How to Use The Language of Baking

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Do you want to spice up your therapy sessions? Try this no fail recipe for pumpkin brownies. They are moist, full of chocolate flavor and absolutely delicious. You will not miss the additional oil or eggs in this recipe. There are only two ingredients, which make it easy to make and fit into a therapy session.  Whenever I bake during a therapy session, I try to focus on very simple recipes so that more time could be spent on speech and language goals. When you try to create a recipe that is too complicated, you can get lost in the activity and lose sight of your speech and language goals.

From my perspective, language and baking naturally occur together. Children really enjoy baking because it can be a stimulating sensory activity as well as language rich activity. When baking in a group, pragmatic language goals can be easily targeted (topic maintenance, turn taking, appropriate topics, etc).

The ingredients in this recipe do not need to be refrigerated and are easily found at any supermarket. They are also very affordable and yield about a dozen brownies! With no added fat, they are much healthier than the normal brownie. Also, the brownies do not contain any additional eggs or oil.

Ingredients:

1 can of pureed pumpkin (15 oz can of pureed pumpkin, not pie filling)

1 box of brownie mix (I used chocolate fudge brownies, 19.5 box)

Sprinkles or topping of your choice

Directions:

  1. Preheat oven to 375 degrees.
  2. Wash hands.
  3. Grease 8 X 8 inch square pan.
  4. Open brownie box and pumpkin can.
  5. Combine pumpkin and brownie mix in a bowl.
  6. Stir until smooth.
  7. Pour batter into greased pan.
  8. Sprinkle batter with topping of your choice (I used 3-4 tablespoons of sprinkles).
  9. Bake at 350 degrees for about 30-35 minutes or until done (till toothpick comes out clean).

10. Cut and let cool.

11. Eat and enjoy!

pumpkin brownies

Ten  speech and language goals that can targeted during baking time:

 

  1. Sequencing. Work on “first, then” and have the child retell the steps to the recipe in the correct order.
  2. Following Directions. Work on one- to two-step directions (e.g. “open the box and pour in the brownie mix”).
  3. Asking For Help: Create situations that a child needs to ask for help such as opening the box of brownies or opening the can of pumpkin.
  4. Expanding vocabulary. You can expand the child’s vocabulary by focusing on new vocabulary such as cooking utensils, ingredients, appliances, etc.
  5. Turn taking. This recipe is excellent to do in a group. Each child can take a turn pouring the ingredients into the bowl, stirring the mixture together and pouring it into the pan. Use a turn card when baking so that each child knows when it’s their turn.
  6. Describing. Have your client describe the ingredients focusing on what they look, smell and feel like. Have the child taste the pumpkin and describe the flavors. Discuss the colors of the ingredients and toppings (if you are using). Does the pumpkin look smooth? What does the brownie mix feel like? What does it smell like?
  7. Actions: Focus on actions such as, “wash,” “open,” “pour,” “combine,” “stir,” “bake,” “cut,” “sprinkle,” “eat,” etc.
  8. Choice making: Baking time is an excellent opportunity to improve choice making such as choosing what step they would like to do, what topping they want, etc. Although the recipe seems very simple, there are a lot of opportunities for making choices.
  9. Recalling information/narratives: Ask the child questions such as “What did we do first?” etc. Ask the child to tell you a story about “making pumpkin brownies.” When you are baking, take some photos with your phone or camera (if you have written permission) and use the photos to recall information and create a narrative. There are many wonderful apps out there that are ideal for creating stories with photographs. Don’t have an electronic device? Have the child draw a story about the pumpkin brownie activity.
  10. Pragmatic language goals: When baking together, pragmatic goals can be worked on. Discuss appropriate and inappropriate language and behavior when baking. If you are baking in a small group, help facilitate conversation between peers and encourage maintaining appropriate topics of discussion.

If your client is nonverbal or minimally verbal, create a communication board so they can communicate during the activity.

Carryover Books: Try reading some of these books after making the brownies together. These books can help carryover the concept of pumpkins and baking.

How Many Seeds in a Pumpkin? By Margaret McNamara

Seed, Sprout, Pumpkin Pie by Jill Esbaum

Betty Bunny Loves Chocolate Cake by Michael Kaplan

It’s Pumpkin Day, Mouse! By Laura Numeroff and Felicia Bond

Carryover Activities: Bring in a small pumpkin and decorate it during a therapy session. Each child can take home a small pumpkin that they decorated themselves.

Becca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor, and parent of two young children, who began her website www.gravitybread.com to create a resource for parents to help make mealtime an enriched learning experience . She discusses the benefits of reading to young children during mealtime, shares recipes with language tips and carryover activities, reviews children’s books for typical children and those with special needs as well as educational apps. She has worked for many years with both children and adults with developmental disabilities in a variety of settings including schools, day habilitation programs, home care and clinics. She can be reached at becca@gravitybread.com, or you can follow her on Facebook; on Twitter; or on Pinterest.

