How One Bold Adventurer Survived the Opening of Exhibit Hall at Convention (We Think)

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At approximately 8:35 pm on the evening of Thursday, November 14, a sheath of papers and an undeveloped roll of film were recovered by a custodian working in the Posters section of the Exhibit Hall at McCormick Place in Chicago. Tucked snugly under a (still warm) seat cushion, the yellowed, tattered handwritten manuscript and frayed film were rushed to the Leader’s office in Rockville, where they were subject to the most intense scrutiny and interrogation. Satisfied with the integrity of contents, astonished at the revelations contained therein, and aflame with ardent desire to share a unique eyewitness account of a quintessential ASHA convention event, the Leader presents the discovered manuscript in its entirety. For intelligibility, we’ve translated from the original Most Distant, Really Dullest, and Certainly Deadest Tongue.

DEAREST READER: Months of arduous sojourn across twilight epochs and treacherous terrain have brought me to this place, this moment, to this gathering of likeminded intrepid explorers poised to shatter the boundaries of convention and assail terra incognita. Mine is a wandering soul consumed by curiosity and troubled by siren calls beckoning through forbidden entryways. Standing and milling with hundreds of students and professionals outside the Exhibit Hall before it opens on the first day of ASHA convention, I am at last after all these long years among my own kind, again. We all want in, through that entrance blocked by McCormick Place staff. Right now. We’re just not always sure of the reason.

Someone pray tell—why are we here, waiting?

Huddled on the carpet some 20 feet away from the others, three students rapid-fire last night’s anecdotes and today’s possibilities while flipping through convention programs. Purses, askew tote bags and half-drunk cups of coffee ring them. Hmmm…perhaps their obviously keen attention to detail lends insights into why hundreds of us are all just, well, standing here ready to spring into whoknowswhat beyond yonder guarded entranceway.

After a lengthy, cross-city quest for a men’s restroom to change from elegant breeches and ruffles into roughen jeans and a too-plain button down shirt, I approach, ever hopeful, pen poised.

“So, are you waiting to get into the Exhibit Hall?”

Two nods, one dismissive glance back to the program.

“If you don’t mind me asking, why?”

Smiles and a chorus of replies. “I hear there’s lots of cool stuff in there—giveaways.” “My friend’s in charge of a poster session.” “I want to visit the bookstore.”

The latter speaker pauses, leaning forward. “We didn’t realize,” she hiss-whispers, “that there’d be so many people here when it opens!”

“Um…” I try to reassure. “You do know it’s open for all of convention, right?”

Shrugs. Blank stares. Heads return to programs and chatter resumes.

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I next squirm, dodge, and dart my way mightily to the front, hoping to converse with those possessing a vast reservoir of experience with such opening day events. One of the security staff is more than happy to chat.

(Me out of breath after crowd-tunneling extravaganza) “Why…in the world…are there so many people waiting… to get in?”

(Chuckle) “It’s always this way, sir.”

“Any reason for it?”

(Slight shake of head and sigh). “It’s just the way these things go.” (Mt. Vesuvius yell eruption) “MAKE SURE YOU ALL HAVE YOUR BADGES READY FOR INSPECTION!!!”

I scuttle-crawl away, none-the-wiser and God help me, somewhat deafened.

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It’s now about 10 minutes before the opening of the Exhibit Hall, and a most fascinating ritual is occurring. The crowd without prompting or dispute is self-organizing into a single, momentously long, serpentine line that curls and stretches into the distance across the palatial hall. Sitters and standers fall into place; no disputes, just a low murmur of expectancy rippling up and down the line. Calling upon fifth-column skills well-honed for decades in His Majesty’s Most Glorious Topsy-Turvy Revolution, I slip into line, one-third back, without incident.

There’s still time to uncover the answer.  Hmm…perhaps another direction. My laborious research en route here did uncover the venerable Black Friday tradition of frenzied mob trampling while seizing limited time deals. Maybe exhibitors likewise promise opening hour deals?

