helping a speech-delayed toddler learn new sounds
July 6, 2020 5:55 AM   Subscribe

Speech therapists, linguists, child development experts, and parents of MeFi, I could use your help. My toddler is quite speech delayed, and because of Covid-19, I'm stuck doing DIY speech therapy. Since I've started working with him, he's started making some new sounds, but it's not at all in the order I expected, so I'd like some advice on what to focus on next.

He is just about to turn 3 years-old and the only clear word that he can say is "mama." We are a bilingual household and he understands two languages very well; he can follow complicated directions in both languages, and communicates with us via pointing and bits of sign language. He has been evaluated by a whole bunch of different doctors (neurologists, psychiatrists, etc) who haven't found anything except he has low muscle tone and is hyper-flexible. Because we are a bilingual household, the doctors told us to not worry about the speech delay until he turned 2, and then it took 6 months to get him into speech therapy, and then two months later, we went into lockdown.

He has had problems with muscle-tone his whole life and has been slow on the gross motor skills like walking and on some of the fine motor skills like using a pincer grip. So my gut feeling is that a big part of the problem he can't get his lips and tongue and cheeks to move the right way because they're not strong enough. For example, before we started practicing, he couldn't put his tongue on the corner of his mouth (after 3 months, he's getting closer but he still can't do it), and he still can't puff up his cheeks to blow bubbles or make proper kissy face (ie with a closed mouth). He doesn't have a tongue tie.

We've been in lockdown since March, which is when I started working with him. Before we started, he could say an M and a B for consonants, and then a slightly muddy A, an Uh, and a couple of muddy sounds between E and A for vowels.

I found a chart of the usual order that babies learn consonants in, and it said that B and M are typically the first, so I started working on the next ones with him: P, D, and T. We sit in front of a mirror and I try and get him to imitate me putting my tongue on the corner of my mouth or raising it to my upper lip, and then I spend a lot of time repeating basic syllables to him (both in front of the mirror and not), like: "Duh, duh, duh. Dinner. Duh, duh, duh," etc. When he gets peanut butter on one of his fingers, I ask him to lick it off, which he couldn't do at all before, and can now sort of do.

After three months of this kind of thing, he can now say a clear A, an O, a TH, a rolled R (as in brrrrrrrr), and a weak Z (not quite there, but pretty close). 4 days ago, I heard him say a clear P for the first time, but I haven't heard him do it again. He still can't say either D or T. This is...not what I was expecting to happen. The one commonality I can think of between the new sounds is they're sort of towards the back of the mouth and they don't require a lot of cheek movement. So my working hypothesis is that maybe his tongue and his lips are getting a bit stronger but his cheeks are still super-low muscle tone.

Do you have advice for exercises he could work on to improve his cheek muscles and the other muscles in his mouth? If we keep repeating the new sounds over and over again with him, will that help build up his muscle tone so he can say other things, or will that only strengthen the muscles that help him make the sounds he can already make? Any other advice would be very much appreciated.

With any luck, his speech therapy is going to start up again in August, but I'd like to keep pushing along with this until then.
posted by colfax to Writing & Language (7 answers total) 1 user marked this as a favorite
I have a similar age child, also a bilingual household, and for the last few months we've been using the Speech Blubs app. They really like it as it has kids saying the words slowly, over and over, and then little videos about the words as a kind of break from the repetition.

It's not a replacement for all the other work you're doing but it has helped us and it is low pressure.
posted by cessair at 6:42 AM on July 6, 2020

Best answer: So, what it looks to me like you're also looking for is other oral-motor activities to strengthen his mouth muscles and control. Straws, whistles, and bubbles are some of the go-tos on that front, and "oral motor" may be a useful search term.

I'd also encourage you to work on other motor activities, to work on his core, strength, and motor planning.

On sounds, mirrors, so he can see what his mouth is doing, songs and books with repeated parts with the same sound over and over are more fun than straight-up drills.
posted by DebetEsse at 1:14 PM on July 6, 2020 [2 favorites]

I would start with PUH.

Just say "Puh. Puh. Puh. PuhPuh!" in a fun, slow, slightly tuneful, simple way, for a few minutes at a time. Don't say anything else during Puh time. Don't make a big deal of it or stare at him or be intense.... maybe do it while driving or changing a diaper.

Or maybe blow bubbles in the yard, in a calm slow way. When each bubble pops, say Puh! Don't say ANYTHING ELSE for a few minutes. Just make bubbles slowly and calmly and happily, and each time one pops, say Puh!

I remember reading a vivid account of how this worked for a blogger whose kid had a speech delay... she used the word POP and he got it, his very first word, in a day!
posted by nouvelle-personne at 3:42 PM on July 6, 2020

A lot of speech-language pathologists are offering teletherapy right now; could you try to set up an appointment with one (specifically, one who works in Early Intervention)? If by any chance you happen to be in Oregon I could probably suggest a name or two for you - feel free to PM if that would be helpful.
posted by DingoMutt at 4:15 PM on July 6, 2020 [3 favorites]

Best answer: Some linguistics may help here.

P, B, M are all labials, meaning they're formed with the lips. They're easiest to learn because the child can see what's happening (you're closing the lips).

The difference between P and B is voicing. That's a buzzing in the vocal cords-- hold your or his fingers over the throat to feel it. If he can do a B, he can do a P, if he can turn off the voicing. To pronounce a P, you literally do the same thing with your mouth that you do with B, you just don't do the voicing.

He can definitely turn off voicing-- he can breathe, after all! In fact, if you have him just breath in and out, he's producing an H. If he can do that and close his lips briefly, he'll get a P.

P and B are stops, meaning we stop the airstream with the lips. T and D are stops, but the tongue stops the airstream just behind the teeth (in English; this may not be true of your second language). If he can stick his tongue out, I would think he can touch his teeth. TH and Z are fricatives, meaning the airflow is impeded but not stopped. See if he can move his tongue just a little forward to briefly stop the airflow to turn them into a T.

This is getting a bit long already, but one more thing: the differences between vowels are mostly about tongue position. A is what you get with a low tongue; it's pretty natural if you just vocalize while opening the mouth wide. If he has O too, he knows how to retract his tongue. Can you get him to start with A, then move the tongue upward? That should produce an EE sound. (He can already do this if he's pronouncing TH and Z.)
posted by zompist at 6:55 PM on July 6, 2020 [2 favorites]

Best answer: Seconding please try to find an SLP who will work with you through teletherapy. Parent coaching would do wonders for you since you seem so motivated to help! If you are on Instagram I would recommend following and getting in touch with @playtalklove. She is a pediatric SLP with loads of helpful information and does parent consults.

Also, non-speech oral motor activities will not help with his verbal skills. So things like straws, whistles, having him move his tongue or lips various ways without it being connected to speech sounds will not help. Focus on building off the consonants and vowels he has and on meaningful words for him (not just repeating sounds for the sake of practicing them).
posted by scrubbles at 10:24 PM on July 6, 2020 [3 favorites]

Response by poster: Thank you, everyone, for the ideas!
posted by colfax at 12:05 AM on July 8, 2020

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