 

When Is Treatment for Stuttering ‘Completed’?

asianboy_89387926Both parents and speech therapists alike find themselves struggling to decide when treatment is complete for someone who stutters. Therapy for a child who has difficulty saying their “r”s has a distinct beginning and end (when a child meets criterion for 90 percent accuracy in conversation), however, stuttering is much more variable, by nature. In fact, once a child reaches the age of 8, it is much more likely that their stuttering is going to persist, in some form.

Does this mean that treatment will continue forever? The idea of treatment continuing indefinitely is daunting to both the therapist who has to continue to think of new and exciting activities and the parent who has to both make room in their schedule and in their budget!

Preschool age children
Many children go through a period of “temporary” disfluency as they begin to place more demands on their language system. Preschool children often have not developed the negative reactions to disfluencies that play a role in persistent stuttering that we see in older children and adults. As a result, for a child this age, it makes sense for a therapist (and parent) to aim to eliminate stuttering. I believe that a period of stutter-free speech is necessary to warrant dismissal from therapy for a young child (minimal “typical” disfluencies such as phrase repetitions or sentence revisions may persist).

Following a month or more of stutter-free speech, therapy should be slowly faded, going from weekly visits to monthly visits and finally entering into a monitoring period. This is a period where parents should keep in touch with their therapist to discuss how their child is doing at home and school. It is important to educate parents that stuttering is highly variable and that if a child does not stutter for weeks or even months, the parents should still continue to follow the program the therapist has set up for them and monitor changes in fluency so that they can quickly address a “reoccurrence,” should it occur.

School-age children/adolescents
As a child enters school and begins to demonstrate a more complex stuttering pattern, total elimination of stuttering may not be a realistic goal. Instead, it is more reasonable for a child this age to have a goal of improving their communication skills to include more forward-moving speech, although maybe not completely stutter-free. In addition a goal should be put in place to reduce the negative impact of stuttering on the child’s academic and social life. With these types of goals, it is much harder for a parent or therapist to assess when a child meets criterion for discharge from therapy.

A child should not be discharged unless a therapist determines that stuttering is no longer having a negative impact on how the child is participating in activities, interacting with others and communicating messages. Benchmarks for success cannot be solely based on frequency of stuttering, as a child who stutters on 50 percent of their syllables may be less impacted by their speech than a child who only stutters on 10 percent of syllables. The amount of impact is largely dependent on the severity of disfluencies (for example, blocks versus whole word repetitions), length of disfluencies (for example, fleeting versus 5 seconds), degree of secondary behaviors (for example, eye blinks, tension in lips, loss of eye contact), and child’s temperament.

Even a child who is not demonstrating any obvious disfluencies may be in great need of intervention. It takes a carefully observant therapist and parent to detect if the child that is seemingly fluent is actually masking disfluencies by avoiding words or situations. I suggest that therapy for school-age children who stutter be ongoing and, at the very least, be on a consult basis.

A child may comfortably get through fifth grade, with stuttering having relatively little impact on them, however, that same child may begin sixth grade, in a new school, and suddenly stuttering may play a very different role in their daily life. Having a speech therapist monitoring your child will allow for you to quickly catch any changes that may warrant more direct and intensive therapy.

Adults
With maturity, adults can decide for themselves if they are going through a period when speech has become a priority (for example, when interviewing for a job, gaining a new responsibility at work that involves speaking, dating, relocating, and so forth).

Brooke Leiman, MA, CCC-SLP, is the fluency clinic supervisor at National Speech Language Therapy Center in Bethesda, Md. Brooke hosts a blog focused on stuttering and stuttering therapy at www.stutteringsource.com. She can be contacted at Brooke@nationalspeech.com.

