Monthly Archives

January 2014

books, literacy, Uncategorized, Uncategorized

The Importance of Literacy & Reading

I apologize for the extended delay. Between winter break, getting sick, and having my phone be out of order (it decided to go for a little swim in the bathroom), life has been busy. I hope that you all had a wonderful holiday season and got to spend some extra time with those that you love most! I know Sanaz and I definitely enjoyed being able to spend a little more time focusing on our families and our personal wellness!

One important issue that came to mind before winter break was that many of the students that we work with rarely pick up a book to read for pleasure. I know growing up, going to the library and Barnes and Nobles were two of my favorite places to visit (well they probably still are :)) As you may have read in my previous posts this school year, my students earn “speech bucks” in my speech room. I gave many of them an incentive over break and told them that they could receive an extra speech buck for every book that they read over break. They also needed to be able to come back and tell me/write a few sentences about the books that they read. I was so excited the week we came back from break when many of my students came into my room excited to tell me that they had read several books!
I am one of those SLPs that feels literacy plays a pivotal role in the development of children. ASHA also states** that literacy is an essential perquisite for: social well-being, academic achievement, and lifetime opportunities.  Literacy skills can support and encourage communication, academic and vocational potential and positive self-esteem! I often based many of my sessions around literacy.
Literacy also just doesn’t begin with school-aged children, it begins far before a child can even read the words on a page by themselves. Reading with young children (toddlers & younger) helps to foster emergent literacy skills. Though parents/therapists often feel like the child is not following the book, pure exposure to books is meaningful in itself.  Just sitting with your child and looking at a book together helps to foster these skills. It is not as important to follow the book word for word, as it is to point out and have a conversation with your child about the pictures on the pages.
My favorite books to use with young toddlers & preschoolers are:
-interactive books: touch & feel books (“That’s not my ____” series (snowman, reindeer, bunny, etc.), books with interactive features (string, knobs to turn), cloth books (these often have mirrors & different textures in them)
-books with colorful illustrations—Eric Carle is known for his vivid illustrations. With young children, it is often the illustrations that captures their attention.
-books with lots of repetitions—any of the “Brown Bear, Brown Bear” books. These books provide many opportunities for children to learn the rhyme and rhythm of the book.
My Favorite books for school-age children:
-Any of Jan Brett’s books—I find that I can target many skills with these books and they have fantastic illustrations that my students love. I love that The Mitten has illustrations that help to encourage prediction—these book contains illustrations at the far right of the page that allude to which character is coming next.
Also check out the activities I created to go with Jan Brett’s The Mitten: 
-The Little Old Lady series—this is a fun series that my students always look for when different holidays come around. Also if you have several books if the series, you can target comparing and contrasting by looking at the different things she swallows in each book. It is also a great series to work on sequencing.

-If You Take a Mouse to School Series: The illustrations in this book are fun for students and it is a great book to target cause and effect with. I also love using this book with kiddos to help them understand how to use conjoining words (“He wanted a donut because he ate a ____”).

-Dr Sesuss Books—These books are great for introducing phonological awareness and rhyming with young children. I use Dr. Seuss books with all of my students who display phonological errors.

Let us know what book you love reading with your children or can’t live without in your therapy rooms. I’m thinking about doing a round-up of my top 5 books to use for each season. Let me know if this is something you would be interested in seeing!

Have a wonderful week everyone! 

** “Literacy: Speech-Language Pathologists Play a Pivotal Role.” Literacy: Speech-Language Pathologists Play a Pivotal Role. American Speech-Language-Hearing Association, n.d. Web. 28 Jan. 2014

parenting, Uncategorized, Uncategorized, Unstructured play

The benefits of unstructured playtime for children

We are going to go on a tangent today and talk about the importance and benefits of free play and outdoor play for children. The reason why I want to talk about this topic is because I feel that many children are not getting enough outdoor and unstructured playtime these days. I looked up some recent research and I’d like to share a few key points. I personally LOVE exploring the outdoors with my speech kiddos. I try to do therapy sessions outside whenever possible and the kids love it (living in California thankfully makes this possible all year round). 

