What I Now Know

What I Now Know:

Communicating with Caregivers

by: Ana-Maria Jaramillo, M.S., CCC-SLP

YES, we know that the overuse of the Internet can be detrimental to our mental and physical health, but when used for just the right amount of time (and the right information), it can be a gift. Being an SLP today is so different than when I graduated 5 years ago or even 10 years ago, when blogging wasn’t really as trendy as it is today. Bilinguistics, a company made up of bilingual SLP’s that provide therapy, resources and CEU’s based in Austin (my hometown), released a blog post several months ago called “How do I tell my Spanish-Speaking Parents that their child has an Impairment?” Woah, was my initial reaction.

I had never really even stopped to ask myself this question for the parents of my monolingual clients, let alone for the parents of my bilingual clients. After two intense years of grad school, I left with more knowledge that I thought my brain could ever soak up, but still felt uneasy when I would have to share the news to caregivers that their child was not developing like the others for that particular age. Sure, I had an undergraduate degree in psychology which helped, but no amount of knowledge can prepare you for the conversations you have with these families. No one taught me how to approach the subject during those two years of grad school or when I got thrown into 5 different schools at once as a CF, many times leading IEP meetings and translating for every provider there. Side note: Remember translating is NOT part of your job description as an SLP! More times than not, I found IEP meetings to be frustrating and draining for the parents – a bunch of providers sitting around a stuffy conference room taking turns focusing and listing off what the child can’t do rather than what the child can do.

Once I received my CCC’s, I left the schools and began working for a pediatric home health company. The majority of my caseload was made up of Spanish speaking families with limited access to resources. Typically, I was the first professional assigned to work with the child, so I found myself constantly sharing the news that their child was “impaired and presenting with signs of X, Y, Z that are consistent with a diagnosis of X, Y, Z.” I dreaded having these conversations, not because I didn’t know enough about the diagnosis, but because I knew that one of the first steps of the grieving process was anger. Rightfully so. I once read somewhere that withholding a diagnosis, like Autism Spectrum Disorder in a child, is like withholding a diagnosis of cancer. The sooner the diagnosis, the more access to care, therapy and services are offered, which leads to a much better prognosis in the end.

As the years went on, it never got easier, but my approach in delivering this uncomfortable news seemed to help caregivers process it in a way that was easier.


  • Read and research. Come prepared to answer all and any questions – clarifying, of course, that you are not a doctor (I’ll get to that in the next couple of steps). Print descriptions, examples of behaviors and checklists of symptoms characterized by the disorder. Visuals such as charts, graphs and tables are even better. Make sure the information, descriptions and checklists are free of clinical medical/speechie lingo and stick to simple terminology that you can easily explain to the caregivers. Fill out all checklists, graphs and charts together – CAREGIVERS are the EXPERTS and know their child best!


  • Spend time talking about the child’s strengths (notice I said strengths not areas of weakness) to determine a baseline and plan of action. A formal evaluation will determine areas of weakness. This is NOT the time for that, assuming an evaluation has already been done at this point. After going through these strengths, develop a plan of action to seek a formal diagnosis from a specialist (unless it is childhood apraxia of speech because an SLP is the only professional that can diagnose this). Recommend your most trusted developmental pediatrician/neurologist/ENT/GI doctor, discuss different types of therapy (OT, PT, ABA, play therapy, etc.) and provide phone numbers/websites for caregivers to contact all of these providers. Make it EASY for them. It can be VERY overwhelming typing “developmental pediatrician near me” or “ABA services” on a Google search and narrowing it down to one. More importantly, provide caregiver with local support groups and online chats/forums to engage in. The information provided in these groups is invaluable.


  • Remember to be culturally sensitive. The American Psychological Association (1993) guidelines acknowledge the necessity of assessing individuals in the context of their ethnicity and culture, respecting their indigenous beliefs and practices (including those involving religion and spirituality), assessing the patients’ support systems, evaluating the patients in their primary language, and taking a history that accounts for immigration and acculturation stresses.Even if you are unfamiliar with that particular culture, be mindful that it is different than your own. If you are working with a family whose first language is not your own, have a translator come out with you – it is important that any information like this be presented in their native language.


  • Be available: emotionally and physically. Remain professional, but be a friend. Be human. Be a shoulder to cry on and a body to hug. Offer words of encouragement and success stories of other children you have worked with. It is important to give caregivers TIME. Time to feel angry, sad and frustrated, but NOT lost. They have you! Once the grieving period has ended, it’s time to get to work. After all, clinician, you change lives.

Should I refer my child to speech therapy?

Should I refer my child to speech therapy?

by: Ana-Maria Jaramillo, M.S., CCC-SLP

It is important to recognize that there are foundational skills that are crucial for speech and language development. The red flags listed below may indicate that your child should be evaluated by a speech-language pathologist to determine if therapy is warranted. If you have concerns with your child’s speech and language development, contact Voz Speech Therapy for a free screening in English or Spanish.  

Red Flags VOZ-page-001

¿Debería referir a mi hijo/hija a una terapeuta del habla?

