August 23, 2018
by Mary Pat

What happens to language development in premature babies?

If you’re a parent of a child born prematurely you might be wondering how that might impact on language development and on becoming multilingual. I did a literature search and have chosen the most recent, good quality research I could find. It’s important to bear in mind that your experience might not fit with these studies and that doesn’t mean that there is a problem. You know your child best and if you’re worried that their speech and language development might be delayed, it’s best to check with a speech & language therapist. If you’re a multilingual family, I have two posts to help you if you encounter professionals who are not supportive of multilingual development. You can read them here and here.

What’s premature?

  • Pre-term generally means being born before 37 weeks (World Health Organisation). Rates are about 10-12% in the US and Africa, about 5-9% in Europe.
  • Other descriptions are late pre-term (34-36 weeks Rates of 60%),
  • moderate preterm (32-33 weeks Rates of 20%),
  • very preterm (28-31 weeks Rates of 15%) and
  • extremely preterm (less than 23 weeks 5%).

The survival rate of extremely preterm babies has increased to about 80% in the last 15 years due to medical and technological advances. And infants born very pre-term (VPT, <32 weeks), with a very low birth weight (VLBW, 1500g), or both make up about 1-2% of all babies born alive.


What does the research say?

A fair amount of research has looked at the developmental achievements and risks to development of very preterm children from preschool to kindergarten, primary school, and adolescence. However, research findings have been inconsistent. Some studies found no difference between VPT/VLBW groups of children and children born at full term (FT) but other studies report large differences. Why are the findings so different? Basically because each study tends to use different methods which complicates things when trying to come to definite conclusions. The variety makes the research hard to interpret in definite ways.

One of the more commonly affected areas of development is language. Language is fundamental to both communication and also for reading and writing and academic achievement. So it’s very important to understand language problems in these children so that they can get the intervention they need on time.

One Italian study found that about 1/3rd of very preterm children (average GA of 30 +/- 30 weeks) could be described as having a language impairment at age 3 and ½. The predominant predictor of language impairment was prior history of communicative and linguistic skills as reported at 2 and ½ years. (Sansavini & colleagues 2014- I’ve put the list of articles at the end of the post). But, when it came to language, both groups of children showed a lot of individual variation in language development. The extremely low gestational age children (ELGA) showed consistent language delays relative to full-term (FT) children but their language growth rate over time was not so different from FT children until the 3rd year. The greater individual variance suggests that some ELGA children might persist in their delay, some might gradually recover, and some might fall further behind showing an atypical pattern of development later (Sansavini and colleagues 2014).

Another Italian study (Ionio and colleagues 2016) found that at 24 and 36 months of age, preterm infants had significantly lower scores for language understanding and expression than those of full term infants. This was when corrected age and uncorrected age were used to score and interpret the test results.

A study from Finland found that in the 1st two years of life, even considering their corrected age, very preterm children shower lower scores than FT children on measures of vocabulary. (Vocabulary is thought of in terms of understanding/comprehension/receptive vocabulary– usually tested by the therapist saying a word and the child pointing to the corresponding picture. Expressive vocabulary then is where the child names pictures)

In that particular Finnish study (Stolt et al, 2009- listed at the end of the post), the comprehension vocabulary size of the FT children at 9-15 months were estimated to be 1.7 times larger than the pre-term children (GA 28 +/- 2 weeks). 32 children participated in that study. Expressive vocabulary was similar between the 2 groups from 9-18 months. By 24 months, FT children knew significantly more words than their pre-term peers, suggesting that differences in expressive language between preterm and FT children become evident around the end of the 2nd year.

Another Italian study of 104 very preterm Italian children (GA 29 +/- 2 weeks) showed a widening effect as time went on. This means that the more skilled children initially (FT) grow more rapidly over time than the less skilled preterm children. They found this effect for receptive vocabulary and gesture or action production from 12-18 months and in expressive vocabulary from 18-24 months. So the pre-term children showed slower gesture and language development to begin with and the gap widened in the 12-24 months period (Sansavini and colleagues 2011- listed below). At 24 months, 20% of the preterm children were delayed in word production and 14% did not yet combine words. Male gender, a diagnosis of broncho-pulmonary dysplasia and low maternal educational level increased the risk of language delay at 24 months. 


Stolt and colleagues in another Finnish longitudinal study from 2016, looked at 29 VLBW children and 28 FT children whose language development was followed intensively between the ages of 9 and 24 months. Their language was also tested at age 5 years of age. For the 1st time in VLBW children, the development of gestures measured between the ages of 9 & 15 months was shown to correlate significantly and positively with language development at 5;0. Also, both receptive and expressive language ability measured at 24 months was a clear and significant predictor of language skills at 5;0 in both groups. The findings particularly underline the role of early receptive language (understanding) as a significant predictor for later language ability in VLBW children. The results provide evidence for a continuity between early language development and later language skills.


Summary for up to age 5

  • At the end of the 1st year and at the beginning of the 2nd year of life, children typically communicate actively using gestures. And their understanding of words develops actively at this age.
  • Pre-term children have been shown to acquire early gestures at a slower pace than full-term children and the difference between groups of PT and FT has been shown to increase as children grow.
  • Early understanding of vocabulary has been reported to develop more slowly in PT children.
  • BUT there are also studies that do not find a significant difference between groups of preterm and FT in receptive vocabulary. Different studies, different methods.
  • At 24 months, PT children have been shown to have a smaller expressive vocabulary than FT children in different studies. Again, there are opposite findings.
  • Receptive and Expressive language ability at 24 months has been reported to be lower in PT at the group level. (This means when groups of children are compared)
  • At 5 years, children typically master all or nearly all of the speech sounds & the most typical grammatical structures of their native language.
  • Some PT children still have lower language skills at school age.
  • Complex language functions (e.g. expressing and comprehending complex sentences) in particular are difficult for at least some PT children up to age 12.
  • The proportion of VLBW children with weak language skills varies between 20% & 27% at 5; 0 depending on the method used whereas the respective value is 10% in FT children.


What about older children then?

One study from the University of Illinois found that in the absence of neurological problems, sophisticated vocabulary and grammar skills may be relatively intact in the conversation of children born prematurely. The 57 children in that study (Mahurin Smith et al 2014 in the list below) were assessed at average ages of 7, 8, and 10 and had been born at less than or equal to 32 weeks gestation of 1500g birth weight.

Finally, one paper that reviewed 12 studies of language ability in children who were very pre-term and/or very low birth weight reported that children born prematurely consistently scored at the lower end of the normal range on standardised language tests, with more pronounced differences seen in overall language skills and in particular in semantic abilities than in the grammar – both in terms of understanding and expression. (Barre et al, 2011 in the list). (Semantics has to do with word meaning- basically vocabulary). The findings to do with grammar were ambiguous.

It’s important to remember that these studies compare groups of children. So although as a group, children born prematurely are at increased risk of language impairment at school age, within those larger groups, many children do show an encouraging degree of resilience. Early outcomes may have limited predictive power for any one child. So what’s true for the group, may not be true for your child. One clear positive factor is where the child doesn’t have any neurological complications such as haemorrhage. And more studies are needed to fully understand the specific nature of language difficulties that these children have.


What about children who speak more than one language?

The children in these studies are all monolingual speakers of their respective languages. Unfortunately, research on that topic is very hard to find. But, there is research looking at children who have Down syndrome or autism or specific language impairment for example. This research shows that these children can and do become bilingual and multilingual. If your child needs two languages or more in their world, then that’s what they need. So don’t think it’s not possible for your child if they were premature. Each situation is different and depending on your circumstances, language outcome will differ. But being bring prematurely is no reason to drop a language.


What to do?

There’s good news here! There is research to show that when mothers are tuned into their premature babies’ unique communication signals, can perceive things from their babies’ point of view, can regard their child as a separate person by respecting their activity and avoiding interruptions, that this mind-mindedness as it’s called, plays a stronger role in supporting expressive language abilities than it does in full term babies. (In the Costatini study listed at the end, they found that high maternal mind-mindedness at 14 months had a significant positive impact on their babies’ expressive language development at 24 and 36 months of age.) An American study with more participants found that high mutual responsiveness between mothers and their premature babies was associated with significantly better language development and marginally better motor development.


What does this mean?   

