe speech-sound disorders, language impairments, and social language challenges. Her primary professional interest is in the evaluation and treatment of children with childhood apraxia of speech (CAS). Margaret is the author of the recently released book, Here’s How to Treat Childhood Apraxia of Speech by Plural Publishing. Her workshops and writing focus on providing practical, evidence-based evaluation and treatment ideas to support children with CAS.

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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's 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

Related links.

• Speech-Language Pathology
• Voice and Swallow Program
• Pediatric Otolaryngology/Head and Neck Surgery (ENT)
• What Is Airway Reconstruction?
• Language Disorders in Children
• The Growing Child: 3-Year-Olds
• The Growing Child: School-Age (6 to 12 Years)

Related Topics

Age-Appropriate Speech and Hearing Milestones

Hearing Problems and Speech and Language Milestones

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Exploring Diverse Speech Therapy Programs and Tools

Speech therapy is crucial for children who face challenges in communication, including difficulties in speaking, listening, understanding language, or articulation. These issues can affect a child’s ability to interact with others and succeed academically and socially. 

The purpose of speech therapy programs and tools is to provide targeted interventions tailored to each child’s specific needs. These programs and tools are designed to make therapy engaging and effective, incorporating a variety of techniques such as interactive games, specialized exercises, and state-of-the-art equipment. They help therapists in diagnosing and treating speech disorders more effectively and allow for customized therapy plans that can evolve with the child’s progress.

Specialized Therapy Approaches and Tools

There are several innovative programs designed to enhance speech therapy, each employing unique approaches and tools tailored to specific needs. These programs help in making therapy sessions more effective and engaging for children facing communication challenges.

Toobaloo is an auditory feedback device that helps children hear themselves clearly while speaking. This tool amplifies and directs the child’s voice straight back to their ears, enhancing auditory feedback and improving phonetic and pronunciation skills. It’s particularly useful for self-monitoring during reading or speech practice.

Auditory-Motor Mapping Training (AMMT)

Auditory-Motor Mapping Training (AMMT) is designed to aid children with autism and other conditions that affect speech development. This approach combines intonation (singing) and motor activities (hand tapping) to stimulate the brain areas involved in speech and language production. AMMT helps in building neural pathways that can enhance the ability to produce spoken language.

Sandplay Therapy 

Sandplay Therapy offers a creative and non-verbal form of communication that involves the use of sand, water, and miniature figures to create scenes in a sandbox. This method allows children to express themselves symbolically and emotionally, which can be particularly beneficial for those who have difficulties with traditional speech therapy methods.

LSVT (Lee Silverman Voice Treatment) is originally developed for Parkinson’s patients but has been adapted to help children, particularly those with motor speech disorders. It focuses on increasing vocal loudness and is adapted to improve articulatory precision. The intensive, repetitive training helps strengthen the neuromuscular pathways needed for speaking.

PROMPT Therapy

PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) Therapy involves tactile-kinesthetic approaches where the therapist uses touch cues on the child’s face (jaw, lips, tongue) to support and guide the movement needed for accurate speech production. This method is beneficial for children with motor speech disorders, articulation problems, and other impairments affecting speech clarity.

Considerations for Implementing Speech Therapy Programs

Before implementing any speech therapy program, it’s crucial to consult with a professional Speech-Language Pathologist (SLP). An SLP can provide a thorough evaluation and recommend a tailored approach based on the child’s specific needs. 

Here are some tips on choosing the right speech therapy program:

Individual Needs and Preferences

Every child is unique, and their therapy should be too. Assess the child’s specific challenges and strengths in speech, language, and communication. Consider programs that align with the child’s interests and learning style, as this can greatly enhance engagement and effectiveness.

Accessibility and Affordability

Consider the practical aspects of the therapy program, such as location and cost. Look for programs that are easily accessible and fit within your budget. Some programs might offer financial assistance or sliding scale fees, and some might be covered by insurance.

Collaboration with Families and Caregivers

Family involvement is key to the success of any therapy program. Look for programs that encourage collaboration between the therapist and the child’s family. This can include training for caregivers on how to support the child’s development at home and regular updates on the child’s progress.