“Hey, is anyone here to nab a bargain?” I call forward and back.

Universal acknowledgment of query but a stunning silence of reply. A few shakes of heads; one roll of eyes.

Dearest reader, I…still don’t understand. But, what the heck, let’s go along for the ride.

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11 am, zero hour. The line begins moving into the Exhibit Hall past security staff…steady…steady…the quick-stepping of hundreds of feet…we’re a millipede slowly picking up steam…and then the hounds unleash. Back segments of the line press forward and come alongside; we’re now four—nay, eight—across and coming on strong.

Faster. Faster. Oh boy.

A backpack-toting student a few millipede steps in front turns to me, brown eyes flashing and giggling. “Hey mister, you know why we’re here?? Because…it’s FUN!” Bursts of laughter.

We’ve just zipped past security and through the entranceway…rows upon rows of exhibits (staffed by some who seem rather startled by the human torrent) flash by to the right.

Goodness—most of us are surging left, a millipede in mad pursuit of the Poster sessions. Or NSLHA. Sustenance, perhaps? Wafts of downright delicious offerings pour in from 2 o’clock.

Pant. Pant. Fasterfasterfaster.  Woops–someone’s foot. Ouch—stand back, good sir. I must confess it’s most difficult to pen this narrative and properly capture visuals while honoring the press and pace of the crowd.

Oh my God, I can’t believe it! There’s hundreds of–

The narrative unfortunately breaks off at this point. The Leader has no reason to suspect that the author came to a grim, bone-crunching, nasty little end. We suspect that the tantalizing offerings of the Exhibit Hall were enough to draw him away from his sordid tale.

Gary Dunham, PhD, is the director of publications at ASHA. He can be reached at gdunham@asha.org.

Tips for Assessing Bilingual Children As a Monolingual SLP

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There are an estimated 337 different languages used (spoken, written, and/or signed) in the United States. Even bilingual speech-language pathologists will encounter situations in which the client’s primary language is unknown.  There are standardized, evidence-based tests for the Spanish-English population. But what about Russian, Vietnamese, German and so on? What do you do?

Here are some key practices that can aid any SLP evaluating a child who speaks an unfamiliar language:

  • Conduct a family/caregiver interview, which can help minimize cultural and linguistic biases. Understanding how others in the family view the client’s communication gives insight into expectations and the possibility for deficits. Is the client able to meet these expectations? If not, why and how? Do they differ significantly from others in that communication circle?
  • Use an interpreter. Meet with the interpreter prior to any contact with the family to review the process, terminology, and what you want him or her to do. If possible, use someone outside the child’s family and circle of friends to reduce the possibility of bias. Interpreters can provide key information, such as, “It was very hard for me to understand him,” or, “He doesn’t use prepositions correctly.” Using such information, along with additional testing measures can help support or negate a true disorder.
  • Use highly pragmatic tests if formal/standardized testing is not available in the child’s primary language. These tests will help determine the client’s grasp of conversational language, which is the first building block to more complex language. The same is true in monolinguals—that the first language we learn is social in nature. We e acquire more complex understanding and use of language by building on social language. You cannot report standard scores when using standardized testing not normed for that language. You can use the information as qualitative data to support the rest of your findings. I personally like administering the Oral and Written Language Scales (OWLS), now a second edition, for this population. It is relatively easy and quick to administer.
  • Employ Dynamic Assessment, which  involves pretest of a skill, an intervention to address that skill, and then a post-test to determine if there was progress. This method of assessment can be useful for evaluating multilingual individuals. If intense intervention is needed, this can indicate  impairment. Review the ASHA website for more information on Dynamic Assessment.
  • Include a communication sample in any communication evaluation. How does the child use language? It often includes either a conversation or story retell. See Portland State University’s website, Multicultural Topics in Communication Sciences & Disorders, for links to typical English when influenced by different languages.

