How to increase sound production in a two and a half year old that is not speaking?

The question below was sent to me through my FB….and the mom was kind enough to allow me to post her question as well as my response….I am hoping that she finds this helpful…and that it may be helpful to another family as well….remember you can find me on FB at: http://www.facebook.com/thespeechmamakim

I also added a new category called: questions and answers…..I will post new questions as I receive them….have fun guys!

 

 

Hi Kim,

 
Thanks so much for giving me your e-mail and offering your help. 
 
We adopted our 2 1/2 year old daughter, Victoria,  8 months ago from Ukraine. She has Arthrogryposis (which is a joint problem, so she can’t walk, not related to speech) and she had a cleft palate, which was repaired in October. Her biggest problem was that she was starved and ignored and had no contact with people. She was just left to lie in her crib all day every day and rarely held. So she had no sounds at all while in Ukraine. The doctor here said she wouldn’t have lived more than another two months in Ukraine. She had to be hospitalized straight from the airport for malnutrition. The doctors thought maybe her jaw was fused, that how much her lips never moved, but her mouth is fine. 

She didn’t even know how to smile for quite a long time. She didn’t know how to eat any solid food at all, only mush. She could barely sit up. She has made lots of progress in other areas, but not with making sounds. 


She only makes the “mmmmmm” sound (mostly when she is frustrated, she doesn’t cry like a regular baby)  and the “ma” sound, not for any specific reason. She has just learned to open her mouth and kind of yell. Her speech therapist thinks she has apraxia, but the ST isn’t really getting anywhere with her. She thinks she will have to use some kind of book where she points to pictures? I want the ST to work on getting her to make sounds, not just point to pictures, which she doesn’t seem too interested in, she wants to put the pictures in her mouth, which is a big step for her since she never wanted anything in her mouth! 

 She just learned how to stick her tongue out and make a raspberry sound recently. She will try to imitate sometimes. If I stick out my tongue, she sticks out her tongue. She does the “more” sign, and she mimics hand movements like “wheels on the bus”, “itsty bitsy spider”. She eats lots of different food now, even hard to chew stuff like caramels. I think she is quite smart and understands alot, but I can’t seem to get her to make sounds. 

I have gotten her to blow into a whistle, make “aaaaa” sounds into a cup, and let me brush her teeth with a battery operated tooth-brush. She can’t blow bubbles yet. She can drink from a straw now too. 

Sorry to write so much! Any advice would be appreciated! I am kind of stressed that she might never talk!
Thanks so much! 

If you want, you can see the changes in her on my blog. We came home in June, so you can see what she used to look like and how she looks now. She has gained 11 pounds! 

Catherine
wronginalltherighways-travcat.blogspot.com
 
 
 
Hi Catherine…sorry for the late response…I have been very busy….i have so many thoughts to share…so will start off by saying that I think she needs more of an opportunity to learn how to use her mouth for sound production before only using pictures….altough I have used pictures in order to decrease frustration…while working on sound production….so you may want to implement a picture exchange system just to decrease her frustration and so that she has a means of communicating. 
 
It does sound like….based upon her early history that she really did not have the opportunity to hear and use language.  So let’s start off with some oral motor exercises so that she becomes more aware of her lips, mouth and tongue.  The first thing I am going to include are some oral motor exercises.  You can begin using the exercises with your daughter….however….I tell parents that if your little one is unable to follow a gross motor directive such as: clap hands….or touch head…she may not yet be able to follow an oral motor command with her lips, mouth and tongue….so if she is not yet understanding how to follow a gross motor command….work on that first….and once she understands those directives….begin with the oral motor exercises I have listed below:
 
 
 
ORAL MOTOR EXERCISES:

Lips
1. Open and close your mouth, as wide as you can
2. Pucker your lips (like whistling), then relax
3. Play with the mirror, make really big, “””cheesy””” smiles and hold it for up to 10 secs if possible, then relax showing off all your teeth (if you have them!)
4. Pucker and hold, then smile and hold
5. Try lip smacking too! Trying to make a “””smacking/popping””” sound (press lips firmly then release…)
6. Pucker your lips and swing left, then right
7. Puff out cheeks and hold air in, then slowly blow the air out
8. Practice blowing kisses and making the “””Kissy””” sound… that works on the muscle around the lips
9. Say “””OOOOOOOOO””” really puckering the lips and then “””EEEEEEEEEE””” pulling back in a sort-of smile!
10. Try to close your lips and hold onto a tongue blade/popsicle stick or something sturdy but light … it’s not as easy as it would seem… but it’s good practice for the lip muscles….