Using nature to teach these two-year-olds language

The benefits of unstructured free play and playing outdoors:

Cognitive benefits: creativity, problem solving, focus, and self-discipline
Social benefits: cooperation, flexibility, and self-awareness
Emotional benefits: stress reduction, reduced aggression, and increased happiness (Burdette and Whitaker, 2005).

Play is critical to healthy child development. Play allows children to use their creativity while they are growing their imagination, physical, cognitive, and social-emotional strength. In order to develop cognitively, socially, and emotionally, children need lots of old-fashioned free play. What is free play? Free play is simply unstructured playtime and it is the best form of self-education and discovery for children. Free playtime helps children learn how to work collaboratively, to negotiate and resolve conflicts, and to share with others. When children move at their own pace without the adult pressure and stress, they discover their own interest areas and engage fully in their interests. 
It’s also very important for some of this free play to take place outdoors when possible. 

According to a study on Attention Deficit Disorder (ADD), the greener a child’s everyday environment, the more manageable their attention deficit symptoms were in general (Taylor, Frances and William, 2001). Another study found that even a view of nature helped reduced stress among highly stressed children (Wells and Evans, 2003). 

Today many families have hurried lifestyles where they jump from one activity to the other. We all want to be great parents and go that extra mile for our children, but sometimes that extra mile is not so great. We put our kids in all these classes to make sure they keep up with other children physically and academically. We rush from swimming to dance to piano lessons to reading classes, and we get so exhausted at the end of the day. I am myself so guilty of the hurried lifestyle. I work throughout the week so I try to pack our weekends with “fun” activities. I know extracurricular activities (e.g. sports, dance, music, art, etc.) are important and we all want our children to excel, but we also want to make sure our kids get to be kids, use their imagination, and play without being rushed into the next activity. I do not think that there is anything wrong with music lessons, soccer, dance, etc. I just believe that it is not fair for our children to be stressed and overworked. Rosenfeld and Wise (2000) believe that the hurried lifestyle is a source of stress and anxiety for some children and may lead to depression. Sometimes the best thing we can do for our kids is to sit back and let them play freely. It may be hard to find a good balance of structured time vs. unstructured time but trying to find that balance is a great place to start. 

Here are some pictures of my little one playing outdoors. He truly enjoys free
play outdoors. We make it a point for him to get outside at least once a day to play (again, thanks to living in California). Sometimes I sit back forever and let him play with dirt, sand, and rocks. It is so much fun to watch little ones play and explore.

Research on the lack of free play and outdoor play:

Children have less free time for play and more time for structured activities: 

Two studies looked at changes in how American children spent their time between 1981 and 1997 and between 1997 and 2002/3. They found out that children’s discretionary time (i.e., time not spent in school, child care, etc.) declined 12% (7.4 hours a week) from 1981 to 1997 and an additional 4% (2 hours) from 1997 to 2002/3. They reported that less time is spent in unstructured activities (e.g., free play) and more time is spent in structured activities (e.g., sports and youth programs). They also noted  a doubling of computer use. In their analyses, they found that a number of these findings were associated with demographic changes in U.S. families, such as the increase in households headed by single parents and the increase in maternal employment (Hofferth and Sandberg 2001).

Children’s homes are filled with media:

According to Rideout and Hamel (2006), Children between the ages of 6 months and 6 years spend an average of 1.5 hours with electronic media on a daily basis and according to Roberts, Foehr, and Rideout (2005), children between the ages of 8 and 18 years spend an average of nearly 6.5 hours a day with electronic media. Nearly one third of children from 6 months to 6 years of age live in households where the TV is on all or most of the time. Children whose parents have lower incomes or less formal education, for example, tend to watch more TV and play more video games than children whose parents have higher incomes and more formal education. It is not surprising that over the past several decades, there has been a dramatic increase in the number of overweight children in the United States.

