Are You Wearing Your Play-Based Hat Today?

Importance of play

Ever leave the house and not know what to wear? As an early intervention SLP, I wear many hats, and there are days when I’m not sure which hat (or hats) I’ll put on. As any therapist knows, the nature of our job is not just treatment related, but often much more. Of course the hat I wear most often is my speech therapy hat but when I enter the homes of my “kids” every week I sometimes encounter life that requires me to be more than just an SLP.

There is a trust that forms when you regularly enter someone’s home. Families respect you not only as their child’s SLP, but also as a resource for other parenting questions. These questions might require my community resource hat, my fellow parent hat or my support hat. Because the parents of our clients trust us to meet many needs, it is important that when they ask questions or seek guidance we are there to help.

For example, many families today experience a societal pressure to push their child well beyond what is developmentally appropriate. Parents set unrealistic expectations for their children and panic if they feel their child isn’t “keeping up.” I’m concerned when I enter homes filled with obscene piles of toys, a television constantly going and a toddler who manipulates my phone and tablet more skillfully than I do! Through my sessions I model play, in the absence of fancy toys and electronic devices, hoping the parents will realize how simply PLAYING with their child is enough. There’s no better way to achieve developmental milestones and enrich children than through play.

Sometimes my example isn’t enough…well OK, it’s often not enough. So frequently I have a conversation about age-appropriate expectations, age-appropriate toys and what children need most from their parents.

When pondering how to start this conversation, I often find myself asking: What can I do to educate families on the importance of play? What can I say to drive home age-appropriate expectations? What are some of the most important points to stress to the families I serve? Professionally, I branched into owning a business devoted to play, plus I learned about how play is changing and why it matters.

Here are some tips you may find helpful to educate parents about the importance of simple play:

• Remind families that children need unstructured playtime and give specific examples of what is learned when a child does “nothing.” A toddler’s day should consist mostly of unstructured play and opportunities to experience their world with all their senses. Tell parents that this is the best way for their child to learn.

• Share with parents the American Academy of Pediatrics’ recommendation of no screen time before age 2 and only two hours per day for children older than 2. Parents are usually shocked to hear this, but even a television in the background distracts a baby/toddler and can make it more difficult for them to focus and learn.

• Inform parents that babies and toddlers do not truly learn anything from flashcards. The powerful marketing beast can sell just about anything to an anxious parent who wants that best for her child. However, research and experience do not support their use, particularly at such an early age. Share what you know about play-based options for teaching language skills.

• Encourage parents to slow down and follow their instincts. Oftentimes parents know what’s best for their child, but are influenced by outside sources. As professionals, we can reassure parents to trust themselves.

If you are an EI SLP I hope you realize your importance not only in the life of the child you serve, but his family as well. You are appreciated and trusted, so may you guide your families so that they are able to enjoy the miracle of their child to the fullest. Choose your hats wisely and don’t keep all that knowledge about PLAY under your hat. We all have a role in supporting families and enriching children’s lives.

Lacy Morise, MS, CCC-SLP of Berryville, Virginia works for the West Virginia Birth to Three Program as an early intervention therapist. She also owns Milestones & Miracles (with her EI PT bestie, Nicole Sergent, MPT) Read her blog and like her on Facebook, follow her on Twitter @milestonesm and Pinterest

“Cuz You Know I’m All About That Case, Node Trouble”

121114_blogNodes_155849552

Meghan Trainor’s song is so popular that excellent covers are popping up everywhere and I think there is a strong possibility of another definition of “bass” being added to the dictionary by next year. Now, while Meghan has no history of voice issues that I am aware of, others in the spotlight have suffered from vocal pathologies so severe that they have had to cancel tours and even rehabilitate their singing voices for years before performing live again.

Voice care has been in the media recently and I think it is important for clinicians to understand exactly what is going on with these popular cases because it will help them answer tough questions. I am always reading whatever I can get my hands on. I know that most SLP’s and AuD’s out there barely have time to dash to the bathroom during a work day, let alone to thoroughly read a peer-reviewed research study. It is our duty as clinicians to have a strong commitment to lifelong learning because our abilities as competent care providers are supported by the information we can synthesize on the spot. It is always okay to say, “I don’t know,” however, I always feel extra special when I can say: “I read about this last week.”

Not having enough information on a topic usually leads to accusations and rash decision making. I had a client recently ask about the procedure that was performed on Joan Rivers, which ended up causing her death. “Don’t you do that?” she asked. I explained that although I do not biopsy vocal cords, I do look at them with a camera and the patient needs to be awake so he or she can say “eeeeee.” I went on to explain that topical anesthetic is sometimes used when the gag reflex is particularly sensitive, but no patient of mine is ever sedated for an exam. Joan Rivers had some unplanned things happen during her procedure and because her healthcare information is private, just like any patient’s, we are left to read and watch news stories compiled with some facts missing.