You go through a lot when your baby arrives earlier than expected. And how you interact with your baby can be affected by what you’ve gone through and by seeing them in an incubator with tubes. What does it mean to be a responsive communicator with your baby? And what are the things you can say and do that will help your attachment develop and build your baby’s language? I’m going to share those tips with you in my next post so make sure to keep an eye on your inbox.


 What I read

Barre, Morgan, Doyle, Anderson (2011). Language abilities in children who were very preterm and/or very low birth weight: a meta-analysis. The Journal of Paediatrics 158(5): 766-774.

 Caskey, Stephens, Tuckr, and Vohr (2014). Adult talk in the NICO with pre-term infants and developmental outcomes. Pediatrics 133: 578.

Costantini, A., Coppola, G., Fasolo, M., & Cassibba, R. (2017). Preterm birth enhances the contribution of mothers’s mind-mindedness to infants’ expressive language development: a longitudinal investigation. Infant Behaviour & Development 49: 322-329.

Ionio, C. & colleagues. (2016) Paths of cognitive and language development in healthy pre-term infants. Infant Behaviour & Development 44: 199-207.

Mahurin Smith, Segebart De Thorne, Logan, Channell, & Petrill. (2014). Impact of prematurity on language skills at school age. Journal of Speech, Language, and Hearing Research 57: 901-916.

Sanavini, Pentimonti, Justice, Guarini, Savini, Allessandroni, & Faldella. (2014). Language, motor and cognitive development of extremely pre-term infants: modelling individual growth trajectories over the first three years of life. Journal of Communication Disorders 49: 55-68.

Sansavini, Guarini, Savni, Broccoli, Justice, Allessandroni, & Faldella. (2011). Longitudinal trajectories of gestural and linguistic abilities in very pre-term infants in the second year of life. Neuropsychologia 49:3677-3688.

Stolt, Lind, Matomaki, Haataja, Lapinleimu, & Lehtonen. (2016). Do the early development of gestures and receptive and expressive language predict language skills at 5;0 in prematurely born very low birth weight children? (VLBW). Journal of Communication Disorders 61: 16-28.

White-Traut, R. & colleagues (2018). Relationship between mother-infant mutual dyadic responsiveness & premature infant development as measured by the Bayley III at 6 weeks corrected age. Early Human Development 121: 21-26.

July 3, 2018
by Mary Pat

7 Top Tips For Communicating With Your Internationally Adopted Toddler When They’re Just Home

Welcome to the 3rd (and final) post in our series for parents of children who were adopted internationally. In our first two posts, we covered what the research says about language development for your child (read it here.) and what questions to ask about your child’s early development before you bring them home (read it here). In this post, we’re going to give you 7 top tips for how to best develop your child’s new language when they come home. We’ll look at the question of multilingualism for children who were adopted internationally. And we’ll look at their mother tongue too.

 #1 Make a photo album

If you know you’ll be getting to meet your child a couple of times before she comes home, you can make a picture/photo album to leave with her. This way, she can become familiar with you and where she’ll be living and other family members like grandparents. You can have great interactions with the book; looking at the pictures and commenting on them using simple language and lots of pointing. Another option here are those books where you can record a message to go along with each picture so she’ll be able to hear your voice while you are away. (Tomy Discovery Forget Me Knot Photo Album is the one we had at home). You can also use the book for conversations once they are home.

#2 Find out as much as you can before she comes home

The information which you collected about your child’s language skills, her likes and dislikes, how she currently communicates etc., will help you feel confident when communicating with her. And as you get to know each other you’ll become more tuned into her style of communicating. The Hanen Centre in Canada have a handy tip called OWL. It stands for Observe, Wait, and Listen. This means that you pay close attention to your child in terms of what they’re looking at. What are they doing? If you say something in response to her, how does she respond? The Wait bit is important for her to take her turn. So you say something or do something while playing like put another brick on the tower. Then you wait to see what she does in her turn. Then you take your turn. The Listen bit then is where you pay close attention to the sounds she makes or the words she says and you say what you think she’s trying to say. You can find more great resources from Hanen here.

# 3 Remember that language development takes time

When your child comes home, she will be learning to adapt to many different things: a new home, new climate, new people, new culture, new routines etc. She’ll also being forming an attachment with you as her parents. In Bríd’s research, she interviewed parents whose children were toddlers when they came home so they had their mother tongue and were then immersed in English. Many of the parents she spoke with felt that communication and interaction occurred naturally in spite of the language barrier early on. At that age it’s often fairly obvious what your child may be trying to communicate. You can pay particular attention to what they’re looking at and what they’re reaching for or pointing to for clues.

# 4 Songs and nursery rhymes in your child’s mother tongue

Many parents in Bríd’s research found it helpful to buy a CD of nursery rhymes or songs in their child’s mother tongue.  They found that they often soothed children during times of upset in the early days after coming home.

#5 Learn some basic vocabulary in your child’s mother tongue

Other parents learned a couple of basic words from their child’s native language e.g. hello, bye-bye, words relating to their child’s regular routine e.g. bed, bath, food, drink, nappy etc. Being able to hear to her native language will act as a means of continuity and familiarity during the transition period.

 # 6 Keep it simple

Only have a small number of toys around to start off with. Get down to her level physically and encourage turn taking in simple games like building and knocking a tower of bricks. (These are going to depend on your child’s age and level of interest)

 # 7 Use gestures and facial expression as well as words

You want to give as many clues as possible to help your child understand what you mean so you can pointing to objects that you’re talking about, use animated facial expressions, varied tone of voice etc. Use natural gestures for things like sleepy/tired, hungry, no, yes and so on.

 Can your child become multilingual?

There’s very little research when it comes to this question but if we look at research on language development in children in general, we know that speaking two languages or more does not cause speech and language problems. And that children who have autism or who have Down Syndrome, for example, can and do become multilingual. (It’s important to remember that when we’re talking about language development, we need to think of listening, speaking, reading, and writing. Multilingual children’s abilities will naturally vary in each of their languages for each of these skills.) If your child was adopted internationally and now needs two or more languages in their new home environment, then the need is the important thing. And there’s no reason why they couldn’t learn two languages or more with high quality input and lots of opportunities to use their languages.


What about their mother tongue?

Children who were adopted internationally tend to make rapid gains in their new language in the early post-adoption period. Their mother tongue loses it significance as it’s not the language of their everyday lives any more. A recent Canadian study involved children who had been adopted from China at over 12 months of age and had not been exposed to their mother tongue for over 12 years. MRI scans showed that their brains had actually retained some representations of their mother tongue in spite of the lack of exposure.


Maintaining links with your child’s birth culture and language is a personal choice. In relation to language, your child’s perceived need for the language and her motivation will exert powerful influences on her development of that language. There’s no easy answer here. It does depend on your personal circumstances and choices. You have to do what works for you and your family. Here’s one woman’s account of her experiences of trying to maintain links to her child’s language and culture.


We hope this series has been helpful. Bríd would like to thank Mary-Pat for asking her to contribute to the blog! Delighted to work together Bríd!


Let’s get talking



Inspired by:

Pierce, L., Klein, D., Chen, J.K., Delcenserie, A., and Genesee, F. (2014) Mapping the unconscious maintenance of a lost first language. Proceedings of the National Academy of Sciences December 2, 2014, 111 (48): 17314-17319.

June 1, 2018
by Mary Pat

13 Questions To Ask When You’re Adopting A Child Internationally

Welcome to the second post in the three part series about speech and language development in children who were adopted internationally.

So in our last post, we looked at what the research has to say about their language development. If you haven’t read that post already, you can read it here.

In this post, we’re going to give you 13 questions that you need to ask while you’re in the process of bringing your child home. Children who are brought home at older ages will have spent a longer amount of time in institutional care which means they’re at higher risk for speech, language, and communication challenges. They also have more catching up to do when they arrive home. But it’s important to remember that the research shows that most children are very resilient and make rapid gains in their language development after coming home. For example, in one study, Sharon Glennen reports that 65% of children aged between 12 and 24 months did not require early intervention services.

