The Arts and Speech/Language Development: Music

By Peter Kao, M.S., CCC-SLP

This is part 1 of a three-part series discussing speech and language development and the arts.

“Music is the universal language of mankind.”

― Henry Wadsworth Longfellow

When I was a youngster, my parents told me, “Playing piano makes you smarter”. At the time, I thought it was a just ploy to get me to practice more. Yet for decades, researchers have studied links between literacy and music. More recently, research has linked training in music to speech and language development. While not necessarily “smarter”, the research shows that students with music training perform better on speech and language tasks than non-musicians.

The Research

Training in music has been shown to correlate with reading scores on standardized tests in school-age children (Strait, Hornickel, & Krauss, 2011). Students from low socio-economic backgrounds with music training retained reading skills over the course of a year better than those without (Slater et al., 2014).

Music training has also been shown to affect encoding speech sounds, auditory working memory, and attention. In fact, children with music training showed neurological differences in automatic brainstem responses to speech sounds and auditory working memory tasks than other children  (Strait, Hornickel, & Krauss, 2011).  A systematic review of research correlating phonological skills in children with music training showed that students who received 40 hours of music training performed better on rhyming tasks than those who had no music training (Gordon, Fehd, & McCandliss, 2015). Current research suggests that a student’s ability to process and produce rhythms has a strong connection to literacy (Harrison, Wood, Holliman, & Vousden, 2017) and syntax (Gordon, et al., 2015).

The Reality

According to the U.S. Department of Education, National Center for Education Statistics (NCES), in 2011-2012, there were approximately 82,000 music educations in elementary schools across the nation. This was a drop from 103,000 music educators in 2007-08. While 93% of elementary schools offered music education, 78% of the schools offered music class only once or twice per week (U.S. Department of Education, National Center for Education Statistics, 2013). The other 23% offered classes three or more times per week.

The Arts and Speech and LanguageMusic PIN2.png

Despite the evidence showing a correlation between language, literacy, and music; music education tends to end up first on the chopping block in schools across the country due to budget cuts.  If our students are no longer attending music classes, how can we give them some of the music exposure in our therapy sessions to compensate?

The Therapy

Here are just a few ideas on how to increase the use of rhythms and music in therapy:

  • Children’s nursery songs: They are full of rhyming patterns, rhythms, and words with complex phonemic patterns.

  • Rhythm-based cues: Clap out syllables with kids working on weak syllable reduction or have difficulty pronouncing longer words.  For the preschoolers, play hand clapping, rhythm games (as a bonus, you indirectly work on gross and fine motor movements, making your OT and PT happy).

  • Theme songs: For my upper elementary and middle school students working on storytelling, sometimes I use sound effects or music clips to give each character or event a “theme song”.  Those same sound effects and music clips can then serve as auditory cues during the retell.

As speech-language pathologists in the schools, we are often presented with challenging cases and asked to to unlock a child’s ability to communicate. Perhaps music could be one of those keys.

Peter Kao, MS, CCC-SLP is a speech-language pathologist working in Milwaukee, Wisconsin. His interests include early childhood language, fluency, and voice disorders. You may contact Peter on LinkedIn.


Gordon, Reyna L., Hilda M. Fehd, and Bruce D. McCandliss. (2015) "Does music training enhance literacy skills? A meta-analysis." Frontiers in psychology 6.

Gordon, R. L., Shivers, C. M., Wieland, E. A., Kotz, S. A., Yoder, P. J., & Devin McAuley, J. (2015). Musical rhythm discrimination explains individual differences in grammar skills in children. Developmental Science, 18(4), 635-644.

Harrison, E., Wood, C., Holliman, A. J., & Vousden, J. I. (2017). The immediate and longer‐term effectiveness of a speech‐rhythm‐based reading intervention for beginning readers. Journal of Research in Reading.

Slater, J., Strait, D. L., Skoe, E., O'Connell, S., Thompson, E., & Kraus, N. (2014). Longitudinal effects of group music instruction on literacy skills in low-income children. PLoS One, 9(11), e113383.

Strait, D. L., Hornickel, J., & Kraus, N. (2011). Subcortical processing of speech regularities underlies reading and music aptitude in children. Behavioral and Brain Functions, 7(1), 44.

U.S. Department of Education, National Center for Education Statistics (2013).Number and percentage distribution of teachers in public and private elementary and secondary schools, by selected teacher characteristics: Selected years, 1987-88 through 2011-12. [Table] National Center for Education Statistics.  Retrieved from

The Arts and Speech/Language Development: Visual Art

By Peter Kao, M.S., CCC-SLP

This is part 2 of a three-part series discussing speech and language development and the arts.
Part 1 was about Music.

