Welcome to the final installment of our Let’s Talk NY blog series on AAC myths. Throughout this series, I’ve addressed misconceptions that often create unnecessary barriers to effective communication intervention. Today, I’m examining a myth about how symbols should be introduced in AAC systems.

This Week’s Myth: “There is a hierarchy in symbols from objects to written words”

This myth suggests that all individuals learning to use AAC must progress through a strict sequence of representational forms:

1. Real objects
2. Miniature objects
3. Photographs
4. Line drawings
5. Abstract symbols
6. Written words

The belief is that individuals must master each level before moving to the next, more “abstract” form of representation.

What Research Tells Us

Romski and Sevcik (2005) directly challenge this myth in their article. In fact, research shows that:

1. Symbol hierarchy is not universal

   Individual preferences and abilities vary widely—some children actually find line drawings easier to recognize than photographs due to reduced visual complexity.

2. Multiple representations can be introduced simultaneously

   Many successful AAC users learn through exposure to various symbol types at the same time, rather than mastering one before moving to the next.

3. Meaningful context matters more than symbol type

   The relevance and motivational value of the symbol often matters more than its place in the presumed hierarchy.

4. Iconicity (visual resemblance) is just one factor

   While how much a symbol looks like what it represents can be helpful, it’s not the only or even primary factor in symbol learning for many individuals.

My Clinical Observations

Throughout my practice, I’ve consistently found that the presumed symbol hierarchy doesn’t align with how many children actually learn to use AAC. I’ve worked with children who:

• Struggled with photographs (which contain visual distractions) but easily learned more simplified line drawings
• Learned abstract symbols (like those in many AAC systems) with no prior exposure to “easier” representational forms
• Benefited from seeing written words alongside symbols from the very beginning
• Showed clear preferences for certain symbol types that didn’t follow the expected progression

What I’ve found most effective is offering options and observing what works best for each individual, rather than adhering to a predetermined sequence.

A More Flexible Approach

Instead of following a rigid hierarchy, I advocate for:

• Assessment of individual visual processing and recognition abilities

• Consideration of motor access needs

  (some symbol types may be easier to access physically)

• Observation of symbol preferences

  through structured trials

• Starting with highly motivating vocabulary

  regardless of symbol type

• Using consistent symbol labeling

  to support learning

• Providing multiple representational forms

  when beneficial

This individualized approach leads to more successful communication outcomes than adherence to a theoretical progression.

Series Wrap-Up

Throughout this blog series, I’ve addressed six persistent myths about AAC that often create unnecessary barriers to effective communication intervention:

1. AAC prevents or delays speech development
2. AAC is the last resort in speech-language intervention
3. Children must have certain skills before they can benefit from AAC
4. AAC is only for children with intact cognition
5. Children must be a certain age to benefit from AAC
6. There is a required hierarchy in symbols from objects to written words

By understanding the evidence that contradicts these myths, I hope you feel empowered to make informed decisions about communication support for your child.

Continuing Your AAC Journey

Whether you’re just beginning to explore AAC options or looking to refine an existing approach, I’m here to support you with:

• Evidence-based assessment and recommendations
• Individualized implementation strategies
• Training for family members and other communication partners
• Ongoing support as your child’s communication needs evolve

Contact me today to discuss how I can help support your child’s unique communication journey.

Reference

Romski, M. & Sevcik, R. A. PhD. Augmentative Communication and Early Intervention: Myths and Realities. Infants & Young Children 18(3):p 174-185, July 2005.

Welcome back to our Let’s Talk NY weekly blog series on AAC myths. Last week, I explored why cognitive abilities should never limit access to AAC. This week, I’m addressing another common misconception that often delays implementation of effective communication supports.

This Week’s Myth: “Children must be a certain age to benefit from AAC”

I frequently encounter the belief that children need to reach a specific chronological age—often 2, 3, or even 5 years—before AAC should be considered. Parents are told: “Let’s wait until she’s older” or “He’s too young for AAC; let’s focus on speech first.”

What Research Shows

Romski and Sevcik (2005) specifically address this myth in their research. As we know:

1. There is no minimum age requirement for AAC

   Even very young children can benefit from appropriately designed AAC systems.

2. Early communication development is crucial

   The first three years of life represent a critical period for language development—waiting to provide communication support during this time can have lasting negative effects.