Many children are vitamin D deficient: 

Kumar and colleagues (2009) found that 9% of 1 to 21 year-old children were vitamin D deficient, representing 7.6 million U.S. children, and 61% were vitamin D insufficient, representing 50.8 million U.S. children. Vitamin D is primarily produced in the skin after exposure to sunlight and is essential for the absorption of calcium. Some children who are not outdoors long enough do not get enough vitamin D. 

Many preschool children do not achieve recommended physical activity levels:

Tucker (2008), reviewed 30 studies published between 1986 and 2007 on the physical activity levels of preschool-aged children and found out that many children are not achieving recommended physical activity levels. According to the National Association for Sport and Physical Education, preschool children should engage in at least 60 minutes of physical activity and up to several hours of unstructured play each day. Tucker also emphasized the important role of early childhood educators, parents, and teachers in promoting children’s healthy physical activity levels. 

Some schools are reducing free playtime to make room for more academics: 

According to the American Academy of Pediatrics, despite the numerous benefits derived from play for both children and parents, time for free play has been markedly reduced for some children. This trend has even affected kindergarten children, who have had free play reduced in their schedules to make room for more academics. 


Our children today are not getting enough free play or outdoor play. Make time for your children’s unstructured playtime and let them be kids. They have the rest of their lives to be overworked. Live a life where you allow yourself time to sit back and enjoy your child’s free play. Take your children to the park or your backyard when you can and let them run around freely so they can get their recommended daily physical activity (perhaps they’ll sleep better too). I am not trying to tell you how to parent; however, as an early intervention clinician, I see so many kids that are not allowed free play and I just want to try my best to bring awareness to the positives of free play and outdoor play. 


Burdette, Hillary L., M.D., M.S.; and Robert C. Whitaker, M.D, M.P.H. “Resurrecting Free Play in Young Children: Looking Beyond Fitness and Fatness to Attention, Affiliation and Affect.”  2005 American Medical Association.

Hofferth, S. L., & Sandberg, J. F. (2001), “How American children spend their time.” Journal of Marriage and the Family, 63(2), 295-308

Kumar, J., Muntner, P., Kaskel, F. J., Hailpern, S. M., & Melamed, M. L. (2009). Prevalence and associations of 25-Hydroxyvitamin D deficiency in US children: NHANES 2001-2004. 

Rideout, V. and E. Hamel. The Media Family: Electronic Media in the Lives of Infants, Toddlers, Preschoolers, and Their Parents. Kaiser Family Foundation, 2006. 

Roberts, D. F., Foehr, U., & Rideout, V. Generation M: Media in the Lives of 8 to 18 Year Olds. Kaiser Family Foundation, 2005. 

Rosenfeld AA, Wise N. The Over-Scheduled Child: Avoiding the Hyper-parenting Trap. New York, NY: St Martin’s Griffin; 2000 

Taylor, Andrea Faber; Frances E. Kuo; and William C. Sullivan. In Environment and Behavior, Vol. 33, No. 1, January 2001. Sage Publications, Inc.

Tucker, P. (2008). The physical activity levels of preschool-aged children: a systematic review. Early Childhood Research Quarterly, 23(4), 547-558. 

Wells, N.M., and Evans, G.W. “Nearby Nature: A Buffer of Life Stress Among Rural Children.” Environment and Behavior. Vol. 35:3, 311-330. 

Apraxia, multisyllabic words, Uncategorized, Uncategorized

Winter Themed Three Syllable Words for Children with Apraxia

Hi all,
I made this packet for my kiddos who have Childhood Apraxia of Speech (CAS). These children typically have a difficult time producing multisyllabic words (words with more than one syllable). This is a Winter Themed packet full of Three Syllable Words. Click on the link to download it. I hope you find it helpful!

