What is bilingualism?

Bilingualism is defined as a speaker’s ability to use more than one language to communicate. For children growing up in bilingual environments, language acquisition is a dynamic journey influenced by the interaction of many differing linguistic inputs. Unlike monolingual children, who are exposed to a single linguistic system, bilinguals learn to differentiate between multiple languages and adapt their communication skills to diverse linguistic contexts. This process requires cognitive flexibility and a keen sensitivity to language cues from an early age.

Do Bilingual children acquire language in the same way that a monolingual child does?

Despite the complexity of bilingual language acquisition, research has shown that bilingual children typically achieve language milestones within a similar timeframe to their monolingual peers. From cooing and babbling in infancy to uttering their first words and eventually constructing complex sentences, bilinguals demonstrate a notable capacity for language learning and expression. Moreover, bilingual children often exhibit advanced metalinguistic awareness, allowing them to reflect on and manipulate language structures in both of their languages.

Code switching in Bilingualism

One of the defining features of bilingual language development is the ability to differentiate between and switch fluidly between languages. This is called code-switching. It is a natural and common phenomenon among bilinguals, serving various communicative functions and reflecting their linguistic versatility.

Challenges for Bilingual language development

Bilingual children may experience language mixing or blending, where elements of one language intrude into the other, particularly during the early stages of language acquisition. Additionally, bilingualism can sometimes be mistaken for language delay or disorder, highlighting the importance of accurate assessment and diagnosis by clinicians familiar with bilingual language development trajectories.

What can we do to help?

As caregivers, and speech pathologists, it is essential to provide bilingual children with a supportive and nurturing language-rich environment that promotes their language growth and development. Encouraging consistent exposure to both languages through meaningful interactions, storytelling, and culturally relevant activities can strengthen their language skills and promote balanced bilingualism. Moreover, valuing and affirming the child’s cultural and linguistic identity is of great importance in building positive self-esteem and a sense of belonging. 

Written by Anna Roy, Allied Health Assistant (Speech Pathology), at De Silva Kids Clinic.

The ability to regulate our emotions are an essential skill that contribute to a child’s wellbeing. They are important for coping with challenges, building healthy relationships, and building long-term success. Parents can play an important role in fostering emotion regulation skills in their children.

Help your child build emotional literacy skills

Support your child to understand and identify different emotions in themselves and others. Emotional literacy requires someone to have the language to name different emotions. Parents can support this by:

• Drawing attention to character’s emotions when reading books together
• Pointing out and labelling emotions of people and characters in movies and TV shows
• Reflecting back the emotion they see their child experiencing in the moment
• Helping their child label emotions they see other people experience at home, in the park, at kindergarten/school

Support emotional awareness

Provide a safe space for open communication about emotions at home. Make this a judgement-free zone where all emotions are “ok”, as long as our actions are safe. Use age-appropriate language to help your child express what emotion they are feeling in the moment. Clarify with your child what they have said, to ensure they feel understood. Validating and normalizing feeling different emotions helps support wellbeing for children.

Model healthy emotional expression

Model how you identify and express your own emotions across the day. Children benefit from watching how others discuss and cope with strong emotions in healthy ways. It is important not only to do this for positive emotions, but also uncomfortable ones. Consider sharing when you feel worried, frustrated, or disappointed, and verbalise which strategies you use to cope with these feelings.

Teach problem-solving skills

Help your child to develop a toolbox of problem-solving skills that they can use when they encounter difficult situations:

• Brainstorming possible solutions and picking the best one for the problem
• Writing a pros and cons list
• Forecasting the consequences for future actions
• Taking the perspective of other people involved

Develop a set of calming strategies

Help your child figure out which types of activities help them feel calm when their body and mind is dysregulated. Examples could include:

• Talking to someone about the problem
• Going for a walk, riding a bike, or
• Creative expression of feelings (draw or paint the feeling)
• Mindfulness relaxation exercises
• A healthy distraction (e.g. favourite movie, time with friends/family).

