Speech-Language Pathology

When Michelle and David welcomed their son Dante into the world in early 2022, they knew he would be extraordinary. Even in the womb, he was bursting with energy “doing cartwheels,” as Michelle affectionately puts it. Two days after birth, their world shifted as Dante was diagnosed with a cleft palate, a condition that had not been detected earlier. It is characterized by an opening or split in the roof of the mouth (palate) that occurs when the tissues do not fully join during fetal development. Cleft palate can lead to difficulties with feeding, speech and ear infections.

“It was a shock… We didn’t know what that would mean for his future.” – David, Dante’s Dad

As older parents, navigating new parenthood during a pandemic, the diagnosis brought with it fear, uncertainty and a lot of questions. They were determined to face it together. Dante had the love of his big half-sister, Heaven (27), by his side for the first three years of his life, plus the support of extended family across Ontario. This was an incredibly challenging time and with services backed up due to the pandemic, Dante did not have his palate repaired until he was 16 months old.

Dante’s energy and curiosity were obvious from the start. He loved Sesame Street, playing with Lego and Play-Doh and charmed everyone he met. Despite the challenges he faced, he has been a vibrant, joyful and social child, more outgoing than his parents ever expected.

However, by 22 months, Dante was speaking fewer than 20 words. His parents, concerned about his speech development, had already engaged private speech therapy, but still weren’t seeing the progress they hoped for. In January 2024, Michelle and David were introduced to Jerome, a Speech-Language Pathologist at Grandview Kids. “Meeting Jerome was a game-changer,” David shares. “He saw what Dante needed, and suddenly, so did we.”

Then came a major realization: Dante wasn’t hearing properly. His ear tubes had fallen out and needed to be reinserted. Once they were, everything changed. By March 2024, with improved hearing and expert speech support from Grandview Kids, Dante’s vocabulary skyrocketed. Other challenges remained as children with cleft palates often substitute certain consonants, a habit known as “backing”—saying “kuh” instead of “buh” or “puh.” Now, Jerome and the family are helping Dante re-learn how to use his voice effectively and clearly. Jerome made therapy approachable and fun. Dante now looks forward to sessions, excitedly pointing out the Grandview Kids’ Ajax headquarters, The Jerry Coughlan Building, on walks, exclaiming, “That’s where we see Jerome!”

“Not every session is perfect,” David laughs. “Some days he’s not in the mood. But other days he loves it. That’s life with a toddler.” Michelle and David didn’t expect to qualify for Grandview Kids’ support since Dante’s case was moderate. However, to their surprise, they were accepted and found the local support close to home invaluable. “We felt lucky. Grateful. Privileged, even,” David says. “Not everyone gets access to these services. And when you do, it makes all the difference.”

Their experience highlights why early intervention is critical. Speech therapy isn’t a four-week process; it’s a journey. And the earlier that journey begins, the more impactful it can be.

“It broke my heart not hearing ‘Dada’ until he was nearly two,” David shares. “But now, we hear him all the time. And it’s the sweetest sound.”

Michelle and David’s advice to other families:

Don’t wait. Trust your gut if something feels off.
Leverage every resource, make connections: doctors, networks and early childhood centres.
Advocate loudly and early for your child and others like them.
Push for funding. Write your councillor. Help make support like Grandview Kids’ available to every family.

“We’re not just helping Dante,” David says. “We’re building a better path for every kid who comes after him.”

Written by Grandview Kids Speech-Language Pathologist, Rikki

Maintaining vocal health is important for everyone, especially in busy, active households. Whether your child or youth is learning to communicate or just loves chatting and singing, caring for their voices can make a big difference. Here are five simple tips to help you practice vocal hygiene at home.

1. Stay hydrated!

Encourage your child to drink plenty of water throughout the day. Try to limit caffeinated beverages, as they can dehydrate the vocal cords.

2. Incorporate voice breaks

Resting the voice is essential for preventing vocal fatigue. Encourage your child to engage in quiet activities that don’t require speaking.

3. Reduce background noise

Talking over background noise, like the TV or music, can lead to vocal strain. Turn off or lower the volume when speaking with your child.

