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Getting Started: Non-English EI Referrals

12 Oct

Hey ya’ll.

If you were an early intervention speech therapist, and you got a referral for a child who does not speak a language that you speak – what would you do?

@liselschwartz and I discussed the other day and I wanted to share some of our ideas. I see a lot of Spanish-speaking children, but I don’t get too many referrals for other languages. Even though I speak some Spanish, my sessions can be a little disjointed. Early intervention is about coaching and guiding parents so they can provide therapy services all week long when you aren’t there. If you can’t talk to them during your sessions how can you make this happen? Here are some ideas!

Figure out how to get an interpreter in there. Our child-find program typically schedules an interpreter for at the least the first session, and then once a month following for non-English speaking families. If you don’t get an interpreter scheduled off the bat, ask your supervisor about what the protocol is for requesting one. When/if you get someone who can interpret for you, try to get some basic vocab words  in THEIR language written down for your knowledge and use. For early intervention my top ten in no particular order are usually:

1. More (some therapists aren’t into this being a first word but it’s quick and easy so I’m sticking with it)
2. Give me/my turn
3. All done
4. Open
5. Help
6. Eat
7. Drink
8. Cookie – or cracker, or apple, or whatever the child eats a lot of
9. Milk – or water, or juice, or whatever the child drinks a lot of
10. Play

– If you can’t get a list from someone who can interpret, trying Googling the words you want – if it’s the wrong word the family will likely know what you MEANT and will tell you the correct word (for example, I didn’t know the Spanish word for “marble” so I just called it “pelota” until a Mom told me “canica.”) If you put into Google “German for ball” it will give you several options, so I just pick the one that sounds closest and the families correct me if I picked the wrong concept. I also LOVE wordreference.com for colloquial definitions.

Put those words to signs for the family. In our center we even make a little sign language book with a picture of the sign and the word below. I know each language has its own corresponding sign language – but this is hard enough without adding extra sign languages to the picture so I just stick with ASL.

mas

de plusmehr

And so on and so forth.

– Do what you can to provide services in their native language. This can hard for a number of reasons (the main being that YOU do not speak Twi or Cantonese or Hmong or whatever). But also sometimes families know that the child is going to be exposed to English in the school system, and so they just want you to speak English to the child. But the two year old should really keep being exposed to their native language so they can communicate with their family members when you aren’t there. This is why it’s vital to get the family playing and doing the therapy, while you coach.

– If caregiver knows someone who can read English, who isn’t there at the time of your sessions, see if you can write down ideas to have translated later. Sometimes Dad or cousin or sister reads English, and so I’ll write down my “ideas” for the week, and then they’ll have that person read later. If you can find something like “Handy Handouts” from SuperDuper (which is in both English and Spanish) that’s ever better – you want to provide resources as much in the native language as you can. As the languages get more “obscure,” the harder this becomes.

– Sometimes families will have a little English in the home, or siblings will speak English, so families will ask, “If the English word is easier to say, can I just model the English word?” (think “ball” instead of “pelota” or “shoe” instead of “zapato.”) I usually try to steer clear of this unless that really is their preferred word that they’d typically use (I see a lot of Spanglish so some families really do just say “apple” instead of “manzana.”) I typically recommend in this circumstance to model approximations of the native language word, rather than modeling the English.

– If there are older siblings in the home who speak English try getting them involved, they can be a huge help for you, and they always love teaching the “teacher” their language and words. 🙂

 

Any other ideas out there? What do you do with kiddos and parents who don’t share your language? What if you can’t get an interpreter, or the family resists an interpreter? Please share!

NP: Florence + the Machine – Blinding

 

tricks of the trade

16 Sep

I just had my 2 year workiversary! (At the end of July.) As such I thought I’d celebrate two months late by sharing some of my early intervention tips!

1. Put it on your head. I don’t know why, but kids think hats are hilarious. Whenever a kid is not looking at me, is about to cry, is crying, is about to bail on a toy, is distracted – whatever – I just put something on my head. 60% of the time this works every time.

2. Bubbles freeze in the winter and crayons melt in the summer. Plan accordingly.

3. Also on bubbles: blow UP not out. When you blow up, you have time to draw attention to the bubbles, talk about the bubbles, sing about the bubbles, and generally enjoy the bubbles. When you blow out they just fall down and suck.