Most of us know that Julie Andrews had great success with “The Sound of Music” and “Mary Poppins,” but many might not know that she battled with vocal nodules, also called nodes, in the 1990’s. Speech-Language Pathologists know now that vocal nodules usually respond to behavioral voice therapy without needing surgical intervention. Julie had her nodules removed in 1997, but the surgery left her with the inability to sing. We wonder, as we do in Joan’s case, what actually happened. If Julie had noncancerous nodules and her behaviors were addressed, perhaps surgery wouldn’t have been necessary at all. Nodules shouldn’t come back if the vocally abusive behaviors are replaced with efficient vocal production techniques. We don’t know if Julie had any voice therapy, but we can speculate that she most likely had scar tissue develop where the nodes were removed. Scar tissue inhibits the vocal fold tissue’s elastic properties resulting in pitch breaks or periods of aphonia.

Nodes have also been addressed by mainstream media in the movie “Pitch Perfect.” Chloe tells the Bellas she has vocal nodes in a dramatic scene, but reveals she has continued to sing despite the diagnosis because she loves it so much. We can’t be expected to know every movie or pop-culture reference to our profession, but it helps to be aware so we can connect to younger clients. Chloe’s story is all too familiar. Some clients find it very difficult to follow treatments because their jobs depend on voice use or they are passionate about performing. It is essential to communicate the importance of adhering to all voice therapy recommendations. Explain that while you understand their passion for their craft, you know that they will have more heartache later if they don’t take time to correct behaviors now.

John Mayer very recently opened up on Twitter to discuss his long and emotional struggle with a granuloma. He says, “It’s 2 years to the day that I had my vocal cords paralyzed so they could heal. It took about as long to get all of my voice back. I can’t tell you how good it feels to hit those notes. Especially on new songs. I’m free again. So grateful.” Well done, John. As clinicians, it’s important that we educate our clients about the length of recovery time, especially for professional voice users.

Polyps have plagued singers like Adele and Keith Urban. Adele reportedly used an app on her phone to speak for her while she was on voice rest for her hemorrhagic polyp, but I wonder if she knew about this avatar program. Technology is readily available these days to improve success for any clients on vocal rest. Both performers underwent surgery to correct these conditions, and hopefully some voice therapy too, as polyps and hemorrhages are functionally caused vocal pathologies. There are four different classes of voice disorders: Functional, Neurological, Organic and Idiopathic. With Adele and Keith’s conditions falling under the functional category, voice therapy could reverse bad habits and keep them from developing any future lesions.

Have you ever provided therapy to a famous client? I know you couldn’t tell anyone even if you have, but it’s pretty exciting, right? Sometimes we need a reminder that a high-profile client’s plan of care should be given the same attention as any other on our caseload. It is okay to feel star struck, but remember to remain calm and collected. Any famous clients will thank you for your professionalism and remember how your intervention helped them get back to doing what they love. Trust me on this one.

So whether your patient is red-carpet-ready or your average-Joe, be knowledgeable and treat clients with equal respect and care so you can “bring savvy back” and be “all about that case.

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She provides voice, swallowing and speech therapy in her own private practice, a tempo Voice Center, LLC. She also lectures on the singing voice to area choirs and students. She belongs to ASHA’s Special Interest Group 3-Voice and Voice Disorders. She keeps a blog on her website at www.atempovoicecenter.com. Follow her on Twitter @atempovoice or like her on Facebook at www.facebook.com/atempovoicecenter.

 

“Use Your Speech Tools!” Why Your Child Who Stutters May Not Be Using His Strategies

Stuttering Tools

When a child who stutters demonstrates the ability to change his speech during a treatment session, it seems obvious that he’d want to use the same strategies to improve speech outside the session as well.  Children, especially teenagers, rarely want to stand out in a way that stigmatizes them, provokes questions or increases the chances of teasing.   So the question arises, “Why aren’t they using their tools?!”

Speech and stuttering modification techniques are often learned quickly and easily within the treatment setting.  However, SLPs and parents often feel discouraged when these tools seem to disappear as soon as the client gets to his car.  Is it laziness on the part of the child?  Is it the fault of the family for not following through with home assignments?  Is the SLP not teaching the best strategies?

Instead of placing blame, consider the following three reasons a child may have difficulty generalizing his skills:

Reason # 1: These Techniques Are Too Hard! 