What is Childhood Apraxia of Speech?
Childhood Apraxia of Speech is a disorder in which a child has difficulty making accurate speech movements. According to the American Speech-Language-Hearing Association (ASHA), Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words. 

Treatment of Childhood Apraxia of Speech:
-Research shows the children with apraxia have more success when they receive frequent and intensive treatment.
-The focus of therapy is on improving the planning, sequencing, and coordination of muscle movements for speech production
-Home practice plays a huge part since frequent repetition of words/phrases is a must
-The Speech-Language Pathologist asks the child to watch his/her mouth and pay close attention to the target words
-Tactile and visual cues are typically used to teach syllables/words/phrases

I like using Dynamic Tactile Temporal Cueing (DTTC)! You can find more information on DTTC here!
Here is a chart from my grad school notes that has helped me a lot!! Thank you  Dr. Potter 🙂 Hope this helps the rest of you clinicians and parents.

Dynamic Tactile Temporal Cueing (DTTC)
Produce target utterance simultaneously with client
Produce target utterance simultaneously with clinician
Produce target utterance, then mouth it while client
produces it
Produce target utterance after clinician, while clinician
mouths it
Produce target utterance without other cues
Repeat clinician’s production
Produce target utterance without other cues
Repeat clinician’s production several times
Present written target utterance on a card
Read target utterance from card presented
Present written target utterance, then remove
Produce target utterance after card has been removed
Ask client question to prompt target utterance
Respond to question with target utterance
Incorporate target utterance into role-playing
Produce target utterance volitionally during role play

Hope you all had a great weekend!

Uncategorized, Uncategorized, voice

Changes in the Female Voice Due to Sexual Hormones During the Menstrual Cycle

In this blog post I will summarize a few studies that have looked at the changes in the female voice during the menstrual cycle. I will start by telling you a little bit about the larynx also known as the “voice box.” The larynx is the organ responsible for human voice production. This
organ is placed at the upper part of the air passage. The vocal folds are
composed of membranous tissue and are situated
within the larynx; their edges vibrate in order to produce voice.
The female and male voice have different characteristics. The voiced
speech of a typical adult male will have a fundamental
frequency from 85 to 180 Hz, and that of a typical
adult female will have a fundamental
frequency from 165 to 255 Hz. The human larynx is a hormonal steroid target organ (Caruso,
Roccasalva, Sapienza, Zappala, Nuciforo, & Biondi, 2000). The female voice evolves from childhood to menopause, under the
influences of hormones such as estrogen, progesterone, and testosterone (Abitbol et al., 1999). During puberty, estrogen and progesterone
affect the form and structure of the larynx and shape the mature female voice,
while testosterone changes and deepens the male voice (Abitbol et al., 1999). We know that females have a reproductive system, which undergoes a
regular cyclic change known as the menstrual cycle. The effect of the menstrual cycle on the voice in females has
been an area of debate and investigation (Chae, Choi, Kang, Choi, & Jin,
2001). The laryngeal changes during the
menstrual cycle mirror those of the endometrium (Abitbol et al., 1999). Endometrium functions as the lining of the uterus. 
Raj et al. (2001) conducted an experiment to study the
voice changes in various phases of the female menstrual cycle. The purpose of
this study was to provide evidence of changes in the female voice due to sexual
hormones during these cycles. The participants included 35 healthy females in
the reproductive age group (20–30 years) with regular menstrual cycles. The
authors divided the menstrual cycles into five different phases: menstrual phase (days 1–5), follicular
phase (days 6–12), ovulatory phase (days 13–15), luteal phase (days 16–23), and
premenstrual phase (days 24–28). The authors studied the different voice
variables using a software program.
The results indicated that out of all five phases, the third phase (ovulatory
phase), which has the highest level of estrogen, showed the best voice and the
fifth phase (premenstrual phase), which has the least amount of estrogen and an
increased amount of progesterone showed the worst voice. The worst voice is
also referred to as premenstrual voice syndrome (Raj et al., 2001).