4. Get yourself pants with a strong knee. I’ve gone through three pairs of pants in less than two years. Double duty knees. Support knees. Worker knees.  Utility knees. Or maybe buy one of those gardening squishy rectangles.

5. In addition, get yourself a poker face. You can’t buy this but I highly recommend obtaining one. Poker face has been something I’ve been working on for years, but now that I’ve sort of got my face under control I find my life is a lot easier. When a kid does something that grosses me out, annoys me, makes me mad, makes me laugh (when I shouldn’t), makes me sad, or shocks me – you would never know. I’m like Mona Lisa MS, CCC-SLP over here. You don’t want parents or children feeding into your emotions during therapy sessions so lock it up!

6. Patience is a virtue.  Learn to wait. I always tell the kids, “I know, waiting is so hard!” and I make them wait for everything…but it took me a long time to learn to wait for them. Waiting waiting waiting. I do it all day. Wait for them to reach, wait for them to vocalize, wait for them to calm down, wait for them to notice. Quit anticipating, quit assuming, quit rushing, quit pushing. COOL YOUR JETS.

7.  Embrace the germs. I mean, Clorox wipe everything and wear gloves when needed. Embrace that you are going to get sick a lot when you first start. Like, a LOT. Way more than you can possibly anticipate. Start stocking up now on all your favorite cold and cough meds, you’re gonna need them. I’m here to tell you that there is a light at the end of the tunnel…after two years I have the immune system of a feral mutt. I can withstand anything (A kid sneezed into my open mouth the other day and I lived to tell the tale.) And you will too. But you have to live through the first six months.

8. Get a mentor (or three). I have a lot of mentors. I have my mentor for picture exchange, I have my mentor for feeding, I have my mentor for behavior, I have my mentor for apraxia…the list goes on. I don’t harangue these people endlessly for lunch dates so we can discuss me and my progress in becoming a grown SLP like them. But I do say, “Hey can I pick your brain about this little guy?” when I need back up. Know when you need backup, and find strong resources. It’s okay to ask for help, and it’s okay to have lots of mentors. (I recommend reading Lean In’s chapter “Are You My Mentor?” if you’re looking to develop mentor-mentee relationships…it’s really very enlightening.)

9. Learn about the other disciplines as much as you can. In early intervention it is SO important to look at the whole child. And until you work with OT/PT/ECE regularly you’re going to have a harder time looking at the whole child (because what are you looking for!?) You’ll see so much improvement when you make adjustments based on those other disciplines. You’ll know when to make referrals, and when to just make a suggestion. It’s hard to help the whole child make major improvements when you’re just looking at his mouth. Cotreat. Observe. Ask. 

10. Be flexible. No two kids are alike. Seriously. None. What worked with one, will work again with none. It’s insane. You will see new things every single day. I always say, “Never a dull moment” with EI. It will keep you on your toes and keep you moving and thinking constantly.  As an early interventionist you’ve got to be open to new ideas – whatever you’ve got planned probably isn’t going to go as you imagined 🙂

 

If you’re just starting out in EI I hope some of these help you on your path. If you’re a seasoned EI Vet – share some of your tips and tricks, I’m always looking for new ideas!

NP: Ingrid Michaelson – Home

early intervention evaluations HELP

8 Jun

Hey friends,

At my facility we are currently using the PLS-5 for early intervention language evaluations for both initial intake as well as transition to the school district. We’re finding that it is somewhat soft, and we’re having a hard time qualifying children based on the standard scores and age equivalencies (it would appear from FB that other SLPs nation-wide are experiencing the same.)

I’m wondering what other tests are out there? I’ve got a list going that includes:

Norm-referenced:
DAYC-2
CSBS
REEL-3 (only goes up to 3)
BDI-2
LAP-D – 30mos+
TELD-3
LUI – for children with suspected or confirmed ASD: http://knowledgeindevelopment.ca/ (I have never heard of this)
CELF-PS – 36 mos+
Criterion based:
Rosetti – only up to 3, questionnaire in Eng and Span
Early Functional Communication Profile Set
The MacArthur Bates and associated alternate language inventories
What are you early intervention clinicians using? Anything you prefer or passionately loathe? Are you having similar difficulties with the PLS-5? We typically have children up to 36 months, but if they were born after May, we can have them almost up to 40 mos so we’re really needing tests that are normed birth-40 mos. We have talked about using the PLS-5 plus one of the inventories like the Rosetti, we’re just kind of investigating what other SLPs are doing right now, before A PLAN is implemented. Suggestions welcome and appreciated!
(The Bayley was suggested but our ECEs use that.)
NP:  Ed Sheeran – Kiss Me

 

Measuring vocabulary development in bilingual children

10 Feb

The topic of my first Research Tuesday Blog is (drumroll please): “Total and Conceptual Vocabulary in Spanish–English Bilinguals From 22 to 30 Months: Implications for Assessment.”

