Five Easy Activities to Prevent Summer Brain Drain

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Over the summer, children lose months of reading and math skills, according to several studies. When they return to school in the fall, teachers dedicate five or six weeks to review, rather than pushing students to explore new challenges. Luckily, we can encourage parents to help! In addition to reading, exploring museums and just playing at the park, check out five easy activities to help parents and clients prevent summertime brain drain.

Going on a picnic

  • How to play: The starting player sets up a pattern of what can or can’t be brought on a picnic and doesn’t tell the other players. For example, if only food starting with the letter “s” can be brought, the starting player would say: “I’m going on a picnic and I’m bringing sandwiches.” Then the other players try to figure out the pattern by guessing words or items that might match the starting word and then listening to what other items are approved.
  • Why it works: This classic game targets memory, word retrieval and vocabulary. Additionally, this is a great game for listening skills!
  • Extra language twist: Work in categories. For example, you must bring fruits, vegetables, clothing items or words that start with a certain letter or sound.

Alphabet game

  • How to play: Start by looking for a word on a sign or billboard that starts with “A”… Once you find a word that starts with “A,” look for one that starts with “B”—go through the entire alphabet! Warning: This game can become quite competitive if you have a “race” to the end of the alphabet.
  • Extra challenge: To make it even harder, make a rule that all players must use an original word—no repeats!
  • Why it works: It’s not an overwhelming amount to read and it still targets articulation sounds and letter identification. It really is so much fun!

I spy

  • How to play: Players describe an item they see.
  • Why it works: Through this game you can work on describing, word-retrieval strategies and listening skills while still having a stress-free, enjoyable time!
  • Extra language twist: Work on “wh-questions” by encouraging players to ask questions to get more information about the object. Also, you may want to limit the objects to certain categories to target categorical thinking. For added structure, remind your child to describe by category, how you use it, what it looks like and where you find it.

Heads up

  • How to play: This is both an app and a board game. In this game, a player has a word on his or her head, and other players describe it. The players continue to describe the word until it is guessed correctly.
  • Why it works: This game targets describing, which helps children express their ideas in a specific, clear and effective way. Additionally, this is a great game for listening skills and gathering information!

Twister

  • How to play: This classic board game has a large “game board” with different colored spots. A player spins the spinner and depending on the color it lands on, each player has to put a hand or foot on the designated color.
  • Why it works – You can help your child work on sounds by writing letters on the Twister board, or work on sight words by writing words on the Twister board. Additionally, this is a great game for listening skills and following directions!
  • Extra language twist: If you use a marker to write words instead on the colored dots, you can work on identifying sight words. You can also use words with target sounds for articulation!

 
Emily Jupiter, MS, CCC-SLP, is a speech-language pathologist at Alphabet Aerobics Speech and Language Education (www.alphabetaerobicsspeech.com) in Manhattan and Southampton, New York. She works primarily with children ages 6 to 14 who have been diagnosed with ADD/ADHD, dyslexia, and expressive and receptive language disorders. emily@alphabetaerobicsspeech.com.

 

 

 

 

 

5 Things You Need to Know About Working in the Neonatal Intensive Care Unit

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If you answered yes to any of the questions in my first post about wanting to work with acute care infants, then read this follow-up!

  1. The NICU is an intensive care unit: Infants in the NICU are critically ill or were in the recent past. These most fragile patients can become physiologically unstable at any time—and it might happen during your therapy. The emotional roller coaster of NICU leaves families fragile, too.
  2. It’s not easy to practice in the NICU environment: Quick and constant losses and triumphs cause emotions to run high. An infant’s status can change at any time. Caregivers are highly skilled and passionate, which sometimes leads to strong opinions and respectful disagreements. The SLP needs to thoughtfully collaborate, yet at times take a stand.
  3. The NICU SLP requires advanced practice skills: It’s not just knowing what to do, but what not to do. We often support feeding/swallowing, so the risk for compromising an infant’s airway is significant. Essential skills include solid critical reflective thinking, the ability to complete a differential, and broad, multi-system knowledge about preterm development and swallowing/feeding. Your preparation should include solid experience with the birth-to-3 patients, as well as continuing education, mentorship and guided participation with many infants in both the newborn nursery and the NICU. The NICU is too demanding to be an initial independent placement after graduate school.
  4. The NICU evidence base is rapidly evolving: Read, read, read as much professional neonatal literature as possible. Sources are not just within our field but also in medical, nursing and OT/PT journals. Our role is not only to understand the evidence base, but to bring it to the NICU team. Neonatologists and neonatal nurses will ask “why?” and we must be able to discuss the research-based evidence along with our clinical wisdom: For example, if you recommend changing from “volume-driven” to “infant-guided” feeding.
  5. The NICU is rewarding: After almost 30 years working full time in the NICU, not a day goes by that I don’t learn something, make a difference in an infant’s life or experience the joy of a grateful “thank you!” from a family. The appreciation from nurses and neonatologists when an infant can now feed safely and, therefore, go home, makes your day. With such rewards, however, comes great responsibility. In our hands lies the potential to influence parent-infant relationships through positive neuro-protective feeding experiences that wire the brain toward feeding and build future connections.

