More than a Picky Eater: How to Really Know?

boy not eating

The struggles of a parent during mealtime with a picky eater can range from bad to worse. It often begins with the ever-present protest of “No!”  then ends with screaming, tantrums and food flying across the room. The question remains: is the food refusal normal of a picky eater or could the signs be more consistent with a feeding disorder?

A pediatric feeding problem is often accompanied by a developmental delay or medical disorder. These can include, but are not limited to, autism spectrum disorders, Down syndrome, gastrointestinal motility disorders, cerebral palsy, respiratory disorders or cystic fibrosis.

Children who were hospitalized for an extended time at birth or who received a tracheotomy or feeding tube may also have difficulty transitioning to an age appropriate feeding pattern. However, children who are considered typically developing can also develop a fear of food. Research shows that 25 percent of children suffer with some degree of a feeding disorder. In children who suffer from a developmental, neurological or genetic disorders, that number rises to 80 percent (Branan & Ramsey, 2010).

A feeding disorder is characterized by any difficulties eating or drinking including chewing, sucking or swallowing. Children who have not developed age appropriate feeding skills and/or have a genetic, developmental or behavioral disorders can have difficulty during mealtime.

Some signs and symptoms of a problem feeder include:

  • Trouble breathing when eating or drinking
  • Choking, gagging or excessive crying during mealtimes
  • Tantrums when presented with new foods
  • Excessive drooling or spillage of foods/liquids from the mouth
  • Difficulty chewing or swallowing food
  • Restricted variety of foods eaten—usually less than 20
  • Refusal of categories of food based on texture or basic food group
  • Refusal to eat meals with the family

In order to better treat children with feeding problems, it is important to understand those children who do not meet the criteria. Children who are picky eaters present with the following signs and symptoms (Toomey 2010; Arvedson 2008):

  • Eat a limited variety of foods; but have around 30 foods they will eat
  • Intake enough calories a day for growth and nutrition
  • Lose interest in a certain food for a period of time, but accept it again after a few weeks
  • Eat at least one food from all major food groups (protein, grains, fruits, etc.)
  • Tolerate a new food on the plate, even if they don’t eat it

Although mealtimes with either issue can be difficult for parents, distinguishing between the two helps SLPs create the best individualized treatment approach.

Once a professional diagnoses a child with a feeding disorder, there are three key concepts to remember:

  1. Contact a child’s pediatrician, nutritionist and other health care providers in order to create the best treatment plan for that child. A multidisciplinary approach provides various viewpoints that bring the whole child into consideration.
  2. Choose foods that are meaningful to the family. If no one else in the family eats broccoli, it may not be a necessary food to add to the child’s eating repertoire.
  3. Create both short term and long term goals to track progress and keep both the child and family motivated.

Treating a child with a feeding disorder is a challenging but rewarding task. The end goal of treatment should always be a safe, happy and healthy eater.

 

April Anderson, MA, CCC-SLP, is a Speech-Language Pathologist at National Speech/Language Therapy Center in Bethesda, MD.  She works with infants and toddlers, as well as school-aged children with feeding disorders. April can be reached at  april@nationalspeech.com.

 

“Play It Again, Sam”: How the Use of Music is Reawakening the Minds of Many Individuals Battling Dementia.

Man listening to music

To say there has been a recent increase of videos on the web highlighting the power of music with individuals with dementia would be a vast understatement. From caregiver videos flooding YouTube to more carefully crafted films, such as Alive Inside, exploding on the scene, the individual stories being told are nothing short of remarkable.

But what does this mean for us as speech and language pathologists? And what does research say about the overwhelming number of anecdotal stories being touted on the internet? The answer to both questions is, A LOT! Many resources, such as the nonprofit organization MUSIC & MEMORY, now offer an extensive list of research citations that highlight the clinical benefits that listening to music can have on cognition and communication. It’s not just researchers taking notice of the mounting evidence. As the Centers for Medicare & Medicaid Services makes a push to decrease inappropriate use of antipsychotic drugs in long-term care settings, some of its efforts go toward funding personalized music programs to help address agitation and other behavioral concerns in a non-pharmacological way. Many states are also embracing this approach with great clinical outcomes to report.

