Language Development and Disorders

Language Development and Disorders Ann Blau MS, CCC-SLP Amy Kantor MS, CCC-SLP Melissa Cronin MS, CCC-SLP

Participant Learning Objectives • Develop an understanding and knowledge of typical developmental language norms based on chronological age • Formulate a diagnosis for language development and skills for a child by applying the typically expected language norms based on that child’s chronological age with the language skills the child presents • Become familiar with various strategies and techniques used for treatment and ways to implement each within the child’s natural environments and during daily routines • Learn how to educate parents regarding language intervention • Obtain a brief overview of Autism Spectrum Disorder (ASD) signs/symptoms and treatment

Case Study Max is a 3 year old boy who presents with difficulties understanding and following simple directions within his daily routine (e.g., Sit in your chair). He produces typical length of utterances of single and simple two words (e.g., says “Milk” to request milk). Max is often unable to respond to yes-no and simple wh- questions (i.e., simple what and where questions) (e.g., when asked Do you want milk? he frequently says “no” but then points and reaches for milk to indicate he does want it). • We will get back to Max after we learn about typical developmental language norms expected for Max and children of all ages from birth through 6 years old • We can determine if Max is performing at age-appropriate skills or not once we know the language skills expected for a typically developing child his age

Typical Developmental Language Norms • Language development begins at birth. Children typically develop language following a hierarchy of language development. However, children develop at different paces. Some children develop language faster and some more slowly than others. • By age 5 years, most children have mastered basic elements of adult language.

Language Development:Birth to 3 months old • Social Communication Skills/Play Skills - Looks at caregivers and familiar others - Becomes quiet and attends to sound, especially to speech • Receptive Language Skills/Understanding Language - Smiles or coos in response to another person’s smile or familiar voice • Expressive Language Skills/Spoken Language - Produces different types of cries when tired, hungry, or in pain/discomfort

Cause for Concern:3 months old • Clinical Clues: • Lack of responsiveness and awareness of environment • Lack of awareness of sound (hearing intact?) • Cry is no different if tired, hungry, or in pain

Language Development:3 to 6 months old • Social Communication Skills/Play Skills • Fixes gaze on face • Begins to develop a gestural repertoire (e.g., reaching, grabbing, smiling) to share intentions with others • Receptive Language Skills/Understanding Language • Responds to name by looking for voice and regularly localizes sound source/speaker • Expressive Language Skills/Spoken Language • Produces cooing, gurgling, chuckling, laughing

Cause for Concern:6 months old • Clinical Clues: • Cannot focus, easily over-stimulated • Lack of awareness of sounds, no localizing toward the source of a sound/speaker

Language Development:6 to 9 months old • Social Communication Skills/Play Skills - Enjoys reciprocal social games structured by an adult (e.g., peek-a- boo) - Cries when parent leaves the room (at about 9 months) - Exhibits object permanence most of the time (awareness that objects exist when not seen) • Receptive Language Skills/Understanding Language - Recognizes familiar people - Associates objects with specific location • Expressive Language Skills/Spoken Language - Imitates vocalizing with another and imitates familiar sounds and actions/gestures - Produces different vocalizations for different states - Produces reduplicative babbling (e.g., bababa, mamamama) and vocal play with intonational patterns that take on the sound of words

Cause for Concern:9 months old • Clinical Clues • Does not appear to understand or enjoy the social rewards of interaction • Lack of connection with adult (lack of reciprocal eye gaze, vocal turn-taking, reciprocal social games) • No babbling or babbling with only few or no consonants

Language Development:9 to 12 months • Social Communication Skills/Play Skills - Indicates joint attention by directing another’s behavior (e.g., shows objects, gives objects to adults, pats, pulls, or tugs on adult, points to object of desire) and coordinates actions between objects and adults (looks back and forth between adult and object of desire) - Exhibits object permanence consistently and finds toy hidden under cloth, box, etc. - Touches an adult to continue activity • Receptive Language Skills/Understanding Language - Understands language of daily routines (e.g., eating, bedtime, bath time) - Responds to “bye bye” by waving “bye” - Begins to show recognition of his/her name • Expressive Language Skills/Spoken Language - Uses vocalizing, babbling to gain attention - Shakes head “no,” pushes undesired objects away to show preference/protest - Imitates new sounds/actions