Flexibility and Adaptability

Select a program that is flexible and can adapt to the changing needs of the child as they progress. The ability to customize the therapy sessions according to the child’s development stages and emerging needs is crucial for sustained improvement.

Scientific Evidence and Effectiveness

When choosing a speech therapy program, it’s crucial to consider the scientific evidence supporting its methods and outcomes. Look for programs that have a strong foundation in research and proven effectiveness for your specific needs. Review studies, published outcomes, and testimonials that demonstrate the program’s success in addressing similar speech and language issues. Programs that are evidence-based are more likely to provide reliable and effective interventions, leading to better outcomes for the child.

Using Forbrain to Help with Speech Therapy

Forbrain is an auditory stimulation headset that uses bone conduction technology and a dynamic filter to enhance speech therapy. By amplifying the user’s voice directly to their nervous system and brain, Forbrain improves auditory feedback. This sharper feedback helps users refine their pronunciation, rhythm, and speech fluency.

Benefits of Forbrain in Speech Therapy:

• Improved Perception: Enhances the brain’s ability to detect subtle differences in sounds, aiding in clearer and more precise speech production.
• Increased Attention and Memory: Helps users maintain focus and better remember verbal instructions or information, crucial for effective learning and communication.
• Boosted Confidence : Users hearing their own improved speech can increase their motivation and confidence in speaking situations.

Forbrain’s effectiveness in reinforcing auditory processing makes it a valuable tool for individuals in speech therapy, educators, and professionals aiming to enhance their communicative abilities.

Final Words

In this article, we’ve explored a variety of specialized speech therapy programs and tools designed to address the diverse needs of children with speech and language challenges. From innovative devices like the Toobaloo and Whisperphone to therapeutic approaches like AMMT, Sandplay Therapy, LSVT, and PROMPT Therapy, each program offers unique benefits tailored to enhance communication skills. 

We encourage parents, educators, and healthcare professionals to utilize the insights and tips shared in this article to make informed decisions about speech therapy. By embracing these tools and approaches, you can significantly support and advance the speech and language development of children in your care, leading to better outcomes and enriched communication experiences.

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Home » Communication Skills » 9 Tips on How to Help a Child with Speech Articulation Problems

9 Tips on How to Help a Child with Speech Articulation Problems

By   Dolly Bhargava, MS

May 15, 2024

Speech articulation problems occur when sounds are not pronounced correctly. This can happen due to issues with the placement, timing, pressure, speed, or flow of movement of the lips, tongue, teeth, palate, or respiratory system (lungs).

Many parents wonder how to help a child with speech articulation problems. If you’ve noticed your child struggling to pronounce sounds clearly, you’re not alone. Here are some tips on how best to help our little ones develop clearer speech.

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1. Understand speech articulation problems

Before we learn how to help a child with speech articulation problems, it’s crucial to understand these issues first. That way, we can tailor our approach to the unique needs and abilities of our children on the spectrum.

Common causes for speech articulation problems in autistic children include:

• Motor coordination issues may cause difficulties with precise speech articulation.  
• Sensory issues may lead to avoidance or difficulty in forming specific sounds.  
• Language processing issues make it challenging to understand and replicate speech patterns accurately. 
• Delays in speech and language milestone development can affect their ability to articulate sounds and form words.
• Hearing impairments cause difficulties for the child in hearing and accurately reproducing speech sounds. 

When a child has difficulty with speech articulation, it can make it hard for others to understand them. This can cause the child to feel frustrated and anxious. 

This difficulty can also impact the child’s self-esteem, confidence , and motivation to speak.  Because of that, the child must receive intervention from a Speech Language Pathologist (SLP).

The SLP will provide articulation exercises that the child can practice at home. Through repetition and consistent practice, there will be an improvement in the child’s articulation skills.

2. Create a safe space for speech practice

Before starting any speech articulation exercise , it’s important to create a safe space for practice first. Make the child feel at ease and not scared to make mistakes. In the space, minimize visual and auditory distractions to help with focus.