So do we all switch professions and become music therapists? Of course not. The need for skilled speech therapists to directly target cognitive-linguistic deficits in long-term care settings is more important now than ever as the aging of our population and the dramatic rise in dementing illness converge, but the research and these dramatic personal stories should make us take pause and reconsider the environments in which we practice. As therapists we have a unique opportunity and perspective to be client advocates.

What information can we share, what videos can we show and whose life can we touch to be a catalyst for change in our communities? Consider your impact and take action today. Still need convincing? Let me leave you with one final image. Watch as Naomi Feil, founder of Validation Therapy, makes a power connection with Ms. Gladys Wilson. I wonder how many speech therapy screen forms were sitting in her medical chart stating she was “non-communicative” when this was filmed.

Robert Maxwell, MA, CCC-SLP is a speech-Language pathologist and clinical specialist for Genesis Rehab Services. He currently chairs the dementia special interest group for Genesis Rehab Services and has presented on the company, local, state and national level with regards to cognitive-linguistic and swallowing deficits related to the dementia population. He can be reached via email at: Robert.Maxwell1@genesishcc.com

Be an Advocate for Your Clients

boy with santa

This summer I had an interesting experience with a major insurance provider. The company initially approved treatment for a 3-year-old client, who I evaluated and diagnosed with severe apraxia of speech. This little guy had maybe five words in his lexicon, all unintelligible to an unfamiliar listener. He could not even consistently attempt to imitate monosyllabic words. His receptive language skills were at least at age level with cognition the same.

After several months of treating him with a motor-planning and sound-sequencing approach, his parents received notification from the insurance company that his treatment was denied because “it was not medically necessary” and his apraxia was deemed “developmental.” The communications stated that my client would “outgrow” his issue in time.

I have been in private practice for almost 28 years and ardently disagree with the insurance company’s reasoning. I consulted with Janet McCarty, at ASHA headquarters, and she provided me with excellent professional advice plus solid evidence to fight for my client. I organized my information then consulted with the family to get their green light to proceed. I went all in to fight this decision with the big insurance company’s medical director.

It became a step by step process to help this medical director understand that apraxia is NOT a developmental disorder, but rather a neurologically based disorder that results in disruptions to a child’s ability to sequence the necessary motor movements to produce speech sounds. My favorite part of this story is when I asked the director how much time I had to discuss my client with him during our peer-to-peer scheduled review, he informed me that “he did not want to be lectured about apraxia because he had Googled it and saw the word ‘developmental’ tossed sporadically around the literature and that was all he needed to see to be convinced that apraxia was not a medical condition with neurological basis.”

I quickly lifted my jaw off my desk, hit my reset button and proceeded to help this “medical expert” understand more about apraxia from this expert in the field of speech and language. While our exchange made some positive impact, he still felt the need to take this case to the next level by calling in a third party pediatric neurologist. I knew that this was going to be a medical professional in my corner. The neurologist and I spoke about my client and I was able to answer specific questions about his treatment and progress. Sure enough, her recommendation was absolutely in favor of this severe speech disorder being neurologically based and treatment medically necessary. She agreed that my client would not outgrow it in time or improve through weekly sessions in small groups.

My point for sharing this story is to say that while it is often frustrating to deal with insurance companies, you have to fight for your clients. When you meet, evaluate, work with a child and their family and you know a child needs treatment, you must advocate and spend the time to fight for this child, no matter how BIG these insurance companies are or how much they try to shut you down.

I need to correct my earlier statement when I referred to my “favorite” part of the story…in fact, my favorite part of this story is that my client, who is now 3.6 years old, was approved for intensive therapy to treat his motor planning disorder. He is making remarkable progress and I am quite confident he can tell Santa what he wants in a complete sentence. Maybe with Mom’s help interpreting, but still excited and able to convey his message!

 

Lorraine Salter, MS, CCC-SLP, has been in private practice in Reading MA since 1986. She studied and earned both degrees from Emerson College in Boston, after deciding that a career in performing arts was not going to pay the bills.  She enjoys the ability to create a strong team for the children she serves through interaction with her clients’ families. You may contact her at lorraine@northshorespeechandlanguageservices.com.