Cause for Concern:12 months • Clinical Clues • Becomes easily upset by sounds that would not be upsetting to others (e.g., sirens) • Does not clearly indicate request for object while focusing on that object • Does not coordinate action between objects and adults • Does not produce consistent patterns of reduplicative babbling • Lack of response to words or communicative gestures may indicate reduced comprehension

Language Development:12 to 18 months old • Social Communication Skills/Play Skills - Gains attention (vocally, physically, may use single word such as “mommy”) - Aware that objects exist separate from a specific location - Begins to recognize operating parts of toys (i.e., attends to knobs, levers, buttons, etc.) • Receptive Language Skills/Understanding Language -Understands agency (knows that an adult can do things for him/her such as activate a wind-up toy) -Understands and follows basic one-step directions within routine with gesture cues (e.g., pointing) at least some of time (e.g., sit down, come here, give me) - Uses finger to point to desired objects (also beginning to vocalize, may use word approximations) • Expressive Language Skills/Spoken Language - Single word productions begin - Produces ritual words (e.g., bye, hi, thank you, please) - Protests (says “no,” shakes head, moves away, pushes objects away) - Comments for joint attention (points to object, vocalizes, or uses word/word approximation)

Cause for Concern:18 months old • Clinical Clues • Lack of communicative gestures • Does not attempt to imitate or spontaneously produce single words to convey meaning • Does not persist in communication (e.g., may hand object to adult for help but then gives up if adult does not respond immediately) • Limited comprehension vocabulary (understands <50 words or phrases without the help of gesture or context clues) • Limited production vocabulary (speaks <10 words)

You Tube Video • Talking Twin babies- jayrandall22011 • Example of reduplicative babbling for communicative intent https://www.youtube.com/watch?v=_JmA2ClUvUY

Language Development:18 to 24 months old • Social Communication Skills/Play Skills - Uses “tools” for functional purpose (e.g., uses a stick to reach a toy) - Engages in very simple play by imitating activities of familiar others (e.g., cooking, reading, cleaning, shaving) - Engages in play of short, isolated schemas (e.g., rocking a baby doll and then putting it to bed; pouring from a pitcher into a cup; pretending to feed doll from a plate using a spoon) • Receptive Language Skills/Understanding Language - Recognizes common objects and their uses - Understands two word combinations even if not yet able to produce them - Understands words for common, familiar objects and actions that are out of view • Expressive Language Skills/Spoken Language - Uses primarily words to communicate (does not rely on gestures and other non-verbal means alone to express self) - Begins to produce two word combinations • First combinations tend to be memorized forms and used in specified contexts (e.g., all done, bye daddy) - Begins to produce word combinations with relational meanings (e.g., more cookie, daddy shoe) and more flexible in use (no longer used in one or two contexts)

Causes for Concern:24 months • Clinical Clues: • Reliance on gestures without verbalization • Limited production vocabulary (speaks <50 words) • Does not produce any two word combinations • Limited consonant productions • Largely unintelligible speech • Compulsive labeling of objects in place of commenting or requesting • Regression in language development, stops talking, or begins echoing phrases he/she hears and often inappropriately

Language Development:2 to 3 years old • Social Communication Skills/Play Skills -Begins using language in imaginative ways (e.g., picks up block, holds to ear, and says “Hi, daddy” pretending block is a phone and daddy is calling) -Uses attention getting devices (e.g., hey, look) -Engages in elaborated single schemas representing daily experiences with increasing details (e.g., puts lid on pan, puts pan on stove; collects items associated with cooking/eating such as dishes, pans, utensils, glasses) • Receptive Language Skills/Understanding Language - Understands and follows 1-step directions without cues (i.e., no pointing) (e.g., “Go get your shoes”) as well as familiar 2-step directions with gesture cues of pointing when needed (e.g., “Go get your shoes and bring them to me” while pointing to the shoes and then to self) - By age 3, understands and accurately responds to simple wh-questions (i.e., what, what-doing, where questions within context such as Where is the ball? What are you doing?) - Understands word order for his/her language for three word combinations • Expressive Language Skills/Spoken Language - Engages in short dialogues with an adult facilitating - Expresses basic emotion (i.e., happy, sad, angry) - Begins providing descriptive details to facilitate listener’s comprehension (e.g., big car, yummy ice cream) - Begins using more words daily and combining words to expand on meanings - Produces typical length of utterance of 3 to 4 words by age 3 - Produces 300 to 500 words by age 3 - No longer simplifies words (e.g., says “banana,” no longer “nana”) and is at least 75% intelligible by the age of 3 years old