Things to be mindful of regarding typical bilingual language development include the following.

  • The silent period occurs when a client is first exposed to a new language. Typically this period ends between six months to a year. Some common misidentifications in this phase are Autism Spectrum Disorder, Selective Mutism, and language delay. It has also been noted that with a significant change in school, family situation and the like can trigger some children to revert to the silent period. This is why family and caregiver interviewing is so essential to diagnosing a language disorder.
  • Bilingual development is recognized in two stages. Basic Interpersonal Communication Skills (BICS), also known as “conversational language,” typically takes two to three years to acquire. Cognitive Academic Language Proficiency (CALP), also known as “academic language,” takes five to seven years to develop. Some common misidentifications during these phrases are Language Disorder and Specific Learning Disability. Be careful that the years refer to a 12-month period of constant and consistent exposure. Our academic calendars are typically nine months, so it may take more academic years to acquire conversational and academic language.

Remember when evaluating any child that there is variety among the “same” cultures and languages.
What additional information do you, or would you, include in an evaluation?

Leisha Vogl, MS, CCC-SLP, is a speech-language pathologist with Sensible Speech-Language Pathology, LLC, in Salem, Oregon. She can be reached at leisha@sensiblespeech.com.

 

Collaboration Corner: Supervision 101

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As a school-based clinician in the Boston area, I’m grateful to have access to some of the greatest learning institutions in the country. As an off-site clinical supervisor, I feel particularly obligated to make all that learning translate into something meaningful. In a public school placement, the school day can become insanely busy. This month I’ve decided to share a few tips that guide me both as a clinical supervisor and a professional.

Create a clear contract of expectations: Provide a copy of the school calendar with holidays, early release days. Provide a week-by-week schedule of expectations, including which specific clients your student will see, and how much supervision will be provided. Include any evaluations, reports and meetings your student will be expected to attend. Provide a mid-term check-in (even if the institution does not require it) and review academic expectations, this way you can give structured and specific feedback.

Know your learner, know thyself: Figure out early in the game, how she or he prefers to get information to you, including email or text messaging. Establish up-front what kind of feedback your student finds helpful, and how/when it is most helpful.  Generally, this seems to work if the student has pretty good insight as to how they function real-time. If they aren’t sure, provide examples. For example, do they mind if you jump in during a session, or do they prefer notes afterward?

Don’t assume anything: I usually get a list of the student’s academic resume and personal experiences. This doesn’t provide me with much information, so I go into the relationship assuming nothing. First, even if my graduate student has experience in a school, each school runs different, and has a unique culture. Second, I can’t assume they have any experience (or minimal experience) working with students like mine. Third and perhaps most importantly, don’t assume reading translates easily into application. A very clever mentor of mine once said, “Remember, you are only as smart as the last thing you read.” This is an important perspective, because not only are you teaching methodology, which brings text to life, but as a supervisor, you are setting the foundation for students’ clinical skills. Show them what they need to learn.

Encourage your student to journal: Reflective learning is the most important part of clinical growth. There is a ton of research supporting opportunities for reflection and professional development. I don’t ask students to show me their journal. I do ask them to take 10 minutes out of their week to sit down and write about two things: something that they learned that week, and something that they need to work to improve. I also encourage them to think larger, not just clinical skills, but interpersonal skills, and how they handled a difficult situation. Then, every other week or so, I have a heart-to-heart on how they think they are doing, and what they think their biggest accomplishes and challenges are thus far.

Leave at least 15 minutes twice daily for check-in: Once in the beginning before school starts to review lesson plans, and then once around lunch or at the end of the day. The first opportunity provides guidance on how to run the lesson; the second should be a chance to discuss how your student perceived the lesson-in-action.