Making changes to one’s speech becomes exponentially harder when you introduce factors that often are not present in the session, such as interruptions, time pressure and feelings of embarrassment or shame associated with stuttering. Learned escape/avoidance behaviors and increased language demands may make it very difficult to use these tools.  Suddenly, what felt like an easy decision to use a new technique, becomes complicated by the person’s desire to be heard in a large group of chatty peers or by the need to formulate an excuse about why he doesn’t have his homework.

How Can I Help?

Children will be more likely to use speech/stuttering strategies if they are first introduced in safe and supportive environments (i.e. home, session room).  To help with this, create a hierarchy of speaking situations and use it to guide where the client practices the strategies.  If a child who stutters is not yet using speech tools in certain situations such as the classroom, it is probably because of where that situation is on his hierarchy. Work with your clients to determine where they would like to use their strategies , while also identifying those situations where they would prefer to concentrate on things other than using their tools.

Reason #2: These Techniques Make Me Sound Weird! 

There are several techniques that may be taught to a child who stutters. Some strategies involve prolonging the initial sound to ease into or out of a word with less physical tension or struggle.  Other techniques include inserting more pauses into speech.   All speech tools require a child to alter their speech in a way that is still different from how his friends sound.  Children may report that they have similar negative thoughts and feelings about using these strategies as they do about their stuttering.  This may play a role in why they are choosing not to use speech strategies outside their sessions.

How Can I Help?

Just as you might spend time trying to help reduce negative reactions to stuttering, you might also spend time desensitizing clients to hearing themselves use strategies through voluntary stuttering assignments.  Children can also benefit from improving their ability to handle listener reactions. This can be addressed by participating in role-playing activities that help the child create “scripts” for responding to curiosity/teasing.  For example: “Why do you sound like that?” “Sometimes I stretch my sounds like that to help me get out of a stutter.”  The more comfortable the child feels with his strategies and ability to respond to questions about his speech, the more prepared he will be to use these techniques outside the session.

Reason #3: These Techniques Aren’t Worth it!  

A cost-benefit analysis can be useful when trying to understand why a child may choose not to use speech/stuttering strategies.  At the surface, it may appear that there are many benefits of using strategies which include increased fluency and improved overall communication. However, SLPs and parents must be careful to consider the costs, as well.  Costs may include increased effort, difficulty concentrating on the content of message, the risk of showing more stuttering and the potential that the strategy doesn’t work.

How Can I Help?

Have discussions with clients about what they perceive as potential costs versus benefits of using strategies in a variety of different speaking situations.  As the child becomes more accepting of stuttering and is better able to tolerate both his feelings about stuttering and listener reactions, physical tension and struggles associated with speaking will decrease.  As this happens, tools become easier to use and costs may not feel so high.

The bottom line 

There are several strategies that may help reduce stuttering frequency and severity.  However, you often can’t offer these tools without first considering and incorporating goals that target how the client thinks and feels about his speech both while stuttering and while using tools.

Brooke Leiman, MA, CCC-SLP, is the Director of the Stuttering Clinic at the National Speech/Language Therapy Center in Bethesda, Md. She is an affiliate of ASHA Special Interest Group 4, Fluency and Fluency Disorders. This blog post is adapted from a post on her blog, www.stutteringsource.com, which focuses on fluency disorders and their treatment.

 

 

Tales From Apraxia Boot Camp

bootcamp
In August of this year, I was selected to be a part of The Childhood Apraxia of Speech Association of North America’s 2014 Intensive Training Institute, otherwise known as “Apraxia Boot Camp.” Twenty-four speech-language pathologists, including myself, trained with three mentors–Ruth Stoeckel, Kathy Jakielski, and Dave Hammer–at Duquesne University over four days. In its third year, the goal of the boot camp is to spread a high level of knowledge about Childhood Apraxia of Speech (CAS) assessment and treatment throughout the United States and Canada. This conference accomplished that and so much more.

This experience was different than any other continuing education seminars that I have attended. We did not listen to speakers discuss CAS. Instead, Ruth, Kathy and Dave became our mentors. This was powerful. They moderated discussions on evaluation and treatment approaches. We reviewed research papers and had long debates on the principles of motor learning. We highlighted and critiqued therapy methods for those brave enough to show videos of themselves. We problem solved and brought up more questions than we knew were possible.

In smaller groups, our mentors provided insights and personal perspectives on how they work. In this intimate setting, we felt comfortable asking questions and sharing our experiences. The mentors shared constructive criticism along with thoughtful suggestions. In all, they made me think, reflect and question everything I do. Why do I give that test? Why do I treat that way? What is the research behind it? They encouraged us to become critical thinkers.