Before you bring your child home, it’s a good idea to get an idea of what their current speech, language, and communication skills are like. This helps you to get to know them better which will improve how you interact together. And it will also be really useful to have this information when and if you are working with a speech and language therapist. Of course it might be difficult to get answers to all of the questions we list below but it is important to see what you can find out. You might need to work with an interpreter to get more information. And some of the questions you can answer from your own observations like about eye contact and interest in interacting with others.

We’re basing this post on the suggestions of Sharon Glennen who has conducted a lot of research in this area.

  1. Does your child make frequent eye contact with adults when they are interacting together? (It’s important to remember that eye contact is cultural. In some cultures, children are not expected to make direct eye contact with adults because that would be disrespectful.)
  2. Does your child respond to his or her name being called?
  3. How does she let people know that she’s hungry or thirsty or that something’s wrong? Is it by using sounds or words or phrases or sentences? Or by moving her body?
  4. How does she show she’s had enough of something? Is it by shaking her head or saying no or crying? By explaining?
  5. Does your child start interactions by calling someone’s name or smiling or pointing?
  6. Does your child enjoy interacting with others? Think about this in terms of interacting with familiar people, unfamiliar people, and other children.
  7. What kinds of things has she available to play with and what kinds of play does she engage in? Does she play with other children or mainly alone?
  8. What can you find out about her medical history including things like information about hearing loss?
  9. Can she follow simple instructions?
  10. Does she need things to be repeated or made simpler so she can follow them?
  11. Do her caregivers think her language skills are generally what they’d expect for a child of her age?
  12. Is she using single words or two words together or sentences? Depending on her age, can she tell a simple story about something that happened?
  13. What do the caregivers think of her pronunciation? Can they understand her easily? If not, are there certain sounds or words that they can give examples of?


The answers to these questions will give you a solid foundation for getting to know your child and how to engage them in interactions with you. In our next post, we’re going to share with you what has worked for other parents in the early stages after coming home and give you some simple but powerful tips for encouraging your child’s language development. If you like this post, please pass it onto your friends!

Let’s get talking!

MP & Bríd









April 27, 2018
by Mary Pat

10 Things You Need To Know About Language Development In Children Who Are Adopted Internationally

If you’re in the process of adopting a child internationally or you’re the parent of a child who was adopted internationally, then this three part series is for you. Joining me is Bríd Mc Andrew: a speech and language therapist who has carried out research with parents of toddlers who were adopted internationally. In this first post, we’re going to look at language development in children who are internationally adopted so you can have a sense of what to expect.


Patterns of international adoption have changed with the overall numbers of inter-country adoptions declining over the years. And now the age at which children are being adopted tends to be older. This means that they will have spent more time in orphanages or foster homes before coming home. (Approximately 88% of children who were adopted internationally have spent time in institutional care). Adoption can help to overcome the early adverse effects of orphanage care as children get used to their new, enriched environment. And children who are internationally adopted show a remarkable resilience when it comes to language development. The research talks about ‘a spectacularly rapid acquisition’ of their new home language, for most children.


When your child comes home they experience a period of rapid change.  They’re now exposed to new people, new climate, new home, new routine, new food etc. As well as this, they’re exposed to a new language: the language of the home which is usually not their mother tongue. So they have been exposed to their mother tongue up until they come home and then their exposure to the home language stops abruptly. It’s replaced with exposure to the new language. (This is called a second first language. Your child is learning a first language for the second time). This is a unique language learning situation. Before they have fully learned their mother tongue, exposure to it is stopped and then it’s replaced with a new language. And they tend to lose their mother tongue quite quickly due to lack of exposure in their new home. Children are wired to communicate and acquire language so it makes sense that this would happen. The purpose of language in early childhood is to form connections with loved ones and to communicate your needs. And at the same time as your child is getting used to their new environment and learning the new language, they’re also engaged in forming an attachment with you.


Language and communication play an important role in the development of this attachment. The way in which you respond to your child’s bids for interaction (either verbal or nonverbal) can influence your child’s feelings of security in his/her environment. Being a tuned in communicator, using both words and nonverbal communication like facial expression and gestures, help form your attachment with your child. (We’ll show you how to do this in the last post in the series.) People’s experiences vary. Some parents have found it easy to form an attachment while others have found it more difficult when they don’t share a common language with their child in the early period after their child comes home.


So, you might be wondering what happens to language development in children who are internationally adopted? It’s quite confusing as there’s a lot of variation between the studies. One recent synthesis of the research so far came to these 10 conclusions:

  1. Overall, children who are internationally adopted present with great variability in their language outcomes.
  2. As a group, they seem to have a higher likelihood for language problems when compared with their non-adopted peers.
  3. There is a lot of variability in language outcomes during the toddler and pre-school years but language skills are still within the normal range compared to children who were not adopted internationally. They tend to do well language-wise up until about age 4.
  4. There tends to be slightly less variation in language skills during the school age years and into adulthood.
  5. School-aged children had slightly to moderately poorer language skills compared with children who were not adopted internationally.
  6. School-aged children tend to perform more poorly on standardised tests that compare their performance to a set of norms than they do on other measures such as checklists and parent reports.
  7. Language outcomes were slightly better for children who were adopted at under 12 months.
  8. Within a few years post-adoption children’s language skills are in line with their non-adopted peers. For example, Glennen (2015) found that children adopted at ages 1 and 2 reached expected language abilities for their age within 15 months of adoption. Children adopted at age 3 reached age-level expectations after 2 years of exposure to their new language, and children adopted at age 4 met expectations after 3 years of exposure.
  9. But later in life as the language demands in school increase, the language skills of children who are adopted internationally can fall behind their peers.
  10. This means that it is important to keep an eye on your child’s language development especially as they progress through school. This may be particularly important if your child tested in the low average range for language development when they were a toddler as they may be at a particular risk for language problems when they start school.

Here’s what else the research evidence says so far:

Essentially it shows that children who are internationally adopted make significant gains in acquiring their new home language in spite of their early experiences in orphanages or baby homes. (Many of the studies look at English). Although orphanages are not ideal places for child rearing, and children may not receive enough tuned-in interaction to acquire well- developed language, these effects can be over come when they come home. Generally, the research shows that by 4 years after coming home, most children who were adopted internationally score within the normal range on standardised tests of languages or checklists that parents complete. (This is compared with children who are learning language from their biological parents). Children who are adopted internationally tend to go through vocabulary growth spurts just like children who are not adopted internationally. Language comprehension or understanding of language tends to reach age-expected levels of development more quickly than expressive language (words, sentences, and grammar).


The research is confusing because each study asks different questions, uses different methods to measure different things, and involves small number of children who have widely varying pre-adoption experiences and has varying findings. And countries differ in terms of the quality of institutional care and their economies. Both of which can affect outcomes. For example, there is research showing that children adopted from South Korea and China tend to have better outcomes than children adopted from countries in Eastern Europe and Latin America. And children raised in foster homes tend to have better outcomes than children raised in orphanages.  So one source says that it’s important to remember that there is a subgroup of children who are adopted internationally who have significant language delays or difficulties. This subgroup is larger than what you find in the general population of non-internationally adopted children. And another study found that three years after adoption, that the percentage of children with language or speech delays matched estimates for what you’d expect in the general population of children being raised by biological parents. And there is still a lot more research to be done to really understand language development for these children.


When most children are brought home, they may have language delays, but they quickly make gains due to increased exposure to the new language and more opportunities to put their language to good use in conversations and through play. Of course, children’s language abilities will vary and more research needs to be done to understand their language development better. But the good news is that the majority of children who are internationally adopted, when given enough exposure and meaningful communication opportunities in the new home language, make remarkable language progress especially in their first year home. For children who are adopted before age 2, the language transition is smooth with most children eventually developing speech and language skills that are average for their age. And rapid gains are made in the first two years after they come home. Older children may take longer to catch up as they have more catching up to do. But there are lots of gaps in the research.


However, there are some children who will experience speech and language difficulties and may require intervention and support. In general, children who were adopted internationally at an older age are at a greater risk for a range of difficulties. (Older meaning after 12 months of age) Although older children may have more advanced cognitive development, they also have more ‘catching up’ to do in terms of language acquisition in order to reach the same level as their peers. Children adopted at older ages may be at an increased risk of speech and language delays, due to spending longer in institutional care. But again, the research is not conclusive that this the case in general. And some studies have found that three years after adoption, age of adoption did not influence children’s performance on speech and language measures. Most of the research tends to focus on children adopted before age 2.


