Stuttering Throughout the Lifespan

 What is stuttering? It can be characterized as a break in the forward flow of connected speech often resulting in repetitions of words, parts of words or whole words. Blockages of airflow can occur in which no sound is being produced or sustained sounds (i.e. mmmmmmm-monkey). It is not abnormal for children of a young age to have disfluencies in their speech as a result of the rapid language development occurring. Research has shown that about 5% of children are likely to be disfluent at some point in their development, typically around age 2.5 to 5 years old. It is not uncommon for children to transition between fluent and disfluent speech, with disfluencies that can often be triggered by a rush to complete a thought, excitement or exhaustion. 

What should I look for?

In most situations stuttering will resolve itself after a short period of time. In other instances stuttering will continue as children develop. During language development, children are rapidly increasing their vocabulary. The sequence and complexity with which they use words can result in a disruption in the coordination of a smooth sentence. 

Typical 

• Repeating phrases and whole words (I want to- I want to play;please-please-go get it)

• Use of filler words (uh or umm)

• No tension of physical struggle when speaking 

• No negative reaction or frustration 

• No family history of stuttering 

• Disfluencies last less than 6 months 

Not Typical

• Repeating sounds or syllables (s-s-s-snake)

• Sound prolongations (mmmmee)

• Blocks: Child appears to be attempting to make a sound but cannot. 

• Secondary physical behaviors that may accompany a stutter including 

• Hand tapping

• Eye blinking 

• Throat clearing 

• Facial grimacing 

• Family history of stuttering 

• Disfluencies last longer than 6 months 

What does treatment look like?

At Building-Blocks Therapy services our trained speech-language pathologists are instrumental at supporting both children, adolescents and adults who stutter by providing strategies to modify speech and reduce tension during stuttering events. Our therapists use strategies to bring awareness to the rate of speech and to normalizing stuttering. Stuttering modification techniques can include stretching initial sounds or sliding into words to decrease tension and consequently disfluencies. Our therapists work hard to treat the whole person including any negative thoughts, feelings and beliefs revolving around their stutter. 

Treatment for adults who stutter often will address the underlying feelings such as guilt and shame that can be associated with stuttering. It is helpful to consider the analogy of an iceberg coined by Dr. Sheehan. The stutter, dysfluent speech and secondary behaviors are most noticeable and prevalent, just like the tip of an iceberg. However, it is the negative thoughts, feelings and beliefs that lie below the surface that make up a majority of the iceberg. As this analogy illustrates, strategies for impacting fluency on the surface are beneficial in the short term however, it is the focus on the feelings below the surface that can bring about long term change. 

https://www.healthychildren.org/English/ages-stages/toddler/Pages/Stuttering-in-Toddlers-Preschoolers.aspx

https://www.stutteringhelp.org/blog/sheehan-stuttering-analogy 

A Guide to Myofunctional Disorders

What are Myofunctional Disorders?

Myofunctional disorders are conditions that affect the muscles and functions of the face impacting how an individual breathes, swallows and speaks. They can be caused by thumb sucking, tethered oral tissue, or just the way the shape of the face developed.

What are myofunctional red flags?

• Open mouth posture

• Slow/picky eating

• Teeth grinding

• Thumb sucking

• Snoring

• Sleep difficulties

• Bags under eye

• Speech difficulties

• Misalignment of teeth

• Jaw pain

• Coughing/choking

• Noisy/messy eating

Other red flags exist, please speak to your provider about other signs/symptoms you or your child may be experiencing.

Who is a candidate for myofunctional therapy?

Myofunctional therapy is suitable for a wide range of individuals starting from around age 4 and extending to adults. A therapist is still able to work with children under the age of 4, though it may look a little different. The therapist uses feeding techniques that are rooted in myofunctional techniques.

What can I expect during therapy?

The goals of myofunctional therapy are to improve oral muscle function and habits across the lifespan. It aims to correct muscle imbalances, compensatory movements, promote proper swallowing and nasal breathing. Therapy consists of teaching the smaller steps to break down the process of oral range of motion until it becomes a rote generalized movement.

What can impact treatment?

The progress of myofunctional therapy can be impacted in a variety of ways. Your clinician is committed to communicating any observed barriers and possible solutions including:

• Upper airway resistance

• Enlarged tonsils/adenoids

• Nasal congestion

• Difficulty following home program

• Current orthodontic treatment

What are oral tethered issues?

Sometimes a myofunctional evaluation reveals tethered oral tissues (TOTs). TOTs are connective tissues in the lips, tongue and/or cheeks restricting the full oral range of motion for feeding and/or speech. After an evaluation, TOTs should be released if they are having a functional impact. 

At Building Blocks we strongly recommend pre and post-op therapy when treating TOTs. This aids in:

• Decreasing the risk of scarring following release.

• Decreasing the risk of re-attachment.

• Overall improvement in functional skills for feeding and speech.

At Building Blocks Therapy Services, our therapists are trained in myofunctional therapy approaches to support your child’s feeding and swallowing. If you have questions about myofunctional therapy please visit www.buildingblocksgr.com or call (616) 570-925.

Shared Reading at Any Age

Boost your child’s language skills with shared reading! Take a look at the strategies below to assist your child with reading at any age!

Infants

• Position yourself in front of your baby with your face clearly visible

• Pick books with simple pictures 

• Model saying 1 to 2 words to describe each page

• For example, “dog” “hi, dog” “dog run” etc.

• Use facial expressions as you read 

• Great books for infants…

• Where’s Spot?

• The Very Hungry Caterpillar

• Brown Bear, Brown Bear, What do you See?

• Polar Bear, Polar Bear, What do you Hear? 

• Little Blue Truck

Toddlers

• Position yourself near you child

• Be flexible! 

