Because the heart of a family is its shared culture, differentiating between language disorders and language differences in bilingual children offers special challenges.

Graciela is almost 3, but she’s not able to answer her mother’s questions, identify objects or combine two or three words to express her needs. At the time of her bilingual speech and language evaluation, Graciela communicated her wants and needs by mostly using gestures and one-word utterances (mostly in Spanish). Her parents report that Spanish is used about 80 percent of the time by mom, dad and Graciela’s grandmother, while English is spoken 20 percent of the time by her two older brothers.

Raising bilingual children
There are obvious benefits in raising a bilingual child. For example, knowing two languages provides a student with cognitive and academic advantages. Bilingualism allows a child to maintain cultural ties with his parents’ heritage thereby promoting cross-cultural understanding and communication. However, the task of maintaining both languages does come with its share of challenges. Respected researcher, educator and linguist, Dr. Lily Wong Fillmore, emphasizes that success in raising children to be bilingual is difficult since most children eventually become English dominant or even monolingual in English. This is due in part to the perceived status associated with speaking English. Children may experience negative attitudes regarding their home language and may refuse to use it. Among the consequences of losing the native language is the compromised communication with family members who don’t speak English. For a child who is experiencing learning difficulties in two languages, the struggles at school and at home can seem daunting.

Assessing and evaluating the problem
Regardless of whether children with deficits in language learn one or two languages at a time, the risk for significant negative social and academic outcomes is the same. Katherine Kohnert, Ph.D., CCC-SLP, an expert in bilingualism and language disorders, reports there is a significant subset of bilingual children who will have chronic deficits in language. She further states that although being bilingual does not cause a language disorder, if an underlying deficit is present (such as dyslexia) it will manifest in both languages.

The greatest challenge bilingual children face is ensuring that they are assessed appropriately. According to Dr. Vera Gutierrez-Clellen, CCC-SLP and Director of the Bilingual Child Language Research Laboratory at San Diego State University, if bilingual children are assessed appropriately, there is no evidence that bilingualism impairs their rate or quality of development in the target languages. When a bilingual child is having difficulty with language learning, the first step is to identify whether he needs more time to acquire a second language versus whether he is exhibiting true language delays in both languages. This can be accomplished through a bilingual speech and language evaluation. Though in some areas the number of bilingual speech-language pathologists is limited, in most cities there are resources available through the child’s school system, university clinics, hospitals and/or outpatient centers. If an interpreter is necessary to assist with the assessment, it is critical to have one that is properly trained. Sometimes using family members as interpreters causes problems, since there are nuances and subtleties in medical and clinical language. When deciding if an interpreter is necessary for a bilingual speech and language evaluation, the following points should be considered:

• The certified speech-language pathologist or audiologist on the staff does not meet the recommended competencies according to the American Speech-Language-Hearing Association (ASHA) to provide services to limited-English proficient speakers.
• An individual who needs services speaks a language which is uncommon for that local area.
• There are no trained professionals readily available with proficiency in that language that would permit the use of one of the previously described alternative strategies

If it is determined in the speech and language evaluation that a child is experiencing difficulties in one language, but scored within normal limits in the second language, it is likely that he has a language difference. In other words, the child may be experiencing a period of language deficiencies in the less proficient language but continues to exhibit age-appropriate receptive and/or expressive language skills in his preferred or dominant language. However, based on anassessment conducted by a bilingual speech and language pathologist, if a child exhibits deficits in both languages, a true language disorder is present. It may be time to pursue speech and language therapy provided by a bilingual clinician.

Graciela’s evaluation was conducted primarily in Spanish, using a trained interpreter, and it was determined that a true language disorder was present. She began regularly attending speech and language therapy sessions with a bilingual clinician for six months. Her therapy sessions were conducted in Spanish. At the same time, Graciela was enrolled in a daycare program where she was immersed in English.
One language or two?

