Speech Therapy

Speech Therapy

Category Archives: Speech Therapy

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.

Introduction to Speech Sound Development

Do you ever wonder if your child or student’s pronunciation skills are appropriate for his/her age?  As a speech-language pathologist, I’m often asked about typical speech development by concerned parents and teachers.  Today’s blog post is intended to address this area.  Whether you currently have concerns or not, this blog post will help you to monitor your child’s pronunciation skills.

To start, it’s important to understand what is meant by “speech.”  Speech is the way we make and pronounce sounds and words.  Speech is different than language, which is the way we communicate.  For more information on the differences between speech and language, check out this post.

Typical Speech Development

Although all children develop at different rates, there are generally accepted ages at which children are expected to correctly say different sounds.

Disclaimer: The information in this post is related to correct pronunciation of English consonants for monolingual English speakers in the US.

Between the Ages of 2 and 3

On average, children between the ages of 2 and 3 are able to correctly pronounce 13 different consonant sounds.  These sounds are: P, B, M, D, N, H, T, K, G, W, NG, F, Y.

Age 4

Typically 4-year-olds can correctly say 7 different consonant sounds.  These sounds are: L, J, CH, S, V, SH, Z.

Age 5

When children are 5, they are expected to say R, ZH, TH (voiced) correctly.  Voiceless TH is expected at age 6.

If your child or student’s speech sound development does not align with the aforementioned age expectations, it is recommended that the child be evaluated by a speech-language pathologist to determine if there is a speech delay or disorder.


Reference: McLeod, S. & Crowe, K. (2018). Children’s consonant acquisition in 27 languages: A cross-linguistic review. American Journal of Speech-Language
Pathology. doi:10.1044/2018_AJSLP-17-0100

Literacy Activities to Try at Home

In honor of Dr. Seuss’s upcoming birthday, I thought I’d do a post about literacy activities.  Did you know that a child’s exposure to books greatly impacts his/her communication and academic skills?  Through this post, I hope to share some easy-to-implement literacy activities.  These activities will help your child improve his communication, vocabulary, and literacy skills.

4 Easy Literacy Activities

1. Engage your child in rhyme

There is probably no one more famous than Dr. Seuss when it comes to rhyme.  Take, for example, one of his most popular books, The Cat in the Hat.  There are rhymes abound on every page.  Keep in mind, though, you don’t just have to rely on Dr. Seuss or other rhyming books to encourage or develop this skill.  Aside from books, other great tools to encourage rhyme are nursery rhymes and children’s songs.  Whether it be a familiar story or song, try pausing at crucial parts to see if your child can fill in the appropriate word (e.g., The cat in the _____).

2. Use wordless picture books

Have you ever heard of a wordless picture book?  If not, it’s exactly as it sounds.  It’s a picture book with absolutely no words.  Now, I’m sure you’re wondering how a book with no words could encourage literacy development, but hear me out.  By using wordless picture books, children can practice making up their own stories and developing narrative skills that are so important for both understanding and telling stories.  If the idea of telling a story is new to or difficult for your child, you can make up the story first and then give your child a turn.  Two great books that I use in therapy are The Boy, the Dog, and the Frog by Mercer Mayer and Pancakes for Breakfast by Tomie DePaola.

3. Have a letter/word scavenger hunt

Who doesn’t love a good scavenger hunt?  Scavenger hunts are activities I use a lot in therapy because many different skills can be practiced while allowing children to run around and have fun.  If your child is just beginning to learn and recognize letters, see if she can find specific ones when you’re out at the grocery store or driving in the car.  This is a game my son absolutely loves.  If your child is learning to read words, you look for familiar words in books, magazines or even on food containers (e.g., the cereal box).

4. Role play your favorite story

Does your child have a story or book that he makes you read over and over and over again?  I know mine sure does.  Whether it’s your child’s favorite book or one that is fairly new, use role play to bring the story to life.  For some children, sitting for a story can be a difficult task, so by bringing puppets or costumes into the mix you can grab their attention.  There are many story kits you can buy to accomplish this task, but I suggest looking for things you already have around the house to act out the story.  The more you and your child use your imaginations, the better the learning experience will be!


This is certainly not an exhaustive list of literacy activities, but I hope it’ll get your mind thinking of other ways you can engage your child in the magical world of story.  For some more inspiration, visit Seussville.