As therapists, we often get used to using the same materials and therapy techniques we learned in graduate school or during our early experiences. Those methods are not always effective with every child we treat nor are they all proven effective with evidence based-research. Specifically, children with CAS require different therapy techniques than other children with articulation or phonological delays.

Ruth, Kathy and Dave provided valuable information in a small, engaging setting. Their mentoring and passion for CAS has inspired me and I hope to pass along this valuable information to others through mentoring, improving my competency in treatment and diagnosis of CAS, and, in the end, helping children to communicate.

Based on my experience, I’d recommend asking yourself a few questions when selecting your next continuing education event:

  • What am I passionate about? Is there a child or an area of speech pathology that truly inspires me?
  • How will it improve my skill set?
  • How will it help me better serve my clients?
  • Who is doing the most current, researched-based evaluation or therapy techniques?
  • How will it further our profession?

 

Amanda Zimmerman, MA, CCC-SLP, is a pediatric speech-language pathologist in Columbus, OH. She can be reached at azimmerman@columbusspeech.org.

Teens and Feeding Therapy:  An SLP’s Top Five Tips!

Making trying new foods fun for teens.

Making trying new foods fun for teens.

As a pediatric feeding therapist, it’s not unusual for me to get a call from a mother who says “My kid’s 14 years old and still eats only six foods. He’s so picky!  I thought he would grow out of it.”  True, with patience and consistent strategies, some kids do indeed grow out of the picky-eater stage, typically at its peak aro

und age three. But if the child had underlying motor, physiological or sensory challenges that stalled the developmental process of learning to eat a variety of foods, it’s not unusual that selective eating behaviors will prevail into the teenage years.  I approach treatment with teens in a similar manner as my younger clients while respecting one important fact: They are teenagers!

Here are my top five tips for interacting with teens while building trust and confidence, plus making feeding therapy successful (and fun!) for both of you:

#5  Use Cool Games:  I always incorporate games into feeding practice.  Learning to try new foods is HARD, at any age.  Including games in the process of biting, chewing and tasting keeps anxiety levels low and still allows learning to take place.  Using games as a means of distraction, such as eating while playing independently on an iPad, does not allow for conscious learning.  Instead, try using games that are reciprocal in nature and where each player’s turn lasts no more than ten seconds.  If your client is working on learning to drink a smoothie, perhaps he might take a drink, get a turn, etc.  Try Blockus, UNO Blast or  Connect-4 Launchers, all interactive and exciting games. Plus, they are easy to clean, which is important in feeding treatment.

#4 Create Your Own Games: To quote a bit of teenage lingo, find out what the teenager “is obsessed with” and create games around that obsession. Does she love three-toed sloths?  Pull up the best sloth videos on YouTube and create a Jeopardy game around them, hiding each video under categories like  “Kristen Bell for One Hundred Please.”   I once had a client who knew every Movie Production Logo in Hollywood.  His mother sent me pictures of ten favorite logos and I laminated two copies of each.  During feeding therapy in his home, we would spread out the laminated pictures all over the kitchen floor and after each bite, try to toss a penny onto a picture.  Get a match, and you get a point.  Another client of mine was obsessed with paintball, but I wasn’t about to do feeding therapy in a paintball bunker.  Instead, I brought my Discovery Toys Marbleworks® and with each bite we added one piece, eventually building intricate contraptions and using the paintballs as marbles.

#3 Ask WHY: Once I get to know a teen, I always ask this question: “Is there a special reason you want to learn to try new foods?” One teen told me that he wanted to ask his girlfriend to Prom, but was afraid that he couldn’t take her to a fancy restaurant for dinner.  “I don’t think they serve pizza there, and that’s all I know how to eat.” That was eye-opening for me!  Now I know his motivation and we have a timeline for success. When there is no motivation, that’s a problem.   It’s common for a teen to reply: “I don’t want to learn to eat anything new – my Mom is making me.”  This is the time to help a teen FIND motivation.  “How’s wrestling going?  Did you know you need protein to build more lean muscle? What types of protein would you like to learn to eat: nuts, hamburger or vegetable protein?”  One of my clients had been consisting on  four strawberry Pediasures mixed with whole milk every day for over three years before starting therapy. He used to eat some solid foods, but over time began to limit his intake until he was food jagging on Pediasure.  He didn’t see a problem, because he liked the way he could gulp down a Pediasure and rush outside during break time to play basketball with his friends. That worked for him because it enabled him to avoid social eating in the cafeteria, which made him very anxious.  I suspected that the high dairy content was making him constipated, thus decreasing appetite.  Let’s face it: A teen is not likely to tell ME about his constipation.  But, I called his pediatrician and requested that they have the constipation talk during the upcoming sports physical.  Once his doctor explained that he would no longer have to struggle with bathroom issues, which was a huge source of embarrassment for him, the teen was open to tasting some new foods.  Feeding therapy, especially with teens, goes best when we focus on the whole child and learning what’s important in his unique world.