Cause for Concern3 years old • Clinical Clues: • Words limited to single syllables, deletion of final consonant • Few or no multi-word utterances • Typically does not demand a response from listeners • Does not ask questions • Poor speech intelligibility (i.e., significantly less than 50% intelligible at 2 years old, 75% intelligible by 3 years of age) • Frequent tantrums when not understood and listener unable to immediately meet his/her needs • Echolalia or “parroting of speech” without communicative intent • Unable to follow routine directions with pointing

Language Development:4 to 5 Years old • Social Communication Skills/Play Skills - Improvises and varies on themes during play - Plans out schemas and scripts for play - Hypothesizes “what would happen if?” during play • Receptive Language Skills/Understanding Language - Understands and follows 2-step related directions without repetition or cues - Understands descriptive words (e.g., size, color) and longer, complex sentences containing descriptive words (e.g., The small black cat that is in the box) - Understands words that describe sequences (e.g., first, then, next, last) • Expressive Language Skills/Spoken Language - Produces approx. 600 to 1500 words - Talks about recent events and experiences - Produces sentences of increasing length and complexity (at least 5 and 6 word sentences)

Cause for Concern:5 years old • Clinical Clues: • Needs repetitions of directions along with cues such as pointing to follow directions when involving 2 steps • Produces noticeably less than 600 words • Produces only simple, short sentences (maybe combines words but only two and three word combinations) • Does not seem to understand long, complex sentences when spoken to him/her

Language Development:6 years old • Social Communication Skills/Play Skills -Takes turns with back and forth commenting/questioning in conversations; Stays on topic and takes turns in conversation as well as initiates conversations with others for social purposes -Engages in highly imaginative activities for events child has never participated in or observed (e.g., astronaut builds a spaceship, flies to a strange planet, explores, eats strange food, talks with creatures on strange planet) -Plans several sequences of pretend play events and organizes what is needed (both objects and other children) and uses language to set the scene, actions, and roles in play -Engages in collaborative play (i.e., play roles are coordinated and themes are goal-oriented) • Receptive Language Skills/Understanding Language - Follows 2- and 3-step directions in sequence with only occasionally needing repetition or cues such as pointing - Points to letters when presented to identify letters on a page - Understands quantity (how many of an item such as five objects in a basket) - Asks and responds to "wh" questions (who, what, where, when, why) including some more complex questions such as outside of the immediate environment/situation and by giving a logical reason

Language Development:6 years old (continued) • Expressive Language Skills/Spoken Language - Speech should be completely intelligible even in connected speech and even if still some articulation errors, thus understood by most others - Consistently uses words to express self (does not ever rely on gestures such as pointing alone) - Retells a personal story or talks about a recent event just experienced - Tells and retells stories and events in a logical order and understands relationships of events/people in story - Expresses ideas by producing a variety of complete sentences - Uses most parts of speech (grammar) correctly

Cause for Concern:6 years old • Clinical Clues: • Consistently needs repetitions of command and cues such as pointing to follow 2-step directions • Speech is often unintelligible due to numerous articulation errors and is especially difficult to understand in connected speech or when outside the immediate context • Relies on gestures such as pointing alone to communicate (i.e., does not consistently use words to express self) • Unable to answer "wh" questions (who, what, where, when, why) when within context of the situation (“Where is the boy?” when shown a picture of a boy in his home)

Back to Max, our 3-year-old boy • Based on typical developmental norms for his chronological age of 3 years, he should be producing utterances that are at least 3 and 4 words rather than his productions of single and simple two words. • Based on his age, he should be understanding and following simple and familiar directions and understanding simple questions, which he shows he is unable to do.

