Late language emergence (LLE) is a delay in language onset. It is diagnosed when language development trajectories are below age expectations. Toddlers who exhibit LLE are referred to as “late talkers” or “late language learners”, and may be at risk for developing language and/or literacy difficulties as they age. Divya has extensive experience working with late talkers, and uses a play-based approach embedded with evidenced-based practices to help them meet their milestones.

Children with oral-motor impairments have trouble controlling their lips, tongue, jaw, and cheek muscles. These facial muscle groups are the foundation for future speech and feeding skills. Very often, weakness in one or more of these muscle groups is the underlying cause for delayed/disordered speech and/or feeding. Some signs are if your child drools, has a frequent open-mouth posture, cannot maintain an appropriate lip seal during mealtimes, or has distorted speech. Divya firmly believes that effective therapy is like a dance, where the clinician skillfully assesses and treats not just the symptoms but also the root cause using specific exercises to strengthen identified muscle groups.

Children with this disorder know what they want to say, but have difficulty with the motor planning required; it is a deficit in the finely-tuned sequence of movements required by the various articulators (lip, tongue, jaw) to say the words they intend to say. Thus, this is not caused by muscle weakness. Children with apraxia are better able to imitate single words than longer sentences. They are better able to say rote phrases or sing rote songs such as “ABC”. Divya uses her PROMPT training combined with concepts of shaping behaviors to help children approximate target words initially. She carries them from this to a place of precise formation of words by providing firm tactile cueing techniques (PROMPT).

‘Language’ is a broad term used to describe receptive and expressive components of how we communicate. Thus, a language disorder is an impairment of one or both of these components. Receptive and expressive language encompasses, but is not limited to, comprehending directions, asking and answering questions, grasping vocabulary and concepts, and expressing needs and wants. Children are expected to say their first word at 1 year, 2-word phrases at 2 years, and 3-word phrases at 3 years. As children get older, they are expected to use longer phrases with increasing complexity, increase their vocabulary, and be able to comprehend written and spoken directions. Some children with language disorders may have difficulty with one or more of these skills, while others will require more support. Divya is able to tailor each child’s treatment plan using structured tasks embedded in research-based evidence.

Patterns of speech that are not age appropriate or developmentally expected can be addressed within PSC. A child should be 25% intelligible at 1.5 years, 50-70% intelligible at 2 years, 80% intelligible at 3 years, and 90% intelligible at 4 years. Some children demonstrate phonological processes, which are a class of errors; these are developmentally appropriate, until a certain age. If children continue to demonstrate these processes beyond the expected age of disappearance, it is considered a disorder. Other children in the elementary school years misarticulate ‘r’, or have a lisp (incorrect ‘s’ production); this is considered an articulation disorder. Divya’s experience and PROMPT training are key in assessing and treating the underlying causes for such articulation errors. Therapy in the toddler age group to address speech delays looks like play, but is embedded in evidenced-based practice techniques. Moving onto the preschool population, therapy begins to look more structured. The key to treating children in the elementary-years is teaching the ‘new’ way of making the target sound vs the ‘old’ way. Teaching correct placement using modeling, utilizing a hierarchy treatment method, and embedding self-monitoring skills within each session are the key ingredients for success! No matter the age, a connection is always made with the child in order to motivate.

Feeding therapy can be used to address not only ‘picky eaters’ but also feeding difficulties related to sensory, oral-motor, behavioral, and/or structural issues. Feeding disorders can be very broad, and thus it is imperative that an appropriate treatment plan is created for your child. Divya has experience with assessing, planning for, and treating a variety of feeding disorders. This treatment plan can often involve a combination of: the use of various tools to increase chewing skills for a safe swallow, desensitizing techniques to address underlying sensory issues, and behavioral strategies to address feeding behaviors rooted in conditioned behaviors. Finally, feeding challenges that arise with your child can be very challenging – Divya knows this first-hand! Research shows that 1 in 4 children ‘will not grow out of it’, as is commonly thought. It is imperative to address these issues sooner than later, and Divya would love the opportunity to create happy family mealtimes.

If thumb/digit sucking persists after the primary (baby) teeth have erupted, it can drastically change the growth patterns of the jaw, and can cause significant misalignment of the teeth. Other long-term complications may also develop. Constant pressure by the thumb or finger can cause a high narrow palate, abnormal swallow patterns, improper tongue position, and speech problems. Divya works with children once they have turned 4 years of age to address thumbing sucking cessation, as this is the earliest age children are cognitively ready to make the leap. The program is rooted in positive reinforcement, and utilizes praise and motivation for success. Specialized tools, oral motor exercise tasks, and reinforcers are utilized to address day and night time sucking habits. Results are seen with no stress, and Divya provides support to the child and family through the whole process.