CHEO Connects!

February 6, 2012

Mary Lynn Taschereau-Park, B.A., B.Ed., CDACommunicative Disorders Assistant

AgendaParticipants will familiarize themselves with:

•Speech and Language milestones for children between the ages of 0 and 5 years

•How to refer children to First Words, the Preschool Speech and Language Program in Ottawa

•Strategies to use in daily activities and routines in order to promote speech and language development

About First Words…

Funded by Ministry of Children and Youth Services PSL in Ottawa Lead agency: Pinecrest-Queensway Community

Health Center Partners: CHEO, OCTC, City of Ottawa, Andrew-

Fleck, IHP, BLV committed to raising awareness 0 to 5 – eligibility to SK

Children’s early learning experiences have a profound effect on their development. Theseearly interactions directly affect the way connections are made in the brain. Early learningexperiences are crucial to the future well-being of children, and establish the foundationfor the acquisition of knowledge and skills that will affect later learning and behaviour.

The Kindergarten Program, 2006Ministry of Education of Ontario

Communication … the foundation !

• Language is the greatest predictor of a child’s success later in school / in life

• Communication development may be the best indicator of a developmental delay

(Wetherby & Prizant, 1996).

Why We Do What We Do....

So children can grow up to be successful adults!

Prevalence of speech and language disorders in preschool children

Approximately 10% of all preschool children have a speech and language disorder in the absence of a sensory, cognitive and/or neurological impairment:

language disorders (60%) articulation and phonology disorders (20% – 25%) fluency disorders (5% to 15%) voice disorders (1%)

Many of these children first present as LATE TALKING TODDLERS.

Early Identification & intervention:it happens BEFORE 30 months!

The developmental “scoop” : Earlier is better!

• Early experiences and early environment are responsible for brain development ("use it or lose it" principle) (Carnegie Task Force on Meeting the Needs of Young Children, 1994; Ounce of Prevention Fund, 1996).

• Ages 0 to 3 provides the greatest window of opportunity to affect neurological and behavioral growth and impact (Rossetti, 2001)

• Direct correlation – the more stimulation:

= +++connection between parent & child

= +++ more brain development

(Early Years studies – Dr. Fraser Mustard)

Early Experiences, identification and intervention make a difference

• Early ID and intervention may – provide better and faster outcomes for the child (early

experience affect brain structure, “use it or lose it” principle),

– prevent a cumulative delay,

– prevent or decrease the severity of language delays in preschoolers,

– enhance school readiness,

– and increase later academic success in school.

SETTING THE PATH SETTING THE PATH EARLY FOR LANGUAGE… EARLY FOR LANGUAGE… Know the milestonesKnow the milestones

Language : risk factors or not?

• Hearing Loss• Family history• Medical conditions• Weak muscles• Lack of stimulation

• Tongue-tied• Laziness• Birth order• Being a twin (except if

there were prenatal or post-natal risk factors)

• Learning two languages

Not a cause

Risk factors

WHY and HOW children communicate

Just a few of the reasons why…..

• To connect socially

• To get attention• To request an object

or action• To copy you

• To tell something

• To show feelings

• To get information

And how!.....

NON-VERBAL • Eye gaze/signal• Giving• Showing• Pointing• Pulling• Pantomime

VOCAL/VERBAL

• Noises

• Vowels

• Consonants

• Sounds for words

• 1 or 2 words (total)

• Many single words

• Joins 2 words

• Links 3 or more words together

First Words Communication Development Quick Reference Chart Page 1

RECEPTIVE LANGUAGE 6 months 1 year 2 years 3 years 4 years 5 years

Understands

Watches your face as you talk

Turns to source of

sound

Startles to loud or sudden sounds

1 step directions: “sit down”

Looks at something

you point to

Understands “no”

Responds to name

2 step directions: “go get your book

and show it to grandma”

Points to many body parts on

request

WHO/WHAT/ WHERE questions

Remembers

familiar stories

3 step directions: “get paper, draw a picture and give it

to daddy”.