Written by Alex Felix-Faure, Senior Psychologist at De Silva Kids Clinic.

Our senses are the gateways to the world, allowing us to perceive and interact with the environment in intricate ways. It is important that parents/guardians, clinicians, and teachers have an understanding of a child’s sensory patterns and furthermore, their needs!

We have many different sensory systems, these include;

Tactile which interprets sensations related to touch, pressure, temperature, and pain.

The vestibular sense contributes to our sense of balance, spatial orientation, and coordination of movements. Our auditory system which doesn’t only enables us to hear but also plays a crucial role in our ability to communicate.

Our visual sense enables us to perceive and interpret the world through the sense of sight.

The olfactory sense detects and identify various smells in our environment, influencing our perceptions, memories, and even emotions.

Lastly is proprioception which is the ability to perceive the position, movement, and orientation of our body parts without relying on visual or auditory input.

An important topic that goes hand in hand with a child’s sensations is self-regulation. Self-regulation is the ability to understand and manage behaviour and your reactions to feelings and things happening around you. It includes being able to: regulate reactions to strong emotions like frustration, excitement, anger and embarrassment. To have the ability to calm down after something exciting or upsetting has occurred. For some children, some environments such as school or the shops can be an overstimulating and therefore an overwhelming environment.

There are different categories to a child’s sensory patterns (Winnie Dunn, 2007).

Seeking: a Seeker is one who has a high threshold to sensations. Seekers enjoy sensation, and they really want more sensation and do things to get more. These are ways people add more sensation to their everyday experiences. Activities seekers may enjoy new textures such as slime, music and colours.

Avoiding: Avoiders have low thresholds. In comparison to seekers avoiders try to get less sensory input. Their brains are geared to detect a lot of input, but they have low thresholds, so every piece of input is potentially seen as harmful or threatening. The less unpredictable input they get, the better they feel. Avoiders can thrive of routine and order and limited surprises.

Sensitivity: Sensitivity is also a low sensory threshold like avoiding. People with sensitivity try to participate, but then they get overwhelmed. They try to do things to keep it to a minimum, but they are in the game participating so sometimes they get overwhelmed. Their brain is trying to take the stuff in, but their low sensory thresholds are flooding them.  Sometimes people with sensitivity can feel overwhelmed or bossy because they are trying to navigate and participate as much as they can.

Registration: Registration shares high thresholds with seekers, but they have a passive self-regulation strategy letting things happen to them then reacting accordingly.

Through observation and assessment, a child’s sensory needs can be uncovered. From this, the necessary interventions can be put in place to better support your child’s needs.

Written by Lucy Nolan, Allied Health Assistant at De Silva Kids Clinic.

Play for children isn’t a simple pass time, but an important part of their physical, emotional, and cognitive development. It allows them to develop skills about cause and effect, builds on social skills, confidence, creativity, coordination and balance, and allows them to explore feelings and emotions as well as build resistance and coping strategies for challenging situations.

Unstructured free play allows children to create their own story with challenges and uncertainty that is typically unattainable thorough structured play with adults.

As children get older they start to participate in cooperative pretend play which allows children to role play and act out scenarios, learning to negotiate, cooperate, and communicate with others. They may take on different roles and make decisions that help express their emotions, fears, and desires in a safe and non-threatening environment. This type of play with others builds resilience, helps process complex emotions and promotes emotional intelligence.

These milestones are general guidelines, and individual children may progress at their own pace.

Need some ideas for things to use for unstructured free play? Try the following:

• Cardboard boxes
• Blankets & Pillows
• Chalk
• Playdough or putty
• Wooden spoons
• Sticks

Written by Jade Oakes, Allied Health Assistant at De Silva Kids Clinic.