#2  Teach positive self-talk: So many older kids engage in negative talk about food because it stops parents from serving it.  Over time, those negative comments become a habit that for lack of better term, is a form of self-brainwashing.  While it’s important to acknowledge a teen’s feelings if he says “I can’t – I’m scared I’ll gag,”  it’s just as important to help him talk positively about eating.  I explain it this way:

I want you to talk to your own brain the way you would talk to your best friend.  If your best friend had practiced with his soccer coach to take a goal kick in soccer but was feeling anxious when it came time to attempt it, he might turn and whisper to you, “I can’t – I’m scared that I’ll miss.” You’d probably tell  him “You’ve practiced with coach and you have the skills to do it!  It’s OK to be nervous – you can still make that goal!”  He needs to hear that from you.  Well, your brain needs to hear the same positive talk from you when you talk about food.  It’s OK to be nervous and it’s OK not to like the taste of it.  We’re just beginning to learn how to how to eat this new food and we are practicing it.”

And this SLP’s #1 Tip? Give Them the Script: Teens may not always have the most descriptive vocabulary, except to narrow taste and texture down to “gross.”   Give them the language and discuss what terms like savory, buttery, creamy truly mean.  A reference list of 345 terms to describe food can be found here.  Plus, it helpful to use comparison phrases such as “It’s similar to tiny dots of corn, but it’s called polenta” in order to build familiarity with a food they’ve experienced in some manner, such as corn.  If the most interaction they’ve had with corn is just staring at it, that’s OK!  Stare at the polenta.  Make it a kitchen science experiment and discuss all the properties of polenta if you need to.  Give them the words that build visual familiarity with polenta: “yellow cornmeal”, “hulled”, etc.  Talk about how it can be baked, fried, grilled or stirred into a porridge.  Interact with it – get to know it.  Now you’ve got a teen whose introducing his brain to polenta by saying: “Polenta is cornmeal, which is made from something I’m familiar with: corn.  I think it looks best when it’s fried, because I like fried foods.” He’s OPEN to the concept of Polenta because he has the terminology to describe it and understand the properties. As you progress from visual interaction to tactile exploration, provide terms that describe the feel of polenta such as “gritty” and “course.” Eventually, you’ll be discussing the same feel in the mouth.  As all SLPs know, language is empowering.

What other strategies do you have when helping teens interact with new foods?  Please list them in the comments section, thank you!

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.

Using Comic Strips in Speech Intervention

comic

For the past couple of years, I have used Carol Gray’s materials extensively during my work with adults with developmental disabilities. Creating comic strip conversations has been extremely helpful in facilitating conversation, resolving social issues between peers, taking turns in conversation and providing different social scenarios within various contexts.

Since I have worked in creating my own comic strip conversations with my clients for some time now, I decided to experiment using the comics section in the newspaper. My clients are motivated by the local newspaper for many reasons. They enjoy browsing through current events, looking at the pictures in the sports section and reading the comics.

The comics within a local paper are inexpensive (in my area it is just $1.00 for the local newspaper), easily accessible and age appropriate for older children, teenagers and adults. Therapy using comic strips has been surprisingly motivating and beneficial to my clients. I never realized how effective using the comics section could be!

I like to keep my favorite comics and laminate them for future use. I have also created a game around using the comics section. My clients take turns choosing from a pile of comic cards and then have a discussion about each particular card. When one client doesn’t understand a particular comic and why it’s funny, I have him ask his peer for assistance. As a group, we have had many extensive and interesting conversations related to the comics. Here are some speech and language goals that can be facilitated with the comics:

1. Expanding vocabulary: The comics are full of language, which make it an ideal time to discuss and define new vocabulary. It will be difficult for a client to understand a particular comic without understanding the actual definition of some of the words. For example in a recent Garfield comic, Garfield thinks “This is a perfect day to stay in bed and contemplate life’s truths.” Discuss what “life’s truths” means with your client. Defining the “contemplate” can help build vocabulary and build in conversation. Ask your client, “What do you contemplate about?”

