Questions and answers:

Below is a question written from a FB mama….with my answer to follow….hoping it is helpful to her and to other mamas as well:

QUESTION:

Awesome! Thank you so much! If you’d rather correspond via e-mail, that’s great, too.
She’s can say B M H W D T,and N all in isolation and in the initial position of words.

She can say P, K, G, F, V, Y S, SH in isolation only. She won’t initiate any of them. She substitutes these sounds with T and D when imitating words.

She does not have L, R, Z, NG or TH yet.

She can say all of her vowels.

She only says the first consonant and vowel of most words, except sometimes she’ll say the last syllable only. She usually deletes all syllables except the first one from words.
Here is most of her vocabulary that I can think of:
Her one intelligable phrase: “wayadoee?” for “what ya doing?”
tie for outside
moe for milk
wayee for water
toetee for cookie (hey, that’s two syllables!)
mee mee for pee pee
boe boe for poo poo
Mah for mom
Da for Dad
Lie for Eli
Ta for Max
Dee dee for Sadie
nana for Landon
abo for apple
nana for banana

She has more words than this…we just can’t understand them most of the time without visual cues.

A lot of air comes out of her nose when she says front sounds. (Sounds similar to blowing her nose?) This got worse when her adenoids were removed in December.

Do you think there’s hope that our girl will speak intelligibly? She didn’t receive the early intervention that our kids with DS receive here in the U.S. I hope her window of opportunity hasn’t passed. I wish we could afford private therapy but it’s so expensive!

She talks all day long, it just sounds like a baby. Little kids who meet her for the first time often ask why she talks like a baby. It makes me sad because she’s much smarter than a baby. :(

Thank you again! I appreciate this greatly!

 

 

ANSWER:

I am hoping that the information below is a good starting point for you and your little one….based upon the information you gave me…I think a good starting point would be to work on the P sound.  B and P are very similar sounds….they are both bilabial sounds…which means that they are produced with both of your lips…and they are both stop sounds…which means that they do not continue during production.  The S sound is not a stop sound…it continues when you make the sound. 

Now, the only difference between B and P is this: when you make the B sound you vibrate your vocal folds (a motor on sound) and when you make the P sound you do not vibrate your vocal folds…a motor off sound.  During the production of the P sound more “work” is done at the level of the lips…which makes sense because you are not vibrating your vocal folds.  Where..with the B sound…less work is done at the level of the lips…and more work at the level of the vocal folds.  Since she can make the B sound…we can help to shape that into the P sound.  Now…since she is only producing the beginnings of words…I would like to start off with nonsense words to get her to become more aware of the ends of the words…I am going to include below the strategy for P and you will see what I mean by non-sense words/syllables:

 

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.

 

 

****It is important to remember the order of articulation…this means that at first we want her to be able to say the sound in isolation…then in syllables..then in short phrases…sentences…and then conversation.  You say that she can say the P sound in isolation…however…it seems from your comment that she will not imitate the P sound..is that correct…and that during spontaneous speech she substitutes the P sound with T or D.  I just want to be clear on this.  Since it seems that she can make the P sound in isolation…I would like you to work on her ability to produce the P sound in non-sense syllables such as below. They are two syllable productions to help her to become more aware of the second part of the word…since she is deleting the second syllable. 

pay-pay

pee-pee

pie-pie

poe-poe

pu-pu

Use the cue for P above in order to faciliate production of the sound….I also will clap my hands or tap on the table to show her that there are two beats in the syllables…is she able to understand this….meaning….if you say: pay-pay…and clap twice as you are saying pay-pay…can you ask her to tell you how many beats are in the word???  Also put a little bit of melody to your verbal production….music is on the right side of the brain…and language is on the left…when we tap into the music side…it helps the language side with verbal production. 

 

When she is ready….below are two links…they are P worksheets.

initial_p_2

INITIALPWORDS

 

 

I also want you to work on the B sound…since it is a sound that she can produce in isolation and in the initial position of the word…use the strategy below…and practice in non-sense words/syllables to have her become more aware of the 2 parts of a word…basically the second syllable of the word.  Once she is able to do this…you can use the link below and print the B worksheets.  So for the non-sense syllables..it would look like this:

 

bay-bay

bee-bee

bye-bye

boo-boo

bu-bu

 

Use the strategy below to elicit the B sound..if she needs…but you do say that she can make the B sound…but she may need it for the second half of the word/syllable.  Clap your hands to indicate the two beats in the syllables…have her become more aware of how many beats are in the non-sense syllables.

 

HOW TO TEACH THE B 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. 

 

CLICK ON THIS LINK FOR INITIAL B WORDS WORKSHEET: INITIALBWORDS

 

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

 

 

Oral motor exercises are a great way for a little one to become more aware of their articulators…use the strategies below to help with her oral motor awareness…please reply with any questions.

Blowing Bubbles

This may seem a bit immature, but it is a great exercise for breath control as well as pursing the lips.

In our own experience the clients that we’ve worked with have all enjoyed this activity. Remember, you’re never too old to have some fun!

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”).

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.

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.

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).

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.

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.

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.

 

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

 
 

Regarding her nasality of speech.  I have seen children that sound more hyper-nasal following an adenoidectomy……your adenoids…your soft palate and the sides of your pharyngeal wall make closure on all sounds except for M, N and the NG sound as in ING.  During production  of M, N and NG…the air escapes out of your nasal passages.  For all of the non-nasal sounds….the air does not escape…and closure is made.  You indicate that she sounded hyper-nasal even before surgery…do you know if it was a structural issue…or that she just was not finding the right placement for front sounds.  Have you discussed with the surgeon that she sounds more hyper-nasal now…and what his/her impression is.  I would need more information regarding that piece.  I have seen nasality of speech change following surgery…I am just wondering how significant it is…please let me know.  Also what sounds she is more hyper-nasal on??  I would discuss with the surgeon though.

 

This is a lot of information….please post with any questions…and keep in touch.  Let me know how she does with the non-sense syllable production.

Have fun!

Best,

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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