The bottom line is that children who are adopted internationally, need time to develop their new language. And most of the children do well when it comes to language development. It’s important to pay close attention when they start school as they may start to experience language problems as the language demands of school increase.


In the next post, we will focus on the questions you can ask before you go to bring your child home so that you can get a sense of their early experience and their current language ability in their in their first language.

Are you the parent of a child who was adopted internationally? We’d love to hear your story so be sure and leave a comment below.

 If you like this post, please pass it on to your friends! And if you haven’t already, be sure and sign up to get the next two posts in the series. 

Let’s get talking,

MP & Bríd.

Inspired by :

Glennen, S. L. 2007. Predicting language outcomes for internationally adopted children. Journal of Speech, Language, and Hearing Research, 50, 529-548.


Glennen S., (2007). International adoption: speech and language mythbusters. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, October 2007, Vol. 14, 3-8.


Glennen, S. (2014). A longitudinal study of language and speech in children who were internationally adopted at different ages: Outcomes and assessment guidelines. Language, Speech, and Hearing Services in Schools 45: 185–203


Glennen S., (2015). Internationally Adopted Children in the Early School Years: Relative Strengths and Weaknesses in Language Abilities. Language, Speech and Hearing Services in Schools 46: 1-13.


Julian, M. M. (2013). Age at adoption from institutional care as a window into the lasting effects of early experiences. Clinical Child and Family Psychology Review, 16, 101-145.


Rakhlin, N., Hein, S., Doyle, N., Hart, L., Macomber, D., Ruchkin, V., Tan, & Grigorenko, E. L. (2015). Language development of internationally adopted children: Adverse early experiences outweigh the age of acquisition effect. Journal of Communication Disorders, 57, 66-80.


Scott, K. A., Roberts, J. A. & Glennen, S. (2011). How well do children who are internationally adopted acquire language? A meta-analysis. Journal of Speech, Language, and Hearing Research, 54, 1153-1169.


April 12, 2018
by Mary Pat

8 Simple Ways To Build Your Toddler’s Vocabulary In Any Language

So in my last post, you read all about your child’s vocabulary and why it’s important. (If you haven’t read it yet, you can read it right here.) It’s not just the number of words that your child knows that’s important. Knowing lots of different types of words like nouns (bottle, dog), verbs (splashing, walking, eating), adjectives (hot, cold, red), prepositions (in, on, under), and adverbs (quickly, slowly) is important too. So how can you help make their vocabulary bigger and wider then? Here are 8 things you can do that are free, easy, and natural. Consistency is key so you’ll need to do these things regularly. These tips assume that your child is already using some single words and is beofre or around 24 months old. These tips apply no matter how many languages your child is learning. Don’t try to do these all at once! Pick one strategy and one situation where you’ll try it out. Once you have the hang of that, then you can try another one.


#1 Use a wide range of words yourself when talking with your child

Diverse types of words are important so that your child has words to combine into sentences. So when you’re talking about what they’re doing, use nouns and verbs, possession words like mine, and yours, prepositions like in and on. Words for feelings like tired, sad, happy, annoyed. And use specific words too. So want and do are called general all-purpose verbs because they’re quite vague and can be used to mean a wide range of things. That’s fine to start out with, but it’s better to have a wider range of more specific verbs in your vocabulary so that you can communicate more precisely. Also remember to keep your own sentences grammatical too. They don’t have to be very long when your child is at the one word or two word stage. Let’s swing is short but grammatical and children learn language from your intonation too. Statements tend to have a downward intonation at the end. But questions have an upward intonation. So the intonation is a clue for your child to learn grammar and the intention behind your words. Are you looking for information or making a comment?


#2 Use everyday opportunities to build vocabulary

This links in with # 1. Vocabulary building opportunities are everywhere once you know how to spot them. Routines are a great place to start. Think about the opportunities available at bath time:

Nouns: bath, water, fun, arm, leg, ankle, knee, thigh, bellybutton and all the bath toys!

Verbs: fill, empty, pour, splash, drink, swim, float, sink, sit, stand, lie, sing, blow, laugh, cry

Adjectives: hot, cold, wet, dry, soapy, bubbly, empty, full

Prepositions: up, down, in, out, high, low, under, on

Feelings: happy, funny, sad, annoyed, tired

Pronouns: my, mine, you, yours, his, hers

Then remember to incorporate a diverse range of word types into these routines.


#3 Talk about what they’re interested in

This is the most effective way to build your child’s vocabulary. It means being face to face with your child, tuning in to what they’re looking at and playing with. And then adding the language in with your comments. You don’t try to direct their attention to something else. Being face to face may mean you have to lie on the ground while they’re sitting so that you are at eye level.


 # 4 Wait for them to take a turn

Building vocabulary is not just about you filling them up with words. It needs to be interactive. So if you make a comment, be sure to wait for them to take a turn. You can look at them expectantly to communicate that you’re waiting for their turn. If you feel the urge to jump in, count to five (or maybe ten!) and hold on! Their turn doesn’t always have to be a word. It depends on what you’ve said and their stage of development. It might be they wriggle around a bit to show they want more tickles or it could be that they point or nod their head or it could be a word or two words together.


#5 Use comments not questions

I wrote another post about this tip and you can read it here. Questions tend to kill conversation and aren’t communicative when you know the answer. So keep your focus on describing what’s happening.


#6 Repeat the words on different occasions and in different situtations

Word learning is complex and takes time. Your child needs to hear the same word many times so that they can store it in their mental dictionary. Once it’s stored, they can begin to use it. As adults we tend to seek out variety and novelty. Children seek out structure and repetition in order to learn. It may drive you mad at times but it’s what they need for language learning.


 #7 Use gestures with your words

Gestures are a kind of forgotten aspect of communicating with infants and toddlers. They’re really powerful though for word learning. You’re most likely using them  already in actions like waving hello and goodbye, pointing, doing the action for sleepy or rubbing your tummy to signal hunger. Facial expressions are good too for adding an extra sense of the word’s meaning and for engaging your child’s interest. So be animated but natural!


#8 Explain what words mean

When your child is age 2 onwards you can do this (or maybe before depending on your child- you’ll know best). So let’s say there’s a pedestrian crossing on your walk to your local park and you always cross the road there. You can tell your child: This is a pedestrian crossing. We’re pedestrians because we’re walking. Pedestrians walk. We can cross here. And so on. You can connect new words to their own experiences for example by saying something like:  Remember we crossed at the traffic lights at the shop yesterday? There’s no pedestrian crossing there.

So there you have it. 8 natural and simple ways to build your toddler’s vocabulary. If you like this post, please pass it on to your friends. If you haven’t already, please be sure to sign up to get the posts delivered directly to your in-box.

Let’s get talking!



March 15, 2018
by Mary Pat

Why is your child’s vocabulary development important?

Your child’s vocabulary- what’s the big deal? Why is it important? It’s kind of amazing really as the research shows that when it comes to vocabulary, size does matter! Vocabulary means knowing and using words. It’s your child’s store of words. It provides the building blocks to language development. And vocabulary knowledge drives the development of grammar. There’s strong evidence to connect vocabulary with your child’s later language and cognitive development. Having a large vocabulary at 24 months, has been linked to stronger performance on measures of maths, reading, and behaviour at age 5. Your child’s vocabulary growth is considered to be directly related to their overall success at school. The size of your child’s vocabulary predicts her ability to learn to read.

How many words should your child know and at what ages? This is a bit like asking how long is a piece of string? Although people have been researching this area for decades, it’s still hard to find clear answers because no study is perfect and they tend to approach the topic in different ways using different methods. Let’s have a look at some ballpark figures though:

  • At 18 months, some sources say your child should say 50 words
  • Other sources say by 18 months they should say at least 24 words
  • I’ve read also read: between 43-50 verbs at 24 months with children acquiring 8 new verbs a month
  • They should be combining words by 24 months

Children of professional parents, girls, and children whose parents tend to use an encouraging style of interaction (as opposed to giving lots of commands for example) tend to have bigger expressive vocabularies. Children who had a very low birth weight or where their mothers had health problems have been found to have smaller vocabularies. One study from the 1980s found that children of professional parents would have experienced 42 million words by the time they were 4 years old! Imagine!! Their children were hearing on average 2153 words an hour. That study also found that between 86-98% of children’s vocabularies at age 3 came from their parents’ vocabularies. (Swear words any one?!!)

