Modern Secondhand Smoke : The Principle of Unintended Consequences Applied

One thing that we as a society have become guilty of is becoming overly connected to our phones. The ramifications of this societal fault are many but one in particular that I would like to focus on is the impact it has had on our toddlers. The average adult picks up their phone 58 times per day for a total of 3 ½ hours spent looking at a screen. Multiply those numbers times 7 (for all the days of the week) and that calculates to picking up your device 406 times and viewing your it for 24 ½ hrs. May I hasten to ask what other thing you do that gets 406 repetitions per week? Is it possible to at least reallocate 12 hours to your children and/ or grandchildren? And what are you teaching your posterity by looking at your device the amount of times that you do?

Now as a speech-language pathologist I’m not in the business of condemning behavior rather I am tasked to help families address a speech and language deficit that is present within their household. And this is certainly one of them. The CDC earlier this year changed the speech milestones for children between 15-30 months due to the data they collected starting from 2004 to 2019. In my opinion, though the data collected was sound, they neglected to continue to utilize all previous data before this time period. In addition, they did not take into consideration the technological boom that has immersed itself into our culture. The access we have and amount of time spent watching TV, sitting in front of a computer, or looking at a phone are all key variables that are relatively new to humanity and should be taking into account when assessing a child’s development. As a parent I understand how easy it is to put your child in front of a screen especially if it helps them calm down or allows them to sit still while you wash the dishes or fold clothes. However, we have to remember that previous generations did not have this luxury during their time at home. Instead, they spent a lot of time talking to their children and incorporating them while taking care of tasks.

One area that speech-language researchers have been focusing on since the 1960s is the “30-million-word gap.” On average, by age three a child who spent time with a parent at home hears about 30 million more words compared to a child who did not get to spend time with a parent at home. The results from this 30 million word gap were delays with their speech and language that not only effected the child in the short term but also long term. Another study came out noting that before starting kindergarten, a child whose parent reads to them at least five books per day has heard 1.4 million more words than those who were never read to. Now, let’s add the amount of time spent consuming tv and/or glazing over our devices and we are creating an even larger gap with our kids…

The last piece I would like to leave with you is a quote from the 2020 American Speech and Hearing Association President:

“But anyone raising or caring for children today should know this hard truth: When parents or caregivers spend too much time turning away from their kids and toward technology, the foundation for a child’s communication skills is weakened. In a world with competing priorities and limited time, experts in my field of speech and language development are already seeing the impacts on children who have missed out on hours of essential, real-life face time—and the results are concerning.

Many of my colleagues across the nation say they are seeing more children entering kindergarten with limited communication and social skills. Older children, they say, are unable to handle formal social interactions, like ordering from waitstaff at a restaurant.”

In our year 2022 this statement has become much more apparent and obvious. May we remember that technology is a wonderful tool that advances each of our lives. However, like any other tool, it can be misused and have the inverse effect in damaging our lives instead of flourishing it. May you use your tools to bring about even greater minds than what we experienced in any other generation.

Treating Disfluencies

The first thing to keep in mind when developing fluent speech is that none of us will ever have 100% fluency when conversating throughout the day. On average, people are about 3% disfluent. Second thing to keep in mind is that fluency techniques must be practiced consistently overtime. Stuttering does not resolve itself over a brief period. Increasing our fluency typically takes lots of practice over a long period of time to heighten awareness and solidify correct use of techniques.

What makes NEATS unique with treating stuttering and cluttering is that we are not only proficient with traditional therapy techniques (stuttering modification, fluency shaping, etc.) but we also utilize newer techniques like the Camperdown and Lidcombe programs. To our knowledge, no speech-language therapy clinic in the state is offering these types of programs except us. So, if you want the best and most current fluency therapy in Nevada, reach out to us. We would love to help!

Talking To Your Baby

toddler wearing head scarf in bed

The most important thing to do when talking to your baby is bombarding them with lots of language. Talk about everything! Do it in a way that is animated and interesting. You’re going to look goofy, if you don’t, you’re doing it wrong ;). Do your best to use short sentences or two-word phrases (e.g., milk want?) to help your baby process what is being communicated.

In conjunction with a short phrase, you should also employ representational gestures (AKA sign language). Be intentional and thoughtful about the short phrases you can use throughout the day. Take some time to think about some short phrases you can use… Lastly, when your baby is beginning to make raspberry sounds or cooing, remember to imitate them. Imitating your baby will eventually lead to him or her imitating you!

Simultaneous Bilinguals

Did you know there are different types of bilinguals? In speech-language pathology circles there is a distinction between a simultaneous and sequential bilingual. The latter will be covered in a future blog, however in this blog we will discuss the former. For the purposes of this discussion, a simultaneous bilingual is defined as a person who acquired two languages from birth or at least before the age of three. Simultaneous bilinguals are considered to be comparable to monolinguals in reaching early language milestones at the same rate as monolinguals (babbling, first words, etc.), they are just as good at learning new words, and most times have a larger repertoire of words at their disposal.  