Kohnert suggests that before one decides between using only one language with a language-impaired child or both languages, it is imperative to remember the role his environment plays. Some environments exacerbate difficulties, while other environments facilitate language learning and performance. The following questions can help guide parents and professionals decide if the therapy plan should include one language or both.

• Are there personal, social or vocational advantages to functional skills in two different languages that warrant providing opportunities and support in both?
• Are both languages needed for meaningful communication in different settings, with different partners?
• Can one language be sacrificed without compromising the person’s quality of life, in terms of personal relationships or social or professional aspirations?

If a child has been diagnosed with a language disorder, there will be several questions that arise regarding how to structure language at home, school and in speech-language therapy to help increase the child’s overall communication skills. It is important to remember that parents are not alone in finding the answers. Parents can turn to their child’s speech-language pathologist and other professionals involved in his care to assist in deciding how to choose the best intervention.

Regardless of which approach is implemented, the key should rest on what is best for the family dynamics. If the ultimate goal is for the child to speak both languages, the family and those involved in the child’s care must collaborate together in efforts to structure his environment so that it can support both languages in his daily routines.

During the course of her therapy, Graciela began to use more English utterances in her sessions and began to use more two-word utterances. Although she was still exhibiting some deficits in both languages at the time of her re-evaluation after one year of therapy, she was demonstrating an ability to use both Spanish and English for functional purposes. Despite her language impairment, she always used Spanish when speaking with abuela (grandma) and English when communicating with her teacher and peers at school. Graciela continued to make steady progress.

For parents facing a possible language learning issue with their bilingual child, it’s imperative to seek the best resources for an effective assessment and course of therapy. At the same time, the child’s home environment and family culture should be taken into account by both the parents and the professionals involved. By assessing all the child’s needs, including the cultural issues, the child’s bilingual language development will progress successfully.

Karen P. Guerra M.S., CCC-SLP is a bilingual speech-language pathologist, with 9 years of experience with pediatric population and bilingualism. In March 2008, Karen was interviewed on her expertise with bilingual children with disabilities (i.e. Autism) on CNN Espanol’s “En Familia.” Karen can be reached via email at karen.guerra@choa.org or at 404-785-3737.

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The Challenges of a Bilingual Child

Students who need speech therapy exhibit a variety of speech difficulties and challenges. These can include articulation, understanding questions and directions, vocabulary development, sentence structure and grammatical understanding, expression of wants and needs as well as thoughts and ideas, and social communications. The primary role of the school’s speech language pathologist (SLP) is to identify the student’s speech and language needs and design a therapy program to address those needs. Factors considered when determining need are age, cultural background, type of learning difference, social skills, overall academic performance, family and teacher concerns, and the student’s own attitudes towards remediation.

The collaborative model, also known as inclusion, works primarily within the student’s natural academic environment. The SLP examines how the student communicates and socializes in the regular classroom to understand the student’s strengths and weaknesses in various educational contexts. The general education teacher and the SLP work together on classroom activities and discuss strategies and techniques for academic instruction.

The collaborative model is the least disruptive to a student’s typical school day. The collaborative model best serves children who:

• have met their articulation, expressive and/or receptive goals in a one-on-one setting and now need to practice those skills in the classroom.
• are working exclusively on pragmatic language goals and need practice with peers and adults in a functional setting.
• are working on goals that require a larger group for practice such as listening and communicating during circle time or in a discussion group.
• need general monitoring from an SLP after meeting goals and while being “phased out” of speech therapy.

The pull-out model is a good choice for students with more severe speech issues that require more intensive interventions. Students receive therapy outside the classroom (pull-out) in small groups or one-on-one with the speech therapist. This mode of therapy allows for direct instruction and the use of sound placement models which are not practical for use in the regular classroom. The SLP makes recommendations to the general education teacher to provide reinforcement in the classroom of what the student learns in therapy.