What if your child is learning two languages or more?

In this situation, your child is acquiring two or more vocabularies. It’s likely that they’re not going to have the same level of vocabulary in any one of their languages as a monolingual speaker of each language would have. Why? Because they’re not 2 or 3 monolinguals combined. And there are lots of factors that influence language development involved. Like how much exposure and opportunities to use the languages they get. The quality of the exposure is also important. It’s not enough to talk to them. It’s about how you talk with them. Other influences are: how alike or different the languages are (for example Spanish and Italian are closer than Spanish and Mandarin Chinese) and the statuses of the languages where you live. But still monolingual vocabulary levels tend to be the measurement benchmark which isn’t the appropriate reference point. The research that compares monolingual and multilingual children’s vocabulary size has found that multilingual children have smaller, bigger, and similar vocabularies when compared with monolingual children’s! If you test an English-only speaking child’s vocabulary, you’re testing their whole vocabulary. But if you test a multi-lingual child’s vocabulary in only one language, you’re only testing one component of their vocabulary. Not fair and not accurate. Studies which measure the total vocabulary of multilingual children have found that they’re the same size or bigger than the monolingual child’s total vocabulary. And when researchers measure what’s called conceptual vocabulary (basically number of concepts or ideas that children have a verbal label for), both groups are similar. So the bottom line is that speaking two languages or more does not disadvantage children when you measure total and/or conceptual vocabulary. Using monolingual norms to make judgements about multilingual children’s language development is a no-no. They’re not an appropriate reference point. If your child’s vocabulary is being tested maybe at school or by a speech and language therapist, make sure you keep your focus on total vocabulary. And also think about the amount of exposure to the languages.


There’s a lot of variation in the research and there are lots of studies that report smaller vocabularies for multilingual children. One study which looked at vocabulary in 1738 children between age 3 and 10 in the US found that that although the bilingual children had smaller vocabularies in both languages, the difference had to do with vocabulary associated with home environments. This isn’t an indication of a problem. Of course there was an imbalance because we use language differently according to the situation we’re using it in.  When it came to vocabulary for school, the monolingual and bilingual children were more comparable. This means that bilingual children are not at disadvantage when it came to academic performance, learning to read and write, and using spoken language for school related topics.  There’s a lovely line at the end of that paper by Ellen Bialystock and her colleagues: Bilingual children are constructing the world through two telescopes, and their two vocabularies provide the lenses.


There are several influencing factors on language development like I mentioned above. One recent study in Canada set out to control for many of these factors such as socioeconomic status, the statuses of the languages, the amount of exposure and so on. That study found a strong and systematic relationship between vocabulary development and the amount of exposure to the languages in the 5 year old children who participated. There was a clear relationship between expressive vocabulary (looking at pictures and naming them) and the amount of exposure: more exposure led to higher scores. When it came to comprehension, it wasn’t so clear. They found that once exposure hit 40-60% in either French or English, increasing exposure didn’t lead to higher scores.


It’s a complex picture but the bottom line is that multilingual children, by and large, pass through the same developmental stages in each of their languages as monolingual children do in their one language.  There are also things that are particular to multi-lingual language development too. And generally multilingual children go through the stages at roughly the same ages. It is important to remember that there’s a lot of variation in early child language development, no matter how many languages your child speaks.


So what can you do to build your child’s vocabulary?

The good news is there are lots of natural, simple ways to do this and I’ll show you how in my next post.

If you like this post, please share it with your friends. And if you haven’t already, be sure to sign up for more posts delivered directly to your inbox.

Let’s get talking!


Inspired by:

Bialystock, E, Luk, G., Peets, K., and Yang, S. (2010). Receptive vocabulary differences in monolingual and bilingual children. Bilingualism 13(4):525-531.

De Houwer, A., Bornstein, M., and Putnick, D. (2014). A bilingual–monolingual comparison of young children’s vocabulary size: Evidence from comprehension and production. Applied Psycholinguistics 35 (6): 1189-1211.

Hadley, PA., Rispoli, M, and Tsu, N. (2016) Toddlers’ verb lexicon diversity and grammatical outcomes. Language, Speech, and Hearing Services in Schools 47 (1): 44-58.

Morgan, P., Farcas, G., Hillemeir, M., Hammer, C., and Maczgua, S. (2015) 24-month-old children with larger oral vocabularies display greater academic and behavioral functioning at kindergarten entry. Child Development 86(5): 1351-1370.

Rudolph, J. and Leonard, L. (2016) Early language milestones and specific language impairment. Journal of Early Intervention 38(1): 41-58.

Thordardottir, E. (2011). The relationship between bilingual exposure and vocabulary development. International Journal of Bilingualism 15(4): 426-445.



March 1, 2018
by Mary Pat

What happens after your child says their first words?

We all eagerly await the day our child says their first word. It’s so exciting! Looking back, the first word my little girl understood was kiss. And her first word was /k/. But ‘That’s not a word!’ you say. Oh but it is in this context as she always used to it to request Katy Perry’s Firework song to be played on the computer. A word is the same sequence of sounds used to refer to the same thing each time. After that came kiss and tickle.  Tells you a lot about what was happening in her world! So first words are expected to come any time from 8- 15 months depending on what you read. (Or even 18 months according to one source I looked at) There’s a lot of individual variation among children in their language development which makes it hard to work out what’s in the range of typical development and what’s not. (If you’re worried that your child is late to talk, read here and here.).


Individual variation in language development is also a key feature if your child is learning 2 languages or more because each family situation is unique in terms of the languages spoken, the amount of exposure to each language that your child receives, the opportunities to use the languages that they have, and the relationship between the languages like Spanish and Italian vs Spanish and Mandarin for instance.


But first words are only a stepping stone in language development. Now, don’t get me wrong, they’re a very important step on the way to developing longer and more complex utterances and sentences. What comes next is important too.


So what happens next? Word combinations is what. Now, things like all gone and thank you are not considered true word combinations because they’re most likely learned as one chunk by your child. The fancy name for them is holophrases. They communicate one single intention like requesting, rejecting, labelling, greeting. Language is used to communicate something and these communicative intentions are important because they show that your child is learning to use language to do something like asking for more tickles or rejecting food that they don’t like. These early combinations are really cool and tend to allow our children to communicate in three useful ways: # 1 making statements about things that interest them, # 2 giving orders (!!) , and # 3 asking questions. Here are some examples:

You do it (order)

Here you are (statement)

All gone (statement)

Go away (order)

I wanna do it (statement or maybe request- would depend on the situation)

Lemme see (order)

Where the bottle (question)

About 11% of our toddler’s language is thought to be made up of holophrases. Thank you is not a true 2 word combination if your child can’t use thank and you in other utterances such as you go or thank me and so on.


If you’re worried about your child’s language development and want to keep an eye on them, you can write down the words they say and then look at what are they doing with those words- they need to develop a range of these communication intentions so it’s good to have a look at what they’re doing with the words they’ve got.


At about 18 months then, children begin to combine separate words into meaningful utterances. There are three types of these.

#1 Word combinations which are made up of 2 words of equal status. What would this look like? Let’s say your child sees a ball on the table and she says Ball table. What she means is The ball is on the table or I can see the ball on the table or Look at the ball on the table. So two little words can mean quite a lot! Our job is to work out what she means and say it as she would if she could. That will help her language to develop in a natural, tuned-in way.

# 2 Pivot schemas where it’s like there are two slots- the pivot word which stays the same and the other slot that can be filled with a range of words depending on what they want to communicate. Isn’t that amazing?! The order of the pivot word + the other slot tends to be fixed. The order of the words tends to mirror the order that your child is hearing in their everyday environment. Common ones are like this:

more + X: more cookie, more fish, more high, more hot, more juice, more read

no + Y: no bed, no fix, no home, no mama, no more,, no down

other + : other bib, other bread, other milk, other pocket, other shirt, other shoe

 # 3 True two word combinations which express two separate ideas. These are really cool too as they’re predictable in the sense of the kinds of meanings they can express. Here are some examples of the range of meanings that our clever infants can communicate about as they discover their world:

Kinds of meanings Your child says What your child might mean
Action + Agent Doggie walk  The dog is walking.
Action + Object Push train I’m pushing the train

You’re pushing the train.