That said, if a child is being spoken to in two separate languages there must be lots of input through both languages for the child to be considered proficient. There are studies that find that children who go to school, and are considered simultaneous bilinguals, do not do as well transitioning into the school setting since there are many more novel words that they have not heard that perhaps a monolingual child may have heard inside the home. The simultaneous bilingual child has a word in both languages for a spoon or a pan (those being items that are seen with high frequency around the house) but does not have a word to talk about a desk, an eraser, or a slew of other school items that are not seen as frequently when a child is growing up around the house. Please see chart below to conceptualize what was just written.

All that considered, though there may be a brief period where the child is delayed in verbalizing (not all bilinguals go through this silent period) or there is a season where they need to catch up with their peers in school, eventually a child does catch up with their monolingual peers and eventually surpasses them in overall vocabulary due to the maturation in both languages. It is our persuasion here at NEATS to encourage parents to raise their children in a bilingual context. Just make sure that you are speaking to your child as much as possible in both languages by bombarding them with various and consistent words, so that they are able to familiarize and learn both languages in a very language rich context.

Patriot Award

Recently, Rebecca Bailey-Torres has been presented the Patriot Award. The Patriot Award reflects the actions made to support citizen warriors through a wide-range of measures including flexible schedules, time off prior to and after deployment, caring for families, and granting leave of absence if needed. Rebecca has supported Israel Montano in his participation with the Navy Reserve and is rightly due this award for her exemplary efforts.

On February 12th Rebecca will be participating in an award ceremony where Governor Steve Sisolak and Major General Ondra Berry will be publicly recognizing her for the support she has provided for her employee and country. Please join me in congratulating and thanking Rebecca for her support!

Israel Montano


2020 was a historic year that hit the world like no other, and in light of COVID-19 impacting our digital age, this blog is revolved around the pro’s and con’s of a now very well-known topic, teletherapy (therapy online). We realize that many are tired of being glued to a screen and want nothing more than to have a concrete face to face interaction. That said, when it comes to therapy, there are benefits to having it online, and of course some draw backs.


  1. Developing therapy skills in a clinician’s office is great when building a foundation before going into the real world, however, rarely is the therapy happening out in the real world. So, how much of what is happening in the therapy room impacting how a person communicates in the real world (generalization)? A fixed and controlled setting (therapy room) is different than a home or a workspace, right? This is where teletherapy comes in handy. Not only are you getting therapy, but you are receiving it in a place where you normally habitat. This enhances the generalization a person receiving from therapy.
  2. There is no added commute to your day. If you are an adult, therapy can potentially happen in your car. If therapy is for a child, you can go directly home after school instead of making an additional trip to the clinician’s office. And when at home, you can be involved in your child’s therapy while also taking care of other things around the house. Having experience with teletherapy, a parent is not always needed during that time, however, it is most profitable if they are present for most of the session. Moreover, when a parent is intimately involved in a session and applies what is being labored in therapy to around the house, the amount of time it takes a child to improve decreases significantly (generalization). Who doesn’t want to shorten their time in therapy?!


  1. If one spends most of the day on a computer then transitions to doing therapy on the computer, this can be unbeneficial to your posture and potentially the efficacy of the therapy due to computer fatigue syndrome. If it is possible to see a clinician in-person, then it is best to go this route. You never want to compromise efficacy for convenience. Additionally, whether you are an adult or child, it is easier to be distracted when one is fatigued.  
  2. Truly, there is no replacement to the quality interaction one has when talking with a person face to face. Though teletherapy can provide a digital face to face interaction, it is very different from having someone tangibly in front of you. Now, if you are a shy introvert then this might be a pro, nevertheless for this blog, it is considered a con.

There are several other points to make for each case but for sake of brevity, we will digress here. Keep in mind that NEATS is providing both teletherapy and in-person services, and concomitantly building a track-record of excellence in both areas of service.

I Never Knew I had a Tongue Tie!

After being trained in orofacial myofunctional therapy a year ago, I realized about 2 months ago that I had a posterior tongue tie. What is that you ask? Well, it is a tongue tie which cannot be diagnosed like an anterior tongue tie which most of the public could see and identify. It must be diagnosed through a functional assessment. For me I realized that the floor of my mouth would lift as a compensatory strategy for reduced tongue range of motion when I was demonstrating for patients during therapy.

Then I started thinking about all the red flags I had over the years. I was a difficult child with temper tantrums (but not if my dad was around). I had braces for 4 years and my teeth have moved. I’ve always had a difficulty swallowing pills. I’ve had temporomandibular joint (TMJ) dysfunction. I’ve had more than one surgery to graph my gums. My mouth muscles would cramp when yawning. I held stress in my neck and back.