This is all there is to see folks

This is all there is to see, folks

To understand the purpose and findings of this article it is beneficial to know the difference between total and conceptual vocabulary.

Total vocabulary is the sum of the words a child knows across two languages.

Conceptual vocabulary gives the child credit for knowing concepts rather than words, and concepts that are represented in both languages are counted only once.

So basically, when looking at a bilingual child’s total vocabulary you would count both the word perro and the word dog. If you were looking at conceptual vocabulary you would only give the child credit for knowing one concept: the furry, four-legged creature in my house which barks and eats kibble is a dog/perro.

The bottom line about this article? The researchers found that when assessing bilingual children, it is most appropriate and beneficial to look at total vocabulary (total vocab FTW!) A clinician is able to look at total vocabulary in a bilingual child by providing the MacArthur Bates Communicative Development Inventory (CDI; Fenson et al.,1993) in English as well as in the family’s home language.

What happened in this research project? Cynthia Core, Erika Hoff, Rosario Rumiche, and Melissa Señor provided families of 47 bilingual families with the CDI and the Inventario del Desarrollo de Habilidades Comunicativas (IDHC; Jackson-Maldonado et al., 2003.) This was a longitudinal study; the children were assessed at 22, 25, and 30 months-of-age.  The children were age and socioeconomically matched with 56 monolingual (English-speaking) children who were assessed with only the CDI.

At the initial 22 month trial, all parents completed the Ages and Stages Questionaire (Squires et al., 1999). The parents of monolingual children completed the CDI, and the parents of bilingual children completed both the CDI and IDHC, at the 22, 25, and 30 month session. The CDI and IDHC provide parents with a checklist of words they have heard their child produce and yields raw vocabulary scores based on this checklist. Both tests provide a percentile based on monolingual norms.

Then the researchers ran all sorts of crazy ANOVAs and t-tests and z-ratios which were totally over my head so I skipped ahead to the conclusion.

Researchers found:

The Spanish-English bilingual children showed a mean conceptual vocabulary which was significantly lower than their total vocabulary.

Total vocabulary in the bilingual children was not different from the monolingual children at any of the three sessions.

Conceptual vocabulary in the bilingWual children was considerably lower than the monolingual children at the 30 month visit.

Total vocabulary assessment did not identify any more/less at-risk bilingual children than bilingual children. Conceptual vocabulary assessment identified a higher number of bilingual children who appeared to have vocab development in the low-average range.

When one compares a bilingual child’s vocabulary to monolingual norms it underestimates the child’s expressive language and over-identifies at-risk children.

Using the CDI (and the home-language counterpart) clinicians can get a clear picture of a bilingual child’s total vocabulary without being responsible for considering the child’s language experiences, and language dominance, and language overlap, and the “balance” in their bilingualism. Clinicians are able to see clear change using these protocols (which we all love).

The authors caution us to remember to take socioeconomic status and receptive language into account. They also suggest that monolingual testing may be appropriate in the event that a clinician wants to know about English proficiency (or the proficiency of the home language.) They also pointed out that similar studies have been done previously with mixed results. ALSO the researchers did a really nice literature review to give you more background on bilingualism, total and conceptual vocab etc., so please read that if you desire.

Direct Link (you will need your ASHA login): http://jslhr.pubs.asha.org/article.aspx?articleid=1797298&resultClick=1

Citations:

Cynthia Core, Erika Hoff, Rosario Rumiche, Melissa Señor; Total and Conceptual Vocabulary in Spanish–English Bilinguals From 22 to 30 Months: Implications for Assessment. J Speech Lang Hear Res 2013;56(5):1637-1649. doi: 10.1044/1092-4388(2013/11-0044).

Fenson, L., Dale, P. S., Reznick, J. S., Thal, D., Bates, E., Hartung, J. P., … Reilly, J. S. (1993). The MacArthur Communicative Development Inventories: User’s guide and technical manual. San Diego, CA: Singular.

