CHEO Connects! February 6, 2012

1. TALK THE TALK:Milestones, Strategies, Activities and Daily routines to promote communication Mary Lynn Taschereau-Park, B.A., B.Ed., CDA Communicative Disorders Assistant CHEO Connects! February 6, 2012

2. Agenda Participants 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

3. 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

4. Children’s early learning experiences have a profound effect on their development. These early interactions directly affect the way connections are made in the brain. Early learning experiences are crucial to the future well-being of children, and establish the foundation for the acquisition of knowledge and skills that will affect later learning and behaviour. The Kindergarten Program, 2006 Ministry of Education of Ontario

5. 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).

6. Why We Do What We Do....

7. So children can grow up to be successful adults!

8. 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.

9. Early Identification & intervention:it happens BEFORE 30 months!

10. 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)

11. 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.

12. SETTING THE PATH EARLY FOR LANGUAGE… Know the milestones

13. 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

14. WHY and HOW children communicate

15. 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

16. 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

17. First Words Communication Development Quick Reference Chart Page 1

18. First WordsCommunication Development Quick Reference Chart(Page 2)

19. 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

20. 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

21. 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

22. 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.

23. 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 • at ANY age

24. Act Early. Know the signs • 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

25. 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)

26. 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 Public Health Information line: (613)580-6744

27. What can I do? USE AND MODEL LANGUAGE RICH STRATEGIES REFER TO FIRST WORDS EARLY

28. USE LANGUAGE RICH STRATEGIES ALL DAY, EVERY DAY !

29. To stimulate speech and language, you need: Interaction Information

30. 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

31. 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

32. THE 4 S : What to do to make your language easy to understand Say Less • Short sentences • Simplify messages Stress • Emphasize key words • Vary and exaggerate tone of voice • Repeat Go Slow • Speak slowly • Use longer pauses between words Show • Talk about familiar things / here-and-now • Use objects or point to the object Excerpt taken from “Learning Language and Loving it” (Hanen Centre)

33. 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

34. 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.

35. Playing with your child

36. Games • Focus on social people games • Focus on interaction • Be clear and consistent – how we start, play the game and finish the game

37. BOOKS and TELLING STORIES Through 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 a LOVE of READING in children

38. MAKE IT INTERACTIVE • Add pictures • Add a song • Add a game • Add a craft • Add an experience • Do it again

39. Talk throughout your day

40. Take home messages • Know the signs • Act Early and Refer • Read, sing and play • Talk … throughout the day, with your child.

41. Questions

42. Eastern 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.

43. 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

44. 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

45. 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