Activities to Encourage Speech and Language Development

Todd, Amira, and Yuen attend a preschool program for 2-year-olds. Todd spoke his first word at 10 months, had a vocabulary of 25 words at 13 months, and was using two-word phrases at 18 months of age. Amira spoke her first word at 14 months and just recently has begun putting two-word phrases together. Yuen has no words that are understood by others. Her needs, desires, and frustrations are relayed by a combination of screams, grunts and temper tantrums.

Speech and language skills develop at varying rates for children. A speech-language-hearing evaluation can determine when skills are developing normally and when professional intervention is needed. Whether or not the services of a speech-language pathologist and/or an audiologist are recommended, many activities can encourage speech and language development and provide learning opportunities. The following suggestions may be modified to meet individual needs.

Birth to 2 Years
A newborn baby's first attempt to communicate is through crying. Many parents identify specific needs (comfort, hunger, pain) and emotions (happy, sad) through the different cries used. Later, the baby will use vowel-like sounds such as "ma," "da," "ba." These sound combinations will be used for both personal satisfaction and for relaying information. Encourage your baby to make these sound combinations. Reinforce attempts by maintaining eye contact, responding with speech, and imitating vocalizations using different patterns and emphases. For example, raise the pitch of your voice to indicate a question. Also, imitate your baby's laughter and facial expressions. Teach your baby to imitate your actions, including clapping your hands, throwing kisses, and playing finger games such as pat-a-cake, peek-a-boo, and the itsy-bitsy spider.

Young children understand the meanings of many words (receptive language) before they are able to produce these same words (expressive language). Talk as you bathe, feed, and dress your baby. Talk about what you are doing, where you are going, what you will do when you arrive, and who and what you will see. Identify colors. Count items. Use gestures such as waving good-bye to help convey meaning: "The doggie says woof-woof."

A child's first words may appear at one year of age. Sometimes a single word is used for several meanings. "Mama" may indicate "I need my Mama," "Where is Mama?" or "That is Mama." Acknowledge the attempt to communicate and expand on the single word. "Here is Mama. Mama loves you. Where is baby? Here is baby."

Reading to your child introduces new words and ideas. Sometimes "reading" is simply describing the pictures in a book without following the written words. Choose books that are sturdy and have large colorful pictures that are not too detailed. Ask your child, "What's this?" and encourage naming and pointing to familiar objects in the book.

2 to 4 years
Most 2-year-olds use one and two word sentences and short combinations, such as "Want juice," "Daddy go." "Baby sleep." Provide appropriate speech that is clear and simple for your child to model. Repeating what your child says indicates that you understand. Build and expand on what was said. "Want juice? I have juice. I have apple juice. Do you want apple juice?"

Use baby talk only if needed to convey the message and when accompanied by the appropriate labels. "It is time for din-din. We will have dinner now."

Flipping through colorful magazines and catalogues is a fun activity. Make a scrapbook of favorite or familiar things by cutting out pictures. Group them into categories such as things to ride on, things to eat, things for dessert, fruits, things to play with. Create silly pictures by mixing and matching pictures. Glue a picture of a dog behind a steering wheel of a car. Talk about what is wrong with the picture and ways to "fix" it. Count items pictured in the book.

Help your child understand and ask questions. Play the yes-no game. Ask questions such as "Are you a boy?" "Are you Marty?" "Can a pig fly?" Encourage your child to make up questions and try to fool you. Ask questions that require a choice. "Do you want an apple or an orange?" "Do you want to wear your red or blue shirt?"

Expand vocabulary. Name body parts, identify what you do with them. "This is my nose. I can smell flowers, brownies, popcorn, and soap." Sing simple songs and recite nursery rhymes to show the rhythm and pattern of speech. Place familiar objects in a container. Have your child remove the object and tell you what it is called and how you use it. "This is my ball. I bounce it. I play with it." Use photographs of familiar people and places, and retell what happened or make up a new story.

4 to 6 Years
When your child starts a conversation, give your full attention whenever possible. Make sure that you have his or her attention before you speak. As your child learns new words, the pronunciations may not be correct. Acknowledge, encourage, and praise all attempts. Show that you understand the word or phrase by fulfilling the request, if appropriate. Pause after speaking. This gives your child a chance to continue the conversation.

Continue to build vocabulary. Introduce a new word and offer its definition, or use it in a context that is easily understood. This may be done in an exaggerated, humorous manner. "I think I will drive the vehicle to the store. I am too tired to walk."