2. Abstract Language/Humor: The comics are excellent in discussing abstract language and humor. In many comic strips, there are often multiple meanings of words. In a recent comic, the discussion between the characters was about “trail mix.” To one character trail mix was the snack, to the other character trail mix was a bunch of items that you picked up along a trail in the woods (e.g. dirt, sand, rocks). This comic began a conversation about the multiple meanings of words and how they had a miscommunication. Discuss the humor in the comic and why it may be funny to the reader. This can be a tricky exercise for many clients especially with autism, but it can be extremely useful as well. Helping a client recognize humor can help build friendships and improve conversational skills.

3. Taking Turns in Conversation: Between characters, there are natural turns in conversation. This can be a great model for conversation. As a carry-over activity continue the comic with an extra blank comic strips. This can help your clients create their own conversations.

4. Improving Literacy/Punctuation: Having your client read the comics can help improve literacy and reading comprehension. Point out different punctuation markers within the comic such as exclamation marks, periods, question marks, etc. Also, discuss the difference between the characters thinking a particular thought versus actually speaking it.

5. Interpreting Facial Expressions and Feelings/Emotions: In many comic strips the characters have extreme emotions. In other comics, the feeling and emotions of a character can be a little tricky due to the high levels of sarcasm. Read the specific comic strip together, discuss the language and then ask your client how the character is most likely feeling.

Rebecca 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.

 

Kid Confidential: Parent Education and Training, Part 1

parents

 

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.

Collaboration Corner: 10 Easy Tips for Parents to Support Language

ice cream

As we make our way through the lazy days of summer, schedules change, and things relax. My usual theme is collaboration; parents can be one of our biggest assets in promoting language development. Parents of young children usually want to know what they can do to support their child’s language development in the absence of a structured day. Though I teach children with disabilities, I find I continually revisit the following tips with parents of young children regardless of whether a child is typically developing or needs a little more support. Here they are in no particular order of importance:

  1. Pay attention to body language, when a child is looking toward or reaching for something, they are communicating. Talk about what they are reaching for, “Oh, you want the bubbles!”
  2. Avoid the “say this” tendency. Don’t pressure the child to speak; keeping the experience positive is important. Instead, model what the child might say when he/she is ready.
  3. Take time to sit and read with your child every day. Label everything you see, and encourage them to point to the words and pictures as you talk about them. Books with repetitive lines are great.
  4. Be playful. Sing songs. Use lots of inflection. With familiar songs, leave some of the words out and see if your child will hum or sing the words.
  5. Provide limited choices when you aren’t sure what your child wants. Holding out 2 items, lessens the stress of having too many choices.
  6. Talk with your child about what you are doing, then provide the opportunity for your child to reciprocate. “I’m making some cookies, do you want to help?”
  7. Use first/then language to guide behavior, and then be consistent, “First you need to eat, then you can read.” Use this language even when moving between activities that are preferred or less preferred.
  8. Use pictures: Take pictures of your child’s day and talk about what is coming up next, or make a photo album of fun activities (vacation, going out for ice cream) to talk about.
  9. Remember language is everywhere, even if you child doesn’t understand everything you are saying, he or she needs the exposure. Car rides, walks outside, blowing bubbles are just a few examples. Describe what you see, and ask questions, e.g, “I see a cow. What does a cow say?”
  10. Simplify your props. Sometimes the simplest toys can bring out the best language. Summer is full of such opportunities: A spinning toy, taking a turn kicking a ball, bubbles…all can support your child’s development, simply by talking to them.

Kerry Davis Ed.D., CCC-SLP,is a speech-language pathologist in the Boston area, working with children who have significant communication challenges. She conducts trainings and workshops, and serves as a volunteer speech pathologist and consultant for Step by Step Guyana, a school for children with autism in South America. The opinions expressed in this blog are her own, and not those of her employer.

Three Reasons Why Kids Get Hooked on “Kids’ Meals”… and How to Change That

chicken

Let me say this up front: I’m not condemning the American Kids’ Meal that is so common in fast food chains and family restaurants, but clearly I’m not keen on eating that type of food when there are other choices.   My own kids have certainly had their fair share of chicken nuggets, mac n’cheese and French fries, just to name a few of the comfort kid foods that predictably reappear on kids’ menus day after day.   This is not a blog about good vs. healthy nutrition, because most parents (including me) know that the traditional fast food fare is not healthy…and that’s exactly why parents want to change the statistics that 15 percent of preschoolers ask to go to McDonald’s  “at least once a day.”    The millions of dollars spent on advertising and toys to market kids meals certainly makes many of us frustrated when much less is spent on marketing a culture of wellness.  By hooked, I don’t mean addicted, although there is research that suggests that food addiction may be a serious component for a subset of the pediatric population Plus, the added sugars in processed foods have been found to be addictive in lab experiments.  But, for the purposes of this short article, let’s keep kids’ meals in this very small box:  Most kids love them.