¿Debería referir a mi hijo/hija a un/una terapeuta del habla?

por: Ana-Maria Jaramillo, M.S., CCC-SLP 

Es importante reconocer las señales de alerta para ayudar identificar la necesidad de contactar un/una terapeuta del habla. Si tiene preocupaciones con el desarrollo del habla y lenguaje de su hijo/hija, llame a Voz Speech Therapy para recibir una consulta gratis. 

para los 18 meses

Pre-Language Skills: The Foundation for Language Development

Pre-Language Skills:

The Foundation for Language Development

by: Ana-Maria Jaramillo, M.S., CCC-SLP 

As a pediatric speech-language pathologist specializing in the early intervention population, the most common question I get asked by caregivers is, “why hasn’t my child said their first word yet?” Then immediately after that question comes, “when is my child going to start communicating?”

Chances are, your child is already communicating – just not verbally. From birth, babies begin communicating using facial expressions, motor movements, eye contact and sounds. This is known as non-verbal communication. Long before communicating with words and phrases, children utilize an impressive array of non-verbal forms of communication to interact with people. These “pre-language” or “pre-linguistic” skills are the foundation for language development and are directly tied to your child’s ability to produce his/her first word. Exciting! As soon as children learn that these non-verbal skills have significance and can influence the behavior of people around them (for example, that they can get their bottle if they make a certain sound or look/point at it), they begin to interact more intentionally. It is through these back-and-forth interactions that a child learns the power of language and communication.

Despite exhaustive study and having read countless articles about these skills while I was studying to be an SLP, it took me many years to fully understand how to teach and identify these pre-language skills in a way that is effective. So, what does a child present like that does not have any pre-language skills? Poor eye contact, no imitation of sounds or motor movements, fleeting attention, inability to sit still for more than 1-2 minutes, flat affect, difficulty waving hi/bye, no pointing and very few sounds/words. So, where do you start with a child that won’t sit with you for more than 1 minute, won’t imitate sounds and has trouble maintaining eye gaze? Start by creating an opportunity for an interaction by picking a preferred toy, action or object that is HIGHLY motivating for the child (i.e. bubbles, wind-up toys, blocks). Once you have your child’s interest, focus on building the following skills:

  1. Joint Attention

Joint attention is when two people share interest in an object or action and there is an understanding between the two people that they are both interested in the same object or action. For example, a child points and looks up at an airplane and then looks at the caregiver to get the caregiver to look at the airplane too. When the child becomes older, he/she may pair the shift in eye gaze with a vocalization to gain the caregiver’s attention. This skill is essential for a child’s social language and comprehension. Typically, we see joint attention emerge around 9 months of age.

  1. Eye Contact

Encourage your child to maintain appropriate eye gaze by having him/her sit and face you while you sing a variety of songs and play games, such as peek-a-boo. Having conversations during familiar routines, such as bath time and meal time, will encourage your child to look at your eyes and mouth to imitate motor movements. When teaching eye contact, try to be at the same level as your child and hold preferred objects around 2 inches from the bridge of your nose. It helps to say phrases such as, “if you want the X, find my eyes.”

  1. Pointing

Show your child an object he or she is very interested in, for example bubbles or a ball.Say “look” loud and clear, then point to the object and label it a few times. Then, encourage your child to reach for it as described above and shape his/her hand into the correct pointing position with his/her index finger. Say, “point” and then name the object and use the sign at the same time. Give the object immediately as a reward. Allow your child time to explore the object, help him/her hold it and turn it to see it from different angles. Repeat this activity frequently each day with different objects until your child can “ask” for the object by pointing to it himself. Encourage your child to look at the object that he or she is pointing to.

  1. Turn-Taking

Play games that the child is already familiar with, such as throwing the ball around or pushing trains. While you play the game, describe what you are doing using simple phrases. After you let the child take a turn, say “my turn” by touching your chest and immediately take a turn. Say the phrase, “your turn” while pointing to the child when he/she takes a turn. Try to take at least 10 turns each, a few times a day with different objects/toys.

  1. Social Gestures/Signs

By 10 months of age, your baby should be waving hi/bye when given a verbal cue. Encourage your child to wave when leaving daycare, saying goodnight, saying good morning and cleaning up (i.e. saying bye to toys). Using signs for “all done, mine, clean up, open, play, book, more, eat and drink” encourage an effective form of non-verbal communication, which can bridge the gap between non-verbal and verbal language. Sign language is extremely effective for children who have a high receptive language, but are not yet producing real words. While signing, always say the word you are signing aloud.

  1. Babbling/Symbolic Noises

Children often use and imitate a variety of environmental noises before they start labelling objects. Animal noises, transportation noises (i.e. cars, trains, airplanes), telephones and door bells are examples of symbolic noises children most frequently use. You can make animal noises for pictures of animals, toy animals and when you see real animals. For example, “Look, there’s a cat, meow, meow! What does the cat say? That’s right, meow!”One of the most effective and fun ways to teach symbolic noises is by singing songs like “Old McDonald” because they are predictable and engaging for your child. To reinforce symbolic noises even more, pretend like you forgot the lyrics and have the child attempt to help you!

Remember to create multiple language opportunities for your child to practice these skills throughout the day. The most effective way to target these skills is by embedding them in your daily routine! How do you target these pre-language skills? Comment and share below!