The pull-out model best serves children who:

• are initially identified for articulation issues and need one-on-one drill and practice work.
• would be easily distracted in a classroom setting.
• have auditory processing issues and need a quiet setting to help them learn.
• need oral motor work with a therapist who manipulates the mouth, lips and face.
• achieve their best focus through sitting on the floor or in motion.
• may be easily embarrassed to have extra adult attention in the classroom setting.

With a student’s best interests as the priority, a speech therapy program within the school setting has many advantages. Whether it takes place inside or outside the regular classroom, the therapy should minimize disruption to a child’s daily routine. The effective coordination between classroom teacher, SLP and parents ensures that speech therapy enriches a child’s school day while meeting his unique speech and language needs.

Our appreciation to Wendy Ames, M.A., CCC-SLP, Sagamore Hills Elementary and Danielle Moore, M.S. Ed., CCCSLP, owner of The Language Group for their contribution to this article.

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Speech Therapy at School: Inside or Outside the Classroom?

by Amy B. Sherman, M.A., CCC-SLP

Have you ever dreamed you were in a foreign land where you can’t understand a word anyone says and your handy-dandy translation dictionary is nowhere to be found? Everyone else is able to communicate but it’s all “Greek” to you.

Entering the world of speech-language pathology can be as bewildering as that dream. The terminology seems alien and complex. There is the added stress of trying to be a well informed advocate for your child. The following terms will help parents new to speech-pathology feel less baf fled and better able to find an appro priate action plan.

Speech – the act of speaking, expressing or describing thoughts, feelings or perceptions through the use of words; an utterance; vocal communication or conversation; the coordination of the muscles, including breath support and voice producing mechanisms (the throat and the mouth).

Articulation – the act of vocal expression by producing a speech sound. This term can refer to a beginning, middle or ending sound or it can be a consonant blend.

Consonant blend or Consonant cluster – two or three consonants that are grouped together to make a specific sound (“br” in “break,” “sp” in “spot,” “spr” in “spray”).

Co-articulation – stringing speech sounds together in words, phrases or sentences.

Phonological process – a pattern where one substitutes, uses, moves or omits several sounds in a particular way and often within a particular place in the word. Some of the more common patterns are:

1. Fronting – consistently replacing a /d/ sound for a /g/ sound and/or a /t/ sound for a /k/ sound.
2. Backing – substituting and using the /k, g/ sounds for the /t, d/ sounds.
3. Initial consonant deletion – omission of the first (initial) sound in words.
4. Syllabic reduction or medial consonant deletion – omission of the middle consonants.
5. Final consonant deletion – omission of the ending (final) conso nants.
6. Consonant cluster reduction – the omission of part of a consonant cluster or blend.

Oral-motor exercises – mouth strengthening exercises to improve strength, coordination, function and movement, as well as to separate movements of and decrease tension of the lips, cheeks, jaw or tongue.

Stimulable – a child’s readiness to produce the specifi c speech movement or speech sound that has been in error. SLPs look at several factors (including use of different cues – visual, verbal, tactile) to determine what the child is ready to address at a particular time.

Intelligibility – the capability of being understood for the purpose of communicating needs, wants and thoughts. It does not refl ect IQ. SLPs use it to describe how much of what a child says is being understood by a familiar and unfamiliar listener.

Apraxia – in developmental apraxia or childhood apraxia of speech, children may know what they want to say, but the words don’t come out right. This is because there is difficulty coordinating or sequencing mouth movements necessary to produce and combine consonants and vowels to form syllables, words, phrases or sentences with control. For more information, please visit www.apraxia-kids.org.

Language – communication of thoughts and feelings through a system of signals, such as voice, sounds, gestures, signs or written symbols; a learned code or system of rules that enables people to communicate ideas and express wants and needs and thoughts; reading, writing, gesturing, signing and speaking are all forms of language. There are three sub-categories within this definition:

1. Receptive language – understanding speech and language (i.e. following directions, choosing the correct color or pointing to the object that is named and any other activity that demonstrates language comprehension).
2. Expressive language or communication – use of language to include uttering or writing grammatically correct sentences, answering questions appropriately, labeling items, telling about a movie or explaining how to complete a task.
3. Pragmatic skills – the social skills and nuances of communication.

