Six Steps to Improve Communications—Listening and Talking—with Parents

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This year’s Better Hearing and Speech Month theme—”Early Intervention Counts”—made me wonder what more I could do to connect with moms and offer families early intervention services. I asked myself a key question:

Am I getting inside the mind of moms whose children I could help?

Throughout May, I communicated with moms everywhere I possibly could. I mean everywhere!

I spoke with moms I knew personally or professionally. I visited online speech-language groups, I peeked at comments on speech-language blogs popular with moms, and I learned what questions moms ask on forums and social media groups.

I noticed a strong trend that moms tend to ask other moms for advice about their children’s communication skills before going to a speech-language pathologist. I asked numerous moms: “Why would you reach out to other moms to share your concerns and/or ask questions about your child’s speech-language development over seeing a speech-language pathologist?”

Let’s look at the most common responses:

  • It’s faster and convenient to ask other moms their opinion or a question, especially online and during evenings.
  • It takes commitment to make a potentially unnecessary appointment with an SLP plus extra commitment for follow-up appointments.
  • I know and trust moms but I don’t know any SLPs.
  • Other trustworthy moms have a wealth of knowledge, especially if they have been through the process with an SLP. These moms give you an idea of what warrants a visit to a professional.
  • Fellow moms share my perspective. They show compassion and understand what I’m going through with my child.
  • I’m not intimidated by “parent friendly” messages that don’t use confusing or technical jargon.
  • Advice from other moms comes free.
  • I’m nervous an SLP will tell me my child needs help or diagnose my child with a disorder.

Based on responses, I’m taking six steps to improve my communication approach, the language I use and how I connect with parents:

  • I’m communicating with moms on my own social media sites and within online groups and forums.
  • I’m being vulnerable by sharing relatable facts about myself personally and my core values for my business.
  • I’m using parent-friendly language and avoiding acronyms and negative terms, such as “disorder,” during our conversations.
  • I’m asking moms more questions about their perceived needs and concerns for their child so I have more opportunities to listen actively and empathize about what they are going through.
  • I’m focusing on and talking about children’s strengths as a way to build a rapport with parents.
  • I’m also acknowledging my appreciation to parents for taking the time and effort to access my services.

If you wonder what types of questions parents ask, here are three valuable online resources:

  1. www.circleofmoms.com
  2. www.mamapedia.com
  3. Search for speech-language support groups for moms and moms on Facebook

Boost the value you get from online communities by reading through the group descriptions, rules, policies and other posts before posting in the group. Contact the group administrator(s) before posting for their best tips on joining.

What have you learned from listening to parents? Please share in the comments!

 

 

Keri Vandongen, aka “Speech Keri,” provides speech-language services for families with young children through her private practice in Alberta, Canada. She also offers online video training and techniques to enhance speech-language practice and carryover. Keri@myspeechparty.com

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.

 

 

 

 

 

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

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

How Do You Know When it’s a Language Delay Versus a Disorder?

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Editor’s Note: This is an excerpt from a blog post that originally appeared on Special Education Guide. 

How do you know when it’s a language delay versus a disorder?

Unfortunately, there is not always a straightforward answer to this question. A language delay is just that—a delay in acquisition of language skills compared to one’s chronological and cognitive/intellectual age-peers. A young child with a language delay may exhibit a slower onset of a language skill, rate of progression through the acquisition process, sequence in which the language skills are learned, or all of the above.

However, there is a subset of children who continue to demonstrate persistent difficulties acquiring and using language skills below chronological age expectations (by preschool or school age) that cannot be explained by other factors (for example, low nonverbal intelligence, sensory impairments or autism spectrum disorder) and may be identified as having a specific language impairment (language disorder).

In contrast to a delay or a disorder is a language difference. With a language difference, communication behaviors meet the norms of the primary speech community but do not meet the norms of Standard English. This difference can exist whether the person in question is a child from a different country or simply from a different neighborhood in the same city.

So, what are some options for addressing language delays and disorders?

Intervention for a delay may take on several forms:

  • Indirect treatment and monitoring
    • Provide activities for parents and caregivers to engage in with the child, such as book-sharing and parent-child interaction groups.
    • Check in with the family periodically to monitor language development.
  • Direct intervention, including techniques such as:
    • Expansions—repeating the child’s utterance and adding grammatical and semantic detail.
    • Recasts—changing the mode or voice of the child’s original utterance (for example, declarative to interrogative).
    • Build-ups and breakdowns—the child’s utterance is expanded (built up) and then broken down into grammatical components (break down) and then built up again into its expanded form.

Intervention for a language disorder is child specific and based on that child’s current level of language functioning, profile of strengths and weaknesses, and functioning in related areas, including hearing, cognitive level and speech production skills. The overall goal of intervention is to stimulate language development and teach skills to enhance communication and access academic content. The developmental appropriateness and potential effectiveness on communication and academic and social success should be considered when developing treatment goals.

 

Aruna Hari Prasad, MA, CCC-SLP, is ASHA associate director of school services.  ahariprasad@asha.org