Follows “If….then…” and group directions e.g, “If you have green socks then raise your hand”

EXPRESSIVE LANGUAGE

6 months 1 year 2 years 3 years 4 years 5 years

Spoken Vocabulary

Uses 3 - 5 single words consistently (*20 single words

by 18 months)

Uses 100 - 150 words

Uses 500 - 2000 words Uses 2000 + words

Grammar Uses some pronouns

(me/mine/you)

Uses plural, present progressive (“truck going down hill”)

Uses adult type grammar

Tells stories with clear beginning/ middle and end

Describes past, present and future

events in detail

Length of Utterance 1 word 2-4 word phrases “truck go down”

“daddy go”

5 - 8 word sentences

Complete sentences

First Words Communication Development Quick Reference Chart(Page 2)

SPEECH 6 months 1 year 2 years 3 years 4 years 5 years

Speech Sounds Imitates coughs and few sounds

ah/eh/buh

Combines sounds as if talking “abada

baduh a bee”

Uses a variety of sounds such as

(p,b,m,n,d,g,w,h)

Uses almost all the sounds of their

language with few errors

Intelligibility of Speech 40% 50-60% 80% 100% 100%

COMMUNICATION 6 months 1 year 2 years 3 years 4 years 5 years

Gesture Different cries for needs

Reaches to be picked up

Waves “bye”,

Shakes head “no”

Imitates others actions

Points with one

finger

Tells stories with clear beginning, middle and end

Play Enjoys social games “peek a boo”

Can pretend play with toys (gives teddy a drink)

Scribbles with

crayon

Combines multi steps in pretend

play (puts blocks in train and drives

train to new spot to unload blocks)

Complex imaginative play

Social Starts to imitate sounds/smiles of

others

Brings toys to show others

Performs to get

attention

Enjoys being with other children

Shows affection for playmate

Talks to try to solve problems with

adults and other children

Increasing independence in

friendships

LITERACY 6 months 1 year 2 years 3 years 4 years 5 years

Pre-Literacy Skills Shows interest in

simple picture books

Holds book right way up and turns

pages

Recognizes signs and familiar logos

(e.g stop sign)

Begins to be aware of rhyme

Matches some letters with their

sounds (e.g., letter “t” says “tuh”)

Knows all letters of the alphabet

Identifies sounds at beginning of some words e.g, “baby start with ‘buh’

sound”

Typical Pattern of Speech Sound Development

p, b, h

n, w, m

t, d, ng

k, g, y

f, s, z

sh, ch, l

j, v

r, th

It is important to refer late talking toddlers…It is important to refer late talking toddlers…

TODDLERS

Who are either slow to say their first words OR slow to combine words

should receive the services of a speech-language pathologist

Language is Important during the PRESCHOOL YEARS

• Preschoolers need to use language to regulate their play and to interact with peers. Expressive language, allows them to….– protest, request and negotiate their play,

– role-play

– learn about the world around them

Language is Important forSCHOOL READINESS & SUCCESS

• Children with a history of language impairments and/or delayed articulation or phonology skills are AT RISK of delays in early literacy requisites/skills.

• Children with good awareness of sounds patterns and language patterns become better readers

• Children with poor awareness of sound and language patterns, are at risk for delayed reading acquisition.

SUMMARY OF RED FLAGSsigns for immediate further referral

• No babbling at 12 months• No gesturing (pointing, waving bye-bye) by 12 months• No single words by 16 months• No 2 word combination spontaneous phrases

by 24 months• Unintelligible speech at 3 years • Limited number of consonants at 2 years• Simplified grammar at 3 ½ years• Difficulty formulating ideas and using vocab at 4 years• Language not used communicatively

– Any loss of ANY language or social skills Any loss of ANY language or social skills – at ANY ageat ANY age

Studies demonstrated that early identification and intervention can help children

We don’t’ have to “wait and see”

Early identification starts with knowing and looking at the child’s language milestones and skills

Act Early. Know the signs

Know the signs• Use tools specific to LANGUAGE:

– First Words milestones brochures

– On-line: www.firstwords.ca – (parent portal), “HOW IS MY CHILD DOING? “ (online screening tool)

Where to Refer: First Words

•For children (0 to SK):•Families can attend any of the First Words Community Screening clinics (613) 580-6744 ext. 28020•OR •Fax direct request to the First Words Intake office at (613) 738-4893

For more info about First Words, families may also contact the Ottawa For more info about First Words, families may also contact the Ottawa Public HealthPublic Health Information line: (613)580-6744 Information line: (613)580-6744

What can I do?