Tongue
1. Stick your tongue straight out, hold, then put it in
2. Move your tongue to the right corner of your mouth then to the left on the outside of your mouth
3. Push the inside of your cheek out with your tongue on the right side, then the left side
4. Lift your tongue up to your upper lip, then your lower lip; don’t use your jaw to lift your tongue up
5. Lift your tongue up behind your front teeth as if you were saying “””la”””
6. Open your mouth and lick your lips with your tongue in a wide circle

Tongue base
1. Click your tongue on the roof of your mouth
2. Stick your tongue out, then pull your tongue back in until it reaches the back of your throat
3. Say the syllable “””ka”””
4. Say the syllable “””ga”””
5. Say the syllable “””ag”””
6. Swallow very hard

 
 
The following oral motor exercises do require some tools in order to help your little one…..

 
 
 
 

Blowing Bubbles

This may seem a bit immature, but it is a great exercise for breath control as well as pursing the lips. Since you said that she can not blow bubbles just yet….blow the bubble for her…catch it on the wand….and see if she can blow the bubble off of the wand….this seems to be an easy trick….and helps the little ones learn how to blow bubbles….let me know if that works for you.

 

Blow a Harmonica

Here is another great oral motor exercise for breath control and lip pursing, but with this one you get to make some noise!

  • If breath control is weak then your goal might be to get “louder” sounds from the harmonica.
  • If your lip strength is weak you might focus on trying to play just one note at a time.

Harmonica’s are inexpensive (you can even use a plastic one), and all in all it’s another fun activity.

Blow a Kazoo

This is also an inexpensive “instrument.” The kazoo will not only help your breath control, but it will also help with vocal control as well.

Why?

Because you have to hum to get any sound out of a kazoo.

At first you can try to make a simple humming sound. As you progress you can try to vary the pitch of your hum and even try to play a simple tune (like, “Mary had a Little Lamb”).

 

www.talktools.com has a set of horns….and each horn works on teaching placement for all of the sounds in English….I use the horn kit with many of the children I see.  The kit comes with a set of instructions….this way you will know which horn to start off with and also which sound the horn works on improving.

 

Using a Straw.

 

Practicing with a straw will obviously work on sucking skills, however it also involves pursing those lips again.

“Thin” liquids like water or apple juice are good starters.

As you progress you might want to try a “thicker” liquid like a milk shake.

www.talktools.com also has a honey bear straw cup….I like it because you can squeeze the bear to help her draw the liquid up….and as you increase the thickness of the liquid she may need some assistance in drawing the thickened liquid up the straw.

Do not use this exercise if you or your loved one has feeding or swallowing difficulties.

 

Tongue Press

Have you ever heard of isometric exercises?

Isometrics are a type of strength training whereby you push your muscles against an immovable force. They are a very effective technique for increasing muscle strength.

For this oral motor exercise you will need a tongue depressor or a spoon. You will also need another person to provide the “immovable force.”

First, stick your tongue straight out in front of you. Have the object pressed against your tongue tip. Push against the object as hard as you can for a count of 5, then relax.

Try to do this six to eight times in a row.

Next, again stick out your tongue in front of you. This time have the object placed on the right side of your tongue. Press against the object as hard as you can (like you’re trying to push the object to the corner of your mouth). Hold for a count of 5.

Try to do this six to eight times in a row.

Do this oral motor exercise one more time pushing against the immovable object with the left side of your tongue.

www.talktools.com has a set of tongue depressors that may work really well with this exercise.

 

Jaw Isometrics

You can do this jaw exercise yourself or have someone help you. Start with your mouth open. Have someone hold your chin firmly. Try to close your mouth using nothing but your jaw muscles – do not move your head! Hold for a count of 5.

You will definitely feel fatigue in your jaw muscles after doing this a few times. Start out only doing 3-5 of these.

Now, for the next jaw exercise you start in the opposite direction. Start with your mouth closed. This time have someone place their hand under your chin. Without moving your head try to open your mouth. Hold for a count of 5.

Try 3-5 and increase the amount as you gain strength.

NOTE: Even if you can open your mouth against your partner’s hand, remember that this exercise will build strength by steadily resisting force.

Doing the exercises properly is important. Take your time and focus on each motion as well as the muscles you are using.

 

Chin Slide

Move your chin from side-to-side without moving your head. Once you’re able to do this jaw exercise pretty well you can adjust the speed from slow to fast to make it more challenging.

