How to Teach Speech Delayed Children

Hi, this is ming here from agentsofspeech.com today we'll talk about how to teach a child who is speech delayed from probably zero all the way to speaking and able to go to primary school, elementary school, whatever you call it. So in this video, it's going to be a little longer because I want to cover as much as I can at any time if you want to skip ahead. But it's better that you listen to all the nuances. All right? I don't see a lot of videos on YouTube that tells you parents from like, nothing to something and something that's actionable. So first of all, before I talk about language levels and how old your child is or whatever, I want to tell you there's a spectrum of therapy training. I think there's conception about how, oh, this therapy is very rigid, like aba, it sucks, whatever. It's traumatizing or whatnot. And there's like all the way over here that's like, oh, floor time is the best. It's very naturalistic. Or Montessori is the best type of teaching or whatever. So whatever vehicle that you are taking your child on for, in terms of therapy, it doesn't matter because all of these therapies have a spectrum of how naturalistic and how structured it is. And to illustrate this, naturalistic just means how much of the thing is the child's idea and the lead and who's taking the lead. So naturalistic is more child led, whereas over here, it's a structured task is more clinician or parent led. All right, so why does that matter? Because if it's always us giving the orders, that's not very naturalistic in the world. Yeah. And when we do a lot of naturalistic approaches, the goals cannot be as clear and as fast and as quickly implemented to impact child's development. Right. So there's. It's like a. It's like a dilemma, but it's not a zero to one. It's always a spectrum. And it's always someone who's. Someone who's doing therapy, like myself or you at home. You. You're always swinging for different goals. You're doing different things. Right. It's not set in stone. All right? And there's no one size that fits all. So we talked about this a little bit deeper now. So in general, in term, there are three. Right. Number one is like the naturalistic approach. Over here in the middle is something, what we call me, or I don't know how to really pronounce it. So sorry if I'M butchering it. And also structured tasks. All right, so for every type of therapy and speech therapy, aba, we will do these ones, these, any of these. Right. We will set them down to do structure tasks. We will tell them to do some commands. We will tell them to do, go. Go through some flashcards. Right. At the same time, we also do a lot of naturalistic things that we follow child's lead, we roll on the floor with them, we play on the seesaw with them, whatever, and we play with toys and we look at what the child likes or don't like and provide language models or whatever. Right. And then the middle is that creating some sort of opportunity? In the ABA community, they call it communication temptation. Right. Communication temptation is when you tempt the child to say something. Or in the speech therapy world, you call it creating language intent. Right. Creating opportunities for a child to actually want to communicate with you. Right. So it doesn't matter. So in the middle is where you have all those advice about putting something on top of somewhere that a child cannot reach and create a communication opportunity, so to speak. Right. Lock things up or whatever. Those are kind of more. More me Liu or my Liu. I don't know which one, to be very honest with you. Obviously it's not English. Right. Anyways, so in this spectrum at Agents of Speech, when we teach parents to do any type of training, in the beginning, we always lean towards structured task. Why do we do that? Isn't that not nice? Well, the thing is, the parent yourself, you need the structure. Because if we give you and tell you to do naturalistic approaches, that's actually the hardest type of therapy to do out there, Right. Even for if, let's say we're training up a junior therapist who just started work, doing naturalistic approach is very hard. I've been through that. It's very, very difficult. You know, like you're trying to play with a kid whilst not trying to get them angry, whilst you're trying to push your own agenda. And the same time, think about how to play with a toy that's, you know, like a car that you can only roll and you have to think of, like, 10 ways to think to. To play with it without imposing or superimposing onto the child's wants and needs or whatever. That's hard, Right? I'm not even going to sugarcoat it. It's some of the hardest stuff. And when you see a seasoned therapist, I'm not even that good myself. When you see someone who is able to do a naturalistic approach whilst Doing assessment while giving a therapy and. Right. And also like write down all data and stuff. That's crazy. Not a lot of people can do it in this world. Right? So when we are teaching parents and we teach something, such a naturalistic approach, which needs someone to be so clear headed, being able to play with children. Right. Have the communication goals or whatever goal you have in mind. Yeah. And also be one upping your child's interests and making it fun for them. So a lot of times when you see Ms. Rachel, right, on YouTube, which we'll talk about probably in a video very soon, is that the way that she talks to children is on the naturalistic approach side. And you can also use it all the way in the structured tests. Right. And it's just a way of communicating with children. Okay. So naturalistic approaches are great, but you cannot always use it because if you always use it, you won't see results and you'll give up. And I can tell you this because I have data to back it up. Most of the parents, in