Early Intervention

Early Intervention

Category Archives: Early Intervention

4 Reading Strategies that Facilitate Language Development

Are you looking for a simple, effective way to facilitate your child’s language development?  Reading to the rescue!

Did you know that reading to children allows for vocabulary and language growth?  Research shows that a child’s exposure to books has direct impact on his communication and academic skills.  Therefore, reading is an important activity for your daily routine.  Try these 4 simple strategies that can be incorporated into book reading to enhance and facilitate language development.

Read to your child with CARE


Comment on pictures and actions occurring in the story.  For example, you could say, “Look! Curious George is climbing the tree.”

Ask Questions

Ask questions about the story and its associated pictures. For instance, you could ask, “What is George doing?” Try to vary the types of wh- questions you ask (who, what, where, when, why).  Additionally, you can ask questions about events that haven’t occurred yet in the story to assist your child with making predictions.  For example, you could ask, “What do you think will happen to George at the end of the story?”


Respond to your child’s communication during the story.  If your child asks a question about the story, you can provide an answer.  If your child makes a comment or prediction, you can provide a response.


Expand on what your child says by adding more words to what s/he has said.  For example, if your child says “George banana,” you could expand by saying, “George is eating the banana.”

Here is a great video from Dr. Roseberry-McKibbin showing CARE in action.


Roseberry-McKibbin, C. (2014). Multicultural students with special language needs: Practical strategies for assessment and intervention (4th ed.). Oceanside, CA: Academic Communication Associates.

5 Household Objects that can Double as Toys

Children learn many things through play.  Unfortunately, though, toys can be expensive.  If you’re looking for some inexpensive play activities, look no further!  Check out this list of 5 household objects that can double as toys.

  • Cups
  • Toilet paper/paper towel roll
  • Tongs
  • Bowl/Container
  • Spoon

Watch this video to see how you can use these objects with your kids.  Remember the sky’s the limit and your imagination is endless!

Let’s Go Bowling: Supporting Communication at the Bowling Alley

It might seem odd that I’m writing a post about bowling on a beautiful, sunny spring day when most people are thinking about spending time outside, but it’s always good to think of activities we can do when the weather isn’t so great (in fact this holiday weekend, the forecast in northern NJ is all rain!).  Bowling to the rescue!  There is actually a great nationwide program for children to enjoy bowling all summer long — for free — called Kids Bowl Free.  Although adults don’t have the option to bowl completely free, there are package options where parents, grandparents, caregivers, etc. can bowl with their children at a significantly reduced cost.

Now that you know about the Kids Bowl Free program, I’m sure you’re wondering what on Earth bowling has to do with supporting communication. Am I right?  It’s not the first activity that comes to mind when you think of supporting communication; however, bowling is a social activity and any social activity is a great opportunity to encourage communication.  The best thing about bowling is that it can be enjoyed by children and adults alike, so any person, young or old, regardless of communication level or type of disability, can enjoy some time at the bowling alley and practice his/her skills.

At the bowling alley, we can support communication by:

  • Socializing with existing friends and making new ones
  • Practicing sharing and taking turns (e.g., It’s your turn.)
  • Talking about colors, shapes and sizes (e.g., red ball, round ball, big ball)
  • Learning about sequence (e.g., I go first, you go next, he goes last.)
  • Using exclamations (e.g., Strike! Good job!)
  • Talking about what’s happening (e.g., The pins fell down.  The ball rolled down the lane.)

That’s just a few ways you can work on communication skills at the bowling alley.  What indoor activities do you enjoy for practicing communication skills?


Introduction to Telepractice

Telepractice (AKA telemedicine, teletherapy, telehealth, telespeech, telerehabiliation, virtual speech therapy) is the delivery of health services via a telecommunications system. This service model is becoming increasingly more popular in the fields of speech-language pathology and audiology. Large factors that have driven the use of telepractice are reducing travel time for the client and/or professional and expanding the reach of services. Telepractice is becoming a more widely used and accepted method of providing speech-language pathology and audiology services. However, many families are skeptical that the services provided through a computer could be beneficial or equally as productive as those provided face-to-face. Despite family reservations, researchers (e.g., Gorgan-Johnson and colleagues) have found that children receiving virtual speech therapy do as well as those receiving services in person.

