How to Read Books with Children with Language Delay

Reading is fun

Photo by John-Morgan

Reading books with your child can provide experiences and vocabulary that he or she may not be exposed to on a daily basis.  Experience allows children to gain understanding.  When a child understands vocabulary and situations, he or she has the foundation to use these words in verbal language.

Always read with your child face to face with the book next to your face, not in front of your mouth.  This will allow your child to see how you move your mouth when you say words, see your facial expressions and engage in eye contact.  With a baby, you can create this opportunity while he or she is on the change table, floor, car seat, bouncy chair or on your thighs facing you.

Reading with your child everyday should start from birth.  At this time, you can read anything to your son or daughter, even The New York Times.  What matters is HOW you read it.  Read with feeling, show emotion and pause to allow your baby to vocalize back to you.

Initially, choose books with a story and meaning.  Vocabulary board books (e.g., books by Roger Priddy or select DK Publishing books) will be boring for you and not provide much benefit for your baby.  Reading longer stories during the first months will help to build your child’s attention.  Books like The Three Bears by Byron Barton, Summer by Alice Low and Chewy Louie by Howie Schneider will be fun for you and your baby.

If your toddler has trouble paying attention to a book, try reading when he or she is “trapped” (e.g., in the highchair eating, in the car seat while traveling, just waking up from a nap in the stroller).  I once worked with a two year old boy who would only happily pay attention to an unfamiliar book while standing in his crib facing me.  Once he became familiar with a book, we could read the book elsewhere.

Choosing the right books can help target speech and language skills you want to develop.

If your child is not talking, choose books that contain words that begin with bilabial sounds.  These are sounds where your upper and lower lips come together (/m/, /b/ and /p/).  Bilabial sounds are generally early sounds produced by children because they can see how an adult is moving their lips, which is helpful for imitation.  Favorite books that include bilabial sounds are It’s Not Easy Being a Bunny (Marilyn Sadlow), The Berenstain’s B Book (Stanley and Jan Berenstain) and any book that contains animal sounds (moo, baa, maa).  Overemphasize /m/, /b/ and /p/ and make eye contact with your child when saying bilabial sounds in any book.

Selecting books with repetitive phrases may allow your child to participate during story time.  Great examples include: Dear Zoo (Rod Campbell), The Very Busy Spider (Eric Carle) and The Gingerbread Boy (Richard Egielski).  Give your child the opportunity to complete the repetitive line, or if he or she is ready, the whole line.  Hopefully, these words will carry over into daily vocabulary.

Rhyming books help children with word prediction, which is crucial for reading development.  Once familiar with a rhyming book, have your child try to fill-in the rhyming word.  Dr. Seuss’ The Foot Book begins: Left foot, Left foot, Right foot, Right – Feet in the morning, Feet at _____ (child should say “night”).

If your child’s speech therapist has determined that understanding and using prepositions is an important goal for your child, use books to reinforce what occurs in therapy.  Trashy Town by Andrea Zimmerman and David Clemesha, Up Above and Down Below by Sue Redding and Around the House the Fox Chased the Mouse by Rick Walton are all loaded with prepositions.

A child with more developed language who has difficulty providing details and descriptions may benefit from “reading” wordless picture books to you.  Pictures in the story should be described so that the story makes sense.  You can use picture books with text, as long as the pictures are detailed themselves.  (You may cover the text with your hand if your child can read.)  This works best with Caldecott Medal / Honor Books.  Excellent examples include Knuffle Bunny books (Mo Willems), No, David! (David Shannon) and Where The Wild Things Are (Maurice Sendak).

Other favorite wordless picture books include A Boy, a Dog and a Frog Series by Mercer Mayer, Pancakes for Breakfast by Tomie DePaola and The Jack Series by Pat Schories.  If you feel your child leaves out important information, ask an open-ended question (e.g., “Ooo – What’s happening over here?”).  Provide a description if you feel this is too challenging.  Perhaps this will increase your child’s awareness to be more specific and when you sit down to read the book again, the new information will be included.

