Category Archives: Speech and Language Development

The Power of Verbal Routines

Contributed by Pediatric Speech-Language Pathologist, Yvonne Smith, M.S., CCC-SLP

My daily life consists of verbal routines. In fact, many of us engage in these routines and don’t even realize it. How often have you heard yourself saying a familiar line from a movie in a given situation? “I’ll be back!” said in the voice of Arnold Schwarzenegger when you are leaving a room. “Houston, we have a problem!” when something is not going right, and one of my often-used phrases, “Oh man!” in the voice of Swiper the Swiper from Dora.

Verbal routines are an extremely helpful tool when you are trying to get little ones to start talking. If I said, “Ready, Set…,” but did not finish that phrase, I bet you could finish it for me. How about, “Twinkle, Twinkle Little…”. This is the power of verbal routines.

These phrase and songs become so familiar that we are easily able to finish the line. I always add a gesture to what I am saying or singing, so even if a child cannot say a word, they can maybe imitate the gesture that goes along with the verbal routine. Using this tool daily with your little one can help them start to “fill in” gestures/sounds/words more easily.

I learned the power of verbal routines firsthand when my youngest was a toddler. One day we went to the grocery store, and as I lifted her into the basket she said, “wokka-wokka-wokka.” Hmmm?  It was only then that I realized that over the last few months, every time we had gone to the grocery store, I had made that same exact noise as I put her in the basket. (Don’t ask me why! I’m an SLP so I’m always making some kind of noise!) She had picked up on that little verbal routine, and although she was a late talker, that was one thing she could do. Should could do it because it was familiar routine for her.  This powerful tool can help your child, too.

Here are a few of my favorite verbal routines.

The Knock-Knock Box:

Anyone that has ever been in my therapy room, knows my “Knock-Knock-Box” routine. I do this with every young child I work with, and let me tell you, they pick up at least some part of it quickly. I always have all my toys in a big box. When we are ready to get a new toy out, we always go through the same routine. We knock on the box 3 times while saying, “knock-knock-knock.” We then “pop” the lid on each side with a verbal “pop-pop,” followed by, “open.”

Most kiddos are knocking on the box after only a few demonstrations, and many will start saying, “nah-nah” pretty quickly.  We can then carry that “knock-knock” routine over to doors and other things we want to open. We can also start to expand the “open” as they start talking more. “I open,” “open it,” “open box,” “John opens,” etc…

Pop Ball

I have a few toys that I consider my “desert island” toys, and “Pop Ball” is one of them. It’s actually called a “Phlat Ball,” but that’s not as fun or easy to say, so I call it “Pop Ball.” You can use this routine with any item that has a “Push and Pop” kind of action with it. We start by saying/signing “ball” and then “push” as we push the ball down. We then sign and say “wait-wait-wait” and “pop” as the ball pops up. Kids absolutely love this, and they pick up on it very quickly. Often, they get the “wait” sign before anything else, and I encourage parents to use the sign to carry over into other situations. For example, when your child needs to wait for a snack that is being prepared, you can sign and say “wait-wait-wait,” and since they are already familiar with this in a routine it can help them understand it in other situations.

Purple Bag (or whatever color you have)


Most of you have probably read the “Brown Bear-Bear Bear” book by Eric Carle. This rhyme follows the same pattern. I have different color bags that I use, and I fill them with animals or objects. Sometimes I will fill the bag with objects that have a specific target sound for the child. (ie: Objects that start with /b/: ball, block, bus, bottle, baby, etc.) I put all of the objects in the bag and hold on to it. The verbal routine starts with “Purple bag, purple bag…. What do I see?” As you start to pull out an object say, “I see…”. I always add gestures to the routine.


(ie: Sign for the color of the bag, point to myself for “I,” hand to my forehead for “see.”) Sometimes I will give them a clue as to what I “see” before I show it to them. (ie: “Ooo, this is something that says, ‘moo.’ Hmmm?”). The skies the limit with this one. You can use any color bag, or I have had some families use something like a toy barn, and make it “Red Barn, Red Barn what do I see…” Use a dump truck and you can say, “Dump truck, Dump truck…” You get the idea, and your child will too.