Talk about spatial relationships (first, middle, last; right and left) and opposites (up and down; on and off).

Offer a description or clues, and have your child identify what you are describing: "We use it to sweep the floor" (a broom). "It is cold, sweet, and good for dessert. I like strawberry" (ice cream).

Work on forming and explaining categories. Identify the thing that does not belong in a group of similar objects: "A shoe does not belong with an apple and orange because you can't eat it: it is not round: it is not a fruit."

Help your child follow two- and three-step directions: "Go to your room, and bring me your book." Encourage your child to give directions. Follow his or her directions as he or she explains how to build a tower of blocks.

Play games with your child, such as "house." Exchange roles in the family, with you pretending to be the child. Talk about the different rooms and furnishings in the house.

The television also can serve as a valuable learning tool. Talk about what the child is watching. Have him or her guess what might happen next. Talk about the characters. Are they happy or sad? Ask your child to tell you what has happened in the story. Act out a scene together, and make up a different ending.

Take advantage of daily activities. For example, while helping in the kitchen, encourage your child to name the utensils needed. Discuss the foods on the menu, their color, texture, and taste. Where does the food come from? Which foods do you like? Which do you dislike? Who will clean up? Emphasize the use of prepositions by asking him or her to put the napkin on the table, in your lap, or under the spoon. Identify who the napkin belongs to. "It is my napkin." "It is Daddy's." "It is John's."

While shopping for groceries, discuss what you will buy, how many you need, and what you will make. Discuss the size (large or small), shape (long, round, square), and weight (heavy or light) of the packages.

Tracy Amiel, MS, CCC, SLP is a speech-language pathologist in Santa Fe, New Mexico. She has worked as a speech-language pathologist in hospitals, the public schools, in a community clinic and a private practice. In these settings, she has gained experience working with children and adults with communication disorders and feeding/swallowing issues.

Tracy answered a variety of member questions which are posted below.

Terry: Tracy, what exactly is tongue thrust? What does it affect, and is it something to be concerned about?

Tracy: Hi, Terry. Tongue thrust is when the tongue moves forward beyond the gums and may even stick out between the lips. It may possibly impact speech sound production and/ or feeding and swallowing depending on the degree. Tongue thrust can be addressed with a speech-language pathologist in conjunction with a dentist.

Debbie: My daughter will be four years old in May. She was a late talker but now has a huge vocabulary. While her vocabulary is huge, she does not speak very clearly. She is very slightly tongue-tied so I wonder if this is part of the problem. For example, anything with a /d/ or /t/ sound in the middle are unclear. Daddy sounds like Dayee, Katie sounds like Kayee, etc. Is this something she will need speech therapy for? Thank you for your time.

Tracy: Debbie, the example sounds /d/ and /t/ you provided are both produced using the tip of the tongue behind the upper front teeth. Without having more of a clear understanding of exactly your daughter's tongue movements, I would suggest meeting with your local speech-language pathologist whether it be school based or clinic based for further investigation. I can reassure that the substitution of /y/ for /d/ or /t/ is not uncommon and can often be remedied quickly.

Allyn: Tracy, thank you for being here. I'm thinking of teaching my child to sign. He is speaking, but I just think it would be a nice thing for him to learn while young. Do you have any suggestions how to get started?

Tracy: Allyn, there are books available that teach basic sign language (i.e., eat, drink, sleep, please, thank-you, etc.) for infants. You may also be able to investigate this further through a local community college course or even perhaps day care. I would suggest that as you introduce the signs, they be coupled with the words as well. Good luck!

TangoMom: My son is 3 years 7 months and has a wide vocabulary (Spanish is our national language) and this year he will learn his first words in English. But he has lots of problems with the use of /f/,/t/, and /ch/ (in fact he's unable to pronounce /f/) Would it be better to improve his Spanish pronunciation before starting other language, or there is no problem about it? Thanks.

Tracy: TangoMom, with the information you provided, it sounds like introducing English as a second language while reinforcing correct production of the specific speech sounds /f/ and /t/ in Spanish would not be a problem. In English, /ch/ does not typically emerge until approximately 4-1/2 or 5.

Julie: My almost 20 month old says a total of two words ("no" and "wow") at this point even though we have endeavored to communicate with him actively since day one. He understands many, many words but won't speak at all but rather screams and screams for everything. We have been getting really frustrated because no matter what we attempt (sign language, saying what he is feeling to him so he can learn what to say, telling him to use his words, etc.) all we get in return is screams. He is very expressive with his face and body language and it is easy to see what he wants about 85% of the time but we are getting more hesitant to do what he is wanting without verbalization (so we don't just keep enforcing screaming and body language as communication).