If you are thinking about moving into NICU practice, you will find lots of information on my website. Stay tuned for more tips to guide your journey!

 

Catherine S. Shaker, MS, CCC-SLP, BCS-S, works in acute care/inpatient pediatrics at Florida Hospital for Children in Orlando. She specializes in NICU services and has published in this practice area. She offers seminars on a variety of neonatal/pediatric swallowing/feeding topics across the country. Follow her at www.Shaker4SwallowingandFeeding.com or email her at pediatricseminars@gmail.com.

 

Tip Back That Tongue! The Posterior Tongue Tie and Feeding Challenges

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In a March 2015 post titled Just Flip the Lip, we explored how the band of tissue or “frenum” that attaches the upper lip to gum tissue can affect feeding development if the frenum is too restrictive. Today, we’ll focus on the lingual frenal attachment that is the easiest to miss: The posterior tongue tie (sometimes referred to as a submucosal tongue tie), a form of ankyloglossia.

Consider that the normal lingual frenum inserts at about midline, just under the tongue and down to the floor of the mouth allowing free range of movement and oral motor skill development. While many pediatric professionals are familiar with a tongue-tie when the frenum attaches closer to the tongue tip (where it’s visible when the tip is gently lifted), the posterior tongue tie requires a specific technique to view. According to Bobby Ghaheri, an ENT surgeon who specializes in treating ankyloglossia, whether anterior or posterior terminology is used, the focus should be on function. As he describes in this article, many anterior ties also include a posterior restriction and releasing just the thin membrane is not always adequate for full tongue function necessary for feeding. The frenum, if visible at all, may appear short and thick, but is often buried in the in the mucosal covering of the tongue.

As a pediatric feeding therapist, I gently lift up the tip of every child’s tongue during the oral examination. But, if I suspect a posterior tongue tie, my next step is to follow the procedure noted in this video by Dr. Ghaheri. This gives me enough information to ask the family to consult further with their pediatrician or primary care provider and a then a pediatric ENT, pediatric dentist or oral surgeon, who may also use specific instruments to better view the attachment. I feel my role as an SLP is to screen, not diagnose.

There are clues that indicate that a posterior tongue tie may be present before following the procedure noted above. The following are just some of the more common indicators of possible restriction of the lingual frenum impacting feeding development:

Appearance

  • Square, heart shaped or indented tip of tongue at rest and/or upon attempted protrusion—this is often indicative of anterior tongue ties, but as noted by Dr. Ghareri, the posterior restriction my still be present.
  • Dimpled tongue on dorsal surface, especially during movement.

Breast and Bottle Feeding

  • Difficulty latching and/or slow feeding.
  • Mother experiences pain while baby nurses.
  • In addition, as seen with upper lip ties, an inadequate latch and/or a poor lip seal may contribute to the following partial list of symptoms:

Spoon and Finger Feeding

  • Retraction of tongue upon presentation of the spoon.
  • Inadequate caloric intake due to inefficiency and fatigue.
  • Tactile oral sensitivity secondary to limited stimulation/mobility of tongue.
  • Over-use of lips, especially lower lip.
  • Difficulty progressing from “munching” to a more lateral, mature chewing pattern.
  • Tongue restriction may influence swallowing patterns and cause compensatory motor movements, which may lead to additional complications, such as “sucking back” the bolus in order to propel it to be swallowed.
  • Possible development of picky, hesitant or selective eating because eating certain foods are challenging.
  • Gagging and subsequent vomiting when food gets “stuck” on tongue.
  • Secondary behaviors to avoid discomfort that are thus protective in nature, such as refusing to sit at the table or being able to eat only when distracted.