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

On the Road Again: ASHA Convention and Telepractice

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I admit it. I am an ASHA convention regular attendee. I am the SLP you see year after year collecting large yellow tote bags, company pens and my new favorite—nail files. This year, I even lined up to have my professional photo taken for my LinkedIn profile. I take in all that the ASHA convention offers, and my schedule allows, year after year.

One reason why the ASHA convention is so important to me is that I rarely stay in one place very long. I am the spouse of an active duty military officer. Therefore, I move a lot. With each move (eight so far), I’ve attended ASHA with a new job title: Department of Defense school SLP, hospital SLP, staff SLP, Lead SLP… This year, I attended ASHA as an SLP that works via telepractice. I deliver services and perform assessments via an online, custom built platform. I’m several states away from my students but I am licensed in the state where they reside and the state in which I reside. Using my home computer(s), a headset, webcam and high-speed internet connection with plenty of bandwidth, I treat, assess and collaborate with other SLPs, school staff and parents daily.

At this year’s convention, I encountered some surprising conversations regarding telepractice. I was met with responses ranging from: “Telepractice. I’m not so sure how I feel about that,” to “Yes, I’ve been looking into doing that. How does it work?” When embarking on a career in telepractice as a service delivery model, I was skeptical too. Was it ethical, effective and authorized? After researching ASHA’s rules and state bylaws, I put my feet in the water. That was four years ago.

During the ASHA convention, I was pleased to attend an increasing number of sessions focused on telepractice. However, these sessions highlighted the work and research still to be done to prove the effectiveness of telepractice as a service delivery model (especially with regards to culturally and linguistically diverse populations).

I still wonder, does an increase in sessions and visibility at the ASHA convention translate to increased acceptance/adoption by SLPs on the ground?

Telepractice is established and has been used in the medical field for more than 40 years. The American Telemedicine Association states that “telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a variety of applications including two-way videos, smart phones, tablets, wireless tools and other forms of technology.” According to ATA, “the use of telemedicine has spread rapidly and is now becoming integrated into the ongoing operations of hospitals, specialty departments, home health agencies and private physician offices as well as consumers’ homes and workplaces.”

I am looking forward to next year’s ASHA convention in Denver. I am already wondering about the sessions, networking opportunities and of course the pens and highlighters. Most of all, I’m looking forward to attending ASHA again as a SLP working via telepractice and the discussions that will surely follow.

Lesley Edwards-Gaither , MA, CCC-SLP, is a Speech-Language Pathologist in the Washington D.C. area.  She is a Lead SLP with PresenceLearning and an affiliate of Special Interest Group 18, Telepractice. She can be reached at legaitherslp@gmail.com

 

Why “Why Not?” Is a Worthwhile Attitude

Why Not?

November 8, 2014: eleven days before the ASHA Convention in Orlando, Florida.

After talking with my CSD professors and mentors about convention and exploring the ASHA website, I knew there was nothing more that I wanted than to attend. My chances of being able to go, however, were slim. After all, it was only a little more than a week away and I hadn’t figured out transportation or housing, much less how to pay for the actual convention.

I noticed the “Student Volunteer” link on the ASHA website, and my eyes lit up. At least until I saw the deadline to apply was two months ago. After a twinge of disappointment, I decided to email the volunteer contact anyway—I figured, “Why not?”

When I got a response back asking if I could work on November 18th from 10 am to 7 pm in exchange for complementary attendance, I practically fell out of my chair. I said yes, and after moving several pieces of the logistics puzzle around, my arrangements were set.

Now that I am fortunate enough to have attended my first ASHA convention, I can say with confidence that it was one of the most eye-opening, inspiring experiences I’ve had. Throughout the week, as I walked from session to session, I often found myself shaking my head in pure astonishment that the whole plan actually came together. The “Why Not?” mentality—grounded in drive, openness and ambition—encourages the pursuit of opportunities that seem beyond reach. Committing to this mindset will not only enable you to “shoot for the stars,” but to land among them.