Do you have any ideas for us? I am feeling like two words of vocabulary at this point is very small and have been worried about it as well as very frustrated. I don't know if it changes things but he did have a choking problem for about 11 months and didn't eat solids until that time when we took him to a feeding clinic that worked with me to help him use his tongue on both sides of his mouth vs. one. Any help you could give me would be immensely appreciated. Thank you! ~Julie

Tracy: Hi, Julie. It sounds like you have been doing good work as far as trying many different strategies to encourage verbal communication with your son. My first question needing to be clarified before really being able to provide any additional information would be about the status of his hearing. Has his hearing been evaluated recently? I would suggest contacting a local speech-language pathologist to further investigate additional strategies tailored to your son to promote verbal communication especially because he is so effective communicating via "screaming" and with his body language.

Phishy: My son has a very large vocabulary and picks up on new words or situations very easily. I am concerned that his beginning "c" sounds come out like "t's" (tookies instead of cookies). I repeat it the way it should be ("yes, you want a cookie") but he does not seem to be catching on. He has a friend named Caden and says his name fine though. This is the only sound he mixes up - even "lellow" has now become "yellow." He is 2.5 now - should I get him checked out? Thanks.

Tracy: Dear Phishy, Typically, both the /t/ and the /k/ sound emerge in the initial position around three years of age. The /t/ sound being a tongue tip sound and the /k/ sound being a back of the tongue sound. I would suggest that you continue modeling correct speech sound production as you have been. If these two sounds do not emerge in the correct placement as anticipated by continuing to be substituted for one another or additional sounds become a concern by three or three and half then pursue a local speech-language pathologist. The substitution of /t/ and /k/ is not an uncommon error pattern and usually is remedied quite quickly in children where there is a concern.

Heather: My son is 3 1/2 and has trouble pronouncing his /r/ sounds, especially at the end of a word. I suspect that this is normal, but I also remember going to a speech therapist at school when I was much older than he is (about seven) for the exact same mispronunciation. Could you give me a sense of what is usual in this situation? Should I just make sure to pronounce things correctly myself and not worry until he's six or seven, for example?

Tracy: Heather, Typically, the /r/ sound does not emerge until approximately five years of age in boys. Yes, keep up the positive work modeling correct speech sound production!

Kim: I have 2.5 year-old twins who just started verbalizing (parroting) this past week. Is this ok or should we be setting up consultations? I am not sure if they have their own language, but it doesn't seem to be very noticeable if they do. Thanks

Tracy: Kim, I am a little unclear as to what you mean by "parroting," however, if you have a concern that words have not emerged that you are able to understand, then yes, I would pursue a local speech-language pathologist.

Lori: I have been correcting a few words that my 2 1/2 year old says. Mainly because his speech has developed tremendously in the last 6 months or so. Words like biss (kiss), bink (drink) and meen (green) which he can pronounce correctly but is so used to saying the incorrect way. Should I be doing this or should I be letting him pronounce them the way he would the incorrect way until he eventually grasps the correct verbage?

Tracy: Yes, keep up the positive work modeling correct speech sound production even with sounds that will not emerge until a later age such as the consonant clusters (i.e., /dr/, /gr/, etc.).

Aliboo: My baby is 47 weeks old. She was 12 weeks early and went through an awful lot. Very recently she was diagnosed with Cerebral palsy. It is far too early to know the full extent of this. BUT, she will only eat liquidized food, like a thick sauce, or puree. If there are any lumps, even soft ones, like in seven month jar food, she kind of gags and spits it out. She will suck a little bit toast, or apple, but again won't swallow. She doesn't have any teeth yet. I don't know if this is a problem, or anything to be concerned about. I am just learning about CP, and dealing with the shock of it all. She is waiting to see the physio, occ therapist and speech therapist. We live in the UK, and there always seems to be waiting lists for everything! I would be interested in your opinion, as I don't know if CP affects eating. Thank you.

Tracy: Dear Aliboo ~ The following information is general information about children with cerebral palsy and not necessarily about your daughter as each person has their own gifts and strengths. Yes, there is the potential that cerebral palsy may impact feeding and swallowing which is referred to as dysphagia.

From a speech therapy perspective, areas of concern may be tongue function, trigger of the swallow response, pharyngeal peristalsis, chewing, gag response and sensitivity in the oral area. It sounds like you will be in good hands with your daughter's team of therapists (i.e., P.T., O.T., Speech) who will be able to support you with any specific questions or concerns tailored to your daughter. My best of luck.

