LIVE Q & A  with  Alexandra Jean

Recorded January 28 2021


Alexandra Jean, M.H.Sc. (C), CCC-SLP, Reg. CASLPO

Speech Language Pathologist

Alexandra Jean is a paediatric Speech Language Pathologist in private practice servicing the Greater Toronto Area. She has a special interest in early language development, oral motor delays and autism. She thrives on helping children and families reach their full communication potential.

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Full Transcript

Recorded January 28 2021


Hi, You’re here.

If you can hear me, see me, if you can type it out in the box and let me know that everything is good, that would be super, super helpful. And then we’ll get started.

Can you guys hear me okay? Maybe? Yeah.

Okay, amazing. Thank you. Sorry guys. We’re making you wait. Of course. So I need to like, get my head back in the game. I started panicking and like, what do I do? So I thought today we could do a recap on language strategies, as well as doing a recap on some of the questions that I’ve been getting a lot lately from families.

And then I have like some household objects and a book handy. If you guys want to see that in terms of using the strategies in a functional activity or context. So I usual, if you have any questions for me, anything specific, you want me to talk about type them up and I will check it out. So we’ve got one that just came in.

So I have a 15 month old who only has a couple of words and a couple of signs. When do I start to worry and engage in SLP? (01:18)

So that is this super good question. And it’s a question that we get all the same question for two middle. I know everybody has that question. Like what, when do I get, start to worry?

You know? So let’s go back and talk about what our expectations are for speech and language milestones for like 12 months and 18 months kind of thing. So at 12 months, what I would want is, you know, anywhere between one and five words and let’s keep in mind. So I’m going to backtrack again. When we’re talking about words, this is what they include words, actual words, word approximations.

So for example, if your child says fall for ball, that counts animal sounds count, exclamation words, count. So exclamation words being like, wow, Oh, ouch, yay. Those all count as words. And then signs count as words also. So when you’re making up your list, you need to keep those in mind that all of those count as work as well for them to count though, they have to be in consistent and spontaneous.

So that means that they are not what I like to call one, hit wonders. Okay. They are words that your child knows and says regularly, and on their own, you don’t need to prompt them. You don’t need to tell them to say it. They just say it. Okay. So that’s what it takes for it to count.

So you can start your list based on that. And it’s the same thing for science. Like if you have to say more and then your child signs more does not count, but if your child goes to a cupboard and signs more than that would count. Okay. So now let’s go back to our milestones here, 12 months. I want to see, you know, one to five words, including everything we just talked about.

And then 18 months, I want to see more than 20. Okay? So that is like the bare minimum is more than 20. And then when we get to 24 months, we’re really looking at some research has said more than 50. Really the newer research says more than 100 and putting two words together.

So that is a huge jump between 18 months to 24 months. So if you have a 15 month old, who only has a handful of words and signs, I, these are the things that I would watch for first. Okay. I would look at is your child’s understanding. And I can’t tell you how many times I hear parents say, Oh yeah, he understands everything.

We’re going to make two differences here today. And if like, there was one takeaway, this is going to be it. There is a huge difference between a child having a really good, what we call receptive vocabulary, which is fancy word for comprehension and functional comprehension. And let’s talk about the two differences. Functional comprehension is in your everyday life.

You tell your child to go put something in the trash or to go get his shoes or it’s time for bed. And they go upstairs and they understand that I call that functional comprehension because it’s something that you do every single day, maybe multiple times a day, your child hears this over and over and over again. So they’ve kind of learned that in the everyday routine, when mom or dad says this, this is what needs to be executed.

What I’m looking for when I say is your child understanding is if I tell your child, show me your nose. Are they able to point to their nose and to their eyes and to their hair and to their ears and to their belly button? Like the main body parts. I usually want like five to seven body parts that are very spontaneous and easy.

The other thing I look for is, is your child able to identify objects? So if I’m looking in the room and all his toys or her toys are all laid out and I say, well, show me the ball. Are they able to point that out? Where’s your Teddy, Richard Teddy go, where’s your spoon. Are they able to point these items out?

And then same thing in a book if they, Oh, this is not a good example for a book. But if you’re looking at a book and you say, show me the fish is your child’s able to point to the fish. That’s what I’m looking for. When we’re talking about comprehension, show me his eyes. Ooh, that’s hard. I am on I’m on like a opposite screen here.

Show me the eyes, the eyes. There it is. Oh, no, look, oops. He’s crap. Right? So that’s what I want to see. When I talk about comprehension, I want to see a child who is able to identify objects, pictures, and body parts really spontaneously. And I want to talk to, he’s able to make choices between two.

If I give him two things, he understands he needs to make a choice of one. Yes. The all time your child will want both that’s okay. But we also need to make sure that they’re understanding that concept when appropriate. So that’s what I would be looking for in terms of the comprehension piece. And that needs to come well before words come.

Okay. Super, super important. The next thing that I would look for, again, for those of you who have like that 15 month old, 14 month old, 16 month old child, who’s not using a ton of words, but things are starting to emerge. If where are the imitation skills act? So the reason why children go from having something like 20 words, 20, 30 words to hundreds of words in the span of six months is because all of a sudden they start imitating like crazy.

So here’s the hierarchy, the levels of imitation first imitation of actions or gestures, then imitation of sounds then imitation of words. Okay. So words are the last thing to be imitating imitated. So when you say, well, what does that mean? Is he imitating my actions?

If you go peekaboo, has he learned to do that? If you read a book and you say, well, your child starts to do the same motion is you’re talking to any, when you wave goodbye, when you blow kisses, can they do that on their own? Those all count as the precursors of communication.

Okay. So I want to see really, really good skills in terms of that imitation and that receptive language first. So if your child is doing those things at 14, 15 months, they’re probably on the right track and has a handful of words. If you’re noticing like, okay, the imitation is really low and now we’re getting to 16 months and now we’re going to 17 months and the imitation is still really low.

Then I would maybe say maybe it’s time for speech and language assessment. But if the imitation is good and you can tell that they’re picking things up as your days go on, then I would just start that word count and see what that looks like right around the 18 month month. If they’re behind that 18 month making a referral, does that help for those people who ask that question?