On Monday, December 7th, I had a frenectomy. Now I know what my patients go through when I refer them for this procedure. There is pain involved, but within 24 hours of the procedure I noticed less back and neck tension.  Many common ailments are signs or symptoms of a tongue tie. Please refer to our orofacial myofunctional tab for more information.

Diagnosing Disfluencies (stuttering)

One of the most common diagnosis people think about when finding out what I do for a living is stuttering. Stuttering is a diagnosis that is on a continuum, there are some cases that are severe and others that are mild. Additionally, there are many different stuttering types. See below for the types of disfluencies you would see with people who stutter:

– Repeating whole words (I, I, I, I want a cookie)

– Repeating first sound or syllable of words (C-C-Can: Mo-Mo-Mommy)

– Repeating ends of words (are we going ing ing there?)

– Prolonging first sound of word (MMMMMMommy)

– Tense blocks at beginning of words (C-an I go?)

– Insertion of silent pauses or broken mid word (y—ou know)

The above list is known to be core stuttering like disfluencies. There is also another set of disfluencies that is common with children who stutter however, if seen without any of the core disfluencies, then your child wouldn’t be considered to have stuttering, but potentially cluttering, depending on the frequency of these type of disfluencies:

– Re-phrasing or revising ideas (can we, I want to go there)

– Adding extra words or “fillers” (um, you know)

– Repeating a whole phrase (I like to, I like to)

– Hesitations at the beginning of a sentence (….uh well I don’t think)

Two more things to note. First, we all have disfluencies in our speech. There is not one person that doesn’t produce one of these types of disfluencies covered, and if you pay close attention, I bet you would realize it happens a lot more than you think. Second, there are other characteristics needed to diagnose stuttering. What has been covered in this blog is the larger indicator of the several indications that lead a clinician to diagnose a person with stuttering. Among those other indications are:

– Physical manifestations (eye blinking, twitching, etc.)

– Self-awareness

– Age

– Length of time person has had disfluencies

Speech-Language Screeners

The purpose of screening is to determine if your child should be evaluated with formal and informal assessments. It should be noted that screeners are flawed in so far as a child may answer the right amount of questions that qualifies a “pass,” when in reality they guessed to achieve that pass or if the question was posed in another way perhaps the child would’ve missed and thus, would merit a “did not pass.”

To mitigate the flawed nature of a screener, there should also be a component that is administered to parents to get a higher quality snapshot of the child’s overall speech and language abilities. We affirm the administration of one should not go without another so, NEATS is now offering free parent screenings and a free child screening. If interested, click this link to find your parent screener or scroll over the “resource” tab and click on “Speech-Language Parent Screener/Questionnaire.” Choose the appropriate age, fill out the form, and then we will be in touch to set up a time for your child’s screening.

Again, this is not a way to ensure your child needs speech and language services. This is to ascertain if they need a more in depth evaluation.

*Though there is a screener for parents of children under the age of two, there are no free child screeners provided for children under the age of three at this time.


adorable blur bookcase books
Photo by Pixabay on

Rhyming is a necessary building block for developing your children’s ability to use and manipulate words. Not to mention how fun and silly it can be for them. The typical age that a clinician expects children to rhyme is at 3-years-old. At this age, your child should be able to produce non-sense words that could rhyme with “cat” (e.g., dat).  Ideally, you want to encourage real words to rhyme with however, at 3 years of age it is important for them to understand how words can sound similar and yet different at the same time.

Why is this important?

It is imperative to be cognizant of how well they rhyme because it can act as an indicator for 1) your child’s hearing ability and 2) your child’s sensitivity to the sound structures in speech. For a little more about the hearing component read here. Regarding their sensitivity to speech, rhyming is the gate way to further a child’s understanding about words and the impact a single sound can make on a word. Once a child demonstrates sensitivity to rhyming, they are much closer to be a well-suited student in learning how to read.

Things to do

  • You can watch/learn rhyming songs like these here and here. I know the videos are a little cheesy however that is high quality for kids!
  • While you are cooking you can make fun rhymes about the food your making or the utensils you are using
  • Create a rhyme book from this free resource from Florida Center for Reading Research

If you have further interest behind the science see the book references and research below:

Bradley, L., & Bryant, P. (1985). Rhyme and reason in reading and spelling. Ann Arbor, MI: University of Michigan Press.

Bryant, P., MacLean, M., & Bradley, L. (1990). Rhyme, language, and children’s reading. Applied Psycholinguistics, 11, 237-252.

Moats, L. & Tolman, C. (2008). The Development of Phonological Skills.

Snow, C., Burns, M., & Griffin, P. (Eds.). (1998). Preventing reading difficulties in young children. Washington, DC: National Academy Press.