Verbal routines are probably one of my top five recommendations to families when we are starting therapy. They are truly powerful, and they are an excellent tool to help get your little one talking. If you have concerns about your child’s speech and/or language skills, be sure to reach out to a licensed and certified speech and language pathologist for the specific needs of your child. Capital Area Speech and Occupational Therapy is here to help you if needed.


CLASP- Providing A Voice for the Voiceless

Providing A Voice for the Voiceless

Contributed by Amy Delk, Capital Area Speech Therapy Staff


Providing a voice for the voiceless. This is part of what Speech Pathologists do each day for their patients, both young and old. CLASP International has taken on this mission as well. CLASP International, or Connective Link Among Special Needs Programs, is a resource that is endeavoring to provide training to Graduate students in Zambia, Africa. This organization is certifying students at the University of Zambia to treat patients with special needs, such as feeding/swallowing disorders, cleft palate, and communication disorders such as autism.

Currently, within the communities of Zambia, such as the capital town of Lusaka, there are no permanent therapists who have the knowledge base and experience required to help those in desperate need. Many times, those in Zambia who need the most urgent help are hidden away. There is a stigma attached to those who are born with congenital, developmental, and acquired medical issues. They are often times seen as cursed, and kept from interacting with others, and kept from being a part of their communities. In severe cases, children born with special needs are neglected and abandoned.

There is hope. CLASP is making huge strides towards teaching the community that therapists can help make a difference, and in many cases save lives. When CLASP provides training to local licensed Zambian therapists familiar with the culture and people, the community sees that there are treatments available, and that there are explanations for speech disorders and other medical conditions. Instead of hiding in shame, those who need help are treated, and have improved quality of life. They thrive, grow, and become part of their community.

Here are some ways that you can help make CLASP a continued success.Stockphoto CLASP

  1. Visit: and find out more about this outreach program.
  1. Donate: If you are able to provide financial support to any of the therapists that make the trip to Zambia each year, please donate in their name, or the general fund. All donations are tax deductible. More information can be found under the Donate tab on the home page of the website.
  1. Volunteer: If you are a licensed Speech Language Pathologist, an Assistant-SLP, an Occupational Therapist, or Physical Therapist, you are urged to apply to the CLASP program on-line and volunteer your time and efforts either stateside or in Zambia.

Resources for Infant Feeding and Oral Motor Concerns

stockphoto  toddler eating YAY

Quick Resources for Infant Feeding and Oral Motor Concerns: Down syndrome, Cerebral Palsy, High Tone/ Low Tone Concerns, or Tube Feedings

Contributed by Capital Area Speech Therapy Staff Speech Language Pathologist:

Dee Arp, MA.,CCC/SLP

The big day is here and you are ready to tell the world; you have just had a sweet little baby!  Then, other news arrives; the sweet little baby also has an unexpected diagnosis that might make it difficult to nurse, feed, or speak some day.  It’s a lot to consider.  There is the added context of having spent hours in preparation for this big day mentally and physically, not to mention the number of hours spent in delivery.  Next thing you know, there are countless appointments lining up with medical specialist after specialist.  Did you ever feel like tuning it all out?  Understandable!  Next comes information overload: What does this diagnosis mean for your baby?  What does it mean for the rest of the family? Will your child be on multiple medications forever? How can you help your child reach his or her best potential?  Breathe in; breathe out.

This post is here to help you find those breaths. It’s a gentle guide for you to some helpful, internet-available resources.  Explore them at your own pace. The hope is that the gathering of resources here will minimize your work in searching.  These sites are full of articles and treatment considerations as your little one develops early pre-feeding and feeding skills. These materials range in topic from the “stages of typical development versus disordered feeding/ oral-motor development” to “reasons why parent training with a speech-language pathologist is important for a baby having Down syndrome”.  Our therapists seek to help you be able to help your child.  We want you all to gain a strong, fighting chance toward realistic progress at home, as well as within therapy by increasing understanding. We encourage high value placed upon early intervention and prevention of further complications.


