Apr 14

Let’s Play! (Part 2)

Carol Westby refers to the Symbolic Levels of play development as “not just the addition of skill, but the reorganization of thought.”  She defines the following 4 dimensions of play which are used when analyzing play activity:

  1. Decontextualization and object substitution: allows play to occur with decreasing environmental support or changing reliance on props from realistic to invented; includes increased use of language
  2. Thematic content: play themes develop from themes in which the children have been frequent active participants, to themes  in which they have participated less frequently, to themes they have only observed, and finally to themes they have invented
  3. Organization of themes: sequential combinations or integrations of actions lead to sequentially and later hierarchically organized play with greater coherence and complexity of action representations
  4. Self- other relationships or decentration: children adopt the roles of others in pretend activities and include others in their pretend; Theory of Mind development is a critical part of this dimension




In Symbolic Level I, children require life-size, realistic props during pretend play.  They only represent events that they frequently participate in such as sleeping, eating, or washing. At this level, there is very little fluidity in play actions. For example, a child may go straight from pretending to be asleep to pretending to eat without any links in between. The beginnings of true verbal communication occur in this level as well. Previously (in the Pre-Symbolic levels) there was only single-word use that was very much context-dependent. So if the child was riding in a car, he might say “car,” but he would not say it if he merely saw a car.


A child in Symbolic Level I would be too young to play with these particular figures (above).  Beside the fact that they are very small in size, these would not be good because children in Level I need very life-like props when they play.  Notice that these figurines are not very life-like at all since they are basically a head and a tube functioning as the rest of the body. It is not until Symbolic Level VI (3 to 3 ½ years old) that children begin to carry out play using replica toys.

A toy kitchen would be a great set for a child in Symbolic Level II (19-22 months). The thematic content of this stage includes acting out activities that the people around them regularly participate in, such as cooking, cleaning, or reading.  This was the kitchen I had when I was little!

A toy kitchen would be a great set for a child in Symbolic Level II (19-22 months). The thematic content of this stage includes acting out activities that the people around them regularly participate in, such as cooking, cleaning, or reading. This was the kitchen I had when I was little!



Apr 05

Let’s Play!!!

The good old days of Pre-K… going back to the classroom after lunch and playing… different stations set up around the room: puzzles, the kitchen area, a store complete with a cash register, maybe even a space to play doctor. Today we expect so much from children, too much sometimes.  We can’t forget how important play time is for healthy development (it certainly touches social, cognitive, physical, and language elements of developing). What will happen when the day comes where our school systems become so focused on 4-year-olds sitting rigidly at desks reciting things and supposedly learning to read? Little kids aren’t built to sit still all day, they need time to explore and interact with their peers. Playing IS learning.

Play is one of the 3 behavioral aspects of the Sensorimotor Stage of cognitive development. As mentioned in my previous post, play allows children to learn about their world and the people in it.

Carol Westby is a Speech-Language Pathologist who has written articles about play development in young children. SLPs often use play as a way of assessing a child’s cognitive abilities. Westby explains that play is “a means of expression and a means of interpretation.”  The expressive aspect of play allows the child to show us what their mental representations of the world are. They exhibit their knowledge and how they apply that knowledge to real world situations.  As an interpretive tool, play allows children to learn about people and events.

Westby categorizes different levels of play, breaking them down by age. There are 2 Presymbolic Levels and 8 Symbolic Levels that children go through during development. Here are the ages corresponding to each stage:

play          Presymbolic Level I- 8-12 mos

          Presymbolic Level II- 13-17 mos


          Symbolic Level I-       17-19 mos

          Symbolic Level II-     19-22 mos

          Symbolic Level III-    2 yrs

          Symbolic Level IV-    2 ½ yrs

          Symbolic Level V-     3 yrs

          Symbolic Level VI-    3-3 ½ yrs

          Symbolic Level VII-   3 ½ – 4 yrs

          Symbolic Level VIII- 5 yrs


[Objects start to enter infant’s play environments around 6 months of age. Prior to this, play is mostly social (doing things like imitating the mother’s gestures). It is also important to note that an infant’s first meaningful word will be produced at about 12 months.]

Object permanence is established in Presymbolic Level I, so that in Level II, the infant starts to become active problem solvers. They are now able to navigate a toy with levers and buttons, learning cause-effect relationships of their actions (if I push this button, music will play). Problem solving is also important for meeting needs of the child.  If an object is beyond their reach, they might point to that object while looking at an adult. Another variation on problem solving is being aware of “in-ness”. Instead of trying to stuff their hand through a small opening of a container to retrieve the contents, the child will turn the container over for the contents to spill out. Much more effective!