Jackson-Maldonado, D., Thal, D. J., Fenson, L., Marchman, V., Newton, T., Conboy, B. (2003). El Inventario del Desarrollo de Habilidades Comunicativas: User’s guide and technical manual. Baltimore, MD: Brookes.

Squires, J., Potter, L., Bricker, D. (1999). Ages and Stages Questionnaire: Parent-Completed Child Monitoring System (2nd ed.). Baltimore, MD: Brookes.

further details regarding my BAG

11 Nov

I was having mall and lunch time with MsSohanSLP on Sunday and she asked when the last time I blogged was.

Shame. I AM ASHAMED. It’s been a stupid long time. I have a wide variety of things I could blog about, and I choose not to because I’m a lazy, lazy SLP.

I thought the easiest way to return to the blogging was to segue from the previous post!

(lazy. i’m so lazy.)

As we know, I do home health with 0-3 about half my work week. As we also know, I have raging ADHD and can’t play with the same toys week after week after week like some kind of therapy zombie. So I *try* to change what I bring to homes each week. It can be a challenge and it requires some creativity, but it can be done, and if you’re a home therapist I encourage you to change it up when you can!

Anyway, since this “school” year started in September, I have been attempting to do THEMES! Yes, my bag is now themed! We do group therapy in my center and we do monthly themes so I thought, why not translate themes to home therapy as well?

So far I’ve done: farm animals, zoo animals, transportation, body parts, food, shapes/colors, letters/numbers, actions, and this week is SENSORY.

Since it’s sensory week I’ve got playdough, paint, shaving cream, crazy textured balls, a small bean box, touch and feel books, and so on and so forth. Also I have wipes and a table cloth because…I’m not dumb.

I’m kind of running out of ideas. I’ll probably do “home” as a theme, and “school” as a theme. Any suggestions are welcome! What are some concepts that you think 0-3 year olds should have under their belt by preschool?

Okay, that’s all for now. I’m going to be better, I swear! Well, I don’t swear but I’m making a sort of promise to be a better blogger. And give me theme ideas please and thank you!

 

NP: Lady Antebellum – Get to Me (this song gets me right in the feels).

What’s in my bag?

28 May

I’m sorry but I just have to say that writing about “my bag” makes me think of Austin Powers. (Warning: that link is NSFW).

Now that we’ve got that out of the way: my therapy bag. What is in it? How do I decide? As many of you know, I’m doing some home health for kids 0-3 (mostly in the two-three range). My car and home are filled with toys, but I abhor taking the same toys into homes every week – I get bored, the kids are bored, the parents are bored. It’s like “Yeah, we know, you knock the blocks down and say, ‘UH OH’ – message and vocabulary received.” I like to keep things fresh and exciting. However, I also have to be realistic regarding my time and energy, and the children’s…everything.

When I’m considering what toys are going into my bag, I have to think about my kids. Some kids are age-level in terms of play. They have strong fine motor skills, strong attention, strong cognition: everything is age appropriate with the exception of their language. The toys I take into these houses are a little more complex and require more imagination: baby dolls with food and cups and plates, Little People paraphernalia, high-level puzzles, high level books.

On the other hand, I have some kiddos who do not yet shake musical toys or bang two objects together. Some of my kids have rather limited attention. Some need a lot of sensory breaks. The toys I take into these houses are more cause-and-effect, texture-based,  noisy, etc.

As a result of all of these factors, I keep some good ol’ stand-bys in the trunk of my car. My employer has a few cabinets of “Community Materials” so those, combined with my own toys, give me enough material to change it up once a week. That doesn’t mean that kids don’t frequently play with the same toys, it just means that something new or something they haven’t seen in awhile gets thrown in the mix pretty regularly.

When I pack my bag to go into a house I try to ensure I have: one book, one fine motor oriented toy, one sensory-something, something with pieces for receptive language,   something for turn-taking and social games, and my phone so I have some language-apps as back up.  Some therapists may think this is a lot but frankly, my sessions are one hour long with two year olds. Five or six toys doesn’t seem like that much to me.

Toys from my personal collection that I have a lot of success with? I share them with you now:

BOOKS!

I like books that have manipulative features for the EI population.

I like books that have manipulative features for the EI population.

 

Puzzles!