Don’t take the little things for granted: Your students are always learning from you; this includes the good and unfortunately, the not-so-good-but-human moments. How you approach a conflict with a student or co-worker is a lesson. How you are able to comment on your mistakes (a good thing) is a lesson. So remember you are always a role model, not just as an SLP, but as a successful professional. Here’s the best part, I find students make us be the clinicians we want to be; even after a long week of parent conferences, a full moon of behavioral outbursts, or after one too many caffeine-fueled moments, they keep us accountable.

After all, after 16 years, I’m still learning, too.

Kerry Davis, EdD, 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 her own and do not represent those of her employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.

Audiologists: As Hearing Aid Competition Stiffens, Show How Your Services Add Value

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Hearing aid consumers have an ever larger pool of hearing aid providers to choose from, with Internet dispensers, discount networks and Big Box retailers offering lower-cost options.

Patients may choose these options voluntarily to save money or because their insurers limit them to such options—but, given that such options rarely involve audiologists, the result is often improper, poorly fitted devices and unsatisfied clients, said audiologist Harvey Abrams, director of audiology research at Starkey Hearing Technologies, at a session on health reform and audiology at ASHA’s 2013 Annual Convention.

This is far from news to audiologists, who of course know that their health care training is necessary for proper selection and fitting of hearing aids. But the value-added of an audiologist’s services is often unrealized by consumers. Thus, said Abrams, as distribution channels expand, the key is to demonstrate that the audiologist channel is the quality channel because it’s centered on the patient and focused on positive outcomes. To differentiate their services and ensure that they meet these standards, Abrams recommended that audiologists:

  • Develop a comprehensive treatment plan that lays out strategies for patients to follow.
  • Administer a patient-focused income measure such as the Client Oriented Scale of Improvement to determine what the patient considers his or her most important treatment needs.
  • Use meaningful tests such as speech-in-noise assessments
  • Establish patient-specific treatment goals based on what the patient wants to achieve, using goals that are specific, measurable, attainable, relevant and timely, or SMART. Identify with the patient what he or she would define as success: For example, being able to carry on a conversation with a spouse in a relatively noisy restaurant.
  • Select hearing aid features on the basis of treatment goals.
  • Verify the hearing aid parameters with probe microphone instrumentation (real-ear verification measures): an objective, evidence-based way to fit hearing aids. Treat but verify.
  • Validate the hearing aid fitting. The definition of treatment success is how well patient goals are met.
  • Prescribe hearing assistive technology, such as FM systems, infrared systems and induction loop systems.
  • Provide post-hearing-aid-fitting aural rehabilitation services in the form of auditory training and/or group aural rehabilitation. Don’t just hand the patient a DVD!
  • Itemize your fees. Building them into the cost of the hearing aids just diminishes your value as a professional because they’re not then seen as payment for professional services, said Abrams. “If you commoditize your services, your patients will shop around, possibly online or at places like Costco,” he explained.


Bridget Murray Law
is managing editor of The ASHA Leader.

Harvey Abrams, PhD, CCC-A, is the director of audiology research at Starkey Hearing Technologies in Eden Prairie, Minn. He has served in various clinical, research and administrative capacities with the VA and DoD. He is an affiliate of ASHA Special Interest Group 7 (Aural Rehabilitation and Its Instrumentation).

Kid Confidential: Tips for Working with Students with Hearing Impairment in the Schools

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This month I revisited the topic of classroom difficulties and possible accommodations and modifications for students with hearing loss in the School Matters column of the ASHA Leader.  As there is so much to discuss on this topic, I was unable to share some of the inside tips I have learned when working with students with hearing impairment in the academic setting.  So I thought I would share this information with you today.