Erin: I wondered if you might offer your professional insights about a personal decision my husband will soon be making concerning his career. We are a young married couple expecting our first child, and my husband is a student at Brigham Young University, majoring in Audiology and Speech Language Pathology. He will finish his undergrad work next April, at which time we will be relocating (possibly to Albuquerque - he is from New Mexico) for his graduate studies. However, at this point in time, he is trying to decide whether he will continue working towards a Masters Degree in Speech Language Pathology, or change directions and work on a Doctorate in Audiology. To him, what is most important is that he be able to help people but, as I mentioned, he's unsure where he will be the most help. I realize that ultimately, the decision is ours, but I wondered if you might be able to offer any advice. Professionally, do you see a greater need in one or the other of these fields? What is it about SLP that you find personally fulfilling? Also, any other advice you might offer would be appreciated. I understand if you cannot take the time to respond, but if you wouldn't mind it, I know he would greatly value your response. Thank you in advance for your consideration. Sincerely, Erin.

Tracy: That is wonderful that your husband is in the field of speech-language pathology and audiology. How exciting! I absolutely love my work as it is incredibly fulfilling and creative. I find speech therapy and audiology to be very closely related and that both fields are about being of service. I can share that either field would offer great rewards both mentally and emotionally. There is quite a demand for people working in these fields also. I am sure he will be thrilled with his decision either way!

Jennifer: My three-year-old son has started stuttering a little, most of the time he talks properly, but once he starts he just can't seem to stop, do have any ideas to help? Your advice would be much appreciated. Many thanks, Jennifer

Tracy: Jennifer, learning to speak is a highly complex task. As a result, children repeat sounds and words, hesitate and stumble during the early developmental stage of speech and language. For most children, those "errors" are only normal nonfluencies. For some children, however, they can be the beginning signs of stuttering. Some children may display stuttering as soon as they begin combining words, but most do not start until approximately one year later. Stuttering often begins gradually and its progression can be episodic, containing oscillations in severity across different communicative tasks and periods of time, repetitions of syllables which may occur on the initial words of an utterance are one of the more common types of nonfluency occurring in beginning stuttering. Signs can occur randomly, however, frequent and consistent appearance of one or more of them should be brought to the attention of a local speech-language pathologist. Some suggestions for talking and interacting with young children who stutter are as follows:

1. Model soft, slow, smooth speech.
2. Associate talking with pleasant activities.
3. Minimize interrupting the child when nonfluency occurs.
4. After a nonfluent utterance, repeat back the content of what the child said.

Millie: My two-year-old son doesn't say much. He just turned two in January. He has said a lot, but he only says it once. He doesn't say anything but "dada," "bye," "hi," "juice," regularly. Is this ok? He understands everything that is said to him and he has wonderful hearing. Everyone keeps asking when he is going to talk. We read to him and we repeat words to him all the time. My doctor said that I'm being too much of a first time mommy and that I anticipate his needs so he doesn't feel the need to talk because he will get it from me anyway, but I don't believe that. So is it ok that he isn't really talking at 25 months?

Tracy: Millie, as mentioned in the article, speech and language skills develop at varying rates for children, however, I would suggest contacting a local speech-language pathologist in order to determine whether or not therapy is warranted.

PaulaSue: Our History: All my girls were born tongue-tied as well as my father and my self. I had the girls clipped soon after birth but I wasn't until 4 1/2 as well as my father. My older two have been in speech classes since last September.

My second daughter has made many improvements with talking (she was one year behind in words) but she is dropping the endings in her words making it very hard for me to understand her and impossible for others. (Actually her older sister understands her and tells me if I can't figure it out.) My oldest daughter doesn't seem to have made any noticeable improvement with her sounds. Even her preschool teachers can't figure her out yet. I try to work with them often doing their "homework" and saying the words correctly. (They have classes twice a month.)

My question is: They are changing my oldest's teacher again (third new teacher)and my middle daughter is getting a new teacher since she just turned three. How do I make it easier for them and not to back slide. I don't think my oldest is making any improvements and she is so shy and once she warms up to a teacher they are gone. Thanks in advance! Paula Sue

Tracy: From your message, it sounds like you are handling the circumstance the best way possible (i.e., appearing to understand and attempting to respond appropriately, etc.). Perhaps increasing the girl's time spent with their school-based speech-language pathologist may help?

