speech delay

Your Child is a Late Talker: When Should You Start Worrying?

Do You Have a Late Bloomer or a Problem?

As a parent, you know your child. You understand what your child means when she points to the door or waves. You listen to your toddler babbling and watch her play. You remember what your older children said and did when they were the same age. Just like it is reasonable to compare your toddler to the other children so too, it is reasonable to worry when this child isn't keeping up.

If you detect even the most subtle of a communication problem, invariably you will ask your friends, relatives or even the pediatrician for an unofficial evaluation. And you may get answers like, "My son was slow, too. Now he won't shut up," or "Don't worry; she'll outgrow it." The doctor may tell you to relax, not to be concerned until the child is ready for school. And the doctor may be correct.

But that nagging feeling won't go away. What if they aren't right? No parent wants just to relax only to find out later that something could have done, and now it may be too late!

While all children go through practically identical stages as their speech and language develop, it is often difficult to gauge the precise point that your child will arrive at any particular stage. The breadth of what is considered normal is quite extensive and can vary a lot.  

The primary variables in your child's speech and language development are:

  1. Her innate capacity to learn the language
  2. Other seemingly unrelated skills that are being learned concurrently
  3. How much talking she hears around her during the day
  4. What type of response is elicited from those who are watching her

What Are You Looking For?

If your child is anywhere between 18 and 30 months old and not talking as well as you think he should, you should be aware of some of the factors that put your child at higher risk of developing speech or language problems.  Having a problem with anything on this list doesn't guarantee a problem, but it may cause for concern.

Understanding - Generally, a child understands what he hears before becoming verbal. This is known as receptive language. Although your child may not be talking like others his age, he may be able to follow simple directions or point to the object when you name it. If the understanding is there even though the language 'isn't, it's highly likely that his language will catch up. If not, this may signal a language delay.

Gestures - Children often gesture to communicate before they begin to use many words. Gestures can include anything from waving "hi" or "bye" to pointing, to putting out her arms signalling that she wants to be picked up. As a rule of thumb, the more your child communicates through gestures, the more likely she will catch up to others her age.

Learning new words - Even children who begin talking slower should be experimenting with new words every month. If she does this, there is less likely to be a language delay. If you aren't hearing many new words, there may be a problem.

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What Causes a Speech Delay?

1. General Speech-Language Delay - Perhaps the most common and most natural problem to solve, this delay is temporary and can be remedied with a combination of speech therapy, be it face-to-face or via teletherapy, combined with reinforcement from home. These children catch up to the others in a relatively short time.

2. Expressive Language Problems - This is when a child can think and understand clearly and develop healthy relationships. While the 'child's talking is "normal," he is unable to transform talking into expressive language. The delay in speech is grounded in the child's struggle to be an effective communicator.

3. Receptive Language Problems - This condition is somewhat the converse of an expressive language problem. Here, the child's comprehension is compromised, so consequently, the child speaks unclearly manifesting the inability to connect words with concepts, instructions, or even objects. While speech therapy, be it onsite or via teletherapy, will help it will often take considerable time to see significant results.  

4. Autism - Children who are on the spectrum often display multiple developmental problems, including speech delay and the inability to communicate clearly. Repetitive activity is also common. In such situations, professional evaluation and treatment are necessary to arrive at an accurate diagnosis..

5. Childhood Apraxia of Speech - This problem is reflective of the child lacking the capacity to enunciate the proper sounds for the chosen word. The result is a speech impairment and difficulty for the listener to understand what the child is trying to say. This condition often requires a multi-pronged approach to resolve.

6. Hearing Loss - Sometimes hearing loss, even temporarily from chronic ear infections, can wreak havoc on a child's speech.  Both the clarity and quality of the child's speech may deteriorate as the hearing loss continues. The child is essentially becoming disconnected from the "speaking world" at a vulnerable juncture in his life.

What Can You Do About It?

It is relatively easy to take the guesswork out of the entire situation. If you think there may be a problem, get your child evaluated and have your child seen by a speech therapist, either face-to-face or via teletherapy. After the SLP meets with your child, she is sure to have ideas to implement immediately. Alternatively, she may suggest meeting with your child regularly for a period of time if your child's condition seems to warrant such intervention.

But often the work of the SLP needs to be supplemented by the child's parents.

handling divorce

The Therapist’s Critical Role in Helping Children Cope With Divorce

The Pain of Divorce

Divorce is neither rare, occurring in 50% of all marriages, nor easy for anyone involved be it the parents or the kids. The entire family feels a tremendous sense of anxiety and loss. Everyone knows that life will never again be the same.

Divorce may be one of the worst moments in the child's life, and it will impact everything happening in that child's life. The experience will likely involve pain, frustration, stress, and sometimes an overwhelming sense of loss.  While most kids are resilient, they need help adjusting to their new reality, which they don't yet quite understand.