Chae et al. (2001) also evaluated
the relationship between voice change and premenstrual syndrome (PMS) by
comparing acoustic measurements made during the follicular phase and the
premenstrual phase. According to the authors, PMS,
which is a result of ovarian hormonal concentration changes, is a general term
for symptoms that begin 1-2 weeks before menstruation and become less intense
as menstruation begins. The
participants included 28 female nurses ages 21 to 30 years. The inclusion
criteria were regular menstrual cycles and no use of oral contraceptives. Two
voice samples were collected from each participant. One sample was obtained when
there were no hormonal changes in the body during the mid-follicular phase, and
the other sample was obtained pre-menstruation, which is 1-2 days before
menstruation. Each participant produced the vowel /a/ as in “father” and
sustained it for 5 seconds, three times in each session. PMS diagnostic criteria
were taken from the Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The diagnostic criteria consists of 11 items such as
markedly depressed mood, marked anxiety, marked affective liability, decreased
interest in usual activities, lethargy, headaches, muscle pain, insomnia and
etc. To be considered as PMS in the DSM-IV manual, five or more of the symptoms
should be present for most of the time during the last week of the luteal
phase, and should disappear a few days after the beginning of the follicular
phase. According to the DSM-IV criteria for PMS, 16 participants (57%) were
PMS-positive and 12 participants (43%) were PMS-negative. The PMS-positive group
showed increased jitter value and the PMS-negative group did not show any
significant voice changes. According to the authors, there was a relationship
between the change in voice and the presence of PMS; however, the severity of
PMS symptoms did not correlate with the severity of changes in voice parameters.
As reported by Chae et al. (2001), during the
premenstrual phase, females have difficulties with high tone phonation due to
the change in the estrogen concentration, which leads to decreased blood
pressure, increased vascular permeability, and increased vocal fold volume. The
authors mentioned that 75% of
women experience some physical changes in the premenstrual phase. According to
the authors, the presence of PMS can be a profound contributing factor for
changes in voice parameters in women. Women who experience emotional, physical,
and behavioral changes during the premenstrual phase should take precautions
and not overly strain their voices because the vocal folds are more vulnerable at
this time (Chae et al., 2001).

Meurer, Garcez, Corleta, and Capp (2009) conducted a study
on menstrual cycle influences on voice and speech in adolescent females in
Brazil. The purpose of this study was to compare the voice parameters during
the follicular and luteal phases of the menstrual cycle. The participants
included 23 adolescent females who had a regular menstruation cycle and did not
use any oral contraceptives. The authors looked at the utterance of the
prolonged vowel /a/, 5 repetitions of the vowel combinations /iu/, 5
repetitions of didochokinesis /pa ta ka/, 6 intonation variations of a
meaningful Portuguese sentence, and a sentence with no meaning that only
included monosyllables and consonants in Portuguese. Forty-seven percent of the
participants reported 4 or more premenstrual symptoms. The results of this
study did not show any fluctuation of hormones in the menstrual cycle. The
participants had similar fundamental frequencies, formant frequencies, vocal
intensity, and speed of speech in both follicular and luteal phases. Another
study on adolescents also showed similar results when the ovulatory and
menstrual phases were compared (Meurer et al., 2009). According to the authors,
reduction in the voice fundamental frequency in the premenstrual phase can be
better perceived by singers who use higher harmonics in singing.