I think there’s a follow-up to that. I’m not wearing my glasses. So I can’t see from far, which is really weird right now when I’m trying to read constantly.

So my 14 month old, doesn’t say anything consistently or spontaneously she babbles, but doesn’t say it with any meaning. Otherwise she understands plenty of, we sent her body parts. He touched the right one and place. He caboose waves claps. How do we encourage her to actually use words? (08:20)

Okay. We will talk about that in just a minute. Let me see here.

My three-year-old says, fought for spot for, for more fall for small. So for snow, this age appropriate. (08:48)

That sounds age appropriate until about three and a half years old. After that, I would like to hear proper S blanks.

So those are called S bonds. When you have S with another continent, we call those S blend words and it is normal. So typically though the expected error would be popped for spot instead of the F. So that’s a little bit atypical, same thing for smaller. I would expect the child to say more instead of smaller instead of four.

So that’s something to kind of watch for. If, I mean, you said three years old for us, it’s really the month, the extra months are really important. So if that’s still an issue around three and a half, I think it’s worth getting a quick assessment and maybe getting a little, a little skit, a little speech therapy there to help work on that skill.

Okay. I promise I’m going to come back to the strategies. I just want to see if there’s anything else that can kind of go along to pair.

My four year old son, he’s a mouth breather and has poor. Most of which was math. It causes him to drool excessively and can’t pronounce R and the sound can seeing a speech pathologist help with muscle control in math. I’m worried about him getting teased at school also. Do you think virtually. (09:59) 

Yes. Yes, yes. And yes. All of the assets. Okay. So with children who are mouth breathers, first recommendation is if you haven’t already get an ENT involved, I always want to have an ENT assess your child’s airway for any possible obstructions or anything like that. When children are math readers, there is too much emerging research about mouth breathing and airway obstruction and all kinds of stuff that that needs to be looked at.

For sure. The other thing is if you have a child who’s drooling a lot, like once we find out the cause, which oftentimes it’s a myofunctional cause then yes, with the appropriate treatment, we can definitely work on those sounds.

We can definitely help with nasal breathing, which will also really help with the drooling. And 100% virtual visits are super effective. Like I see kids in my practice right now and I never, if you asked me a year ago, I would have been like, what are you talking about this never going to work. I see kids literally from like 15 months until like, I think my oldest right now is 10, something like that.

And they all do incredible and they all have different needs. So virtual visits are super, super appropriate and very, very effective. I hope that answers that question. Let’s see.

I have two has close to 150 words. He is trying to put to words again, I guess I do, but we were still waiting for back and forth from station. What can I do to make him progress in that area? (11:36)

Okay. We’ll talk about that. When we go to strategies, if that’s okay.

Yes. That it is helpful. However, it leads me to believe that he needs Susan, how does work do we need a referral? How speeches can be done during COVID? (11:49) 

Okay. That’s a really good question. How does that work? Okay, so speech therapy, you can self refer, whether it’s to the public system or the private system, you do not need the support of your doctor or anything like that. Which honestly, I think is great because I mean, sometimes it’s really, I always encourage families, like let your doctor or your pediatrician know that these are the concerns or who you’ve got involved, that kind of thing.

Super, super helpful. But if you can, self-refer why add an extra step to the referral process? Like if it’s not necessary, then just move forward with that, but keep them in the loop for sure. So you can, self-refer in Ontario. I would need to know where you are, but so if you’re in Ontario, the public system, you can do a self referral.

We just need to find your, your local preschool speech and language program, depending on where you are. A lot of the preschool speech and language programs right now are super, super backlogged. And they were backlogged before COVID and now you, we tacked on COVID and now it’s really out of control.

So there will definitely be a wait list. So you can expect that. And you can definitely also ask when you make the referral, when you think you can expect for your child to be seen. The other thing is, so if you’re going private and you can also, self-refer just check with your insurance company, some of them do still require a referral from a doctor, although that’s really, really uncommon nowadays.

So you can definitely do that. And then again, it would probably be virtual. There are some speech pathologists who are doing in-person, but yeah, both are totally age appropriate. Typically is very play-based for me, I run my practice based on mostly functional activities and functional vocabulary. So that’s, that’s what you can sort of expect, hopefully that helps.

Okay. I’m seeing more questions come in and I don’t want to forget any. So I’m going to keep going down. I’m keeping the strategies part for later. Cause I have examples that I want to give you as we go through the strategies and hopefully that’s going to answer a bulk of your questions. So I’m just going to keep scrolling to see if there are any, any, any questions that I can answer that are unrelated to strategies. Thank you so much for doing this. You are so welcome.

I have a question for my almost four year old. He has an occasional stutter. I don’t know what is normal and what is not, but I noticed it happens more frequently when he is tired or excited. (14:25)

Okay. So stuttering, there are two different types. One of them is actually stuttering and the other one is just what we call normal disfluencies. So with children, it’s very, very common to have episodes of normal disfluency and that can look like I’ll see it often around two, two and a half when their language is booming. And then all of a sudden kids are like, I want milk.

So they’re getting stuck on the I I, and oftentimes that is exacerbated by fatigue or excitedness, or there’s a lot of noise around the house. And he was trying to be heard. That is not a true stutter. That is a normal disfluency. And usually it will ebb and flow depending on the cognitive overall like brain demands of your child.

When you’re looking for a true stuttery star for true stuttering. Here are some things that you want to look for. You want to look for episodes of like blocking. So that would look like the baby, right? So the, the, the mouth really stops. There’s a blockage. The other thing you could look for is what we call prolonging of sounds.

So for example, if your child is talking about building a snowman, for example, then that could look like snow, right? So he’s getting like your child will be getting stuck on that and prolonging that center. The other thing we would look for is how much of it is present, how long those observations have been made. So if typically, if it’s over six months, then we definitely want to take a look at it and treat, and you want to look for what we call secondary characteristics also.

So secondary characteristics look like if you’re blocking all, a lot of kids will like blink their eyes where there’s going to be a lot of visible tension. So those are all things to look for in true stirring. These are not present signs when it’s like normal disfluency okay.

So that, that’s what I, that’s what I would recommend to look for. If you are concerned about centering highly, highly recommend getting it assessed earlier, because the earlier you treat it, the better it’s, the treatments are much more effective when kids are little for stuttering. Yeah, definitely. Get it checked out. If it is, then you treat it.