3. Typical language development begins with multimodal communication

   Infants naturally communicate through gestures, vocalizations, and facial expressions long before they speak—AAC simply builds on this natural process.

4. Early AAC intervention supports development across domains

   Research shows that providing communication tools early can positively impact cognitive, social, and emotional development, not just communication skills.

My Clinical Observations

In my years implementing AAC with children of various ages, I’ve consistently observed that:

• Very young children can successfully use simple AAC strategies like basic signs, picture exchange systems, or voice-output devices
• Children who receive AAC support early typically show less frustration and fewer challenging behaviors
• Early communication success builds a foundation for more complex communication development
• Families who implement AAC early often report more positive interactions and stronger bonds with their children

In contrast, when AAC implementation is delayed until a child is “old enough,” I often see entrenchment of less effective communication methods (like hitting and screaming) that can be difficult to replace later.

Developmentally Appropriate AAC

Rather than focusing on chronological age, I advocate for developmentally appropriate AAC implementation that:

• Matches the child’s current abilities while promoting growth
• Incorporates motivating communication opportunities based on the child’s interests
• Involves all communication partners in consistent implementation
• Grows and changes as the child develops

Looking Ahead

Next week, I’ll address our final myth in this series: “There is a hierarchy in symbols from objects to written words.” We’ll explore why the presumed progression from objects to photos to line drawings to abstract symbols isn’t always necessary or beneficial.

How I Can Support You

If you have a young child who might benefit from AAC support, I can help with:

• Age-appropriate communication assessment
• Selection of developmentally appropriate AAC tools
• Strategies for embedding AAC into everyday routines
• Coaching for family members and caregivers

Contact me today to discuss how early AAC implementation might benefit your child’s communication development.

Reference

Romski, M. & Sevcik, R. A. PhD. Augmentative Communication and Early Intervention: Myths and Realities. Infants & Young Children 18(3):p 174-185, July 2005.

Welcome back to our Let’s Talk NY weekly blog series on AAC myths. Last week, I discussed why prerequisite skills aren’t necessary for AAC implementation. Today, I’m addressing a myth that has unfairly limited communication access for countless individuals.

This Week’s Myth: “AAC is only for children with intact cognition”

This myth suggests that only individuals with average or near-average cognitive abilities can benefit from AAC systems. I’ve encountered this misconception frequently in my practice, with statements like “His cognitive level is too low for AAC” or “She wouldn’t understand symbols due to her intellectual disability.”

What Research Tells Us:

Romski and Sevcik (2005) explicitly address this misconception in their work on AAC myths. The research evidence indicates that:

1. Cognitive abilities cannot be accurately assessed without adequate communication

   Without a reliable way to express knowledge, many individuals appear to function at lower cognitive levels than they actually possess.

2. All communicators exist on a continuum

   Every person, regardless of cognitive abilities, has something to communicate and benefits from having effective tools to do so.

3. AAC systems can be adapted to various cognitive levels

   From simple choice-making to complex language systems, AAC can be customized to meet individuals where they are.

4. Communication skills can develop alongside cognitive skills

   Rather than waiting for cognitive development to reach a certain threshold, communication development can actually support cognitive growth.

From My Clinical Experience:

Throughout my years of practice, I’ve worked with many children with significant cognitive challenges who made remarkable progress when given appropriate AAC support.

I recall working with children who were described as “too cognitively impaired” for AAC, yet surprised me by learning to use icon/picture-based systems to make choices, express basic needs, and engage socially. These same children often demonstrated understanding and abilities that surprised their families and other professionals once they had a way to communicate.

What’s particularly striking is how access to communication often reveals previously unrecognized cognitive abilities. When children can express preferences, demonstrate knowledge, and ask questions, we gain a much clearer picture of their true capabilities.

A More Inclusive Approach:

Instead of using cognitive assessments (which are often language-based themselves) as gatekeepers to AAC, I advocate for:

• Universal access to communication

  Every person deserves effective communication tools, regardless of cognitive profile.

• Presumed potential

  Beginning with the assumption that individuals have the potential to understand more than they have expressed without support.

• Appropriate customization

  Adapting AAC approaches to match current abilities while supporting growth.

• Focus on functional communication

  Prioritizing meaningful, motivating communication opportunities over abstract skill development.