Learning how to articulate correctly takes time, so providing a patient, supportive , and non-judgmental environment for children to practice speech is critical.

Use encouraging words and positive reinforcement to help build confidence and motivate the child to practice. 

3. Make learning and practicing fun

It’s more likely that a child will enjoy their speech articulation practices if you include the things they like to do. Be creative by incorporating fun and engaging activities into speech therapy sessions and daily practice routines.

Here are some ideas on how you can make speech practice more enjoyable:

• Integrate games like word bingo, charades, or board games with speech-related tasks while targeting specific speech goals.
• Utilize speech therapy apps that offer interactive exercises and feedback 
• Create theme-based exercises based on the child’s interests, such as animals, superheroes, or favorite hobbies.  
• Incorporate music by using songs with repetitive lyrics to target specific speech sounds that the child can sing along to.
• A change in scenery can be very motivating for some children. Doing speech practice while participating in nature walks, scavenger hunts, or outdoor games may help. 

4. Speak slowly and clearly

To help your child accurately understand and replicate your modeled speech pattern, slow your speech rate and use clear and short phrases for explanations.

A lot of autistic children are visual learners . Using visual aids such as flashcards, picture books, or videos may enhance learning and make concepts more understandable. 

5. Practice sounds they struggle with

Work with your SLP to prioritize sounds that need to be targeted. Focus on this small number of target sounds initially to promote consistency and repetition in practice.

Once mastery is achieved, gradually introduce additional sounds for further improvement. No matter how many sounds a child struggles with, it’s important not to overwhelm them. Take it step by step, and celebrate every small achievement.

6. Make your corrections gentle

When providing feedback and corrections to children with speech articulation problems, it’s important to be gentle and supportive. Avoid criticizing your child or showing your frustrations.

Practice patience and understanding when correcting your child’s speech errors. Each child is on their own unique learning journey, which means they progress at their own pace.

It is important to create a supportive environment where the child is respected for their own unique learning journey of improving their articulation.

7. Praise good pronunciation

To other people, your child’s small victories may not seem much. But only you and your little one know how important every step of this journey is.

Acknowledge improvements, no matter how small, and celebrate successes along the way. This positive reinforcement will help shape speech articulation skills.

As a child’s speech improves, parents, caregivers, and educators should praise and acknowledge instances of clear and accurate pronunciation. That way, they’ll be motivated to keep learning and using the lessons they’ve learned.

8. Make reading to your child a new daily habit

Reading aloud to children is essential for language development and speech articulation.

Regular reading sessions can expose children to various sounds, words, and language patterns, aiding in speech clarity and fluency.

To motivate and engage your children in interactive reading experiences, try the following:

• Create a routine for reading at a certain time every day.
• Choose books based on their interests.
• Opt for books with engaging illustrations, interactive elements like flaps or textures, or ones that prompt participation through questions or actions.
• Use different voices for characters, vary your tone, and encourage children to join in on repetitive phrases or sound effects.
• Ask open-ended questions that encourage more than a yes/no answer.
• Act out stories by using props or costumes.

9. Practice regularly

Consistent practice is critical for improving speech articulation skills. Parents, caregivers, and educators should incorporate regular speech exercises and activities into the child’s routine.

No matter what activity, verbalize words that include the targeted sounds. Also, ask your child questions so that they get to say the words with the target sounds.

Sitting down to exercise speech articulation each day isn’t the only way to learn. Incorporating practice into your child’s daily routine through everyday activities and language will be just as effective.

Patience is key

By incorporating activities that focus on specific sounds, providing positive reinforcement, and seeking professional guidance when needed, parents and caregivers can play a crucial role in helping their child improve their speech clarity and confidence.

Remember, patience is the most important part of helping a child with speech articulation problems. Be patient with yourself and your child, and celebrate progress along the way.

Q: Can articulation disorder be corrected?

