How Young is Too Young to Start Speech?

Communication disorders are among the most common disabilities in the United States. A child’s overall future and success can be improved greatly through the early identification of communication disorders, establishment of their causes, and subsequent intervention.

 Children with a history of language difficulties are at risk for poorer outcomes in a variety of areas:
• expressing their wants and needs
• academic achievement and educational attainment
• social-emotional relations (e.g., like making or keeping friends)
• occupational status

Early intervention is meant to ensure that our intervention will offset challenges that these children and their families may face.  If we can build a solid foundation early on, we will achieve better outcomes in their futures.

References: American Speech-Language-Hearing Association (2010). Incidence and prevalence of communication disorders and hearing loss in children-2008 edition. http://www.asha.org/research/reports/children.htm

The Hanen Program and PROMPT Training

It’s been a while since I last posted to my blog. For that, I apologize. There have been so many exciting things happening!

I have taken 2 fantastic classes.

PROMPT is a non-profit company that teaches SLPs like me to train tactual sensory systems. This is most commonly used in people with disturbed motor patterns. It can be used to treat apraxia, dysarthria, phonological processing disorder, and simple articulation differences. I took a 3-day intensive workshop which leaves me trained in this program.  Here is a link to their site http://promptinstitute.com/

The Hanen Program teaches SLPs to provide parents and caregivers with the knowledge and training they need to help young children develop the best possible language, social and literacy skills. This program is dedicated to teaching parents to communicate with their children on their level. Many times we, as adults, dominate conversations with our little ones. We mean well but we forget to give the child a turn in the conversation. We ask too many questions. We talk WAY too much. This program teaches us to turn over the reigns to the child. Let the child lead our conversation, our play and our teaching style.  It is altogether different from what we do instinctively. I also took a 3-day intensive workshop with Hanen which leaves me Hanen certified. Here is a link to their site http://www.hanen.org

These two programs have so much to offer in the world of speech-language pathology. They are two of the most coveted programs in my field. I am so happy and proud to say that I am now PROMPT trained and Hanen certified.

Language Improvements in Kids with ASD

Around this time of year, I like to look through my files and find any children who have not been assessed in the last year AND who have made significant progress on their goals.

One child I see is diagnosed with ASD and ADHD. His family came to me a year and a half ago after moving to the Seattle area. He was in first grade and had severe speech and language delays. He scored in the 0.5th percentile for his core language, in the 2nd percentile for receptive language and in the 1st percentile for expressive language.

Now that I’ve been working with this little guy for a year and a half, I figured it was time to reassess him. He went from 0.5th percentile to the 10th percentile in his core language. His receptive language went from the 2nd percentile to the 30th percentile! His expressive language score went from the 1st percentile to the 14th percentile! These improvements are HUGE and so exciting.

For those who are unfamiliar with percentiles, here is an explanation http://en.wikipedia.org/wiki/Percentile.

I can’t take all the credit for these gains. This child has a lot going for him. He has dedicated parents who bring him to me for speech therapy twice per week religiously. They don’t miss a session unless it’s absolutely unavoidable. They have a close relationship with his teacher and they hold the school administration to the child’s IEP and ask for frequent reports on what the’s working on and how he’s doing.

Speech therapy is proven to decrease the symptoms of ASD and these results are what we all strive for in this field.  It’s a validation of what we work so hard to do every day.

Snow Days

Recently we had snow and ice storms in Seattle which caused schools to close for 2-5 days, depending on the schools and districts. Over 100,000 people lost power in the area. I was out of the office for the entire week because all but one client cancelled that week. This nearly drove me out of my mind. Although I didn’t lose power, it was impossible for me to drive without slipping and sliding all over the road so any outings had to be on foot or by public transportation.

I thought about my clients a lot during this time. If I was going crazy in my house, what were they feeling? What were their parents feeling?

So how do we get through these days?

Make jewelry:

1. Cut a piece of string the length of a necklace long enough for your child.
2. Get out the paint and the pasta, beads, popcorn, or other creative objects which will fit on your string.
3. Start stringing the necklace.

Build a fort: Collect chairs, blankets, pillows, stools, and sheets to build an indoor tent. Every kid loves this activity. When you’re finished building, make s’mores and get the flashlights for a night of camping under the ‘stars’.

Make play-doh:   There are tons of recipes online. Here’s one http://www.instructables.com/id/How-to-Make-Playdough-Play-doh/

Make origami: There are also a lot of websites that give step by step instructions on how to make everything from a bear to a swan. Just Google “kids origami instructions”. I also use my local library to check out books on origami because it is something that all my kids absolutely love.