How Children React

The first thing to recognize is that children experience significant anxiety when they live with persistent parental discord. For younger children below the age of ten, this parental discord and tension often create a deeply felt sense of instability and insecurity.

If that discord morphs into separation and then divorce, that instability and insecurity will only become exacerbated. Generally speaking, divorce tends to intensify a younger child's dependence, and it tends to accelerate the adolescent's independence.

Children and adolescents are grieving the loss of their family, nothing less than their emotional foundation in this world. Although technically speaking, this isn't grief; nonetheless, grief is probably the best way to understand the child's experience and emotional journey.

Typically the stages of grief include anger, depression, denial, bargaining, and acceptance. While every child is different with some experiencing certain stages of grief and not others, or not in this specific order, it is helpful to be aware of the classic stages of grief to help identify the child's reality.

Since for younger children, the trauma of divorce occurs when the line between reality and fantasy is still blurred, some children wonder if their mommy and daddy will continue to love them. Or they may take personal responsibility for their parent's broken relationship by attributing the divorce to their bad behavior.

It is critical for both the parents and the therapist to be accepting of any feelings that the child expresses. Allowing the child the ability to maintain and communicate feelings is critical to the child's healing, avoiding perhaps permanent emotional scarring from the experience, and facilitating a "smoother' transition into the new reality.

The Important Role of the therapist

At times the child of a couple who is going through a divorce may already be seeing a therapist, and at other times the impending divorce may be the trigger for the child to enter therapy. Either way, the therapist must be prepared to become as involved as necessary to provide the support and help the child so desperately needs.  

The importance of a sensitive and compassionate therapist at this most vulnerable time in a child's life cannot be overstated. Aside from insights that the therapist can share, children need a neutral, supportive space to share their sadness, confusion, and anger they are feeling, and to find constructive ways to deal with these painful emotions.

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Therapeutical Strategies

1. Clarification

If the parents have been able to do so thus far due to the charged emotional atmosphere, the therapist will need to explain the divorce to the child in a simple, straightforward way. Often the emotions and incriminations that the child is being subjected to will confuse the child as to what is happening and why.

Sugar-coating the situation will not only be unhelpful but will prove detrimental. Children and adolescents need to be made aware of how their life will change. The more that children know of the practicalities of their new reality, and the quicker they can resume their routine, the better chance they have of succeeding in this challenging situation.

2. Reassurance

It is difficult to stress enough the importance of impressing upon the child that the divorce isn't the kid's fault. Children, by nature, are "egocentric" and live with the belief that they have the power to control events through their thoughts and behavior. They need to be able to grasp and internalize that their parents' decision to end the marriage has nothing to do with them.

A corollary to this is that a child must know that he/she still has the love of both of parents and that this parental love is non-negotiable (unlike the financial arrangement). Unfortunately, the child may logically presume that since my parents don't love each other anymore, maybe I'm next on the chopping block!

3. Feelings

Many children bury their emotions during this difficult time. They figure that if they can ignore their feelings that their pain will somehow subside or go away completely. As a therapist, you need to draw those feelings out delicately. You might begin by telling the child, "It is perfectly normal to feel sad and even angry about the divorce."

Encourage the child to maintain an ongoing dialogue by creating a safe emotional environment, accepting any feeling. Don't be afraid if the child expresses something that seems terrible or even violent. Keep in mind that the expression isn't the problem and that the only way for the child to begin to cope and heal is to share what’s inside.

4. Expectations

It is to be expected that when a child is going through the divorce that invariably the child will tend to withdraw, regress either socially or academically, and even act up. These are normal reactions. This is why communication, especially with the therapist, is so crucial. The parents are often too obsessed with their problems to "hear" their child.  

Know as well that often boys and girls react differently to divorce. Studies have shown that boys show their distress in more noticeable ways, such as acting out in school or social situations. Girls, on the other hand, seem to be "alright" at the moment. However, it is often the case that later, when they become involved in a close relationship, they are gripped with a sense of suspicion or fear of abandonment.

Bottom Line

If possible, the therapist should convey to the parents that children who survive divorce the best are those children whose parents put their children's needs above their own needs wherever possible. Frequently when working with a child of divorce, the role of the therapist extends beyond the clinical session and migrates into the position of being the child's advocate.

effective therapy

Is an Excellent Therapeutic Alliance the Secret to Effective Therapy?

Defining the Therapeutic Alliance

Sometimes called the "therapeutic alliance," and other times, the "therapeutic relationship," this term describes how the child and therapist, be it face to face or via teletherapy, engage and connect. There are those who say very simply that this intangible but genuine connection is the "bond" that develops in the therapy room.