A: Yes, articulation disorders can often be corrected with appropriate intervention and therapy. The specific approach to correction depends on the child and the nature of their articulation disorder. Speech-language pathologists (SLPs) specialize in diagnosing and treating communication disorders, including articulation disorders.

Q: How long does it take to correct an articulation disorder?

A: The duration it takes to correct an articulation disorder can vary widely. It depends on several factors, including the severity of the disorder, the individual’s age, their willingness to participate in therapy, and the effectiveness of the therapy program itself. 

Q: What’s the best form of articulation speech therapy?

A: The best form of articulation therapy is determined by factors such as the individual’s age, specific speech disorder, severity, motivation, and preferences, so it’s important to consult with a qualified speech-language pathologist to determine the most suitable therapy plan.

Q: When do speech problems in toddlers become evident?

A: Speech issues in toddlers usually become noticeable around 18 months to 2 years old when they start forming words. If a child isn’t meeting speech milestones like babbling or using single words by 15-18 months, it’s essential to consult a speech-language pathologist for early intervention and support.

References:

Mahr TJ, Soriano JU, Rathouz PJ, Hustad KC. Speech Development Between 30 and 119 Months in Typical Children II: Articulation Rate Growth Curves. J Speech Lang Hear Res. (2021) Nov 8;64(11):4057-4070. doi: 10.1044/2021_JSLHR-21-00206. Epub 2021 Sep 29. PMID: 34586882; PMCID: PMC9132150. https://pubmed.ncbi.nlm.nih.gov/34586882/  

Namasivayam, A. K., Coleman, D., O’Dwyer, A., & van Lieshout, P. (2020). Speech sound disorders in children: An articulatory phonology perspective. Frontiers in Psychology, 10, Article 2998. https://doi.org/10.3389/fpsyg.2019.02998

Netelenbos, N., Gibb, R. L., Li, F., & Gonzalez, C. L. R. (2018). Articulation speaks to executive function: An investigation in 4- to 6-year-olds. Frontiers in Psychology, 9, Article 172. https://doi.org/10.3389/fpsyg.2018.00172  

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Can TV Shows and Videos Help Your Child Learn to Talk?

With so many speech-focused apps, shows, and YouTube videos at our fingertips, it isn’t a surprise that some families rely on them to help teach their child to talk. It all seems like an easy, convenient way to learn new words and language concepts. 

But do educational videos and shows for kids really work? Some of these online speech resources are helpful and clinically based. However, they can’t replace one-on-one speech therapy with a licensed speech-language pathologist. Let’s take a look at why that is, how children learn language, and when it makes sense to talk with a speech therapist.

Can TV shows and videos teach your toddler to talk? 

Many studies have been done to test the effectiveness of educational TV shows and videos aimed at young children. To date, the overall evidence doesn’t support the value of these shows.

For example, in this study , young children learned verbs by interacting with real people, not watching a screen. This study revealed that the main predictor of a child’s language growth was how often they were read to, as opposed to watching an educational show that taught common words. And in this study , it was the parent’s involvement in watching alongside their child and interacting with them that helped them learn new words.

It’s true that your toddler might watch a YouTube video and then start saying new words. But as children develop their speech and language, their skills need to move beyond imitating what’s on a screen.

Children learn best when they interact with a caring adult, who models language for them and responds when the child does or says something. 

It’s important to consider the context in which the new speech skills are happening. For example, if your child can say “hi!” to a character on screen, but isn’t saying “hi” to other people in real life, that skill hasn’t transferred yet. It’s more beneficial for your child to work on that skill in daily interactions with people, rather than simply practicing it with a TV or tablet.

It all comes back to how babies and toddlers develop language. Children learn best when they interact with a caring adult, who models language for them and responds when the child does or says something. That back-and-forth interaction is key to speech and language development. It’s essentially what communication is! And watching a video doesn’t allow kids to learn in this way.

The effects of too much screen time

Of course, another downside to learning speech from videos is that it adds to the overall effects of too much screen time, especially in toddlers . Many studies have shown that greater amounts of screen time are linked to a higher likelihood of developmental delays in communication.