Benefits of Telepractice

  • Decreases the rate of cancelations or no shows
    • Sessions can still occur in bad weather or when the speech-language pathologist (SLP) or client are sick.
  • Allows underserved populations to receive evaluations and treatment
    • Individuals living in rural towns may struggle to find local in-person services for their needs. Furthermore, individuals from culturally or linguistically diverse backgrounds may struggle to find appropriate services in their area. By using telepractice, these clients are able to receive the services they deserve.
  • Increases family involvement in the sessions
    • Family members can have a more active involvement by assisting clients with the session activities.
  • Increases interest or attention with clients that are motivated by and/or more comfortable in front of computers
    • Clients may be more engaged during their sessions because they enjoy being on the computer. They may also feel more comfortable asking and answering questions and performing difficult tasks with the computer screen as a safety net.
  • Allows clients to connect with professionals who specialize in their disorder or disability and/or can provide services in their native language
    • Speech-language pathology is a broad field. Although all SLPs receive some degree of training in all aspects of speech, language, and swallowing disorders, most  specialize in certain areas over areas.  For example, some SLPs may specialize in working with children with autism while others may have extensive training in treating adults who have aphasia. In addition, the majority of SLPs are monolingual and/or do not have the training to provide appropriate services to a bilingual client.
  • Makes sharing information easier
    • Clients and SLPs can share their computer screens and upload files to enhance the therapy session.
  • Helps clients and families to remember and understand what occurred during the session
    • Virtual therapy sessions can be recorded (with permission) and used for later review. By recording the sessions, clients and family members can watch what occurred. Watching the recordings assists clients with practice and carryover of skills. Moreover, watching previously recorded sessions allows everyone to observe the progress that has occurred.

How can we help?

At Liberty Speech Associates LLC, we provide telepractice sessions for the following purposes: accent modification, counseling, speech-language evaluations and treatment, speech-language screenings, and collaboration with related professionals. For more information on our telepractice services, contact us today.


  1. Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N. (2010). A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy. Journal of Telemedicine and Telecare, 16(3), 134139.
  2. Grogan-Johnson, S., Gaebel, R., Taylor, J., Rowan, L. E., Alvares, R., & Schenk er, J. (2011). A pilot exploration of speech sound disorder intervention delivered by telehealth to school-age children. International Journal of Telerehabilitation, 3(1), 3141.
  3. Grogan-Johnson, S., Schmidt, A. M., Schenker, J., Alvares, R., Rowan, L. E., & Taylor, J. (2013). A comparison of speech sound intervention delivered by telepractice and side-by-side service delivery models. Communication Disorders Quarterly, 34(4), 210220.

Learning to Talk: Speech and Language Milestones Birth to 3

The first 3 years of a child’s life are crucial to overall development. A lot of changes occur in just 3 short years. For example, a child begins walking, talking, and developing a unique personality. It can be an exciting time for families as they watch their children develop new and exciting skills. While it is an exciting time, it can also be scary if you don’t know what to expect. How do you know if your child is developing “normally” (especially if this is your first child)? I’m here to help you navigate through the first 3 years with this blog post about speech and language milestones.

Before discussing the milestones, I’d like to briefly explain the terminology used to describe communication. Understanding the differences between these terms is important in monitoring your child’s development.



There are two types of language: receptive and expressive. Receptive language is our ability to understand words. Receptive language is fundamental in the development of expressive language and speech. A child’s ability (or inability) to understand sounds and words will impact how s/he uses those words. Expressive language is our ability to express ourselves. Many people think that expressive language is synonymous with speech, but that, in fact, is not true. Expressive language is a broader term. It’s how we express ourselves in all modalities, whether it be speaking, writing, gesturing. Speech, however, is the physical act of talking; it is the way we make sounds.


So now that you understand the different aspects of speech and language, let’s see how your child is doing:



Before 6 months, a child typically:

Vocalizes and coos

Varies vocalizations based on needs

Begins babbling

By 1 year, a child typically:

Follows some simple directions

Identifies familiar objects

Enjoys Peek-a-Boo

Imitates sounds and words

Says a few words

Waves and uses gestures

Between the ages of 1 and 2, a child typically:

Points to objects/pictures upon request

Pays attention to books and pictures

Answers simple questions

Uses new words frequently

Begins combining words

Uses words instead of crying or gesturing

Says the b, d, p, m, n, and h sounds correctly

Is understood 50% of the time by age 2

Between the ages of 2 and 3, a child typically: 

Follows two-step directions

Uses 2- and 3-word phrases and sentences

Tries to have a conversation

Is understood 75% of the time by age 3

Says the w, t, k, g, and f sounds correctly


Although these milestones are agreed upon by many in the field, it’s important to keep in mind that all children are different. Speech and language development can vary slightly from child to child. Therefore, it’s important to think about your child in comparison to other children in your family or in your community that are around the same age.