If it’s not then perfect. Let me see here.

My 3 year old has been randomly adding the P sound to the front of words. Three banana becomes penny. Anna delicious becomes Policious tomato becomes tomato giraffe. (17:03)

Okay. Okay. Is looking pretty atypical actually, especially because of the age. So if you’re Todd was much younger, I wouldn’t be too concerned about that, but because your child is three and at three, we really start to get really good clarity of speech.

We have a lot of sounds that become really mastered. I would want to have that assessed and figure out what’s going on for sure. Yeah. Not like worry like crazy. I don’t want to say that isn’t to have you super worried, but it’s an atypical transformation.

So I would definitely get it checked out and see it’s a pretty consistent pattern too, for not consistent target words. So what I mean by that is the words that you’re giving me as an example, they’re all different. They all start with different sounds other than the fact that they mostly have to two to four syllables, they’re all completely different, but the error pattern is the same.

So that’s a little bit unusual and I would want to check that out.

My 22 month old used to say only one syllable example, mew for music. She starting to say more than one syllable only. Now for a few words, she’s not combining two words yet, is it okay? Thank you. (18:25)

Okay. Syllable reduction, totally age appropriate.

I’m not too too worried about that. That really starts to go away around the two year Mark. So you’ll really start hearing more and more words that have multiple syllables actually have more than one syllable when it comes to the number of words, do that word count based on the suggestions that I was making at the beginning of this. So if you logged in later, we are looking for, you know, over a hundred minimum, a hundred words at 24 months.

So you can start that word list. Animal sounds, count, exclamation words, count word approximation. So new for music would count as word signs, count as long as they are consistent and spontaneous. So start that. And then if the number of words seems to be growing appropriately to reach that 100 target at 24 months, then that would be good.

Again, some kids about the combining two words yet some kids like you’ll see a difference in a week or two weeks, right? So I never want to tell parents like, well, you should be worried, worried now because things can change so, so quickly, but definitely keep an eye out for it because definitely by 24 months, we want to get those word combinations.

Okay. So hopefully that helps.

And here out of curiosity or are, is only four months old. And I’m trying to learn what I can do to encourage probably even early development, any tips for creating the best environment for language and communication development. I imagine better communication earlier helps reduce frustration for the child as they mature and form their opinions. (19:55)

Yes, yes, yes, yes, yes, yes. The better the communication, the less frustration we know all of us. We’re definitely going to talk about strategies after I get to that and the non-related questions, because I just want to be able to bulk all the strategies together because they’re applicable for all of the ages that you guys are asking. Okay.

So we will definitely keep that going.

My son is who finished 20 months has about 35 words, mainly animal sounds, but I cannot point to parts of his body or in a book, he can do it and he can do it kind of with objects. He seems to understand things like, do you want milk? Let’s change your diaper, passing your Teddy, but I’m super worried now. (20:36)

Okay. None of this is to make you guys super, super worried. And I totally understand, you know, like that, Oh my gosh. Now I need to do something about it. Here’s the thing I always tell families. My job is to make you just worried enough. Right? I don’t want to have a parent like completely unworried in the sense that like everyone around them says, Oh, it’ll be fun.

And like, cause they see this in practice all the time. Right. He’ll be fine if we catch up or my kid didn’t talk until he was three in LA. Right? Cause when people are telling you that there’s huge other part of things that is missing in terms of possible long-term impacts that we know about. So I don’t want to have that kind of scenario happen.

So my job is to make you worried enough in a sense that you’re looking out for things and that we can work on things. Okay. So that’s the first part that I want to address. I don’t want you to leave this live and then be super, super worried. So if he is not pointing to body parts, not pointing in a book, then you practice that.

That will be your first thing to practice. Okay. And I say this all the time, like we are building a house here and the house starts with social skills, play skills, comprehension, and then works. Okay. And then on top of that, the roof or the cherry on top is how the speech sounds, you know, the good sounds, not too many speech, sound errors, clear speech, et cetera.

Okay. So what’s your, if you’re noticing now, you’re like, okay, my child doesn’t do this. This is what we want to work on. When it comes to pointing, I’ll address that right now. Cause we’re not going to talk about that too, too much later, but just practice it.

And if your child doesn’t do it, where’s your nose. And then they don’t do it. Take their hand and do it. There’s your nose. And you can do it in front of a mirror. You can do the same thing here. If you are looking here, I’ll just look at this here.

And you say, show me the lion roar. Show me the lion and your kid just looks up at you or just wants to change a page. You can go, whoops. I keep messing up. You can go. There is the lion and then take their hand. Let’s pretend my pen is your child’s hand. And you’re going to say, whoops,

Oh my gosh, am I going to get this right by the end of the block? There’s the lion here is the lion. And then you move on. Okay. So doing some hand over hand and doing lots of modeling with your own super, super helpful to learn about all that pointing to objects and pictures and body parts. So try it out.

Let me know how it goes.

We have a bilingual family, sorry. There’s I have trouble. Okay. I try to speak to the baby in Russian dad speaks in English. We speak between each other in English. I want my baby. I want my baby to speak both languages, but I’m worried that baby will be confused and will have a delay in speech as well. I, in mind you advise how, what the best approaches for both languages. Also grandparents has been five speak Polish. Is there too many language? (23:32)

No, no, no, no, no. Okay. So when it comes to bilingualism and multilingualism, it’s totally fine. This is like the biggest misinformation out there when it comes to language development. Okay.

Bilingualism does not cause language delay. So whoever’s telling you this it’s wrong. It’s totally wrong. That has been completely debunked in the past few years with research, you have to, we and I, and I’ll, I’ll say this like as a baseline speech and language research is fairly new. Like it’s, it hasn’t been around in terms of a profession for hundreds and hundreds of years, it’s a fairly new profession, which means that we learning and learning and learning as more research develops.

And so bilingualism is something that has been heavily researched in the past few decades. And really it is, it is a bonus actually. So there are lots of different ways that you can introduce multiple languages to children. And there is not one way that is better than the other.