There is a difference between passive and active screen time, and some shows and apps are more educational than others. But even the highest quality videos still count toward screen time. And the more time your child spends sitting in front of a screen, the less time they spend interacting with the world around them.

Think about taking a walk around the neighborhood. If your child is in their stroller watching their favorite show on a tablet, they're missing an opportunity to interact with you, ask questions, point to objects, learn new words, and more. As described above, all of these activities build speech and language skills.

What can speech therapy give you that the Internet can’t?

What about speech therapy apps? You might be thinking, “Why would I pay for someone to help my child if I can get that help from speech apps or videos?” The truth is, we aren’t comparing apples to apples. Support from online resources and support from a speech therapist aren’t the same thing.

A licensed speech-language pathologist, also called a speech therapist, is trained to evaluate your child’s strengths and weaknesses. Based on that evaluation, they identify what your child needs to work on to improve their daily communication, along with the techniques and exercises to help them reach those goals. 

Importantly, a speech therapist can identify and diagnose communication-related conditions. Speech therapists work with a variety of disorders, such as articulation and phonological disorders, lisp, speech delay , language delay, apraxia of speech, and stuttering. They also work with autistic children and children with ADHD . Many of these conditions have similar symptoms, although they require specific types of treatment.

Let’s take a look at some of the disorders that can benefit from individualized treatment by a speech therapist:

Articulation disorders

This is the inability to form clear sounds past a certain age. Word sounds may be distorted, added, dropped, or swapped altogether. Some common signs of an articulation disorder can include:

Errors due to differences in the orofacial structures (example: saying “hip” instead of “ship”)

Distorting sounds in words (example: saying "thith" instead of "this")

Swapping sounds in words (example: saying "wadio" instead of "radio")

Phonological disorders

A phonological process disorder is a regular pattern of mistakes in certain words. While this is common in children learning to talk, if it extends past a certain age it may mean a disorder. Signs of a phonological process disorder can include:

Saying only one syllable in a word (example: "bay" instead of "baby")

Simplifying a word by repeating two syllables (example: "baba" instead of "bottle")

Leaving out a consonant sound (example: "at" or "ba" instead of "bat")

Changing certain consonant sounds (example: "tat" instead of "cat")

A lisp is a specific type of speech sound error. A lisp refers to a person’s difficulty in pronouncing the /s/ or /z/ sounds. This is because of an incorrect motor pattern of tongue positioning. When a person has a lisp, they are positioning their tongue in a way that blocks the airflow needed to make the /s/ and /z/ sounds. This distortion of airflow creates the lisping sound we are familiar with. 

Receptive and expressive language disorders

A receptive language disorder is an impairment of the ability to understand language. Children may struggle to grasp the meaning of what people are saying. Or they may have trouble interpreting the context of written words when reading or writing. This can make it difficult to make sense of the world around them. A child with a receptive language disorder may have:

Difficulty following simple conversation

Difficulty paying attention to tasks shared with another person

Difficulty identifying named objects/photos

Difficulty following directions

Difficulty understanding questions asked of them

A child with an expressive language disorder may be able to understand what's said to them, but they have trouble expressing what they need to say. They may struggle with learning and using new vocabulary words, stringing words together into clear sentences, or telling a story. An expressive language disorder can present in a variety of ways. Here are a few signs you may see in your child:

Grunting instead of using words

Difficulty gesturing to express their wants/needs

Lack of a variety of consonant-vowel combinations

Limited amount of words in their vocabulary

Difficulty forming phrases and sentences

Difficulty with various areas of grammar

Poor ability to answer questions

Childhood apraxia of speech

Childhood apraxia of speech (CAS) is a motor-planning disorder. In fact, the root of the word, “praxis,” means “planned movement.” The person has the language capacity to talk, but the signals between their brain and mouth muscles aren’t sent correctly. A child with CAS may know exactly what they want to say, but their brain struggles to tell the muscles in their mouth how to move in order to make the right sounds.

Childhood apraxia of speech may sound like this:

Inconsistent errors in speech: A child with apraxia may pronounce the same word differently each time they say it. 