This oral motor exercise can also be done with resistance (which will make it another isometric exercise).

The following oral motor exercises provide tactile stimulation. Tactile Stimulation refers to stimulating or “waking up” a muscle area by sense of touch.

 

Brushing

Using a toothbrush, brush the upper and lower lips. You can purchase toothbrushes with different levels of stiffness. Try to use different levels ranging from very soft to stiff (never use anything that may cause pain).  I also like to use an electric toothbrush….if you can not get the toothbrush in her mouth…use it on the outside of her mouth on her lips…cheeks and jaw to wake up the muscles of her mouth….also www.talktools.com has a set of jigglers that are used just for this reason….

You can also use the brushing technique on the muscles surrounding the mouth (including the jaw).

 

Icing

Putting ice on the lips will certainly help “wake up” those muscles. You can use a plain ice-cube for this exercise, but ice pops are easier to use and add some flavor as well.

Run the ice from the middle of the lips outward to the corner. Do this on both sides and then ask your loved one to smile. Repeat the icing movements and the smiling attempts several times.

Rather than using the items above I prefer the ice stick also offered by www.talktools.com  it is wonderful for working on lip rounding and lip closure.

 

Licking Ice Cream

Who wouldn’t enjoy this activity? Put some ice cream in a cone and let it melt a little. Then practice using just your tongue (no lips) to lick the dripping ice cream.

This is a great tongue exercise and a delicious treat all at the same time. How is that for fun therapy?

Once again, this is not intended for use by anyone with feeding or swallowing difficulties.

 

Peanut Butter on the Lips

Rub some peanut butter on your lips and do your best to lick it all off. Make sure you apply the peanut butter from one corner of the mouth to the other.  You said she does not prefer peanut butter….how about using creamed cheese or ice cake frosting???

This will force the tongue to reach from side-to-side to lick that tasty spread. This should go without saying by now, but never use this with anyone experiencing feeding or swallowing difficulties.

 

Using Feedback During Independent Practice

If you are practicing independently, how do you know if you are doing the oral motor exercises correctly?

A simple solution: Use a Mirror.

A mirror is often used by therapists to give patients immediate feedback. This gives them the chance to see if they are doing each exercise correctly and if not, what needs to be modified.

If you are practicing at home, using a mirror will help you adjust and self-correct your oral motor practice.

 

Catherine….start off with these suggestions….and also the strategy listed below for the B and P sound…they are easy bilabial sounds…let me know how she responds to all of this…and we can move on after I hear back from you.

 

HOW TO TEACH THE P SOUND:

The P sound is considered to be a bilabial sound.  This means that you are using your lips together to make this sound.  It is an unvoiced sound, which means that your vocal folds do not vibrate/move when you make this sound. 

Visual Cue/Physical Cue:

To help your child produce this bilabial sound it is good to give her a visual cue/physical.  Which means that you are showing her what the sound “looks like” or the type of sound it is.  By this I mean……I like to teach children to understand the difference between a short sound that stops (like the P sound), a long sound that continues (like the S sound) or a vibrating sound/motor on sound (like the G sound).  

When working on the P sound I use a specific physical cue to help the child “see” and “feel” what the sound is like…….the cue I often use during therapy works just like this (and remember your child’s speech and language pathologist may have one that works better for your child and elicits the sound more effectively).  Use the cue that works best for you and your child. 

Okay, now back to the cue:  Make a fist with your hand and then open up your fingers as fast as you can.  While doing this action, produce the P sound.  Have your child watch you and then help her to do the same with her hand. 

Tactile Cue:

You can also have your child feel the puff of air that comes out of your mouth when you make the sound.  That gives her a tactile cue….she feels the air on her hand.  I find in therapy that the more cues that I give a child, the easier it will be for her to make the sound. 

Verbal Cue:  Be sure to give her a verbal cue-this means that you are modeling the sound for her so that she can hear the correct pronunciation of the sound.  You can produce the sound in different vowel combinations.  Once she is able to make the sound, try it with different vowel combinations such as the following: Pa, pa, pa.  Pe, pe, pe.  Po, po, po and Pi, Pi Pi. 

Melodic cue: When saying the sounds be sure to put a little bit of melody to what you are saying….music is on the right side of the brain and language is on the left.  When we tap into the right and left side at the same time…it makes it easier for your child to say the sound.  I often give parents the bologna example.  If you can’t remember how to spell bologna don’t you sing the bologna song????  B O L O G N A.