When approaching your aspirations with a “Why Not?” attitude, here are a few things to keep in mind:

  • Communicate in a professional tone. Whether you are writing an email or interacting in person, be mature in your presentation to show that even as a student, you will be able to fit in seamlessly with experienced professionals.
  • Providing too much information is better than too little. This is the part where you make it easy for them to say yes. Emailing to inquire about a volunteer position? Attach a resume before they ask for one. Tell them why you are the best possible fit. Hold nothing back when pursuing an opportunity.
  • Be persistent. Professionals are busy, so don’t take lack of response personally. If you do not hear from anyone after a few days, send a polite follow-up email to ensure that they saw your previous message. Persist also in setting deadlines for yourself. If you say you will do or send something, then follow through.
  • Become comfortable with being uncomfortable. This is one of my life mottos after being an avid gymnast for 14 years and I find it applies to almost every challenge I encounter. Asking yourself “Why not?” forces you to get out of your comfort zone and pursue opportunities not easily attainable. The more you put yourself out there, the better you will become at it.

Pursuing opportunities with the “Why Not?” mentality serves me well in attaining my ultimate goal of becoming an SLP, and affords me a variety of experiences, including the writing of this article. After receiving a hand-out to write for the ASHA Leader at the convention, I chuckled at the idea. When I took out the folded piece of paper from my backpack days later, however, I opened up my laptop, started typing, and thought: “Why not?”

 

Robyn Croft is a third year undergraduate student in the Communication Sciences and Disorders Department at the University of Texas at Austin studying Speech/Language Pathology. She is a Student Clinician at the Michael and Tami Lang Stuttering Institute. She can be reached at robyncroft00@gmail.com.

Lessons Learned from #ASHA14

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Before the convention, I wrote a blog post about how to prepare to speak at the ASHA convention for the first time. When I wrote the post, I had spoken at another convention; however, I attended that convention as a speaker rather than the primary goal to participate in continuing education. At the ASHA Convention I planned to do both.

As I write, it is Sunday morning after the convention. I am reflecting on what went well and what didn’t go well as a speaker and attendee (not in regards to the convention in general).

 

What Went Well

I stayed organized. I used the resources I mentioned in my previous post to stay organized with my presentations. I also designated a paper folder to put information I would need paper copies of (e.g. shuttle routes, tickets, speaker’s notes, and master schedule). My master schedule was a great compensatory strategy for someone with a tired and busy brain. I will use the same system next year.

 

My food was amazing! Not only did I not get “glutened” (I have Celiac’s disease), but also my food was delicious and I didn’t stand in line waiting for food and I could eat on my schedule. The premade meals I ordered (external source) were a major success. It was relatively inexpensive to have delicious food pre-made and delivered to my hotel. I felt like I beat the system! Traveling is usually full of extra energy finding food I can eat and worrying if I’ll get sick (and dealing with it when I do).

 

I had a ton of fun! I was able to reconnect with friends and colleagues I haven’t seen since last year. I made new friends and connections. Sessions were inspiring. Several sessions had amazing speakers that couldn’t hide their excitement for being there. I love to see that excitement in a presenter. I went to a few large group events and quieter, smaller events too.

 

What I’ll Do Different Next Year

Submit fewer sessions. As I mentioned in my prior post, I didn’t anticipate all of the sessions would get accepted. I will submit fewer sessions next year. With so many sessions, it was challenging to schedule meetings and focus on relationship building at the convention. There were some conversations that I really would have liked to continue in order to form professional partnerships. (Thankfully, I can reach out to those people via email to continue the conversation.) Next year I won’t submit as many.

 

Book better flights. In Chicago, I left too early. This year I’m leaving too late. My flight doesn’t depart until 8:40pm on Sunday. The buzz from the convention has halted and I’m ready to go home to my family. Of course, next year it will be in Denver. I live in Boulder, so the convention center is a 35-minute drive from my home. No flights necessary. Travel will be much easier next year!

 

Sleep more. I was so excited to present on Friday morning (and inspired by Thursday’s sessions) that I was wide-eyed in the early hours of the morning, which meant I got about 3-hours of sleep. Just like I tell my clients all the time, adequate sleep is so important for your brain. I was processing slower, tripping on my words, and lost my place in conversations and while speaking in sessions! Anyone have suggestions for turning down excitement and wonder?