What is important if you want your child to be bilingual or trilingual is to expose them, right? The level of proficiency your child will develop will be based on how much exposure they’ve had to those languages. So if you, if everything is in English home, like the family languages, English daycare is in English and they only get Polish exposition exposure with the grandparents.

You know, once a week, you can’t necessarily expect that your child to have the same level of proficiency as they will English because of the difference of how much exposure they’re getting. Right? That being said, that doesn’t mean that they’re not going to speak Polish. It just means that their level of understanding and proficiency is going to be affected by how often they’ve been exposed to it.

As a kid, there is no best approach. There’s lots of different approaches. Like I said, like some people say one parent, one language or one environment, one language, which would mean like one parent, one language, you mean kind of what you’re doing, where mom only speaks. Russian dad only speaks English. And then you have a family language that you all speak together.

One language, one environment that would be for example, English or Russian only at home. And then English only outside of the home. Honestly, none of these methods, there’s not one that’s better than the other. And like I said, it does not cause a language delay babies were born with the ability to learn any language of the world and however many languages of the world.

So that is super, super important to remember and to go, even beyond that children who are bilingual or multilingual actually have been shown down the line to have higher overall cognitive skills. So their attention span is better. We’re looking at like the speed of processing memory. All those cognitive skills are actually better in a bilingual people or multilingual people. So there’s no harm with multiple languages.

Keep going. Do not limited. The only time that we might talk about changing how many languages a child has is with a child who had like severe, severe language delay. But even that is like very, very case by case. And in all the years that I’ve been working, I have not had to have that, have that conversation very often, truly. Okay.

So keep going with that. You are so welcome. I get really animated when it comes to bilingualism because it’s like, everybody tells you like, Oh, you shouldn’t do this. You shouldn’t do that, but that’s not true. Not true. Do you know if things like, Oh, sorry, I skipped one. I going to come back.

My 18 month old will use the D sound for BI, but can say other words appropriately, she also will use sounds like for acknowledging yes. In certain circumstance I’m saying, yes. How can we get her to use the word more? (28:59)

Okay. You’re not going to like what I’m going to have to say. But if your child goes like for yet, odds are someone around her is using that. So it happens all the time when I’m laughing, because I think this is so funny and I love catching parents in like, you know, the chicken and the hen house or whatever. I don’t know what the expression is.

Anyway. Someone is using that. And that’s how your child is used is using that for yes. If you want her to use yes. Then you need to model. Yes.

And you need to catch yourself when you’re talking with your husband or your spouse or your friends, or if you’re on the phone and they’re constantly hearing and they interpret that as yes. Then that’s what you’re modeling. The more you start to use the words that you want your child to use, the more they will use them. Okay. So I’m sure you’re going to be catching yourself where you will catch your husband or grandma or someone.

Someone is doing this for short. I have parents all the time. I’m going to give you a side note here. They’re like, Oh, my kid says, yeah. Instead of yes. And I was like, yeah, because guess what we all say all the time. We don’t say yes. Yes, yes. Every time someone talks you say, yeah. Yeah. Okay. Yeah. Right.

So that’s what kids are hearing. That’s why they’re using. Yeah. There’s nothing wrong with it. So yeah. Catch yourself. Okay.

And then there was a second part to your question, 18 months, having an issue with the D and B sounds in terms of pronunciation. (29:31)

Not a huge, huge thing.

I would definitely want that to be like pretty much gone by too. Those sounds really developed by two. So you can just emphasize it. Oh, cool. Bye. Mommy. Squeezes her lips when she says bye. Right. And just get down to their level, show them how you’re doing it. That should help. Okay. Moving on.

Do you know if things like food allergies, eczema, or autoimmune issues? (30:00)

No, definitely not. Food allergies. Eczema auto mean I haven’t. No, not really. I’ve got kids who like spent significant amount of time in the hospital as babies or as newborns for, and combination of those things were other things. Those kids will sometimes have language delays that we suspect are more caused by the lack of social exposure and stimulation because they’re in a hospital bed for months.

But again, these are most of the time I’m talking about like I’ve seen cardiac patients and stuff like that who, you know, have been in the NICU, their whole neonatal life and then are in the ICU or in a hospital bed until they’re, you know, 12, 14, 16, 17 months. Those are often kids that we’ll have, we’ll see language delays.

But just because again, that lack of exposure and the ability to, I mean, hospitals do their best, but it’s not the same as being home and exploring. And you know, for so many limitations.

Fun question, we are not bilingual at home, but have been exposed to other languages growing up. Can I teach my child? The heart sounds from an English perspective when they’re little, so acquiring the pronunciation of languages is easier for them later. Rolling RS in Spanish and Hebrew are in the back of the throat. (31:05)

Okay. So that’s a tricky one because all of these sounds develop at different ages. And for depending on the language, they will develop at different ages. So for example, the French eye does not develop at the same age necessarily as the English R does not develop necessarily as the same at the same age as a Spanish.

So that’s just something to consider. I mean, you can have fun with it. Like there’s nothing wrong with it. If your child has no language delay, I mean, technically you can teach them whatever you want and I have no problem with it, but that’s just something to kind of consider is that those sounds all develop at different ages depending. So one of them might be easier depending on how old your child is to develop.

And again, exposure is going to have an impact for that, right? Like if you have for yourself is never exposed to French and you’re going whoosh, like they’re not, it’s not going to be easy for them to say as like, you know, the art and English that they’re exposed to all day long. So that’s something that I would consider so helpful.

My husband and mother-in-law speak in Sams need to get on them. Thank you. You are so welcome. Okay.

My four and a half year old twins have some issues with, with S and L and some words yo-yo instead of yellow sleep, instead of sleep, how can I help? (32:32)

Okay. So when it comes to that, I, at that age, I would want those sounds to be pretty, pretty consistent and pretty precise. So I would definitely recommend some speech therapy at this age.

They would probably be referred to the school system. So that’s something to consider for the public services. And then you have the option of private services, if that is an option for you. But yeah, definitely. I would, I would want to work on that.

Sleep for sleep is pretty unusual. Yeah. Because S and L have the same point of articulation. So I would definitely recommend a speech assessment.