Tell a story: One thing I like to do with my kids is what I call a story chain. I start a story and we take turns adding to it. It’s a really great way to develop story telling and sequencing skills. I use a baton, flashlight or a microphone to pass around when it’s our turn. We don’t talk unless we have the microphone. We can also do this by acting out the scenes if you need more physical exertion for your child.

Play a game: Games like Monopoly and Guess Who are fantastic but sometimes, they can get a little boring. Try playing Charades or Telephone. Kids crack up every time!

What are your ideas for snowy/rainy days?

Changes to Autism Diagnosis

A parent asked me yesterday about the change in the diagnostic criteria for autism in the DSM-V.  Here are my thoughts…

The changes that are being made are, in my humble opinion, very positive. Currently, if a child is diagnosed with autism, they either have it or they don’t. As every parent of a child with autism knows and as the name implies, this is a spectrum disorder.  At this point there is no way of distinguishing a child who is functionally verbal, socially curious, and performing at grade-level cognitively from a child who is functionally non-verbal, is overstimulated by ANY social interaction and cognitively way below grade level. They are both diagnosed as having autism disorder. The same goes for PDD-NOS, Asperger’s syndrome, and CDD.

The new changes would place these four disorders under the umbrella term, autism spectrum disorder and would “specify a range of severity as well as describe the individual’s overall developmental status–in social communication and other relevant cognitive and motor behaviors.” The full article can be found here: http://www.dsm5.org/Documents/12-03%20Autism%20Spectrum%20Disorders%20-%20DSM5.pdf

The proposed changes would help with more accurate diagnosis and more refined therapy techniques. Placing children in such a general category as autism disorder can be dangerous. If we have more specific assessments and criteria, it will likely lead to more accurate results in diagnosis and therapy.

Increasing Food Repetoire in Kids with Sensitivies

Food sensitivities often co-exist with language delays. Many times parents think that their child is just really picky until it is brought to their attention that a repertoire of so few foods is not healthy or typical.

Often kids will eliminate textures, flavors, or colors.  Some examples of this are that a child will only eat crunchy salty foods or they will only eat bland colorless foods such as rice or potatoes. There are many ways to incorporate new textures and flavors into a child’s diet but I have found food chaining to be most successful for this type of sensitivity.

This blog is a great place to start http://cheriandlaura.blogspot.com/ and here are some quick tips and tricks I give to many parents.

• Introduce new foods slowly. If he is aversive to a food, put it in a bowl next to his plate and over time transition it to his plate.
• Do not force foods on him.
• Do encourage him to play with foods (especially food that he is aversive to)
• Fingerpaint with pudding (then lick your fingers)
• Use dips like BBQ, ranch, humus, sour cream, gravy
• Add a small amount of a new food to his preferred food but let him see you add them (add 2 small cooked carrot pieces to his mac & cheese)
• Eat with him and play with his food with him.
• Use his dips for your food
• Make mealtime fun and encourage siblings to model for him
• Encourage him to help with mealtime preparation
• Transition new foods slowly and do not ever force him to eat the new food.

Children are usually most successful with this through a trained speech-language pathologist rather than a parent initially.  Parents will be transitioned into mealtime training over time.

How to Stimulate Language

Here are several tips I give to every parent who comes through my office doors with a child who is language is delayed.

• Follow your child’s lead, play what they want to play and how they want to play
• Wait for your child to indicate what they want using a consistent form of communication rather than anticipating the need and meeting it right away.
• Require consistent communication. This could mean a word, a sign, or a consistent sound or gesture. This does not include crying, pointing or grunting.
• Talk about what you are doing and what your child is doing. Play the narrator. Label objects and describe actions, etc.
• Keep your sentences short to match your child’s language ability. You should add 1 or 2 words for each word they use. (if your child uses 1 word phrases, speak to them using 2-3 word phrases).
• If your child has a very consistent word or two they say, then when they say that word add a new word to the end or beginning and repeat it back to them (if they say ‘ball’, repeat back ‘big ball’ or ‘ball go’).
• Always use choice questions rather than yes or no questions (‘do you want milk or juice?’ rather than ‘do you want milk?’)
• Repeat simple words (please, more, again, mine, want, help, stop, all done, wait, mom, dad, baby, potty, go, eat, pop, etc.)
• Incorporate sign language with verbal language. This is a proven method to increase your child’s verbal language. Even very simple signs can be easily incorporated. www.alspro.com
• Be patient! Wait for your child to finish talking before you  respond.