Sometimes it is helpful if you “read” a wordless picture book to your child first.  Describe what you see or make-up the story-line.  For example, when David, the main character in the book No, David! is about to fall off the chair while reaching for a cookie, you can say: “Be careful David, you’re going to get hurt!” or “No cookies before dinner!!”

Coming next week: Encouraging Speech and Language Skills while Sharing Books with a Group of Children

Stephanie Sigal, M.A. CCC-SLP, is a speech language therapist practicing on the Upper East Side of Manhattan, NYC. She works with babies, toddlers and school age children with expressive language delay and articulation disorders. Stephanie provides home based speech therapy and encourages parents to facilitate their children’s speech and language skills. To learn more about Stephanie, please visit www.sayandplayfamily.com

Not all Health Information on the Web is Created Equally

modern chair with attached computer monitor

Photo by Mads Boedker

In addition to being a speech-language pathologist, I am also working towards a Master’s degree in communication. My specific area of interest is health communication, which I came to rather naturally as my work at ASHA evolved. Part of what I do is develop content for brochures and other consumer materials, including what exists on the ASHA website. In the beginning, I approached this from my SLP background and clinical experience and described clinical disorders and other topics from that perspective. Over time, I started to realize that what I developed, while not wrong, was likely missing the mark in terms of what the reader wanted. I came to this realization after stumbling across information about health literacy, which led me to research on the readability of consumer materials developed by health professionals and organizations, including ASHA.

I also learned about how people use the Internet to search for health information and how the information they often find is difficult to understand or does not address their specific questions. I stepped back and took a more critical look at the information that existed in ASHA materials and on the website and found that there was room for improvement. And I’m happy to report that ASHA has spent a number of years now working on making those improvements, which hopefully some of you have noticed in products like consumer brochures and the Let’s Talk: Patient Education Handouts, as well as on the public side of ASHA’s website (for those of you who haven’t yet seen the recently updated information about hearing and hearing loss on ASHA’s public site, I invite you to take a look).

This semester I am taking a class on eHealth Communication, which focuses on the theory and practice of communicating health information via electronic means. We recently had a discussion about health related web pages and how they are “hit or miss” in terms of being understandable, valid, and meaningful. We talked about how the average web user may not always know whether a site is “good” or filled with misinformation. We had many questions, such as can people easily figure out if the content was developed by a credible source or guided by those with a financial interest in the decisions readers might make from what they read on the site? Are they able to make decisions based upon what they read (or see and hear if video and audio are included on the site)? Do they find information that means something to them or is it too generic or complex to have any real value?

Coincidentally, the day after this discussion, the leader of ASHA’s wellness team posted an article from the New York Times talking about this very issue. The article compared and contrasted two well-known health web sites – WebMD and the Mayo Clinic – and talked about the content, the design, and the motivations behind the two sites. The class discussion and the article got me thinking – how do I assess the sites I go to? I definitely look at the number and type of ads and I try to figure out who authored the information. I also look at how it is written and will only delve into really complex, technical content if I am highly motivated about the topic. Because of my background and personal interest in health communication, I may be more critical of the writing style, use of terminology, and layout than most, but I do consider that when deciding if I want to spend any time on a site.

So now I ask you – what factors do you consider when determining if you are going to spend time on a site? Do you suggest sites for your patients? How do you decide which ones are the most appropriate? Do you ever follow-up to see if they found the site or found it useful? The Internet is full of information and not all of it is good. Knowing that many people search the web for health information, it really seems that it is our professional responsibility to help guide our patients as best we can. And maybe we can learn something ourselves along the way.

Amy Hasselkus, M.A., CCC-SLP, is associate director of health care services in speech-language pathology at ASHA. She is also currently enrolled in a Masters degree program in communication at George Mason University, with an emphasis on health communication.