Second, we speak Persian and English at home. We are going to full French school. I don’t know French. And their exposure to French is just at school or YouTube videos. They can’t speak French. Better speed. We should. I continue with French school considering they are very behind for other children. That’s they had a mild speech delay when they were younger. (33:31)

I, okay. So this was all at the same person. So I definitely want a speech assessment for them, for sure. We need to figure out what’s going on first, before we can make any recommendations like that.

If you don’t know what’s going on, it’s really hard to say like, Oh, well, you should do this. Or you should do that because it looks like there might be multi, multiple layers of what’s going on. It is also, it does also happen that just children who have an early language delay, like when they’re very, very little that there are some things that do come out of that later on, especially if it went untreated, we know that.

So knowing that they had a mild speech delay earlier on, I would definitely. And with what you’re saying, get an assessment, get an assessment. That way we can take care of all the weeds out and figure out what’s going on.

And then we can make appropriate recommendations based on that. Okay. I think that I’ve made it through all those questions. And now we can talk about strategies. You guys can continue sending questions, but I’m just going to dive into strategies and keep an eye out. Okay. All right. So hold on. I’m getting some notifications here.

At what age do kids speak in two and three word sentences to 24 months? (35:00)

24 months. I want word combinations. Yeah. I just got a big smile emoji. Yeah. 24 months, for sure. And really like, it should, it should be easy guys. Like when language is hard, this is when I say, like, get an assessment because truly you can, sometimes it’s just getting one or two strategies in place that you do alone at home.

And it’s like, it solves what you need, you know, what your child needs. So definitely easy, easy, easy kids whose language development develops. Normally parents don’t have to think about it. Like I say that all the time, like you just don’t have to think about it. Literally. Like your child will come home and use new words and you’d be like, where did you get that from?

You’re just, they it’s just comes in. So if you’re, if you’re noticing that your child is falling behind having an assessment yeah. Cause then we can just tweak some stuff most of the time. Yeah. Okay.

Do you think there will be a lot of language delays in COVID babies? (36:02)

Yes. No. No.

So with the COVID kits and I will tell you that I am, I have concerns about COVID babies. And I was talking about this with a client recently, especially the ones who were like born either. Like, like let’s say kids who were born early 20, 20, I’m concerned for these kids because they have gone a full year now with no social exposure other than being at home.

And it’s not over. So knowing what we know concerns me, and I’m worried about these kids, social and play skills, once they will be thrown back into environments like school and childcare and that kind of stuff. The other thing is, so, like I just said, when it comes to language, kids whose language develops normally, like typically it happens very easily.

You don’t have to put a lot of effort into it. Their language does just develops based on your home environment. And you being like, Oh, let’s change your diaper. I know it’s time to eat and whatever, like let’s get in the car. And like that kind of thing, they pick it up the language develops. So I’m not worried so much about that.

I am worried about kids whose language is not developing normally, and that it’s not necessarily being flagged because there are a lot of families who are not seeking who are not going to their doctor checkups who are, you know, completely hibernating and total lockdown. That worries me that we’re missing a lot of these kids. And again, just that social piece in play piece is so big that I am concerned about fat park.

For sure. I think that kids whose, who are neuro-typical will pick it up really quick. But if you think of even like going to the grocery store, everyone has masks on how many of you have had children and you know, or even as adults, you go, you’re in the grocery lineup and you’re like, you know, to the baby, like that’s in the car in front of you and you’re playing peek-a-boo with them.

Like our kids now are not getting that these babies are not getting any of that. And that concerns me because it is a fundamental part of language development, but maybe I’m wrong and we will see, but I’m definitely curious to see what the next like three years will bring us with that generation of babies.

For sure. This is a follow-up comment too.

We had an assessment and went through speech therapy. They’re not behind now in that case, what’s the recommendation in my cases, send them to the French school. (38:30)

Honestly, I like just based on this, the, the speech sound errors at four and a half that they’re making all like I would say is, is to get a speech assessment.

I’m I really think that’s the best recommendation I can give you. I’m really sorry if that’s not what you want to hear, but I think that would be the safest bet to figure out what’s going on. Because even if it’s just an articulation thing, that’s fine. But then we also need to figure out why are they not picking up French?

The way that other kids are in their school? Which is, it seems like what you were saying, because there are a lot of other kids in French immersion who were in the same situation as you bilingual home environment, they only get French at school. So why would they be picking it up and not your kids? That’s what I, that’s what I’m wondering.

Okay. I hope that makes maybe more sense when it’s presented that way. Because oftentimes we think like, well, you know, we have this very unique situation, but don’t forget, oftentimes your situation might seem unique, but a lot of kids have the same type of situation in terms of the language exposure and stuff like that. And so we want to figure out why is there a difference?

Okay. I just wanted to pick your brain. Your work is awesome. Thank you. I think you’re absolutely right regarding social development and aspect of this pandemic. Yeah. We’ll see. I talk about this plenty. Alrighty. So I, you guys can keep sending in your questions. I want to move into strategies because there are lots of people who asked about strategies earlier on and I kept delaying it so that I can group it all End.

I love how I have the, I always have the price on my books. I’m never afraid I never take them off. Okay. So strategy number one, we already talked a little bit about getting your child to point using hand over hand and using lots of modeling yourself and showing. So that’s super, super important. The next thing is, Excuse me, when it comes to stimulating your child’s language, we want to the first strategy.

And I talk about all the time, all day long and talk about this is making comments and describing instead of asking questions. So I’ll give you an example. I brought an orange, I also have an Apple. So depending on what your kid likes, this will apply more to you.

But oftentimes I’ll see that with parents. Do you want an Apple? Is this an Apple? Is it yummy? This is what I hear all day long. And it’s totally natural to do that. It’s like totally, totally neuron. That being said, if you have a child who does not have the word Apple, that is putting a lot of pressure on them.

Okay. So think about it. I’m going to use the example of cars, because I don’t know anything about cars except that I like to drive them. Okay. If I have a mechanic talking to me and is saying, is this, this, does it make the car go fast? How do you fix this? I’m going to feel very pressured.

And I’m not going to want to talk to this person because I have no idea what they’re talking about. If I just gave you a really high level example to show you how your child might feel about this. Okay? If you keep asking questions about something that they don’t have the skill for yet, they will feel very pressured. And typically what happens is the opposite of what we want.

