Kid Confidential: Parent Education and Training, Part 3

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I began this series noting the positive effects of parent education and training and sharing tips for how to provide it.  Then, in part 2, I discussed how I implement parent education/training in my therapy sessions.  Here, in part 3, I discuss how I use digital recording to support parent training and education.

Although I own a tablet for therapy, my most valued device on that tablet is the video camera. Most of the time you will not find me with some speech or language app open on my tablet. Rather, you’ll see me with toys all over the floor and my tablet set up with the camera ready to record.

When working closely with parents during therapy, I find that digital recordings provide helpful feedback on a parent’s use of therapy techniques.  It works especially well during real-time education and training (you can read about this in part 2 of this series), as so much of language development depends on the ways caregivers communicate with young children.

The following are some personal rules I like to follow when using digital recordings in therapy:

  1.  Be careful of confidentiality when recording:  This seems so basic but I always get parents’ permission prior to recording their child.  Also I am very cautious when sharing digital recordings of clients as I always worry about secure emails, websites and such.  I tend to use thumb drives, when I can, to share the digital recordings with parents in person just to ensure security. If I cannot provide the parents with a thumb drive on the spot week to week (the one big problem I have found using my tablet camera) I will be sure to still review the digital recording on the spot during the session for educational purposes.
  2. Record only portions of the session:  I understand parents do not have a lot of time to review recordings, so I try to only record simple models of techniques by myself, followed by parents’ trials with my positive feedback and suggestions for modifications or changes. This way, if parents question how to implement the techniques, they have a quick refresher ready for them. My rule of thumb is to try and keep these recordings to five minutes or so. This way parents can quickly access the information they need.
  3. A few things I like to record when I can:
    1. Initially, I always try to record basic parent interactions and hopefully PLAY with their child (this is not about telling the parent how “wrong” they are in the way they interact with their child, but rather it’s about increasing parental awareness of the types of interactions they tend to have with their child.  For example, are they always asking their child questions? Are they talking “at” rather than “to” their child?  This video review is non-judgmental but educational in nature.
    2. Sibling interactions can also be very helpful as well if the sibling is older and can understand and learn to use various techniques to help the younger child.
    3. Sometimes taping sibling interactions is a great way to teach parents how to play with their language delayed child.
    4. I try to record “before” and “after” the use of strategies. Parents love to see how they themselves have changed over time and I love to show them!
  4. Record great parent and sibling interactions:  The last things I like to try to record are moments of wonderful interactions between the child and his parent and/or siblings. I love sharing those moments and reviewing all the great techniques used by the family members. This is not only a great review, but continues to encourage and empower parents to keep up the good work. I also like to keep previous recordings so that parents can see their personal progress over time.  It is amazing to watch their faces when they see how far they have come!

In my experience, digital recordings can really enhance parent education and training, can be a great reminder and resource for parents, and can encourage and empower parents to continue to use good therapy strategies and techniques at home to continue fostering language development in their child.

Maria Del Duca, MS, 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.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of ASHA Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced in New Jersey, Maryland, Kansas and now Arizona.  Maria has a passion for early childhood, autism spectrum disorder, rare syndromes, and childhood apraxia of speech.  For more information, visit her blog or find her on Facebook.

Kid Confidential: Parent Education and Training, Part 2

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Last month I discussed why parent education and training is important and offered tips to effectively train and educate parents.  Today I’ll be discussing how I realistically implement parent training and education.

There are two main ways in which I incorporate parent training and education: at the end of a therapy session and during real-time.

End-of-therapy session Education/Training

I typically use this type of parent education and training for older children (school-age and up) who are working on specific speech and language goals that require some traditional “drill and kill” therapy.  I will also use this type of training for young children who have been receiving speech therapy from myself for some time, long enough that parents are already familiar with implementing techniques at home.

Tips for effectively implementing end-of-session training and education:

  1.  Time management:  I ensure that I end the speech session with adequate time left (usually 10-15 minutes) to effectively educate and train parents (following the tips I shared in part one of this series).  If I feel rushed, due to numerous parent questions, parents requiring more assistance when demonstrating skills, etc. I take a mental note and end my therapy activities a bit earlier the next session so I can provide appropriate training and education.
  2. Review the session:  I then quickly review the session’s activities.  As parents are usually in the room/area where therapy is being provided they are already familiar with the activities I have provided and will quickly know and understand the goal of therapy that session.
  3. Technique(s)—Explain, Model, Take Turn, Feedback: Then, as in last month’s column, I will follow the same steps: explaining the rationale for the technique(s) used, model the technique(s), have parent(s) take their turn and provide feedback.
  4. Follow up:  I always begin the next session with follow up on how implementing the previous week’s techniques are going.