Beyond the age of 6, children gradually begin to think in more complex ways. This growth helps them understand and use the subtleties of language. Children gradually advance from understanding simple sentences to being able to interpret complicated content within a paragraph. They advance from writing a few words at a time to composing complex stories and reports. Once they enter middle adolescence, their speech is almost adult-like.Children who have well-developed language skills tend to have better memories and attention spans. This makes learning easier for them, and children who are successful in school tend to develop a healthy self-esteem. Also, children who have good language skills often make friends more easily than children who have trouble expressing themselves with words.The following slides will discuss the development of language during the school years, early adolescence, and middle adolescent/teenage years. Language Development: Beyond the age of 6

Language Development: What to expect of the 7-8 year old child • Children at this age typically have gained most of their grammar knowledge and are using it in conversations. Full and detailed stories are beginning to be the norm and the way that children at this age interact socially. They are much better at following directions. Mastery of basic reading and writing skills should be complete so that instead of "learning" to read and write, they will be "reading and writing" to learn. • Receptive Language Skills/Understanding Language • Follows 4-step spoken directions • Can follow complex directions with little repetition such as a series of instructions or a procedure for completing a task (example: cooking). • Demonstrates understanding of grade-level stories by answering questions • Understands words with multiple meanings • Expressive Language Skills/Spoken Language • Rules of grammar and exceptions to those rules are mastered • Uses increasingly complex sentences in regular communication (example: “First we went to the park and then we rode our bicycles. Next we . . . “) • Gives directions with 3-4 steps • Begins to express his/her opinions and can retell both real and imaginary events. • Begins to give synonyms and categories in word definitions (7-9 years) • Example: A dog is an animal that barks. • Production of figurative (non-literal) language begins and increases (7-9 years)

7-8 Year Old • Reading • Uses phonics (knowledge of sounds) strategies when reading to pronounce newly-encountered words • Recognizes more words by sight • Re-reads and self-corrects when necessary • Uses meaning clues when reading to understand text (pictures, headings, titles) • Locates written information to answer questions • Explains key elements of a story (main idea, characters, plot) • Identifies and uses spelling patterns in words • Uses his/her own experience to predict and justify what will happen next • Reads a story, summarize, and retell story sequences • Writing • Writes legibly • Uses a variety of sentence types in writing essays, poetry, short stories (fiction and non-fiction) • Uses basic punctuation and capitalization • Spells frequently-used words • Progress from inventive (made-up) spelling in independent writing to more accurate spelling

7-8 Year Old • Social communication Skills • Begins and ends conversations appropriately • Stays on topic and takes turns during conversation • Explains words and ideas when conversation breaks down, gives background information or definitions of words • Uses language to inform, persuade (give convincing arguments), and entertain • Can take others' perspectives, which also increases the ability to persuade (7-9 years) • Uses language to establish and maintain social status (7-9 years) • Begins to understand jokes and riddles based on sound similarities (7-9 years)

Language Development: What to expect of the 8-9 year old child • Grammar knowledge is complete and children are also better at thinking about language and how it is organized and relates to itself. Synonyms, categorization, and figurative language are among their newest language skills. • Receptive Language Skills/Understanding Language • Listens attentively in group situations • Follows greater than 4-step directions • Demonstrates understanding of grade-level content material • Expressive Language Skills/Spoken Language • Uses clear and specific vocabulary in conversation and discussions • Uses subject-related vocabulary (example: words related to weather when discussing different weather conditions/science) • Can explains what he/she has learned • Gives synonyms and categories in word definitions (7-9 years) • Production of figurative (non-literal) language increases (7-9 years) • Begins to understand jokes and riddles based on sound similarities (7-9 years)

8-9 Year Old • Reading • Summarizes a story accurately • Uses word analysis skills when reading • Re-reads and corrects errors when necessary • Predicts and justifies what will happen next • Compares and contrast s • Asks and answer questions about the reading material • Uses acquired information to learn about new topics • Reads grade-level books fluently • Uses clues from language content and structure to help in understanding what is read • Writing • Plans, organizes, revises, and edits • Includes details in writing • Writes stories, letters, simple explanations, and brief reports • Spells simple words correctly, corrects most spelling independently or with a dictionary for help • Cursive writing is written clearly