Think of the different skill sets required to complete each of these puzzles. Something as simple as taking a puzzle to a kid's house takes a lot more thought than you would ever think.

Think of the different skill sets required to complete each of these puzzles. Something as simple as taking a puzzle to a kid’s house takes a lot more thought than you would ever think.

Sensory!

Bean Box! I like these but holy smokes get ready for a mess.

Bean Box! I like these but holy smokes get ready for a mess.

 

This stuff is called "Gazz it" - it's 99 cents at Walgreens and it's a weird alternative if you're sick of play-doh

This stuff is called “Gazz it” – it’s 99 cents at Walgreens and it’s a weird alternative if you’re sick of play-doh

 

Fine motor!

Kids love to bang on things.

Kids love to bang on things.

Shape sorter ball is always a hit. Wooden stacker is a personal fave. And that ball thing is just something different.

Shape sorter ball is always a hit. Wooden stacker is a personal fave. And that other ball thing is just something different.

Social fun times

I just want to bang on my drum all day. And shake shake shake. And pat. And tap. And clap. And imitate motor movement. And sing songs using baby signs. Yay!

I just want to bang on my drum all day.
And shake shake shake. And pat. And tap. And clap. And imitate motor movement. And sing songs using baby signs. Yay!

Cause-and-effect

These poppers are always fun. For early players you can do a simple "POP" and for more advanced kids you can do some receptive "Who is in the trash can? Push the boat. Where'd he go?" games

These poppers are always fun. For early players you can do a simple “POP” and for more advanced kids you can do some receptive “Who is in the trash can? Push the boat. Where’d he go?” prompts.

 

These are just some of my favorites right now, DEFINITELY not a be-all-end-all list. And as an FYI – I get nearly all of my toys at Goodwill. Don’t feel like you have to spend a fortune to get some nice materials. And if you don’t have a lot that is okay, my supervisor always says you should be more interesting than the toy. If you can get a kid engaged and playing with YOU then you are all good in the hood.

NP: Love Somebody – Maroon 5

Receptive Language….huh?

25 Feb

Once again I have to point out that during my time in the higher education system, I learned the definitions and the textbook information and other sorts of useless stuff, BUT I didn’t really learn quite how to specifically address disorders. When I got out in the world for internships and you know, MY JOB, that proved to be a problem since I do speech THERAPY.

What disorder do I speak of today? Receptive language delays and disorder.

As I had been taught, receptive language abilities and skills enable a child to understand the meaning of sound and spoken language.

Yeaaaah….so…..about that?

After a few weeks at my CF I finally asked my supervisor, “Um, so, this is really embarrassing but…if a kid has receptive language delay…what do you DO for that?”

She, luckily, is a kind and non-judgmental human and gave me some tips. Which I now pass onto you!

Make a word sandwich: Say it, Show it, SAY IT

Use a slow speech rate

Exaggerate key words and speech sounds

Support comprehension with signs, touch, vision, music and any other modalities/senses

Use simple language, give plenty of repetition and experience with new words

Model response expected then repeat the direction

Give visual cues when giving directions

And the part that I’m bad at: reduce cues to assess comprehension

How can someone be bad at that? It’s my natural inclination to point, or repeat myself WAY too many times. My supervisor and I were watching a video of me doing therapy last week and Lord Almighty if I told that kid to “Get the cup”  one more time he probably would have punched me.

I need to improve my scaffolding. To say the least. My supervisor gave me a way to kind of…think about what I’m doing.

Step One: Give child direction “Get the cup!”

If child does not respond, Step Two: Repeat yourself and give them an extended period of time to respond.

If child does not respond, Step Three: Point to the cup and say “Get the cup!”

If child does not respond, Step Four: Hand over hand, help the child get the cup, and say “You got the cup!”

Also consider things like, is the child doing something else when you prompt him? We noticed that I was telling my kiddo to get the cup while he was pretty focused on cleaning up. It would have been more beneficial for me to wait for him to finish what he was doing, then prompt him.

And don’t prompt the child to do something that hasn’t been the focus of play or isn’t in his line of vision (unless you’re testing object permanence which why would you be doing that? Get back in your scope!) I’ve been known to do this when trying to do the PLS (it’s all, “Get the child to identify a duck” and I’m like “Crap where is the duck? ‘Find the duck!‘” and the duck is over on the table behind a book and the kid is doing a puzzle or blowing bubbles.)