the beginning when I tried to teach, no matter inside the clinic or online, right. If I try to teach them naturalistic approach, only parents are going to give up and say, dude, I don't even know what's going on. Especially Asians, right. They're like, I'm just playing with the kid, what's going on? I'm not teaching anything. And this is where cultural differences come in, right? Cultural differences. Is that more Asian people, Asianer people like myself, parents who are residing in this part of the world, who have this kind of culture, they tend to lean towards structure tasks and they don't care so much about naturalistic approaches or meeting the child in the middle. Okay? So I have to understand all therapy training, all therapy has a spectrum. It goes from here to here. And it depends on the child's mood, it depends on the child's capabilities, their language level right now, their behavior, so on and so forth. These are all things that we have to be careful about. All right. After that, I want to talk about the general rule of thumb of providing therapy for children in terms of their ages. Right. So below two is where you want to learn a lot more. Like parent training. Instead of bringing your child to a therapy center of which your child has like an attention span of like 5 minutes and they sit for 5 minutes and then they walk off and then they roll around and that's, that's your 30 minutes and that's your, you know, I don't know how much money it is for 30 minutes or how you won't even get public service at below two for sure. This must be private. So below two, if you're trying to learn something at home or with the therapist or whatever, it must be parent training as number one, because you can provide. If you know how to communicate with children, well, then it doesn't matter how you do things, it doesn't matter what goal you have. Because if you communicate in a way that is effective with the kid and the children actually like speaking to you, it's just a matter of time until the child actually likes and learns the things you're trying to like, teach them. All right? The second thing is you need to do a lot more naturalistic approaches. So anything that is like floor time related or, you know, learning how to play, learning how to talk, some, something from the Hannon program is very good. And the problem with like telling you to look at Hannon program whatnot is that these things, you require someone to look after you when you're doing it. Someone needs to give you feedback. Someone needs to like listen in and look at what you're doing and give you direct feedback about where you're losing the kid, where you're saying too many words, where is that you are putting too much pressure on the kid and so on and so forth. That's why parent training is very important all through of childs from what we call preschool, right? From 2 to 6 years old, okay? So that's below 2. If you go to 2 to 3 years old, you still need a lot of parent training and a lot of naturalistic approaches, right? But at the same time, you're starting to do some milieu stuff, right? Meaning that you are sabotaging the environment. Not sabotaging, but like kind of creating an environment where the child has to talk to you. Okay. A lot of times when you see us work on agents of speech is that we put things in containers, right? We, we create situations where the child is supposed to find the next thing, the next, I don't know, next puzzle, next body part of Mr. Potato Head, you know, we remove the dice, remove something and it creates a communication need that the child has to talk to you in order to get what they want. And so at 2 to 3 years old is where it's okay for you to start trying this kind of methods to try and tell your child that there's a means to an end to communication is that if they do something, whether if it's like imitating something, you know, doing a gesture, looking at you, you know, just Rolling over, getting closer to you. That will allow the child to get what they want quicker. All right, that's communication in the very beginning, which we'll talk about later on as well. All right, so if your child is over three years old, it's more on the structured task, because then the child has a lot more attention span to sit down. And we can teach boom, boom, boom. And a sitting. We go. We go really quickly in a short span of time, structurally, so that we can teach as much as possible so that they can catch up. Right. We also need a lot of milio and inside as well. So this milieu is more about, like, establishing play routines, sequential play. Right. Of which we talked about a lot in this channel. So you can go check it out. I don't want to repeat myself. And then you still need actualistic approaches, of which it's not only just to, like, follow your child's lead anymore, but in everyday situations, you think about how to communicate effectively with your kid. Right. Think about how to do activity together. Where you're taking. You're allowing the child to. To take the lead. But at the same time, provide a lot of language models when your child is doing it. So example for child likes to make a sandwich with you or coffee with you, or is that he likes to wait for your term when you guys are brushing teeth. Those are also very good opportunities to provide a lot of language models. Right. When I say language models and naturalistic approaches, you're not supposed to ask your child for any language back because naturalistic approach is more of a giving. You're always giving. And the language boom, boom, boom, over there, over here, keep on talking, narrating everything and stuff. But you also need milieu and structured tasks so that you're actually asking for that language back and making sure that your child understands. Okay. So other than that, you still need parent