9 Questions to Ask your Insurance Company about Speech Therapy Coverage

Navigating the insurance process can be a tricky and frustrating thing.  Sadly, there are many restrictions to speech therapy coverage, so asking the right questions is crucial to determine if/how much speech therapy will be covered for you or your loved one. But I’m here to help you with that.  I’ve compiled a list of the top 9 questions you should ask your insurance company about speech therapy coverage.

 These questions will help you understand your speech therapy benefits

1. What diagnosis (ICD-10) and treatment (CPT) codes are covered for reimbursement?

There are a variety of different diagnosis and treatment codes that could be applicable to your speech therapy coverage.  It’s important to speak to your speech-language pathologist (SLP) to determine which codes apply to you.

2. What codes and/or conditions are excluded from my coverage?

As mentioned above, not all speech therapy coverage is created equal.  Unfortunately, many insurance plans exclude different codes or conditions from coverage.  This means that even if you choose to use a SLP or clinic/company that accepts your insurance, your services may still not be covered.  In many cases, insurance companies exclude “developmental” speech therapy services.  These types of services typically apply to children who are “late talkers” or have a “speech delay” or “language delay.”

3. What conditions are covered?

As important as it is to find out what conditions and codes are excluded from your coverage, it’s equally important to verify what conditions are covered.

4. Do I need a prescription to obtain speech therapy coverage?

Some insurance plans require your doctor to write a prescription for speech therapy.  If you need a prescription, but don’t obtain one prior to starting speech therapy, the services will likely not be covered.

5. Do I need a pre-certification or prior authorization for speech therapy coverage?

Your plan may require pre-certification or prior authorization for speech therapy coverage.  This is a process in which you need to be pre-approved for the services in question.  If your insurance company does require it, it’s important to ask what the pre-certification/prior authorization requirements are.

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6. Are out-of-network speech therapy services covered?

There are many instances where you may choose to use an SLP for speech therapy services that does not accept insurance or is not in your plan.  You may choose to do this due to the SLP’s reputation, expertise, and/or proximity to your home.  If you are looking to pay for services with your insurance, it’s crucial that you confirm if out-of-network benefits are covered prior to initiating services with an out-of-network SLP.  However, if you are not worried about seeking reimbursement, you may begin services without contacting your insurance company.

7. Do I have a deductible, copay or coinsurance?

Even if speech therapy, and the specific codes/conditions described above, are covered, you may be responsible for a deductible, copay, and/or coinsurance.  If you are responsible for any one of these expenses, an important follow up question would be specifically how much you are required to pay.

8. Can I be reimbursed for out-of-pocket speech therapy expenses?

If you can receive reimbursement for out-of-pocket speech therapy expenses, there are additional questions you should ask.  For example, what is the reimbursement rate? You should also find out what you need to do and/or submit to obtain reimbursement.

9. How many speech therapy sessions are covered per calendar year?

Did you know that many insurance plans have a limit on how many therapy sessions a person can receive?  Seems kind of crazy, doesn’t it?  Well it’s important to find out if this is applicable to your plan.  Some plans restrict patients to 60 therapy visits during a calendar year.  That may not seem bad if you are receiving speech therapy one time per week.  However, many plans that have this restriction often lump speech therapy, physical therapy, and occupational therapy together in those 60 visits.


I hope you found these questions clear and helpful in deciphering your speech therapy insurance benefits.  Here’s to hoping you can begin to become the master of your insurance benefits.

Visit our blog again soon for more speech therapy related content!

5 Tips for Aphasia

If you’ve made your way to this post, it’s probably because you are currently caring for someone with aphasia.  Unfortunately, most people have never heard the word “aphasia” unless they or a significant other has received that diagnosis.  So without much knowledge on this diagnosis, it can be tricky to provide the best care for your loved one.  Although no two people are alike or present with the same aphasia characteristics, there are simple ways you can enhance your interaction and communication with your loved one.

Here is a list of easy-to-implement tips you can use while caring for someone with aphasia.  By using these tips, you can improve your communication and interaction with your loved one.

1. Reduce noise

A signature difficulty for people with aphasia is understanding spoken language.  If you are talking in a crowded restaurant or with a loud TV in the background, it will be harder for your loved one to understand what you’re saying.

2. Speak slowly

Slowing your rate of speech can enable a person with aphasia to understand you better.  It’s not necessary to speak unnaturally slow, but be mindful of your rate.  Add a few more pauses in between phrases or sentences to give your loved one time to process.

3. Use visuals

Visuals, such as pictures, gestures, drawings, and written words, can provide an extra layer of support for people with aphasia.  For example, if a person with aphasia cannot understand the spoken word “spoon,” you can provide additional support by showing him/her a picture of a spoon or demonstrating what to do with a spoon.  These visuals will allow the person with aphasia to successfully understand your message.