Harnessing Learning Styles

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How many times have you heard someone say, “I’m a visual learner” or “I need to do it to understand it.” These are styles of learning. Depending on what research you find, there are 20, 16, 7, etc… types of learning. Among those styles of learning, I have seen a trend of seven to be the most common: visual, aural, verbal, physical, solitary, social, and logical. While some people can strictly use one style of learning, most are a combination. So let us take a closer look at these learning styles and how we can incorporate them into our speech sessions.
1) Visual (Spatial). People who are visual learners learn best when pictures, images, and spatial understandings are used. A lot of our students tend to be visual learners. They benefit from color coding, picture schedules, and graphic organizers to help understand material and process information. Students who are visual learners may benefit from using a story with pictures when addressing listening comprehension or photos of actions being done when working on verb tenses.
2) Aural (Auditory). Those who are aural learners do best when sound (speaking), music, or rhythms are used. These students may remember something best when it is put to a familiar tune or rhythmic pattern. Tapping or clapping out concept/word meanings can be used to help them improve storage and retrieval of information.
3) Verbal (Linguistic). People who are verbal learners prefer to talk out their questions and thoughts to understand. These are the students who may take the ‘long way’ to answer a question because they are ‘talking’ out their thought process. Give them time and listen closely as they explain. Does their explanation make sense? Is there a logical sequence to their thought process? If you are having trouble determining if they are truly understanding, have them write down ( in quick points ) or draw their thought process out as they explain it.
4) Physical (Kinesthetic). Those who are physical learners, learn best by doing and feeling, rather than seeing and hearing. These students can benefit from crafts and activities that relate to their speech and language goals. These students may benefit from performing actions when working on verb tenses or basic concepts/following directions.
5) Logical (Mathematical). People who are logical learners do best when material is presented in a direct, no fuss manner. They pick up on patterns quickly which makes them stronger with numbers (math). When presenting speech and language concepts to logical learners, try and pair the concept with a real-life, relatable example and keep everything as straight forward as possible. If you are targeting pragmatics, emphasizing expected lunch room conversation and behavior, you may choose to have your session in the lunch (if possible) and create the situation you are attempting to address. Be sure to give clear direction and explanation, for example: “Your friend has your favorite cookies in their lunch and you want some. It is rude to take without asking, so if you want some you need to ask politely. Can you show me how to do that?”
6) Solitary (Intrapersonal). Solitary learners prefer to study alone and teach themselves when possible. These students may say they understand a concept when they don’t in order to allow themselves time to look at and process the information in their own way. When introducing a new speech and language concept or area, give these students time to examine the information themselves. This may be difficult due to the length of sessions, but try to provide them some time, at least 5 minutes. Once they have had time with the material invite them to explain it to you. This will allow you establish their understanding.
7) Social (Interpersonal). Those who are social learners prefer to learn within groups and do best when they can bounce ideas of someone. They do well communicating verbally and non-verbally with others. Students who are social learners may enjoy ‘teaching’ a fellow student a concept they are working on. This will require them to focus and understand their own goal to ‘teach’ the other student.
How to Determine Learning Styles
Now that you have some background about some different learning styles, how do you figure out which of these profiles fit your students? Depending on their age there are a few options.
Early Intervention: Just because your clients are young doesn’t mean they don’t lean toward a particular learning style or two. Parent questionnaires and your observations can help to compile information about how to set up your sessions to be engaging and productive while presenting material that fits their learning style. Babyzone has an online quiz for parents to help gather information about what style of learning their little one may prefer.
Elementary: For elementary students, trial and error and parent questionnaires may be used to gather information. Since elementary students are younger and still learning about themselves, getting insight from parents will probably be the most reliable source of information. Once collected, it will allow you to test out some methods in your sessions to find what works best and what doesn’t. Scholastic has an online questionnaire for parents to fill out about their child’s learning style, just make sure the age parameter is set correctly for the child.
Junior High: These students are a bit more mature than elementary, and have had the time and experiences to hopefully learn a bit more about themselves. You may be able to have students fill out basic learning profile questionnaires or quizzes with you. Piedmont Education Services and Edutopia both have short questionnaires that students can fill out with you. Then you can discuss what the results indicated and if the student’s agree. They may even be able to give you suggestions about what they think may help them.
High School: Oh high school students. If you work within this setting I am sure you have been informed how they already know how they can and cannot learn what works for them and what doesn’t. Allow them to humor you and take another look at their learning style. Accelerated Learning has a 35 question quiz to see what learning style characteristics your high school students demonstrate. Who knows, they may learn something new about themselves. I would also suggest including them in discussions about how to target their learning styles.

Maureen Wilson, M.S., CCC-SLP. is a school based speech-language pathologist from Illinois. She also holds a certificate in Inclusionary Teaching. Her blog, The Speech Bubble offers ideas and resources for speech therapists.  You can follow her on Facebook, Instagram, and Pinterest.

How to Put the ‘Super’ in Supervisor

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Being a supervisor in any setting brings to mind a myriad of responsibilities. Is it best to guide or direct, monitor or inspect, influence or manage? As a supervisor to well over 120 speech-language pathologists in school settings during the past 15 years, I have learned a lot about duties and people.

Each situation or SLP calls for different handling at different times, but staying true to one’s own supervisory style is most important, I feel. Consistency helps everyone stay connected and working toward mutual goals.

Over the years I have developed a list of seven skills that have, time and again, helped me stay on track and support staff, even when I really had no idea how to handle a particular situation! If the following list can help even one person, I offer it with humility, as I am still learning and growing:

  1. Listen! Actively listen to staff (and parents!). Do not interrupt or begin to form a response until the person is done speaking. Sometimes people only need to be heard.
  2. Be available. Let staff know how, when, where to find you helps alleviate concerns.
  3. Take responsibility for your actions and for those on your staff. Do what you say you will do.
  4. Give credit where credit is due. Usually the best ideas have come from the staff.
  5. Lead, follow or get out of the way. Okay, I stole this one from Thomas Paine, but it is true. Often it is necessary to lead, but recognize and follow a good idea when it is offered. At times, you have to let a staff member figure out a solution for him or herself (this I learned from a seasoned supervisor).
  6. Stay informed. Stay current with knowledge and skills for your area of the field; it is fine to learn from other staff or supervisors.
  7. ACT. Be accountable, credible, trustworthy

Your list may be very different from mine, and I would be happy to compare notes. Supervision has been, by far, my most challenging and interesting job during my 30+ year career in speech-language pathology. And I am honored to be able to work with a dedicated and professional group of individuals! Each one has taught me valuable lessons about coaching, guiding, monitoring and supervising. The staff is truly the most valuable asset, and, as such, honing one’s supervisory skills is critical to your and their success. Good luck!