Stutter, stuttering, dysfluency (also spelled disfluency) – to speak with repetition or prolongation of part of a word or the whole word; a disruption in the word that is being produced.

Voice disorders – problems with the voice (vocal folds, throat, or larynx, and may also include the breathing mechanism, known as the diaphragm) that can include an audible quality such as hoarseness, roughness, weakness, breathiness and raspiness. The voice can be too loud or too soft in volume. Also, it can be too high or too low in pitch.

Audiological testing – “audiological” refers to the ears and hearing which are tested in two ways:

1. Audiological screening – performed by a speech-language pathologist or physician, usually conducted with headphones worn by the child and is scored only as a pass/fail. If a child fails a screening, he would then be referred for an audiological evaluation.
2. Audiological evaluation – a more extensive test of the ears and usually performed by an audiologist.

Central auditory processing (also known as auditory processing) – occurs when the sounds that are heard are adversely affected and interpreted differently by the central nervous system. Subtle sounds between words are not recognized even though the sounds themselves are heard loud and clear. This can especially occur in a noisy environment or when listening to complex information (www.ldonline.com/article/8056). Effective auditory processing is associated with other higher level communication-cognitive skills including phonological processing, understanding and interpreting auditory information and attention to and memory for auditory information.

Though there are many terms associated with speech-language pathology, you won’t be expected to become an expert after reading just one article. This list gives you an effective starting point, and with the help of professionals, it will sound less like “Greek” and more like terms that apply to your child’s specific needs and treatment plan.

Amy B. Sherman, M.A., CCC- SLP is the owner of Atlanta Speech Therapy and Training. She specializes in evaluating and treating children beginning at 16 months providing personalized therapy with a whole-child approach. She can be reached at 770-330-9944.

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It Was All Greek To Me

A parent listens with great anticipation for her child’s first words. What if there’s a delay? Then the questions start flooding her mind: Am I expecting too much? Is she too young for evaluation? Is there someone who can give me some guidance? These unanswered questions, coupled with parental intuition, often directs the parents to early intervention.

The first time I saw Natalia she was 19 months old. She was adopted about six months prior from an orphanage in Russia and was accompanied to the evaluation by her parents and 8-year-old brother. At 19 months old, she was petite and looked closer to 1 year of age. Her mother reported that she mastered walking two months ago and that her greatest area of concern was Natalia’s language skills. Natalia communicated exceptionally well by pointing and after a speech and language evaluation, Natalia was diagnosed with having a motor planning/programming disorder (often referred to as dyspraxia or apraxia of speech). The evaluation team readily agreed to make Natalia eligible for speech-language services. At 20 months, she began intervention to address her expressive language skills through the state’s early prevention program called Babies Can’t Wait (BCW), (See bottombar).

 Infants and children are at risk for language delays
Children at risk for speech and language delays include babies who are born prematurely, babies with recurrent middle ear infections, babies adopted from foreign countries (often coming from orphanages with little to no language stimulation) and babies who are hearing impaired.

Take early action to determine language development
For parents concerned about a child’s speech and language skills, no age is too early to listen to your intuition and to take action. It is often beneficial to first talk to your child’s pediatrician about your concerns. Pediatricians will frequently refer parents to a speech and language pathologist (SLP) if a child’s speech and language skills are delayed. However, a parent alone can make the appointment without a medical referral.

For a child under the age of 3, BCW may be a good place to start to determine needs and appropriate services and anyone concerned about a child can make the referral. Many SLP’s are trained in assessing a baby’s feeding skills such as sucking and swallowing if this is an area of concern with a newborn.