Distorting sounds: Because people with apraxia do not place their mouth muscles in the right position, sounds often come out incorrectly. Pronouncing vowels can be especially hard, as well as longer and more complex words.

Groping for sounds: People with apraxia can seem like they’re “groping” or struggling for words. They may try saying a word several times before they say it correctly.

Inappropriate intonation, stress, or rhythm of words: Kids with apraxia may struggle with the rhythm and flow of speech. They may segment syllables in a word, omit syllables in words, or pause inappropriately while speaking.

Difficulty with volitional movements: A person with apraxia may have a tough time initiating what they want to say, such as asking a question, as compared to more automatic speech, such as saying the alphabet

Stuttering, sometimes called stammering or disfluency, is a communication disorder that disrupts the natural flow of speech. Stuttering can begin gradually and develop over time, or it can appear suddenly. People who stutter often repeat certain syllables, words, or phrases ("li-li-like this"), prolong them ("lllllike this"), or experience abnormal stops of certain sounds and syllables. Here are some other common signs of stuttering:

Routinely using interjections, such as “um” or “like,” that disrupt the flow of speech

Talking slowly or taking a lot of pauses

Stopped or blocked speech; you may see your child’s mouth open, but nothing is being said

Fast eye blinking, trembling, or shaking lips when speaking

Increased stuttering when tired, excited, or under stress

Being afraid or nervous to talk

The importance of diagnosing your child’s speech issues

As you can see, there are a wide variety of speech and language conditions. Some are very different, while others appear to have similarities. This is where differential diagnosis becomes important.

Here’s an example. Let’s say your child is 3 years old and not talking much . It may be that they have an expressive language delay. However, some kids who appear to have a speech delay actually have childhood apraxia of speech. Not surprisingly, these conditions would be targeted differently in speech therapy, and a professional is needed for a diagnosis. It’s also important for speech therapy to begin as early as possible , while the child is still young. 

Where to find a speech therapist near you

If you’re reading this and thinking your child might benefit from an evaluation, reach out to a speech therapist. It’s better to have an evaluation done and learn that your child doesn’t need intervention, rather than waiting too long and keeping your child from important time in speech therapy.

There are many places to search for a speech therapist. Expressable offers a large national team of licensed speech therapists with a range of specialities. After a free consultation call to learn more about your child, we match you with a speech therapist for an evaluation based on your child’s needs and your family’s schedule. Therapy sessions can be done on weekdays, weekends, and in the evening, and with online speech therapy, there’s no commute involved. 

Other sources for speech therapy include:

Doctor or pediatrician recommendation: Your health care provider may be able to give you a referral to a local speech therapist.

Insurance company: If you have health insurance , contact them to better understand their policies and coverage for speech therapy. They may have a list of in-network speech therapy providers that you can research and contact.

Online directories: There are several online directories where you can search for speech therapists by location and qualifications. One of these directories is compiled by the American Speech-Language-Hearing Association (ASHA), which is the professional credentialing organization for speech-language pathologists.

Colleges: Receiving therapy from a college student studying to become a speech therapist is an affordable option for some families.

As a parent, you have a lot on your plate. But if your gut is telling you that your child may need help with their speech and language, talk with a speech therapist to get your questions answered. If your child needs speech therapy, the sooner they can begin, the better!

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What Is Speech Therapy?

I f your child needs speech therapy, you're not alone. Here's everything you need to know about speech therapy for kids and toddlers.

If your child is currently in speech therapy or you're wondering if they might be a candidate for it, you're not alone. According to the American Speech-Language Hearing Association (ASHA), almost 8% of children in the United States have a communication or swallowing disorder. It doesn't mean you've done anything wrong, but it can be tough for families. The good news is speech therapy can make a difference.

So, what is speech therapy and how can it help? Here’s everything you need to know. 

How Does Speech Therapy Work?

Speech therapy is the treatment of communication, voice, and feeding/swallowing disorders by a trained professional.