Here are the top five lessons I learned when working with students with hearing impairment in the schools:

  1. Work with the student’s audiologist.  I am not a specialist in the area of hearing.  Therefore, every time I have a student with hearing loss referred to me or placed on my caseload, the first thing I do (after reading the audiological evaluation report) is contact the audiologist to ask all of my questions and voice any concerns.  I know, as school-based speech-language pathologists, you struggle to have enough time in the day to do everything you need to do but this is the first and foremost important piece of advice I can give you when working with children with hearing loss of any severity (including children with sound field amplification systems, hearing aids, and cochlear implants-CI).  Audiologists do not expect us as SLPs to know everything about their field.  In fact, they are more than happy to share their wealth of knowledge.  I have learned so much regarding simple tests I can perform for quick assessment of my student’s hearing perception at varying distances to determine how they are perceiving that audiological input (i.e. Ling 6 sound test), how and when to recommend a student with CI to return to their audiologist to once again MAP their CI, what classroom behaviors are evidence of improved hearing and understanding and conversely which suggest possible malfunction of hearing equipment.  Without an audiologist’s guidance, I would not be able to do these things today.
  2. Consult with your district’s teacher of the hearing impaired frequently.  Although, the teacher of the hearing impaired may not be an audiologist, he/she knows the practical strategies and techniques to use while teaching students with hearing impairments in the academic setting.  I have learned how to teach speech and language skills effectively in 1:1 therapy, small group therapy, and in-class therapy for children with hearing loss.  I have learned how to troubleshoot if a hearing aid isn’t working correctly, how to hook up the FM system “boots” to a CI, and what to look for in the classroom and therapy setting that may indicate the need for further analysis of hearing equipment.  Using the teacher of the hearing impaired as a frequent resource to share ideas and answer your questions can be an invaluable and integral part of your therapy plan.
  3. Record in-depth observations:  This is a technique I use to determine if growth is being made in all observed areas even if not specifically targeted on current IEP goals (e.g. improvement in social skills, changes in responding to environmental noises, changes during large group classroom lessons, etc.) or if current progress is not yet quantifiable.  Quality records can help you to share the changes effectively (positive or negative) in your student’s speech, language, or academic skills with the student’s audiologist and hearing impaired teacher to determine the next steps in the therapy process.  I have found emailing my in-depth observations to audiologists for my clients with CI is an enormous help when they are working on MAPping my client’s CI. Parents cannot notice nor may they fully understand the big and small improvements or difficulties a child may exhibit in the school environment.  Therefore, it can be a challenge for audiologists to determine MAPping changes and needs based solely on parent report and child response.  Noting these observations, such as environmental and speech sounds, to which the child no longer responds, assists the audiologist in making the appropriate adjustments to the students CI so as maximal learning can occur.  Don’t underestimate the importance of functional observations.
  4. Get the classroom teacher on board.  Many times classroom teachers just feel lost when expected to appropriately modify for students with hearing loss in their classroom.  They may be anxious about working with this population, which can manifest itself in what seems to be uninterest or even noncompliance.  However, the truth is the classroom teacher may not know what do to and may be looking to you, the SLP, for assistance.  Showing how simple modifications made in the classroom, in real-time, result in improved learning opportunities for their student is one of the quickest ways to get your student’s teacher on board.  Also frequent classroom visits can help you in identify and address additional situations that may be inhibiting your student’s learning (e.g. environmental noises affecting hearing, lack of sufficient visual support in the classroom, classroom instructional language used is too complex, instructor not appropriately amplified at all times, etc.).  Helping to address and make the appropriate changes and adjustments needed in the classroom environment throughout the school year, can be extremely helpful for your student as well as for the classroom teacher.
  5. Do not be afraid to say “I don’t know, but I’ll find out.”  This is the best tool to use when working collaboratively with a number of various professionals.  You can bring your current knowledge and clinical experience to the table, however, no one expects you to know everything about treating every disorder or deficit.  It really is OK to say “I don’t know,” but just make sure you follow that with “but I’ll try to find out for you,” because ultimately classroom teachers, parents, staff members, and other therapists just want to know you are there to help and support them.  Since you already established a great working relationship with your student’s audiologist, I would recommend you start there when you have additional questions you cannot seem to easily answer or research.

Those are my top five tips for working with students with hearing impairment in the school environment.  Do you have additional tips you’d like to share?  Feel free to comment below.