If your child is not following the pattern described above, or a pattern similar to those of the children in your family or community, your first step should be to have your child’s hearing tested by an audiologist. An audiologist is a hearing doctor and can complete a thorough examination of your child’s hearing ability (a pediatrician cannot perform this type of test). Hearing loss (even very mild hearing loss), as well as frequent ear infections or fluid in the ear, can impact a child’s speech and language development.

After you’ve had your child’s hearing tested, your next step should be to contact a speech-language pathologist to have your child’s speech and language skills evaluated.



ASHA (n.d.). How does your child hear and talk? http://www.asha.org/public/speech/development/chart/

Coplan, J., & Gleason, J.R. (1988. Unclear speech: recognition and significance of unintelligible speech in preschool children. Pediatrics, 82,447-452.

McLeod, S. (2009). Speech sound acquisition. In J.E. Bernthal, N.W. Bankson & P. Flipsen Jnr (Eds.), Articulation and phonological disorders: Speech sound disorders in children (6th ed., pp. 63-120 + 385-405). Boston, MA: Pearson Education.

Is it Apraxia?

Apraxia, also known as childhood apraxia of speech (CAS), has become the go-to diagnosis for many children in Early Intervention (under 3 years of age). However, many of these children do not have apraxia or are too young to receive a true diagnosis. So what is apraxia?


Apraxia is a motor speech disorder that makes it difficult for a person to coordinate the movements of the mouth for speech. Apraxia can occur in children or adults, but for the purpose of this post, I will focus on CAS. There is some debate over the exact diagnostic features of CAS, but some commonly described symptoms are:
  • Inconsistent errors 
  • Inappropriate prosody 
  • Vowel errors 
  • Limited inventory of consonants and vowels 
  • Increased difficulty with longer, more complex words and utterances


Additionally, children with CAS tend to be “late talkers;” however, late talking in and of itself does not warrant a diagnosis of CAS. As can be seen by the aforementioned symptoms, the characteristics of CAS are described with regards to talking, so if a child is not yet talking or not talking much, a clear diagnosis of CAS cannot be made. In fact, the American Speech-Language-Hearing Association goes so far as to say that “diagnosis below age 3 is best categorized under a provisional diagnostic classification, such as ‘CAS cannot be ruled out,’ ‘signs are consistent with problems in planning the movements required for speech,’ or ‘suspected to have CAS.’ 

If you have concerns with any aspect of your child’s speech or language development, it is suggested that you contact a local speech-language pathologist so that a thorough evaluation can be completed.



Hearing 101

Our hearing ability has a great impact on our communication, from birth through adulthood.  Yet, when I recommend hearing tests to current or potential clients, I am often met with the same response, “My child hears fine” or “I hear fine.” Although one’s hearing may appear “fine,” it is not guaranteed that the person can truly hear everything. What we hear is broken down into frequencies (pitch) and decibels (loudness).  It is possible to experience hearing loss at certain frequencies rather than others. So even though you or your child may appear to hear everything, it is not necessarily the case.

Hearing Loss and Communication


For children, hearing loss can lead to a variety of communication difficulties.  For example, a child with hearing loss may experience difficulty formulating grammatically correct sentences.  S/he may also have trouble developing an age-appropriate vocabulary.  In addition, a child with hearing loss may mispronounce consonant and vowel sounds.  Other difficulties may include: following directions, responding to questions, understanding class material, and socializing in large groups.


For adults, hearing loss can also lead to communication difficulties.  For example, speaking on the phone or in loud environments (e.g., restaurant) may be difficult.  It also may be hard to fully understanding someone’s message.  Hearing loss may impact an adult’s willingness to engage in group social situations.

Hearing Tests for Everyone

Because hearing loss has such a significant impact on our lives, it is crucial that all individuals get their hearing checked regularly.  Usually when we think of a “hearing test” we envision the experience we had in the nurse’s office at school; however, this “test” is actually a hearing screening. A hearing screening is a quick test that determines if an individual requires a complete audiological evaluation (hearing test). A hearing screening is on a pass/fail scoring system; if a person does not respond to a tone on the screening, s/he automatically fails and is referred for a complete evaluation. Hearing screenings are also done with newborns. A complete audiological evaluation is conducted in a soundproof booth and is done by an audiologist.

If you or a loved one are having difficulty hearing or communicating, a hearing test is a must.  Even if you don’t have specific hearing or communication concerns, regular hearing tests are strongly recommended.  Refer to American Speech-Language-Hearing-Association website for guidelines on when and how often to have your/your child’s hearing tested.