One book resource is extremely helpful and worthy of first mention.  It provides parents (and professionals) with numerous checklists and orderly charts describing some of the various functional issues at hand.  It is a great guide through those earliest stages of feeding and oral-motor concerns.  It may even be a wonderful resource for your Pediatrician or Family Doctor as you enter this unexpected journey.  The book is titled, Nobody Ever Told Me (or my Mother) That! The author is Diane Bahr, a speech-language pathologist.

Here are some favorite internet resources that offer multiple recommended readings for a rich variety of topics related to infants having oral-motor and/or feeding concerns listed alphabetically:

  • Debra Beckman is a speech-language pathologist that instructs in the area of specific oral-motor interventions and has developed a specific assessment in this area. Articles cover a variety of topics including: cheek patterns, drooling, jaw & lip patterns, tooth grinding, and tooth patterns

  • Marsha Dunn Klein is a certified occupational therapist with the company, Meal Time Solutions. The articles include explanations of why its important to manage some of the sensory aspects of feeding as well as new ways to present food items to assist in these issues.

  • Suzanne Evans Morris is a certified speech-language pathologist. She and Marsha have written several helpful books together within this topic.  She is a part of a company called New Visions

  • Sarah Rosenfeld-Johnson and Lori Overland are also two influential, certified speech-language pathologists in the areas of pre-feeding and feeding development. Lori actually offers a course geared toward Pre-Feeding skills in young children with Down syndrome.
  • Kay Toomey is a pediatric psychologist specializing in feeding disorders. There are several handouts included here to help determine when feeding difficulties may be out of the normal category.  Items such as, “Red Flags for Feeding Disorders”, and another one distinguishing between “Picky Eaters vs. Problem Feeders” can be found here.

Thank you for your time and interest.  Remember, just as babies learn to sit up before they stand, parents also go the processes of learning what is best for their children.  Take your time along the way and enjoy the process.

Phonological Processing Skills of Children Adopted Internationally – Research Says…

I am joining fellow speech pathologist bloggers in reading and blogging about a recent research related to our field. For more information or to see more research reviews, check out this blog.

I have several amazing friends who have recently adopted or are in the process of adopting children internationally. Over the past couple of years, I have also worked with a few children who have been adopted internationally. For these reasons, I found this study about certain language skills of children adopted internationally to be a great one to review.
Phonological processing skills are very important for oral language and literacy development. Phonological skills include phonological awareness, phonological memory, and rapid naming. Phonological processing skills are referred to as the decoding component of reading. These skills as well as comprehension are essential for reading success.

The children who participated in the study were adopted from China before 25 months of age. The study was performed when the children were between 6 years, 8 months – 9 years, 3 months. They were individually given a formal phonological processing test. Some of the children were receiving speech therapy for articulation or language impairment.

The researchers wanted to find whether children who were adopted internationally had difficulties with phonological processing skills at the school-age when compared with a normative sample of children their age. After formal assessments, the study noted that these children preformed within the average range of scores to the tests’ normative sample.

They also examined whether age at time of adoption had an impact on phonological processing skills at school-age. The results indicated that age at time of adoption was not correlated with reading comprehension or phonological processing skills. It should be noted that this particular study only examined children who had been adopted before 25 months old. Previous studies have found that age of adoption is correlated with later school language skills. These previous studies may have studied a broader age range of adopted children.

Scott, K., Pollock, K., Roberts, J., and Krakow, R. (2013) Phonological Processing Skills of Children Adopted Internationally. American Journal of Speech-Language Pathology, 22, 673-683.

Can a Pacifier Hinder Speech Development?

I recently read a blog post about giving your baby a sippy cup on ASHA’s blog. I really enjoyed this post. If you have the chance, I recommend checking it out. The writer is a speech pathologist who works with children with feeding problems.