"All art is communication of the artists' ideas, sounds, thoughts; without that no one will support the artist."
- Lionel Hampton

The creation of visual art has been shown to be an effective tool in the emotional development of children, especially in how they handle negative emotions (Brown & Sax, 2013; Dalebroux, Goldstein, & Winner, 2011).  But what about language development?  While there is not a large body of  research linking visual art to language development, there is some research available..  This post covers some of this  research and discusses how visual art can be used to enhance speech/language therapy sessions.

The Research

Research on visual art and its effect on language development is limited.  For children with Autism Spectrum Disorders (ASD), current research suggests that interventions using drawing as a medium can increase expressive language output, especially if descriptive language is incorporated to describe the  art and emotions depicted in the art (Round, Baker, & Raynor, 2017).  Group art therapy intervention has also been shown to increase social skills, such as assertion, in children with ASD.  Negative social behaviors, such as internalization and hyperactive behaviors, decreased in children with ASD as a result of being able to draw to express their emotions (Epp, 2008).


visual arts in language development

Coates and Coates (2006) found that in typical preschool programs in the UK preschool children’s art showcased a wide variety of interests and continued scenarios from previous imaginative play.  When children were given the opportunity to draw  in pairs or groups rather than with an adult, language focused on the content of the art.  Children shared ideas, asked each other questions, discussed the content of their pieces, and used descriptive language to share their art with others (Coates & Coates, 2006).

The Therapy

One common pitfall that many therapists (myself included) fall into when discussing children’s art is asking the question, “What did you draw?” leading to short, concrete responses instead of allowing the children to freely express themselves.  As therapists, I believe we should use the same procedures eliciting language samples through art as we do with interactive play by following the child’s lead and allowing him/her to discuss the drawing while the therapist comments and responds.

While more research needs to be done in the area of visual art and children’s language development, using and creating art allows children to express their interests and emotions, and use personal narratives to describe what they are seeing, feeling, and experiencing.

Peter Kao, MS, CCC-SLP is a speech-language pathologist working in Milwaukee, Wisconsin. His interests include early childhood language, fluency, and voice disorders. You may contact Peter on LinkedIn.

Brown, E. D., & Sax, K. L. (2013). Arts enrichment and preschool emotions for low-income children at risk. Early Childhood Research Quarterly, 28(2), 337-346.

Coates, E., & Coates, A. (2006). Young children talking and drawing. International Journal of Early Years Education, 14(3), 221-241.

Dalebroux, A., Goldstein, T. R., & Winner, E. (2008). Short-term mood repair through art-making: Positive emotion is more effective than venting. Motivation and Emotion, 32(4), 288-295.

Epp, K. M. (2008). Outcome-based evaluation of a social skills program using art therapy and group therapy for children on the autism spectrum. Children & Schools, 30(1), 27-36.

Round, A., Baker, W. J., & Rayner, C. (2017). Using Visual Arts to Encourage Children with Autism Spectrum Disorder to Communicate Their Feelings and Emotions. Open Journal of Social Sciences, 5(10), 90.


"Stop Copying Me!" Echolalia and Autism

“Stop copying me!”  The 4-year-old snaps at her 2-year-old brother.  

“Copy me,” he exclaims in glee, echoing her last few words.  This scenario may seem familiar to you if you have interacted with very young children.  This pattern of imitating the speech of others is called echolalia.  Echolalia, or repeated speech, is a natural part of language acquisition and usually decreases as a child begins to generate his/her own utterances spontaneously.  


%22Stop Copying Me!%22_PIN.png

Echolalia in individuals with autism, however, often persists for much longer periods of time.  In children with autism echolalia has been described as a persistent phenomenon and is often described as one of the most common language symptoms in autism (Saad & Goldfeld, 2009; Sterpni & Shankey, 2014). Even deaf children with autism have been found to demonstrate echolalia in their use of echoed signs (Shield et al., 2017).

Echolalia:  Delay or Disorder?

While many disciplines have believed in the past that echolalia has no communicative function and as such should be discouraged, speech-language pathologists have long held that echolalia has important communicative and cognitive functions (Prizant & Duchan, 1981).  In her book, Natural Language Acquisition on the Autism Spectrum: The Journey from Echolalia to Self-Generated Language, Marge Blanc further specifies that echolalia should be considered a delay, not a disorder (Blanc, 2012).  Dr. Barry Prizant, author of Uniquely Human: A Different Way of Seeing Autism, recently shared the following thoughts on echolalia:

Research has found that some forms of delayed echoic utterances are produced with intent; that is, the utterances are produced as a means to an end or for the purpose of accomplishing some goal (e.g., requesting objects, directing others' behavior, labeling, etc.). It is possible that, due to specific linguistic formulation difficulties, autistic persons must often rely on utterances "borrowed" from others in order to express their needs and intentions . . . even though the internal structure (i.e., semantic-syntactic relationships) of such utterances may not be analyzed or fully comprehended (Prizant, B., Email Communication, October 30, 2017).