Early Intervention: What It Is and What It Isn’t

Early Intervention (EI) is a great program for young children and their families to receive related services.  Services might include speech therapy, physical therapy and occupational therapy. In NJ, this program covers children from birth to age 3. Although it is a great program, there are many misunderstandings about what EI is and isn’t.  My hope is that through this blog post families seeking EI services will understand what the experience entails (and what it doesn’t).

What Early Intervention is:


If your child is receiving EI services, the therapist(s) should typically not be bringing in any of their own toys or special gadgets. As EI service providers, we’re supposed to show you how to use what you have in your environment to encourage various developmental skills.


EI is about you as a family. There should be ongoing discussion between you and your therapist(s).  It’s our goal to assist your child and your family with day-to-day routine activities (e.g., food shopping, story time at the library).  Your family’s needs and goals should dictate the goals and types of services that are provided. Because EI is centered around the family, family members/caregivers should be active participants in the therapy process. In fact, family members should be essentially driving and providing the services.

A Learning Experience

The learning experience is for you as the parent as much as it is for your child. You’ll learn new techniques and activities (or how to manipulate old activities) to facilitate your child’s overall development.

What Early Intervention isn’t:


It is a common misconception that EI is free.  Unfortunately, in NJ, this is not the case. The evaluations, as well as all meetings, are at no cost to the family. However, the actually services, such as speech therapy, are at a cost. The cost is on a sliding scale based on your family’s income. Your EI therapists are not privy to any of your income or billing information.

Traditional Therapy

As mentioned above, EI is based on a family-centered approach. If you are looking for traditional therapy, where your child works 1:1 with a particular service provider based on goals that the service provider deems fit, EI is probably not the best choice for you.


Many times doctors recommend that a child receive a certain number of hours of therapy (e.g., 2 hours per week of speech therapy) based on his/her medical condition or disability. However, because EI is not a medically-based or clinical program, these recommendations don’t hold much weight. As a family-centered model, you, as the parent/caregiver, are driving the therapy.  EI service providers are supposed to spend the least amount of time in the home necessary to show you different techniques that you can implement on a day-to-day basis.

A Babysitting Service

This may seem obvious, but EI is not a babysitting service.  Your service provider is there to help you to help your child.  You should be actively involved in the therapy sessions, so that your child receives the most benefit. If your service provider tells you to leave the room or you choose to leave the room because you have a lot to do, you are not receiving EI services in the manner they were intended and your child’s progress may be affected.

Please leave a comment with your experiences with the NJ Early Intervention System. If you live in another state, I would also love to hear what EI is like where you are.

Stimulating Communication Without Spending a Dime

I often get asked about the best toys and gadgets to stimulate communication in children.  And, although I do have some favorites, communication occurs everywhere, everyday (#CommunicateEverywhere).  No special gadgets or gizmos are needed.  So keep your money in your pocket and use your everyday routines to work on your child’s speech and language skills.  There are numerous ways that you can help your child learn and stimulate his communication without spending a dime…or leaving the house.  Here 9 tried and true activities for communication development:

Speak to Your Child

Children understand a lot more of what we’re saying than we think.  Speak to your child even if you think s/he doesn’t understand or isn’t listening. You can describe activities as they’re happening (e.g. Mommy’s making dinner), model words and phrases, ask questions, and so on…

Read Books and Look at Pictures

If you have children’s books at home or have access to books from the library, read them to your child. Or if your child won’t sit and listen to the story, you can make the activity more interactive by asking him to find, name, or describe certain pictures. You can also take turns “reading” the story. You can read or describe the story to your child and then pass the book along and allow him to re-tell the story using the pictures for support. If you don’t have access to books, or are interested in trying something else, use your own photos to make a book. Children are sometimes more engaged when they see pictures of themselves or people they know

Invite Your Child into the Kitchen

Some families are hesitant to bring kids into the kitchen because it’ll lead to a mess. But the benefits of bringing your child into the kitchen should outweigh the mess. You can teach your child various skills, such as sequencing and counting.

Let Your Child Participate in Chores

Not only does this help children learn, it also helps you gets the chores done! Talk about a bonus! If you are doing laundry, have your child match up the socks. Doing this one activity, your child can learn the skill of matching similar objects, can learn colors (if you have socks with different colors or designs), and can practice counting (among other things).

Do Arts and Crafts

There are millions of websites (and Pinterest boards) out there with arts and crafts activities that can be done with children of all ages. Arts and crafts that are particularly beneficial are those that can be used multiple times, such as homemade dough, masks, or puppets.Watch this video about a simple bunny puppet craft that can be used to stimulate communication.  The list of skills a child can learn from one craft is endless.