The blog post discusses why a sippy cup isn’t the best choice when weaning your baby from a bottle. The writer discusses that a sippy cup can cause problems with speech development. Along with sippy cups, pacifiers and bottles can contribute to speech problems if used too frequently or too long.
First of all, pacifiers are a controversial topic. I personally don’t think they are bad when used with an infant. In fact, I think it can be a lifesaver for a tired mom or dad. A pacifier is a great way to help soothe and relax an infant. Some babies will sleep better with a pacifier. It has also been reported that the use of a pacifier at night can reduce the risk of SIDS in newborns.

One problem with a pacifier can be if the baby uses it all the time. This could interfere with opportunities for babbling. Babbling is an important part of speech development.

Another problem with bottles, pacifiers, and sippy cups comes when a child uses them for too long. The baby uses an immature suck/swallow pattern when using a bottle, pacifier, or sippy cup. This can interfere with developing the proper the tongue placement for a normal swallow and for producing some speech sounds.

Ideally by the time a baby is 12 months, he should be weaning from the bottle or pacifier. If your infant uses a pacifier, remember to give her plenty of time to explore her voice.

For more information about this topic check out Mommy Speech Therapy.

Identifying the Signs of Communication Disorders

Jamie Putnam, co-founder of Capital Area Speech speaks about identifying the signs of communication disorders and early intervention here.

Children should begin saying words by 12 months old. They should begin combining words by 18-24 months. You should understand most of their speech by age 3. They should not have speech sound errors after age 6-7.

Early intervention has been proven the best outcome for progress. You can find more information on language development, articulation, and early intervention by clicking on the links.

If you have concerns about your child’s speech, please contact a speech pathologist.

The American Speech-Language Hearing Association’s Identify the Signs campaign is a great resource to go to for more information about this topic.

Language and Literacy

Emergent literacy begins at a very young age. When babies turn pages in books, when toddlers scribble on paper, and when preschoolers recognize signs and logos are all part of emergent literacy. It is very important to begin reading when your child is very young. Research has linked early exposure to books and stories to learning to read and to academic success.
Reading to your child is linked to increased language and literacy skills. You can find more about the research here. Children are exposed to wide variety of words through books that they would not learn through typical conversation. In addition to language and literacy growth, book sharing is a great bonding time with your child.

The American Academy of Pediatrics recommends reading daily to your child beginning at six months of age. It is good to try to read together for fifteen minutes each day. According to a study from the National Commission on Reading, reading aloud to children is the single most important intervention for developing literacy skills.

How do you read to a baby? Use simple picture books with few words. Good book choices for babies include Goodnight Moon by Margaret Wise Brown, Goodnight Gorilla by Peggy Rathmann, and Brown Bear Brown Bear by Bill Martin and Eric Carle. While book sharing, talk about the pictures. Use different voices or sing to increase attention during reading time.

Engage your preschool or elementary age child in the reading. Let the child have choices in choosing the reading source. Be expressive when you read stories. Talk about what you are reading. Ask what will the story be about, what will happen next, how does the character feel, what was your favorite part of the story, etc. Let him/her “read” to you. This will help build self-esteem and confidence.

Some of my favorite children’s books include: Pete the Cat Series, Llama Llama series, Dr. Suess books, David Shannon books, Captain Flinn and the Pirate Dinosaurs, Down By The Cool Of The Pool, Hush, Click Clack Moo: Cows That Type, My Friend Rabbit, The Giving Tree.

Offer a variety of reading sources for your child. Some of my children’s favorite books are science books about space and weather. Picture books, magazines, encyclopedias, are all great reading sources. Put children’s books where your child can easily access them.
There are inexpensive ways to increase your child’s library. Lego offers a free children’s magazine. Scholastic offers $1-2 books. You can check out several books at a time at your local library. Your library and local bookstores should also offer story times geared for your child’s age group too.

Go have fun reading with your favorite little ones!