Types of Verbal Echolalia

Echolalia can be divided into two types, immediate and delayed.  Immediate echolalia, as suggested by its title, is echolalia that occurs very close to the modeled stimulus.  For example, “This is fun!” imitated as “fun!” by a child with autism after the clinician says it.  This type of echolalia typically occurs within two conversational turns (Prizant & Duchan, 1981; Stiegler 2015).  

Delayed echolalia, on the other hand, is echolalia that occurs some time after the modeled stimulus has occurred.  This is often informally called “scripting.”  For example, a child who repeats an entire episode of his favorite TV show viewed the evening before may be said to be “scripting.”  Another example of delayed echolalia or “scripting” is a child who repeats, “Johnny, no,” on his morning bus ride even though the words were said by his mother much earlier.  Delayed echolalia is echolalia that occurs after two or more conversational turns (Prizant & Rydell, 1984; Stiegler 2015).  

Meaning in Echolalia/Another Way of Acquiring Language

Some researchers have suggested that delayed echoes are more likely than immediate echoes to be produced with evidence of comprehension (Rydell & Mirenda, 1994).  Through observation and study of the child’s language, clinicians can often determine whether an echoed utterance has meaning in that particular context (Stiegler, 2015).

An example from my own clinical practice comes to mind.  I had a student who “scripted” regularly.   On this particular day, I was taking a little longer than usual to get his favorite activity together.  His scripts kept employing the phrase, "You're wasting my time. You're wasting my time," in a string of other longer, and seemingly meaningless, comments.  Eventually I began to observe the repeated phrase and realized he was trying to tell me "you're wasting my time" even though he was actually repeating the phrase, “Something's wrong with you, really. You're wasting my time. I have to find my son.”  Blanc describes this phenomenon as a “language soup” of sorts.  She explains that meaningful and useful phrases can be extracted from this “language soup” and mixed and matched to form new meaningful and useful phrases (Blanc, 2012).

 While many typically developing children begin learning language by first using single word utterances and then combining those words into longer and longer utterances, children with autism may acquire language differently by first capturing “sentence-length strings” and then pulling out individual words and phrases.  Both methods of learning language are said to be valid (Blanc, 2012; Stiegler, 2015).  In the example from my own clinical practice, my student used a “sentence-length string” to convey his impatience rather than a single word “hurry.”

One of our goals as clinicians working with children who demonstrate echolalia is to help the child begin to recognize and use functional words and phrases repeated in their echoed utterances and to use those words and phrases to begin to generate their own utterances for the purpose of commenting, requesting, refusing, etc.  In response to my student’s use of delayed echolalia to communicate, I responded by agreeing and apologizing.  “We’re wasting time.  Sorry.  Almost done."  He stopped scripting that line immediately after.  

How Can Clinicians Help?

So, how can clinicians effectively help children who frequently produce echoed utterances to use them in a clear and meaningful manner?  The following are a few suggestions from the literature and clinical experience:

  1. Complete comprehensive language sampling and analysis in order to determine what utterances are frequently echoed and the context in which they are being used across settings (Blanc, 2013; Stiegler, 2015).  

  2. Model developmentally appropriate phrases that are specific to the individual’s interests and intentions and are immediately useful (Stiegler, 2015).  

  3. Give the child an opportunity to hear utterances similar to his/her scripts in different contexts (Blanc, 2013).

  4. Provide planned language experiences for the child. This works best if you understand the child’s loves and interests and are familiar with his/her frequently used “scripts” (Blanc, 2013).

  5. Respond with comments or affirmations (Davis, 2017).

  6. Give plenty of opportunities for the initiation of spontaneous communication by shaping therapy sessions around preferred and enjoyable tasks.

  7. Create opportunities where the child must initiate communication to achieve a goal (e.g., favorite activities visible, but just out of reach). This is also known as creating ‘temptations,’ or using sabotage.

  8. Ensure teachers and parents are following a similar plan to help with generalization of skills to other communicative settings.