Language Development: What to expect of the 9-10 year old child • Children at this age are applying what they learn in school to other aspects of their lives as well as other school subjects. • Their language skills are becoming more abstract and complex. They are also beginning to read and write more difficult sentences than they typically use in their conversations. • Other complex organization skills are acquired and children use speech and language for many social purposes. • Receptive Language Skills/Understanding Language • Listens to and understands information presented by peers • Forms opinions based on evidence • Understands jokes and riddles based on word ambiguity (9-12 years) (example: "He is an unbelievable man" implies either the man is a liar, or he is an honorable man.) • Understands most common idioms/proverbs/sayings • No longer requires visual support to follow complex instructions • Expressive Language Skills/Spoken Language • Participates in group discussions • Can express his/her own opinions with supporting ideas (for example, share an opinion about a movie recently seen) • Gives accurate directions to others • Summarizes and re-states ideas • Organizes information for clarity • Uses subject area information and vocabulary for learning • Gives effective oral presentations • Can explain relationships between meanings of multiple-meaning words (analogies) (9-12 years) • Uses more abstract and specific vocabulary and grammar, complex sentences in writing than in conversation (9-12 years) • Uses more figurative (non-literal) language in conversation (like puns)

9-10 Year Old • Reading • Reads grade-level books fluently • Uses previously learned information to understand new information • Follows written directions • Takes brief notes • Links information learned to different subjects • Learns meanings of new words through knowledge of word origins, synonyms, and multiple meanings • Uses reference materials • Explains the author's purpose and style of writing • Reads and understands a variety of literature • Makes inferences (draws conclusions based on assumptions) from texts • Summarizes content, includes main idea and details • Writing • Writes effective narratives and explanations, and several paragraphs on the same topic • Develops a plan for writing stories with a beginning, middle, and end • Organizes writing to convey a central idea • Edits final copies for grammar, punctuation, spelling

9-10 Year Old • Social Communication Skills • Becomes aware that his spoken language as well as body language can combine to give the same message or may present two different ideas and that this can be used for comedy. • Can now understand how the language of his home differs from formal school language and can adjust his use of language appropriately • Can identify what ‘slang/street talk’ is and when to use it • Can adjust his speech to suit familiar situations (for example, when speaking to a younger child he would know to simplify the words used)

Language Development: What to expect of the 10-12 year old child • Children at this age use language functionally, and adjust their choice of words or level of sophistication to suit the context (e.g., classroom versus. They select vocabulary based on cultural or other factors (e.g., children may begin to swear to fit in with peers, or use the slang of their identified cultural group) • Children at this age can prioritize, organize, plan, report, and summarize effectively. Their writing is more complex than their conversational language. They also tell jokes using more complex language and ideas and can understand sarcasm. • They are able to form their own opinions, present their points of view, and actively participate in discussions with others. • Receptive Language Skills/Understanding Language • Listens and draws conclusions in subject areas • Selects comprehension strategies to understand increasingly complex information which may be presented by guest speakers, recordings, documentary or news reports • Understands longer recounts which may include persuasive arguments and historical recounts • Expressive Language Skills/Spoken Language • Uses language effectively for a variety of purposes/situations • Summarizes main points • Reports about information gathered in group activities • Makes planned oral presentations appropriate to audience • Is able to explain results through discussions • Can persuade by presenting a well formed, convincing argument for or against an issue • Uses props, visual aids or knowledge of the audience to present information in an engaging manner • Experiments with presenting the same information or facts in different ways depending on the perspective of audience members • Learns how to use questions of others to continue and strengthen their own argument in discussions

10-12 Year Old • Reading • Prioritizes information according to the purpose of reading • Learns meanings of unfamiliar words through knowledge of word origins, word beginnings (prefixes), and word endings (suffixes) • Reads a variety of literacy forms (imaginative, informative or persuasive) • Describes development of character and plot • Describes characteristics of poetry • Analyzes an author's language and style • Uses reference materials to support opinions • Writing • Writes for a variety of purposes • Uses effective vocabulary • Varies sentence structure • Revises writing for clarity • Edits final copies • Social Communication Skills • Uses gestures, facial expressions, and appropriate voice during group presentations • Participates in class discussions across subject areas • Explains words and ideas when conversation breaks down, gives background information or definitions of words • Has well-developed conversational skills and can use language skills to negotiate in situations where there is conflict • Understands how language rules change to indicate closeness in a relationship and how tone and body language support the words spoken in conveying respect (example: children understand how to interact differently with the school principal than with their father) • Has an understanding of social conventions and can be polite, apologize, and read most social cues (their speech can even sound almost adult-like)