4. Practice good posture

Proper posture allows for better airflow and more efficient voice production. Encourage your child to sit up straight when speaking.

5. Speak from an appropriate distance

Practice speaking with your child from a reasonable distance rather than from different rooms or floors of the house.

Written by Grandview Kids Speech Language Therapy Assistant (SLTA), Nicole N.

On September 23, we recognize and continue to raise awareness of the use of sign languages around the world, the importance of protecting the linguistics surrounding it, and respect for deaf individuals and their culture. Today there are over 300 different sign languages used globally within the Deaf communities. For this, we celebrate ‘The International Day of Sign Languages.’

Nicole N., pointing to her white t-shirt which has the alphabet in American Sign Language (ASL). — Nicole N., pointing to her white t-shirt which has the alphabet in ASL.

This day is not only significant to deaf individuals but also to those who are allies in the Deaf community. Here at Grandview Kids, I take great pride in being an ally by educating others about the Deaf community, being an advocate for equality of language rights and sharing my knowledge of using American Sign Language (ASL). In 2019, I graduated from George Brown College with the American Sign Language and Deaf Studies Program, which taught about past and current social issues the Deaf community faces, how to communicate through ASL, and provided practical opportunities to connect Deaf individuals within the surrounding community.

In my role as a Speech Language Therapy Assistant at Grandview Kids, I am able to share my ASL skills and experiences with clients, families and colleagues working in the Infant Hearing Program (IHP) and Preschool Speech and Language Program (PSL). This unique language allows for inclusive learning and can include a total communication approach, meaning finding communication methods that work for each individual, which can include ASL signs.

Nicole N., signing the word MORE in ASL.

Nicole N., signing the word COW in ASL. — Nicole N., signing the word MORE in ASL.

Within a session, I can connect with caregivers, families and clients to provide and model specific ASL signs/words to support clients’ communication for requesting, commenting and protesting, as well as provide a language-rich environment that can transfer outside of the sessions to daily opportunities. Supporting clients’ independence and confidence to communicate through ASL, watching vocabulary grow and develop from sign approximations to 1-word signs and move into 2+ word signing combinations is something I am grateful to watch and experience.

ASL will continue to be an ongoing learning journey for me as I grow personally and professionally, which I am proud to share within Grandview Kids!

Written by Grandview Kids Communicative Disorders Assistant, Jennifer

With Easter coming up this weekend, many will likely have ‘surprise eggs’ (plastic Easter eggs) hanging around the house. In speech, we use surprise eggs for lots of activities!

One of these activities (see full instructions below) involves hiding cut-out pictures or objects that depict your child’s target sound in the surprise egg, which will help your child achieve their speech goal.

Target sound refers to the speech sound that the child is working on. For example, a child’s speech goal may be to work on producing an “L” sound accurately. This means that the target sound is the “L” sound (i.e., “lion”, “lamp”, “laugh”, etc.).

Preparing the egg hunt

Google your child’s target sound and print out some pictures that correspond with your child’s speech goal. Cut them into pieces, put one in each egg and hide them around the house (you could also find objects that correspond to the child’s target sound). As your child opens each egg practice the word.

For example, you may cut out a picture of a lion or find a lion toy to hide in the child’s egg to work on the target sound “L.”

Fun, simple and motivating!

Written by Georgian College CDA student, Alexandria, and edited by Grandview Kids Speech-Language Pathologist, Teresa

What is fluency?

When looking at the concept of fluency from a speech and language perspective, we are referring to the continuity, smoothness, rate and effort of our speech and sound production. Every single person has experiences with disfluencies (breaks or disruptions in speech), whether it be using filler words such as “um” or “like,” briefly hesitating mid-sentence, or having to repeat a few words or phrases — these are all completely normal and expected to occur every once and a while. However, there are instances when disfluencies are occurring at an atypical rate, causing substantial interruptions in the flow of the language being produced by the speaker. This is known as a fluency disorder.

Stuttering

The most commonly known fluency disorder is stuttering. Stuttering is characterized by a specific set of disfluencies that co-occur with excess tension in the voice and/or face. You can tell there is tension because the sounds or words sound sticky or stuck.