Echolalia should not be automatically viewed as mindless repetition of words and something that should be discouraged at all costs.  Echolalia is more than just a part of the many symptoms of autism spectrum disorder.  Echolalia is a part of society as a whole. It is a natural part of language acquisition and often leads to self-generated utterances.  Perhaps the next time you catch yourself using a funny phrase from a movie in conversation with a peer, or observe a small child imitating an older sibling, you will reflect further on echolalia and the role it plays in the development of language.


Givona A. Sandiford, Ph.D., CCC/SLP, is a licensed speech–language pathologist with over ten years of experience working with individuals with autism and other speech/language disorders. Dr. Sandiford has served as a speech–language pathologist in public schools, alternative schools, outpatient clinics, home health, private practice, and various other settings. She has also served as a peer reviewer for the Journal of Autism and Developmental Disorders. She is the owner of MeloComm Speech and Language Therapy and the developer of Melodic Based Communication Therapy (M.B.C.T.) for nonverbal autism, which was the subject of her dissertation research. Her research on Melodic Based Communication Therapy was the recipient of the LLU School of Allied Health Professions 2013 Outstanding Doctoral Research Award and has been published in and cited by multiple publications in peer–reviewed journals.  Dr. Sandiford enjoys research, reading, writing, painting, creating apps to help treat speech and language impairments, and working closely with students with disabilities.




Blanc, Marge (2012). Natural Language Acquisition on the Autism Spectrum: The Journey from Echolalia to Self-Generated Language.  Madison, WI. Communication Development Center Inc.

Blanc, M., Prizant, B., Snow, M., & Lee, K. (2013). Natural Language Development in Autism: Echolalia to Self-Generated Language. American Speech-Language-Hearing Association Convention. (Natural Language Acquisition Summary Handout (Blanc, 2012)). Retrieved from:

Blanc, M. (2013, March/April). Echolalia on the spectrum: The natural path to self-generated language. Autism/Asperger's Digest. Retrieved from

Davis, K. (2017). Echoes of Language Development:  7 Facts about Echolalia for SLPs. The ASHA Leader Blog. Retrieved from

Prizant, B., & Duchan, J. (1981). The function of immediate echolalia in autistic children. Journal of Speech and Hearing Disorders, 46(3), 241-249.

Prizant, B., & Rydell, P. (1984). Analysis of functions of delayed echolalia in autistic children. Journal of Speech and Hearing Research, 27, 183–192.

Rydell, P., & Mirenda, P. (1994). Effects of high and low constraint utterances on the production of immediate and delayed echolalia in young children with autism. Journal of Autism and Developmental Disorders, 24, 719–735

Saad, A., & Goldfeld, M. (2009). Echolalia in the language development of autistic individuals: a bibliographical review. Pro-Fono, 21(3), 255-260.

Shield, A., Cooley, F., & Meier, R. (2017). Sign Language Echolalia in Deaf Children With Autism Spectrum Disorder. Journal of Speech, Language, and Hearing Research, 60(6), 1622-1634

Sterponi, L., & Shankey, J. (2014). Rethinking echolalia: Repetition as interactional resource in the communication of a child with autism. Journal of Child Language, 41(2), 275-304. doi:10.1017/S0305000912000682

Stiegler, L. (2015). Examining the Echolalia Literature: Where Do Speech-Language Pathologists Stand? American Journal of Speech-Language Pathology, 24, 750-762. doi:10.1044/2015_AJSLP-14-0166




Crafty Creations: Gingerbread People

By Peter Kao

Using art and craft projects in your therapy is a great way to keep kids engaged while they practice their speech and language skills. Creating visual art has been shown to increase verbal output and nonverbal communication, specifically in children with autism spectrum disorders (Round, Baker, & Raynor, 2017).

Recommended age: 6 years and up

Bring Crafty Creations _FB.pnggingerbread man craftivity


To create this Crafty Creation, you will need the following materials (most of which should be available at your local craft store):


  • Prefabricated craft foam gingerbread figure cutouts

  • Assorted 3-D rhinestone stickers

  • Assorted colors of decorative tape*

  • Googly eyes (optional)

    * Certain kinds of tape don’t have enough adhesive to stick to the craft foam.  Colored electrical tape, decorative duct tape, or drawing with markers can be good alternatives.


Below is a list of how speech and language skills that can be targeted using this craft.



  • Articulation / Phonology:  Every 5-10 productions adds a decorative item to the gingerbread man.

  • Expressive Language:  Labeling body parts, requesting, using descriptive language (describing where items are placed, what the gingerbread figure looks like).
    Upper elementary, middle, and high school students may create a story about their gingerbread characters.

  • Receptive Language:  Following multiple step directions.