Oral Hygiene, Dental and Other Issues Related to Feeding

  • Dental decay in childhood and adulthood because the tongue cannot clean the teeth and spread saliva.
  • Possible changes in dentition with certain compensatory methods to propel bolus posteriorly for swallowing, such as finger sucking.
  • Open bite.
  • Snoring.
  • Drooling.
  • Messy eating.
  • Requiring frequent sips of liquid to wash down bolus.

On sharing my findings with a child’s caregivers and primary care physician, a pediatric dentist, oral surgeon or ENT will determine next steps for the frenectomy. Linda Murzyn-Dantzer at Children’s Hospital Colorado shared her insight on the use of laser treatment for frenectomies. She noted that the laser can be used safely in a clinic setting, eliminating the need for treatment under sedation or general anesthesia. The laser itself provides some analgesia and often there is minimal need for other anesthetics, which may not be well-tolerated and may compete for other cell receptors and influence oxygen levels.

The laser can help to control bleeding and stitches may not be required. The laser offers precision when cutting tissue, and if the patient moves even slightly, the controls allow the beam to be stopped almost instantly. Traditional surgical techniques are also an option and used in a variety of situations, but Dr. Murzyn-Dantzer chooses the use of a laser over electrocautery techniques that may overheat or burn tissue, affecting cell layers beneath the targeted tissue and causing post-operative discomfort and increased healing time.

 

Melanie Potock, MA, CCC-SLP, treats children, birth to teens, who have difficulty eating. She is the co-author of “Raising a Healthy, Happy Eater: A Parent’s Handbook—A Stage by Stage Guide to Setting Your Child on the Path to Adventurous Eating” (Oct. 2015), 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@mymunchbug.com

The Pseudoscientific Phenom—Facilitated Communication—Makes a Comeback

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Correction: A previous version of this blog inaccurately suggested faculty in the Communication Sciences and Disorders Department at Syracuse University promoted facilitated communication. The Institute of Communication and Inclusion is housed in the School of Education at Syracuse and is not associated with the Communication Sciences and Disorders Department.

In the early 1990s, professionals who served children with autism and other developmental disabilities were swept up by a breakthrough method known as facilitated communication (FC). The method included a “facilitator” who provided physical support at the finger, hand, wrist and/or arm of a child who was believed to be typing his or her thoughts. The method allegedly “unlocked” these children from the prison of an unresponsive body to reveal average and sometimes superior intelligence, advanced literacy skills and profound insight about their experiences.

Although no validating evidence was available, popular media latched onto the story and FC fervently spread throughout the country. When researchers investigated claims made about FC, they discovered facilitators subconsciously authoring the messages and concluded FC was fake. For the most part, FC was widely dismissed by the professional communities and became a history lesson on the dangers of credulity, pseudoscience and the importance of evidence-based treatment.

However, beliefs about FC’s demise are premature.

Facilitated communication remains at the fringes of special education and related professions. The primary advocacy has come from faculty affiliated with the Institute of Communication and Inclusion at Syracuse University. A confluence of recent events reinvigorated the method, which is increasingly touted as “a form of augmentative and alternative communication.” Despite overwhelming scientific consensus that the client isn’t totally controlling the message, the method recently underwent a strategic rebranding and is now called “supported typing” or “rapid prompting method.”

Several indicators suggest FC is not just poised for a comeback, but that it’s already begun. A number of credible organizations lend FC unwarranted legitimacy, including the University of New Hampshire Institute on Disability/Center Excellence in DisabilityUniversity of Northern Iowa, Massachusetts Department of Elementary and Secondary Education, and Vermont Department of Disabilities.

Supporters in academia publish articles in peer-reviewed journals that portray FC in positive light, albeit without demonstrations of its efficacy. Indeed, the method is regaining popularity and school districts are beginning to adopt it for their students with autism.

Facilitated communication—known for being the quintessential pseudoscientific fad in developmental disabilities—is infamous for the number of unsubstantiated charges of sexual abuse made by users. In late 2014, the Wendrow family, whose story was featured on 20/20, was awarded nearly $7 million for wrongful prosecution after sexual abuse allegations were made via FC. Former Rutgers University Philosophy Department Chair and leading FC proponent Anna Stubblefield, who claimed any criticism about FC constituted hate speech, was recently charged with multiple accounts of aggravated  sexual assault after she allegedly acted as a facilitator to obtain consent for sex from a man with a severe disability and communication impairment. Stubblefield pleaded not guilty and her trial is set for August 2015.