In today’s world of therapy and counseling, most see the therapeutic alliance as an essential tool for effective therapy. Aside from the necessity of developing therapeutic skills and techniques, for a clinician to be truly successful, s/he must devote ample time and focus on developing a healthy relationship with the client as well.

In the early days of psychotherapy, there wasn’t much emphasis placed on the importance of this relationship. It wasn’t until Carl Rogers, the founder of humanistic or ‘person-centered’ therapy, came along in the 1950s, that clinicians began to see the critical connection between successful therapy and this alliance.

The Importance of the Therapeutic Alliance

Today there is a significant body of research demonstrating the benefits of the therapeutic alliance developed between therapist whether onsite or delivered via teletherapy and client.

A comprehensive 2011 overview taking into account many of the previous studies on the subject made the following assertion that “the quality of the client-therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures.”

When you think about it, this makes perfect sense. At the core of any relationship between friends, family, or colleagues is trust. And so it follows that any benefits accrued through such a relationship are built upon that trust. What transpires in the therapy room between therapist and client is no different.

Ironically, many of those who seek help from a therapist doesn’t feel at ease around other people, and that includes their family and friends. Generally, their past is riddled with events and relationships that taught them quite the opposite, to be suspect of others even when they profess to love. This is often why they are in therapy altogether!

This is why the alliance or relationship between therapist and client isn’t only valuable but is essential. The child who has been placed in therapy by a parent, caretaker or administrator can’t expect to get very far without this cornerstone of trust and genuine belief that the therapist is there to help.

For some children, the most crucial aspect of the therapy, at least at the beginning, is that the child finally can experience what it means to relate healthily to another person. Perhaps for the first time in his/her life, the child can remove the mask, stop playing the games, and feel safe interacting with an adult from whom there is no fear.

Key Ingredients of a Healthy Therapeutic Alliance

Carl Rogers, known as “the father of the therapeutic alliance,” laid out the three primary aspects of a healthy therapeutic relationship.

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  1. Empathy- Is the therapist supportive and understanding?

  2. Congruence- Is the therapist genuine and not pretending to be a ‘guru’?

  3. Unconditional Positive Regard- Does the therapist see your human value?

Ways to Nurture the Therapeutic Alliance

Keeping the client feeling emotionally safe

Children may be little, but they can often sniff very early on in the session if the therapist, whether face to face or vial teletherapy, is judgemental. While the child will want feedback from the clinician, that’s providing the feedback is given in a manner that is informative and not critical.

It is often not so easy to distinguish between criticism and feedback, but the child, while perhaps unable to articulate the distinction, knows the difference.  Both feedback and criticism involve evaluation; however, the difference lay in that criticism contains fault finding and judgment, whereas feedback is merely passing on corrective information.

It is imperative that in conjunction with sharing feedback that is constructive, the therapist maintains an abiding interest in building the child’s self-esteem. Sharing appreciation of the child, positive comments when appropriate, and expressing enjoyment of the session will often go a long way to enhancing the child’s self-esteem.

The Power of Relationship

Therapists often claim that they rarely recall either from their reading research studies, or their own clinical experience where clients reported that it was some particular intervention or technique that was most helpful to them. Instead, clinicians say that clients told them that feeling understood and heard was the most valuable part of the therapy.

Let’s not kid ourselves. The therapeutic relationship doesn’t replace effective therapy. But without the rock-solid foundation of the relationship between therapist and client, most therapists agree that anything else accomplished in the session won’t have much if any long term value.

There is no set formula that will facilitate creating the emotional bond between therapist and client. The chemistry will be different in every situation. It might be a strong emphasis on offering supportive and positive feedback, sharing humor, empathetic listening, or impressing upon the child the therapist’s genuine compassion and concern.

Acceptance, Validation, and Empowerment

Another crucial aspect of the clinical session is assisting the child to open up so he/she can be heard and understood. This won’t happen unless the child feels safe and unconditionally accepted. Once the child opens up, it is essential to validate what the child said to promote a sense of comfort with regards to expressing feelings.

Allowing the child the freedom to stray from the straight and narrow path of the session and veer off on tangents can have a potent subconscious impact on the child. The child feels more than just the object of the dialogue. Instead, by taking the initiative the child feels empowered. This can be very beneficial to the therapeutic relationship.

Bottom Line

Taken together, these various contributors can do much to cement the bond between therapist, be it face to face or via teletherapy, and client. The bottom line?  Perhaps the most significant factor in an active, healthy, effective therapeutic alliance is for the therapist to help the child. Genuine help more than anything else will build that precious trust and all but guarantee an upward spiral of success in the therapy.

loneliness children online therapy

Is the Loneliness Epidemic Afflicting Our Children As Well?