4. Shorten your sentences

It’s important that you speak to your loved one like an adult, but modify your sentence length so that processing is easier.  You can continue to talk about topics of interest (e.g., hobbies, politics, family), just keep it short and sweet.

5. Modify your questions

In everyday conversation, we use a lot of open-ended questions.  For example, we might say something like, “what are you doing today” or “why did you do that?”  However, for people with aphasia, these types of questions can be tricky.  Open-ended questions require them to find the word/words needed to answer the question, which may not be easy.  There are two different ways you can modify your questioning to assist your loved one.

1) Give possible answer choices for your questions.  For instance, if you wanted to ask, “what are you doing today,” you could provide pictures or written words of possible answers.  By providing choices, the person with aphasia will be better able to say an appropriate response or can point to the appropriate picture if s/he still can’t access the words to say them aloud.

2) Ask yes/no questions when possible.  For example, instead of saying, “what are you doing today,” you can ask “are you going to the store today?”

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!

Speech and Language: What’s the Difference?

Most people use the words speech and language interchangeably. However, in the field of speech-language pathology, these two terms are widely different.

What is Speech?

Speech refers to the actual act of speaking and producing sound.  For example, a person’s accent and pronunciation of different sounds and words would be classified under the speech umbrella.  Also under that umbrella are fluency and voice.  Fluency is how fluidly a person speaks and if there are any stuttering episodes or pauses present.  Voice refers to a person’s pitch, volume, rhythm, quality (e.g., hoarse), and resonance (e.g., nasal).  All of these characteristics of speech can be used to convey language, but one doesn’t need speech to have language.

What is Language?

There are two basic components of language – receptive and expressive.  Receptive language refers to a person’s comprehension – ability to understand spoken words, written words, gestures, sign language, etc.  Expressive language is a person’s ability to express his thoughts and feelings, using any mode of communication.  Although many people use speech to express themselves, communication can occur in other ways too.  For example, facial expressions, hand gestures, writing, and drawing are all components of expressive language.

Where Can Breakdowns Occur?

Speech and language difficulties can affect people of all ages and in different ways.  For example, a toddler may be delayed in speaking, but understand words and instructions.  A different toddler may be saying words and sentences, but have trouble correctly pronouncing those words.  And yet another toddler may be talking and pronouncing words correctly, but may have trouble comprehending others.  An older child may experience difficulties with reading and understanding classroom content.  An older child may also have trouble telling an understandable and logical story.  Some adults may have persistent speech and/or language difficulties that didn’t resolve or weren’t treated in childhood.  Adults can also experience speech and/or language difficulties as a result of neurological diseases (e.g., Parkinson’s, Alzheimer’s) or stroke.

Disclaimer: This post is just a general summary, but not an exhaustive list, of where speech and language breakdowns may occur for children and adults.  For more information about possible speech and language difficulties, check out the “Disorders” section of the Liberty Speech Associates website.

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.

Stroke 101

Today’s blog post is all about stroke – signs, risks, and types. 


Many individuals don’t realize that they are having a stroke because they don’t know the signs. Therefore, it’s important that you know them.

Three signature signs are:

  • facial drooping
  • weakness on one side of your body
  • slurred speech
Look out for these signs for yourself and your loved ones. Stroke can happen to anyone.

Risk Factors

Although many people believe that stroke only happens to seniors, that is not the case. In fact, there are many adults in their 20s, 30s, and 40s having strokes. There are several risk factors that put you at a higher risk to have a stroke at any age.

Risk factors include

  • obesity
  • a sedentary lifestyle
  • frequent consumption of drugs or alcohol (cigarettes also fall in this category)
  • high blood pressure
  • diabetes
  • heart disease

Common Types of Stroke


An ischemic stroke is the most common and is the result of blocked or narrowed arteries


A hemorrhagic stroke is caused by a leak or rupture of a blood vessel

Transient Ischemic Attack (TIA)

A TIA (AKA “mini stroke”) is the result of a temporary blockage leading to a short period of stroke symptoms.

Be sure you always remember the signs and that you Act FAST. F for facial drooping, A for arm weakness, S for slurred speech, and T for time. The sooner you respond to the signs and symptoms and get yourself checked out, the better your odds are in the long term.
Please leave a comment below with any questions or comments you have regarding stroke. Visit our website and the Liberty Speech Associates YouTube channel for more information on stroke and other disabilities that can impact communication.