 

Overall the 2014 ASHA Convention was an excellent experience. I feel so inspired from the sessions I attended, people I met, and presenting. I have so many ideas help make the first quarter for 2015 amazing for Gray Matter Therapy.

 

Rachel Wynn, MS, CCC-SLP, specializes in eldercare, and, as the owner of Gray Matter Therapy, provides education to therapists, healthcare professionals, and families regarding dementia and elder care. She is an affiliate of ASHA Special Interest Group 15 (Gerontology) and an advocate for ethical elder care and improving workplace environments, including clinical autonomy, for clinicians.

Collaboration Corner: 5 Take-Aways to Support AAC, Apps and Language

TEchnology and augmentative and alternative communication

This past month, my colleague Sean Sweeney (AKA @speechtechie) and I had the opportunity to join forces and write about AAC, apps and literacy development. Our article will be in the next issue of SIG 12: Perspectives in Augmentative and Alternative Communication.

This gave us a great opportunity to discuss how AAC users can benefit from apps to enhance treatment outcomes. Here are five highlights:

Feature matching is important: When choosing AAC or apps for learning, the tool must meet the needs of the user. For AAC, this includes the size, layout and physical accessibility of features to maximize independent use. For apps, this includes Sean’s FIVES criteria, which examines the context, appropriateness, accessibility and therapeutic considerations for learning. Just like any other tool in your kit, if it isn’t a good match then opportunities for communication or learning are potentially lost.

Make CORE align with the CORE: Using generative language formats, including core and fringe word vocabulary, benefits the student two-fold: building in opportunities for language growth throughout the day, while also meeting those pesky Common Core Standards. For example, a first grade ELA standard CCSS.ELA-Literacy.L.1.1.c, “Use singular and plural nouns with matching verbs in basic sentences.” Using core vocabulary allows the student to meet this standard through basic sentence construction activities. A first grader may enjoy learning this through the “Collins Big Cat” series, a free app that reads stories out loud and then has the option of the student recording his voice (or in this case, synthesized voice). The app also has a more interactive component, which allows the student to build scenes and narrate his own version of the story.

Apps and AAC are powerful together: Students love the interactive nature of apps. “Toca Hair Salon” is a highly interactive hair salon studio allowing students to describe how they are going to cut, color or otherwise coif the animal or person of choice. Another simple app, “Pogg,” is a cute alien that hops, sings and performs other actions, all at your student’s direction during a session. Beyond paper flashcards, the apps give students immediate reinforcement, so then work feels less like work.

Separate communication tools from other tools: If you are going to use apps and AAC at the same time, one practical solution is to use separate tools. Toggling between apps and AAC is cumbersome, and slow session momentum. In addition, having separate systems prevents the user from confusing a communication device with other technology, which is an important distinction. If your tools look the same, change the colors of the cases. If you have students that like to surf and press that home key, enable guided access so that only the AAC app is available.

Model, model, model through apps and AAC: Finally, apps provide the opportunity to model AAC live, and in unpredictable ways. You have more opportunities to explore and learn together. Don’t have curling iron as a fringe vocabulary item when using your “Toca Hair Salon” app (it’s not there, believe me)? Show your student how you can give clues to what you mean and talk it through using what is available on your AAC: “Let’s see, it’s a tool, it’s hot and it makes your hair curly…what is it?

There’s your abridged version and takeaways…log in to your SIG 12 portal for more info, and to get CEUs….ASHA renewal is right around the corner!

 

 

Reference

Sweeney, S. & Davis, K. (2014). In press. Reading, writing and AAC: Mobile technology strategies for literacy and language development. SIG 12: Perspectives in Augmentative and Alternative Communication. American Speech Language and Hearing Association.

 

 

Kerry J. Davis, EdD, CCC/SLP is a speech-language pathologist in the Boston area. She holds a special interest providing services to children and adolescents with complex communication profiles, including AAC. Davis is a volunteer SLP and consultant to Step by Step Guyana, a school for children with Autism in South America.

 

“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

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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.