Real-Time Education/Training

This type of education and training is so effective for my very young clients (birth-5 years) as parents are such an integral part of language development at this stage, that it is necessary they are involved the entire therapy session.  This can sometimes propose a problem with there are numerous siblings present, however I tend to incorporate siblings into therapy in order to save time as well as train siblings how to use communication techniques as well.  My motto in this instance is “if you can’t beat ‘em, join ‘em!”.

Tips for effectively using Real-Time Education/Training:

  1. Techniques—Trial, Explain, Model:  The first thing I do with these young kiddos via play therapy is to trial a number of techniques.  Then I determine the most effective techniques and explain to the parent(s) the rationale for using them.  I then model the use of each technique, one by one, and demonstrate the positive effects of its use several times in a row (I strive for 5-10xs in a row to demonstrate the effectiveness to parents).
  2. Questions: I then ask the child’s parent(s) if they have any specific questions before they trial the technique. Usually they do once they realize they will be asked to perform the same technique.  If I need to provide specific step by step instructions, this is the time.
  3. Parent Model:  Then I have the parent’s take a turn using each technique a number of times (again I strive for several in a row-5 to 10xs-to build confidence).
  4. Feedback:  I provide feedback on each use of the technique.  I share the strengths that I see, I note the positive child responses, and of course address any weaknesses or modifications as needed.
  5. Make a list: For parents new to using therapy techniques, I will sometimes write a list of the techniques or the process of implementing a technique so they can refer to it between therapy sessions.  For my most basic language facilitation strategies/techniques I have created my own parent training/education handouts which you can find here.
  6. Follow up: I always begin the next session with follow up on how implementing the previous week’s techniques are going.

Yes, real-time education/training can eat up a lot of your therapy time.  However, it is time well spent as long as the training is effective and parents can demonstrate independence with the use of the chosen techniques.  In my experience, using real-time parent education/training actually brings up several questions and concerns parents either do not think of prior to our discussions or are reminded of during therapy.  It’s a wonderful way to make the connection between the parent’s ability to change their communication approach and their child’s improved language development.  The goal of course with any parent education/training is to leave the parent feeling empowered in their ability to help their child.  A small amount of training can go a long way!

Next month, I will be sharing how I use digital recording to support parent education and training.

Maria Del Duca, MS, 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.

Kid Confidential: Parent Education and Training, Part 1

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This is part 1 of a three part blog series on the topic of parent education and training.  Look for part 2 and part 3 coming up over the next two months.

Parent education and training is not only an important part of our job as SLPs it is an essential part of our job.  Still, I’ve spoken to many SLPs over social media who still feel like they are lacking this particular skill for a number of reasons. For SLPs in the schools, their caseloads are so high and paperwork demands so daunting, they are left with little time to collaborate with school staff let alone contact parents on a regular basis. For private practitioners, speaking from experience, I think we are so focused on targeting the necessary skills and making gains with our clients, that we forget how important parent education can really be.

We know that parent involvement in general education is certainly beneficial. Children whose parents are involved in their school tend to have better academic performance and fewer behavior problems. It makes sense that parental involvement in speech services also would result in positive effects such as increased home practice of target skills and generalization of learned skills to the home environment.  In fact, there are whole therapy models (i.e. DIR/Floortime, Hanen, etc.) that incorporate parent education and involvement as key factors in their models and have the research to back it up.  The DIR/Floortime model’s portion of parent education and training has been tested and retested among various populations all resulting in positive effects, faster progress and improved generalization of social skills for children with ASD (see list of additional resources below).

So the question we need to ask ourselves is why we aren’t tapping into this wonderful resource and effectively educating and training parents of our clients?  For myself, I can tell you that it took some time to become effective in this manner. Initially it seemed as if I was more of a teacher explaining the rationale for various techniques however I was missing some very important steps. Over time, I have improved upon my ability to educate and train parents and I will share with you my tips for effective parent training:

  1.  Trial techniques:  The first thing I usually do is trial various techniques to determine which techniques the child responds successfully.
  2. Explain rationale:  Once I determine the most effect speech therapy techniques for the child (which we have to accept will change over time, maybe even at each session depending on the child’s ability and behavior), I will explain the rationale behind the techniques to the parent(s) present (either in my therapy room or in their homes when providing therapy).
  3. Model technique(s):  Modeling the technique(s) immediately after explaining the rationale will demonstrate the effectiveness of the technique(s) and make more sense to the parent(s).
  4. Parent’s turn: Allowing the parent(s) to take turns trying to eliciting the communication skill via the use of determined techniques will give them much needed practice in the safety of the therapy session.
  5. Give Feedback: Giving feedback is necessary to training.  It allows parents to feel successful with the skills they currently exhibit and provides additional ideas for the areas in which they are weaker.
  6. Follow up: I think it is so important to follow up with parents session to session to determine how well the techniques are working at home, how comfortable they feel using the techniques and if there are adjustments that need to be made for more effective use.