Literary tie-in: Read or watch a telling of the classic folktale, The Gingerbread Man.  
This would be a great extension for students working on retelling stories , answering wh-questions, identifying main idea, and inferencing/predicting.


Round, A., Baker, W. J., & Rayner, C. (2017). Using Visual Arts to Encourage Children with Autism Spectrum Disorder to Communicate Their Feelings and Emotions. Open Journal of Social Sciences, 5(10), 90

Peter Kao, MS, CCC-SLP is a speech-language pathologist working in Milwaukee, Wisconsin. His interests include early childhood language, fluency, and voice disorders. You may contact Peter on LinkedIn.


Executive Functions – Falling Within the Speech-Language Pathologist’s Scope

Executive Functions – Falling Within the Speech-Language Pathologist’s Scope

Many Speech-Language Pathologists agree that there is nothing greater about our field than its amazing diversity. I have been told by my mentors several times, “you will never work with two clients who are the same.” It is inherently clear that each person is their own unique individual. The various speech and language disorders are just part of what makes the people we serve so diverse. From your basic articulation case, to apraxia, fluency, AAC, swallowing/feeding, and TBI, there is a reason why the Praxis training booklet is so large. Even with all of this incredible diversity, there are still some glaring similarities. Many of us know that one child who loves to read, speaks with excellent vocabulary, yet cannot seem to stay organized, remember their homework, or complete a task. The one child who has several friendships, yet cannot control their impulses at home. How can one child be so strong in so many areas, yet fall short at the simplest tasks that we all seem to complete unconsciously everyday? What these children lack is a specific set of skills. Neuroscientists who have studied child and human development have specified these as skills of Executive Functioning – the skills needed to execute, learn, and live productively. 

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Therapy Games Are Serious Business

Yes, we speech therapists play games with our kids.  To the casual observer, playing a game during speech therapy looks a lot like, well, playing a game. The game itself is overt; the part that people see. The speech-language therapy piece is covert.  We covertly observe and strategize to give them what they need at that moment in time.  We analyze intensively, then do, to shape and ease the child into improvement.  It’s therapy, not teaching.

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Back to School: We’re All in this Together

It’s that time of year again: stores are stocked with school supplies, yellow school buses have come out of hibernation, and the Fall air is energized as everyone returns to school...This article discusses factors in the school setting that can help increase team collaboration, ultimately improving students’ academic growth.  Here, we discuss the role of the SLP in fostering collaborative relationships.

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Down Syndrome: What is Down Syndrome? - Part 1

Down syndrome is one of the most common causes of intellectual disability. An intellectual disability is a disability that greatly affects mental abilities and adaptive behavior. Mental abilities include learning, reasoning, planning, problem solving, and so on. Adaptive behavior includes everyday skills needed to live, work, and interact with others in the community.

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Selective Mutism: The Role of Speech-Language Pathologists

Selective mutism is an infrequent childhood communication disorder that often first manifests itself at school. A child with selective mutism may not be able to speak with teachers and/or peers at school, however, is able to speak fluently with parents and siblings at home. School based speech language pathologists (SLPs) often are the first consulted when a child does not speak at school. This article discusses the definition of selective mutism, characteristics, etiology, and the role of SLPs in assessment and treatment as a part of an interdisciplinary team.                    

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Service Delivery Models Utilized by School Based Speech-Language Pathologists

Speech-language pathologists (SLPs) who work in schools have the opportunity to provide therapeutic services through a variety of service delivery models. A service delivery model can be understood as an orderly arrangement of resources with the purpose of meeting a specific educational goal (Cirrin et al., 2010). It specifies “where, when, and with whom the intervention takes place” (Paul & Norbury, 2012, p. 88). The four main types of service delivery models discussed in this article include: 1) pull-out model, 2) push-in model, 3) consultant model, and 4) response to intervention (RTI) model.

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Co-Created Curriculum: Motivating Students Using their Interests

Co-Created Curriculum: Motivating Students Using their Interests

"I’ve been thinking a lot recently about the importance of creating and using materials that are specific to the interests of the kids that I serve. With that in mind, I decided that the next step wasn’t to keep repurposing materials that may or may not still be engaging or culturally relevant for our kids. Instead, I decided to ask them what they would want to do if they could make a game. The first answer that I got, of course, was a blank stare.

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Caseload or Workload, That is the Question....

Caseload or Workload, That is the Question....

Given the ever expanding role of the SLP in the district, there needs to be a solid push to move to the workload model. The push must come from families of students and the professionals themselves. SLPs are expected to serve a widening population. We must do this and provide the students with the amount of therapy that is to be determined by their need, not by the amount of students on the caseload.

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