For children over the age of 3, the local public school is an option to receive free services if the child meets certain eligibility requirements. SLP’s also have private practices. In all cases, an evaluation will be made during the initial visits.

A language evaluation is comprehensive and standardized
The SLP will assess a child’s comprehension and use of language, based on both parent report and observation of the child. A standardized testing instrument, such as the Preschool Language Scale-4, is utilized to compare a child’s language skills to that of his peers. Evaluation tasks may include picture pointing and symbolic play skills, as well as oral motor/ feeding skills.

Receptive language assessment questions include:

1. Does the child recognize and respond to changes in tone of voice and turn and look to the direction of a sound?
2. Does the child recognize and respond to his name consistently?
3. Can the child identify objects, pictures and body parts?
4. Does the child follow simple and complex verbal directions?
5. Does the child demonstrate comprehension of concepts such as big/little, wet/dry, up/down?

Expressive language skills assessment questions include:

1. Does the child cry differently for different needs?
2. Does he vocalize pleasure and displeasure?
3. Can the child put two sounds together such as “da” or “ga” and do.

Elyse Burton, M.C.D., CCC-SLP, is a private speech and language pathologist and can be reached at burtonspeech@mindspring.com.

Articulation Skills
Developmental Acquisition Norms – Recommended ages of acquisition for phonemes (speech sounds), based on the age at which 90% of children correctly produced the sound.

P, B, M, W, H	Age 3
N	Age 3-3.6
T	Age 3.6-4
K	Age 3.6
G	Age 3.6-4

Iowa and Nebraska norms, taken from Smit, Hand, Freilinger, Bernthal, and Bird (1990). Journal of Speech and Hearing Disorders, 55, 779-780

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The Educational Value of a Parent’s Intuition

Does your ride home from school sometimes feel like a one-way conversation of one-word answers to your many questions? Is your child eager to share the events of the day but you have to try to piece together what he or she is trying to say? Or maybe it’s quiet altogether, and you’re not sure how to start a conversation.

These situations may be just as frustrating for your child as they are for you. Every child has something valuable to say and wants to be heard and understood. Whether your child is 3 or 13, five simple steps—timing, topics, thoughtful questions, tricky traits and telling stories—can help you make the most of conversations with your child.

It’s All About Timing
Timing and location are key factors to make conversations most productive with your children. Distractions also play a major role in effective communication. Most children are not able to divide their attention between you and their favorite television show. Watch for times of the day when your child seems to be relaxed and more naturally talkative. Some children, like many of us, need time to wind down after their “work day” and may not be up for a discussion right out of the school doors. Instead, you may find it effective to incorporate conversation starters into a comfortable family routine. For example, each night at dinner pull a conversation starter out of a box that each family member has to answer.

For ideas, check out:
http://www.familyfirst.net/parenting/conversationkids.asp
http://www.kinderkorner.com/starters.html

Hot Topics
The topic of conversation also plays a big role in how much children want to interact. Finding subjects that interest children does require thought. Listen carefully and note what they tend to talk about with others. You can ask more specific questions if you learn the names of some friends and teachers, and also become familiar with their weekly routine and any special themes or events at school. Try getting their input on family decisions like where to go for vacation, which meal to cook for dinner or even what their punishment should be for a bad behavior. You certainly don’t have to take the advice, but you may be surprised to find out how well your child can share ideas!

Thoughtful Questions Lead to Thoughtful Answers
Once you have some good subject matter, be careful about the way you ask questions. Avoid “yes/no” questions that will lead you to a dead end quickly. Be specific enough that your child has a good place to start and is clear about what you want to know. For example, when asking a child “What happened at school today?” we often hear “nothing,” or maybe just get a bewildered look. A question like “What was the best part of your day?” or “What did you make in art class?” provides more direction. Then follow up with a request to “tell me more about it.” If that is still too open-ended, use specific “wh” questions and encourage him to close his eyes and picture what he is telling you (See Figure 1). If the child is trying to describe a particular object, provide some visual cues for details, such as the describing board (Figure 2). For younger children, try to make it a game and cover up a circle with a treat or coin each time they think of a different characteristic.