These are my basic tips for effective parent education and training.  Next time I’ll be talking about how I realistically incorporate parent education and training in my speech therapy sessions.

DIR/Floortime Resources:

  • Casenhiser, D., Shanker, S., & Stieben, J. (2011). Learning Through Interaction in Children with Autism: Preliminary Data from a Social-Communication-Based Intervention. Autism, 17 (2), 220-241.
  • Pajareya, K., & Nopmaneejumruslers, K. (2011). A pilot randomized controlled trial of DIR/Floortime™ parent training intervention for pre-school children with autistic spectrum disorders. Autism15 (5), 563-577. doi: DOI: 10.1177/1362361310386502
  • Solomon, R., J. Necheles, C. Ferch, and D. Bruckman. “Pilot study of a parent training program for young children with autism: The P.L.A.Y. Project Home Consultation program.” Autism, 2007, Vol 11 ( 3) 205-224.

 

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.

Kid Confidential: The Latest on Treatment of Ear Infections

ear infection

For those of us speech-language pathologists who serve the birth-5 year old population (or have young children of our own), it is always important for us to know the most recent health and safety regulations that can affect our clients/students. Here are the newest regulations regarding the medical treatment of ear infections.

As otitis media affects three out of four children by the age of three, and there is a correlation between chornic otits media and communication delay, it is likely that we as SLPs will treat students with acute or chronic otitis media.  As a result we must understand the American Academy of Pediatrics (AAP) guidelines regarding the medical treatment of this condition.

Although, these regulations were initially released in 2004, it appears there is still much confusion among the medical community and, as a result, a second publication of the same AAP medical regulations for treating otitis media was released in 2013.

The regulations were written in response to antibiotic overuse and resistance in children.  Traditionally children are treated with antibiotics as the first line of defense for acute otitis media.  As there are a number of causes for ear pain, it is crucial that pediatricians firstly make an accurate diagnosis of otitis media prior to administration of antibiotics.  Doctors are urged to diagnose otitis media only when a moderate to severe bulging of the tympanic membrane (i.e. ear drum) is present.  Mild bulging and recent ear pain (i.e. meaning within 48 hours) exhibited along with other signs of ear infection (e.g. fever) also may be diagnosed appropriately.  Therefore, if the pediatrician is unsure of the diagnosis of otitis media he/she is discouraged t to prescribe antiobiotics.

Although pain is present, antibiotics are not necessarily to be considered the first course of action. In fact, in response to ear pain and/or low grade fevers, pain relievers are to be recommended initially as “about 70 percent of kids get better on their own within two or three days, and giving antibiotics when they aren’t necessary can lead to the development of superbugs over time” reports Dr. Richard M. Rosenfield, professor and chairman of otolaryngology at SUNY Downstate Medical Center, Brooklyn.

Antibiotics are only to be prescribed when the child is exhibiting several signs or symptoms of otitis media (e.g. pain, swelling for at least 48 hours, fever above 102.2 degrees Fahrenheit, etc.).  Immediate prescription of antibiotics should be recommended in the event a child’s tympanic membrane ruptures.

Although it is important to understand the medical treatment of otitis media, perhaps it is more important for us to understand the simple preventive measures a parent can take to help avoid the development of ear infections in the first place.  In addition to this medical treatment plan, the guidelines also stress avoidance of tobacco exposure, receiving the influenza vaccination, and breast feeding exclusively for the first 6 months (if possible) as additional ways to prevent infant ear infections.

Medial guidelines for “silent ear infections” (i.e. middle ear fluid without presence of other symptoms typically following acute otitis media or colds) consist of “watchful waiting.”  If a child is diagnosed with “silent ear infections” also known as otitis media with effusion the pediatrician should initially provide no medical treatment.  A follow up reexamination should take place three to six months later.  If fluid persists for more than three months, the pediatrician should recommend a speech/language and hearing assessment.  If middle ear fluid persists more than four months and signs of hearing loss are evident, a pediatrician may recommend placement of PE tubes or refer their patient to an ENT for further assessment.

I very much appreciate the AAP for adding in the guideline of further assessment in the areas of speech/language and hearing if fluid persists longer than three months.  This demonstrates the AAP’s understanding of the important of communication development and the need for a quick resolution to such delays rather than the typical “wait and see” attitude that parents often report to encounter particularly in instances of “late talkers.”  Now we, as SLPs, have guidance and support from the AAP for our clients/students with long-term persistent middle ear fluid.

Please refer to the resources below for further information.

Resources:

Jaslow, R. (2013, February 25). Antibiotics for ear infections: Pediatrician release new guidelinesCBS News.

New guidelines for treating ear infections. (2004). The Harvard Medical School Family Health Guide.

 

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.

Kid Confidential: “Join In on the Stim!”