Abitbol et al. (1999) did a study on sex hormones and the female
voice. The study lasted over 3 menstrual cycles in 97 women, ages 23-36 years. All
of the participants were vocal professionals with a premenstrual voice disorder.
As reported by the authors the clinical signs of the vocal premenstrual
syndrome are: vocal fatigue, decrease range with a loss of high tones, loss of
vocal power, and loss of certain high harmonics. The authors also mentioned
that dynamic vocal exploration by televideolaryngoscopy
shows congested vocal folds, edema of the posterior third of the vocal folds
and of the cricoarytenoid areas, posterior chink, and less flexible epithelium,
with vibration of decreased amplitude. The authors performed a dynamic vocal
exploration using televideolaryngoscopy during the ovulatory and premenstrual
phases. The participants were asked to sing some notes and a song. The results
indicated that the vocal folds were mucosal, vascular, muscular, and
inflammatory during the premenstrual phase. All participants showed mucosal
signs such as edema of the vocal mucosa, thickened and decreased glandular
secretion leading to dryness of the larynx and impairment of amplitude. Vascular
signs such as dilation of the small varicose veins and submucosal vocal fold
hematoma were present in 71 of the participants, leading to voice fatigue and
making singing impossible in some participants. Muscular signs such as
decreased muscular tone, decreased power of vocal muscle contraction, and vocal
fold nodules were present in 59 participants. Inflammatory signs were present
in 5 patients. In terms of treatment, the authors concluded that replacement
hormone therapy is an individualized therapy and a gynecologist with special
interest in this area is the best judge of the correct assessment and treatment
of the vocal symptoms as well as the other premenstrual symptoms. A
laryngologist would recommend the use of multi-vitamin therapy to clinically
improve tone, amplitude and hydration of the vocal folds. If vocal fatigue does
not go away after 3 months of treatment, then voice therapy is helpful for many
patients (Abitbol et al., 1999). The authors also mentioned that the
female voice changes with the years and it is constantly under hormonal
influence; it reveals personality and translates emotions.
In conclusion, sexual hormones do affect the female
voice in some women especially during the premenstrual phase of the menstrual
cycle. Women have their best voice during their ovulatory phase with the
highest level of estrogen and their worst voice during the premenstrual phase
with the least amount of estrogen (Raj et al., 2001). Women have difficulties
with high tone phonation due to the change in the estrogen concentration, which
also results in decreased blood pressure, increased vascular permeability, and
increased vocal fold volume (Chae
et al., 2001). The presence of PMS is an
important factor in voice parameters in women especially women who experience
emotional, physical, and behavioral changes during the premenstrual phase and
these women should take precautions. (Chae
et al., 2001). No fluctuations of hormones in
the menstrual cycle have been reported in adolescent females. The research done
on this age group has showed similar voice parameters in the different phases
of the menstrual cycle (Meurer et al., 2009). And finally a study done on all
women with premenstrual voice disorders showed that all the women had vocal
folds that had mucosal, vascular, muscular, or inflammatory signs during the
premenstrual phase (Abitbol et al., 1999). Sexual hormones do affect the female voice in most women
during the premenstrual phase. Hormones such as estrogen play an important role
in hormonal changes that affect the larynx and the voice in women throughout
the menstrual cycle.
Abitbol, J.,
Abitbol, P., & Abitbol, B.  (1999).
Sex hormones and the female voice.
Journal of 
Voice, 13, 424-446.
S., Roccasalva, L., Sapienza, G., Zappala, M., Nuciforo, G., & Biondi,
S.  (2000). Laryngeal cytological aspects in women with surgically
induced menopause who were treated with transdermal estrogen replacement
therapy. Fertility and Sterility, 74,
Chae, S.,
Choi, G., Kang, H., Choi, J., & Jin, S. 
M.  (2001). Clinical analysis of
voice change as a parameter of premenstrual syndrome.  Journal
of Voice
, 15, 278-283.
Meurer, E.,
Garcez, V., Corleta, H., & Capp, E. (2009). Menstrual cycle influences on
voice and speech in adolescent females.
Journal of Voice,
23 (1), 109-113.
A., Gupta, B., Chowdhury, A., & Chadha, S. (2010). A study of voice changes in various phases of menstrual cycle and in postmenopausal women. Journal of Voice, 24 (3), 363-368.