Tracy (TABess): By what age do most children with a speech delay catch up? Is there an age that if they haven't caught up by where it's harder or more difficult to catch up? My son who is four has a delay and has been diagnosed with an expressive speech disorder and has been in a public preschool program for (a month at the end of last school year and all of this school year) his delay still has very hard to understand speech. His hearing is fine and he has no other physical problems.

Tracy: Actually, there is no timeline that generalizes to all children. Progress and carryover are person specific. Consult with your local school-based speech-language pathologist as to how your son is doing and her anticipated outcomes.

Mollie: Thank you for taking questions! My son is 6 years old and in kindergarten. He has been in speech therapy since he was four, and we have seen a little progress. But still needs work. He has a large vocabulary, but his problem is dropping the endings of words (-ing, etc), and just general pronunciation. His hearing has been tested and is fine. He has said to me "my tongue just doesn't seem to work like the other kid's tongues." We can correct him when he says words incorrectly (most often a-cause or a-fore instead of because or before), but then he just goes right back to it.

How do we help him re-learn these words? I think he has gotten some comments already from the kids at school. Should we be seeing progress by now? Any thoughts on what else we should do? Thank you!

Tracy: Dear Mollie, It sounds like you are doing excellent work supporting your son with his speech therapy. Talk with his current therapist as to oral-motor exercises that can be done at home like in the mirror as well as discuss with her the possibility of increasing their time together doing therapy. Perhaps stay in close contact with your speech-language pathologist and reinforce her therapy at home for a designated block of time--that it is clear with your son is speech time--and then all the other time is play time. With young children there are so many systems growing in the human body that it may seem as if there is little or no progress, however, he may be assimilating all the new information in order to get ready for the next growth spurt. The speed of progress is very person specific as we all have our own gifts and strengths.

Michelle: Can you pass on any good info on Dyspagia? My youngest just had a swallowing study and it showed she is swallowing food whole and is aspirating thin liquids. We have started using thick it at a nectar consistency. An our SLP has started focusing 45 min a week on feeding issues. She is 18 months old, has low tone issues, no diagnosis.

Tracy: I am happy to hear that your daughter is working directly with a speech-language pathologist on feeding and swallowing issues. The information I provide is general as the information from your SLP will be tailored to your daughter. Areas possibly to be addressed are normalizing oral sensitivity, increasing self-awareness, increasing tongue mobility and increasing lip closure/ control. Areas that may need to be specifically addressed with your SLP are positions that help your daughter suck/ swallow, choosing the right nipple/ utensils, oral alerting activities and what actually happens when your daughter swallows.

Elizabeth: I have a good friend whose daughter got ear tubes the same time my daughter did - at about 20 months. Her ENT has never had her bring the child back to have the tubes or her hearing checked. We have to go every 6 months. My Question - Her daughter will turn 3 in June of this year and I can hardly understand a word she says. The parents can understand her most of the time but sometimes they still have trouble. Her daughter's vocal tone is that of a deaf child. Should I say something or is this even something we should worry about?

Tracy: That is a tough question and, to be honest, the decision to speak with your friend is up to you. Yes, I would suggest a follow-up appointment with either the ENT or an audiologist. From a speech-language pathology perspective, you have to have "input" to have "output", therefore, making sure hearing function is adequate is important to the development of speech and language skills.

Kristen: My son is 18 months old and does not say any words other than "uh oh" and "Daddy." He use to say Momma but hasn't in a few weeks. Is this normal? Shouldn't he be able to say more than this? He will on occasion repeat a word that you say but will only say it once. I feel that he is a little lazy in the talking department. Is there some test that I should ask the pediatrician for? Is this possibly a sign that he has a hearing problem although he was tested at birth?

Tracy: Hi Kristen. You are on the right track. I would suggest speaking with your pediatrician about an additional hearing screening and/ or evaluation. Depending on the results with the audiologist, I would then suggest pursuing a local speech-language pathologist.

Noella: I am Canadian (English-speaking), and my husband is Korean. We are soon to be expecting our first son, and we really want to bring him up bilingually. What do you think is the best technique for teaching two languages at the same time? Thanks for your advice.

Tracy: How exciting, Noella! That is wonderful to be exposing your son to two languages at such an early age (approximately one year of age). I would suggest staring with one language and depending on how easily he picks it up, introducing the second language. As he gets older (approximately two years of age), you can also set up a specific block of time (i.e., 15 minutes) to use one language or another and then let the rest of the time be play time in either language. Good luck and have fun!