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.

Don’t Beat Yourself Up—Your Client’s Behavior is Not Your Behavior

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My posts are meant primarily for new speech-language pathologists, and I know of a recent situation encountered by a clinical fellow—who we’ll call Karen—that I think warrants discussion. The fellow is just completing her second week at work; she has 16 children from age 3 to age 12 on her caseload for a total of 45 sessions. Some are preschool children with significant language impairment, and some are grade school children with autism spectrum disorder.

One in particular is an 8-year-old boy, Eli (not his real name), who has ASD and no real verbal language, and who displays serious negative behaviors—some of them hostile and aggressive, like biting—spurring intervention from the crisis-management team. His previous speech therapist had recorded some very positive sessions with him in her session notes. Eli’s IEP mandate is for three sessions a week, so Karen had only seen him only five times but had reported a few very positive sessions with him.

Yesterday, as Karen started her session with Eli, she felt confident that she could have him use his communication book to request items during a food activity.  That is, she felt confident until, out of the blue, with no provocation, Eli grabbed her arm and bit down hard. Karen pulled her arm away before Eli broke the skin, but not before he bruised and hurt her. And at the same time that he bit Karen, Eli bit his own lip and bled all over the materials Karen had spent a lot of time making for him. Well, there went her confidence. Needless to say, Karen was extremely upset, but she managed to hold it together long enough to get Eli and herself to the nurse, get him cleaned up, get an ice pack for her arm, get her materials wiped up and disposed of, and get herself to my office to decompress.

She came tentatively to my door and sheepishly peeked in to ask if I was busy. I noticed the ice pack on her arm and asked how she got hurt. It was then that she lost it and began to cry. She wasn’t really hurt very much, but she was very distraught. Ahh, what a wonderful teaching moment, I thought. OK, don’t be so shocked! I am not uncaring. It is just that it is not often I get such an immediate opportunity to discuss “not being emotionally involved” with a new speech-language pathologist.

We have all heard that we should not be emotionally involved with our clients. To me that was a very strange sentence when I was a new SLP. Of course I was emotionally involved! I was invested in the client’s success. I cared about the client. What were people talking about—about this not being emotionally involved? Well, over the years I have come to understand what this means, and I have tried to pass this information along to the clinical fellows and externs I supervise.

To me, it is about not having your ego caught up in the clients’ performance, but to have it grounded in your own performance. I have developed a few questions that a CF (or an extern, or any SLP) can ask herself or himself when feeling bad about a session. Let’s take a look at each one, as applied to Karen’s situation:

  • How do I really feel? I asked Karen if she was hurt. Was that why she was crying? Was she just upset about being bitten? As she examined her feelings, she determined that she felt she had done something wrong. Why did the child bite her? She said that she did not want to have the child taken off her caseload but that the bite made her feel that she wasn’t doing a good job. So she identified that she felt like a failure.
  • Why do I feel this way?  Well the other clinical fellow never reported being bitten by Eli, so Karen felt she must have done something wrong.
  • Could I have done something differently to change the outcome of the session? Aside from staying far enough away from the child that he couldn’t grab her (not always therapeutically appropriate), she concluded that she could not have done much differently.
  • What precipitated the client’s behavior? Karen could not really identify anything.
  • Did I do the best I know how to do? Karen she said she thought she had.

Regardless of your own answers to these questions, as applied to your own situations, every session can be a learning experience for the new clinician. Either you did all you could do, and you did it properly, or you did not. Either way, the client’s behavior is not your behavior. Your emotions should be based on your behavior. If you think you could have improved things, you did not fail. You learned. If you think you could not have done anything differently, you learned that you cannot always avoid a negative outcome, no matter what you do.

No matter what, you must not allow your emotions to get the better of you. You must be intellectually involved in your treatment and in your outcomes. Your sense of success and failure must come from knowing that you know what to do. Or it can come from knowing that you know how to improve, or that you know how to seek the help you need to improve. When you are present in your sessions and aware of your behavior and can assess your behavior after a negative outcome, you are remaining objective and not being “emotionally involved.”