In my next post I’ll describe some features of the Symbolic Levels of play development. Enjoy the rest of your weekend!  

Mar 21

Cognition- The Sensorimotor Stage

If you have taken an introductory psychology course you probably remember learning about Piaget’s Stages of Cognitive Development. They are Sensorimotor (birth to 2 yrs), Pre-operational (2 to 7 yrs), Concrete Operational (7 to 11 yrs), and Formal Operational (11 yrs and up). The most critical of these stages relative to language development is the Sensorimotor Stage so let’s discuss that in more depth.

The Sensorimotor Stage can be broken up into 6 substages, 3 of which are conceptual and 3 behavioral. One of the concepts developed in this stage is object permanence. I love this one! Peek-a-boo is such a fun activity for caregivers at this stage. You put your hands in front of your face and the baby genuinely thinks you disappeared because he can’t see you. When object permanence is fully developed at around 8 to 12 months, the infant knows you are still there—that things are permanent and now can be represented cognitively (and most likely is wondering why you find this game so amusing). A second concept that develops is causality. Infants learn that one event causes another event and that their behaviors can lead to certain effects. The third concept is means-ends. They figure out a way to get to a goal. Infants figure out there is a cause/effect relationship that can be used to solve problems. When infants start to use words at about 12 months, they can start using language to get what they want, but before this they can use gestures as communication tools.


Now on to the 3 behaviors that develop during the Sensorimotor Stage. Communication advances so much during this stage. From being a newborn who cries to get attention, to a 2 year old who speaks in 2 or 3 word utterances this is certainly a critical point in language development for children. Imitation, the duplication of a behavior, is also a factor in language and cognitive development. There can either be immediate imitation, or deferred imitation. In deferred/delayed imitation the child will do the imitating later on, when the model is not present. Chances are if your child says something you think is out of the blue, it is actually an imitation of something they heard in their environment (from hearing you talk or from watching TV). So again, be careful what you say even when you think your kids aren’t listening! They pick up on more than you think. Last but certainly not least, play. Play is used as a learning tool for children at all ages. Children use this to learn about the world around them and the people in it as well. In the Sensorimotor Stage, one form of play that is exhibited is symbolic play, where children use one object to represent another. So a plain old box may now represent a house or a rocket ship, etc.

More to come on play interactions…definitely a topic worthy of 1 or 2 more posts. Stay tuned!

Mar 14

Syntax- There is a Method to Our Madness

I know you just read that in Yoda's voice! Inverted syntax at its finest.

I know you just read that in Yoda’s voice! Inverted syntax at its finest.

Toddlers have quite an impressive and expressive vocabulary of 150- 300 words in their lexicon, or personal dictionary. The early word combinations children use at around age 2 are already following predictable word-order patterns. Even though they are only saying a couple words at a time, they will typically be in the subject-verb-object order that the English language employs.

By the time children are preschool age, there are dramatic changes in syntax. Their MLU increases (average length of utterances) and there is an increase in the complexity of sentences they communicate. Children start using interrogative and imperative sentences, and are able to use several bound morphemes. This is the point in a child’s life when they ask so many questions. “Why mommy?” over and over again.

Syntax is sentence structure which contributes greatly to the meaning of sentences. There are 3 main functions syntax performs:

  1. Creates basic structures for sentences
  2. Combines simple sentences to form complex ones
  3. Moves/ reorders elements of sentences

It is not until about age 6 that they start to master the use of complex sentence structure. They will now start to use and comprehend figurative language — such as idioms, metaphors, and similies—to represent abstract concepts. Between the ages of 6 and 12 is also when children start to understand poetry. They now have the cognitive abilities needed to sort through these abstract and sometimes out of order syntactic structures found in poetry. Poets change this subject-verb-object order to place emphasis on specific words or ideas. It causes the reader to slow down because the word order is not what we are used to seeing.


Mar 08

Morphology and MLU


My post from two weeks ago, Form, Content, Use- Repeat., spoke about phonology, so now it’s time to talk about the next component of form in language: morphology. A morpheme is the smallest unit of a word that carries meaning. Take the word “kick” for example. This word has one morpheme since it cannot be broken down into smaller components each with their own meanings. The word “kicks” has 2 morphemes (1st= kick, 2nd= s).

There are two categories morphemes can be placed into. Free morphemes can stand on their own, like “kick”. It doesn’t need to be attached to anything to make sense. Bound morphemes, on the other hand, need to attach onto another morpheme. Prefixes and suffixes fit into this category (the fancy categorical name for these is “derivational” morphemes because they can change the class of a word) as well as the plural “s” added to the ends of words (a kind of tense marker in the category of “inflectional” morphemes). 