Janice Tucker, SLP.D, CCC-SLP, is a supervisor of speech-language support programs in Pennsylvania. She is past president of the Pennsylvania Association of Speech Supervisors and past vice president of the Pennsylvania Speech-Language-Hearing Association. She is an affiliate of ASHA Special Interest Groups 16, School-Based Issues, and 18, Telepractice.

Collaboration Corner: The Technology You Need to Get It Done

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Like most school years, I’m always amazed at how chaotic re-entry can be. As a traveling therapist (locally, and now globally) a few everyday tech tools are an integral part of connecting with my colleagues and consulting with other educators. As practitioners, we are stretched in a thousand different directions. Here are some quick ideas to use with these virtual life-savers. Best of all, they are free:

Googledocs: Get online and create group documents without several versions sent around in different attachments. It’s a totally collaborative platform. In my workplace, we have used it to:

  • Make group SMART goals even smarter; create group professional development goals all in the same place.
  • Make Power Point presentations for that next staff meeting virtually.
  • Create spreadsheets to share caseload information, class lists, inventories of tests and supplies.
  • Collaborate on evaluations and writing reports.
  • Have a place to access reports and notes from any laptop or computer.
  • Create meeting minutes for everyone on the team to access.

 

Doodle: Have a team meeting to set up? This little online tool allows you to email several time slots to one group of people all at once, and poll the best date.

 

Microsoft Word - Collaboration Cornersept[4].docx

 

Skype: Nothing like a little face time, right? Using Skype is free, but conference/group chats are available for a small monthly free. If you have a camera and a working mic on your laptop, or i-device you are good to go. I can consult with South America while looking at the notes I’ve pulled up from my google docs. I like Skype because it is super user-friendly for those who are a little tech-shy. This year I’m even using Skype to consult with supervising a SLPA in training. Through Skype I can chat with his supervisor who is out of state.

Dropbox: Similar to Google docs this has the additional ability to drop in video, notes, or whatever information you want to share all in one folder. You simply download the app to your desktop or portable device. If you put it on your iPad, then you can take videos on the go, and put them directly into the shared folder. This is great forum to video your sessions with your students, and share them with parents and teachers.

Happy techno-collaborating!

 

Kerry Davis, PhD, CCC-SLP, is a city-wide speech-language pathologist in the Boston area. Her areas of interest include working with children with multiple disabilities, inclusion in education and professional development. The views on this blog are my own and do not represent those of my employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.

Tips to Wrangle Your Most Unruly Speechies

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At the beginning of each school year, I have great expectations that this year is the year that all my little speechies are going to manage their behavior well in my treatment room with minimal incentives on my end. So much for great expectations. Because, of course, every year, I’m presented with new challenging behaviors to tackle because we educators know that “all kids are unique and different.”

Just when I think I have mastered all that I need to know about behavior management, one my little sweet speechies decides to bring a new unpleasant behavior into my speech room.

The good news is, I have learned much about managing these behaviors, both in the school setting and at home—from raising two little ones! These are my tips for keeping your therapy room calm and productive:

  • Say what you mean and mean what you say. Set the behavior expectations for your speech room at the beginning of the year and explain the consequences for not following your expectations. Each session, review these with students who need frequent reminders about their behavior. Visually post your rules and consequences, so they can see and hear them. Don’t be afraid to snap the whip and follow through with your consequences because it sends the message to the whole group that you mean business.
  • Bring on the visuals. Use visuals to remind students who struggle with transitions about the start and end of activities. I use a Time Timer and two to three warnings to let my students know when the activity will end. I am also creating a visual necklace that displays prompts to help show students what I want them to do. Visuals such as “all done,” “sit,” “clean up,” and “calm down” are on my list. I also use visual scheduling in treatment. For example, I might draw a chair with the child sitting down, then playdoh, cards for artic, and then clean up or a good-bye visual. As we complete each task, the child marks an X on it.
  • Empower students. We all want to be in control of our lives even when we can’t control our circumstances. This is the same for children. And although they cannot dictate the session, we can still give them choices, such as “You can sit in your chair or you can stand behind your chair,” or, “You can work for Legos or stickers,” or “You can finish your worksheet and earn your speech bucks, or sit in your chair and lose your speech bucks for the day.”
  • Encourage sensory integration. Some of your kids may struggle with focusing, staying still and controlling impulsiveness because their sensory regulation is off. Having fidget tools such as squishy balls available upon request may help your student. I explain that the squishy ball is a “tool” and if used as a toy, it will be taken away. Also, incorporating movement breaks or activities that infuse movement help keep our little speechies focused and in control of their body.
  • Abandon ship when necessary. We all plan wonderful, amazing treatment sessions filled with activities that we “think” all kids will love. Sometimes your most ideal therapy activities may not work for certain children. Don’t hesitate to abandon a toy or activity when a child does not appear interested in your fabulous board game! You will get more meaningful interactions with toys and activities that your students prefer, rather than trying to force them to like what you want to do. I always try to reintroduce an activity a couple weeks later to see if they may want to try it out again.