training. It's a lot easier with your child is over three years old because then it's actually okay for you to ask for more help because now you can. It's actually worth your money to put your child inside of a therapy center. And you know, like, you're getting your money's worth. Whereas a lot of times, if your child is below two, they're just rolling around like, and doing nothing. And the therapist cannot, like, push them because if they do push the kid, the kid goes into a bad mood and then it ruins everything and you need to start all over again. All right, so now let's. After we talked about, like, the ages, now let's Talk about the language levels. I think we talked about this before in previous YouTube videos, but I'll summarize it here. All right, so first of all, what do you do with non verbal children? The most important thing when you're dealing with a non verbal children. From my perspective, when I'm teaching parents and I'm doing my therapy on my own is establishing verbal imitation. That's the most important thing for me. The reason why, I'll tell you why. Right. Is because if I don't do verbal imitation, I will not know whether this whole thing is only language related or is it speech related. So if I don't have verbal imitation down, I cannot go on or you cannot go down the rabbit hole of assessing whether this is. There's a speech disorder component to this and we have to address it. Right. Which means there might be like some sounds that the child cannot produce or whatever. And we just saw one of the parents in our poaching program for non verbal children is that after we got the kid to start imitating words, we found out she doesn't have any of the consonants. That's why she wasn't speaking that much. Right. And the reason was she wasn't very good at making sounds in the very beginning and she knows it. So that's why it's important for me to establish verbal imitation first. Okay. There are other therapists, like, I'm not saying anyone is wrong as long as it's working for you. And it's basically like verbal imitation is also one of the pre linguistic skills that you should target anyways. But what happens a lot is like parents get sidetracked and think about, oh, I need to teach joint attention, I need to do like eye contact or whatever, I need to do matching, I would do whatever. But all these things, they don't matter as much because it doesn't give you a plan of action, so to speak. So what you got to do now is to think about how you can teach verbal imitation to nonverbal children so you can think about why there was a non verbal situation in the very first place. Okay. That's number one. Second of all is the play skills. So if you're not targeting play skills, then that's going to be a problem down the line if you don't have enough context to communicate with your kid. And it's always, it's always to do with using rewards or trying to bribe or trying to like, that's how you get stuck with like I want sentences later on. And that's because you don't have enough play contexts to target more language down the line. So you have to build it up during the nonverbal phase. And your target shouldn't be to get your child to talk is to get your child to play. That's it. Okay, so then when, after your child gets through non verbal phase, and then we go on to like 1, 2, 3 word phrase level, right? So we kind of like teach a play routine, right? And we also teach a lot more play skills. So why do we do this? Is because most of the time from our case, right, children who cannot do. We're combining to make sentences or phrases is because they don't have enough vocab. And this is where parents will say, no, my kid knows like 150 words. They know all the planet names, animals or whatever. But. But the problem is this. Can you put two planet names together and make a sentence? You cannot, right? What do you need? You need different word classes, meaning you need places, you need adjectives, and you need verbs. The most important thing of all. All right, and if you look at how we. A linguist, I'm not a linguist, but if you see how linguists will like break down the structure of a sentence, the huge chunk is called a verb phrase. And that's because the verb creates or like kind of embeds the whole. Not, not embed. That's the wrong word. The verb leads charge of all the words that come in a sentence. And I stand corrected to any linguist here. You can say whatever that you need to, to educate me, but I'm just saying if you don't have verbs, you cannot glue words together, man. It's just impossible. What are you going to say? A bunch of nouns in one go? That's impossible. So that's why in the one to three word phrase level, we teach a lot more play and we try to teach verbs whilst we're doing the play. And we're like, we're very targeted at those action words, all right? And that's what. What has been working for us because then those words actually mean something. Instead of it's always I want whatever or like give me whatever, which, what we call carrier phrase, which is not cool. And we do a lot more play skills so that we can expand later on. All right, we will. And we do teach with flash cars and stuff for sentence production, what we call and speech therapy. So for instance, if they learn that and play, then maybe we can do it in a 2D and it'll be faster, right? So as I was telling you, a naturalistic approach is always slow because you're always waiting for the kid to kind of respond to whatever you're trying to give in a naturalistic way. But structured way is always the fastest because just it's direct order. Whereas the milieu is where all the playing is even structured play is kind of me. Right? You're trying to play, and then you try to take the language out once the child understands the context. Right. So from like one to three word level, we