Now onto MLU…which is pretty impossible to understand without knowing what a morpheme is, but we have that covered.  MLU stands for mean length of utterance. To calculate the MLU, first you need a language sample from a child consisting of about 50-100 utterances. To get this sample the SLP can record a session in which they ask the child questions and create a dialogue through play interactions. After the language sample is attained, the SLP then counts the number of morphemes the child said and divides this by the number of utterances.

Counting morphemes in child samples is a bit different than counting morphemes in fully developed adult speech. Young children often say words together, as if they were one word. If a child says “choo choo train” when you ask what he is playing with, it would count as one morpheme if there is no other evidence that he says “train” by itself.  Same thing goes for catenative forms of words such as “gonna.” It would count as one morpheme instead of the normal two for an adult who knows it is a shortened way to say “going to.” Fillers such as “um,” “oh,” and “well” do not get assigned morphemes at all.

After the MLU is calculated (total number of morphemes divided by number of utterances), the SLP will be able to see which developmental stage the child is in with regards to language development. There is a high correlation between MLU and chronological age of the child. This is partly due to the child’s increase in working memory (short term memory) as they get older allowing for sentences to be longer. A longer sentence has a better chance of having more morphemes.

Feb 28

Hollywood and Speech-Language Pathology


It’s that time of year again! Oscar weekend! The various accents actors/actresses can produce can make or break their character’s success. And who can actors turn to for accent modification? Yep, Speech-Language Pathologists! Behind the scenes, coaching can be used to target 1 or 2 specific sounds (phonemes, remember those from my last post?) in a particular language. By modifying the way those couple of sounds are produced by the actor, a different accent can be formed. An array of people from medical professionals to businesspeople may also want to seek accent reduction therapy to improve their communication skills.

Prior to therapy, an evaluation is done on the current state of speech, looking at the person‘s sound pronunciation and the stress, rhythm, and intonation of speech they use. According to ASHA, SLPs might choose to evaluate by having the client read words, sentences, and paragraphs, and will listen to your conversational speech. Sometimes an accent will appear stronger in one of these scenarios than the others so it is important to observe all of them.

I’ve always found accents to be interesting. It is important to note that accents are speech DIFFERENCES and should not be considered speech or language DISORDERS.  ASHA’s definition of an accent is “the unique way that speech is pronounced by a group of people speaking the same language.” Therefore, everyone speaks with an accent. You may not think you have one if you speak in a similar manner to those around you, but in the end that’s what makes it an accent.

Accents are typically categorized one of two ways. The first is regional accents. For example, someone from Boston, Massachusetts will pronounce things differently than someone from Florida.  Same goes for people in Queens and Long Island. Even though they may live within an hour of each other, they can sound considerably different. The second is foreign accents. A person raised speaking English will sound different than someone who was raised speaking Italian and learned English as an adult, or even in late childhood.  

So the next time you watch a movie, pay attention to the accents. Does the actor sound much different than they would if doing an interview out of character?  Enjoy the Oscars this Sunday!

Feb 21

Form, Content, Use– Repeat.

These are the three components of language, umbrella topics so to speak, which comprise what we use to create a message. Form includes phonology (rules about speech sounds), morphology (small units of meaning within words), and syntax (word order). Content includes semantics (meaning of words). And Use includes pragmatics (rules for communication through language). Throughout the semester we will go into more depth about each of these subcategories, but for today let’s start with phonology.

This is where those lovely phonics books we did as kids come into play! A phoneme is the smallest linguistic unit of sound that can signal a change in meaning. When Speech-Language Pathologists write out these sounds they put them in between slashes called virgules so they do not get mistaken for English letters which get put in quotation marks. For example, /k/ is the “k” sound at the beginning of the word “cat” or at the beginning of the word “kite”.  There are a total of 43 phonemes or distinct sounds in English. And just like I mentioned in my earlier post, “Vowels in IPA,” it is important to remember that some sounds can be represented by more than one English letter. The /f/ sound is spelled/ represented differently in the words “fish,” “phone,” and “muffin.”


The top part reads "you wish you could read this shirt" It is written using IPA (International Phonetic Alphabet) which uses phonemes, not letters.

The top part reads “you wish you could read this shirt”. It is written using IPA (International Phonetic Alphabet) which uses phonemes, not English letters. This system is used by SLPs to record exactly what their patient said and how the words sound when produced. It can be a great tool when looking for patterns of language use or misuse.