All in all, behavior management is an ongoing process that takes time, trial and error, and a willing SLP to dive in and try new techniques!

Felice Clark, CCC-SLP, is a school-based speech-language pathologist in Sacramento, Calif., and author of the blog, The Dabbling Speechie. 

Kid Confidential: Teaching Parents the Power of Play

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I don’t know if it is just my experience or if you too have found this to be a problem, but I have noticed the more I work with very young children, the more I realize parents do not actually know how to play with their children.  I know this is a trend I am finding to be true more and more often, however, I am still shocked when I see it.

Play is such an integral part of a child’s development as it affects all areas of growth including, but not limited to, social skills, communication development, cognition, problem solving and reasoning skills, and imaginative thinking.  Therefore, for those of us SLPs who are working with infant, toddler and preschool-age populations it is not just enough to model play or target language development, we must teach parents how to play.  You know the saying “If you give a man a fish, he eats for a day.  If you teach a man to fish, he eats for a lifetime.”  Well I believe this to be similar–we need to teach parents how to play so their children can continue to develop during the time we are not present as service providers and throughout their childhood.

I have noticed that sometimes even involved parents who are willing to participate in book reading and speech and language drill type activities, are still not always comfortable participating in play.  Involved parents want to know what they can do to help.  The problem is they don’t fully understand the importance of play or how their child’s thinking skills change and grow via play.

So what do I do about this?  How do I try to teach parents how to play?  Here are a few techniques I have used:

  1.  Parent education:  The first thing I do is teach parents why play is so important and how learning takes place.  I explain to parents why we need to incorporate play into our therapy and why their child needs to participate in play with them when I am not present. I also explain the types of play their child is currently exhibiting versus what types of play they should be exhibiting at their age (you can find more details on ages and stages of play here).  This truly helps parents fully understand their child’s current level of functioning and why focusing on play skills is so important to communication development.
  2. Never make assumptions:  When I was fresh out of graduate school I made assumptions that parents knew and understood child development.  But the truth is we cannot assume that parents have had the same experiences as we have had.  Even if we are working with parents of a large family, this does not mean they know or fully understand how to play with their children.  I have learned after making many mistakes to never make assumptions about what parents do or do not already know.  Rather than treating parents as if they are in need of education, I will say something like “I would be remiss if I did not explain/show you how to…”.  Other times, I will say something like “I’m sure you already know this but I need to explain that…”.  Again, these are just two ways to help share my knowledge with parents while not treating them as if they are uneducated or making the assumption that they know more than they do.
  3. Model and explain play:  I then create play scenarios at whatever level of play the child is functioning currently while attempting to expand the play and improve language and problem solving skills.  I carefully explain what I am looking for in a child’s play and how I am changing the play slightly in order to achieve those goals.
  4. Give the parents a turn:  It is imperative that I make sure parents have a turn taking over the play interaction.  I want to empower parents and make them feel as if they can play with their child when I am not there.  However, the only way to do that is to make sure they have an opportunity to practice these skills while I’m still there to assist.  If help is needed, I will guide the interactions while continually reducing support throughout the session.
  5. Videotaping for success:  Videotaping parent/child play interactions can be an invaluable way to educate and empower parents.  I like to videotape portions of interactions so parents can refer back to the videos as needed.  When parents see how they have taken suggestions and turned them into positive interactions with their child, they begin to anticipate and invest their time into participating in play more often with their child.
  6. Follow up weekly:  The key to making this technique work is to make sure I follow up with parents and hold them accountable for their child’s play week to week.  I encourage parents to take videos on their smart phones and save them for our next session.  This way I can see the growth in their child and continue to provide assistance as needed.

Parents are always looking for the “right” ways to play.  So I give them a few tips:

  1. Show some emotion:  I explain that parents need to make sure their face, voice and entire body is showing the emotion they want to exude.  So when parents look their child in the eye, smile wholeheartedly and say, “I’m excited to be playing with you today!” or “This is really fun!”, I know they understand the importance of emotional in play.
  2. Play when you can:  Parents often times shut down if they think I am asking them to play for hours a day with their child which ultimately results in no play from them at all.  Instead I ask them to try to play for one or two 15 minute increments a day.  For parents who work full-time and have several children, I have found this to be a more realistic expectation and request from them.  Also encouraging them to involve their other children in play is a stress reliever for some parents as children are great models for each other and many times siblings are vying for their parent’s attention.  Incorporating siblings in play, seems to help provide the much needed parental attention while teaching the whole family how to interact with a child who may have delays.
  3. Turn off the TV and turn on some music:  Parents believe their children do not watch much television however when I ask if parents like to leave the television on for background noise I tend to get more “yes” answers than “no”.  So I encourage parents to get rid of the visual distractions like television and if they must have some background noise, play some child friendly music instead.
  4. Change out toys the child has available to them:  I have noticed even with my own child that when I periodically change out toys available, I see very different types of play.  This can keep a child’s play dynamic and guard against stagnation.
  5. Mix and match toys:  Mixing and matching toys that would not typically go together encourages growth in a child’s imaginative play.  I have seen some amazing pretend play when I brought random toys to therapy for my clients.
  6. Use nondescript toys/objects:  Some of the best pretend play I’ve observed comes from objects that don’t seem to look like anything in particular.  Have you ever placed a few boxes and a bucket of blocks in the middle of a room and watched preschoolers play?  It’s amazing the “thinks they can think”.  The more nondescript the object, the more creativity goes into the play.Parents always ask me if they are “doing it right,”  if they are playing the right way with their child.  My response is always the same “If your child is smiling, laughing or fully engaged with you, then you are doing it right.”