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Autism Spectrum Disorders (ASD) is one of the great loves in my professional career. Persons with ASD are fascinating and wonderful and many times their behavior actually makes sense to me. I know what you are thinking, “This woman has got to be on the spectrum herself.” Well although I do believe that we all exhibit hyper- and/or hypo-sensitivities to various stimuli and that we all have what I like to call “a little autism in us,” it just may not be on the scale of persons who are diagnosed with ASD formally. It may not consume our entire interactions as it does for some students with ASD. So the question is, what do we do about it?

When I was in graduate school, the prevailing acceptable intervention was based on behavioral modification techniques. I was expected to spend time determining why that stimulatory behavior occurred (i.e. avoidance, stress, seeking sensory input, coping mechanism, sensory overload, etc.) and replace it with a more appropriate behavior. I still agree that this treatment strategy is appropriate in certain situations. For instance, if the student is seeking sensory input, let’s provide him/her with an appropriate sensory diet (under the supervision of an OT with the appropriate experience). If the student is exhibiting behaviors that are harmful to him or herself or others, they MUST be replaced by more appropriate safe behaviors. If the student is overloaded and attempting to escape/avoid a situation, let’s give him/her a break and/or modify the activity and expectations.

But are there times when we should actually encourage the stimulatory behavior? Are there times when we should not only support it, but “join in on the stim”? My answer to this is ABSOLUTELY! I know I just lost a few of you, but hear me out. The first time I read this idea, I was skeptical as well.

Jonathan Levy, author of “What You Can Do Right Now to Help Your Child with Autism,” challenges parents and therapists alike to do just this, join the child in his/her world by simultaneously imitating the stimulatory behavior. The idea is that for children who are profoundly affected by ASD and who spend all or most of their time exhibiting stimulatory behaviors actually need us to invade their world and physically pull them out of it by imitating them.

According to Levy, by joining your child/student in their stimulatory behavior you are telling them several things:

  • You understand their need to use this behavior.
  • You have something in common with them.
  • You want to interact with them and you are willing to enter their world.
  • They are safe to “be themselves” around you and you will not interrupt their need to stimulate themselves using these behaviors.

Does this actually work? According to Jonathan Levy, this is a technique Barry and Samahria Kaufmann, authors of the Son-Rise Program and founders of the Autism Treatment Center of America (ATCA), not only believe in, but have used successfully on their own child as well as numerous children nationally and internationally for more than 25 years. Anecdotally, I can tell you from my personal experience, I have done this and I have noted several positive changes with consistency:

  • Almost immediate increase in eye contact or facial referencing.
  • Students with ASD began to approach and/or gravitate to me whenever I entered their classrooms.
  • Students began to tolerate my touch or would take my hands and place them on their own bodies. For example, I had a female student once start pulling on my arms. I figured out very quickly she wanted me to do this to her. Although nonverbal, she made a request for the first time in her life! After I provided that sensory feedback, she was able to sit on the floor with her class during a large group lesson for the very first time.
  • And after a few weeks of joining in the stimulatory behaviors, I began to hear vocalizations. And for some of these children, it was the first time they ever vocalized!

Yes I was that therapist, jumping around in circles, flapping my hands, vocalizing various moans and groans along with my students. I was that therapist sitting at the lunch table filtering light through my fingers and screeching with my student as he attempted to eat. I was also the first person they made eye contact with; the first person, to which they handed a picture (i.e. PEC); the first person, with whom they exhibited joint attention; and the first person to whom they intentionally vocalized when making a request.

So does this technique work? I believe that it does if used properly for the appropriate students. This is not a technique that I believe every student with ASD requires or can benefit from, but it certainly appears to make significant changes in those who are so profoundly affected that they cannot find a way out of their own worlds without us stepping in and meeting them where they are.

Mr. Levy does leave us with a word of caution. Some children do not respond immediately to this technique as they are so far within their own worlds it could take them weeks to even notice your attempts to join the stimulatory behavior. But he ensures us, that this is not a reason to give up and believes that by giving the child adequate time, he will take note of your attempts to enter his world and you will break through the child’s barriers of stimulatory protection (Levy, 2007).

This has not been the case for me as I saw changes fairly immediately. However, I do believe that can be attributed to the fact that if the child is in a school setting, they are aware at some level that there are other people within the room, whether they seem to show it or not. I believe the school setting is unique in that just the setting itself forces the child with ASD to, even on a subconscious level, acknowledge there is a world bigger and different than what is found within themselves.

So the next time you have a student with ASD on your caseload that is profoundly affected and appears to spend all or most of his/her time exhibiting stimulatory behaviors, no longer ask yourself “What do I do with this child?”. Rather, make an attempt to enter their world and “join in the stim”. By doing this, you may just be the first person who has ever been able to connect with them.

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 New Jersey, Maryland, Kansas and now Arizona. 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.