Looking Ahead:

Next week, I’ll explore another common myth: “Children must be a certain age to benefit from AAC.” We’ll discuss why early implementation of AAC can be crucial for communication development.

How I Can Help:

If your child has been denied AAC services due to cognitive concerns, I can provide:

• Strength-based assessment that looks beyond standardized test scores
• AAC recommendations that match your child’s current needs and abilities
• Implementation strategies that build on existing skills
• Ongoing support as communication skills develop

Contact me today to discuss how AAC might benefit your child, regardless of cognitive profile or diagnosis.

Reference

Romski, M. & Sevcik, R. A. PhD. Augmentative Communication and Early Intervention: Myths and Realities. Infants & Young Children 18(3):p 174-185, July 2005.

Welcome back to our Let’s Talk NY weekly blog series on Augmentative and Alternative Communication myths. Last week, I explained why AAC should not be considered a last resort in speech-language intervention. This week, I’m addressing a closely related myth that frequently creates barriers to communication access.

This Week’s Myth: “Children must have certain skills before they can benefit from AAC”

This myth is particularly persistent in clinical practice. I often hear statements like, “He needs to demonstrate cause-effect understanding first” or “She doesn’t have the attentional skills for AAC yet.” Such prerequisites might include:

• Certain cognitive abilities
• Specific motor skills
• Demonstrated cause-effect understanding
• Particular attention span
• Symbol recognition
• Specific communicative intent

What the Research Shows:

The evidence shows that:

• Learning happens through doing

  Children learn the skills needed for AAC by actively using AAC systems, not by mastering prerequisites in isolation.

• Communication is a basic right

  Access to communication should not be contingent on demonstrating specific skills.

• Presumption of potential

  Research supports approaching all individuals with the assumption that they may be able to communicate when provided with appropriate tools and support.

My Clinical Observations:

Throughout my career, I’ve worked with many children who were denied AAC because they supposedly lacked “prerequisite skills.” When finally given access to appropriate communication tools, these same children often surprised everyone with their capabilities.

I recall working with children who were deemed “not ready” for symbols but quickly began using picture communication systems when given the opportunity. Others who supposedly “lacked attention” became highly engaged when presented with motivating communication opportunities through AAC.

What I’ve consistently found is that:

• Many skills thought to be prerequisites actually develop through using AAC
• Children often demonstrate abilities through AAC that weren’t apparent in other contexts
• Motivating communication opportunities tend to naturally elicit the focus and engagement needed

Shifting Our Approach:

Instead of asking “Does this child have the skills needed for AAC?” I believe we should ask:

• “What AAC system might work best for this child right now?”
• “How can we modify the environment to support successful communication?”
• “What motivating opportunities can we create for meaningful communication?”
• “How can we build on the communication skills the child already demonstrates?”

This approach focuses on creating opportunities rather than waiting for readiness—an approach supported by decades of research.

Looking Ahead:

Next week, I’ll address another pervasive myth: “AAC is only for children with intact cognition.” We’ll explore how AAC can benefit children across the cognitive spectrum and why assumptions about cognitive abilities should never limit communication access.

How I Can Support Your Child:

If you’ve been told your child isn’t “ready” for AAC, I can help with:

• Strength-based communication assessment
• Identifying appropriate AAC options based on current abilities
• Creating motivating communication opportunities
• Supporting skill development through active AAC use

Contact me today to discuss how your child might benefit from AAC, regardless of their current skill level.

Reference

Romski, M. & Sevcik, R. A. PhD. Augmentative Communication and Early Intervention: Myths and Realities. Infants & Young Children 18(3):p 174-185, July 2005.

Welcome back to our Let’s Talk NY weekly blog series on Augmentative and Alternative Communication (AAC) myths. Last week, I explored how AAC supports rather than hinders speech development. This week, I’m addressing another harmful misconception that often delays critical intervention.

This Week’s Myth: “AAC is the last resort in speech-language intervention”

I frequently hear from families who have been told to “try everything else first” before considering AAC. Speech-language professionals sometimes suggest that AAC should only be introduced after traditional speech therapy approaches have failed. This perspective can lead to missed opportunities and unnecessary delays in providing effective communication support.

What Research Tells Us:

The research directly contradicts this “last resort” approach:

• AAC can be a first-line intervention

  Romski and Sevcik (2005) emphasize that AAC can and should be implemented early in the intervention process, not as a last resort when other methods have failed.