You may ask yourself, “Well, what does it mean to create an environment that is rich in language?”. Let us unpack this with another question. What is language? Language is more than words. It is a socially shared system that goes beyond words. It is adaptive, generative, and multimodal. Think about it. If you were to search “new words in the dictionary 2023”, a list of words would appear. How else can we stay up to date with all these new words that kids are using these days? Otherwise, we would be termed pretty cringey when we use these new slangs incorrectly. You see what I did there?

Language is the core of social communication. We attribute meaning to what is communicated. But this meaning is arbitrary. It is learnt. It is conventionalised. You need to learn the pairing of the language used and its meaning to effectively understand it and use it. For example, when I say the word “apple”. How do you know what it is that I am referring to? Well, it is because you have learnt and seen what this object is. You know that it can be red, green, or pink, that it is a fruit and so on. You had to learn this word in order to be able to use it and understand it. Without language, how would we be able to do all things important? How would I be able to order my morning coffee if I could not effectively use language to communicate? Or if you did not know what the word coffee means! For all my coffee lovers, let me answer this for you, IT WOULD BE DISASTROUS!

Even the ability to understand words from other languages work under this learning principle. I have an Eastern European background but was born here in Australia. How did I become bilingual? I was exposed to both languages in an environment that was rich with language. I was able to hear words used in context which allowed me to extract their meanings.

Like I said previously. This learning is not limited to the learning of words. Sign language (e.g., Auslan) and other forms of gestural communication (e.g., Key Word Sign) are inclusive of this concept. Their beautifully intricate and specific hand, finger and arm movements all work to hold meaning. Without having this shared understanding, its functionality and effectiveness would crumble, and so would spoken language.  

Regardless of whether you use spoken language or gestural communication or even a combination of both, it would become frustrating if the way we communicated was not understood by a listener. For example, children who are non-verbal are more likely to become frustrated because their means of communicating through sounds alone, is not understood by the listener.

We can foster our children’s language development through providing a language rich environment. This can be done in the following ways:

1. Let the child lead you: When you are engaging in play with your child, let them be in control. I am not saying that you should let them make a mess of the house just because they are “in control”. What I mean is for you to let them lead you during play. You are still the parent/ guardian. Getting them to brush away their morning breath or to put their dishes in the sink are still important routines that you as a parent/guardian need to keep implementing. These routines in themselves offer great language exposure to a wide variety of words that they get to here repeatedly! After all, this is what we want. We want repetition.

But, with regards to play, let your child guide you and show you what they enjoy. If they continuously want to engage with the same toy, then let them! Again, language exposure is all about repetition. So, the activity being used to promote development is not confined to one specific way where it constantly needs to be different. It may seem tedious when the activity and the words being used are repetitive, but this is the best exposure. Singing nursery rhymes such as Twinkle, twinkle little star or Old McDonald are all repetitive and follow a pattern. But how did you learn these songs? Through repetition. So, when exposing your child to the same words, and pairing it with the correct object or action, this increases their awareness that words hold meaning and will begin to build their understanding.

2. Use of Key Word Sign (KWS) alongside spoken language: Using both forms of communication is an extremely effective way of enhancing a child’s exposure to language. It provides non-verbal children a means to communicate when spoken language is still developing. It reduces communication related frustrations as the child is still able to request and communicate their wants and needs through KWS. But this strategy is not limited for children who are non-verbal. Typically developing children can also be exposed to and use this form of communication. It is similar to being exposed to a second language. KWS is like another language, just it involves gestures. So, what is the harm of teaching children another language?

3. Provide time/ Pause to encourage responses: This strategy provides children with the opportunity to have an attempt at saying a word or sound. Like I said previously, repetition is always key. Ideally, provide a 5 – 10 second pause to allow the child time to respond. If the child does not, that is ok! They are still learning. In this instance, then you would complete the ending to provide the child the full sentence or phrase. For example:

• Ready – Set (Pause) Go!
• What colour is this ball? (Pause) Blue. The ball is blue.