Language Development: What to expect of 13-15 year olds • Between 13 and 15, teenagers’ ways of thinking about themselves, others, and the world shifts to a much more adult level.The teen enters middle adolescence with a focus on things they can experience here and now, and moves to being able to imagine the range of possibilities life holds. • As teens seek independence from family and establish their own identity, they begin thinking abstractly and become concerned with moral issues. All of this shapes the way they think and communicate. Language reflects the teens’ desire to be accepted by their peer group, and will result in them speaking more like other kids (at school ) and less like their parents (at home). Expect the following changes as a progression of development rather than as age-based milestones: • Decision-making skills improve: • They learn to distinguish fact from opinion • They learn to evaluate the credibility of various sources of information • They become able to anticipate the consequences of different options • Reasoning skills improve: • They begin to apply concepts to specific examples • They learn to use deductive reasoning and make educated guesses • They learn to reason through problems even in the absence of concrete events or examples • They become able to form hypothetical solutions to a problem and evaluate which solution is best • Arguing skills improve (and are demonstrated often and with great passion) • They now begins to express opinions about political and social issues

What can you do? • Now that you know the language skills that are typically expected to be developing and mastered at the various ages, what can you do if a child like Max is not demonstrating skills expected by his age? • There are many useful strategies to encourage, teach, and improve language development within a child’s natural environments (e.g., home, school) and during daily routines (e.g., meals, bath, dressing)

Encourage language development • How adults (parents, teachers, familiar others) respond to a child’s efforts to communicate is critical • Children learn best when encouraged to try and praised when they succeed. This is especially true for children with language difficulties. Reward the child’s speech attempts: - Physical: smile, hug, kiss, touch - Verbal Praise such as “good”; “I like your words”; “I like how you asked for milk” - Natural Consequences: provide appropriate action in response to your child’s speech attempt (e.g., child: “milk,” adult: “You want milk” as you give the child milk) • Help the child communicate more clearly whenever applicable and possible (e.g., child: “Mi-.” Adult: is not sure what child wants, asks child to show what wants by pointing, bringing adult to item, etc., and then adult says “Milk. Do you want milk? Okay, here is some milk” as adult gives the child milk)

Simplify your language • Research has shown that all over the world, parents and other adults change and simplify their normal language when speaking to a child (e.g., simplify words used, decrease speed of talking, alter pitch and loudness) • These changes are often called “motherese” or “fatherese” • Providing simplified language makes it easier for child to understand and learn language especially for a child with delayed language development • Your phrases and sentences are models, or examples, for the child to hear, learn from, and imitate. This is how the child, especially with delayed language abilities, can better understand what is being said and begin to produce more appropriate words, word combinations, phrases, and sentences

Understanding and following directions • Max demonstrates difficulty understanding and following directions. How can we help him? • Use simple sentences along with gestures of pointing to help understanding of the command • Give only 1-step directions until he is able to understand and follow 2-step commands • Example: Instead of the 2-step command “Go get your shoes and bring them to me” simplify to “Give me your shoes” as you provide the gesture cue of pointing to the shoes and then pointing to self)

Responding to simple questions • Max demonstrates difficulty understanding and responding to simple questions (i.e., yes-no and simple what and where questions). • Provide models of answers along with explanations and/or actual objects to help teach Max the concept of questions and the vocabulary for answering • Example: Adult: “Do you want milk?” as holds up the cup of milk, “Yes? or No?” Child: indicates wants milk by reaching for milk, nodding with head, or any other behavioral means, Adult: models the correct response “Yes. Yes, you want milk. Yes, milk” as gives the milk

Provide Feedback • When a child produces a language error, provide feedback (e.g., child: “Look, car” as points to a bus; provide feedback by saying “That’s a bus. We ride on the bus. Look, there’s a car” as you point to a car) - This provided vocabulary for the word “bus” versus “car” without directly correcting, thus naturally promoting the child’s desire to continue communicating while giving child correct language to hear and eventually use him/herself • Feedback gives information to the child about correctness/incorrectness of language, thus allows the child to hear and eventually correct his/her own mistakes