Tricky Traits Can Cause Trouble
It is also important to consider any special character traits that might make conversations more challenging. For instance, if a child typically has a hard time paying attention and focusing on tasks, be sure to start conversations in one-on-one settings. Remove other distractions, such as desired snacks or favorite toys, which might cause interruptions. Be patient. Try not to rush your child or complete his sentences before he has a chance to give it his best shot.

Training With Stories
Reading to and with your child is a perfect springboard for jumpstarting discussions at any age. In fact, narrative (story re-telling) abilities provide a strong foundation for answering more open-ended questions and describing events. Engaging your child in stories provides great practice for these skills in a safer and more predictable context than everyday conversation. Familiar books with good illustrations are best to use even for older children because they will help them recall events, keep events in sequence and provide more details.

As you read to or with your child, direct your questions to include the most important components. At the simplest level, this would consist of “who,” “where,” and “what” questions. At the next level, expand your questions to also address where the story happened, when it happened, who was in the story, what was the problem, how was it solved and what happened in the end.

As children feel successful in these more structured situations, they will gain the confidence to answer more open-ended questions at other times of the day and share their thoughts and ideas more effectively with others. Building these skills will provide a natural jumpstart to your child’s ability to engage in conversation with you and others and truly reflect all that he knows and has experienced.

Jennifer Kay Self has a Bachelor of Arts in Communication from Wake Forest University and a Master of Science in Communication Sciences and Disorders from UNC Chapel Hill. She has practiced speech-language pathology with pre-school and school-aged children in north metro Atlanta for five years. She can be reached at jenniferself@comcast.net or at 404-550-0262.

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Jumpstart Conversations with Your Kids

by Michelle Ivey , M.A., CCC-SLP

Speech disorders are the most common type of early childhood communication frustrations for parents and children alike. Research has shown that in some cases there is a connection between early speech problems and later reading difficulties. Intervention at an early age may help ease these frustrations and make learning to read a more enjoyable task for these children.

A two-year-old may seem precious when he asks for “pesetti” for dinner after he finishes playing with his “twuck”. The sentence, “Him eat chip” is fine coming from a toddler. If a child seems shy and reluctant to talk, that’s expected at young ages. However, there could be a problem that warrants intervention if these communication patterns persist into a child’s third or fourth year. Speech sound disorders are the most common type of childhood communication disorder. Early receptive (what is understood) and expressive (what is spoken) language disorders are also common. These problems may require treatment by communication specialists such as speech-language pathologists. Unfortunately, even after the errors are corrected, a child still might have further reading difficulties. If there is a family history of reading disorders, such as dyslexia, the possibility of reading problems increases.

Speech Disorders and Reading
Some speech errors are considered simple articulation substitutions. If a child is making only a few errors and they are not related, the diagnosis could be articulation disorder. Examples of this include saying “pish” for “fish” and “wan” for “ran.” This is a less complex diagnosis to remediate than a phonological process disorder. In phonological disorders, there are families of errors, such as a child saying “tootie” for “cookie,” “pid” for “pig” and “rin” for “ring.” These errors all occur when a certain group of sounds is consistently produced in a forward position in the mouth, rather than in the back where they should be made. These phonological errors tend to be more frequently related to future reading problems than simple articulation errors.