They will shut down and not be interested and they will walk away most kids. So what do we do instead? We just say Apple, here’s your Apple. It’s a tasty Apple. Yum, yummy Apple. Okay. So in this second example, you have gotten the word Apple, like, I don’t know, five or six times. And so you and with no pressure, you’re not asking a question.

You’re not expecting anything in return. Although let’s be real. If your child decides to imitate Apple, that would be awesome. But we’re going in with no expectations. We are just showing them and telling them so that when they are ready, they can imitate it. But remember earlier, I was telling you all the things that count as a word.

So if I go, this is a yummy Apple, yum. And I do this on my belly at the same time. Yum, yummy Apple. And if your kid goes after that is a communication attempt and that will count as a communication attempt. And that will count as your child’s imitating you. Because again, if we go back to what our hierarchy is in terms of that imitation, we are looking for actions, gestures then sounds then works.

Okay. So even if your child were to just rub their belly, you’ve got step one, step two, they go, Hmm. And then the last step is going to be Apple. And that might not all happen in one day. Okay. But if you’re asking questions, which often a lot of parents do again, totally normal, natural, natural thing to do.

If you go, is this an Apple? Do you want your Apple? Is it yummy? Your child will likely either not say anything or if they have the word yes or yeah. They will answer that. They’ll go. Yeah. And then your interaction is over. And we know that parents are asking you a lot of questions when you’re stuck in a loop of yup.

Yup. Yup. And that’s also something that I hear all the time. Parents are like, Oh, he tells me. Yeah. Yeah. And no, all the time, all day long, their favorite words. They’re the favorite words because we’re constantly asking them. Yes, no questions. Right. If we’re not asking to ask me questions, they can’t answer.

Yes or no. It’s that simple. We want to label and said, okay, it’s an Apple, it’s a red Apple, yummy, yummy Apple. Okay. And then see what your child will do to imitate either your action, your sound or your words. Does that make sense? So that was strategy. Number one, I’m going to put my fruit away.

It’s a huge, huge strategy. And I talk about it all the time. This week I had a parent tell me, cause we introduced the strategy with a family. And this parent said to me, they messaged me after our appointment. So, Oh my goodness, my kid, instead of saying, do you want to clean up? The parents just said, clean up, clean up time and started cleaning up.

And the kid just jumped in and started cleaning up. She’s like, normally he never cleans up. He always says no. And then walks away because she asked him, do you want to clean up? No. Do you want to clean up? Nobody wants to clean up. Right. So we’re just labeling giving it as a, as a comment, giving it as a statement, super, super important.

And it’s going to serve you, not just when you’re showing things, but when you’re playing, when you’re getting them dressed, when you’re bathing them, all of the things. All right. The other thing that we’ve brought up actually going to take my fruit back. And the other thing that was brought up to me is, well, how about when I give my kids choices?

And I thought that was a really good question, because guess what? Oftentimes, when parents are giving choice to kids, they’ll go, do you want an orange or an Apple? Which one? Which one do you want? And then that’s not really enticing for a child to imitate. So what would I do instead?

And what I would recommend you do instead is just present the two objects, Apple or orange. It’s so weird looking at the screen guys. Cause when I know like that, it’s in the other direction. So confusing. Doesn’t take my J okay. So I’m going to do that again. Cause I got distracted Apple or orange and then usually what happens is your child will reach for one or the other.

Okay. So let’s say your child points four shows Apple. So why would you, if I would put the orange down or put the orange away and then it would go half-full and then I go back to the skill that I just showed you earlier. It’s an Apple, Apple. And then I would just wait, see what your child does. If they reach again, perfect.

I’ll get you your Apple yummy Apple. And then you give them the Apple. And if they, if they make an attempt, then we interpret that attempt. If they don’t make an attempt, we do the model again. And then we give it to them. Does that make sense? You guys are awfully quiet right now. Does that help?

Totally. Okay. Awesome. Yes. Yes. Yay. Okay. That’s helpful. Sometimes they’re like, okay. Is anybody even still here? Okay. So that is like my main strategy comment, comment, comment. Even when you’re making choices or offering choices, comment. The other thing is, I don’t know if you guys notice.

What happens when the kid knows what he wants, but won’t say it, but grab it. (48:03)

We are stronger and taller than our children, friends. Here’s what I would do. I got an LOL. I’m very proud of myself. I like to think that I’m funny, but my husband disagrees. Okay. So your time knows what he wants. You probably know what your child wants. The idea is that we’re not giving into that.

Right? The other thing that I’ll hear often, and I just want to give you like all the scenarios to which these strategies apply. I’ll hear parents. Oh, he’ll just scream. He just screams. And I give him what he wants. Okay. Here’s a question for you. Do you want your child to scream for what he wants or do we want to teach them a new strategy where they can use a gesture or sound or word to get what they want?

Right. So here’s what we would do to answer that question. Your child reaches, grabs it out of your hand. You are too low Apple or orange. Hang tight. If you know, they’re going to grab, hang on tight. Okay. Don’t let them grab it. You want the ball? Well, you want the Apple? Mm it’s a yummy Apple grip onto it.

They do not need to grab it. Okay. Just hold on and wait. The waiting part is so important because if kids are constantly screaming and getting what they want or they scream and you know what they want, so you give it to them right away. Then they are learning that screaming is the communication. We don’t want that. The same goes for grabbing.

If you like, I’m not holding onto it very tightly right now, if you let your child grab things constantly out of your hand or off the counter or off the table, they are learning that that behavior is sufficient to communicate their needs. We know that that is not the appropriate behavior. They need to use their words. And if your child, if it’s a word that you know, your child has, let’s say, you know, your child says banana, except they just grab it out of your hand, hold onto the banana and tell your child, use your words.

You want that. And then let them finish so that they are learning a new skill. And the new skill is, use your words. Okay. Super, super important.

Because honestly, like we don’t want our kids to be screaming and grabbing and things for communication. It’s frustrating to them and it’s frustrating to us. And here’s the thing. When they go to another context, eventually when we’re out of lockdown, that’s not going to fly in most other places. It’s not going to fly at daycare. It’s not going to fly at school.