The method also appears to have played a role in the murder of a child with autism. In November 2014, wealthy businesswoman Gigi Jordan was convicted of murdering her 8-year-old son. Jordan’s defense centered on her claim that she committed a mercy killing after her son allegedly requested via FC they both commit suicide.

Professionals responsible for teaching communication skills to children, youth and adults with autism and other developmental disabilities should take stock when examining claims of hidden communication skills, sudden breakthroughs and inspiring anecdotes that are incongruous with generally accepted research. Evidence-based interventions and treatments do exist to support acquisition of communication and other skills for these learners, though progress often is painstakingly slow. FC and its variants remain illegitimate and ultimately usurp the voices of individuals with communication impairments.

If those teaching individuals with autism and other developmental disabilities to communicate adhere to evidence-based approaches, they better serve their clients, prevent harm, and halt the proliferation of pseudoscience in autism.

Editor’s Note: Jason Travers will be speaking at the upcoming Schools Conference in Phoenix, July 10-12.  His presentation, Get the Message? The Communicative Nature of Inappropriate Behavior in Learners With ASD, will also be featured at Convention in October. See the full schedule for Schools, which is co-located with the Health Care & Business Institute.

Jason C. Travers, PhD, is an assistant professor of special education at the University of or Kansas. He earned his PhD at the University of Nevada, Las Vegas, while working as a special educator of students with autism in the nation’s fifth-largest school district. He investigates the racial disparity in the administrative prevalence of autism as well as the efficacy of technology for preventing inappropriate behavior while supporting academic, social and communication skills of students with autism. A board-certified behavior analyst, he teaches graduate courses in applied behavior analysis, evidence-based instructional strategies for learners with autism, and issues in special education. jason.travers@ku.edu

 

Apraxia Awareness Day: 10 Tips on Giving Kids With CAS a Voice

May 14 marks the third annual Apraxia Awareness Day, a movement headed by the Childhood Apraxia of Speech Association of North America (CASANA). The association’s motto—”Every Child Deserves a Voice”—entreats industry pros to correctly identify and treat kids with apraxia who may not develop intelligible speech. This is why apraxia awareness day is so important.

When I wrote the 10 Early Signs and Symptoms of Childhood Apraxia of Speech, many SLPs voiced their concern about how CAS is supposed to be a rare disorder and they are seeing over-diagnosis. Their concerns are valid. Current data, according to the ASHA portal, state that CAS occurs in every one to two children per 1,000. Over-diagnosis is a problem precipitated by factors that include:

  • Lack of clear and consistent diagnostic guidelines.
  • Lack of adequately validated diagnostic tools.
  • Professionals other than SLPs (pediatricians, neurologists) diagnosing CAS.
  • SLPs inadequately trained in diagnosis and treatment.

Over-diagnosis can cause families undue emotional stress and financial hardship. It also might divert important resources from those children who most need them.

According to research, children with CAS also often go undiagnosed if they truly DO have it! Differential diagnosis is critical with this disorder. Children not identified with CAS may struggle their entire lives and quite possibly not achieve intelligible speech without early and appropriate intervention. Consider that last line again: Without proper diagnosis and treatment, children with CAS may NOT achieve intelligible speech. This is what’s at stake!

awareness day

Apraxia awareness is crucial for professionals and families, so every child who has CAS gets the services he or she needs and deserves, regardless of how “rare” the disorder.

These children and parents rely on SLPs to be their heroes. So please, take time today—or soon—to learn more about childhood apraxia of speech. And if you suspect CAS in a client or student:

  • Seek out resources.
  • Attend a conference.
  • Listen in to a webinar.
  • Talk to and consult with your colleagues.
  • Wear blue and speak up for those who don’t yet have a voice.
  • Above all, be part of the solution.

These children and families are counting on you.

Having trouble getting reimbursed for CAS treatment? Read advice on making successful appeals.

And more resources to learn more about childhood apraxia of speech:

 

Laura Smith, MA, CCC-SLP, is a school-based and private clinician in the Denver metro area specializing in childhood apraxia of speech. She’s CASANA-certified for advanced training and clinical expertise in Childhood Apraxia of Speech and often speaks at conferences and consults for school districts or other professionals. Like her on Facebook, follow her on Pinterest, or visit her website at SLPMommyofApraxia.comlauraslpmommy@gmail.com