Feb 14

How to be a Successful Conversationalist

There are those people (or at least one person) in our lives who are fantastic story tellers, captivating our imaginations with every word.  There are also those people who are terrible at getting their point across. You know, that person that makes you cringe a little when the phone rings or you see that tiny speech bubble on Facebook turn red. Having a conversation shouldn’t be exhausting! There is a formula to having a pleasant, meaningful conversation with someone, and I’m confident that if you become aware of these 4 simple points you can make significant improvements.


Grice’s Cooperation Principle

  1. Quantity- contributors shouldn’t provide too little or too much information
  2. Quality- governed by truthfulness- aka: not lying
  3. Relation- should be relevant to the topic being discussed- try not to be constantly random
  4. Manner- each participant should be reasonably direct


Herbert Paul Grice was a philosopher who characterized conversations as “a form of cooperative activity.” This is true, you need two or more people to have a conversation. The 4 maxims or “rules of conduct” listed above are how Grice explained what’s to be expected from a conversation. Whether people are actually following these is a different story (and if it’s unclear whether they are or not, the conversation is hard to follow).

The principle of Manner is the maxim that is the least obvious, so let’s briefly discuss that. Its basic focus is organization. For example, if you are prompted to tell your life story, the proper thing to do is go in order from as far back as is suitable, up to the present day. You wouldn’t say, “Well, I went to high school in New York, and when I was five I became a big sister…” because that makes your listener jump around too much. You also seem confused yourself, as if you can’t remember things so you just say them as they come to you! The order information is presented to the listener will cause that listener to make inferences. A good example of this is the following:

“She graduated from college and got married.” vs. “She got married and graduated from college.”

My assumption is that these events happened in the order they are mentioned, so in the first sentence the woman graduated college prior to getting married.

Following these 4 maxims will make your conversations run much smoother. Let me know if being more aware of these helps you out! I’m always ready to read your comments!



Feb 07

Technology Empowers Life


We all know that technology is a powerful force in our lives today, nearly impossible to avoid. Kids continue to astonish us by successfully navigating their parents’ smartphones and tablets without any formal instruction. It is precisely this ease of use that is one component of technology helping patients gain communicative ability.

There are two major categories of communication devices patients can use. The first is Augmentative communication, which supplements speech. This would be for patients who have some language already but still need assistance. The second kind is Alternative communication which replaces speech altogether. The individual who would use this is nonverbal.

Microsoft’s new TV ad featured during Super Bowl XLVIII demonstrates just how important technology is. The part that caught my eye was technology’s ability “to give voice to the voiceless.” Steve Gleason is a former NFL player who is living with ALS. One job an SLP must do is work with their patient to provide a personalized device. Not all devices will be successful for a particular person since each individual has their own challenges they face. The ad shows Gleason using a high-tech aided alternative communication device so he can communicate with his son. Since he is nonverbal and also has extremely limited physical capabilities, Gleason’s device allows him to use a scanning technique. He controls what the computer verbalizes based on where his eye gaze goes on the screen.

Below are both the Super Bowl commercial and a second video explaining Steve Gleason’s inspiring story about re-gaining some independence using this communicative technology.


Just because someone has a disability doesn’t mean they have to be disconnected from the people around them. Everyone has the right to have their own voice heard.  


Feb 01

Can You Hear Me Now? Good.


Hearing begins to develop during the second trimester at about 18 weeks gestation. By the third trimester, the fetus responds to auditory stimulation. This is why by the time babies are born they have had extensive access to the general rhythm and intonation of the language in their environment, and therefore show a preference for their mother’s voice. Yep. Mom is the favorite, it’s science!

Hearing is essential for speech recognition and comprehension, which is why it is a concern for SLPs. The Newborn Hearing Screening is administered so any hearing impairment can be detected.  If hearing loss goes undetected, the child can fall behind their same aged peers in the areas of language, cognitive, and social skills.

Not every state mandates Newborn Hearing Screenings. Unfortunately, this means that some newborns leave the hospital with undetected hearing loss. Only 95% of babies are screened within 1 month of birth. The screenings are not painful for the baby at all, and can even be performed while the baby is asleep. The video below shows how the screenings are conducted.



As the video points out, the screening test done in the hospital soon after birth can only detect hearing loss at the 35 dB (decibel) level.  Here is a list of the different levels of hearing loss that can be found:

26-40 dB = mild loss

41-55 dB = moderate loss

56-70 dB = moderately severe loss

71-90 dB = severe loss

91+ dB = profound loss


So this means that the hospital screening does not have the capability of detecting mild hearing loss. This is why a supplementary hearing test should be administered especially if there is a family history of hearing loss.

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