It might not fly at grandma and grandpa’s house. Right. So we have to get over that hump of that frustration and those habits and instill those new skills. We are teaching them new skills. Okay. There’s a lot of questions that just came up. So I just want to scroll through really quick before I keep going. And if you have questions about the comment, them strategies, we just talked about, let me know.

Cause I know it’s a lot, it’s a lot to process. And then parents become really, really aware of everything that they do. And it’s really hard to change everything at once. So we’re not changing everything at once here. We’re just becoming aware of some of the things that we’re doing and thinking about a new skill.

How does social exposure do you think is healthy or 20 month old is mainly at home, but goes to his grandma’s and sees his cousins a few hours a week. But I think I should probably try and set up play dates. We cannot afford daycare. (51:40)

That’s totally fine. I think whatever you can do, I think everything is really difficult right now with COVID.

So I wouldn’t want you, like, I certainly wouldn’t encourage parents to put themselves at risk of COVID for social development. Like I don’t think that that trade-off right now is what we should be considering in parents who can’t afford daycares in like a non lockdown, non COVID world. Then I definitely encourage play dates, taking your child to the park, taking a child sledding, taking your child even to the grocery store.

There’s social interaction at the grocery store for a child doing the drop-ins, the early ons, the, the free play groups. If there are so many, so many options outside of COVID that are possible. So I, you know, a few times a week, like with a variety of those things, I think is fine. Yeah.

What would you suggest increased language capacity in 18 month old, we read, engage a lot, do some singing. She plays with her sister three and a half year olds a lot too. What else can we do? (52:46)

What I just described lots and lots of labeling and offering choices. Reducing the questions. You’re probably asking a lot of questions without realizing it.

And your, your older sibling, the oldest sibling is probably asking you lots of questions too. And potentially even talking for the little ones so encouraged. Oh, use your words all. We want your brother to use his words. Hold on. Look. We have to show him. You have to tell him what it is. Okay. If, if the sister’s really chatting, get her on board, tell her it’s an Apple show him. Okay. Use that same strategy.

So when we say hat here or head in my 14 month old touches her head, does that count as a word? No, no, that is, this is or if we say blink and she does, does that count? (53:34)

No, but that tells me that your child has good receptive language, which is super, super, super important.

Okay. That was part of the comprehension piece is being able to identify body parts, understand actions, that kind of thing. It does not sound as it does not count as communication attempts. If, if she started, if you started practicing, let’s say like this for hat, hat on hat on, and then your child, you’re you say, Oh, we’re going outside.

And your child ran to the door and went like this to you. That I would consider that a communication attempt. Yeah. That would be the difference. Let me know if that makes sense.

Any recommendations for kids with select mutism, any strategy to use. (54:20)

Okay. That’s a super hard question. Selective mutism is one of those things that’s really hard to treat.

And I shouldn’t say really hard to treat. It’s really hard to treat alone. Okay. The best practice for selective mutism is getting a team on board who has a lot of expertise in selective mutism, which is not me. I do not have a lot of expertise with selective mutism, but I would highly recommend the speech pathologist who does as well as a counselor, social worker, therapist, psychologist, who has a lot of experience with both.

The best practice is to have both involved, super, super important. I wish I could give you more, but I honestly I’ve seen maybe one kiddo in ever since I graduated with selective mutism. I like that. Becoming more aware. We’ll definitely implement. Thank you. Got it.

Labeling options, et cetera. Yes. Okay. Thanks. Awesome. Okay. That’s kind of the main strategy.

Someone had a question about books. (55:21)

Wait, why did I feel like I’m missing something for the last few minutes? Do you guys want to see books? How to implement that strategy in a book? You guys know? I love books.

Yes. Okay. Let’s do it. My $10 buck. You guys. I don’t know. I never take the prices off. Like most of the time I never even noticed before I started doing virtual therapy, then every book I pull out, I’m like, what is the sticker price still on here? I never realized, Alrighty. So I’ve got this one today.

It’s a feed me book. I don’t know if you can tell there’s like a felt piece to it with the teeth. So books, what I recommend is face-to-face, if you’ve heard me talk about this before I say all the time, face-to-face, if you are sitting on the floor, you are not face to face with your child. You are not level.

You are an adult, which means you are many feet taller than your child. That means that you either need to come down or your needs to come up. So if you’re on the floor, you can prop them up on a cushion. I often recommend like, get the booster off the kitchen, like the kitchen chair, like get it off the dining room chair, get it in the playroom.

So your child has somewhere to sit on and that is facing you in love more level with you. Okay. Or pop them on a couch while you’re sitting on the floor or kneeling on the floor. That kind of thing. Okay. I will make one exception. I don’t want you guys to hate me too much. When you are doing story time before bedtime, you do not have to do any of these things.

I am totally okay with you using your story time for cuddles before bedtime. This is really when we are looking at books as an activity. Okay. So if you have a child who loves books during the day, then that’s how I would want you to use them during the day. If you have a child who does not like books, this is how I would like you to introduce books to them. Okay.

How many story times per day would you suggest? (57:22)

However many as you want and your child is interested and will tolerate and don’t forget it is okay. That your child looks at two pages and then move on. Totally. Okay. All right. And then they’ll come back to it later or a different book later and then do two pages of fact.

That’s totally fine. I don’t mind. All right. So I’m going to get started here and I’m going to be so confused because of everything that’s like flipped over. So I think I’ll just look at it this way, if that’s okay. So I will ignore this might look weird to you guys too, because the writing is on the right, like on the left anyways.

You know what I mean? It’s this book is normal. The writing is on the left side. What we’re used to. That’s not what you’re seeing. So I would ignore this completely. We don’t need like with a little, little one, like under three where we’re not working on reading, we’re not working on letters. We’re not working on phonemic awareness.

None of that stuff. We are working on language. The words don’t matter. Okay. So here’s what would likely happen is your child will probably go straight to the teeth. We see writing on the left properly. That is not, that’s not fair for me. I’m glad that it’s normal for you though. That makes it even more confusing anyway. Okay.