Irene Gilbert Torres, MS, CCC-SLP, chair of ASHA’s Multicultural Issues Board, is a clinician in New York City. She concentrates primarily on infant and preschool evaluations and supervision of graduate students. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations; 16, School-Based Issues; and 17, Global Issues in Communication Sciences and Related Disorders. She can be reached at irenetorres@optonline.net.

Planning for Holiday Meals with a Picky Eater

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As an SLP  focused on the treatment of pediatric feeding disorders,  there is one common denominator among all the families on my caseload:  The stress in their homes at mealtimes is palpable.   Now that Thanksgiving and other food-centered holidays are approaching,  the anticipation of an entire day focused on food has many parents agonizing over the possible outcomes when well-meaning relatives comment on their child’s selective eating or special diet secondary to food allergies/intolerances.

This time of year, I try to find practical ways to reduce the stress for these families.   One of the first steps in feeding therapy is for parents to lower their own stress level so that their child doesn’t feed into it (pardon the pun).   I often address parent’s worries with a “What IF” scenario.  I ask, “What’s your biggest fear about Thanksgiving?”   The top 3 concerns are as follows:

What IF Junior won’t take a bite of Aunt Betty’s famous green bean casserole?

It’s not about the bite, it’s about wanting Aunt Betty’s approval.   Focus on what Junior CAN do.  If he can sprinkle the crispy onion straws on top of Betty’s casserole, call Betty ahead of time and ask if he can have that honor.  Explain how you would love for him to learn to eventually enjoy the tradition of the green bean casserole and his feeding therapist is planning on addressing that skill in time.  But, for now, she wants him to feel great about participating in the process of creating the green bean masterpiece.  If Junior can’t bear to touch the food because he is tactile defensive, what can he do?  Pick out the serving dish perhaps and escort Aunt Betty carrying the dish to the table?  Taking the time to make Aunt Betty feel special by showing interest in her famous dish is all Betty and Junior need to feel connected.

What IF Grandpa Bob reprimands Junior for “wasting food” or not eating?

Keep portions presented on the plate quite small – a tablespoon is fine.  Many families use ‘family-style” serving platters or buffet style, where everyone dishes up their own plate.  Practice this at home.  It’s not wasting food if Junior is practicing tolerating new foods on his plate.  That food went to good use!  If Grandpa Bob grew up during the Great Depression, this might be tough for him to understand.  If he reprimands Junior, change the subject and tell Junior your proud of him for dishing up one whole brussel sprout! That requires some expert balancing and stupendous spoon skills!

What IF Junior gags or vomits? 

Not surprisingly, this is the one sensory reaction that most relatives sympathize with and try desperately to avoid.  Preparing the host ahead of time is gracious and appreciated.    Preparing your child is helpful too and Stress Free Kids.com offers these tips.  I recommend that parents identify what stimuli is most noxious to the child and talk with the host about those, offering assistance in preparing special food or supporting the host’s planned menu as much as possible.  Bring a change of clothes for Junior, just in case, as well as a quiet activity for him to enjoy if you sense that the meal may be just too overwhelming for him.  Plan other activities that don’t involve food to emphasize the message of the season: Being grateful.

Gather together with thankful hearts.  That is the theme for this year’s Thanksgiving.  Let go of the fear and ask “What IF Thanksgiving went just fine?”  Happy Thanksgiving everyone!

 

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.

Coaching Parents to Foster Their Child’s Expressive Language Skills

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I recently had the opportunity to provide tele-speech-language services to a toddler with autism spectrum disorder. I knew it would be difficult to have him sit in front of a computer for long periods, so I decided that I would employ a “parent coaching” approach, empowering his parents to more effectively help their son.