Fun tip for P: Hold a tissue in front of your child’s mouth….about an inch and a half away….ask her make the P sound……when she makes the P sound…..she should be able to see that her puff of air made the tissue move.  I also do this with small colorful scarves.

 

 

HOW TO TEACH THE B SOUND:

When teaching the B sound be sure to use  two very important cues.  When your little one is shown the physical cue and feels the tactile cue she will have an easier time in producing this sound. 

The B sound is a bilabial sound…this means that you use your two lips together to make this sound.  The B sound is a non-nasal sound….this means that the air escapes out of your mouth NOT out of your nose as in the M sound.  The B sound is considered to be a STOP sound….this means that it is a sound that stops and does NOT continue as in the S sound.  The B sound is also a vibrating sound…this means that your “motor is on”…….your vocal folds are moving/vibrating.  Please refer to the initial B worksheet for simple words that you can start off with when teaching the B sound. 

The B sound is also considered to be a bilabial sound-this means that your two lips work together in order to make this sound-they are making closure (lips together).  The only difference between the B sound and the P sound is that when you make the B sound your vocal folds vibrate.  Sometimes I tell the children that their “motor is on” when they make this sound.

Visual Cue/Physical Cue and Tactile Cue:

Make a fist with your hand and gently bang on a table or on your thigh while producing the B sound.   You should ask your little one to do the same.  This cue is showing your child that the B sound is a sound that stops.  The S sound is a sound that continues during production, however, the B sound stops.  So be sure to demonstrate to your little one……by gently banging you fist on a table or your thigh. 

While you bang your fist on the table place your other hand on your throat so that you can feel the vibration of your vocal folds.  Now when practicing with your child-you can do the movement with your hand making the fist and have her do the same with her fist…..and while you are both doing this….have her take her own hand and feel the vibration on your throat.  Be sure to explain to her that “your motor is on”.  By saying “motor on” you are telling her that her vocal folds are moving/vibrating.  The B sound is a stop sound…..and a motor on sound. 

By using the physical cue (fist banging on table) and tactile cue (feeling vibration of the vocal folds) you are telling her two things: showing her that the B sound is a sound that stops and does not continue like the S sound and that when making the B sound your vocal folds move.

Verbal Cue:

Be sure to always model the production of the target sound.  Remember this means that you are demonstrating how the B sound should sound like when produced correctly.  When she is ready….have her practice the B sound followed by vowels, then in simple words, next short phrases and then in longer sentences.

Melodic cue:

Remember to use melody as a cue when producing target words.  It is easiest when the word has more than one syllable.  Words like: baby, baker, butter, and birdie.  Be sure to change your pitch and inflection…..that will help her to say the word. 

  

Remember when practicing target sounds…be sure to follow the order of articulation process:

START OFF WITH SYLLABLES….SUCH AS: BA, BA, BA  THEN DO: BE, BE, BE. NEXT: BO, BO, BO.

I tell parents when working on syllables…be sure to use the target sound and go through all of the vowel sounds….as I started to above.  After you practice in syllables…follow the order below.

SAY THE WORD IN ISOLATION (JUST THE WORD-NOT IN A SENTENCE)

SAY THE WORD IN A SHORT PHRASE

SAY THE WORD  IN A SENTENCE

SAY THE WORD IN A LONGER SENTENCE

TRY IN REGULAR CONVERSATION

 

HOPE THIS WAS HELPFUL!

Kim

About Kim

My name is Kim Marino and I have been practicing as a licensed speech and language pathologist since 1993. I work on Long Island providing diagnostic evaluations and services to children from birth to age 21. My experience is vast and am proud to say that I work with children that may present with articulation and phonological concerns, oral motor feeding concerns, Down Syndrome feeding, cognitive rehabilitation, auditory processing delays, receptive language delays, cleft palate feeding and sound development and expressive language delays. Most importantly, I am the mother of four amazing children and am happily married to my childhood sweetheart. I feel blessed to have my four children and so lucky to share this journey in life with my husband. I always had it somewhere in my head that I wanted to develop a blog or a website of some sort so that I could provide families with an additional resource....so that parents could help their little ones become a better communicator. And as I was developing this blog....I realized that I also needed to share the stories about my life and my children....and the funny things along the way that help to keep me smiling. Whether you are a working mother or not...finding balance between home, children and life can be a challenge....I hope that my blog helps to bring a smile to your face..and also some tools to help you help your little or big one. I hope you enjoy! Kim
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