The below link shows an amazing example of what repetition can do and how pausing is so powerful!

https://www.facebook.com/watch/?v=913688659422590

4. Parallel talk AND Self-talk: These techniques help to model language. By this I mean that they help children to put names to objects, feelings and sounds while also providing early exposure to the grammatical correctness of how words are used to form sentences. Examples include the following:

• Parallel Talk: Talking about what THE CHILD is doing, hearing, seeing, or feeling.
  • Examples:
    • “You are drawing”.
    • “The sun is yellow”.
    • “You are brushing your hair”.
    • “Push the boat”
    • “You are wet”.

• Self-Talk: Talking about what YOU are doing, hearing, seeing, or feeling.
  • Examples:
    • “I am cooking”.
    • “I am drinking water”.
    • “I am putting apples in the bag”.

The bottom line is that language provides us with the opportunity to imitate, interact, listen, and respond with intention. It is not just defined as the words that we use, but also the connections and exposures required to help shape its use in a way that is understood by others (i.e., verbally and/or gesturally). Therefore, it is important to maximise the ways that we provide children with the opportunity to hear, contribute and respond to language.

Written by Natalie Pavlovska, Allied Health Assistant at De Silva Kids Clinic. 

As a new Speech Pathologist working at De Silva Kids Clinic, I have come to realise that this is the true definition of a supportive and welcoming work environment and team.

Working at DSKC has shown me that this is the place where you thrive and build your learning skills on a daily basis, with the best support you can possibly get. The therapists and staff are very approachable and are always there to guide you through any difficulties you are facing. I am regularly being asked “How are you settling in? How are you finding everything around here? Do you need any help?” Being asked these questions as a new therapist in a new workplace environment, means the world to me because it makes me feel like I am not alone, and I have people to guide me through this journey every day.

I will say with all confidence that the settling in period has been very smooth and stress free. The management team are very understanding and have ensured that they ease me through building my caseload very slowly, so I am not overwhelmed with a new environment and a large caseload at the same time. I have a supervisor that regularly checks in with me and makes sure that I have no issues with any admin related tasks, or concerns with any clients. I feel safe and comfortable enough to approach my supervisor with any areas of difficulties or concerns I may be facing. This in return makes me feel that I am truly supported, and that my learning skills will continue to develop along with my love and passion for Speech Pathology.

Everyone at DSKC is very approachable and they certainly know how to have fun! We all have lunch together every day and talk about everything fun with lots of laughter. There are regular group activities organised to help us stay motivated and ensure that we have a great work life balance.

I have realised that the awesome work environment I see at DSKC is far more than just the physical. The positive work environment that I have come to see and experience at DSKC, is a place that promotes employee wellbeing, productivity, and growth. It is a great working practice with great values, a supportive atmosphere, and a trusting culture that encourages us to perform our best. This also applied to whether we are working collectively in the same physical space at the clinic or remotely.

Overall, I have had a very positive and encouraging experience as a new Speech Pathologist working at De Silva Kids Clinic, and I am certain that I will continue to have the best experiences at DSKC.

Written by Nour Sleiman, Speech Pathologist at DSKC

What is a tongue-tie?

A tongue-tie is a condition that is present at birth. It looks like a short, tight, and thick tissue that is called a lingual frenulum. This tissue is found at the bottom of the tongue, that can make it hard for the tongue to move freely.

Causes

Typically, the tissue separates before birth, allowing the tongue to move around freely. With a tongue-tie, the tissue remains attached to the bottom of the tongue and restricts the movement, causing complications with breastfeeding and speech articulation development. There is no known reason or cause for this, although some research has indicated that cases of tongue-tie have been linked with certain genetic factors.