Types of stuttering include:

Word repetitions (e.g., “I can do-do-do it.”; “Baby-Baby-Baby-Baby needs a bath.”)
Part-word or syllable repetitions (e.g., “Mo-Mo-Mo-Mommy I see a dog”; “Ca-Ca-Ca-Can you help me?”)
Sound repetitions (e.g.,“C-C-C-Can you help me?”; “T-T-Today is my birthday.”)
Prolonged sounds (e.g., “Ssssssssssarah is here today.”; “Caaaan I have juice?”)
Blocks: no airflow or voice for a moment or longer (e.g., “Can I have _____ juice?”)

About 5% of all children go through a stage of stuttering between the ages of 2 and 5. On average, 75% of those who do are eventually able to grow out of the stuttering on their own, taking anywhere between 6-24 months to disappear. You may be wondering, why is it that so many children go through this? Well, according to doctors and scientists, there is no definitive answer or cause as to why certain people develop a stutter, though a handful of factors may be directly linked. These factors include gender, family history and genetics, as well as minor differences in how the brain processes information during speech. Whether it be a stutter that a child outgrows or one that persists to the point of professional intervention, there is generally no sole cause.

Unfortunately, the negative impacts of stuttering are not limited to just the production and fluency of speech, but also the person’s, who is stuttering, mental well-being. There is an increased level of tension and anxiety associated with stuttering, especially in certain situations where verbal communication is unavoidable, such as talking on the phone, or during social outings, which can increase the severity and frequency of the stuttering. This can have an emotional impact on both children and parents. The child may become shy and self-conscious about the way they speak, causing resistance and avoidance to talk, while parents might become worried for their children and fear that the stuttering will persist into adulthood. Thankfully, there are treatment options and intervention methods available to families regarding fluency disorders, including assistance from a Speech and Language Pathologist (SLP). If you feel that your child is developing, or having difficulties with a fluency disorder, do not hesitate to seek help from a professional as early as possible.

In addition to professional intervention strategies that you will be given while working with an SLP, it is important to take the time as a parent to understand and accept that your child is stuttering and that everything will be okay. Communication barriers can often lead to agitation and stress for both parties involved, so make sure to remain patient with your child (and yourself), reassure them that you are listening to them and ultimately give them the time they need to communicate things with you. Please refer below for additional strategies.

Illustration of boy reading aloud to a group of three peers.

Fluency Enhancing Strategies

1. Listen patiently

Listen patiently and positively when your child is talking; give them lots of time to finish.
Avoid jumping in to fill in words or to give advice like “slow down”, “stop and think”, or “start again.”
Never mimic, correct or punish stuttering.

2. Slow down the pace of talking

Keep your speech slow and relaxed; take time to pause between ideas.
Try to talk as if someone was trying to write down what you were saying.

3. Pause before beginning to talk

Wait for a second or so before responding to your child to help calm the pace of conversations and to let them know they don’t need to rush to begin their speech.
Pausing reduces the chance of accidentally interrupting your child.

4. Model language that is appropriate for the child’s level

Spend some time modelling language that isn’t too long or complex for your child to say easily; practice saying one idea at a time and pause between ideas.

5. Avoid high-pressure questioning

Avoid asking too many questions or asking a second question before the first is answered.
Ask questions that help your child to communicate (e.g. “Who did you play with today?”, rather than those that test your child’s knowledge or memory, e.g. “What did you do at school?” or “Tell grandma what you’re learning at school”).
Use comments instead of questions sometimes and WAIT for your child to be ready to talk.

6. Reduce corrections

Avoid correcting your child’s speech sounds or grammar for now; your child will learn from hearing your correct model in natural conversations.
Respond positively to your child’s talking and ideas as they are; avoid constant “teaching”.

7. Support good turn-taking habits

Help all members of the family to take turns talking and listening; only one person should speak at a time and everyone should get a turn to talk; no one should “hog the stage”.

8. Make time for talking

Make time each day for talking with your child that is unhurried and undistracted; this is the best way to learn which strategies are most helpful; 5 minutes a day can make a big difference.

Fluency Enhancing Strategies provided by the Speech and Stuttering Institute, Fluency 201 Training, October 2015.