Push the train with me.

Agent + Object Man hat The man has a hat.

The man is wearing a hat.

Action + Place


In bath I’m in the bath.
Object + Place Teddy bed The teddy is in the bed.
Possessor + Possession Jamie car This is Jamie’s car.
Thing + Attribute Water hot The water is hot.
Demonstrative +Object This train THIS train (not THAT train).

This is a train.

Our children are expected be combining two words together by 24 months of age with about 50% of their utterances expected to be made up of two word combinations at this age.  Before being able to combine words, your child needs to have a diverse vocabulary. That means nouns, verbs, prepositions, and adjectives. A recent study found that children who were described as being late word combiners (not combining words at 24 months) were found to be more at risk for future language problems than children who were slow to produce their 1st words (late word producers- not producing single words by 15 months).

How will you know when your child is ready to start combining words?

# 1 When you notice that their vocabulary includes  different kinds of words like I mentioned above. Nouns (car, house doggie), verbs (eat, sit, walk, crawl, smile, laugh), adjectives (hot, cold, bad, sore), and prepositions ().in on under). Once they have a wider range of vocabulary than just nouns, they have the foundations they need to start combining them.

# 2 When they use Gestures and Words

This is another cool thing about our infants! Before they can put two words together, they usually use one word plus a gesture which adds extra information so that they can get their message across. (If you want to read more about baby sign which is different from natural gestures, you can read all about it here.). So if your child points to the packet of biscuits on the kitchen counter and says Mama, she’s expressed two ideas. # 1 Agent Mummy and # 2 Action- give me a biscuit! Your child pointing to the biscuit while saying biscuit only expresses one idea. So does lifting their arms up to you saying Up– one idea. But lifting arms up and saying Mama is two ideas: Agent Mama+ Action Lift me up.

So what can you do to help things along? Here are four of the most supportive things you can do when playing with your child to encourage them to start combining words:

# 1 Observe what your child is interested in and comment on what they are looking at. This means you’ll have to resist the urge to point something out to them that you think is interesting. So let’s say they’re looking at a cat out the window. They might point and say Cat. You then say Oh, I see a cat or The cat’s in the garden. It’s important to keep your sentences grammatical too. Keep them short and simple but full sentences. Do your best to avoid trying to teach them overtly by drawing their attention to something else- this isn’t an effective way to teach them. Following their lead is more helpful.

# 2 Abandon all attempts to get your child to repeat what you want them to say! It’s not communicative and is a form of pressure to perform. Interactions with your child need to be meaningful to them and having them repeat things isn’t a genuine communication exchange. Bite your lip! I know it’s hard especially when they’re so cute but it’s worth it in the long run!

# 3 Make sure you use a range of different words other than just the names of things when you’re playing with your child. So talk about how the dog is spotty or brown or big or small or under the bed and so on.

# 4 Say it the way they would if they could. This comes back to #1 above. It’s best to use short grammatical sentences and not things like doggie bark for instance. So if  your child says doggie bark, then you can say The doggie is barking or Doggies bark which are short, expanding on your child’s effort, and still grammatical.

What two word combinations did your child use? What one’s are they beginning to use? Be sure to leave a comment below.

If you like this post, please pass it on to your friends. And if you haven’t signed up already, be sure to sign up to get the posts straight to your inbox.

Let’s get talking!


Inspired by

De Houwer, A. (2009) An Introduction to Bilingual Development. Bristol: Multilingual Matters.

Hanen’s It Takes Two to Talk.

Hart and Risely (2003) The Early catastrophe: the 30 million word gap by age 3. American Educator Spring 2003: 1-8.

Paul, R. (2018) Language Disorders from Infancy through Adolescence: Assessment and Intervention. (3rd ed) London: Wiley.

Rudolph, JM. and Leonard, LB. (2016) Early language milestones and specific language impairment. Journal of Early Intervention 38(1):41-58.

Saxton, M (2010) Child Language: Acquisition and Development. London: Sage.



February 14, 2018
by Mary Pat

When should you start reading with your child?

So I’ve started writing a book about how to develop all of your child’s languages when you speak two languages or more. I’m doing a lot of reading around the topic at the moment and there’s one thing about children and language development that regularly blows my mind. What’s that? It has to do with when babies start to learn language. There is a robust field of research on what’s called infant speech perception which shows that once their ears begin to function in the womb, in about the 7 month of pregnancy, babies start to learn about languages. While still on the inside, they can distinguish between sounds like a power drill, a door closing, their mother’s voice, a bell, and music. Not impressed? How about this- unborn babies can learn to recognise the telling of a particular story.

One study from the 80s had mothers read a particular story to their babies at 7 and ½ months into the pregnancy. One of the stories was the first part of Dr Seuss The Cat in the Hat. Another one was adapted from the 2nd half of The Cat in the Hat and was called The Dog in the Fog. And the third one was called The King, The Mice, and The Cheese. Mothers were asked to read one story twice a day from 7 and ½ months which meant that by the time the babies were born, they had heard the story about 67 times. Three days after they were born, the babies were found to show a preference for the story they had heard while in the womb over the other two stories. (How did the researchers work this out? They measured the sucking rates of the babies and the babies tended to suck more enthusiastically when hearing the familiar story).

Other  studies have shown that where babies were read prose passages for 6 weeks before they were born, they preferred those passages when they were born over ones they hadn’t heard before. They preferred the familiar passages even when they were read by an unfamiliar female voice. So it wasn’t just their mother’s voice they were responding to but the acoustic properties of the speech signal- the sounds, the intonation. And by monitoring  babies’ heart rates while they were still in the womb, researchers noticed that at 37 weeks of the pregnancy, the babies distinguished between familiar and new poems.

What do the findings mean? They mean that babies tune into intonation patterns of the languages they hear from their outside world environment. Intonation is like the music of language- the ups and the downs. Hearing through layers of muscle, skin, fat, and amniotic fluid is going to sound a bit like the noise from next door-the sound waves are passing through a lot before they reach the baby.

There are other amazing things babies can do after they are born and even before they’re six months old but that’s for another day! So to answer the question, when should you start reading to your baby? You can start as early as 7 and ½ months or so into your pregnancy. When they’re older, the actual way you read with them becomes important. If you’d like to know how to share books with them naturally in fun ways that build their language skills, I have an e-book that shows you just how to do that. You can get that here.

If you liked this post, please share it with your friends. And if you haven’t already, be sure to sign up to get more posts directly to your in-box every two weeks.

Let’s get talking (and reading!)


Inspired By:

Before First Words website.

Paradis, J., Genessee, F., and  Crago, M. (2011) Dual Language Development and Disorders: A Handbook on Bilingualism and Second Language Learning. (2nd ed.) USA: Paul Brookes Publishing.

Saxton, M (2010). Child Language: Acquisition and Development. London: Sage.


January 18, 2018
by Mary Pat

3 Important Reasons Why LOL Surprise Dolls Are Good For Your Child And You…

So my little girl has become enamoured with LOL Surprise Dolls recently. I was reluctant to let them into our world but relented in the end. Setting aside all totally reasonable arguments about toy companies manipulating us and our children, not to mention the environmental impact from all that plastic , there are 3 major reasons why LOL Surprise Dolls really are great. Read on to find out what they are. (If LOL Dolls are not the latest craze in your house, you can substitute many other toys that our children come to love for the same benefits)

#1 The most obvious reason is to do with your child’s imaginative play, vocabulary, memory, and story-telling skills. Of course, these are not the only toys that develop these skills but if you have succumbed to them, you may as well console yourself that there are genuine benefits! They are great for all of these things though. The range of story lines and characters are endless and your child’s ability to re-purpose other toys to add into the story lines is also very good for symbolic play development. Language is all about symbols and if your child can use the LOL balls to make a train or a carousel or a boat, this is very good for play and ultimately, language development. Play is also great for working out things that might be bothering them at school or limits that have been set at home. It’s very useful emotionally to have a baddie in your story that you can vent some steam through without actually hurting anyone! Story telling is also very good for language development and learning to read.