• Follow your child’s lead

• Toddlers often like to ask questions about the book and pictures

• Shared book reading with your toddler might NOT be reading the words on the page

• Instead, you might spend the time answering your child’s questions

• For example, your toddler might point to pictures in the book and ask, “what’s that?”

• You should name the picture or action, i.e. “dog” then add another word(s) to describe the picture or action, i.e. “dog run” “big dog” “hi, dog” etc. 

• You might also ask your child to identify and find things on each page

• For example, you might say, “where is the cat?” “what does the cat say?”

• Let your toddler practice turning pages

• You might say, “next page” then wait for your child to turn the page

• Great books for toddlers…

• Llama Llama Red Pajama

• The Little Engine that Could

• Corduroy

• If You Give a Mouse a Cookie

• Goodnight, Goodnight Construction Site

Preschoolers

• Position yourself near the child

• Like toddlers, preschool readers may also want to ask many questions about the book and pictures

• Follow your child’s lead

• If your preschooler points to a picture and asks, “what’s that?” then you should name the picture or action and add 2+ descriptor words

• For example, your child points to a dog in the picture book and asks, “what’s that?” 

• Then, you might say, “Dog. Dog is big and black. Dog runs fast!” 

• The number of descriptor words you model will depend on your child’s language level

• For example, if your child typically uses 3 words to communicate wants and needs, then you should model 4-5 words in a sentence to describe a picture scene

• Alternately, some preschoolers may be ready to answer open-ended questions about pictures 

• For example, you might ask, “who is in the picture?” “where are they?” “what is the man doing?” “what color is the house?” 

• At this age, children may also be able to answer questions to make predictions

• For example, you might ask, “what do you think will happen next?”

• Great books for preschoolers…

• I Can Read Biscuit

• Pete the Cat books

• We’re Going on a Bear Hunt

• Madeline

• Are You My Mother?

School-aged children

• Position yourself near the child

• At this age, your child will likely be able to enjoy longer stories with more words per page and/or pictures with more details 

• Similarly to preschoolers, school-aged children will benefit from answering questions about the book or pictures

• For example, “what are they doing?” “who is in the tree?” “where are the kids?”

• In addition to these simple questions, you might start to ask questions about motivation or emotion

• For example, “why are the kids running?” “why is the boy crying?” “why does she feel happy?”

• This is also a great age to start asking questions about the main idea

• For example, at the end of the story, you might ask, “what was the story about?” 

• If this is still too difficult for your child, then ask questions about the events of the story in order, i.e. “what happened first?” “what happened next?” “how did the story end?”

• You might also ask your child to retell the story from their own memory

• For example, at the end of the book, you might say, “now you tell me the story back with as many details as you can remember. What happened in the book?”

• Great books for school-age children…

• Good Dog book series

• The Rainbow Fish

• Curious George books

• There was an Old Lady Who book series

What’s the role of the Speech Therapist in reading?

At Building Blocks Therapy Services, each of our Speech Therapists is equipped with the skills and knowledge to help you and your child learn language through shared reading! We care about your child’s ability to communicate at home, school and in the community. Please, visit www.buildingblocksgr.com or call (616) 570-925 to learn more about supporting your child’s language development through shared reading. We look forward to building a relationship with you and your child!

Source:

Reading Milestones (2022), Cynthia M. Zettler-Greeley, PhD

https://kidshealth.org/en/parents/milestones.html

The Purpose of Play

 Play (verb) to engage in an activity for enjoyment.

Why play with your child? 

Through play, children learn to communicate their thoughts & ideas and develop skills of social & emotional regulation. 

Play should vary based on your child’s age or developmental level. 

For the earliest language learners and for children with difficulty learning language, start by simply being with the child. Sit at the child’s level. Observe what toys or objects the child is interested in, then join in. Show the child that you’re interested in their ideas! 

Sensory-motor play is another way to engage with early language learners and children with language difficulties. Engage a variety of senses as you play with the child. For example, rub the child’s back, tickle the child, push the child on a swing, blow bubbles, sing, clap out a rhythm to a favorite song. Notice what the child likes! Which type of play gets the child’s attention? 

When playing, vary the play after you have done the same pattern a few times in a row. For example, some examples of varying play while opening and closing a door might be opening and closing with a song, playing peek-a-boo, pretending to hit your head then fall down “ouch.” Variations in play often get the child’s attention and they will likely ask for “more”!

As a child moves into the higher developmental levels, he should show a good awareness of intentional and 2-way communication. The child should also start using first words! Now the child is ready to engage in play to expand their language. When speaking TO the child, do NOT use baby talk! When speaking FOR the child, use words to express the child’s perspective. For example, if the child says “up” then you model “pick me up.” 

Children also learn feelings and empathy during play. Label the child’s feelings in the moment, “you’re mad that your sister took your snack!” Your child will also learn as others model identifying their own feelings “I feel happy that you played with me!”

As the child begins simple pretend play, you can model silliness and imagination! Pretend a towel is a puppet and say “what a mess! Let me clean you up.” Any objects that are part of your child’s routine can be included in pretend play (clothes, shoes, toothbrush, utensils, etc.). Use big gestures and silly voices!

What’s the role of the Speech Therapist in play?

At Building Blocks Therapy Services, each of our Speech Therapists is equipped with the skills and knowledge to help your child learn language through play! We care about your child’s ability to communicate at home, school and in the community. Please, visit www.buildingblocksgr.com or call (616) 570-925 to learn more about supporting your child’s language development through play. We look forward to building a relationship with you and your child!

Sources:

• The Play Project, https://playproject.org

• Talking to children matters: Early language experience strengthens processing and builds vocabulary (2013). doi: 10.1177/0956797613488145