Speech-language pathologists (SLPs) have a master's degree in speech-language pathology and specialize in evaluating, diagnosing, treating, and preventing these disorders. SLPs hold a license to practice in their state. 

You may also come across ASHA-certified SLPs. They have taken an additional step to pass a national exam and complete an ASHA-accredited supervised clinical fellowship.

Related: Everything You Need to Know About Language Development and Speech Delays in Children

What Does Speech Therapy Treat?

There are various reasons a child may need speech therapy. Common ones include:  

1. Speech sound disorders. This means a child has difficulty with the production of speech sounds and how we combine them into words.

2. Language disorders. A child will have difficulty understanding and/or using language to communicate. Language disorders may impact vocabulary development, grammar, as well as the ability to tell a story, follow directions, answer questions, and more.

3. Social communication disorder/pragmatic language disorder . In this case, a child will have difficulty using language to socialize. This may include difficulty understanding social cues, taking turns during conversation, initiating or maintaining a conversation, and understanding personal space. A social communication disorder often leads to difficulty forming friendships. Children with these language barriers may have a concurrent diagnosis of autism spectrum disorder .

4. Cognitive - communication disorder . This includes difficulty with memory, reasoning, problem solving, and organization, impacting the ability to communicate.

5. Voice disorder . Children will have differences in voice quality (e.g., being too hoarse or too nasal).

6. Fluency disorder/stuttering . Kids will have difficulty maintaining a smooth flow of speech. A fluency disorder may include repetitions of sounds within words, prolongations of parts of words, and/or pauses in speech.

7. Feeding/swallowing disorder . This presents as a difficulty with sucking, chewing, and/or swallowing food or liquid.

Signs a Child May Need Speech Therapy

Children may need speech therapy when they have not acquired speech/language milestones by an expected age. While milestones can vary from child to child, parents should refer their child for an evaluation if they have any concerns. Evaluation, which may include both standardized and non-standardized testing as well as observation, can help diagnose a speech/language disorder.

Some signs that may indicate a need for speech therapy include:

• A child isn't babbling by 6-7 months
• The child is having difficulty with feeding and/or swallowing
• A child beyond the age of 1 has no words
• A child beyond the age of 2 is not combining words into phrases
• The child's speech is difficult to understand
• The child is omitting syllables or sounds in words
• Speech errors are noticed during conversation
• The child has difficulty following directions or understanding spoken language
• The child has difficulty answering questions
• The child has a smaller vocabulary than what is expected for their age
• The child is stuttering
• The child's voice quality has changed or is noticeably hoarse or nasal
• The child has difficulty communicating with others socially
• The child has hearing loss
• The child has a cleft lip or palate

Related: Parenting a Child With a Speech Delay Can Be Lonely

What is Early Intervention Speech Therapy? 

Early intervention refers to state-funded evaluations and interventions—including speech therapy—for children, ages birth to 3, and their families. In some states, early intervention continues until the age of 5. While professionals may refer a child to early intervention, parents can also refer their child on their own.

Speech Therapy for Toddlers 

Speech therapy for toddlers usually resembles play where toys are used to elicit target skills, says Dominica Lumb, M.S., CCC-SLP, who has over 30 years of experience conducting speech therapy with children in various settings. 

Children are given choices during play to encourage the need to communicate. While working on language skills, toddlers are encouraged to request objects, ask questions, answer questions, and use appropriate vocabulary.

Parents may be included in therapy sessions at this age. They may be taught to model speech sounds or how to label objects and actions during everyday routines to enhance vocabulary development.

Speech therapy can also work differently depending on a child’s needs. For example, one may require a mode of communication that differs from speaking. That’s referred to as augmentative and alternative communication (AAC) and may include picture boards or computers/iPads for communicating through text or voice synthesizer. This can begin in early intervention and beyond.

Speech Therapy for Elementary-Aged Kids

Speech therapy at this stage is typically more structured. Games are often used for motivation, but goals are targeted through practice and repetition. Children practice new skills throughout a continuum until they're able to use these skills naturally in all environments.