Do you spend time teaching parents about the power of play?  If so, how do you go about it?

Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.

How To Become a Telepractitioner—Without Going Private

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Working in schools for 23 years was very rewarding for me, but in 2012, I found myself looking for a different avenue for delivering speech-language pathology services. Simply, I was ready for a change.

Therapy sessions seemed to have become more condensed, requiring me to work with groups rather than specific students, which was not always beneficial for them. Incorporating technology into therapy sessions seemed to help my students maintain focus, motivating them to work. Whether I used technology to help students practice articulation drills, writing organization or social skills, they enjoyed it.

Could I find a job opportunity that would allow me to bring together my interests in working from home and using technology to provide speech-language services? The answer seemed to be “telepractice,” also known as “teletherapy.”

I knew leaving my position in the schools would be a bit intimidating. Questions began swirling through my mind: What were the “pros” and the “cons” of leaving my current position? Would it be worth leaving the schools to work from home? Did I want to provide treatment as an employee of a company or as a private provider?

I’ve always wanted to work from home; being able to transport my children to and from school and spending time with them afterward was a major motivator. I’ve also longed for scheduling flexibility that working from home would allow (the ability to throw in a load of laundry between sessions or plan in the evening without needing to drive back to work). But would I miss the staff camaraderie? What about students’ hugs? Would I feel isolated? Since I began providing telepractice treatment, the answer to each of these potential drawbacks has been “no.” To me, the “pros” have far outweighed the “cons.”

I researched telepractice some more on the ASHA website, which reviews studies pointing to teletherapy’s efficacy, and joined ASHA Special Interest Group 18, Telepractice. I later attended a teletherapy training in Maine that tasks that would ordinarily take 60 minutes to complete when providing “onsite” speech/language therapy could be accomplished during approximately 35 minutes of teletherapy!

Next, I considered providing teletherapy as a private practitioner, but I balked at the additional marketing and operational work that would require, even though I knew it would mean being my own boss and making my own schedule.

After careful consideration, I decided to accept an offer to become a teletherapist with a company I knew delivered quality training and treatment. At my company’s direction, I attended American Telemedicine Association-accredited training provided by Michael Towey.

Regarding equipment, I recommend using:

• A laptop with at least a 15” screen and built-in webcam (or you can use an external webcam).
• A headset with attached microphone or external speakers with an external microphone (I prefer a headset because the microphone is always close to the students’ mouths).
• A document camera for use during therapy. You can find most of this equipment on Amazon.

The software I use is a HIPPA-compliant, video-conferencing platform provided by my employer. It is important to consider security and compliance when selecting a Web-conferencing platform (Skype, for instance, is not compliant). Some telepractice companies require that you purchase your own equipment as well as their telepractice software. Be sure to consider that in your research.

For materials, I have found different online resources to draw from: SLP blogs (such as ChapelHillSnippets.com), eNewsletters, and ASHAsphere. I often use my own materials via a document camera. Once I received the necessary equipment and became comfortable with it, I worked on reviewing each student’s IEP, listing goals/objectives for each, and documenting IEP/re-evaluation due dates. Training a paraprofessional was the next step because I needed someone to: chaperone students coming to and leaving from therapy, be a behavior manager as needed, serve as a technology problem-solver, help as a student-response “confirmer,” and be a “skill-carryover” assistant when possible.

Connecting with students via teletherapy has a different “feel” when compared to onsite therapy. While working in the schools, students would draw pictures for me, hug me, and stop in my speech room to see how my day was going. Obviously hugs aren’t available over the Internet, but I have found that there are other ways to connect with students.

Frequently, when students first join the session, their faces light up, and I’ll hear, “Good morning, Mrs. Sippl! What are we doing today?” If my students earn a few minutes of free-choice time at the end of a therapy session, frequently they will ask to draw or color online. Once they’re done, they’ll explain that the drawing is for me and that I need to print it out to hang on my wall. As you can see, the “connection” with students is not lost. It is just different.

Based on my own telepractice experiences, my sense is that students are able to accomplish more in less time compared with face-to-face therapy. Teletherapy has its own rewards, and students find ways to show you how important you are to them. Once, as I was working with a Kindergarten student, she looked at me and exclaimed, “Hi, Mrs. Sippl! I’m so excited to see you today! I love you!”

Tracy Sippl, MS, CCC-SLP, is a Seymour, Wis.-based speech-language pathologist and tele-therapist with Cumberland Therapy Services. She is an affiliate of ASHA Special Interest Group 18, Telepractice. 