Deb: My four-year-old son is going to a Speech Evaluation next month through "child find." What can I expect the evaluation to be like and consist of?

Tracy: Hi, Deb. Typically, a speech-language evaluation at around the age of four is play-based with a speech-language pathologist. More than likely, you will be asked to remain in the room for your observations and input given you have spent the most time with your little one. In addition, if possible, an objective assessment will be administered. The appointments are meant to be fun with lots of toys and in the safety of a warm and nurturing environment.

Maureen: I was just curious as to the best time to get your child evaluated by a speech pathologist. My son will be 5 in April and has some trouble with pronouncing certain letters: for example, "yellow" comes out "lellow," "Beth" comes out "Beff," and "real" comes out "weal." He will be entering kindergarten in the fall at our church's school, and I'm not sure that speech therapy is offered there. We're considering sending him to public school if that's the only way to get speech services provided for him. Should we wait until he is in public school in 1st grade? Any advice you could give me would be greatly appreciated! Thank you.

Tracy: Maureen, some of the speech sound error patterns (/f/- /th/) you mentioned are age appropriate and some suggest (i.e., /l/- /y/, /w/ - /r/) a possible concern. I would suggest pursuing a local speech-language pathologist sooner than later. Often times, in private school settings, the school will contract with a local speech-language pathologist. I am not certain if those services in your area are free as they are in the public school system. Further investigation with your church based school site is suggested.

Tracy: Happymom, this is a tricky question as in my field there are definitely two camps to the story. I am going to be safe and say it is really child specific. Yes, there are benefits of having a child cup drink which stimulates lip function, and use a straw with stimulates tongue function. There are some children who really need the transition phase of the sipper cup whether it be "free flow" or with suck-action. I can share with you that not all countries have the sipper cup as a transition stage, therefore, suggesting that a child typically developing would be able to go straight from the bottle to a cup and then a straw.

Jessica: My daughter is 2 1/2. She has not said a word. Her hearing has checked out, her motor and cognitive skills are good. She is a healthy and happy kid. We are taking her to see a speech therapist, what are the question we need to ask?Thanks,j.

Tracy: You are definitely on the right track by first having had your daughter's hearing evaluated and then seeing a local speech-language pathologist. Typically, a speech-language evaluation is play-based with a speech-language pathologist. More than likely, you will be asked to remain in the room for your observations and input given you have spent the most time with your little one. In addition, if possible, an objective assessment will be administered. Based on the experience at the time of the evaluation, if needed, the speech-language pathologist will more than likely provide some immediate strategies for you to implement at home. The appointments are meant to be fun with lots of toys and in the safety of a warm and nurturing environment.

Melissa: My seven year old son has been in speech therapy since he was two. His last two SLP's have mentioned that they believe he has apraxia. I also have a 21 month old daughter who has also just begun speech therapy. I see her displaying many of the same speech problems that my son did at this stage in his development, for example dropping the ends of words, using the same consonants for every word (baba can mean grandpa, open, or potty), delayed expressive language yet advanced receptive language. My question is- is apraxia hereditary, are we heading down the same slow path to appropriate speech again with our daughter? If so, is there anything else we can do to help her to speak more clearly sooner? It has been such a slow process with our son.

Tracy: Dear Melissa, a child with developmental apraxia of speech has trouble correctly producing and sequencing sounds, syllables and words. Generally, there is nothing wrong with the muscles of the face, tongue, lips and jaw. The problem is thought to arise from difficulty accessing the "motor plan" from the brain for saying a sound or a word. The cause of the disorder is unknown. The treatment program developed by the speech-language pathologist will likely focus on improving skills in planning, programming, storing and retrieving motor patterns related to speech production. The success of treatment will depend on several factors such as the severity of the disorder, whether there are additional problems and how severe they are, how ready the child is to pay attention, follow oral directions and commit information into long-term memory, parent's commitment to treatment sessions and home practice assignments, and what other services the child receives and how much time is committed to those services. In addition, another focus of treatment is to create a supportive environment that helps the child feel successful in communicating his/ her ideas. The speech-language pathologist will probably provide several shorter treatment sessions each week rather than one longer session per week. The speech-language pathologist may use treatment strategies that include oral-motor, tactile, auditory, visual, imitative and phonetic development activities. Repetition or "drill" is important for rehearsing syllables, words and phrases to make them automatic. If developmental apraxia of speech has been diagnosed, please remember it will take time and commitment. Without it, the problems associated with the disorder may persist into adulthood.