As for vocabulary, we have had endless discussions about the following words: opposites, club, sugar, spice, angel, demon. So you have concrete vocabulary like club and then more abstract terms like angel and spice when talking about a character as opposed to food. This is building your child’s vocabulary network in terms of multiple meanings for words. Strong vocabulary is linked to learning to read so it’s a neat way of building a diverse vocabulary. We’ve also had great chats about concepts such as worth and value. As in, is the big glitter ball worth the €65.34 and the 22 weeks it will take you to save for it? Other concepts we’ve explored are terms like ultra-rare, popular, and common. And manipulation, supply, and demand, duplicates. My little girl got Kitty Queen who is, according to some people like gold dust because she’s ultra-rare. However, she’s not interested in Kitty Queen; she prefers Kicks who’s popular. So we talked about the value you attach to something. (On a side note, I discovered I could have sold the infamous Kitty Queen for £85 or more because of the value attached to her by a lot of people.) We’ve also talked about word play when we see the names of some of the dolls like M.C. Hammy, Hoops D.O.G.G. and Curious Q.T..

#2 The second reason LOL dolls are actually a good thing has to do with your child’s emotional development, emotional literacy, and resilience. How so?
When you buy an LOL doll, you don’t know which one is inside. We were very lucky initially and never got a duplicate. But that day came and we had only opened the first layer of plastic (I know, I know- 7 bloody layers!) and got the little clue so she knew it might be one she had already. And so it was. Cue hysteria! Oh she railed against those dolls and declared she never wanted to see another one (‘Oh please, yes’ I thought! And then ‘Although she’d better play with the ones she has after all the money I’ve spent’.!! ). So because I was on holidays and not exhausted, I found it in me to acknowledge her feelings and say things like ‘It’s really disappointing. You didn’t want Beats again. You wanted Kicks. She’s your favourite. It’s so upsetting when you get a duplicate’. I also had to fend off my well-intentioned mother from chipping in with things like: ‘There are lots of little girls who have no dolls you know’!! It was really interesting though. After a few minutes of intense emotion, she calmed down and about 20 minutes after that she was able to come up with solutions to her dilemma. For example, she could use Beats’ clothes for another doll. She could pretend that Beats had an identical twin or a clone or that Beats was a changeling. This is the whole point of allowing our children to feel what they’re feeling. It allows them to be better problem solvers. And it gives them a safe place to feel what they’re feeling without any pressure to stop it or change it into something we deem more acceptable. They need to feel accepted as they are. If they can’t do that with us, then how can they ever come to feel that they’re okay just the way they are? And that what they feel isn’t something undesirable but something that makes us uniquely human and connected to each other as we all feel these feelings at one time or another?

#3 Believe it or not, LOL Surprise Dolls are good for you too! What? Yes! Two reasons- A: they allow you to enter your child’s world, find out what’s important to them, and get to know them better. When you join in and play, you can see what they value, what they’re interested in, what might be bothering them, and be amazed by their imaginations. These are precious gifts indeed.

And B they give you an opportunity to teach your child about goal setting, planning, and money. And to be their guide to handling challenging emotions on the journey towards their goal. LOL dolls are an expensive toy at €11.99 each so they’re never going to be a frequent treat. So my little girl decided to save for this one big ball that has 4 dolls in it and a range of accessories. She has identified what she wants- the big glittery ball- the goal. It’s good to know what you want and have a specific outcome so you’ll know when you’re there. Together we have worked out the numbers- it will take 22 weeks to save for it and you can’t buy anything else in the meantime. We’ve had chats about how you could get to your goal quicker (problem solving and generating solutions) – like do more work to earn more money- and she’s working out what exactly she’s prepared to do to get to her goal faster. As it turns out, cleaning the bathroom sink for €1 extra is not one of them! So she’s clarifying her values.

It’s going to take her a long time to save the money so she’s having to learn to deal with feelings of longing and struggle and frustration. And disappointment when some of her strategies like asking for her pocket money in advance and I say ‘No’. Or trying to get more pocket money without adding value in the world. (Hard lessons indeed! We’d all like money for nothing!!) This gives me plenty of opportunities to guide her through the feelings, acknowledge them, let her feel them, and move on. This is not easy! Especially when it can start first thing in the morning as the first thing that comes out of her mouth as she tries to get me to give her money to get to her goal faster! It’s so hard not to preach about patience as my mother used to do!! Or get annoyed by the seemingly relentless focus on what she wants. But is gives me great opportunities to put what I’ve been reading and learning into practice and build the muscle of being tuned in and guiding her through the rough seas.

So what are your child’s favorite LOL Surprise Dolls? Be sure and leave a comment below!

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December 2, 2017
by Mary Pat

What exactly is a speech problem?

So your child has a speech problem. But what exactly is a speech problem? For this post I’m talking about problems with speech sounds and pronunciation. Having a lisp. Or saying tar when you mean car. Or speech that sounds slurred or strained. Other speech problems would be stuttering or stammering. I’ve written other posts about that. If your pre-schoolchild starts to stutter, you can read this. If your family speaks 2 languages or more, and you’re worried about your child stuttering, you can read this. Voice problems like being hoarse are another kind of speech problem which I’ll be covering in a future post.


There’s a lot of theoretical discussion in speech and language therapy about how to classify the different types of speech sound problems. There’s no universally agreed upon one yet. I’m sharing with you the one I use to teach speech and language therapists in training. The idea is that any child’s speech sound problem should be able to fit into the system. Essentially there are 7 possibilities and 1 exception when it comes to children’s speech sound problems. So let’s get started!

 # 1 Articulation Impairment- in the mouth

This is where your child has trouble producing particular sounds, usually /s/ or /r/. For English speakers this can be a lisp (technically called an inter-dental /s/). Usually /s/ is made with the tip of your tongue up behind your front teeth. With a lisp, your tongue comes between your teeth. I had a lisp until I was 17 and had no idea I had one until I visited a local speech & language therapist to find out about training to be one!! I couldn’t make a /s/ with my tongue tip behind my front teeth. So I make my /s/ with my tongue tip behind my lower teeth. My little girl has a lisp too. I think it’s really cute for now! She has no front teeth though so I’m waiting to see what happens when her permanent teeth come in. For /s/, the air is directed out of the center of your mouth. Make one and see if you can put your focus on what’s happening in your mouth when you do. Then try and do a lisp. Another articulation impairment affecting the /s/ sound is when the air comes out the sides of the tongue- often called a lateral lisp. Both of these sounds are not speech sounds in English which can be another way of working out that your child has an articulation impairment (and they only speak English).


An articulation impairment can also affect /r/ so your child might say wed when they mean red. If you ask them to say /r/, they can’t do it. Same applies for the /s/. A general rule of thumb is that articulation impairments are in the mouth- a problem with the physical articulation of sounds. The meaning of words is generally not affected so it won’t necessarily be harder to understand your child because their meaning will still be clear.


Problems with /r/ are a little more complex in that meaning is affected. Wed and red do not mean the same thing.  So I tend to think of problems with /r/ as an articulation impairment with phonological consequences. Bear with me- I’ll explain more about phonology in # 2 below!


Speech therapy for articulation impairments is basically showing your child how to produce the sound by itself. This involves explaining how to make the sound. Then the sound is combined with a vowel. Either a vowel first followed by the /s/ for example, ee-s. Or the /s/ first followed by the vowel, s-ee. Then the sound in words- either at the beginning (son) or the end (house). Then in phrases and sentences and ultimately in spontaneous speech when it has become automatic. I got rid of my lisp by saying the prayers at Mass out loud until I could do it without thinking about it!! Some researchers say that your child would need to be at least age 7 and really committed to changing their speech for therapy to work. It’s a lot of drill work and practice so motivation is important. Here’s a handy table with ages at which you can expect most children to say particular sounds- interpret flexibly though as there is a lot of individual variation. These are from Australia and not written in stone- use as a rough guide.

Next up is

 #2 Phonological Delay: in the mind

Big word phonology! ‘What the hell is that?’ you may be wondering. It has to do with the organisation of sounds and meaning. It’s about rules. So for example knowing that in English you can have str at the beginning of words like strawberry but not nd at the start of words. If you do crosswords a lot, you’ll recognise patterns like this and use the knowledge to work out what the answer might be.