Why am I writing about this for ASHA? As a pediatric SLP who focuses on feeding, one of the frequent comments I hear from parents is “As long we’ve got chicken nuggets,  then my kid will eat.”   Besides the obvious “just say no” solution, what parents truly are asking is,  “How do I expand my kid’s diet to include more than what’s on a kids’ menu?”  Whether we are considering our pediatric clients in feeding therapy or simply the garden-variety picky eater, that is an excellent question with not a very simple answer.

In feeding therapy, therapists take into account the child’s physiology (which includes the sensory system), the child’s gross motor, fine motor and oral motor skills  and also behaviors that affect feeding practices.  Therapists then create a treatment plan designed to help that specific child progress through the developmental process of eating.  While the nuances of learning to bite, chew and swallow a variety of foods are too complex to cover in a short blog post, here are just three of the reasons why kids get hooked on kids’ meals and some strategies to avoid being locked into the standard kids’ menu and begin to expand a child’s variety of preferred foods:

  1. Kids barely have to chew.  The common fast food chicken nugget is a chopped mixture of …well, if you want to know, click here.  Warning: it will ruin your appetite for chicken nuggets, so if your kids can read,  clicking might be the first solution.  However, in terms of oral motor skills, bites of chicken nuggets are a first food that even an almost toothless toddler can consume with relative ease.  Simply gum, squish and swallow.  Macaroni and cheese?  Oily French fries?  Ditto.  There’s  not a lot of chomping going on!
  • In feeding therapy, SLPs assess a child’s oral motor skills and may begin to address strengthening a child’s ability to use a rotary chew, manage the food easily and swallow safely.  Many of the families we work with eat fast food on a regular basis and we might start with those foods, but slowly over time, more variety is introduced.
  • For general picky eaters or those progressing in feeding therapy, the key is to offer small samplings of foods that DO require chewing, as long as a parent feels confident that their child is safe to do so.  Starting early with a variety of manageable solids, as described in this article for ASHA, is often the first step.   For older kids, the texture (and comfort) of “squish and swallow” foods can contribute to food jags.  Here are ten tips for preventing food jags, including how to build your child’s familiarity around something other than the drive-thru.
  1. At restaurant chains and drive-thrus, kids’ meals are readily available.  Helpful hostesses grab the crayons and the matching kids’ menus as soon as they spot a parent walking in with little children.  Kiddos quickly become conditioned to ordering mac n’ cheese or hot dogs.   Parents want a peaceful, enjoyable experience dining out, so naturally they like the kids’ menu option because it appeases everyone.  But it’s just that–an option.
  • In feeding therapy,  SLPs assess and often treat a child’s ability to be flexible with food at home and in the community.  A hierarchical approach is often utilized, where exposure to new foods occurs as a gradual process over time.
  • As a parent, if your child likes to stick to the same routine at a restaurant, begin with helping your child order from the “adult” menu, knowing that you can request adaptions to certain dishes if needed.  If the prices feel too steep, order a side for the kids, and give them samplings of everything on your plate.  Keep in mind that often the goal is simply experiencing the presence of new foods, so order a side dish that is a favorite food plus present a selection of new options from your plate if you are concerned your child will not eat anything.  Now you and your child have a new routine and the tasting piece occurs once the routine is established.   If you order a salad in the drive-thru, consider skipping the kids’ meal and creating a kid’s sampling of grilled chicken cubes, sunflower seeds, mandarin oranges or other options directly from your salad when you arrive at your destination.   Request an extra packet of dressing if your kids like to dip.
  1. Kids Meals are QUICK! Quick to buy, quick to eat and quick to raise blood sugars and thus, feel satisfied.  I get it – part of today’s hectic lifestyle is shuttling kids to and from activities and often, mealtimes happen while riding in the mini-van.  Fast food chains understand this too – that’s why it’s marketed as “fast food.”
  • In feeding therapy, this reliance on drive-thru food affects progress in therapy.  For example, it’s not uncommon for elementary school kids in feeding therapy to  have trouble eating in the chaotic school cafeteria and be “starving” when a parent picks them up from school.  The quickest, easiest solution: The drive-thru every day after school.
  • In today’s quick-fix society, our children are losing the valuable skill of waiting.  Feeling hungry and then making a snack or meal together to satisfy growling bellies is one way to practice the art of waiting.  Have some pre-cut veggies ready in the refrigerator to nibble on if waiting for the meal is too challenging.  Besides, it’s the perfect time to place them on the counter while your prepping the entrée because you’ve got hunger on your side!  Hint: Blanched veggies, patted dry and then chilled, hold more moisture and taste slightly sweeter to some kids.  The higher moisture content makes them easier to crunch, chew and swallow.  Most blanched fresh vegetables last for several days in the refrigerator.  Remember, keep presenting fresh foods so that the more common option is a healthy one, rather than the oh-so-well marketed processed foods found on many kids’ menus today.