Also be thinking, is the child not responding to me because of a processing issue or because he doesn’t understand the language?

Hopefully since I just shared this with you, it will stick in my brain a little better. And Liza – I’ll write about Deaf culture after my ASL course on Thursday because that’s our last day talking about culture specifically!

NP: The Lumineers – Stubborn Love

 

Checking in so you guys don’t think I died

15 Oct

YO.

Okay so listen, I still don’t have a computer (or internet) in my home and sometimes I just don’t want to blog from my tiny QWERTY phon keyboard. But that doesn’t mean I don’t have things to share!

1) A mom said I wasn’t kid friendly. But to be fair we ALL know that I have NO poker face whatsoever. I’ve been told this again and again and I just cannot get my face under control. Anyone who has seen my pictures on Facebook knows that my face does exactly what it wants. And I’m an open book anyway so that really doesn’t help. Talk about your heart on your sleeve – more like my heart is on my face.

2) A mom told me I was really connecting with her kid! See – people have good things to say too.

3) One of my adult patients was really into hair. And hugging. And patting my arms.

4) I’ve been doing so MANY swallow evals and I’d love to tell you about them in another post I’m just giving you a quick and dirty run down so hold your horses!

5) I did an AAC eval and I’m starting AAC device trialing this week – see number four for elaboration.

6) I’m trying to talk @kimabts into being a wug for Halloween.

uh. This is a wug.

7. It’s almost my three month anniversary at my job and as such I’m almost done with segment 1 of my CF! Holy guacamole!

8. I got strep for the first time! Yay early intervention! Also all of the children have rashes. Delightful.

9. I always thought I was really good at singing songs about my life activities but now that I’m in EI I can sing anything! WITH a tune. SOMETIMES in SPANISH.

10. My desk collapsed at work and someone came and put a traffic cone next to it. If they were smart they’d just make me wear a traffic cone around my neck at all times.

Yeah. Cone of Shame. Also I was almost crushed by speech therapy materials.

Also if anyone knows of a “communication board” to use with adults in the hospital setting tweet at @kimabts and let her know. I don’t really know any more details than that so don’t ask me ask her!

Okay now I’ll write about visual swallow studies and AAC. And maybe CFs. We’ll see. I only have an hour on this computer in the library.

NP: You Da One – Rihanna

Planning early intervention sessions: should you even try?!

29 Sep

I got an email from Emily, a new CF and an EI therapist asking how I plan my sessions. It seems like good info to share. If you guys have ideas or things you do please share! I always love hearing new ideas:

“I’ll tell ya, I have NOT been doing lesson plans like I did in grad school. How can I? Right now I’ve got, 6 kids I see in the center and 7 that I see in their homes – plus adult and child evals. There’s not a chance to do lesson plans unless I want to work a zillion hours of overtime!

Here’s what I do: before a session I make sure I have a data sheet with my client’s goals written on them. I bring a bag of items into the home. One bag, for the whole day. Every kid gets the same bag (except sometimes I take out the doll or the barbie coloring books for the boys – more for the parents than for the kid.) (Also I wash the toys between sessions!) I alternate the items every week or two so I’m not using the same toys every week. Then I offer choices, “Hey Timmy, I brought a puzzle and a car” and then follow their lead. That way I know whatever we’re using – they’re motivated by it.

With 0-3 you really CAN’T plan – you have no idea what this kid is going to want or how long they’ll be interested. My supervisor says make yourself the toy, you are the spectacle, you need to be in the spotlight. I’m not so great at that yet – but I’m working on it!

I take what interests the kids and I fit their speech-lang goals into their interests. If I don’t have a toy that I can see an obvious way to slip in /m/ words I make that toy make robot /m/ sounds or car /m/. It is way easier to squash goals into an activity rather than hoping that a kid will want to play with the MMMMMonkey or the M-soup you brought. In grad school I would try to plan a WHOLE 50 minute session around the sound /p/ but I had the time and energy to do that. Now it just isn’t realistic. And how badly does a two year old need to say “peach” or some other crazy initial p-word?

And you’re right: targeting functional language is a great thing to do! More, give me, mine, all done, go, up, down, in, out, wow, hi, help, no, etc. I do it in every session and there is a lot of functional language that targets those early sounds (p, b, m, n, w, h) and then (t, d, g, k) (at least according to the GFTA).”

NP: KT Tunstall – The Other Side of the World