A Creative Approach to Food Allergies and Trick-or-Treating

Oct 32

 

Ever notice how many kids who are in feeding therapy also have food allergies?  With Halloween just around the corner, I’m encountering parents in my practice who are scared to let their food-allergic kids go Trick or Treating.  As their child’s feeding therapist, I try to offer creative strategies to ease their minds and still allow their little munch bug an evening of safe but spooky fun!

Trick or Treat Nirvana (What’s a Parent to Do?) 

Halloween is one of my favorite holidays.  My neighborhood is a child’s Trick or Treating nirvana; street after street of tightly packed  houses, much like enormous Pez® candies crammed inside a spring-loaded Casper the Ghost container. It’s the perfect setting for little fists holding giant plastic pumpkins to collect as many pounds of sugar as humanly possible in the shortest amount of time.  The neighbors are obsessed with decorating their homes to the hilt and consequently our sidewalks are packed with little Batmans, Disney Princesses and giant Rubik’s Cubes negotiating their way to each and every over-the-top decorated home and loading up on anything the neighbor’s offer when the kids shout “TRICK OR TREAT!”

So what’s a parent to do when their child with food allergies so desperately wants to join in on the door to door fun?  Well, keep this in mind: For the kids, Halloween is about ringing a doorbell, shouting “TRICK OR TREAT”,  remembering to say “thank you” as they scurry off to the next house and most of all – giggling non-stop with their friends.  It’s truly about the social experience, and not so much about what gets thrown in the bag.  But for many of my clients, what ends up in their bags is vitally important for safety reasons. Here a few strategies for parents to consider.

Enlist the Help of a Few Neighbors 

1.    Secret Passwords Nobody wants a child to miss out on the big night.  Most friends and neighbors will be thrilled to stash your candy alternatives by their front door.  If your alternative treat needs to be kept separate from other food substances,  be sure to let them know.  If your child is old enough and/or you are not present,  just tell them that  Mrs. Smith needs to hear the secret password (e.g. “monster mash”) because she is saving something just for them.  The last thing you want is Mrs. Smith accidently giving some random fairy princess your child’s special allergen free treat!

2.    Create a “TREASURE HUNT” with clues that lead your little pirate to the buried treasure where X marks the spot.  Give ten clues to ten neighbors; use brown grocery bag paper, black ink and even singe the edges for that authentic “treasure map” look.  Each piece of paper provides the next clue on where to go:  “Yo ho ho, ye pirate gents! Go to the next house with the white picket fence!”  Little do they suspect that the 10th clue will send them back to their own house, where they will discover a giant X and a special treasure buried beneath, just for them!

Tangible Alternatives to Candy

Whether you are planting a few of these with your sweet neighbors or giving them away to the little creatures knocking on your door that night, here are a few tangible alternatives to traditional candy:

1.    Eyeballs (and other spooky treats):  Google that Michael’s coupon or head to your favorite craft store to stock up on creative options for candy.  Whether you are trying to avoid sugar or the top 8 allergens, bringing home a pillow-sack of party favors such as blood-shot super ball eyes, miniature magnifying glasses, Halloween stickers or a tiny decks of cards is still a nice pile of loot for your little goblins to dump on the living room floor when they get home!

2.    My favorite treats are glow-in-the-dark bracelets.  We activate all of them just before the doorbell starts to ring and put them in a clear plastic bowl so they give off an eerie glow when we open the front door.  Trick or Treaters pop them on their wrists and run off to the next house, literally glowing.  Because my nick-name is “safety-mom,” I feel better knowing that everyone’s kids are a bit more visible running around in the dark.

3.   Think outside the box.  Most toy or craft stores have bins of whistles, harmonicas and bubbles to use in replace of candy.  Don’t forget small packets of origami paper, craft buttons, jewelry kits and beads, etc.  There are isles and isles of wonderful candy substitutes that will keep your child busy long after the other kids’ candy is eaten.  Believe me, parents all over town will be eternally grateful to see something creative in their children’s sacks rather than yet another pack of sour gummy worms.  Create a little karma for yourself!

Allergen Free Candy

A spectacular list of allergen-free candy (many, free of the top 8 allergens) is available on The Tender Foodie blog.  Be the “good house” that the kids rave about with the really cool candy.

Got Too Much Candy?  Here’s How to Get Rid of it FAST!
1.    Hold a Candy Auction:  Dig into that Monopoly game and grab those pastel paper bills!  Here’s your child’s chance to hold a candy auction! When all the bidding is over, he gets to count out how many paper bills (dollar amount is now a moot point) he received and trade those in for real money, but half goes into his savings account.

2.    Worth Their Weight in… Dollars:   Finally, a chance to use your bathroom scale and rejoice as the numbers go UP!  Kids get to weigh their loot and get paid $5 for every pound.  The next day, extend the family fun by going to the toy store or a favorite “haunt” to buy something together.

Safety Considerations
In addition to the general safety considerations for all trick-or-treaters noted here,  there are additional safety considerations for children with food allergies:

1.    SEPARATE CANDY:  Make it clear to other adults if alternative treats need to be separate from other food substances due to cross-contamination.
2.    Bring an EPI-PEN and if you are not accompanying your child, make sure his friends know where the pen is stored.