According to the Center for the Improvement of Early Reading Achievement, phonemic awareness (dealing with the individual sounds in a word) is one important part of phonological awareness and an early key to reading ability. Children with difficulty in phonological awareness consistently have problems with reading. However, good phonological awareness training at the initial stage of understanding phonemes or individual sounds can be beneficial in improving skills of those without speech impediments according to Gail Gillion, a speech language pathologist and researcher. Examples of skills included in phonemic awareness are recognition of sound similarities and differences, multiple sound blending and individual deletion and substitution of sounds. The awareness of rhyme and alliteration is the beginning of these skills. Once children can attend to the sounds of words, rather than the meanings, and isolate individual parts of the word, they can be successful with phonemic awareness activities. This results in more complex abilities to blend sounds together or omit some sounds to make new words.

Language Disorders and Reading
According to many reading experts, children with phonological disorders are not the only ones at risk for future reading problems. Children with early language disorders also may have difficulty with reading in elementary grades. This is especially true for children with errors in syntax (grammar), immature sentence structures and vocabulary. Generally these errors are delays, rather than deviances, from typical development. Examples of syntactical errors include omission of grammatical structures that have information as part of the word, for example “she write” rather than “she writes.” An immature sentence structure may lack relational phrases and conjunctions such as “I get shoes. I go.” rather than “I get my shoes, and then I go”. A vocabulary deficit is often evident when a child has difficulty using specific descriptions or words and possibly using vague terms such as “thing.” In addition to these sentence structure differences, children with later reading difficulties may be late to begin talking. Furthermore, once they begin talking, they may be more soft-spoken than peers and appear to avoid talking unless it is necessary. These children may not enjoy listening to books as much as their peers do.

Many linguistic concepts are involved in phonological processing. For a child who has a language delay these necessary skills may be difficult to master. Examples of language concepts necessary for phonological processing include first, last and middle, same and different and beginning and end. Difficulty understanding these concepts can lead to problems with the application of the phonological awareness skills. Difficulty understanding these concepts can lead to problems with the application of phonological awareness skills in word play activities such as making up silly rhymes and taking the last sound off a word.

Overall, reading involves the intertwining of many skills in different areas such as grammar, vocabulary, sound awareness and letter awareness. These are skills that are related to phonological processing and language. These underlying concepts are the foundation for a lifetime of reading.

Parents’ Role
If your child is exhibiting some of the problems associated with phonological and language disorders, you might want to investigate the possible need for intervention. You can communicate with a speech- language pathologist about whether your child is at risk and then implement a plan the therapist develops. It is important to be evaluated by a licensed speech-language pathologist as the first step. If the child is in school or daycare, communicating with the teacher or daycare provider is also important. Those that are close to him and see him on a daily basis should take notice if he enjoys storytime, nursery rhymes and books. Lack of interest in these areas may indicate difficulty with phonological awareness. Finally, take an objective look at your child. Is he showing any preliteracy skills? Is he recognizing print such as the names of stores or packages? Is he beginning to have letter awareness? While your child does not need to know each letter and sound by preschool, he should be beginning to show an interest. Try playing sound games and telling silly jokes. Difficulty with any of these can be early indicators of risk factors.

Research has demonstrated that children as young as 3 can benefit from explicit instruction in phonemic awareness. In addition, children can benefit from instruction to facilitate print awareness. Parents can help with beginning activities (see sidebar); however they should consult with a professional regarding their individual child’s needs. Parents of children with early language and articulation disorders need not panic. Many children have speech sound disorders and language disorders that require therapy. This information does not mean that every child with these types of disorders will have reading difficulty. There is only an association with a higher risk for a problem. Knowing this makes parents more informed and better able to catch difficulties early. Experts recommend not being over zealous about treatment or making any diagnosis on your own. Consultation with those involved in the child’s care will ensure that problems are addressed at appropriate times and with the best plan of action.

Michelle Ivey is a speech-language pathologist at an Atlanta outpatient pediatric practice.

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Spaghetti or Pesetti?

Pragmatic language refers to language used in social context. More specifically, “pragmatics” means knowing what, when and how to say something in a social situation, and it also can be referred to as “social skills.” When children have difficulty using pragmatic language, additional practice can often result in improvement.