Increasing Loneliness Among Children and Adolescents

Loneliness has long been thought of as a problem afflicting the elderly. However, research suggests that both children and teenagers are also increasingly being affected by this painful social problem. It has been found that children are frequently both expressing and seeking support for their feelings of being alone and isolated.

In fact, new statistics show that there is a rising number of children who are contacting Childline (an organization that provides information, counseling, and referral services for families and children to ensure the safety and well-being of the children) about feelings of isolation and loneliness.

These figures show that girls report their loneliness almost four times more than boys. While this may or may not reflect the actual numbers as it may be that girls are more apt to reveal their feelings that boys, nonetheless, many girls are suffering.  The children claimed that their loneliness was often due to social media and parental neglect.

The Multiple Adverse Effects of Loneliness on Our Youth

The connection between social behavior and normal development

We all know that healthy social relationships are much more than just the joy of sharing experiences with friends, but are central to human well-being. As a consequence, it has been argued by many in the field of mental health that engaging in social interactions and behaviors are vital to a child's healthy development.

And the converse is true as well. Absence of these interactions and relationships are detrimental to the child's development in various ways. Research has shown that children who suffer social isolation generally perform inferior in the educational realm, are more likely to be part of a less advantaged social class as an adult, and are more prone to psychological distress throughout their lives.

How Insufficient Social Interactions Impact the Stress Response

Unfortunately, children who don't have the necessary amount of social interaction or relationships will gradually become socially isolated and experience the pain of loneliness. The research has found that this loneliness is linked to higher levels of stress.

The human stress response is designed to protect the body from environmental threats and dangers. Because social interaction is a basic human need when a child is denied the satisfaction of that need the stress response mechanism in the body perceives the situation as a threat.

When this stress response mechanism is triggered, the brain automatically releases stress hormones to protect the body from the perceived threat, thus activating the body to protect itself from danger. However, the body cannot release these stress hormones and protect the body from stressful situations indefinitely.

When this stress response becomes activated over an extended period, the body is at greater risk of developing high blood pressure, an infectious illness, deterioration of the cognitive faculties and cardiovascular disease, which depending on the severity can potentially be fatal.

Social Support Helps Children Survive and Thrive

Research has shown that when a person receives social support, stress levels not only drop but that social support helps people to cope with high levels of stress from other sources. Also, research has suggested that social support is instrumental to a person's feelings of competence and mastery, which are so critical in increasing one's quality of life.

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Social Isolation and Mental Health Problems

In a research study of 4,227 adolescents, scientists at the Norwegian Social Research Institute (NOVA) compared youths who had a close friend in whom to confide with those who didn't and found that those without such a friend had a significantly higher preponderance of depressive symptoms than those with close friends.

Other studies have shown that there is a greater connection in depressive symptoms in loneliness due to a lack of friends than isolation due to a poor relationship with parents. It could be that for adolescents, social support from friends is more critical than the support from parents.

The Dangerous Impact of Loneliness on the Brain

In tandem with those studies that show an increased stress response when a person feels lonely, loneliness increases the brain's alertness, which can cause insomnia. It has also been shown that social isolation and a lack of relationships can have a detrimental effect on the structure of the brain.

Studies done with mice and young monkeys subjected to extreme social isolation demonstrated how damaging this isolation could be upon the brain. At the beginning of their development, the mice and monkeys were quarantined for a couple of months to study the impact of being socially isolated on their cognitive functioning.

This isolation caused deficits in the chains of communication in cells known as oligodendrocytes impairing functioning in the prefrontal cortex of both the mice and the monkeys. Damaging the connections in the prefrontal cortex reduced essential cognitive functions such as social interactions and thought.

These scientists suggest that just as the social isolation of the mice and the monkeys disrupted brain functioning, the findings could be extrapolated to children as well. In other words, social isolation could be responsible for deficits in brain function.

In a different study, it was shown that social isolation retards the activation of dopaminergic and serotonergic neurons. Activating these neurons is critical to maintaining our emotional well-being.

Relieving Our Children's Loneliness

Parents who sense that their children may be suffering from loneliness shouldn't make light of it. On the contrary, they should engage their children in conversations about friends, relationships, and social interactions in general. Also, they should be very aware of how their children's' usage of social media is affecting their mood.

Sometimes children don't open about something as sensitive as their social life. In which case, Childline offers the following advice:

  • Begin the conversation at a time where there won't be an interruption such as on a ride in the car or on a walk.
  • If your child says something alarming, don't overact as that may mean the end of the conversation.
  • Don't push your child to talk if this isn't a good time. Wait a few days if necessary.
  • Be very careful to honor and respect what your child says. Being that a child's heart is very delicate, it must be treated as such.