• Early communication success matters

  Providing a reliable communication method early helps prevent learned helplessness and behavior challenges that often develop when children lack effective ways to express themselves.

• AAC works alongside other interventions

  AAC is not an either/or proposition—it can be implemented simultaneously with speech therapy and other communication approaches for comprehensive support.

What I’ve Observed in My Practice:

In my years working with children with complex communication needs, I’ve seen the consequences of delaying AAC implementation. Children who come to me after years of “speech-only” approaches often show signs of communication frustration, reduced social engagement, and limited language development.

Conversely, when I’ve been able to implement AAC strategies early in the intervention process, I typically observe:

• Reduction in frustration behaviors
• Increased engagement in therapy activities
• More consistent progress in overall communication development
• Development of language concepts that actually support speech attempts

One particular pattern I’ve noticed is that children who use AAC during therapy sessions often become more willing to attempt verbal approximations, possibly because the pressure to speak is reduced when they have a reliable backup communication method.

The Multi-Modal Approach:

Rather than viewing AAC as a last resort, I advocate for a multi-modal approach to communication intervention that may include:

• Traditional speech therapy techniques
• AAC strategies tailored to the individual’s needs
• Environmental modifications to support communication
• Partner training to recognize and respond to all communication attempts

This comprehensive approach ensures that the child has access to effective communication while continuing to develop all potential communication modalities.

Looking Ahead:

Next week, I’ll tackle another persistent myth: “Children must have certain skills before they can benefit from AAC.” We’ll explore why presuming competence and providing opportunities for communication is more important than waiting for prerequisite skills to emerge.

How I Can Support You:

If you’re considering communication options for your child, I can help you navigate the decision-making process with:

• Comprehensive communication assessments
• Evidence-based recommendations tailored to your child’s unique needs
• Implementation strategies that work in real-world settings
• Ongoing support as your child’s communication abilities evolve

Contact me today to learn more about how AAC might fit into your child’s communication journey—not as a last resort, but as a valuable tool in a comprehensive approach.

Reference

Romski, M. & Sevcik, R. A. PhD. Augmentative Communication and Early Intervention: Myths and Realities. Infants & Young Children 18(3):p 174-185, July 2005.

Welcome back to our Let’s Talk NY weekly blog, where we explore important topics in communication support. This week, I’m starting a new series on common misconceptions about Augmentative and Alternative Communication (AAC) that often create unnecessary barriers to its implementation.

This Week’s Myth: “AAC will prevent or delay natural speech development”

Many parents and even some professionals worry that introducing AAC tools might discourage a child from developing verbal speech. This concern is understandable—why would someone work hard to speak if they have an alternative way to communicate?

However, research consistently shows the opposite effect. A comprehensive review by Millar et al. (2006) examined 23 studies of AAC intervention and found that 89% of participants demonstrated gains in speech production after AAC implementation. More recent studies continue to support these findings.

Why AAC Actually Supports Speech Development:

• Reduces communication pressure

  When children don’t feel pressured to speak, they often become more willing to try vocalizing on their own terms.

• Provides consistent models for language learning

  Many AAC systems pair visual symbols with spoken words, reinforcing the connection between concepts and their verbal labels.

• Creates more opportunities for social interaction

  With increased ability to communicate comes more social engagement, providing natural opportunities to practice and develop speech.

What I’ve Observed in My Practice:

Throughout my years working with children who use AAC, I’ve consistently observed an interesting pattern: rather than inhibiting speech development, AAC often serves as a catalyst for verbal communication.

I’ve worked with numerous children who, after being introduced to picture communication systems or speech-generating devices, began attempting word approximations or even clear words—sometimes while simultaneously using their AAC system, and sometimes independently. This pattern aligns perfectly with what research tells us: providing an alternative communication method actually reduces pressure and creates a supportive environment for speech attempts.

In many cases, I’ve seen children who were initially frustrated and had few communication attempts suddenly become enthusiastic communicators through AAC, with spoken words emerging shortly afterward. The confidence they gain from successful communication seems to encourage more verbal attempts.

Looking Ahead:

Next week, I’ll tackle another persistent myth: “AAC is the last resort in speech-language intervention.” We’ll explore why AAC should be considered a valuable tool from the beginning of intervention rather than waiting until other approaches have failed.