will do flashcards and like pictures and whatnot, just so that we can accelerate the process. Once that, once the child gets enough verbs and understands how to put words together and we can do it in a structured task. Boom, boom, boom. And do it quickly. Right. And you must be thinking then, then when do we do naturalistic? Well, the thing is, once you establish skills and structured tasks and then right in the middle for milieu, and then you try to bring it across to the naturalistic plan where you're doing something together naturalistically and you provide these the same language models of what you were teaching in the structured task. And that would make sense for the kid to start generalizing those words to real life. Okay, and the next one we'll talk about is sentence level. So sentence level is where the kid is most probably a little mature and they're able to speak in sentences. And therefore you can bargain with them a little bit and tell them what they're supposed to do. And at this level, we don't play around. We give them a bunch of teaching materials that are 2D, like flashcards, pictures, I don't know, you know, even on the iPad, to save time. Because we want to get to the problem at sentence level. We want to give as much practice as we can. So there's a lot of times that 2D materials are cards that are sequencing cards. That, for instance, is like a boy puts on a shoe, the boy ties a shoelace, the boy goes out of the door, whatever. So if you don't know what it is, just search on Google sequencing cards, speech therapy, and you'll see a bunch. Right? Okay. So other than the sequencing at sentence level, we start to the milieu for this is that we don't just do toys, we do board games. The reason why is because there are specific sentences and different structures, like if, then because whatever, that we can target and teach them to use. And at the same time, we want to also teach them game rules so that they can do some verbal reasoning and we can ask them why questions. Okay, so that's sentence level and how do we do a naturalistic approach with sentence level? Well, it's very easy. You try to speak with again with the sentences that you have taught in the structured task and that milieu, right. And you bring it every day and you keep on repeating it to them when you're playing around with them doing chores or whatever, you say it to them and repeat and give language models. That's it. Okay. At story level is which children are starting to form multi utterances. So an utterance is just in one breath how much they can say, right? They go like, this is an orange cat. Like the one you saw that was going back and forth. That's one utterance. And then the next utterance would be, he was walking around, that was another utterance. And the next utterance would be, he was disturbing my YouTube video. Right? That's the last utterance. So there's a multi utterance. And once we get here of which we've been doing already in the sentence level with like sequencing cards or sequencing activities or sequential play or explaining game rules and board games or whatnot. At story level, we try to make it as. As long as possible. So then we have something called story elements, which to be honest, I'm not 100% very comfortable with with teaching and stuff because I'm also learning how to teach this at this moment in time. All right. To parents. That's what I mean. I can do it myself with children. I can teach story elements to children. But teaching story elements to parents is still something that I'm not 100% comfortable with because I'm still thinking about how to do things. So you have teaching stories how tell story. There are elements in the story. I won't go into it. You can do a Google search. Inferencing is something that we do. And that's for instance, if you see a picture and you have to do a higher language level kind of explanation about something. Right. So for instance, if you see that the ice cream was on the floor, right. You asked what happened. And the chart has the inference, oh, someone dropped it. But it wasn't explicitly stated in the picture. Right. And how did he know is because there was a bite in the ice cream, right. And then the ice cream fell on the floor and it melted. That's about it. Okay. So you have the inference from non literal things. And this is where a lot of children on the spectrum have a lot of difficulty because they can only see things that are literal. Right. And we also do a lot more higher language targets. So for instance, we do stuff like synonyms. Right. Antonyms or whatever. And we also do like word definition and those are high level language targets that I'm not going to talk about right now. And slowly, as I'm teaching parents how to do this and asking for help from other therapists to teach parents how to do this at home, once I am comfortable with a way of like how I teach a non verbal to like 1 to 3 word phrase level things to parents, then I'll talk about it. But right now I'm not at this moment of this video, I'm not that comfortable with talking about it right now. We're still working out with our, our coaching clients and once we do have something and I know how to say it in a way that will make you understand, then we'll talk about it. All right, so thank you for this, for listening to this whole video. And if you haven't, please go to agents of Speech.com checklist to grab a list of tools and toys that we recommend you getting. Okay. The tools and toys will now reside inside of our online community. So once you sign in with your email, what's going to happen is that you'll get access to somewhat of a private Facebook group and you can see all the resources there. All right, thank you so much. I hope to see you very soon inside of that community and I'll see you in the next week on another video. Bye.