REFER TO FIRST WORDSREFER TO FIRST WORDS

EARLY EARLY

USE AND MODEL LANGUAGE USE AND MODEL LANGUAGE RICH STRATEGIESRICH STRATEGIES

USE LANGUAGE RICH USE LANGUAGE RICH STRATEGIES ALL DAY, STRATEGIES ALL DAY,

EVERY DAY !EVERY DAY !

To stimulate speech and language, you need:

Interaction Information

Interaction strategies

Be face-to-face Establish eye contact Observe Wait – to see the child’s interest Listen Follow the child’s lead Take a turn

Information strategies

Talk slowly Short sentences Repeat and/or emphasize key words Add a gesture or symbol or visual cue Repeat often Be face-to-face

THE 4 S : What to do to make your language easy to understand

Say Less• Short sentences• Simplify messagesStress• Emphasize key words• Vary and exaggerate tone of voice• Repeat Go Slow• Speak slowly• Use longer pauses between wordsShow• Talk about familiar things / here-and-now• Use objects or point to the object

Excerpt taken from “Learning Language and Loving it” (Hanen Centre)

Songs … linking it to language

• Use nursery rhymes to let children hear the rhythm and flow of our their language

• Sing simple songs with your child and use ‘call and response’ activities

• Use body language in songs, stories and in everyday activities

Join in and play

• By joining in and playing together, you create many opportunities for the child to learn more language and to practice talking with you.

• Pretend play is important for language development. Model simple pretend actions (e.g., feeding, combing hair, sleeping, dressing, washing,etc.) for the child.

Playing with your childInstead of..... Try to.....

Insisting that your child play with a toy of your choice....

Watch to see what toys they child finds interesting, then play along.

Watching the child play from the sidelines.....

Get your own toy and copy what the child is doing with that toy (if appropriate)

Telling your child what to do with the toys.......

Get a toy and show him/her how to play with it. Model simple pretend actions

Asking questions about their play... Just make comments on the play activity and what your child is doing

Feeling reserved or self-conscious when playing with your child.....

Forget about how you look and be playful! You are the best toy in the house

Games

• Focus on social people games• Focus on interaction• Be clear and consistent – how we start, play the

game and finish the game

BOOKS and TELLING STORIESThrough storytelling, we are activating

language and literacy!• Children learn through experience and repetition- Reading books offers

both!• Reading BOOKS and telling stories:

– helps children learn NEW LANGUAGE (new words and sentence structure)– shows how a book works (orientation, page by page, pictures give clues to the

story)– makes them more aware of PRINT (words on a page equals spoken language)– helps children LEARN TO READ

READING to children fosters READING to children fosters a LOVE of READING in childrena LOVE of READING in children

MAKE IT INTERACTIVE

• Add pictures• Add a song• Add a game• Add a craft• Add an experience• Do it again

Talk throughout your day

Take home messages

• Know the signs• Act Early and Refer • Read, sing and play

• Talk … throughout the day, with your child.

Questions

Eastern Ontario Infant Hearing ProgramEastern Ontario Infant Hearing Program

• By phone: (613) 688-3979 or 1-866-432-7447

• By fax:( 613) 820-7427

• If not eligible for IHP, child is referred to CHEO Audiology or to community Audiology clinics for follow up.

Services provided to:•newborn up to 3 months (for those not screened at birth)•child up to 2 years with a hearing concern (except for otitis media) •or child diagnosed with a permanent hearing loss.

Eastern Ontario Blind - Low Vision Early Intervention Program (BLV)

–for children 0 to 6 who are diagnosed with blindness or low vision by an ophthalmologist.

–Children of any age should be referred to CHEO Ophthalmology or a community Ophthalmologist for assessment and diagnosis.  

–If a child is diagnosed with blindness or vision loss, the child can be referred to BLV.

–By phone: 613-688-3979 or 1-866-432-7447.

–By fax: 613-820-7427

Contact information

• Mary Lynn Taschereau-Park• taschereau@cheo.on.ca• First Words Preschool Speech and Language

Program of Ottawa• www.firstwords.ca• First Words (613)688-3979

REFERRING CHILDREN:

WHY?• When a child is talking very

little, others may communicate less with that child.

• The interaction of ‘less talk – less input’ has long term negative effects

WHEN? When a child does NOT

meet developmental milestones

When a child presents with high risk indicators

When a parent is concerned When there is a positive

family history of speech or language delays