Complications

• Breastfeeding
  – Latching
  – Feeding efficiency – how much milk they take per suck
  – Maternal pain and milk supply
  – Early weaning
• Bottle Feeding
  – Creating a seal and dribbling milk
  – Very slow bottle feeds
  – Difficulty controlling milk flow
• Solids
  – Slow transition to solid foods
  – Gagging on lumps of food
  – Chewing difficulties
  – Messy eating.
• Oropharyngeal dysphagia risk: The child has difficulties initiating a swallow, resulting in a higher risk of food or liquids going down the wrong way and into the lungs.
• Potential for food refusal
• Speech difficulties: Tongue-tie can interfere with the ability to make certain sounds — such as “t,” “d,” “z,” “s,” “th,” “r” and “l.”
• Poor oral hygiene: for an older child or adult, tongue-tie can make it difficult to sweep food from the teeth. This can contribute to tooth decay and inflammation of the gums. Tongue-tie can also lead to the formation of a gap or space between the two bottom front teeth.

Treatment:

Surgical treatments:
Frenotomy: The lingual frenulum is cut,
Frenectomy: The lingual frenulum is surgically removed
Frenuloplasty/z-plasty: Helps to release scar contracture and relieve soft tissue tension

The treatments would be performed by a surgeon.

Written by Nour Sleiman, Speech Pathologist at De Silva Kids Clinic.

My name is Janice, and I am currently in the first year of my Master of Speech Pathology degree, and this is a day in my life as a student Speech Pathologist at De Silva Kids Clinic!

 As a student speechie, my role includes generating session plans, running sessions, and providing feedback to my assigned clients’ families, with support from my amazing clinical educator, Anita. I benefit from our discussions and debriefings before and after sessions, which help me gradually improve my reasoning and clinical skills. I also value self-reflection on my strengths and areas of improvement after each session, as it plays an indispensable role in personal and professional growth. 

Resourcing and rehearsing before each session have been significant parts of my daily routine. I create various types of materials/activities and develop appropriate contingency plans to tailor to each client’s specific needs. At DSKC, I have access to a wide range of resources to facilitate the implementation of speech pathology services!

Another fascinating part of DSKC is the opportunities to observe the sessions run by other speech pathologists and occupational therapists. Learning from these experienced professionals has been inspiring because it not only enables me to reflect on how they adapt their own interactional style to the needs of their clients but also helps me come up with effective strategies and engaging intervention activities to enhance my practice.

While working in a paediatric setting has been a new challenge for me, I genuinely appreciate the chance to complete my intermediate placement at DSKC with the supportive multidisciplinary team. I have been able to perceive

a gradual change in myself when interacting with the little ones- from incredibly nervous to more confident and independent. It has been pleasant and rewarding to be a student speechie at the De Silva Kids Clinic, and I am ready to continue my exciting learning journey with such an invaluable experience!

Written by Janice, Speech Pathology Student from Melbourne University.

My name is Katy, and I am currently in my first year of my Masters of Speech Pathology degree, and this is a day in my life as a student Speech Pathologist at De Silva Kids Clinic!

 My role as a student speechie includes creating session plans for my assigned clients and debriefing them with my clinical educator. For each session, I develop and create resources for the activities tailored to each client. Resourcing has been very fascinating as I am able to see various types of materials that I have only seen in textbooks. Under the supervision of my clinical educator, I am able to run sessions on a daily basis according to the session plans that I create.  This has been an invaluable experience where I am able to reflect and develop my clinical skills. After each session, I self-reflect on my strengths and weaknesses and draft up a progress note for my clinical educator to review. As a speech pathologist, I believe that it is essential to reflect on self-performance consistently as it is significant for our personal and professional growth. 

I have also had the opportunity to observe other Speech pathologists in the clinic during their sessions. It is always very intriguing to see how each SLP’s have their own strategies when working with children. Through observing, I managed to pick up on a few different strategies and intervention activities that I will try to utilise in my future clinical interactions. 

I am very grateful to be given the opportunity to be placed in De Silva Kids Clinic for my intermediate placement. It has been an amazing four weeks where I have been able to see myself grow and develop over the time. Through observing and running sessions I was able to gain an insight into my future career path in the paediatric setting. Making this placement more memorable than anything else was being able to work with an amazing team and a supportive clinical educator, Anita. It has been a real pleasure to start my journey as a speechie here! 