3.    Trick or Treating IN GROUPS only.  As for any child, stay together.

4.    Give your child a fully charged CELL PHONE with emergency numbers on top; make sure her friends know how to use it, too.

5.    Make sure your child is wearing an ID bracelet that is visible despite her costume.

6.    Ask the other children to WAIT to eat their candy until it can be inspected at home.  This is a general safety rule for all kids, but also prevents accidental contact via another child during the excitement of trick or treating.

Expectations – Your’s and Your Child’s
Consider your own expectations and how those may define your child’s expectations for Halloween.  Remember, “It is not necessary for children to have the full blown experience in order for them to have a good time”  Lori Lite (Stress Free Kids)

 

Ask your child what they would like to do.  Perhaps he just wants to be in charge of passing out the glow bracelets while the two of you wear matching glow-in–the-dark Vampire teeth!  So often as parents, we try to do make a huge production out of a holiday because we feel we owe it to our kids.  Funny thing is, most of the time, the kids are just thrilled to be a small part of it as long as they are sharing it with YOU.

So enjoy and be in the moment.  Wear a funny hat.  Tell a spooky story.  Take LOTS of pictures and video, too.  Stick a plastic spider on someone’s chair at dinner.  Don’t be afraid to scream – it’s the one night you can do so with abandon!   Happy Halloween!

 

Note: Portions of this article were originally printed on The Tender Foodie.

 

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs and includes both her book and CD for each attendee.  She can be reached at Melanie@mymunchbug.com.

A Tool to Help Children Ask for Help

questioning child
Richie is an engaging 9-year-old boy who is in treatment to improve his language skills. He is compliant and cooperative in sessions and is eager to learn new information. There’s only one problem: Richie is unable to spontaneously ask questions and request clarification when he doesn’t understand what he is told.

He’ll just sit quietly, making nice eye contact with the clinician. His entire body posture says, “I am listening to you!” But when it comes to answering questions about what he’s learned, Richie clearly doesn’t get. He might attempt to answer the questions and stumble halfway through before giving up. He might also provide an answer completely unrelated to the question. But most of the time, much to our frustration, Richie will simply shrug his shoulders and reply, “I don’t know.” This is typically when some might ask him with barely disguised frustration: “Why didn’t you tell me before that you didn’t understand?” Richie will shrug his shoulders again.

But here’s what’s important: He is not trying to be oppositional. He really doesn’t know.

Richie has impaired executive function, and this causes difficulties with initiation—asking questions, getting help, beginning to work on tasks and so forth—and pursuing clarification when he needs it.

Executive function is a set of mental processes regulated by the frontal lobe of the brain that help with optimal life functioning. Intact executive function allows us to manage, plan, organize, strategize, attend to, and remember things appropriately. However, if EF is underdeveloped or impaired (damaged) as a result of an injury or disorder, such as attention-deficit hyperactivity disorder or fetal alcohol spectrum disorder, then the child will present with significant difficulties in various areas of functioning. This will make it difficult to appropriately meet school requirements or engage in successful social interactions.

While it is important that children with EF impairment receive remediation in all affected areas, I typically start by targeting initiation, specifically improving the child’s ability to ask for help when needed. Why is that skill more important than the rest? For starters, it lets you know when something is wrong, or in some extreme cases, very wrong.

Imagine working with a 10-year-old verbal child who all of the sudden shuts down and cries while clutching her stomach. You spend valuable time questioning, prodding and cajoling until, about 10 minutes later, you find out that the child had an acute stomach ache. She was simply unable to initiate and tell you, “I need help. My stomach hurts.”

This is why it is important to use charts and other such strategies to help these children navigate treatment. To illustrate, I’ve created a “Strategies of Asking for Help” chart for my clients who are verbal but have mild cognitive impairment (IQ 70+) or have average cognition. I keep this chart in the child’s line of vision and remind him or her to choose a relevant strategy from the chart to alert me when in need of help. For example, under the category, “if confused,” the chart advises saying, “I don’t know where to find the answer.”

Of course, prior to using the chart, I pre-teach the child the strategies on the chart. I also explain when to use each strategy (during what type of tasks/questions/situations), as well as why it is so important to ask for help. Depending on the severity of the child’s impairment, I may need to spend several sessions pre-teaching these concepts to optimize the child’s success.

I also don’t limit use of the chart to language treatment sessions. What would be the point if the child only learns to ask for help during treatment, but is unable to do so when working on assignments in class or homework at home? Consequently, I provide a copy to both teachers and parents to attach to the child’s desk in class and at home.

Thus, the chart serves as a continuing visual reminder to ask help, along with strategies for how to do it. For your own free copy of the chart, download a copy here from my blog, Smart Therapy LLC.


Tatyana Elleseff, MA, CCC-SLP,
is a bilingual speech-language pathologist with Rutgers University Behavioral Healthcare and runs a private practice, Smart Speech Therapy LLC, in Central New Jersey. This post is adapted from a post that originally appeared on her blog, Smart Speech Therapy LLC. She specializes in working with multicultural, internationally and domestically adopted children and at-risk children with complex communication disorders. She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education, 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, and 16, School-Based Issues.