Gradually increasing and expanding language • Max produces utterances consisting of only single and two word combinations, delayed expressive language for his age • Provide models of appropriate phrases/sentences that are just beyond the child’s language level by gradually including more information to your sentences by adding words within the simple sentence structure - Keep your sentences just beyond the child’s language level (e.g., Child: “The dog.” Adult: “Yes, the big dog.”; Child: “Milk.” Adult: “You’re drinking milk. I like milk, too.”; Child: “Truck go.” Adult: “Truck goes fast. It is a big truck.”) • Exaggerate important words with your voice - Children naturally attend more to words that are stressed (e.g., “The BIG dog”; “Give me the CUP”) • Use gestures when you speak to help child understand the words - Facial gestures: show on your face surprise, excited, happy, sad, scared, etc. - Hand gestures: “come here” as wave toward self; “give to me” as hold hand out, palm side up; “sit down” as point and/or tap on chair

Talking to the child • Self-talk – talking about what you are doing, seeing, or feeling at the time you are doing it (e.g., Wet clothes. I am hanging them up. I am washing the floor. It is dirty.) • Parallel talk – talking about what the child is doing as it happens by describing the child’s actions, items being used, and feelings (e.g., You are playing with the doll. The doll is hungry. You’re feeding the doll. We are going to the park. You look excited to go.)

Language during daily routines • Mealtimes: Max and all children can practice listening to others and/or speaking during mealtimes • Language is based on ideas and experiences. Through interactions with their world, children learn meaning. There are many specific concepts, or ideas, that may be a natural part of the mealtime routine. By using these concepts and talking about them, children learn the vocabulary and how to use them in their language. • Nouns (objects) – names of foods, dishes and utensils, furniture, etc. • Verbs (actions) – eat, drink, taste, chew, swallow, cut, pour • Descriptive words (adjectives, quantity) – hot, cold, sweet, sour, empty, full, all, none, yummy, yucky, colors and shapes of foods, crunchy, mushy, hungry, thirsty, all gone, more • Examples: Come to the table. The peas are green. The bread is crunchy. Soup is hot. I want more milk. I like the apple. The orange is sweet. Stay in your chair. Use your fork to eat. I am hungry. This is yummy.

Other daily routines • Bathtime: Can be a good time to talk about different objects and actions as they are being performed with Max and with all children • If during the morning, can talk about plans for the day. If during the evening, can discuss the events from that day • Nouns – towel, soap, bathtub, sink, shampoo, bubbles, sponge • Body parts – head, hair, leg, foot, toes, arm, hand, fingers, nose, ears, eyes • Verbs – rub, wash, splash, dry off, drip, pour, spray • Descriptive words – wet, dry, clean, dirty, cold, hot, empty, full, big, little, slippery • Examples: I like the bubbles. On your head. Soap in your hair. The water is cold. Dirty hands, clean face. Give me the soap. Pour the water in. Wash your toes.

Other daily routines • Dressing: Can easily be a language lesson with Max and with all children that includes vocabulary and many concepts including plurals (e.g., one hand, two hands; one sock, two socks), actions (e.g., Put your shoes on), and communicating preferences (e.g., I want the blue shirt) • Nouns – shirt, pants, socks, shoes, pajamas, hat, button, undershirt, underpants • Body parts – arm, leg, hand, foot, tummy, head, fingers, ankle, wrist, elbow, chin • Verbs – pull, push, put on, raise, stand up, sit down, button, zip, snap, tie • Adjectives – colors, dirty, clean, new, old, same, different, pretty, ugly, light, dark, hot, cold, long, short, striped • Examples: That is a shirt. Here are your shoes. Pretty dress. It is too small. Zip your coat. It is cold outside. Wear your hat.

Reading and storytelling • Reading books and telling stories encourage language development and build a strong foundation for future reading, writing, and learning • Young children like Max have shorter attention spans so simplify stories for them by using fewer words (e.g., Look. A bunny. Bunny is eating. He’s eating carrots.) • As the child can sit longer, expand language to make the story more complex (e.g., See the cow? The cow is big and brown. He is looking for grass to eat.) • Ask questions during and after the story to talk about what happened (e.g., Where’s bunny? Where’s bunny’s carrot?) (What was the cow eating?)

Read aloud for 15 minutes a day…it doesn’t have to be 15 minutes in a row. You don’t have to finish the book. You don’t have to read all of the words. Talk about the pictures instead. Be excited as you turn the pages. Let your baby chew on the board book for a while. Just engage! Do it every day and do it for at least 15 minutes.

Language Development and Disorders