I started by having the parents videotape their daily interactions with him, which revealed that they were aware of their son’s difficulties and in-tune with his communication needs. However, even though this little boy appeared quite bright, it was difficult to distinguish when he was answering a question from what he had learned, or if it was a rote response. The parents had specific goals they wanted their son to achieve, so how was I going to help them?

I provided the boy’s parents with information about expressive language development and explained that their expectations appeared to be beyond this child’s current capabilities (determined by the boy’s age, as well as his disability). Next I took the language and vocabulary skills the parents wanted their son to learn—such as labeling an apple—and broke them out into smaller steps. These are the types of activities I suggest parents use to help a child grasp a language concept:

  • Present the child with several apples, preferably of different colors.
  • Talk about the outside of the apples: color, shape, size, smell, taste and texture.
  • Cut open the apples (“What do you see?”) , and eat some of each, talking about how it sounds and tastes as you bite into each piece.
  • Cut an apple in half horizontally and use washable tempera paints to make apple prints on paper using the different colors apples can be.
  • Find a simple recipe to make applesauce or another food from apples.
  • Eat apple slices with peanut butter and talk about how it tastes, and about the messiness and stickiness.
  • Make a pretend apple out of PlayDoh.
  • Compare the “fake” apple with the real one, explaining that you can eat a “real” apple but not the “pretend.” This models analytical thinking.
  • Bring in another fruit, such as an orange, and do the same steps.
  • Try making and drinking homemade orange juice.
  • Compare an apple to an orange.
  • Show video clips of people picking apples and oranges, showing how both grow on a tree.
  • Add bananas, doing the first seven steps (tastes great with peanut butter).
  • Roll the items across the floor and talk about how they roll. Compare.
  • Use this method to teach about common fruits you either purchase or see in the market.

Of course, just relating these steps to parents isn’t enough, because they have a tendency to take over for their child if they see the child struggling. For example, it’s tempting for them to place the child’s hands on the paper to make the apple prints, which removes the child from the process and leads to a loss of interest. To help parents avoid this, I explain that learning involves making mistakes. Other suggestions I provide include:

  • When speaking to your child, keep your sentences simple and to the point (approximately three to four words per utterance: “Are you hungry?” versus “Are you ready to go have some sandwiches for lunch?” Expanding utterances will come along a bit later!
  • Speak slowly because it may take the child additional time to process the information.
  • Do not require the child to look you in the eye when you are speaking to him. A glance at your face, especially at this age, should suffice. Toddlers are busy-bodies and need to keep moving and exploring.
  • If you ask a child a comprehension question, he or she may provide a quick or rote answer to be able to do what he wants to do.
  • Allow time to just play with your child. Let the child direct the play. Have a few toys out to choose from and follow his or her lead.
  • Make simple remarks about what is going on, but avoid asking questions to probe for an answer: “What color is your truck? How about that car? What is this part of the car called?” This is play time, not teaching time.
  • Model out loud how to think about items: “You have a big, blue truck! Wow! Mine is small. I have a small, yellow truck. “
  • Model out loud how to problem-solve (over-and-over-and-over again): “Oops! The wheel came off my truck. Hmmm. How can I fix it? {looking over the whole truck while thinking….} If I get something to help the wheel stay on, I should be able to fix it. If I use glue, the wheel may not spin.”
  • Allow some “quiet” play time as well and let your child do the talking (or not if he so chooses). This is a great opportunity to just sit and listen to what your child is saying (to you and/or the toys).

I have parents send me some YouTube video of them performing some of these activities with their child. In subsequent sessions, we discuss what works well (and not so well) with the child, and I share more activity ideas and literature with them.

Tracy Sippl, MS, CCC-SLP, is a Seymour, Wisc.-based speech-language pathologist and tele-therapist with Cumberland Therapy Services. She is an affiliate of ASHA Special Interest Group 18, Telepractice. This post was adapted from a post on the Cumberland Therapy blog,  Right Therapy–Right Results–Right Now.