How I Can Help:

If you’re curious about whether AAC might support your child’s communication development, I’m here to help with:

• Comprehensive AAC evaluations
• Individualized intervention planning
• Training for families and caregivers
• Ongoing consultation and support

Contact me today to learn more about how I can support your child’s communication journey.

Reference

Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The Impact of Augmentative and Alternative Communication Intervention on the Speech Production of Individuals With Developmental Disabilities: A Research Review. Journal of Speech, Language, and Hearing Research, 49(2), 248–264. https://doi.org/10.1044/1092-4388(2006/021)

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As a parent of a late-talking toddler, you might feel worried or unsure about how to best support your child’s language development. The good news is that there are many natural, everyday opportunities to help your little one build their communication skills. Let’s explore some effective strategies you can start using today!

Make Reading Time Count

Reading together isn’t just about getting through the book – it’s about creating an interactive experience that encourages language development. Here’s how to make the most of your reading sessions:

- Forget about reading every word on the page. Instead, talk about what you see in the pictures. “Look at that big red truck! The truck is driving down the hill. Vroom!”

- Let your child guide the interaction. If they point to something, name it and add a description. “Yes, that’s a dog! The brown dog is running fast!”

- Use sound effects and gestures to make the story come alive. Moo like a cow, pretend to eat like a hungry caterpillar, or make whooshing sounds for the wind.

- Read favorite books multiple times. Repetition helps children learn and predict what comes next, building their understanding and eventually their ability to join in.

Turn Daily Routines into Language Lessons

Every part of your day offers chances to model language naturally. Here are some ways to weave language learning into everyday activities:

Mealtime Magic

During meals, talk about what you’re eating and doing: “Let’s scoop up the yogurt. Mmm, it’s cold and creamy! Would you like more banana? I’m cutting the banana into small pieces.”

Bath Time Banter

Bath time is perfect for teaching action words and concepts: “Splash! The water is warm. Let’s pour the water – watch it go down, down, down! Now let’s wash your toes… your knees… your tummy!”

Getting Dressed

Name clothing items and body parts: “Time for your red socks! One sock on your right foot, one sock on your left foot. Now let’s put on your cozy sweater. Arms up!”

Simple Tips for Success

1. Get down to your child’s eye level when talking. This helps them see your face and mouth movements while creating a stronger connection.
2. Use simple but complete sentences. Instead of just saying “car,” say “The car is driving.”
3. Give your child time to respond. Count to 10 silently after asking a question or making a comment.
4. Follow their lead. Talk about what interests them in the moment, whether it’s a passing airplane or their favorite stuffed animal.
5. Celebrate and respond to all attempts at communication, whether it’s pointing, gestures, sounds, or words.

Remember: Every Child Is Different

While it’s natural to worry about speech delays, remember that every child develops at their own pace. These strategies can help support your child’s language development, but if you have concerns, don’t hesitate to reach out to a speech-language pathologist for guidance.

Want to learn more about supporting your child’s communication development? Contact Let’s Talk NY Speech-Language Services. We’re here to help your little one find their voice!

Hey there, parents and teachers! Ever wondered why some kids struggle with reading even though they’re sharp as a tack in other areas? The answer might be in how they process sounds. Let’s dive into the fascinating connection between auditory processing and reading skills.

What is Auditory Processing?

Think of auditory processing as your brain’s sound control center. It’s not about hearing sounds (that’s what your ears do), but rather how your brain makes sense of those sounds. When a child has trouble with auditory processing, it’s like trying to listen to a podcast with spotty reception – all the information is there, but it’s hard to piece it together.

The Reading-Sound Connection

Here’s something cool: reading and sound processing are totally BFFs in your brain. Research has consistently shown that strong auditory processing skills are crucial for developing good reading abilities. Let me break down why:

Phonological Awareness

Remember learning about “sounding it out”? That’s phonological awareness in action! Research has demonstrated that children who struggle with auditory processing often have trouble breaking words into sounds (phonemes).

This makes sense when you think about it – if it’s hard to tell the difference between similar sounds like “bat” and “pat,” reading becomes much more challenging. Phonological awareness is like the foundation of a house – without it, the whole structure of reading can become unstable.