So your child would probably go straight for the teeth that is to be expected. And then that’s what I would talk about and say teeth, it’s a seal. You feel as teeth, sharp teeth, sharp teeth. And then I would talk about the seal. And then I would see if your child points to something else or if they just turned pink, if they turn the page and we follow their lead, if they point to something else, or if they’re just looking at the picture, you could point to something like it’s a bow, look at the bow, a bow on his head, on his head and just leave it like that.

So notice how I’m making comments. I’m just labeling things and showing things and making things interactive.

But there’s really no pressure at all. I’m repeating things and I’m giving it time to soak in. Okay. Super, super important. And then if I’m working on body parts, I might go to seal his eyes, my eyes seal his eyes and I would kind of leave it like that and see what your child does. Right. They might be pointing and looking at you.

They might put into their eyes. They might come into the seals eyes and they might turn a page. And then I will do the same thing. Guess what your child’s going to do. It’s going to go for the teeth. That lion is hungry, right? So I’m adding in some sounds. Then I could add in the gesture. Yum, he’s hungry.

What? That is sharp teeth. And then I can point to his nose, all that kind of stuff. Okay. We can turn the page again. They’ll probably go from teeth. This book is called feed me. It’s $10. I’m just kidding guys. I’m making fun of my own self shark. Here’s a shark. Your child might start singing baby shark if they were from that generation.

So go ahead, baby. Shark, doo doo doo doo sharp teeth. Right? So you’re just playing along. You’re just making this activity very interactive. And it’s a polar bear. That’s up big mouth. So big. Okay. And then I would talk to whatever you’re pointing to. I would point things out label, turn the page, keep going.

Oh, who’s that? You could call this a boy. You could, if you have a boy or if you have a brother, you could say, Oh, that’s Jack daddy. Daddy’s hungry. Right. So just label and take some of the pressure off of your reading this all the time. Except at bedtime. There’s a good chance that your kid’s walking away.

Yeah. Because it’s not interactive enough. And if we want to work on the language, then we have to make it interactive. Okay. So yeah, this book is feed me. I bought it. It’s Indigo press. So it’s probably from chapters. I know I bought it from chapters, but it’s probably like a created by chapters. Any questions from you guys?

I feel like we covered a lot. Did I miss anything? If I missed something, shoot it. I don’t want to have missed anything. Tina, wait, while you type, you guys took up here.

Are you taking new clients? (1:02:37)

Yep. I am taking new clients. I actually opened up a bunch of spots in January for new assessments.

So yes I taking.

Where can we find you? (1:02:53)

You can find me on the parent playbook. You can find me on Instagram, Alexandra, Jean dot FLP. So it’s my first name, my last name dot SLP. And then all my info. Yeah. Oh, thank you. Thank you, parent playbook. I should’ve thought of typing that in.

There’s my Instagram. And then yeah, all my contact info.

Is there, are you able to do assessments online? (1:03:24)

Absolutely. Absolutely. It goes really well. And it’s like very, it’s so comfortable for parents because you’re home in your environment and children are in their environment with their own choices. So that’s great.

Do you have any other sessions? (1:03:38)

What do you mean? Like parent playbook live sessions? Is that what you mean? Yes. Yes. So the past lives are on the Facebook group and then my content is uploaded to the parent playbook website. So you should be able to see that. Just going back to my question. Oh yeah. Sorry. Thank you for reminding me of the questions that I might’ve missed.

I have a 2.7 year old. He has close to 150 plus words. He was trying to put two words together and he says things like, yes I do. But we are still waiting for back and forth conversation. What can I do to make the progress in there? (1:04:09)

Okay. So one of the things like the skills that I just talked about will help with that back and forth reciprocity, that social reciprocity.

Definitely because if you’re noticing and I’ll give you the example of the book, just because that’s what I have right now. But when you’re doing a lot of waiting and commenting and you’re taking the pressure off, that’s going to bring a lot of engagement. The other thing too to consider is usually kids will start combining words when they have at least like 50 to a hundred words, oftentimes it’s closer to the 75, a hundred words.

Things like, yes I do. Or even here you go, oftentimes I don’t necessarily always count them depending on how they’re coming out. I don’t necessarily always count them as word combinations because oftentimes even though they’re multiple words, they’re like an expression. That’s just how so it’s like rote learned. It’s like wrote, learned that way.

It’s learned as one unit. Does that make sense? It’s like, if you say, here you go, it’s you, you learn that expression as one unit. So yeah. So the back and forth conversation doing lots and lots of comments, reducing the pressure is going to engage a lot more effect. And then if you want to get more word combinations, I’m going to encourage you to use expansion.

And if there’s interest in that, we can definitely spend more time on that. Next time I do a live. But expansion basically is if your child says, I’m gonna go with my fruit here. Cause that’s what I, that’s what I brought today. I wanted this to be very functional for you guys at home.

If you’re talking to Apple and you know, they want to eat the Apple, like it’s snack time, then I would say, eat the Apple or the Apple or red Apple. Like if your child justice, Apple. So you’re matching what your child is saying, which is Apple. And then you’re adding on you’re matching and adding, which is expansion.

And that gets kids closer to using two words together through as together. Okay. Same thing. If your child comes up to you with a book and says book book, then you could say, read a book range. You could work on turn the page. So these are easy. Turn the page. If your child says teeth, teeth that I would say sharp teeth.

Right? So I’m matching what he’s saying, which is teeth and like adding an extra word too. So in modeling two words, which is where we want them to get. Yeah. Let me know if that answers that Super helpful. Okay. Amazing. You are so welcome. I’m going to give you guys a couple more minutes. If there are any last burning questions before we log out and then you guys have the link there to find me.

I think that was the only question that maybe I missed. If there thank you. You are fabulous. Oh, thank you. You just made my day. I think that was the only question that I didn’t really get to. But if there is anything else, now’s your time to retype it. Anything else, guys? Thank you so much. It was very helpful.

You are so welcome. I’m glad I never want to put too many strategies out at once. And you’ll notice that every time I go live, you guys, because it’s too much, it’s too much on parents. You have to give yourself grace. You’re doing the best you can, especially right now. And yeah, giving you like five different strategies is not gonna be effective and it’s gonna be overwhelming.

So just go one at a time. I mean thing. All right. Well thank you so much for tuning in and I will see you in a little bit. Okay. Have a great afternoon guys. Bye.


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