Written by Katy, Speech Pathology Student from Melbourne University.

Who is this treatment for?

 This treatment is designed for children 6 years and younger who stutter. The children who participate in this program can have all different levels of severity for their stutter, as this does not impact the effectiveness of the treatment. It may be suitable for some older children and your trained Speech Pathologist can advise this. 

What is the treatment? 

The Lidcombe Program is a behavioural treatment where the Speech Pathologist indirectly treats the child’s stutter by training the parents/caregiver on  how to deliver the program at home. As it is an  intensive treatment, the majority of the program is required to be completed by a parent/caregiver as they spend the most time with the child. 

The program teaches the parent/caregiver to ignore the child’s stutter and praise their smooth speech. 

There are 2 stages of the treatment program. These are: 

Stage 1: Weekly sessions with Speech Pathologist, parents/caregiver and child. Daily practice sessions at home with parent/caregiver. 

Stage 2: Maintenance of reduced/no stutter at home in any environment. Attend monthly – 3 monthly appointments with Speech Pathologist to check on progress at home. 

Stage 1:

 The parent/caregiver and child attend weekly sessions with their Speech Pathologist. These weekly sessions are for the Speech Pathologist to train the parent/caregiver on how to provide the treatment by demonstrating various features of the program, observing the parent/caregiver providing the treatment, Speech Pathologist to give feedback on what was observed, discussing what was conducted at home during the past week and negotiating a Severity Rating of the child’s stutter for the session.  

The parent/caregiver are to conduct daily practice  sessions at home with the child. These practice  sessions are recommended to last for 10-15  minutes and can be conducted twice a day if your  Speech Pathologist recommends it. The purpose of    the practice sessions are to elicit stutter free speech     so that the parent/caregiver can give praise for the child’s smooth speech. Therefore, praising the behaviour we want to see (smooth speech) and changing the behaviour. This verbal praise is called Verbal Contingencies (VC) – for example, “super smooth”.  

The Speech Pathologist will guide the parent/caregiver on how to structure the practice session to achieve stutter free speech. The aim of the program and practice sessions are to achieve unstructured and conversational speech that is stutter free. Towards the end of stage 1, we are expecting the child to be stutter free – very mild stutter. Once this has been achieved over 3 consecutive weeks, then the clinician will recommend the transition to stage 2. 

Stage 2:

Stage 2 is dedicated to the maintenance of the stutter free speech/very mild stutter and this stage can last up to a year. This will consist of reducing the number of sessions with the Speech Pathologist to monthly – up to 3 monthly and training the parent/caregiver on how to identify any sign of a relapse in the stutter and how to approach this within the Lidcombe program. Sometimes this can be to return to some practice sessions at home or simply just increasing the verbal contingencies (praise) within conversation. 

Once stage 2 is completed, Speech Pathologist will discharge your child from the Lidcombe Program. 

However, maintenance is often lifelong for most people who stutter. 

Evidence behind treatment:

Independent reviews report the evidence base for the Lidcombe Program to be the most comprehensive for early stuttering treatments. The evidence base includes children from the following countries: Australia, the United Kingdom, New Zealand, the United States, Canada, the Netherlands, Sweden, Malaysia, Kuwait, and Iran. An analysis of 134 children in a randomised controlled clinical evidence and randomised controlled trials for the Lidcombe Program showed that its odds ratio was 7.5 for attaining below 1.0 percent syllables stuttered at 6.3 months post-randomisation. This means that, at 6.3 months post-randomisation, children who received the Lidcombe Program had 7.5 times greater odds of having no stuttering or almost no stuttering than children who did not receive the Lidcombe Program. 

This research shows us as clinicians and you as parents, that this program has strong evidence supporting its effectiveness for treating a child 6 years and younger for their stutter. 

Written by Allie Godbold, Speech Pathologist at De Silva Kids Clinic.