Keep Your Used Toilet Paper/Paper Towel Rolls

After you’ve used up all the paper, use the rolls for a variety of functions: to make binoculars, to use it as a microphone, to use it as a telescope…Oh the fun your child can have with that. If using it as a microphone, take turns making silly sounds (and then eventually words or phrases) into it. Your child will be encouraged to try and speak and imitate you during this fun and interactive game. If using it as binoculars or a telescope, your child can become an adventurer, looking for people and objects that are around the house or in pictures.

Have a Scavenger Hunt

You can do this by hiding pictures or objects around the house and having your child find them. Your child can work on skills, such as identifying specific objects (e.g. Johnny, where’s the ball?), naming objects (ball!), describing objects (big ball), using location phrases (on the table), and so on.

Sing songs

Singing is a great way to engage your child and encourage sound or word imitation. Try using songs that have accompanying hand movements, such as the Wheels on the Bus. Children typically imitate movements before they imitate words. After you’ve sung the same song multiple times, pause at key parts in the song to see if your child will fill in the blank.  For example, you would say, “The wheels on the bus go….” and your child would finish “round and round.” Depending on your child’s age or developmental level, he may not be able to say or pronounce the appropriate words, but may be able to produce a sound (e.g. “ah”).

Play I Spy

You can work on various concepts with your child by playing this typical children’s game. Concepts could include: colors (I spy something yellow), sizes (I spy something large), shapes (I spy a circle), etc. Your child can practice identifying objects based on your descriptions and/or your child can practice describing objects for you to find.


I think this list is good enough to get you started and demonstrate the point that expensive toys or contraptions are not needed to have fun, learn, or speak. So spend some much-needed time at home with your child relaxing and doing some of these fun activities. Keep in mind that all of the activities can be made simpler or more complex depending on your child’s age or skill level.

Check back for more activities in upcoming posts!

Bilingualism: Separating Myths from Truths

About two years ago, I wrote an article entitled To Be Bilingual: That is the Answer, Not the Question for in the NJ Speech-Language-Hearing Association’s publication VOICES. This article aimed to debunk myths about bilingualism that are spreading like wildfire around the U.S. The article was primarily seen by speech-language pathologists and audiologists in NJ, but the unfortunate truth is that it’s not just NJ speech-language pathologists and audiologists that are spreading these myths; it’s doctors, physical therapists, teachers, social workers, families…The list goes on and on.


At least once per day bilingual families tell me that they’ve been told by another professional to use only English in their households due to the dangers of bilingualism. Who knew bilingualism could be so dangerous? It’s truly crazy when you think about it. I spend hours each day listening to ludicrous, unfounded myths about bilingualism. So I’m going to take the time now to provide the research-based truths. It’s my hope that by sharing the information in this blog, rather than in an article like I did the first time around, it’ll reach more people nationwide and across the world.



The dreaded myths:

Bilingualism confuses children.

Bilingualism causes delayed speech and language development.

Code-switching is indicative of a delay or problem.

Children with delayed speech and language skills should only learn English.

Individuals with developmental disabilities (e.g. autism, down syndrome) cannot become bilingual.


These myths couldn’t be further from the truth and yet they continue to be spread around. Why they continue to be spread is beyond me. I don’t know if it’s a lack of awareness and knowledge or what, but it bears repeating (a million times over) that these myths are NOT in any way true.



The research-based truths:

Bilingualism DOES NOT lead to delays or confusion.

Code-switching is a normal part of development in bilinguals.

Parents and family members should speak their native language at home with their children.

All children, regardless of whether or not they have a disability, can become bilingual.



Bird, E. K., Cleave, P., Trudeau, N., Thordardottir, E., Sutton, A., & Thorpe, A. (2005).      The language abilities of bilingual children with down syndrome. American Journal of Speech-Language Pathology, 14, 187-199.

Genesee, F., Paradis, J., & Crago, M. B. (2004). Dual language development and disorders: A handbook on bilingualism and second language learning. Baltimore: Paul H. Brookes Publishing Co.

Kremer-Sadlik, T. (2005). To be or not to be bilingual: Autistic children from multilingual families. Paper presented at the 2003 at the ISB4: Proceedings of the 4th International Symposium on Bilingualism. Retrieved October 20, 2011, from www.cascadilla.com/isb4.html

Macnamara, J. (1966). Bilingualism and primary education. Edinburgh, Scotland: Edinburgh University Press.