After early intervention, children may continue receiving services in elementary school through an individualized education plan (IEP). The IEP is written by all specialists who will be working with the child. It states the child's goals and documents any accommodations the child may need to meet them.

Therapy at this age may follow a “pull-out” model where a child receives support in a separate classroom or a “push-in” model where an SLP provides services within the regular classroom. This model can change throughout the duration of therapy. For example, a child working on the correct production of a sound will typically begin with pull-out therapy and, when ready, will be observed in their classroom to assess for carryover of this skill.

SLPs in the school setting also consult with teachers to provide the support children need to communicate effectively in the classroom.

What About Private Speech Therapy?

While children must qualify for speech therapy through early intervention and in public schools, private practices can provide services beyond these standards.

Speech therapy in the private practice setting typically occurs one-on-one with the child receiving the SLP's undivided attention. But group therapy may occur when beneficial to the child.

"Therapy in the private practice setting is very child and family focused," explains Shanna Klump, M.S., CCC-SLP, CEO of Kid Connections Therapy in Severna Park, Maryland. "The family's goals for their child are often at the forefront of the work we do. In addition, parents and other family members often participate in the sessions to learn strategies that can be implemented at home to encourage generalization of skills."

What Age Is Best To Start Speech Therapy?

Parents should refer their child for a speech/language evaluation when they first notice their child is falling behind in any area of speech/language or is no longer meeting speech/language milestones . It is never too late or too early to start therapy but, in general, earlier intervention leads to a better outcome. If you're unsure if your child requires speech therapy, a referral to an SLP is always recommended.

Related: 7 Ways to Help Your Child's Language Development

How Parents Can Refer Their Child for Speech Therapy

A parent can contact their local early intervention office to learn about speech therapy options. The Centers for Disease Control and Prevention (CDC) provides early intervention contacts by state. Parents can also reach out to their child's health care provider to determine where their local early intervention office is located.

A school-aged child can be referred for a speech/language evaluation by reaching out to the child's teacher or the school's SLP.

An evaluation by a private SLP is an option at any age, but evaluations through early intervention or a public school district are provided at no cost. ASHA ProFind connects parents to SLPs who have indicated they are accepting referrals.

Does Insurance Cover Speech Therapy?

While public school therapy is free, private outpatient speech/language therapy is often covered by health plans, but with limitations.

According to Klump, insurance coverage for speech therapy varies by state, insurance plan, and diagnosis. She explains that while some states require habilitative service coverage for children, others do not.

Often, private practices, including Klump's Kid Connections, complete a benefits verification before initiating speech evaluation or therapy. In her experience, therapy sessions without insurance coverage may cost between $100-150, depending on location.

As each health plan has its own coverage, it is important to reach out to your insurance company to determine your out-of-pocket costs.

Insurance and Speech Therapy Coverage

If you're looking to see what insurance covers, Shanna Klump, M.S., CCC-SLP, CEO of Kid Connections Therapy, suggests parents obtain the following information from their insurance carrier:

• Visit limit. This may be a hard or soft limit which refers to whether an extension of services could be granted if deemed medically necessary
• Whether the visit limit is combined with other services. For example, occupational therapy and physical therapy are sometimes grouped with speech therapy in the number of sessions covered
• Whether there are exclusions to coverage for different diagnoses
• If a deductible must be met
• The co-pay amount per session

How Long Will My Child Be in Speech Therapy?

Speech therapy can take anywhere from months to years. Each child makes progress at their own rate and has individualized goals based on their communication needs. Just as children develop and meet milestones individually, the time it takes them to master new skills will vary.

How Effective Is Speech Therapy?

Speech therapy has been found to be effective for children. One study of more than 700 children with speech or language disorders up to 16 years old, found an average of six hours of speech therapy over six months significantly improved communication performance. Speech therapy was shown to be much more effective than no treatment over the same period.

Children of all ages typically find speech therapy engaging, fun, and rewarding. They're able to see their progress and use their newly learned skills proudly. Speech therapy is an effective way to enhance a child's ability to communicate and through these communication skills, a child will have better access to the world.

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