Sounds are organised in classes to do with shared properties so we have long sounds like /s/ /z/ /f/ /v/ and short sounds like /t/ /d/ /p//b/. If you say them yourself, you’ll feel the difference. There are front sounds /t/ /d/ /n/ and back sounds /k/ /g/ and the sound at the end of words like sing. There are quiet sounds like /p/ and /t/ and loud sounds like /b/ and /d/.  To feel this difference, put your fingers on your throat and say a long /s/. Then say a long /z/. You should be able to feel a difference with some slight vibration on the /z/.


Children who have a phonological impairment might say deben instead of seven.  Or tar when they mean car. Or boon when they mean spoon. If your child has a phonological impairment, this means that they have trouble with learning the rules of their language. (This learning the rules is happening unconsciously). In a way, it’s a language problem that affects the organising of speech sounds into a system of sound contrasts. The contrast is important because that’s connected to the meaning of words. If you want tea, you need to be able to say tea and not have key come out instead.


There are 2 kinds of phonological impairment. The first one is phonological delay. So for children who speak English as their only language, the ages and stages of speech development are fairly clearly mapped out. When they’re learning to speak intelligibly (takes up until about age 5 and possibly up to age 8), they make predictable and acceptable errors. For example aminal instead of animal, hopsital instead of hospital. We expect them to make errors like leaving out the last consonant in a word when they are between 18 and 24 months. In fact in this time period they may be making all of these errors at the same time:

  • leaving out one of the consonants where two come together: boon for spoon
  • saying tat when they mean cat
  • saying tar when they mean car.
  • saying dit when they mean sit
  • saying wed when they mean red
  • saying door when they mean tore and
  • saying gog when they mean dog


And that’s typical development! No need to correct them. The best thing to do is to repeat the words correctly after them in a natural sounding way. Here’s a very quick video I’ve made to show you how to do this.


A phonological delay then is when these kinds of errors don’t go away at the ages you’d expect them to. (There’s a lot of individual variation in early child speech and language development so it’s important to think of the ages and stages in a flexible way). So if your child’s 3 and a half and is still leaving out the consonants at the ends of words. Or they’re 6 and saying sawn when they mean Seán. And here’s another handy table with general ages at which these error patterns (also known as phonological processes) should be gone by. But remember, speech development for multilingual children won’t be exactly the same as this because of the language systems interacting.

The next one is:


# 3 Consistent Phonological Disorder

Some errors that children make are not found in typical development. (I’m talking about monolingual English speakers here. It’s slightly different when you speak two or more languages.) Things like leaving out the first sound in a word or the middle sounds in words or using a back sound instead of a front sound. That would be saying kar when they mean tar. This is called a phonological disorder. There are 2 kinds of phonological disorder. The first one is a consistent phonological disorder where your child says the word wrong the same way each time. So it’s always kar for tar. There’s still a consistent pattern in the errors.


Speech therapy for phonological delay and consistent phonological disorder focuses on helping children organise their speech sound system and learn the rules. So it would mean talking about long sounds and short sounds for example. Having your child listen and identify long and short sounds and then producing long and short sounds. They would play games where they pick a picture from a pile of pictures with word pairs such like sick (long sound at the start) and tick (short sound at the start). The therapist can’t see which picture. Your child says the name of the picture and the therapist points to the one she hears. The idea is that if your child says tick and the therapist points to tick,  but your child meant sick, they realise that they need to use a short sound instead.


# 4 Inconsistent speech disorder

 The other type is an inconsistent speech disorder. The problem here is with selecting and sequencing speech sounds correctly. It means that your child will say the same target word (the word they’re trying to say) differently each time they say it. So seven might be teben, deben, seben. You can see how this makes it hard to understand your child because there’s no predictable pattern in their speech. Things change constantly.


The therapy for an inconsistent speech disorder is called. It the core vocabulary approach and works like this. The therapist together with you, your child, and your child’s teacher make a list of 50-70 words that are meaningful to your child and that they’ll have an opportunity to use in day to day interactions. Words like people’s names, pets’ names, foods, favourite things, words like sorry and please and thank you. Generally, your child attends for 2 thirty minute sessions in a week over the course of 6-8 weeks. The first goal is to get their best production. It doesn’t have to be the same as yours. It just has to be consistent so that they’re always saying a word the same way. That will make it easier to understand them and for them to experience successful communication. That’s the first step and it goes on from there.


#5 Childhood Apraxia of Speech (previously known as Developmental Verbal Dyspraxia or developmental dyspraxia.

This is a difficult one to explain. The technical description says it’s a difficulty planning and programming movement sequences resulting in errors in speech sound production and prosody. I know! What would that sound like though? Well if your child is very hard to understand, has trouble producing many consonant and vowels, has trouble saying long words, and has unusual sounding speech, then they may have childhood apraxia of speech.


It affects 1-2 children per 1000. There are a range of interventions for children with CAS. Two that I have used are the Nuffield Centre Dyspraxia Programme and the Kaufman Speech to Language Protocol which is a little like Core Vocabulary. One early aim is to get consistent production of your child’s best attempt at the words they’re aiming to say. There’s unpublished case study data on the website to show it works. As for the Nuffield programme, there’s published and unpublished evidence about it.


#6 Childhood Dysarthria

This means weakness or slowness or poor coordination of speech movements. It can affect your child’s breathing, vocal quality, muscle tone, nasal-sounding speech or, slurred-sounding speech. It’s not as common as the other types. It’s caused by neurological impairment which could occur during or after birth like cerebral palsy. Intervention for children with childhood dysarthria depends on the type of dysarthria, how severe it is, and on what aspects of speech are involved.


#7 A combination of issues

Children’s speech may fit neatly into one category. For example, your child has a lisp or articulation impairment and that’s it. However, because children’s speech sound systems and their language is developing, they may have trouble in other areas too. So for example,  your child may have dysarthria related to cerebral palsy and trouble with the physical production of speech sounds, they may also have a phonological impairment.  Or they have a cleft palate affecting their speech (nasal sounding) and a phonological delay, not related to the cleft palate. So while I’ve presented the types separately, it’s not as simple as that in reality. The idea is that SLTs need a system to explain your child’s speech symptoms so they can plan intervention according to their understanding of the type of speech problem it is. So if your child has a lisp, they need articulation intervention. And so on. The intervention needs to fit with the diagnosis.


The exception

There’s another category called speech difference. And this is an important one for families who speak two languages or more. If you’ve read my post on what you need to know about speech development for multilingual families (here ), then you’ll know all about languages interacting and how ultimately with high quality input and opportunities to use all of their languages, the speech of most multilingual children develops without problems. What can make it a little more challenging to identify one of the speech problems above is that the languages interact in ways that can produce errors that would be considered a disorder in monolingual English speakers. For example, leaving out the first sounds in words is unusual in monolingual English speaking children but not unusual for French speaking children. That’s why multilingual children need to be assessed in all of their languages and why SLTs need to find out about the different sounds in the different languages they try to work out if there is a problem or not. They call this difference vs disorder in the literature.

Lastly, accents are not speech problems. Everyone has an accent whether they think they do or not! The fancy word for it is idiolect and it includes language as well as speech. So for example I say I do be talking to her. Or I’m after burning the dinner. These are common for some Irish English speakers and artefacts from the Irish language. It’s also common for Irish English speakers to sound like they’re saying dis, dat, dese, and dose  for this, that, these, and those . If you live in South London, you might say souf for south and it’s dialect not a diagnosis! In the US, for Tuesday you say toosday. In Ireland we say chewsday! Tomayto, tomato! Accent is not a speech sound problem.  And no accent is better or worse than any other. Now, if you’re an adult who learned a second language later in life and you feel that your accent is interfering with getting your message across, then a speech and language therapist can help you although it’s important to know that this an area that is only beginning to emerge in speech and language therapy practice and not without controversy. If you want to read more about accents and speaking two languages or more, here are two interesting articles by the renowned Francois Grosjean. (You can read them here and here.


If you’re concerned that your child has a speech problem, be sure to contact your local services.

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Inspired by:

Barbara Dodd (2005) Differential diagnosis and treatment of children with speech disorders. London: Whurr.

McLeod & Baker (2017) Children’s speech: An evidence-based approach to assessment and intervention. London: Pearson.