Reading Fluency

When kids can process sounds quickly and accurately, they’re more likely to become fluent readers. Think of it like building blocks – each skill supports the next one. Strong auditory processing helps children:

- Recognize speech sounds more easily

- Connect those sounds to letters

- Blend sounds together to form words

- Read with better speed and accuracy

Red Flags to Watch For

If you notice your child or student showing these signs, they might be dealing with auditory processing challenges:

- Difficulty following verbal instructions

- Trouble distinguishing between similar sounds

- Reading below grade level despite strong intelligence

- Struggling to sound out new words

- Getting easily distracted by background noise

What Can We Do About It?

The good news? There’s lots we can do to help! Here are some evidence-based strategies:

1. Rhythm and Music Activities

Music and rhythm activities can help strengthen auditory processing skills. Try:

- Clapping syllables in words

- Singing songs with rhyming patterns

- Playing rhythm games

- Moving to music while emphasizing beat patterns

2. Clear Communication Strategies

When working with children who have auditory processing challenges:

- Face them when speaking

- Speak clearly but naturally

- Use visual cues along with verbal instructions

- Give one instruction at a time

- Reduce background noise when possible

3. Reading Practice with a Twist

Make reading practice more auditory-friendly:

- Use audiobooks along with printed text

- Practice phoneme manipulation games

- Record reading sessions and play them back

- Play word games that focus on rhyming and sound patterns

Remember…

Every child’s journey to reading is unique. If you’re concerned about your child’s reading or auditory processing, don’t hesitate to reach out to an audiologist or speech-language pathologist for an evaluation. Early intervention can make a huge difference!

Resources for Parents and Teachers

Reliable Organizations:

- Reading Rockets (readingrockets.org)

- Understood.org

- International Dyslexia Association (dyslexiaida.org)

- American Speech-Language-Hearing Association (asha.org)

Types of Helpful Tools:

- Interactive reading programs

- Phonological awareness apps

- Audio-supported reading materials

- Speech-to-text tools

Remember, helping a child with auditory processing challenges isn’t just about fixing a problem – it’s about unlocking their full potential as learners and readers. Keep it fun, stay patient, and celebrate every victory, no matter how small!

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Note: This article provides general information and should not be considered as medical or professional advice. Please consult with qualified professionals for specific concerns about your child’s development.

A Parent’s Guide from Let’s Talk NY, Speech-Language Services, PLLC

Welcome to Speech Therapy!

Starting speech therapy is an important step in supporting your child’s communication development. This guide will help you understand what to expect and how you can be an active participant in your child’s journey.

What Happens in Speech Therapy?

Assessment

First, I’ll get to know your child through:

- Observing their current communication skills

- Playing and interacting with them

- Reviewing their developmental history

- Understanding your concerns and goals

- Conducting appropriate evaluations

Goal Setting

Together, we’ll create goals that are:

- Meaningful for your child

- Realistic and achievable

- Important for daily life

- Measurable to track progress

Therapy Sessions

Each session is tailored to your child and might include:

- Play-based activities

- Structured practice

- Games and fun exercises

- Activities that build on their interests

- Strategies for home practice

Your Role as a Parent

During Sessions

- Observe treatment sessions

- Learn strategies to use at home

- Ask questions

- Share your observations

- Celebrate progress

At Home

- Practice recommended activities

- Use strategies in daily routines

- Notice and encourage attempts

- Create communication opportunities

- Stay consistent with practice

Tips for Success

1. Be patient - progress takes time
2. Celebrate small victories
3. Keep communication fun
4. Use everyday moments for practice
5. Share your questions and concerns

Signs of Progress

Look for:

- Increased attempts to communicate

- Better frustration management

- New sounds or words

- More confidence

- Improved interactions

Remember

- Every child progresses at their own pace

- Consistency is key

- Communication should be fun

- You are your child’s best advocate

References:

- Gaffney, T., Newbury, J., Sutherland, D., & Macrae, T. (2023). Speech-language pathologists’ practices and perceptions of parent involvement in paediatric services funded by the NDIS in Australia. International Journal of Speech-Language Pathology, 26(6), 890–901. https://doi.org/10.1080/17549507.2023.2281222

- Justice, L. M., & Redle, E. E. (2013). Communication Sciences and Disorders: A Clinical Evidence-Based Approach.

- Paul, R., & Norbury, C. F. (2012). Language Disorders from Infancy through Adolescence.