Pragmatic language involves specific communication skills. First, a child needs to be able to use language for different reasons such as greetings, farewells, asking questions and telling stories. Children also need to be able to change their language according to the different needs of the situation, such as providing background information to a speaker, speaking to a teacher or talking to a peer. Following rules of conversation, such as turn-taking, introducing new topics, correcting errors or saying something a different way when a message is not understood the first time also falls under the umbrella of pragmatic language skills.

Children who have difficulty taking turns in a conversation might seem unable to monitor their own vocal volume, as they might respond in a voice that is too soft or perhaps too loud. They sometimes interrupt or talk incessantly about a topic and are unable to “read” the signals that their listener is no longer interested in a subject or wasn’t interested in it in the first place. Often, their behavior seems rude or inconsiderate when, in fact, the child simply does not yet have the skills to take another person’s perspective when talking.

Pragmatic difficulties can have a negative impact on a child’s peer relationships. Often, making friends is extremely hard for a child who struggles with pragmatics. Who wants to be friends with the boy who won’t stop talking about dinosaurs or the girl who can’t remember not to interrupt her friends during every conversation?

Pragmatic difficulties often coexist with other language problems. According to research published in a 2000 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, children with executive functioning and attention deficit hyperactivity disorder commonly struggle with pragmatic issues. Specifically, these children might have trouble forming abstract concepts, reading the emotions of other people and “have difficulties in short-term memory, of the kind needed to be flexible and not impulsive in their responses in various social situations,” the researchers wrote.

Pragmatic language skills include:

• The ability to turn-take in a conversation;
• Awareness of having to introduce a topic of conversation instead of just launching into something without giving the listener prior information;
• The ability to maintain a topic and switch topics when appropriate;
• The ability to maintain sufficient eye contact;
• Body awareness, or knowing where your body is in space in correlation to the listener and keeping an appropriate distance from them; and,
• The ability to know how to talk to different groups of people (peers versus adults).

There are several ways that parents can help children practice using language appropriately across social situations.

1. Take advantage of day-to-day happenings where social skills can be practiced. Greetings in the morning at the breakfast table or saying goodbye to friends and family members when leaving for school are naturally occurring examples of everyday pragmatic language. Praise your child or “catch them doing good,” and model how his or her communication worked in that situation. For example, say, “John, that was great how you let Jennifer finish her story before asking her to pass the milk for your cereal.”

2. Role play with your child. Pretend to be a peer or a new teacher and practice greetings, farewells and turn-taking. As difficulties or struggles arise, show your child, instead of just telling them, how to do it differently the next time. For example, “Lisa, if you want the crayons, how could you get them without just reaching over a friend or getting in their personal space? You could ask, ‘Hey Brandon, could I have the crayons please?’ ”

3. Use visual cues to help when sequencing a story. A fun and easy way to practice telling Grandma about an outing to the aquarium would be to use pictures of your arrival, the different sea animals that were seen, your visit to the gift shop and the snack you ate in the restaurant. By providing the story structure in picture format, your child can begin to see the sequence of events that will help their story make sense.

4. Social skills training is also an option for helping children learn the nuances of social language. Children either receive this training in small peer groups led by professionals trained in pragmatic language, or through specific one-on-one sessions with a speech-language pathologist. The purpose of these pragmatic language groups is to specifically teach children how to develop listening skills, read body language and plan out their conversations so their listeners have enough understanding to follow along with their stories.

If you are a parent of a child with pragmatic language deficits, there are things you can do to help. A speech and language pathologist can give you tips and advice on your child’s specific pragmatic language strengths and weaknesses. Also some children might benefit from a social skills group that gives them specific strategies for improving social awareness. There are many such resources in Atlanta, so with a bit of effort, you can help your child find success.

Danielle Moore is a speech and language pathologist with The Language Group. She can be reached at 404-477-9400 or through her Web site at www.thelanguagegroup.org.

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Pragmatics: The Social Side of Language