Why Does My Speech Pathologist Send Homework?

Does your speech pathologist give homework? I do. As a parent, I also understand how hard it is to add one more thing to our day. If your child is in school, I’m sure they have a ton of homework as it is. Adding a task that requires even an extra 10 minutes a day can seem very overwhelming. So why do speech pathologists send homework when we know you already have busy schedules? Our goal is for your child to progress and master (or finish) their goals as quickly as possible.

Homework/home practice is critical for progress to be made whether your child has language, speech, or fluency disorders. There are times you may be asked to do more work than other times. When practice is carried over at home, we tend to see much more rapid progress in therapy.
If you struggle to find time to practice at home, ask your therapist for ideas you can do to make homework less stressful. Be on the lookout here for an upcoming post about carryover therapy during daily routines and car rides or using school homework to also work on therapy goals.

Does your child need an evaluation or a screening?

Speech-Language Screening vs. Evaluation
What are the differences?
By Ashley Ward, B.A., SLPA

When there are concerns regarding your child’s speech and language development, there are two main first steps to begin the process of acquiring answers. Speech-language screenings and full evaluations are two different assessments with a common goal: to provide information about your child’s speech and language skills. Below are the contrasts of these two types of assessments.

Speech-Language Screening:
Speech-Language screenings are generally conducted as a brief meeting to determine strengths and weaknesses through informal protocols.

• Typically occur in the fall at the beginning of the school year.
• Can be completed at a school or in a private clinic.
• No formal testing is used—Speech-language pathologists will bring age-appropriate printouts of colors, shapes, objects, etc. and ask simple identification questions to get an idea of your child’s speech and language skills. They will also bring a short screening form to record observations and comments.
• No standard scores are calculated comparing your child’s skills to their same-age peers.
• No formal written report of the speech therapist’s findings will be compiled.

Generally after a screening, a written summary will be provided with the results of the screening and recommendations on what steps to take next. This can include a request for a full evaluation, a wait period for a re-screen, or a referral to another type of therapy.

Speech-Language Evaluation:Speech-Language Evaluations are longer assessments where formal testing materials are used based on the type of concern (difficult to understand, small vocabulary, substituting certain speech sounds for a different sound, etc.)

• Mainly conducted in a private clinic.
• Insurance is generally contacted prior to the evaluation to determine eligibility and coverage of services.
• One or more formal tests will be administered.
• Standard scores will be calculated, placing your child in a percentile ranking comparing their skills to their same-age peers.
• A formal evaluation report will be written with your child’s background history, specific details of their performance, standard scores from the administered test(s), and recommendations on what to do next.

After an evaluation, a follow-up consultation will be scheduled with the speech-language pathologist who performed the testing to go through the comprehensive written report and to discuss further recommendations.

Getting your child screened or evaluated is the first step in ensuring they receive the services they need to develop and thrive.

Capital Area Speech offers free in-office speech and language screenings for all civil service employees as well as for the employees of the following: Dell, City of Austin, and the University of Texas at Austin.

For more information on what to look for, visit for the American Speech-Language-Hearing Association official campaign for identifying the early indicators of communication disorders.

Should you get help or wait and see?


The Importance of Starting Therapy Early
By Ashley Ward, B.A., SLPA

Decades of research demonstrate the importance of beginning speech-language and/or occupational therapy early in a child’s life. Otherwise known as early intervention, this strategy is centered on building and improving a child’s speech, language, communication, social-emotional, and play skills. Infants and toddlers who are not reaching their developmental milestones or are at risk for a delay or impairment can greatly benefit from early intervention services.

A child’s earliest experiences have a huge impact on their brain development. Research shows that the time between birth and 36 months is a critical time for progress and growth where specific circuits in the brain, which create the foundation for learning and behavior, are most “flexible” (The National Early Childhood Technical Assistance Center, 2011). These early years present a window of opportunity for development that will not be available later in life. Early intervention therapy can minimize, and even prevent developmental delays, in children with impairments.