SLPs and parents, what strategies do you use do limit traditional kid food and help kids become more adventurous eaters?  Please comment and share your tips!

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.

How to Make Social Skills Stick

sticky

 

At Communication Works, a private practice in Oakland, California, we’re passionate about partnering with parents and caregivers in the treatment process. When it comes to social learning, many children struggle to carry over learned skills from the therapy setting or school to their home environment. Parents are in a perfect position to help practice and facilitate those skills and help make them stick! As professionals, we can give parents the awareness and knowledge as well as the tools and strategies to help them embrace teachable moments and guide their children. Even though parents are busy and sometimes overwhelmed, we can enlist their help without making stressful demands on their time. Parents are usually eager to help as long as we offer specific, easy activities that fit within the family’s natural routines.

Whenever possible, try to support the things parents are already doing and to piggyback onto those activities, such as reading bedtime stories, doing chores, or eating dinner. As an example, if a child is working on conversational turn taking in therapy, families can pass a “talking stick” (a spoon or spatula) at the dinner table to signify whose turn it is to talk and facilitate taking turns when describing each person’s day. If the child is working on “wh” or “wonder” questions (who, what, when, where, etc.) and you are using a visual prompt to facilitate this in therapy, make a copy of that visual and send it home for parents to use with their children during meal times or when having conversations in the car..

If you’ve created a roadmap or social story for an event at school, share a copy with parents. If the child has an event coming up (a graduation, birthday party, holiday, etc.), offer examples of details the parent can share with the child about what is expected during that event. For example, if a child is planning to attend a graduation for the first time, the parent can explain about caps, gowns, and diplomas (and why students toss the caps into the air) as well as how much sitting still and listening time the child can expect. If the child hasn’t yet attended a July 4th celebration, the parent can prepare the child for a big crowd and loud noises. They can discuss the type of behavior expected in a crowd and how to make the event more enjoyable and comfortable for the child, perhaps by bringing earplugs or asking for a break when feeling overwhelmed.

Parents also appreciate simple suggestions for teachable moments that may occur during part of the family routine or in the community. For example, if you’ve worked on increasing observational skills and understanding nonverbal language, talk to the parents about setting up a time for them, to take their child out for a snack and do some “people watching.” This can not only be an excellent opportunity to generalize a skill learned in the therapy setting, but can be a great bonding experience for parents and children. Teach the parents how to play “social detective” with their child and identify how the other people in the coffee shop are related, how they are feeling, and possibly what they are talking about. If you’re teaching sequencing during a therapy session, show parents how to practice this skill by sequencing out the steps for baking cupcakes or making a birthday card. If you’re focusing on self-regulation strategies like calm breathing, show the parent how to practice by placing a teddy bear or book on the child’s belly and watching it go up and down. As you develop new lessons, think about how parents could easily adapt them for home use. Be sure to provide handouts or information for them to share with other family members, and keep activities “no fuss” for busy parents.

Therapists working in schools will have limited time with parents, but can communicate through notes, logs, or a binder that goes back and forth from home to school. If you work in a private setting, consider bringing parents into group or individual sessions for a portion of the time, and have the child(ren) show what they have learned. Take a few minutes to brainstorm with the parent about ways to practice at home. Parents appreciate knowing the why’s as well as the how-to’s. Without overwhelming them with pages of information, provide the reasoning behind a particular activity as well as specifics about how to carry it out at home.

Social learning is a 24/7 process, and kids need support to be able to bring learned skills into the home and community. If professionals don’t collaborate with parents, the child misses countless opportunities for practicing essential social skills. When we do engage parents in the process, they can serve as both coaches and cheerleaders for their children. If we give parents the right tools, knowledge, and encouragement, they can feel confident and inspired to play an essential role in bridging the gap between therapy and real life.

Elizabeth Sautter, M.A. CCC-SLP is co-director and co-owner of Communication Works, a private practice in Oakland, California, offering speech, language, social, and occupational therapy. She is the co-author of the Whole Body Listening Larry books. Her most recent book is Make Social Learning Stick! How to Guide and Nurture Social Competence Through Everyday Routines and Activities. She can be reached at makesociallearningstick@gmail.com or follow her: website; Facebook; Pinterest; Twitter.